Publications by authors named "Xiaowei Tang"

111 Publications

Role of peroral endoscopic myotomy in geriatric patients with achalasia: a systematic review and meta-analysis.

Dig Dis 2021 03 22. Epub 2021 Mar 22.

Background: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia.

Method: PubMed, Embase and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events and clinical reflux.

Results: There were seven studies with a total of 469 geriatric patients, pooled technical success of POEM treatment was 98.1% [95% confidence interval (CI), 95.1%-99.3%], and the pooled clinical success was 92.5% (95% CI, 89.3%-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, P<0.00001), and the LES pressure significantly reduced by 13.53 mmHg (95% CI, 5.14-21.91, P=0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3%-17.9%) and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9%-23.2%).

Conclusions: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.
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http://dx.doi.org/10.1159/000516024DOI Listing
March 2021

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China.

BMC Gastroenterol 2021 Mar 9;21(1):116. Epub 2021 Mar 9.

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.

Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children.

Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children.

Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%). The etiology of pancreatitis in children was markedly different from that in adults (p < 0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p = 0.018) and occurrence rate of pancreatic necrosis (p = 0.041), SIRS (p = 0.021), acute peripancreatic fluid collection (p = 0.014). Univariate and Multivariate Cox regression analysis showed that female (p = 0.020; OR 3.821; 95% CI 1.231-11.861), hypertriglyceridemia (p = 0.045; OR 3.111; 95% CI 1.024-9.447), pancreatic necrosis (p = 0.023; OR 5.768; 95% CI 1.278-26.034) were the independent risk factors of ARP. Hypertriglyceridemia AP had the highest risk of recurrence compared to other etiology (p = 0.035).

Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Children have simpler conditions than adults. Female, hypertriglyceridemia, and pancreatic necrosis were associated with the onset of ARP.
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http://dx.doi.org/10.1186/s12876-021-01706-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941124PMC
March 2021

Clinical outcomes of endoscopic resection for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria: a 7-year experience from a large tertiary center in China.

Surg Endosc 2021 Mar 19. Epub 2021 Mar 19.

Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Haidian District, No. 28 of Fuxing Road, Beijing, 100853, China.

Background And Aims: Few studies have evaluated the value of endoscopic resection (ER) for the treatment of gastric gastrointestinal (GI) stromal tumors (GISTs) originating from the muscularis propria (MP) in a large population, and no studies have evaluated risk factors for piecemeal resection. This study aimed to evaluate the efficacy and safety of ER for gastric GISTs in a real-world setting and to explore factors associated with piecemeal resection.

Methods: From January 2013 to December 2019, 185 patients with gastric GISTs originating from the MP were assessed. Clinicopathological and endoscopic data were collected and analyzed. Baseline characteristics of the en bloc resection and piecemeal resection groups were compared to evaluate predictive factors for piecemeal resection.

Results: There were 71 males and 114 females with a mean age of 57.0 ± 9.7 years. The mean size of GISTs was 15 mm (range 4-65 mm). A total of 123 were very low risk, 52 were low risk, and ten were moderate risk. In this study, 103 GISTs were treated with endoscopic submucosal excavation (ESE), 68 GISTs were treated with endoscopic full-thickness resection (EFR), and 14 GISTs were treated with submucosal tunneling ER (STER). Either en bloc resection or complete resection was achieved in 160 (86.5%) patients. No recurrence was noted during follow-up. Only five patients experienced minor complications, with a complication rate of 2.7%. Multivariate analysis demonstrated that size (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.004-1.118; P = 0.035) and shape (OR 5.434, 95% CI 1.638-18.027; P = 0.006) were independent predictors of piecemeal resection.

Conclusion: ER was effective and safe for the treatment of gastric GISTs originating from the MP. Piecemeal resection did not seem to affect the efficacy of ER, and no recurrence was noted during follow-up. Large size and irregular shape are risk factors related to piecemeal resection of ER.
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http://dx.doi.org/10.1007/s00464-021-08443-9DOI Listing
March 2021

Scoping Review and Bibliometric Analysis of the Most Influential Publications in Achalasia Research from 1995 to 2020.

Biomed Res Int 2021 4;2021:8836395. Epub 2021 Feb 4.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Objective: To identify and evaluate characteristics of the most influential articles in achalasia research during the period 1995-2020.

Methods: Articles in Scopus, Web of Science Core Collection (WoSCC), and PubMed were scanned from 1995 to 2020 with achalasia as the keyword. We retrieved the articles that met all criteria by descending order after using EndNote to remove the duplicated references. Our bibliometric analysis highlighted publication year, country, journals, and networks of keywords.

Results: Fifteen percent of the top 100 most-cited articles were published in They were performed in 15 countries, and most ( = 55) were from the USA. The number of citations of the 482 articles ranged from 30 to 953, 38 of which had been published in . Those articles were from 31 countries, and most of the studies ( = 217) had been performed in the USA. Most of articles ( = 335) were clinical research. Treatments were hotspots in the field of achalasia in the past years. The most influential title words were "achalasia," "esophagomyotomy," "pneumatic dilation," and "lower esophageal sphincter."

Conclusion: Our study offers a historical perspective on the progress of achalasia research and identified the most significant evolution in this field. Results showed treatment was the most influence aspect in achalasia.
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http://dx.doi.org/10.1155/2021/8836395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884120PMC
February 2021

The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis.

Dig Surg 2021 8;38(2):136-148. Epub 2021 Feb 8.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China,

Background: Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention.

Method: We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model.

Results: Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8-98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0-93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6-44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50-6.40, p < 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10-25.39, p < 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99-1.01, p = 0.89), 1.02 (95% CI, 0.98-1.06, p = 0.36), and 0.88 (95% CI, 0.67-1.16, p = 0.38), respectively.

Conclusions: POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.
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http://dx.doi.org/10.1159/000512627DOI Listing
February 2021

Current antipsychotic agent use and risk of venous thromboembolism and pulmonary embolism: a systematic review and meta-analysis of observational studies.

Ther Adv Psychopharmacol 2021 14;11:2045125320982720. Epub 2021 Jan 14.

Department of Psychiatry, Huai'an No. 3 People's Hospital, Huai'an 223001, Jiangsu, China.

Background: Antipsychotic agents (APS) are widely used drugs to treat psychotic symptoms and can effectively reduce both positive and negative symptoms of schizophrenia. For decades, some studies suggested that there is a relationship between using APS and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, results remain inconclusive.

Method: This review has been registered in International Prospective Register of Systematic Reviews (PROSPERO, ID: CDR42020155620). Relevant studies were identified among observational studies published up to 1 October 2019 in the databases MEDLINE, EMBASE, and Cochrane Library. Random or fixed-effects models were used to calculate the pooled odds ratio (OR).

Results: In total, 28 observational studies were included. The results showed that compared with non-users, current APS users have significantly increased risks of VTE [OR 1.55 95% confidence interval (CI) 1.36, 1.76] and PE (OR 3.68, 95% CI 1.23, 11.05). Subgroup analyses suggested that new users were associated with a higher risk of VTE (OR 2.06, 95% CI 1.81, 2.35). For individual drugs, increased risk of VTE and PE was observed in taking haloperidol, risperidone, olanzapine, prochlorperazine but not in chlorpromazine, quetiapine or aripiprazole. However, careful interpretation is needed because of high heterogeneity among studies and scarce data.

Conclusion: The present comprehensive meta-analysis further indicates a significantly increased risk of VTE and PE in current APS users compared with non-users. Subgroup analyses suggest that new users are more likely to develop VTE. However, due to significant heterogeneity among studies, conclusions should be considered with caution.
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http://dx.doi.org/10.1177/2045125320982720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812411PMC
January 2021

Association of Infection with the Development of Colorectal Cancer.

Nutr Cancer 2020 Dec 16:1-11. Epub 2020 Dec 16.

Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Sichuan, China.

The role of () in the development of inflammatory bowel disease (IBD) and colitis-associated carcinogenesis (CAC) has seldom been investigated. We examined the abundance of in 58 colorectal cancers (CRCs), 20 IBDs, 40 cases of normal colorectal mucosa (NCs), and 20 adenomas (ADs) by 16S rRNA fluorescence in situ hybridization (FISH). Number of CD4CD45RBT cell and expression of IFN-γ and TNF-α in these tissues was determined by immunofluorescence. The abundance of was significantly higher in CRCs than that in IBDs (), ADs ( < 0.001) and NCs ( < 0.0001). The abundance of in IBDs was significantly higher than that in ADs (). Moreover, the average number of CD4CD45RBT cell was significantly higher in CRCs than that in IBDs () and NCs (). In addition, there was a positive correlation between the abundance and density of CD4CD45RBT cells in 30 colorectal tissues (). The frequency of co-staining for CD4CD45RBT cells and IFN-γ was significantly higher in positive group than that in negative group (). may play a role in the initiation of IBD and CAC, possibly through promoting the transformation of T cells into CD4CD45RBT cells and increasing the expression of proinflammatory cytokines IFN-γ.
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http://dx.doi.org/10.1080/01635581.2020.1862253DOI Listing
December 2020

Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis.

Dis Esophagus 2021 Apr;34(4)

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Peroral endoscopic myotomy (POEM) is a novel minimally invasive intervention, which has shown to be effective and safe for treating achalasia in adults. Presently, POEM was also reported to be effective for achalasia in children. So we conducted this study to explore the clinical outcomes of POEM for pediatric achalasia. A systematic literature search in PubMed, Embase, and Cochrane databases was performed, which covered the period from January 2009 to June 2020. Selecting studies and collecting data was independently by two reviewers according to predefined criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 2 and Review Manager 5.3. A total of 11 studies with 389 children were identified in the final analysis. Pooled technical success of POEM treatment achalasia was achieved in 385 children (97.4%; 95% confidence interval [CI], 94.7%-98.7%), and the pooled clinical success was achieved in 348 children (92.4%; 95% CI, 89.0%-94.8%). After POEM, the Eckardt score was significantly decreased by 6.76 points (95% CI, 6.18-7.34, P < 0.00001), and the lower esophageal sphincter pressure was significantly reduced by 19.38 mmHg (95% CI, 17.54-21.22, P < 0.00001). The pooled major adverse events rate related to POEM was 12.8% (95% CI, 4.5%-31.5%) and the gastroesophageal reflux rate was 17.8% (95% CI, 14.2%-22.0%). Our current study demonstrated that the POEM was an effective and safe technique for treating achalasia in children. Further randomized comparative studies of POEM and other therapeutic methods are warranted to determine the most effective treatment modality for achalasia in children.
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http://dx.doi.org/10.1093/dote/doaa112DOI Listing
April 2021

The influence of the COVID-19 epidemic on the gastrointestinal endoscopy practice in China: a national survey.

Surg Endosc 2020 Nov 11. Epub 2020 Nov 11.

Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.

Background And Aim: With the worldwide spread of coronavirus disease 2019 (COVID-19), it has devastated the economy and taken a toll on people' life in every aspects. In this study, we aimed to evaluate the influence of the COVID-19 epidemic on the GI endoscopy practice in China.

Methods: The nationwide survey conducted from 13 to 19 April, 2020. A predesigned standard structured questionnaire was sent to all members of the Chinese Society of Digestive Endoscopy (CSDE) in mainland China by email. Number of various GI endoscopic procedures and participants getting endoscopic training from January 1 to April 10, 2020 (the COVID-19 period) and the same period of 2019 were collected and analyzed.

Results: A total of 468 hospitals responded to this survey, and most of them (85.4%) were tertiary referral hospitals. The sum number of GI endoscopic procedures deceased significantly from 3,203,594 in 2019 to 1,512,619 in 2020, including 2,996,779 to 1,401,665 of diagnostic procedures and 206,815 to 110,954 of therapeutic procedures. More than half of centers (57.1%) reduced about 1,000-5,000 endoscopic activities. Of 271 hospitals (57.9%) providing endoscopic training, the total number of participants decreased from 2,977 in 2019 to 1,131 in 2020. Most of hospitals (93.8%) adhered to the recommendation of endoscopy practice issued by CSDE during the outbreak of COVID-19, and there was no cases of infection in endoscopic departments of all surveyed hospitals.

Conclusion: With the influence of the COVID-19 epidemic, there has been significant decease of GI endoscopy practice in mainland China.
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http://dx.doi.org/10.1007/s00464-020-08149-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657378PMC
November 2020

Corrigendum to "Identifying Plasma Biomarkers with high specificity for major depressive disorder: A multi-level proteomics study". Journal of Affective disorders 277 (2020) 620-630.

J Affect Disord 2021 Feb 10;281:1006-1011. Epub 2020 Oct 10.

Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China; Department of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China; Mental Health Center Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China. Electronic address:

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http://dx.doi.org/10.1016/j.jad.2020.09.120DOI Listing
February 2021

Corrigendum: DNA Methylation and Gene Expression of Matrix Metalloproteinase 9 Gene in Deficit and Non-deficit Schizophrenia.

Front Genet 2020 14;11:823. Epub 2020 Aug 14.

Department of Geriatric Psychiatry, Nanjing Brain Hospital, Affiliated to Nanjing Medical University, Nanjing, China.

[This corrects the article DOI: 10.3389/fgene.2018.00646.].
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http://dx.doi.org/10.3389/fgene.2020.00823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456980PMC
August 2020

Identifying Plasma Biomarkers with high specificity for major depressive disorder: A multi-level proteomics study.

J Affect Disord 2020 12 1;277:620-630. Epub 2020 Sep 1.

Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China; Department of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China; Mental Health Center Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China. Electronic address:

Background: There are currently no objective diagnostic biomarkers for major depressive disorder (MDD) due to the biological complexity of the disorder. The existence of blood-based biomarkers with high specificity would be convenient for the clinical diagnosis of MDD.

Methods: A comprehensive plasma proteomic analysis was conducted in a highly homogeneous cohort [7 drug-naïve MDD patients and 7 healthy controls (HCs)], with bioinformatics analysis combined with machine learning used to screen candidate proteins. Verification of reproducibility and specificity was conducted in independent cohorts [60 HCs and 74 MDD, 42 schizophrenia (SZ) and 39 bipolar I disorder (BD-I) drug-naïve patients]. Furthermore, verification of consistency was accomplished by proteomic analysis of postmortem brain tissue from 16 MDD patients and 16 HCs.

Results: Levels of C-reactive protein (CRP), antithrombin III (ATIII), inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and vitamin D-binding protein (VDB) were significantly higher in MDD patients, both in the discovery cohort and independent replication cohort. In comparison with SZ or BD-I patients, two proteins (VDB and ITIH4) were significantly elevated only in MDD patients. In addition, increased VDB and ITIH4 were observed consistently in both plasma and postmortem dorsolateral prefrontal cortex tissues of MDD patients. Furthermore, a panel consisting of all four plasma proteins was able to distinguish MDD patients from HCs or SZ or BD-I patients with the highest accuracy.

Conclusion: Plasma ITIH4 and VDB may be potential plasma biomarkers of MDD with high specificity. The four-protein panel is more suitable as a potential clinical diagnostic marker for MDD.
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http://dx.doi.org/10.1016/j.jad.2020.08.078DOI Listing
December 2020

The 100 top cited articles in the field of digestive endoscopy: from 1950 to 2017.

Rev Esp Enferm Dig 2020 Sep;112(9):701-707

Gastroenterology, Affiliated Hospital of Southwest Medical University, China.

Background: the present study aimed to describe the characteristics of articles that had the most citations in the field of digestive endoscopy.

Method: articles included were obtained from the Web of Science database, which were selected and ranked according to the number of citations. The characteristics of the 100 most cited articles were then analyzed.

Results: the number of citations of the top 100 of 303,063 eligible papers ranged from 370 to 2,866. The most cited paper was a study of colorectal cancer prevention using colonoscopic polypectomy. The most common topics discussed by the top 100 papers included colonoscopy (n = 33) and upper gastrointestinal endoscopy (n = 23), with most of the papers focusing on diagnosis (n = 24) and treatment (n = 15).

Conclusion: by identifying the most influential publications, the present study could serve as a guide toward further development in the area of digestive endoscopy.
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http://dx.doi.org/10.17235/reed.2020.6828/2019DOI Listing
September 2020

Outcomes of peroral endoscopic myotomy in challenging achalasia patients: a long-term follow-up study.

Surg Endosc 2020 Aug 13. Epub 2020 Aug 13.

Department of Gastroenterology, The First Medical Center of Chinese, PLA General Hospital, Road Fuxing No. 28, Region haidian, Beijing, 100853, China.

Background: Peroral endoscopic myotomy (POEM) has been shown to be effective for achalasia patients. Our study aimed to analyze the clinical outcomes of POEM for challenging patients.

Methods: We retrospectively enrolled 278 challenging achalasia patients who underwent POEM from January 2011 to July 2019. The outcomes of POEM such as procedure time, adverse events, and risk factors of adverse events were analyzed.

Results: Of the 278 patients (134 males and 144 females) with a mean age of 47.0 years, 103, 223, 93, and 98 patients had prior treatment and were Ling classification IIc/III, submucosal fibrosis (SMF) classification 2/3, and esophageal mucosa in achalasia (EMIA) classification c/d/e/f, respectively. The mean procedure time was 45.9 min (range, 15-158 min). The mean length of the tunnel and myotomy were 10.1 cm (range, 7-17 cm) and 6.6 cm (range, 5-13 cm), respectively. The major adverse event rate was 14.1%, while the minor adverse event rate was 4.7%. SMF classification 2/3 was an independent risk factor for incomplete tunneling, adverse events, and procedure time ≥ 90 min. The mean follow-up time was 37.2 months (range 1-99 months). The mean Eckardt score and esophageal sphincter pressure were both significantly declined postoperatively. The clinical success rate was 95.6%.

Conclusion: POEM is safe and effective for challenging achalasia patients. SMF classification grade 2/3 was shown to be an independent risk factor for incomplete tunneling, adverse events, and procedure time ≥ 90 min. For these patients, POEM should be performed by experienced endoscopists, some cases are better served with traditional surgery, such as minimally invasive Heller with Dor fundoplication.
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http://dx.doi.org/10.1007/s00464-020-07864-2DOI Listing
August 2020

Altered levels of BMD, PRL, BAP and TRACP-5b in male chronic patients with schizophrenia.

Sci Rep 2020 08 12;10(1):13598. Epub 2020 Aug 12.

Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu, People's Republic of China.

Bone mineral density (BMD) has been found to decrease in schizophrenia patients. We examined BMD and the levels of prolactin (PRL), bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase isoform 5b (TRACP-5b) in male chronic schizophrenia patients and compared them with healthy controls in a Chinese Han population, which has not been reported before. Male patients with chronic schizophrenia (SPs; n = 79) and healthy controls (HCs; n  = 56) were recruited. BMD and plasma PRL, BAP and TRACP-5b levels were measured and compared between the two groups. The SPs group was further divided into two subgroups: the elevated PRL group (PRL ≥ 25 ng/ml, EPRL; n  = 38) and the normal PRL group (PRL < 25 ng/ml, NPRL; n = 41) in accordance with PRL levels. The levels of BAP and TRACP-5b were measured using sandwich enzyme-linked immunosorbent assay (ELISA) while serum PRL was measured with an Access Immunoassay Analyzer. BMD was determined by quantitative computed tomography. BMD levels significantly decreased and serum PRL and TRACP-5b levels were significantly higher in male chronic schizophrenia patients. The EPRL group had remarkably lower BMD and BAP level and higher TRACP-5b levels compared with the NPRL group and HCs. Moreover, there was a negative correlation between BMD and TRACP-5b in the EPRL group. We found that BMD, BAP and TRACP-5b levels in the EPRL group were significantly different than HCs and the NPRL group. PRL levels in schizophrenia patients may be related to BMD and bone metabolism. Monitoring BMD and markers of bone metabolism in clinical practice may therefore be helpful to understand the bone health status of schizophrenia patients.
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http://dx.doi.org/10.1038/s41598-020-70668-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423890PMC
August 2020

The safety and efficacy of endoscopic ultrasound-guided ablation therapy for solid pancreatic tumors: a systematic review.

Scand J Gastroenterol 2020 Sep 30;55(9):1121-1131. Epub 2020 Jul 30.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Background And Aims: Recently, endoscopic ultrasound (EUS)-guided ablation therapy, as a minimally invasive technique, has shown its potential to substitute surgery in treating solid pancreatic tumors, such as small potential malignant pancreatic tumors, small insulinomas and locally advanced pancreatic ductal adenocarcinoma (LAPDAC). Therefore, we conducted this systematic review to assess the safety and efficacy of EUS-guided ablation therapy for solid pancreatic tumors.

Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane library and Web of Science databases from inception to February 2020. The endpoints were clinical success and complications rates. The pooled event rate was calculated using Comprehensive Meta Analysis software.

Results: Fourteen studies with a total of 158 patients were included in our final analysis. The major types of solid pancreatic tumors were nonfunction pancreatic neuroendocrine tumors ( = 78, 49.4%), LAPDAC ( = 48, 30.4%) and insulinomas ( = 26, 16.5%). Overall, the pooled clinical success rate was 85.9% (95% confidence interval (CI): 75.4-92.4%,  = 25.18%), pooled complications rate was 29.1% (95% CI: 18.6-42.3%,  = 50.40%). Subgroup analysis was performed based on ablation methods, which showed clinical success rate for radiofrequency ablation (RFA) was 83.5% (95% CI: 67.9-92.4%), and 87.9% (95% CI: 66.2-96.4%) for ethanol ablation (EA). In terms of complications rate, it was 32.2% (95% CI: 19.4-48.4%) for RFA, and 21.2% (95% CI: 6.8-49.9%) for EA.

Conclusions: EUS-guided ablation therapy is a promising alternative treatment for solid pancreatic tumors, especially for p-NETs and insulinomas < 2 cm, with rarely severe complications. Further prospective studies with long-term follow-up are warranted in future.
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http://dx.doi.org/10.1080/00365521.2020.1797870DOI Listing
September 2020

Endoscopic surveillance of esophageal cancer before the treatment of achalasia.

Gastrointest Endosc 2020 08;92(2):457-458

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

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http://dx.doi.org/10.1016/j.gie.2020.02.047DOI Listing
August 2020

Clinical outcomes of endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a systematic review and meta-analysis.

Minim Invasive Ther Allied Technol 2020 Jul 16:1-9. Epub 2020 Jul 16.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Background And Aims: EUS-guided gastroenterostomy (EUS-GE) has been used for gastric outlet obstruction (GOO) with promising clinical outcomes. Therefore, we aimed to determine the clinical outcomes of EUS-GE for GOO.

Material And Methods: We used the keyword 'EUS-guided gastroenterostomy' to search in Pubmed, Web of science, Cochrane databases. Clinical outcomes of EUS-GE were evaluated in terms of technical success, clinical success and complications.

Results: Ten studies reported 297 patients managed with EUS-GE. Weighted pooled rates (WPR) for technical success, clinical success and complications of EUS-GE were 91% (95%CI 87%-94%), 88% (95%CI 83%-91%) and 6.8% (95%CI 4.1%-11.0%). The most common complications were abdominal pain, 6.7% (95%CI 2.5%-16.5%) and bleeding, 4.8% (95%CI 1.5%-13.9%). Two studies compared EUS-GE with surgical gastrojejunostomy (SGJ). Pooled risk ratio (RR) for technical success, clinical success and complications were 0.87 (0.78, 0.97),  = 0%; 0.92 (0.82, 1.04),  = 0%; 0.28 (0.11, 0.68),  = 0%. Three studies compared benign GOO with malignant GOO. RR for technical success and clinical success were 1.05 (0.82, 1.34),  = 0%; 0.98 (0.72, 1.33),  = 0%.

Conclusions: Although EUS-GE and SGJ had similar clinical success rates, EUS-GE had a lower complication rate. EUS-GE is a safe, effective, and minimally invasive choice for patients with GOO.
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http://dx.doi.org/10.1080/13645706.2020.1792500DOI Listing
July 2020

Characteristics and publication status of gastrointestinal endoscopy clinical trials registered in ClinicalTrials.gov.

Surg Endosc 2020 Jul 13. Epub 2020 Jul 13.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Street Taiping No. 25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China.

Background And Aims: This study aimed to examine the fundamental characteristics of gastrointestinal (GI) endoscopy trials and evaluate their publication status.

Methods: A cross-sectional analysis was performed in the ClinicalTrials.gov database, and then the PubMed, Medline, Google Scholar, and Embase databases were searched. A dataset containing GI endoscopy clinical studies from ClinicalTrials.gov registered until November 24, 2017, was downloaded. Data of observational and interventional studies were extracted and analyzed. Publications in peer-reviewed journals were examined for completed trials, and factors associated with publication were identified.

Results: A total of 1338 of 253,777 clinical trials were assigned into GI endoscopy, of which 1018 were interventional and 320 were observational studies. Of all the trials, those from the USA comprised the largest percentage (n = 377, 28.18%). The most common field for registered trials was gastroscopy (n = 436, 32.6%), followed by colonoscopy (n = 215, 16.1%), endoscopic ultrasound (n = 186, 13.9%), endoscopic retrograde cholangiopancreatography (n = 176, 13.1%), and novel endoscopic procedure (n = 103, 7.7%). A total of 501 trials were completed before November 25, 2015, 281 (56.1%) of which were published. The median time from study completion to publication was 21 months (interquartile range, 12-32 months). Trials that were comprised of medium sample sizes (150-1000 subjects), conducted in Europe or Asia and other countries, and single or quadruple blinded were more likely to be published.

Conclusions: GI endoscopy is rapidly evolving in clinical applications. Most clinical trials in GI endoscopy are published promptly. These findings demonstrated that investigators are active in performing and communicating the results of clinical trials in the field of GI endoscopy. In the future, the sample size calculation should be presented in detail in the registration system to maintain trial reporting transparency.
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http://dx.doi.org/10.1007/s00464-020-07786-zDOI Listing
July 2020

Efficacy and Safety of Peroral Endoscopic Myotomy in Achalasia Patients with Failed Previous Intervention: A Systematic Review and Meta-Analysis.

Gut Liver 2021 Mar;15(2):153-167

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries "achalasia," "peroral endoscopic myotomy," and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected. The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.
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http://dx.doi.org/10.5009/gnl19234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960968PMC
March 2021

Endoscopy works during the pandemic of coronavirus COVID-19: recommendations by the Chinese Society of Digestive Endoscopy.

United European Gastroenterol J 2020 08 2;8(7):798-803. Epub 2020 Jul 2.

Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China.

Since December 2019, a novel coronavirus disease, COVID-19, has occurred in China and has spread around the world rapidly. As an acute respiratory infectious disease, COVID-19 has been included in type B infectious diseases and managed according to the standard of type A infectious disease in China. Given the high risk of COVID-19 infection during endoscopic procedures via an airborne route, the Chinese Society of Digestive Endoscopy issued a series of recommendations to guide the endoscopy works in China during the pandemic. To the best of our knowledge, no new infectious case of COVID-19 resulting from endoscopic procedures has been reported in China to date. Here, these recommendations are integrated to provide guidance about the prevention of COVID-19 for endoscopists. The recommendations include advice about postponing non-urgent endoscopies, excluding the possibility of COVID-19 in patients undergoing endoscopy, protection of medical staff from coronavirus infection, and cleaning of endoscopy centres.
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http://dx.doi.org/10.1177/2050640620930632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335943PMC
August 2020

Different risk factors between early and late cancer recurrences in patients without additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer.

Gastrointest Endosc 2020 07;92(1):223-224

Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, Beijing, China.

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http://dx.doi.org/10.1016/j.gie.2020.01.045DOI Listing
July 2020

Peroral endoscopic myotomy versus pneumatic dilation for achalasia: a systematic review and meta-analysis.

Eur J Gastroenterol Hepatol 2020 11;32(11):1413-1421

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou.

Presently, the primary endoscopic options for the treatment of achalasia are peroral endoscopic myotomy (POEM) and pneumatic dilation. But the clinical outcomes of POEM and pneumatic dilation for achalasia have not yet to be fully evaluated. So, we aimed to compare the clinical outcomes between the two treatment modalities. We searched all the relevant studies published up to September 2019 examining the comparative efficacy between POEM and pneumatic dilation. Outcomes included success rate, Eckardt score, lower esophageal sphincter pressure and adverse events. Outcomes were documented by pooled risk ratios and mean difference with 95% confidence interval (CI) using Review Manager 5.3. Seven studies with a total of 619 patients were identified. There were 298 patients underwent POEM treatment and 321 patients underwent pneumatic dilation treatment. The clinical success rate was higher in the POEM group than that in the pneumatic dilation group at 6, 12 and 24 months' follow-up, with a risk ratio of 1.14 (95% CI, 1.06-1.22, P = 0.0002, I= 0%), 1.34 (95% CI, 1.24-1.45, P < 0.00001, I= 17%) and 1.35 (95% CI, 1.10-1.65, P = 0.004, I= 70%), respectively. The change of Eckardt scores was more obvious in the POEM group than in the pneumatic dilation group, with a mean difference of 1.19 (95% CI, 0.78-1.60, P < 0.00001, I= 70%). The rate of gastroesophageal reflux and other complications for POEM was significantly higher than for pneumatic dilation, with a risk ratio of 4.17 (95% CI, 1.52-11.45, P = 0.006, I= 61%) and 3.78 (95% CI, 1.41-10.16, P = 0.008, I= 0%). Our current evidence suggests that the long-term efficacy of POEM was superior to that of pneumatic dilation, but accompanied by higher complications.
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http://dx.doi.org/10.1097/MEG.0000000000001800DOI Listing
November 2020

Bibliometric Analysis of 100 Top-Cited Articles in Gastric Disease.

Biomed Res Int 2020 15;2020:2672373. Epub 2020 May 15.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou 646099, China.

Objectives: The bibliometric analysis uses the citation count of an article to measure its impact in the scientific community, yet there is still no comprehensive summary of gastric disease researches via bibliometric analysis. We aimed to evaluate the situations and trends of the most cited articles in gastric disease via bibliometric analysis and to provide physicians a practical guide in assessing the most influential articles written on this subject.

Methods: The 100 top-cited articles in gastric disease were compiled using Web of Science. The articles selected were evaluated for their number of citations, year of publication, country of origin, type of study, and others.

Results: The database had 484,281 articles published between 1965 and 2019. The most cited article received 4,017 citations and the least received 604, with a mean of 1,149 citations. We classified the articles into seven categories: gastric cancer ( = 53), Helicobacter pylori ( = 17), ulcer ( = 7), gastrointestinal stromal tumors ( = 6), gastritis ( = 5), gastric bypass surgery ( = 2), and others ( = 10). Altogether, 69 of the articles were from the USA ( = 41), the UK ( = 17), and Japan ( = 11). Among all the institutions, Royal Perth Hospital led the list with 5 articles. One-quarter of authors owned three or more of these top-cited articles. The 100 papers were published in 33 journals, and most of them were clinical researches ( = 47).

Conclusions: Our study provides a historical perspective for the scientific progress of gastric disease, and the articles of significant findings that contributed great impact on the prevention and treatment of gastric disease had been identified.
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http://dx.doi.org/10.1155/2020/2672373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245662PMC
March 2021

Near-focus mode for accurate operation during endoscopic submucosal tunneling procedure.

Minim Invasive Ther Allied Technol 2020 May 23:1-8. Epub 2020 May 23.

Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Sichuan, China.

When using the endoscopic submucosal tunnel technique (ESTT), the working space in the submucosal tunnel is limited, and the visual field is obscured during close inspection or hemostasis. We aimed to evaluate the efficacy and safety of near-focus mode technique for accurate operation during the submucosal tunneling endoscopic procedure. A retrospective two-center study was designed. A total of 51 patients undergoing ESTT procedures with near-focus mode ( = 29) or traditional mode ( = 22) between February 2016 and May 2019 were included in this study. When using the near-focus mode during the ESTT procedure, it is convenient to ensure a clear image and accurate operation. Adverse events occurred more frequently in the traditional group than in the near-focus group (45.5% vs 17.2%,  .036). The near-focus group exhibited a lower rate of bleeding compared to the traditional group (0 vs 18.2%,  .029). Furthermore, the mean hospital stay after the procedure was shorter in the near-focus group than in the traditional group (5.7 days vs 6.7 days,  .013). The visual field is more clearly exposed during submucosal tunneling when using the near-focus mode than when using traditional procedures. This technique appears to be more efficient and secure than the traditional ESTT procedure.
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http://dx.doi.org/10.1080/13645706.2020.1768408DOI Listing
May 2020

Spraying vitamin C solution for relief of mucosal irritation caused by Lugol chromoendoscopy.

Gastrointest Endosc 2020 06;91(6):1409-1410

Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.

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http://dx.doi.org/10.1016/j.gie.2020.01.020DOI Listing
June 2020

Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis.

Gastroenterol Res Pract 2020 20;2020:4952721. Epub 2020 Apr 20.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.

Background And Aims: Recently, a new type of metal stent, named lumen-apposing metal stents (LAMS), has been designed to manage pancreatic fluid collections (PFC), and a few studies have reported its efficacy and safety. Therefore, we conducted this meta-analysis to investigate the role of LAMS for PFC.

Methods: We searched the studies from PubMed, MEDLINE, Embase, and Cochrane databases from inception to May 2019. We extracted the data and analyzed the technical success, clinical success, and adverse events of LAMS to evaluate its efficacy and safety.

Results: Twenty studies with 1534 patients were included. The pooled technical success, clinical success, and adverse event rates of LAMS for PFC were 96.2% (95% confidence interval (CI): 94.6%-97.4%), 86.8% (95% CI: 83.1%-89.8%), and 20.7% (95% CI: 16.1%-26.1%), respectively. Eight studies including 875 patients compared the clinical outcomes of LAMS with plastic stents. The pooled risk ratio (RR) of technical success and clinical success for LAMS and plastic stent was 1.01 (95% CI: 0.98-1.04, = 0.62) and 1.06 (95% CI: 1.01-1.12, = 0.03), respectively. As for the overall adverse events, the pooled RR was 1.51 (95% CI: 0.67-3.44, = 0.32).

Conclusions: Our current study revealed that LAMS has advantages over plastic stents for PFC, with higher clinical success rate and lower complication rate of infection and occlusion.
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http://dx.doi.org/10.1155/2020/4952721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189322PMC
April 2020

Peroral endoscopic shorter versus longer myotomy for the treatment of achalasia: a comparative retrospective study.

Esophagus 2020 10 2;17(4):477-483. Epub 2020 May 2.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China.

Introduction: Peroral esophageal myotomy (POEM) is a novel endoscopic treatment for achalasia. It has gained popularity worldwide among surgeons and endoscopists, but no studies have compared peroral endoscopic short with long myotomy for achalasia. We aimed to compare the clinical efficacy and safety between peroral endoscopic shorter and longer myotomy.

Methods: The retrospective study enrolled 129 achalasia patients who underwent POEM from July 2011 to September 2017. Based on the myotomy length (ML), patients were divided into shorter myotomy (SM) group (ML ≤ 7 cm, n = 36) and longer myotomy (LM) group (ML > 7 cm, n = 74). Procedure-related parameters, symptom scores, adverse events and manometric data were compared between two groups.

Results: The mean ML was 6.0 ± 0.6 cm in SM group, and 11.5 ± 3.1 cm in LM group (p < 0.001). The mean operation time was significantly less in SM group than LM group (46.6 ± 18.5 min vs 62.1 ± 25.2 min, p = 0.001). During a mean follow-up period of 28.7 months, treatment success (Eckardt score ≤ 3) was achieved in 94.4% (34/36) of patients in SM group and 91.9% (68/74) in LM group (p = 0.926). There was no statistical difference in the incidence of intraoperative complications (8.4% vs 8.2%, p = 0.823) and reflux rate (8.3% vs. 14.9%, p = 0.510) between two groups.

Conclusions: Peroral endoscopic shorter myotomy is comparable with longer myotomy for treating achalasia with regard to clinical efficacy and has the advantage of shorter procedure time.
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http://dx.doi.org/10.1007/s10388-020-00739-4DOI Listing
October 2020

Decreased Serum EGF in First-episode and Chronic Schizophrenia Patients: Negative Correlation with Psychopathology.

Sci Rep 2020 04 16;10(1):6506. Epub 2020 Apr 16.

Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, 215137, P.R. China.

Previous studies have demonstrated that neurotrophic factors may play a critical role in the severity of clinical symptoms in schizophrenia. However, it remains unknown whether serum levels of epidermal growth factor (EGF) in schizophrenia are similar to those observed in the case of other neurotrophic factors. Therefore, we compared serum EGF concentrations in first-episode drug-naive (FEP) patients and medicated chronic schizophrenic patients with healthy controls in order to explore whether EGF levels are related to psychopathological symptoms. We measured the serum levels of EGF in 78 first-episode medication-naive schizophrenia patients, 76 medicated chronic schizophrenic patients, and 75 healthy controls using the sandwich ELISA method. Disease severity were measured using the positive and negative syndrome scale (PANSS). Serum EGF levels showed a significant decrease in schizophrenia patients in comparison to healthy subjects. Serum EGF levels in FEP patients are indistinguishable from chronic cases. EGF levels were related to PANSS general symptom subscales in both FEP never-medicated and medicated patients. It is interesting that serum EGF levels were negatively correlated with the PANSS cognitive subscales, with the exception of the patients with chronic schizophrenia. Our preliminary results indicated that EGF may play a role in this illness and that it could be used as a potential biomarker of disease severity. Moreover, EGF may be associated with cognitive subscales of PANSS in FEP patients. Future studies should investigate the relationship between EGF and cognitive function as measured using standardized neuropsychological assessments to identify potential biomarkers related with cognition.
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http://dx.doi.org/10.1038/s41598-020-63544-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162869PMC
April 2020

Bibliometric analysis of the 100 most-cited articles in the field of hepatology.

Gastroenterol Hepatol 2020 Aug - Sep;43(7):349-357. Epub 2020 Mar 30.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China. Electronic address:

Objective: Bibliometric search of citation classics can function as a tool to identify extraordinary landmark articles and advanced research studies. We aimed to examine and characterize the 100 most-cited published articles in the field of hepatology.

Patients And Methods: A comprehensive list of the 100 most-cited articles published from 1950 to 2017 in the field of hepatology was compiled after searching the Web of Science with relevant terms, including "liver," "hepatitis," "hepatic," "hepatocellular," "hepatology," "cirrhosis," and "steatohepatitis." The articles were ranked according to their citation counts and were evaluated for characteristics including country, institution, authorship, publication year, subspecialty and others.

Results: The database search returned 323,291 articles associated with liver disease published between 1950 and 2017. The 100 most-cited articles were from 21 major journals, with the highest number of articles being published in Hepatology (n=20). The average number of citations of the 100 most-cited articles was 1946.8; among these articles, the most frequently cited article received 5515 citations, and the least frequently cited article received 1155 citations. In total, 60 were original articles among the 100 most-cited articles. The most frequently represented specialties were hepatitis, hepatocellular carcinoma, and nonalcoholic fatty liver disease, which accounted for 53.3%, 23.3%, and 11.7% of these articles, respectively.

Discussion: Our study identified citation classics and provided a review of the most advanced studies in the field of hepatology. This can help to guide clinical treatment and future academic research resulting in advancements in hepatology.
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http://dx.doi.org/10.1016/j.gastrohep.2019.11.015DOI Listing
March 2020