3501
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Robinson A, Ohri A, Liu B, Bhuket T, Wong RJ. One in five hepatocellular carcinoma patients in the United States are Hispanic while less than 40% were eligible for liver transplantation. World J Hepatol 2018; 10:956-965. [PMID: 30631400 PMCID: PMC6323520 DOI: 10.4254/wjh.v10.i12.956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate trends and disparities in hepatocellular carcinoma (HCC) outcomes among Hispanic patients in the United States with a focus on tumor stage at diagnosis.
METHODS We retrospectively evaluated all Hispanic adults (age > 20) with HCC diagnosed from 2004 to 2014 using United States Surveillance, Epidemiology, and End Results (SEER) cancer registry data. Tumor stage was assessed by SEER-specific staging systems and whether HCC was within Milan criteria at diagnosis. Multivariate logistic regression models evaluated for predictors of HCC within Milan criteria at diagnosis.
RESULTS Overall, Hispanics accounted for 19.8% of all HCC (73.3% men, 60.9% had Medicare or commercial insurance, 33.5% Medicaid, and 5.6% uninsured). Thirty-eight percent of Hispanic HCC patients were within Milan criteria at diagnosis. With latter time periods, significantly more patients were diagnosed with HCC within Milan criteria, and in 2013-2014, 42.6% had HCC within Milan criteria. On multivariate regression, Hispanic males (OR vs females: 0.76, 95%CI: 0.68-0.83, P < 0.001), Hispanics > 65 years (OR vs age < 50: 0.67, 95%CI: 0.58-0.79, P < 0.001), and uninsured patients (OR vs Medicare/commercial: 0.49, 95%CI: 0.40-0.59, P < 0.001) were significantly less likely to have HCC within Milan criteria at diagnosis.
CONCLUSION While one in five HCC patients in the United States are of Hispanic ethnicity, only 38% were within Milan criteria at time of diagnosis, and thus over 60% were ineligible for liver transplantation, one of the primary curative options for HCC patients. Improved efforts at HCC screening and surveillance are needed among this group to improve early detection.
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Affiliation(s)
- Ann Robinson
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
| | - Ajay Ohri
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA 94620, United States
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3502
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Qazi Arisar FA, Abid S, Shaikh PA, Awan S. Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients. World J Hepatol 2018; 10:944-955. [PMID: 30631399 PMCID: PMC6323522 DOI: 10.4254/wjh.v10.i12.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/07/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease (CLD) patients.
METHODS In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay (> 5 d), and early readmission (within 7 d).
RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and 64.6% (n = 258) were male. Six-week mortality was 13% (n = 52). Prolonged hospital stay and readmission were present in 18% (n = 72) and 7% (n = 28) of patients, respectively. NCDs were found in 47.4% (n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in 41% (n = 165), 17.5% (n = 70), and 1.75% (n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease (CKD), low albumin, and high Model for End-Stage Liver Disease (MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventional MELD score predicted mortality even better than MELD-Na (area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity independently.
CONCLUSION Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.
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Affiliation(s)
- Fakhar Ali Qazi Arisar
- Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Shahab Abid
- Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Preet Ayoub Shaikh
- Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Safia Awan
- Section of Gastroenterology, Department of Medicine, Faculty Offices Building, the Aga Khan University Hospital, Karachi 74800, Pakistan
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3503
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Dirchwolf M, Marciano S, Martínez J, Ruf AE. Unresolved issues in the prophylaxis of bacterial infections in patients with cirrhosis. World J Hepatol 2018; 10:892-897. [PMID: 30631393 PMCID: PMC6323518 DOI: 10.4254/wjh.v10.i12.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/05/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis (SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Only prophylaxis due to gastrointestinal bleeding has a known and short-time duration. All other indications imply long-lasting exposure to antibiotics - once the threshold requirement for initiating prophylaxis is met - without standardized criteria for re-assessing antibiotic interruption. Despite the fact that the benefit of antibiotic prophylaxis in reducing bacterial infections episodes and mortality has been thoroughly reported, the extended use of antibiotics in patients with cirrhosis has also had negative consequences, including the emergence of multi-drug resistant bacteria. Currently, it is not clear whether restricting the use of broad and fixed antibiotic regimens, tailoring the choice of antibiotics to local bacterial epidemiology or selecting non-antibiotic strategies will be the preferred antibiotic prophylaxis strategy for patients with cirrhosis in the future.
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Affiliation(s)
- Melisa Dirchwolf
- Unidad de Hígado, Hospital Privado de Rosario, Rosario 2000, Argentina
| | - Sebastián Marciano
- Unidad de Hígado, and Departamento de Investigación del Hospital Italiano de Buenos Aires, Buenos Aires 1424, Argentina
| | - José Martínez
- Unidad de Hígado, Hospital Privado de Rosario, Rosario 2000, Argentina
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3504
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Pasanta D, Tungjai M, Chancharunee S, Sajomsang W, Kothan S. Body mass index and its effects on liver fat content in overweight and obese young adults by proton magnetic resonance spectroscopy technique. World J Hepatol 2018; 10:924-933. [PMID: 30631397 PMCID: PMC6323521 DOI: 10.4254/wjh.v10.i12.924] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/03/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the association between liver fat content (LFC) and weight status in young adults using proton magnetic resonance spectroscopy (1H MRS) technique.
METHODS Seventy-eight healthy young adults, between 19-30 years of age participated in this study. This group was then separated into a control of 39 subjects and an overweight/obese group (OW/OB group) consisting of 39 subjects. Blood biochemical quantity and 1H MRS was performed for LFC assessment.
RESULTS LFC was found to be almost three times higher in OW/OB group when compared to the control group. A 48.7% incidence of non-alcoholic fatty liver disease in the OW/OB group was found. Blood biochemical measurements showed statistically higher low-density lipoproteins and triglyceride, lower high-density lipoproteins, and increased glycosylated hemoglobin and fasting glucose in the OW/OB group. Body mass index was a significant independent predictor for LFC after adjusting for age and sex (multiple linear regression; β = 0.459, P < 0.001).
CONCLUSION Due to the prevalence of high LFC in the OW/OB group, it can be proposed that weight gain and obesity are sensitive indicators of high hepatic fat content.
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Affiliation(s)
- Duanghathai Pasanta
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Montree Tungjai
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sirirat Chancharunee
- Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Warayuth Sajomsang
- National Nanotechnology Center, National Science and Technology Development Agency, Thailand Science Park, Pathum Thani 12120, Thailand
| | - Suchart Kothan
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
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3505
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Dousse D, Bloom E, Suc B. Pancreaticoduodenectomy complicated by Budd-Chiari syndrome: A case report and review of literature. World J Gastrointest Surg 2018; 10:107-110. [PMID: 30622679 PMCID: PMC6314861 DOI: 10.4240/wjgs.v10.i9.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some life-threatening complications remain atypical and undescribed.
CASE SUMMARY We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings (i.e., acute liver failure) and radiological findings (i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature.
CONCLUSION Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.
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Affiliation(s)
- Damien Dousse
- Department of Visceral Surgery, Toulouse-Purpan University Hospital, 31059 Toulouse Cedex 9, France
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
| | - Eric Bloom
- Department of Visceral Surgery, Toulouse-Purpan University Hospital, 31059 Toulouse Cedex 9, France
| | - Bertrand Suc
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
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3506
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Hayashi S, Takenaka M, Hosono M, Nishida T. Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography. World J Clin Cases 2018; 6:1087-1093. [PMID: 30613666 PMCID: PMC6306631 DOI: 10.12998/wjcc.v6.i16.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Suita 564-0018, Japan
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
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3507
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Baumann S, Chandra L, Skarga E, Renker M, Borggrefe M, Akin I, Lossnitzer D. Instantaneous wave-free ratio (iFR ®) to determine hemodynamically significant coronary stenosis: A comprehensive review. World J Cardiol 2018; 10:267-277. [PMID: 30622685 PMCID: PMC6314882 DOI: 10.4330/wjc.v10.i12.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/23/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
Coronary angiography is considered to be the gold standard in the morphological evaluation of coronary artery stenosis. The morphological assessment of the severity of a coronary lesion is very subjective. Thus, the invasive fractional flow reserve (FFR) measurement represents the current standard for estimation of the hemodynamic significance of coronary artery stenosis. The FFR-guided revascularization strategy was initially classified as a Class-IA-recommendation in the 2014 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. Both the Deferral vs Performance of Percutaneous Coronary Intervention of Functionally Non-Significant Coronary Stenosis and Flow Reserve vs Angiography for Multivessel Evaluation studies showed no treatment advantage for hemodynamically insignificant stenoses. With the help of FFR (and targeted interventions), clinical results could be improved; however, the use in clinical practice is still limited due to the need of adenosine administration and a significant prolongation of the length of the procedure. Instantaneous wave-free ratio (iFR®) is a new innovative approach for the determination of the hemodynamic significance of coronary stenosis, which can be obtained at rest without the use of vasodilators. Regarding the periprocedural complications as well as prognosis, iFR® showed non-inferiority to FFR in the SWEDEHEART and DEFINE-FLAIR trials. Furthermore, iFR®, enhanced by iFR®-pullback, provides the possibility to display the iFR®-change over the course of the vessel to create a hemodynamic map.
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Affiliation(s)
- Stefan Baumann
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
| | - Leonard Chandra
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
| | - Elizaveta Skarga
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim 61231, Hesse, Germany
| | - Martin Borggrefe
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
| | - Ibrahim Akin
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
| | - Dirk Lossnitzer
- First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany
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3508
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Mao XW, Xu G, Xiao JQ, Wu HF. Ureteral double J stent displaced into vena cava and management with laparoscopy: A case report and review of the literature. World J Clin Cases 2018; 6:1160-1163. [PMID: 30613675 PMCID: PMC6306637 DOI: 10.12998/wjcc.v6.i16.1160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
We reported displacement of a ureteral double J stent into the vena cava and laparoscopic management in a 69-year-old patient with a history of ureteral stent placement. Preoperative computed tomography and plain X-rays showed malpositioning of the double J stent and displacement into the inferior vena cava. The characteristics of stent misplacement precluded endovascular procedures and explorative laparoscopic surgery was performed. The intra- and postoperative periods were uneventful. Postoperative imaging demonstrated that the new double J stent was in the right position. The patient was discharged 7 d after the operation and was symptom free at the 4-mo follow-up.
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Affiliation(s)
- Xia-Wa Mao
- Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Gang Xu
- Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jia-Quan Xiao
- Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Hui-Feng Wu
- Department of Urology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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3509
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Chen CF, Liao HT. Platelet-rich plasma enhances adipose-derived stem cell-mediated angiogenesis in a mouse ischemic hindlimb model. World J Stem Cells 2018; 10:212-227. [PMID: 30613314 PMCID: PMC6306556 DOI: 10.4252/wjsc.v10.i12.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the angiogenic effect of platelet-rich plasma (PRP)-preconditioned adipose-derived stem cells (ADSCs) both in vitro and in a mouse ischemic hindlimb model.
METHODS ADSCs were divided based on culture medium: 2.5% PRP, 5% PRP, 7.5% PRP, and 10% PRP. Cell proliferation rate was analyzed using the MTS assay. The gene expression of CD31, vascular endothelial growth factor, hypoxia-inducible factors, and endothelial cell nitric oxide synthase was analyzed using reverse transcription polymerase chain reaction. Cell markers and structural changes were assessed through immunofluorescence staining and the tube formation assay. Subsequently, we studied the in vivo angiogenic capabilities of ADSCs by a mouse ischemic hindlimb model.
RESULTS The proliferation rate of ADSCs was higher in the 2.5%, 5%, and 7.5% PRP groups. The expression of hypoxia-inducible factor, CD31, vascular endothelial growth factor, and endothelial cell nitric oxide synthase in the 5% and 7.5% PRP groups increased. The 5%, 7.5%, and 10% PRP groups showed higher abilities to promote both CD31 and vascular endothelial growth factor production and tubular structure formation in ADSCs. According to laser Doppler perfusion scan, the perfusion ratios of ischemic limb to normal limb were significantly higher in 5% PRP, 7.5% PRP, and human umbilical vein endothelial cells groups compared with the negative control and fetal bovine serum (FBS) groups (0.88 ± 0.08, 0.85 ± 0.07 and 0.81 ± 0.06 for 5%, 7.5% PRP and human umbilical vein endothelial cells compared with 0.42 ± 0.17 and 0.54 ± 0.14 for the negative control and FBS, P < 0.01).
CONCLUSION PRP-preconditioned ADSCs presented endothelial cell characteristics in vitro and significantly improved neovascularization in ischemic hindlimbs. The optimal angiogenic effect occurred in 5% PRP- and 7.5% PRP-preconditioned ADSCs.
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Affiliation(s)
- Chia-Fang Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Han-Tsung Liao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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3510
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Zupcic SG, Zupcic M, Duzel V, Šimurina T, Milošević M, Basic S, Vuletic V, Kapural L. Effect of clonidine on the cutaneous silent period during spinal anesthesia. World J Clin Cases 2018; 6:1136-1145. [PMID: 30613672 PMCID: PMC6306629 DOI: 10.12998/wjcc.v6.i16.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/17/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia.
METHODS A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB.
RESULTS Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms (P = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms (P < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms (P < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms (P < 0.001).
CONCLUSION Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP.
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Affiliation(s)
- Sandra Graf Zupcic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
| | - Miroslav Zupcic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Viktor Duzel
- Department of Anaesthesia, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, United Kingdom
| | - Tatjana Šimurina
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Health Studies University of Zadar, Zadar 23000, Croatia
- Department of Anesthesiology and Intensive Care Medicine, General Hospital Zadar, Zadar 23000, Croatia
| | - Milan Milošević
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health WHO Collaborative Centre for Occupational Health, Zagreb 10000, Croatia
| | - Silvio Basic
- Faculty of Medicine, J. J. Strossmayer University, Osijek 31000, Croatia
- Department of Neurology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Vladimira Vuletic
- Clinic of Neurology, Clinical Hospital Centre Rijeka, Rijeka 51000, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Leonardo Kapural
- Center for Clinical Research, Winston Salem, NC 27103, United States
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3511
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Kayaaltı S, Kayaaltı Ö. Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy. World J Clin Cases 2018; 6:1146-1154. [PMID: 30613673 PMCID: PMC6306640 DOI: 10.12998/wjcc.v6.i16.1146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/09/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the results of midazolam-ketamine-propofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety. METHODS American Statistical Association (ASA) I-II 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist (SSA) and sedation under the supervision of an endoscopy nurse (SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSA group and the nurse with a patient-controlled analgesia (PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale (VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy. RESULTS Total propofol consumption in the SSEN group was significantly higher (P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences (P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group. CONCLUSION Colonoscopy sedation in ASA I-II patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.
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Affiliation(s)
- Selda Kayaaltı
- Division of Anaesthesiology and Reanimation, Develi Public Hospital, Develi, Kayseri 38400, Turkey
| | - Ömer Kayaaltı
- Computer Technology, Kayseri University, Develi Huseyin Sahin Vocational College, Develi, Kayseri 38400, Turkey
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3512
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Xie BS, Zhong JW, Wang AJ, Zhang ZD, Zhu X, Guo GH. Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic porto-systemic shunt plus embolization: A case report. World J Clin Cases 2018; 6:1217-1222. [PMID: 30613686 PMCID: PMC6306627 DOI: 10.12998/wjcc.v6.i16.1217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension (IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt (TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leading to duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
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Affiliation(s)
- Bu-Shan Xie
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jia-Wei Zhong
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - An-Jiang Wang
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen-Dong Zhang
- Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xuan Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Gui-Hai Guo
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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3513
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Yoon HY, Kim Y, Park HS, Kang CW, Ryu YJ. Combined silicosis and mixed dust pneumoconiosis with rapid progression: A case report and literature review. World J Clin Cases 2018; 6:1164-1168. [PMID: 30613676 PMCID: PMC6306638 DOI: 10.12998/wjcc.v6.i16.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rapidly progressive pneumoconiosis (RPP) occasionally occurs in coal workers, particularly those with high exposure to silica. Here, we report the case of a 64-year-old male miller with RPP.
CASE SUMMARY The patient had a persistent cough for one month and had been clinically diagnosed with pulmonary tuberculosis in 2011. He worked in a stone processing factory from the ages of 20 through 37 and has owned his own mill for the past 25 years. His chest radiograph showed significant increases in the size and number of lung nodules since his last follow-up in 2013. By percutaneous needle lung biopsy, the nodular lesions showed diffuse infiltration of phagocytic macrophages and birefringent crystals by polarizing microscopy. He was finally diagnosed with RPP of mixed dust pneumoconiosis combined with silicosis.
CONCLUSION In this case, mixed dust pneumoconiosis with silicosis might be accelerated by persistent exposure to grain dust from working in a mill environment.
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Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 15871, South Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University, College of Medicine, Seoul 15871, South Korea
| | - Heae Surng Park
- Department of Pathology, Ewha Womans University, College of Medicine, Seoul 15871, South Korea
| | - Chung-Won Kang
- Department of Occupational and Environmental Medicine, Ewha Womans University College of Medicine, Seoul 15871, South Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 15871, South Korea
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3514
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Yeh CC, Yang SSD, Huang SC, Wang YC. Uncommon cause of voiding dysfunction in a female patient-vaginal abscess: A case report. World J Clin Cases 2018; 6:1199-1201. [PMID: 30613682 PMCID: PMC6306639 DOI: 10.12998/wjcc.v6.i16.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/12/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaginal abscess is a treatable disease and should be considered in female patients with voiding difficulties and perineal tenderness. There are no reported cases of vaginal abscess causing voiding dysfunction in the absence of a previous surgery. Early diagnosis and drainage of vaginal abscesses may lead to excellent outcomes.
CASE SUMMARY We presented a case of vaginal abscess that caused voiding dysfunction without surgery history. A 64-year-old woman had a past history of type 2 diabetes mellitus. She came to our clinic following urinary difficulty with perineal tenderness. Bladder ultrasonography revealed a pelvic cystic lesion with a mass effect on the bladder. The presence of a vaginal abscess was suspected following pelvic examination and transvaginal ultrasound. After transvaginal drainage of the vaginal abscess and a full course of antibiotic treatment, she recovered well without any urination symptoms.
CONCLUSION Voiding dysfunction caused by vaginal abscess is rare but should be considered in female patients with perineal tenderness.
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Affiliation(s)
- Chia-Chi Yeh
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 23142, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 23142, Taiwan
| | - Su-Cheng Huang
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 23142, Taiwan
| | - Yi-Chun Wang
- Department of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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3515
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Kinami S, Takahashi M, Urushihara T, Ikeda M, Yoshida M, Uenosono Y, Oshio A, Suzukamo Y, Terashima M, Kodera Y, Nakada K. Background factors influencing postgastrectomy syndromes after various types of gastrectomy. World J Clin Cases 2018; 6:1111-1120. [PMID: 30613669 PMCID: PMC6306647 DOI: 10.12998/wjcc.v6.i16.1111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postgastrectomy syndromes (PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire.
AIM To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study (PGSAS) data as an additional analysis.
METHODS The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy (DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy (PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures (MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach (laparoscopic or open), and the status of the celiac branch of the vagal nerve.
RESULTS The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.
CONCLUSION Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Masazumi Takahashi
- Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
| | - Takashi Urushihara
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - Masami Ikeda
- Department of Surgery, Asama General Hospital, Saku 385-0222, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
| | - Yoshikazu Uenosono
- Department of Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 169-8666, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University Daisan Hospital
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3516
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Antonelli E, Villanacci V, Bassotti G. Novel oral-targeted therapies for mucosal healing in ulcerative colitis. World J Gastroenterol 2018; 24:5322-5330. [PMID: 30598577 PMCID: PMC6305528 DOI: 10.3748/wjg.v24.i47.5322] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC), a chronic, relapsing, remitting disease of the colon and rectum, is characterized by inflammatory ulceration of the mucosa. Current UC therapy relies on controlling acute episodes and preventing relapse. To predict modifications in the natural course of UC, mucosal healing (MH) has emerged as a major treatment goal. Endoscopic evaluation is considered the gold standard for assessing MH, which can be achieved by conventional drugs and biologics in many, but not all, patients. Consequently, interest is focusing on the development of new substances for UC therapy, and new oral agents are in the pipeline. This review will focus on the ability of newly developed oral drugs to induce and maintain MH in UC patients.
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Affiliation(s)
- Elisabetta Antonelli
- Gastroenterology Section, Perugia General Hospital, San Sisto (Perugia) 06156, Italy
| | | | - Gabrio Bassotti
- Department of Medicine, Gastroenterology and Hepatology Section, University of Perugia Medical School, San Sisto (Perugia) 06132, Italy
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3517
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Araújo T, Khayat A, Quintana L, Calcagno D, Mourão R, Modesto A, Paiva J, Lima A, Moreira F, Oliveira E, Souza M, Othman M, Liehr T, Abdelhay E, Gomes R, Santos S, Assumpção P. Piwi like RNA-mediated gene silencing 1 gene as a possible major player in gastric cancer. World J Gastroenterol 2018; 24:5338-5350. [PMID: 30598579 PMCID: PMC6305533 DOI: 10.3748/wjg.v24.i47.5338] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/07/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To establish a permanent piwi like RNA-mediated gene silencing 1 (PIWIL1) gene knockout in AGP01 gastric cancer cell line using CRISPR-Cas9 system and analyze phenotypic modifications as well as gene expression alterations.
METHODS CRISPR-Cas9 system used was purchased from Dharmacon GE Life Sciences (Lafayette, CO, United States) and permanent knockout was performed according to manufacturer’s recommendations. Wound-healing assay was performed to investigate the effect of PIWIL1 knockout on migration capability of cells and Boyden chamber invasion assay was performed to investigate the effect on invasion capability. For the gene expression analysis, a one-color microarray-based gene expression analysis kit (Agilent Technologies, Santa Clara, CA, United States) was used according to the protocol provided by the manufacturer.
RESULTS PIWIL1 gene knockout caused a significant decrease in AGP01 migration capacity as well as a significant decrease in cell invasiveness. Moreover, functional analysis based on grouping of all differentially expressed mRNAs identified a total of 35 genes (5 up-regulated and 30 down-regulated) encoding proteins involved in cellular invasion and migration. According to current literature, 9 of these 35 genes (DOCK2, ZNF503, PDE4D, ABL1, ABL2, LPAR1, SMAD2, WASF3 and DACH1) are possibly related to the mechanisms used by PIWIL1 to promote carcinogenic effects related to migration and invasion, since their functions are consistent with the changes observed (being up- or down-regulated after knockout).
CONCLUSION Taken together, these data reinforce the idea that PIWIL1 plays a crucial role in the signaling pathway of gastric cancer, regulating several genes involved in migration and invasion processes; therefore, its use as a therapeutic target may generate promising results in the treatment of gastric cancer.
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Affiliation(s)
- Taíssa Araújo
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - André Khayat
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Luciana Quintana
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Danielle Calcagno
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Ronald Mourão
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Antônio Modesto
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Juliana Paiva
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Adhara Lima
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Fabiano Moreira
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Edivaldo Oliveira
- Laboratório de Cultura de Tecidos e Citogenética, Instituto Evandro Chagas, Belém 66087-082, Brazil
| | - Michel Souza
- Laboratório de Cultura de Tecidos e Citogenética, Instituto Evandro Chagas, Belém 66087-082, Brazil
| | - Moneeb Othman
- Institute of Human Genetics, Universitätsklinikum Jena, Jena 07747, Germany
| | - Thomas Liehr
- Institute of Human Genetics, Universitätsklinikum Jena, Jena 07747, Germany
| | - Eliana Abdelhay
- Laboratório de Célula Tronco, Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro 20230-130, Brazil
| | - Renata Gomes
- Laboratório de Célula Tronco, Centro de Transplante de Medula Óssea, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro 20230-130, Brazil
| | - Sidney Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
| | - Paulo Assumpção
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
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3518
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Sobhani N, Generali D, Zanconati F, Bortul M, Scaggiante B. Current status of PI3K-mTOR inhibition in hormone-receptor positive, HER2-negative breast cancer. World J Clin Oncol 2018; 9:172-179. [PMID: 30622925 PMCID: PMC6314865 DOI: 10.5306/wjco.v9.i8.172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 02/06/2023] Open
Abstract
Breast cancer (BC) is the most common cancer in women and second only to lung cancer in terms of mortality. Among the three different BC subtypes, the oestrogen receptor positive represents nearly 70% of all cases and it is usually treated with anti-oestrogen drugs. However, the majority of hormone receptor positive metastatic BC patients develop resistance to anti-oestrogen treatments. The need for more down-stream therapies brought to the development of therapeutic strategies inhibiting the phosphatidylinositol 3-kinase-mammalian target of rapamycin (mTOR) pathway. Inhibitors of the mTOR have been tested in different clinical trials; everolimus has been Food and Drug Administration approved for the treatment of oestrogen receptor positive/human epidermal growth factor receptor 2 negative BC patients in combination with exemestane in patients who have progressed to anastrozole or letrozole after the encouraging results coming from BOLERO-2 trial. Similar results were obtained by the TAMRAD investigatory study testing tamoxifen in combination with everolimus in advanced BC. This editorial focuses on the results from BOLERO-2, BOLERO 4 and BOLERO-6, which tested the clinical importance of mTOR inhibition. We comment also on the role of phosphatidylinositol 3-kinase-mTOR inhibition as reported in the BELLE-2 and BELLE-3 trials and the future directions for the inhibition of this tumour metabolic axis.
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Affiliation(s)
- Navid Sobhani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Academic Hospital, Trieste 34149, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Academic Hospital, Trieste 34149, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Academic Hospital, Trieste 34149, Italy
| | - Marina Bortul
- Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Academic Hospital, Trieste 34149, Italy
| | - Bruna Scaggiante
- Department of Life Sciences, University of Trieste, Trieste 34127, Italy
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3519
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van de Bunt F, Pearl ML, van Essen T, van der Sluijs JA. Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy. World J Orthop 2018; 9:292-299. [PMID: 30598873 PMCID: PMC6306517 DOI: 10.5312/wjo.v9.i12.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/16/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy (BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus (IS) and subscapularis (SSc) muscles in the genesis of this bony deformation is explored.
METHODS Bilateral magnetic resonance imaging (MRI) scans of 35 infants (age range: 2-7 mo old) with BPBI were retrospectively analyzed. Retroversion was measured according to two proximal axes and one distal axis (transepicondylar axis). The proximal axes were: (1) the perpendicular line to the borders of the articular surface (humeral centerline); and (2) the longest diameter through the humeral head. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.
RESULTS Retroversion on the involved side was significantly decreased, 1.0° vs 27.6° (1) and 8.5° vs 27.2° (2), (P < 0.01), as compared to the uninvolved side. The size of the SSc and IS muscles on the involved side was significantly decreased, 2.26 cm² vs 2.79 cm² and 1.53 cm² vs 2.19 cm², respectively (P < 0.05). Furthermore, the muscle ratio (SSc/IS) at the involved side was significantly smaller compared to the uninvolved side (P = 0.007).
CONCLUSION Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.
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Affiliation(s)
- Fabian van de Bunt
- Department of Orthopedics, Amsterdam UMC, VU University Medical Center, Amsterdam 1081 HV, Netherlands
| | - Michael L Pearl
- Department of Shoulder and Elbow Surgery, Kaiser Permanente Medical Center, Los Angeles, Ca 90027, United States
| | - Tom van Essen
- Department of Orthopedics, Amsterdam UMC, VU University Medical Center, Amsterdam 1081 HV, Netherlands
| | - Johannes A van der Sluijs
- Department of Orthopedics, Amsterdam UMC, VU University Medical Center, Amsterdam 1081 HV, Netherlands
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3520
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Stapff MP. Using real world data to assess cardiovascular outcomes of two antidiabetic treatment classes. World J Diabetes 2018; 9:252-257. [PMID: 30588287 PMCID: PMC6304296 DOI: 10.4239/wjd.v9.i12.252] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/10/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the effect on cardiovascular outcomes of sodium-glucose co-transporter-2 (SGLT2) inhibitors in a real world setting by analyzing electronic medical records. METHODS We used TriNetX, a global federated research network providing statistics on electronic health records (EHR). The analytics subset contained EHR from approximately 38 Million patients in 35 Health Care Organizations in the United States. The records of 46,909 patients who had taken SGLT2 inhibitors were compared to 189,120 patients with dipeptidyl peptidase (DPP) 4 inhibitors. We identified five potential confounding factors and built respective strata: elderly, hypertension, chronic kidney disease (CKD), and co-medication with either insulin or metformin. Cardiovascular events were counted as stroke (ICD10 code: I63) or myocardial infarction (ICD10: I21) occurring within three years after the first instance of the respective medication in the patients' records. RESULTS Of the 46909 patients with SGLT2 inhibitors in their EHR, 1667 patients (3.6%) had an ICD code for stroke or for myocardial infarction within the first three years after the first instance of the medication. In the control group, there were 10680 events of 189120 patients (5.6%), which represents a risk ratio of 0.63 (95%CI: 0.60-0.66). The overall incidence of stroke or myocardial infarction in the strata with a potential confounding risk factor reached from 4.9% in patients taking metformin to 12.5% in the stratum with the highest risk (concomitant CKD). In all strata, the difference in risk of experiencing a cardiovascular event was similarly in favor of SGLT2 vs control, with Risk Ratio ranging from 0.62 to 0.81. CONCLUSION Real world data replicated the results from randomized clinical trials, confirmed the cardiovascular advantages of SGLT2 inhibitors, and showed its applicability to the US population.
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3521
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Danilova I, Medvedeva S, Shmakova S, Chereshneva M, Sarapultsev A, Sarapultsev P. Pathological changes in the cellular structures of retina and choroidea in the early stages of alloxan-induced diabetes. World J Diabetes 2018; 9:239-251. [PMID: 30588286 PMCID: PMC6304297 DOI: 10.4239/wjd.v9.i12.239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/11/2018] [Accepted: 11/03/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the temporal sequence of pathological changes in the cellular structures of retina and choroidea in the early stages of diabetes in laboratory animals.
METHODS Experimental type 1 diabetes was modeled by three intraperitoneal injections of an alloxan solution into 30 male nonlinear rats at 16 wk of age. The 30th and 60th days from the final alloxan injection were chosen as the endpoints. Light and electron microscopy and morphometric and immunohistochemical studies were performed on histological slices of eyeballs from experimental animals.
RESULTS Diabetic disturbances progressed to 60 d of the experiment. Thus, in the retina, a partial destruction of photoreceptors accompanied by interstitial edema was observed. The morphometric analysis revealed a reduction in the thickness of the retina. A reduction in the number of blood vessels of the choroid with disturbances of the endothelial cells and the vascular walls and a persistent reduction in the number of melanocytes were observed. The number of proliferating Ki-67 positive cells decreased, and the number of macrophages increased with diabetes development.
CONCLUSION The starting point in the development of destructive changes involves early reduction in the number of melanocytes of the choroidea and alterations in the retinal pigment epithelium.
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Affiliation(s)
- Irina Danilova
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Svetlana Medvedeva
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Svetlana Shmakova
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Margarita Chereshneva
- Laboratory of Immunophysiology and Immunopharmacology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Alexey Sarapultsev
- Institute of Chemical Engineering, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Immunophatophysiology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Petr Sarapultsev
- Institute of Chemical Engineering, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Immunophatophysiology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
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3522
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Chen J, Du L, Wang DR. Experience in the diagnosis and treatment of mesenteric lymphangioma in adults: A case report and review of literature. World J Gastrointest Oncol 2018; 10:522-527. [PMID: 30595806 PMCID: PMC6304307 DOI: 10.4251/wjgo.v10.i12.522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mesenteric lymphangioma (ML) in adults is a very rare disease. We report six hospitalized adult patients with ML in our hospital between January 2013 and July 2018 to investigate the characteristics and prognosis of ML in adults.
CASE SUMMARY The male-to-female ratio was 3:3, and the median age at diagnosis was 55.2 years. Clinical manifestations varied; however, most were acute cases (5/6). No history of trauma was reported. None (0/6) of the patients were accurately diagnosed with ML in the emergency and outpatient departments. Mesenteric cysts were identified in four patients (66.7%) by abdominal ultrasound and in five patients (83.3%) by computed tomography. ML was postoperatively confirmed by pathology. Most MLs (4/6) were associated with infection of other systems. ML was located in the mesentery of the small intestine (n = 4), ileum (n = 1) and rectum (n = 1). Cyst fluid was clear (n = 4), chylous (n = 1) and bloody (n = 1). Surgical procedures included complete tumor removal and partial intestinal excision (n = 6). Recurrence and adhesive intestinal obstruction were not observed during the 3-12 mo follow-up period.
CONCLUSION ML in adults is a rare benign acquired disease that can be cured by surgical treatment. Infection may be a cause of ML.
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Affiliation(s)
- Jie Chen
- Department of Gastroenterology, Northern Jiangsu Province People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Lin Du
- Department of Cardiovascular, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Dao-Rong Wang
- Department of Gastroenterology, Northern Jiangsu Province People’s Hospital, Yangzhou 225001, Jiangsu Province, China
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3523
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Su JJ, Xu K, Wang PF, Zhang HY, Chen YL. Histological analysis of human pancreatic carcinoma following irreversible electroporation in a nude mouse model. World J Gastrointest Oncol 2018; 10:476-486. [PMID: 30595801 PMCID: PMC6304300 DOI: 10.4251/wjgo.v10.i12.476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/15/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To determine changes in the morphology and function of pancreatic cancer cells after irreversible electroporation (IRE) treatment, and to explore the clinical significance of IRE treatment for pancreatic cancer providing an experimental basis for the clinical application of IRE treatment.
METHODS IRE was carried out in an athymic nude mouse model of pancreatic carcinoma generated with human pancreatic cancer cells 1. In therapy groups, IRE electrodes were inserted with 90 pulses per second at 800 V/cm applied to ablate the targeted tumor tissues. Histological assessment of the affected tissue was performed by hematoxylin and eosin staining (HE). Quantification of cell proliferation and apoptosis was performed by evaluating Ki67 and caspase-3 levels, respectively. Flow cytometry was used to assess cell apoptosis. Ultrasound imaging was carried out to evaluate IRE treatment results. Pathological correlation studies showed IRE is effective for the targeted ablation of pancreatic tumors in an orthotopic mouse model.
RESULTS IRE was efficacious in removing tumors in the orthotopic mouse model. The IRE-ablated zone displays characteristics of nude mouse models at different time-points as assessed by hematoxylin and eosin staining. Immunohistochemical analysis of samples from the pancreatic cancer models showed significantly enhanced caspase-3 cleavage and Ki67. Flow cytometry data corroborated the above findings that apoptosis in tumor cells was observed immediately on the first postoperative day, and with time the middle and late stages of apoptosis were observed. For ultrasound imaging studies, the IRE ablation zone became a hyperechoic area due to increasing inflammatory and immunologic cellular contents.
CONCLUSION IRE is a promising new approach for pancreatic cancer, with many potential advantages over conventional ablation techniques.
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Affiliation(s)
- Jun-Jun Su
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- Division of Gastroenterological Surgery, Department of Surgery, Shanxi Provincial People’s Hospital, Taiyuan 030012, Shanxi Province, China
| | - Kai Xu
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Peng-Fei Wang
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Hao-Yun Zhang
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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3524
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Velnar T, Bosnjak R. Radiosurgical techniques for the treatment of brain neoplasms: A short review. World J Methodol 2018; 8:51-58. [PMID: 30596035 PMCID: PMC6305523 DOI: 10.5662/wjm.v8.i4.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/06/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy has long been used as an adjunct to neurosurgery for the treatment of malignant and benign intracranial tumors and other intracranial lesions. Intracranial tumors can be irradiated in three different ways: I) fractional radiotherapy, II) stereotactic radiotherapy and III) stereotactic radiosurgery. The third is most often by means of a gamma knife or a specially designed linear accelerator. Additionally, radiosurgery is increasingly used in combination with systemic therapy to treat metastases.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- AMEU-ECM, Maribor 2000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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3525
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Tang WJ, Peng KY, Tang ZF, Wang YH, Xue AJ, Huang Y. MicroRNA-15a - cell division cycle 42 signaling pathway in pathogenesis of pediatric inflammatory bowel disease. World J Gastroenterol 2018; 24:5234-5245. [PMID: 30581272 PMCID: PMC6295831 DOI: 10.3748/wjg.v24.i46.5234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether cell division cycle (Cdc)42 is regulated by microRNA (miR)-15a in the development of pediatric inflammatory bowel disease (IBD).
METHODS We cultured 293T cells, used plasmids and performed dual-luciferase assay to determine whether Cdc42 is a miR-15a target gene. We cultured Caco-2 cells, and stimulated them with tumor necrosis factor (TNF)-α. We then employed lentiviruses to alter the expression of miR-15a and Cdc42. We performed quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunofluorescence to determine whether Cdc42 is regulated by miR-15a in Caco-2 cells. Finally, we collected ileocecal tissue by endoscopy from patients and performed qRT-PCR to examine the expression of miR-15a and Cdc42 in pediatric IBD patients.
RESULTS Target Scan and dual-luciferase assay revealed that Cdc42 was a miR-15a target gene. MiR-15a expression increased (P = 0.0038) and Cdc42 expression decreased (P = 0.0013) in cells stimulated with TNF-α, and the expression of the epithelial junction proteins zona occludens (ZO)-1 (P < 0.05) and E-cadherin (P < 0.001) decreased. Cdc42 levels decreased in miR-15a-mimic cells (P < 0.001) and increased in miR-15a inhibitor cells (P < 0.05). ZO-1 and E-cadherin decreased in miR-15a-mimic cells (P < 0.001) but not in the miR-15a inhibitor + TNF-α cells. In Lv-Cdc42 + TNF-α cells, ZO-1 and E-cadherin expression increased compared to the Lv-Cdc42-NC + TNF-α (P < 0.05) or miR-15a-mimic cells (P < 0.05). Fifty-four pediatric IBD patients were included in this study, 21 in the control group, 19 in the Crohn’s disease (CD) active (AC) group, seven in the CD remission (RE) group, and seven in the ulcerative colitis (UC) group. MiR-15a increased and Cdc42 decreased in the CD AC group compared to the control group (P < 0.05). miR-15a decreased and Cdc42 increased in the CD RE group compared to the CD AC group (P < 0.05). miR-15a was positively correlated with the Pediatric Crohn’s disease Activity Index (PCDAI) (P = 0.006), while Cdc42 was negatively correlated with PCDAI (P = 0.0008). Finally, miR-15a expression negatively correlated with Cdc42 in pediatric IBD patients (P = 0.0045).
CONCLUSION MiR-15a negatively regulates epithelial junctions through Cdc42 in Caco-2 cells and pediatric IBD patients.
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Affiliation(s)
- Wen-Juan Tang
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Kai-Yue Peng
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Zi-Fei Tang
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Yu-Huan Wang
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Ai-Juan Xue
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Ying Huang
- Department of Gastroenterology, Children’s Hospital of Fudan University, Shanghai 201102, China
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3526
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Yu J, Zhou CJ, Wang P, Wei SJ, He JS, Tang J. Endoscopic titanium clip closure of gastric fistula after splenectomy: A case report. World J Clin Cases 2018; 6:1047-1052. [PMID: 30568962 PMCID: PMC6288501 DOI: 10.12998/wjcc.v6.i15.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient’s general condition improved significantly, and he had no post-procedural abdominal complications. On post-clipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.
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Affiliation(s)
- Jing Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Cheng-Ji Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Pan Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Shou-Jiang Wei
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin-Song He
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin Tang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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3527
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Anami S, Minamiguchi H, Shibata N, Koyama T, Sato H, Ikoma A, Nakai M, Yamagami T, Sonomura T. Successful endovascular treatment of endoscopically unmanageable hemorrhage from a duodenal ulcer fed by a renal artery: A case report. World J Clin Cases 2018; 6:1012-1017. [PMID: 30568956 PMCID: PMC6288507 DOI: 10.12998/wjcc.v6.i15.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
A 52-year-old woman was admitted with hypovolemic shock. Emergency endoscopy revealed three hemorrhagic duodenal ulcers (all stage A1) with exposed vessels. Two ulcers were successfully treated by endoscopic clipping; however, the remaining ulcer on the posterior wall of the horizontal portion of the duodenum could not be clipped. Because her vital signs were rapidly worsening, we performed transcatheter arterial embolization (TAE) as it is less invasive than surgery. Computed tomography aortography showed that the duodenal hemorrhage was sourced from the lower branch of the right renal artery. In general, the duodenum is fed by branches from the gastroduodenal artery or superior mesenteric artery. However, this patient had three right renal arteries. The lower branch of the right renal artery at the L3 vertebral level was at the same level as the horizontal portion of the duodenum. Complete hemostasis was achieved by TAE using metallic coils and n-butyl-2-cyanoacrylate. After TAE, she recovered from the hypovolemic shock and was discharged from hospital. She has had no recurrence of the hemorrhagic duodenal ulcer for over 1 yr, and follow-up endoscopy showed no necrosis or stricture of the duodenum. Although she developed a small infarct of her right kidney, her renal function was satisfactory. In summary, the present case is the first reported case of hemorrhagic duodenal ulcer in which the culprit vessel was a renal artery that was successfully treated by TAE. Computed tomography aortography before TAE provides valuable information regarding the source of a duodenal hemorrhage.
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Affiliation(s)
- Shimpei Anami
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
- Department of Radiology, Kochi Medical School Kochi University, Nankokushi, Kochi 783-8505, Japan
| | - Naoaki Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Takao Koyama
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi Medical School Kochi University, Nankokushi, Kochi 783-8505, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayamashi, Wakayama 641-8510, Japan
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3528
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Zhang MY, Tian BL. Pancreatic panniculitis and solid pseudopapillary tumor of the pancreas: A case report. World J Clin Cases 2018; 6:1036-1041. [PMID: 30568960 PMCID: PMC6288509 DOI: 10.12998/wjcc.v6.i15.1036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Solid pseudopapillary tumor of the pancreas (SPTP), also known as solid and papillary epithelial neoplasm of the pancreas, is a rare pancreatic exocrine tumor that is difficult to diagnose before surgery. Pancreatic panniculitis is a rare type that occurs in less than 3% of all patients with pancreatic diseases. We here report a 19-year-old woman who presented with persistent left upper quadrant pain without obvious cause for 1 d. The patient also developed subcutaneous nodules involving lower abdomen bilaterally and lower limbs, and subcutaneous nodules were pathologically diagnosed as pancreatic panniculitis. Plain abdominal computed tomography revealed a soft-tissue mass in the body and tail of the pancreas, which was closely associated with the gastric wall. Contrast-enhanced ultrasound showed inhomogeneous echogenicity in the anterior pancreatic body, which had blurred parenchymal demarcation of the body and tail of the pancreas. Contrast-enhanced abdominal computed tomography revealed a mixed density mass with solid and cystic components in the body and tail of the pancreas, and the solid component was markedly enhanced. The lesion was pathologically diagnosed as SPTP after laparoscopic resection. Clinicians should be aware of the clinical manifestation, diagnosis, and treatment of pancreatic panniculitis and SPTP.
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Affiliation(s)
- Meng-Yu Zhang
- Department of Pancreatic Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Hepatobiliary Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Bo-Le Tian
- Department of Pancreatic Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
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3529
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Luo XG, Wang J, Wang WL, Yu CZ. Intermittent abdominal pain accompanied by defecation difficulties caused by Chilaiditi syndrome: A case report. World J Clin Cases 2018; 6:1042-1046. [PMID: 30568961 PMCID: PMC6288512 DOI: 10.12998/wjcc.v6.i15.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
We report a case of intermittent lower abdominal pain and distension accompanied by defecation difficulties for 3 years due to Chilaiditi syndrome in a 59-year-old male. Before admission to our hospital, the patient had undergone gastroscopy, which showed gastritis and duodenitis, and colonoscopy, which showed cecum deformation and cicatricial changes of the mucous membrane in the colon hepatic flexure. A computed tomography (CT) scan of the abdomen at our hospital confirmed right hepatic atrophy and interposition of the colon. Moreover, CT simulation endoscopy identified cystic dilatation in the colon hepatic flexure with the widest diameter of 8.2 cm. The patient was diagnosed with Chilaiditi syndrome. As the patient was unable to endure his defecation difficulties, he underwent a laparoscope-assisted right hemicolectomy. The patient had a good recovery. During the follow-up period of 9 mo, the patient remained symptom-free.
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Affiliation(s)
- Xia-Gang Luo
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Wang
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Wu-Lin Wang
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Chun-Zhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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3530
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Zhang WG, Xu LB, Xiang YN, Duan CH. Plexiform fibromyxoma of the small bowel: A case report. World J Clin Cases 2018; 6:1067-1072. [PMID: 30568965 PMCID: PMC6288503 DOI: 10.12998/wjcc.v6.i15.1067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Plexiform fibromyxoma is a rare, special type of mesenchymal tumor. The most common presenting symptoms are anemia, hematemesis, and hematochezia, without sex or age predilection. The reported cases have mainly occurred in the gastric antrum and pylorus region, with some cases in the duodenum.
CASE SUMMARY We report here a case of plexiform fibromyxoma in the upper segment of the jejunum, which was continuously followed up for 3 years after surgical removal. Plexiform fibromyxoma showed multinodular or plexiform growth. The cells in the tumor node were spindle-shaped but few in number and mitotic figures. Small blood vessels and mucous matrix were found among the tumor cells. Immunohistochemistry revealed that the plexiform fibromyxoma cells were positive for smooth muscle actin, focally positive for CD10, and negative for cytokeratin, CD117, DOG-1 (discovered on GIST-1) desmin, S-100, epithelial membrane antigen, and CD34. Ki-67 labeling index was < 5%. Plexiform fibromyxoma showed benign biological behavior. After 3 years of consecutive postoperative follow-up, no obvious signs of metastasis or recurrence were found by imaging examination.
CONCLUSION Plexiform fibromyxoma is a rare type of mesenchymal tumor. The diagnosis mainly depends on pathological examination, and it should be distinguished from other gastrointestinal mesenchymal tumors.
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Affiliation(s)
- Wei-Guang Zhang
- Department of Endoscopy, the Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Liang-Bi Xu
- Department of Endoscopy, the Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Yi-Ning Xiang
- Department of Pathology, the Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Chen-Hong Duan
- Department of Endoscopy, the Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
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3531
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Song BG, Sinn DH, Chi S, Kim K, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW. Additional role of liver stiffness measurement in stratifying residual hepatocellular carcinoma risk predicted by serum biomarkers in chronic hepatitis B patients under antiviral therapy. Eur J Gastroenterol Hepatol 2018; 30:1447-52. [PMID: 30063482 DOI: 10.1097/MEG.0000000000001226] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 06/29/2023]
Abstract
BACKGROUND The risk of hepatocellular carcinoma (HCC) remains among patients who are treated with antiviral therapy (AVT). The degree of liver fibrosis has been suggested as an important biomarker to stratify the risk of developing HCC. We tested whether liver stiffness (LS) measured using transient elastography is useful over two noninvasive serum biomarkers of fibrosis [the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4)]. PATIENTS AND METHODS A retrospective cohort of 1014 CHB patients who were under AVT with nucleos(t)ide analogs for at least a year was analyzed. The risk of HCC development according to serum biomarkers (APRI and FIB-4) and LS was compared. RESULTS The HCC risk was higher for those with a higher degree of liver fibrosis, as estimated by the LS, APRI, and FIB-4. When the two serum biomarkers were used to group the patients, the 3-year HCC incidence rates were 7.3, 3.0, and 1.3% for both high APRI (≥0.5) and FIB-4 (≥1.45) scores, either a high APRI or FIB-4 score, and both low APRI and FIB-4 scores, respectively (P<0.001). Among the 758 patients with discordant or both low APRI and FIB-4 scores, the LS value was high (>6) for a significant proportion of the patients (39.9%). The HCC risk was significantly different according to the LS value (3-year HCC incidence rate of 1.1, 2.0, and 6.8% for LS <6, 6-9, and >9, respectively, P<0.001). CONCLUSION Among CHB patients under AVT, LS could stratify risk for HCC, including patients with discordant or both low APRI and FIB-4 score. This finding indicates that LS measurement plays an additional role over the serum biomarkers in stratifying the residual risk of HCC.
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3532
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Youn JK, Park T, Kim SH, Han JW, Jang HJ, Oh C, Moon JS, Choi YH, Park KW, Jung SE, Kim HY. Prospective evaluation of clinical outcomes and quality of life after gastric tube interposition as esophageal reconstruction in children. Medicine (Baltimore) 2018; 97:e13801. [PMID: 30593168 PMCID: PMC6314723 DOI: 10.1097/md.0000000000013801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/30/2018] [Indexed: 02/05/2023] Open
Abstract
Few studies on gastric tube interposition for esophageal reconstruction in children have assessed the long-term outcomes and quality of life (QoL). The aim of this study is to evaluate the long-term outcomes and QoL after a gastric tube interposition by reviewing our experiences with esophageal reconstruction.Twenty-six patients were included who underwent gastric tube interposition from 1996 to 2011 at our institution. We reviewed the medical records and conducted telephone surveys, prospectively performed esophagography, endoscopy, 24-hour pH monitoring, and esophageal manometry. The median follow-up period of 12 (range, 3-18) years.Median age at the time of surgery and survey were 9 (range, 2-50) months and 12.4 (range, 3.1-19.0) years, respectively. There were 14 cases of reoperation of gross type C and B esophageal atresia (EA) and 10 cases of long gap pure EA. The z scores of anthropometric data at the survey did not increase after the operation. Severe stricture in esophagography was observed in 20% of patients, but improved with balloon dilation with intact passage. Gastroesophageal reflux was able to be treated with medications. Esophageal peristalsis was observed in 1 of 8 patients in manometry. No Barrett esophagus or metaplasia was not found from endoscopy. QoL was similar to the general population and did not differ between age groups.Gastric tube interposition could be considered for esophageal reconstruction in pediatric patients when native esophageal anastomosis is impossible. Nutritional evaluation and support with consecutive radiological evaluation to assess the anastomosis site stricture are advised.
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Affiliation(s)
- Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon
| | - Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Yangsan Hospital, Yangsan
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | - Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University, Dongsan Medical Center, Daegu
| | - Chaeyoun Oh
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul
| | | | - Young Hun Choi
- Department of Radiology, Seoul National University Children's Hospital
| | - Kwi-Won Park
- Department of Surgery, Chung-Ang University Hospital
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
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3533
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Muengtaweepongsa S, Tantibundhit C. Microembolic signal detection by transcranial Doppler: Old method with a new indication. World J Methodol 2018; 8:40-43. [PMID: 30519538 PMCID: PMC6275557 DOI: 10.5662/wjm.v8.i3.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Transcranial Doppler (TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke (or stroke with undetermined etiology), and patent foramen ovale (PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.
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Affiliation(s)
- Sombat Muengtaweepongsa
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Charturong Tantibundhit
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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3534
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Popescu FD, Vieru M. Precision medicine allergy immunoassay methods for assessing immunoglobulin E sensitization to aeroallergen molecules. World J Methodol 2018; 8:17-36. [PMID: 30519536 PMCID: PMC6275558 DOI: 10.5662/wjm.v8.i3.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/17/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Molecular-based allergy diagnosis for the in vitro assessment of a patient immunoglobulin E (IgE) sensitization profile at the molecular level uses allergen molecules (also referred to as allergen components), which may be well-defined, highly purified, natural allergen components or recombinant allergens. Modern immunoassay methods used for the detection of specific IgE against aeroallergen components are either singleplex (such as the fluorescence enzyme immunoassay with capsulated cellulose polymer solid-phase coupled allergens, the enzyme-enhanced chemiluminescence immunoassay and the reversed enzyme allergosorbent test, with liquid-phase allergens), multiparameter (such as the line blot immunoassay for defined partial allergen diagnostics with allergen components coating membrane strips) or multiplex (such as the microarray-based immunoassay on immuno solid-phase allergen chip, and the two new multiplex nanotechnology-based immunoassays: the patient-friendly allergen nano-bead array, and the macroarray nanotechnology-based immunoassay used as a molecular allergy explorer). The precision medicine diagnostic work-up may be organized as an integrated “U-shape” approach, with a “top-down” approach (from symptoms to molecules) and a “bottom-up” approach (from molecules to clinical implications), as needed in selected patients. The comprehensive and accurate IgE sensitization molecular profiling, with identification of the relevant allergens, is indicated within the framework of a detailed patient’s clinical history to distinguish genuine IgE sensitization from sensitization due to cross-reactivity (especially in polysensitized patients), to assess unclear symptoms and unsatisfactory response to treatment, to reveal unexpected sensitizations, and to improve assessment of severity and risk aspects in some patients. Practical approaches, such as anamnesis molecular thinking, laboratory molecular thinking and postmolecular anamnesis, are sometimes applied. The component-resolved diagnosis of the specific IgE repertoire has a key impact on optimal decisions making for prophylactic and specific immunotherapeutic strategies tailored for the individual patient.
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Affiliation(s)
- Florin-Dan Popescu
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
| | - Mariana Vieru
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
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3535
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Verma M, Dahiya K, Ghalaut VS, Dhupper V. Assessment of quality control system by sigma metrics and quality goal index ratio: A roadmap towards preparation for NABL. World J Methodol 2018; 8:44-50. [PMID: 30519539 PMCID: PMC6275555 DOI: 10.5662/wjm.v8.i3.44] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/04/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023] Open
Abstract
AIM To study sigma metrics and quality goal index ratio (QGI).
METHODS The retrospective study was conducted at the Clinical Biochemistry Laboratory, PGIMS, Rohtak, which recently became a National Accreditation Board for Testing and Calibration of Laboratories accredited lab as per the International Organization for Standardization 15189:2012 and provides service to a > 1700-bed tertiary care hospital. Data of 16 analytes was extracted over a period of one year from January 2017 to December 2017 for calculation of precision, accuracy, sigma metrics, total error, and QGI.
RESULTS The average coefficient of variation ranged from 2.12% (albumin) to 5.42% (creatinine) for level 2 internal quality control and 2% (albumin) to 3.62% (high density lipoprotein-cholesterol) for level 3 internal quality control. Average coefficient of variation of all the parameters was below 5%, reflecting very good precision. The sigma metrics for level 2 indicated that 11 (68.5%) of the 16 parameters fall short of meeting Six Sigma quality performance. Of these, five failed to meet minimum sigma quality performance with metrics less than 3, and another six just met minimal acceptable performance with sigma metrics between 3 and 6. For level 3, the data collected indicated eight (50%) of the parameters did not achieve Six Sigma quality performance, out of which three had metrics less than 3, and five had metrics between 3 and 6. QGI ratio indicated that the main problem was inaccuracy in the case of total cholesterol, aspartate transaminase, and alanine transaminase (QGI > 1.2), imprecision in the case of urea (QGI < 0.8), and both imprecision and inaccuracy for glucose.
CONCLUSION On the basis of sigma metrics and QGI, it may be concluded that the Clinical Biochemistry Laboratory, PGIMS, Rohtak was able to achieve satisfactory results with world class performance for many analytes one year preceding the accreditation by the National Accreditation Board for Testing and Calibration of Laboratories. Aspartate transaminase and alanine transaminase required strict external quality assurance scheme monitoring and modification in quality control procedure as their QGI ratio showed inaccuracy.
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Affiliation(s)
- Monica Verma
- Department of Biochemistry, Pt. B.D. Sharma, University of Health Sciences, Rohtak 124001, Haryana, India
| | - Kiran Dahiya
- Department of Biochemistry, Pt. B.D. Sharma, University of Health Sciences, Rohtak 124001, Haryana, India
| | - Veena Singh Ghalaut
- Department of Biochemistry, Pt. B.D. Sharma, University of Health Sciences, Rohtak 124001, Haryana, India
| | - Vasudha Dhupper
- Department of Biochemistry, Pt. B.D. Sharma, University of Health Sciences, Rohtak 124001, Haryana, India
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3536
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Zhang YY, Zhang CX, Li Y, Jiang X, Wang YF, Sun Y, Wang J, Ji WY, Liu Y. Development of a novel rat model of heterogeneous hepatic injury by injection with colchicine via the splenic vein. World J Gastroenterol 2018; 24:5005-5012. [PMID: 30510375 PMCID: PMC6262251 DOI: 10.3748/wjg.v24.i44.5005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/20/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023] [Imported: 06/24/2023] Open
Abstract
AIM To develop a novel rat model of heterogeneous hepatic injury.
METHODS Seventy male Sprague-Dawley rats were randomly divided into a control group (n = 10) and a colchicine group (n = 60). A 0.25% colchicine solution (0.4 mL/kg) was injected via the splenic vein in the colchicine group to develop a rat model of heterogeneous hepatic injury. An equal volume of normal saline was injected via the splenic vein in the control group. At days 3, 7, and 14 and weeks 4, 8, and 12 after the operation, at least seven rats of the colchicine group were selected randomly for magnetic resonance imaging (MRI) examinations, and then they were euthanized. Ten rats of the control group underwent MRI examinations at the same time points, and then were euthanized at week 12. T2-weighted images (T2WI) and diffusion weighted imaging (DWI) were used to evaluate the heterogeneous hepatic injury. The heterogeneous injury between the left and right hepatic lobes was assessed on liver sections according to the histological scoring criteria, and correlated with the results of MRI study.
RESULTS Obvious pathological changes occurred in the hepatic parenchyma in the colchicine group. Hepatic injury scores were significantly different between the left and right lobes at each time point (P < 0.05). There was a significant difference in apparent diffusion coefficient (ADC) of DWI and liver-to-muscle ratio (LMR) of T2WI between the left and right lobes of rats in the colchicine group (P < 0.05) at each time point, and similar results were observed between the colchicine and control groups. Besides, there was a significant correlation between hepatic injury scores and ADC values or LMR (r = -0.682, P = 0.000; r = -0.245, P = 0.018).
CONCLUSION Injection with colchicine via the splenic vein can be used to successfully develop a rat model of heterogeneous hepatic injury. DWI and T2WI may help evaluate the heterogeneous injury among liver lobes.
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Affiliation(s)
- Yan-Yan Zhang
- Medical Imaging Center, The Affiliated Hospital of Liaoning Traditional Chinese Medical University, Shenyang 110032, Liaoning Province, China
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Chao-Xu Zhang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yu Li
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xuan Jiang
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yong-Fang Wang
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yang Sun
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jun Wang
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wan-Ying Ji
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yi Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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3537
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Abstract
Globally, over 300 million people are living with viral hepatitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to eliminate hepatitis by 2030. Different World Health Organization member countries are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets. The aim of the study was to give an update about the progress and challenges to achieving hepatitis elimination by 2030. According to the latest data, 87% of infants had received the three doses of hepatitis B virus (HBV) vaccination in the first year of their life and 46% of infants had received a timely birth dose of HBV vaccination. There is a strong need to improve blood and injection safety. Rates of hepatitis B and C diagnosis are very low and only 11% of hepatitis B and C cases are diagnosed. There is a dire need to speed up hepatitis diagnosis and find the missing millions of people living with viral hepatitis. Up to 2016, only 3 million hepatitis C cases have been treated. Pricing of hepatitis C virus drugs is also reduced in many countries. The major hurdle to achieve hepatitis elimination is lack of finances to support hepatitis programs. None of the major global donors are committed to invest in the fight against hepatitis. It will be very difficult for the low and middle-income countries to fund their hepatitis control program. Hepatitis elimination needs strong financial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe.
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Affiliation(s)
- Yasir Waheed
- Multidisciplinary Laboratory, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
| | - Masood Siddiq
- Department of Medicine, Jinnah Memorial Hospital, 2-Civil Lines, Rawalpindi 46000, Pakistan
| | - Zubia Jamil
- Department of Medicine, Fauji Foundation Hospital, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
| | - Muzammil Hasan Najmi
- Department of Pharmacology and Therapeutics, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
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3538
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Akbulut S, Yilmaz M, Alan S, Kolu M, Karadag N. Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature. World J Gastrointest Surg 2018; 10:90-94. [PMID: 30510634 PMCID: PMC6259024 DOI: 10.4240/wjgs.v10.i8.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/17/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 244280, Turkey
| | - Mehmet Yilmaz
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 244280, Turkey
| | - Saadet Alan
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 244280, Turkey
| | - Mehmet Kolu
- Department of Radiology, Inonu University Faculty of Medicine, Malatya 244280, Turkey
| | - Nese Karadag
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 244280, Turkey
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3539
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Assih M, Ouattara AK, Diarra B, Yonli AT, Compaore TR, Obiri-Yeboah D, Djigma FW, Karou S, Simpore J. Genetic diversity of hepatitis viruses in West-African countries from 1996 to 2018. World J Hepatol 2018; 10:807-821. [PMID: 30533182 PMCID: PMC6280160 DOI: 10.4254/wjh.v10.i11.807] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
The severity of hepatic pathology and the response to treatment depend on the hepatitis virus genotype in the infected host. The objective of this review was to determine the distribution of hepatitis virus genotypes in West African countries. A systematic review of the literature in PubMed, Google Scholar and Science Direct was performed to identify 52 relevant articles reporting hepatitis A, B, C, D, E and G viruses genotypes. Hepatitis B virus (HBV) genotype E with a prevalence of 90.6% (95%CI: 0.891-0.920) found in this review, is characterized by low genetic diversity. Hepatitis C virus (HCV) genotypes 1 and 2 represented 96.4% of HCV infections in West African countries, while hepatitis delta virus, hepatitis A virus, hepatitis G virus genotypes 1 and HEV genotype 3 were reported in some studies in Ghana and Nigeria. HBV genotype E is characterized by high prevalence, low genetic diversity and wide geographical distribution. Further studies on the clinical implications of HBV genotype E and HCV genotypes 1 and 2 are needed for the development of an effective treatment against this viral hepatitis in West African countries. Surveillance of the distribution of different genotypes is also needed to reduce recombination rates and prevent the emergence of more virulent viral strains.
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Affiliation(s)
- Maléki Assih
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Abdoul Karim Ouattara
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Birama Diarra
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Albert Theophane Yonli
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Tegwindé Rebeca Compaore
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast 00233, Ghana
| | - Florencia Wendkuuni Djigma
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Simplice Karou
- Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA-UL), Universite de Lome, Lome 00229, Togo
| | - Jacques Simpore
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
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3540
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Gougelet A. Exosomal microRNAs as a potential therapeutic strategy in hepatocellular carcinoma. World J Hepatol 2018; 10:785-789. [PMID: 30533178 PMCID: PMC6280159 DOI: 10.4254/wjh.v10.i11.785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second cause of cancer-related death worldwide. The incidence of HCC is constantly increasing in correlation with the rise in diabetes and obesity, arguing for an urgent need for new developments in the treatment of this lethal cancer. Exosomes are small double-membrane vesicles loaded with distinct cargos, particularly small non-coding RNAs called microRNAs, representative of each donor cell and secreted to affect the features of neighboring cells or recipient cells located further away, like in the case of metastasis. A better understanding of the role of exosomes with a microRNA signature in cancer pathogenesis gave rise to the concept of their use as a non-invasive diagnostic biomarker and in the treatment of cancer, including HCC. In this communication, we review recent works that demonstrate that hepatic stellate cells establish an epigenetic communication with liver cancer cells, which affects their pro-malignant features. If naturally secreted patient-derived exosomes show major limitations concerning their clinical use, bio-engineered exosome mimetics that incorporate controlled components and exhibit no protumoral properties could be promising carriers for the treatment of liver cancers, which is the organ preferentially targeted by systemic injection of exosomes.
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Affiliation(s)
- Angélique Gougelet
- Inserm, U1016, Institut Cochin, Paris 75014, France
- Cnrs, UMR8104, Paris 75014, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France
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3541
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Salmon D, Trimoulet P, Gilbert C, Solas C, Lafourcade E, Chas J, Piroth L, Lacombe K, Katlama C, Peytavin G, Aumaitre H, Alric L, Boué F, Morlat P, Poizot-Martin I, Billaud E, Rosenthal E, Naqvi A, Miailhes P, Bani-Sadr F, Esterle L, Carrieri P, Dabis F, Sogni P, Wittkop L. Factors associated with DAA virological treatment failure and resistance-associated substitutions description in HIV/HCV coinfected patients. World J Hepatol 2018; 10:856-866. [PMID: 30533186 PMCID: PMC6280155 DOI: 10.4254/wjh.v10.i11.856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To describe factors associated with treatment failure and frequency of resistance-associated substitutions (RAS).
METHODS Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients starting a first direct-acting antiviral (DAA) regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defined as: (1) non-response [HCV-RNA remained detectable during treatment, at end of treatment (EOT)]; and (2) relapse (HCV-RNA suppressed at EOT but detectable thereafter). Sequencing analysis was performed to describe prevalence of drug class-specific RAS. Factors associated with failure were determined using logistic regression models.
RESULTS Among 559 patients, 77% had suppressed plasma HIV-RNA < 50 copies/mL at DAA treatment initiation, 41% were cirrhotic, and 68% were HCV treatment-experienced. Virological treatment failures occurred in 22 patients and were mainly relapses (17, 77%) then undefined failures (3, 14%) and non-responses (2, 9%). Mean treatment duration was 16 wk overall. Post-treatment NS3, NS5A or NS5B RAS were detected in 10/14 patients with samples available for sequencing analysis. After adjustment for age, sex, ribavirin use, HCV genotype and treatment duration, low platelet count was the only factor significantly associated with a higher risk of failure (OR: 6.5; 95%CI: 1.8-22.6).
CONCLUSION Only 3.9% HIV-HCV coinfected patients failed DAA regimens and RAS were found in 70% of those failing. Low platelet count was independently associated with virological failure.
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Affiliation(s)
- Dominique Salmon
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Hôtel Dieu, Unité des Maladies infectieuses et tropicales, Paris 75004, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France
| | - Pascale Trimoulet
- CHU de Bordeaux, Hôpital Pellegrin, Laboratoire de Virologie, Bordeaux 33000, France
- CNRS-UMR 5234, Microbiologie fondamentale et Pathogénicité, Université de Bordeaux, Bordeaux 3000, France
| | - Camille Gilbert
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
| | - Caroline Solas
- APHM, Hôpital La Timone, Laboratoire de Pharmacocinétique et Toxicologie, Marseille 13005, France
| | - Eva Lafourcade
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
| | - Julie Chas
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service Maladies infectieuses et tropicales, Paris 75020, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d’Infectiologie, Dijon cedex 21079, France
- INSERM-CIC 1342 Université de Bourgogne, Dijon 21000, France
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, GHUEP site Saint-Antoine, Services Maladies infectieuses et tropicales, Paris 75011, France
- Université Pierre et Marie Curie, UMR S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris 75646, France
| | - Christine Katlama
- Université Paris-Sorbonne, Paris 75005, France
- Assistance Publique des Hôpitaux de Paris Hôpital Pitié Salpêtrière, Services Maladies infectieuses et tropicales, Paris 75013, France
| | - Gilles Peytavin
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmacologie, Paris 75877, France
- IAME, UMR 1137, Sorbonne Paris Cité, INSERM, Université Paris Diderot, Paris 75890, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service Maladies infectieuses et tropicales, Perpignan 66000, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service Médecine interne-Pôle Digestif, Toulouse 31300, France
- UMR 152 IRD Université Toulouse III, Paul Sabatier, Toulouse 31330, France
| | - François Boué
- Hôpital Antoine-Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Service Médecine interne et immunologie, Clamart 92140, France
| | - Philippe Morlat
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
- Centre Hospitalier Universitaire de Bordeaux, Service de médecine interne, Hôpital Saint-André, Bordeaux 33000, France
| | - Isabelle Poizot-Martin
- Aix-Marseille Univ, APHM Sainte-Marguerite, Service d’Immuno-hématologie clinique, Marseille 13274, France
- Sciences Economiques and Sociales de la Santéand Traitement de l’Information Médicale, UMR912 INSERM, Aix-Marseille Université, IRD, Marseille 13009, France
| | - Eric Billaud
- Department of Infectious Diseases, CHU de Nantes and CIC 1413, Inserm, Nantes 44000, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne, Hôpital l’Archet, Nice 06202, France
- Université de Nice-Sophia Antipolis, Nice 06100, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d’Infectiologie, Hôpital l’Archet, Nice 06100, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon 69004, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Reims 51100, France
- Faculté de Médecine EA-4684/SFR CAP-SANTE, Université de Reims, Champagne-Ardenne, Reims 51100, France
| | - Laure Esterle
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
| | - Patrizia Carrieri
- Sciences Economiques and Sociales de la Santéand Traitement de l’Information Médicale, UMR912 INSERM, Aix-Marseille Université, IRD, Marseille 13009, France
| | - François Dabis
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
| | - Philippe Sogni
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d’Hépatologie, Paris 75014, France
- Inserm U-1223 - Institut Pasteur, Paris 75015, France
| | - Linda Wittkop
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux F-33000, France
- CHU de Bordeaux, Pôle de santé Publique, Service dâinformation médicale, Bordeaux F-33000, France
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3542
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Dumitrascu T, Eftimie M, Aiordachioae A, Stroescu C, Dima S, Ionescu M, Popescu I. Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy. World J Gastrointest Surg 2018; 10:84-89. [PMID: 30510633 PMCID: PMC6259023 DOI: 10.4240/wjgs.v10.i8.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/24/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023] [Imported: 06/24/2023] Open
Abstract
AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy (SPDP). No previous studies explored potential predictors of morbidity after SPDP.
METHODS The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni- and multivariate analyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo.
RESULTS Overall morbidity rate was 34.1% (14 patients): grade I (6 patients, 14.6%), grade II (2 patients, 4.8%), grade IIIa (1 patient, 2.4%), and grade IIIb (5 patients, 12.2%). A number of 5 patients (12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients (19.5%). Univariate analysis identified male gender (P = 0.034), increased body mass index (P = 0.002) and neuroendocrine pathology (P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio (OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index (OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP.
CONCLUSION Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.
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Affiliation(s)
- Traian Dumitrascu
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Mihai Eftimie
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Andra Aiordachioae
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cezar Stroescu
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Simona Dima
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Mihnea Ionescu
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Irinel Popescu
- Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest 022328, Romania
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3543
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Cruz HM, Barbosa JR, Baima Colares JK, de Moraes Neto AHA, Alencar MDFL, Bastos FI, da Mota JC, Carvalho-Costa FA, Ivantes CAP, Lewis-Ximenez LL, Villar LM. Cross-sectional study to determine viral hepatitis knowledge in different urban populations in Brazil. World J Hepatol 2018; 10:867-876. [PMID: 30533187 PMCID: PMC6280162 DOI: 10.4254/wjh.v10.i11.867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/22/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate viral hepatitis knowledge among individuals from different resource areas and health conditions to identify possible gaps.
METHODS A cross-sectional, descriptive study was carried out among 447 individuals from five distinct populations in Brazil: Southeast Viral Hepatitis Ambulatory (n = 100), South (n = 89) and Northeast (n = 114) Health Center, Southeast (n = 77) and Northeast (n = 67) low resource areas. All individuals answered a questionnaire assessing sociodemographic characteristics and viral hepatitis awareness. The perception was scored based on the average number of correct answers of all participants and categorized as “low” (0-28 correct answers) or “desirable” (29-46 correct answers). Associations between sociodemographic characteristics and perception were also evaluated.
RESULTS A low level of knowledge was observed in individuals from Northeast Health Center, Northeast and Southeast low resource areas while desirable knowledge was observed in individuals from Viral Hepatitis Ambulatory and South Health Center. According to sociodemographic characteristics, desirable scores were more common among those with secondary education (47.1%), those who declared themselves as white (46.3%), and those who lived in houses with three individuals (25.5%). Multivariate analysis showed an association between viral hepatitis perception and type of population.
CONCLUSION The results demonstrated high level of knowledge among study participants from health clinics from the Southeast region of Brazil and the importance of education programs in increasing the level of knowledge in low resource areas.
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Affiliation(s)
- Helena Medina Cruz
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040360, Brazil
| | - Jakeline Ribeiro Barbosa
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040360, Brazil
- Postgraduate Program in Pathology, Federal University of Ceará, Fortaleza, Ceará 60020181, Brazil
| | - Jeová Keny Baima Colares
- Postgraduate Program in Pathology, Federal University of Ceará, Fortaleza, Ceará 60020181, Brazil
- Postgraduate Program in Medical Sciences, University of Fortaleza, Ceará 60430160, Brazil
| | | | - Maria de Fátima Leal Alencar
- Laboratory of Innovations in Therapies, Teaching and Bioproducts, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040360, Brazil
| | - Francisco Inácio Bastos
- Institute of Communication and Scientific Information and Technology for Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Jurema Corrêa da Mota
- Institute of Communication and Scientific Information and Technology for Health, Oswaldo Cruz Foundation, Rio de Janeiro 21040900, Brazil
| | - Filipe Aníbal Carvalho-Costa
- Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040900, Brazil
| | | | - Lia Laura Lewis-Ximenez
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040360, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040360, Brazil
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3544
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Grandhe S, Lee JA, Chandra A, Marsh C, Frenette CT. Trapped vessel of abdominal pain with hepatomegaly: A case report. World J Hepatol 2018; 10:887-891. [PMID: 30533189 PMCID: PMC6280163 DOI: 10.4254/wjh.v10.i11.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Abdominal pain with elevated transaminases from inferior vena cava (IVC) obstruction is a relatively common reason for referral and further workup by a hepatologist. The differential for the cause of IVC obstruction is extensive, and the most common etiologies include clotting disorders or recent trauma. In some situations the common etiologies have been ruled out, and the underlying process for the patient’s symptoms is still not explained. We present one unique case of abdominal pain and hepatomegaly secondary to IVC constriction from extrinsic compression of the diaphragm. Based on this patient’s presentation, we urge that physicians be cognizant of the IVC diameter and consider extrinsic compression as a contributor to the patient’s symptoms. If IVC compression from the diaphragm is confirmed, early referral to vascular surgery is strongly advised for further surgical intervention.
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Affiliation(s)
- Sirisha Grandhe
- Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, CA 95817, United States
| | - Joy A Lee
- Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Ankur Chandra
- Department of Vascular Surgery, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Christopher Marsh
- Scripps Center for Organ Transplant, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Catherine T Frenette
- Scripps Center for Organ Transplant, Scripps Green Hospital, La Jolla, CA 92037, United States
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3545
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Sobotka LA, Hinton A, Conteh LF. African Americans are less likely to receive curative treatment for hepatocellular carcinoma. World J Hepatol 2018; 10:849-855. [PMID: 30533185 PMCID: PMC6280157 DOI: 10.4254/wjh.v10.i11.849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma (HCC).
METHODS A retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.
RESULTS A total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant (OR: 2.66, 95%CI: 1.92-3.68), resection (OR: 1.82, 95%CI: 1.48-2.23), and ablation (OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant (OR: 2.18, 95%CI: 1.40-3.39) and ablation (OR: 1.46, 95%CI: 1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant (OR: 2.41, 95%CI: 1.62-3.61), resection (OR: 1.79 95%CI: 1.39-2.32), and ablation (OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.
CONCLUSION Racial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.
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Affiliation(s)
- Lindsay A Sobotka
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, OH 43210, United States
| | - Lanla F Conteh
- Department of Gastroenterology and Hepatology, The Ohio State Wexner Medical Center, Columbus, OH 43210, United States
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3546
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Radpour R, Forouharkhou F. Single-cell analysis of tumors: Creating new value for molecular biomarker discovery of cancer stem cells and tumor-infiltrating immune cells. World J Stem Cells 2018; 10:160-171. [PMID: 30631391 PMCID: PMC6325074 DOI: 10.4252/wjsc.v10.i11.160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
Biomarker-driven individualized treatment in oncology has made tremendous progress through technological developments, new therapeutic modalities and a deeper understanding of the molecular biology for tumors, cancer stem cells and tumor-infiltrating immune cells. Recent technical developments have led to the establishment of a variety of cancer-related diagnostic, prognostic and predictive biomarkers. In this regard, different modern OMICs approaches were assessed in order to categorize and classify prognostically different forms of neoplasia. Despite those technical advancements, the extent of molecular heterogeneity at the individual cell level in human tumors remains largely uncharacterized. Each tumor consists of a mixture of heterogeneous cell types. Therefore, it is important to quantify the dynamic cellular variations in order to predict clinical parameters, such as a response to treatment and or potential for disease recurrence. Recently, single-cell based methods have been developed to characterize the heterogeneity in seemingly homogenous cancer cell populations prior to and during treatment. In this review, we highlight the recent advances for single-cell analysis and discuss the challenges and prospects for molecular characterization of cancer cells, cancer stem cells and tumor-infiltrating immune cells.
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Affiliation(s)
- Ramin Radpour
- Tumor Immunology, Department for BioMedical Research (DBMR), University of Bern, Bern 3008, Switzerland
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern 3008, Switzerland
| | - Farzad Forouharkhou
- Department for Bioinformatics, Persian Bioinformatics System, Tehran 14166, Iran
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3547
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García-Compeán D, Jiménez-Rodríguez AR, Del Cueto-Aguilera ÁN, Herrera-Quiñones G, González-González JA, Maldonado-Garza HJ. Meckel’s diverticulum diagnosis by video capsule endoscopy: A case report and review of literature. World J Clin Cases 2018; 6:791-799. [PMID: 30510945 PMCID: PMC6265001 DOI: 10.12998/wjcc.v6.i14.791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] [Imported: 06/24/2023] Open
Abstract
BACKGROUND Meckel’s diverticulum (MD) occurs predominantly in children and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is difficult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy (VCE) in the diagnosis of MD is unknown, and the endoscopic patterns are not defined. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.
CASE SUMMARY We present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding (OGIB). They had a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglobin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retained in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.
CONCLUSION VCE is useful for the diagnosis of MD. However, endoscopic characteristics must be recognized in order to establish preoperative diagnosis.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
| | - Alan R Jiménez-Rodríguez
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
| | - Ángel N Del Cueto-Aguilera
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
| | - Gilberto Herrera-Quiñones
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
| | - José A González-González
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
| | - Héctor J Maldonado-Garza
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
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3548
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Abstract
Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned two-stent strategy, in terms of both short-term efficacy and safety. In left main (LM) bifurcations, double kissing (DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo 45100, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara 44124, Italy
| | - Debradata Dash
- Interventional Cardiology, Thumbay Hospital, Ajman 415555, United Arab Emirates
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3549
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Spiliopoulos S, Kitrou PM, Brountzos EN. Revisiting endovascular treatment in below-the-knee disease. Are drug-eluting stents the best option? World J Cardiol 2018; 10:196-200. [PMID: 30510636 PMCID: PMC6259030 DOI: 10.4330/wjc.v10.i11.196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/19/2018] [Accepted: 10/12/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia (CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents (DES), in short- to medium- length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations. Nonetheless, the use of this technology in every-day clinical practice remains limited mainly due to concerns regarding the deployment of a permanent metallic scaffold and the possibility of valid future therapeutic perspectives. However, in the majority of the cases, these concerns are not scientifically justified. Large-scale, multicenter randomized controlled trials, investigating a significantly larger number of patients than those already published, would provide more solid evidence and consolidate the use of infrapopliteal DES in CLI patients. Moreover, there is still little evidence on whether this technology can be as effective for longer below-the-knee lesions, where a considerable number of DES is required. The development and investigation of new, longer balloon-expanding or perhaps self-expanding DES could be the answer to this problem.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Radiology Department, Interventional Radiology Unit, University of Athens, Attikon University General Hospital, Athens 12461, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, Patras 26500, Greece
| | - Elias N Brountzos
- 2nd Radiology Department, Interventional Radiology Unit, University of Athens, Attikon University General Hospital, Athens 12461, Greece
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3550
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Fujikawa T, Ando K. Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature. World J Clin Cases 2018; 6:767-775. [PMID: 30510941 PMCID: PMC6264996 DOI: 10.12998/wjcc.v6.i14.767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/20/2018] [Accepted: 10/16/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To elucidate the effect of antithrombotic therapy (ATT) on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.
METHODS Published articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy (APT) and/or anticoagulation therapy (ACT) were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome (both bleeding and thromboembolic complications) were extracted from each study.
RESULTS Thirteen published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with perioperative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no significant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events (TE) associated with laparoscopic digestive surgery in patients receiving ATT was not significantly higher than those with no ATT or interrupted APT.
CONCLUSION Laparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not significantly higher than in patients with no ATT or interrupted APT.
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Affiliation(s)
- Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
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