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Transmission of cryptococcosis by liver transplantation:A case report and review of literature

World Journal of Hepatology 2020年第5期12卷 253-261页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge carolina de fatima couto Priscila Brizolla de Campos Gabriel Oliveira Nunes Caja department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70673900Brazil

BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(C.neoformans)species complex.These fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency virus.The fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been reported.CASE SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the procedure.The patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few days.Blood cultures were positive for C.neoformans.Liver biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous formations.Magnetic resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical regions.Treatment with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the symptoms.The recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of infection.The organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ procurement.CONCLUSION This case highlights the risk of transmission of fungal diseases,specifically of C.neoformans,through liver graft during liver transplantation.

关键词： Cryptococcosis Liver transplantation Cryptococcus neoformans Case report Immunosuppression Fungal infection

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Urban heat mitigation by green and blue infrastructure:Drivers,effectiveness,and future needs

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The Innovation 2024年第2期5卷 145-166页

作者： Prashant Kumar Sisay E.debele Soheila Khalili Christos H.Halios Jeetendra Sahani Nasrin Aghamohammadi Maria de fatima Andrade Maria Athanassiadou Kamaldeep Bhui Nerea Calvillo Shi-Jie Cao Frederic Coulon Jill L.Edmondson David Fletcher Edmilson Dias de Freitas Hai Guo Matthew C.Hort Madhusudan Katti Thomas Rodding Kjeldsen Steffen Lehmann Giuliano Maselli Locosselli Shelagh K.Malham Lidia Morawska Rajan Parajuli Christopher D.F.Rogers Runming Yao Fang Wang Jannis Wenk Laurence Jones Global Centre for Clean Air Research(GCARE) School of SustainabilityCivil and Environmental EngineeringFaculty of Engineering and Physical SciencesUniversity of SurreyGuildford GU27XHUK Institute for Sustainability University of SurreyGuildford GU27XHSurreyUK School of Built Environment University of ReadingWhiteknightsReading RG66BUUK School design and the Built Environment Curtin University Sustainability Policy InstituteKent StBentley 6102Western Australia Harry Butler Institute Murdoch UniversityMurdoch 6150Western Australia Atmospheric Sciences department Institute of AstronomyGeophysics and Atmospheric SciencesUniversity of Sao PauloSao Paulo 05508-090Brazil Met Office FitzRoy RoadExeter EX13PBUK department of Psychiatry and Nuffield department of Primary Care Health Sciences Wadham CollegeUniversity of OxfordOxfordUK Centre for Interdisciplinary Methodologies University of WarwickWarwickUK School of Architecture Southeast University2 SipailouNanjing 210096China Cranfield University School of WaterEnvironment and EnergyCranfield MK430ALUK Plants PhotosynthesisSoil ClusterSchool of BiosciencesUniversity of SheffieldSheffield S102TNUK UK Centre for Ecology&Hydrology Environment Centre WalesDeiniol RoadBangor LL572UWUK Air Quality Studies Department of Civil and Environmental EngineeringThe Hong Kong Polytechnic UniversityHong KongChina department of Forestry and Environmental Resources Faculty Excellence Program for Leadership in Public ScienceNorth Carolina State UniversityChancellorRaleighNC 27695USA departments of Architecture&Civil Engineering and Chemical EngineeringUniversity of BathBath BA27AYUK School of Architecture University of NevadaLas VegasNV 89154USA department of Tropical Ecosystems Functioning Center of Nuclear Energy in AgricultureUniversity of São PauloPiracicaba 13416-000Sao PauloBrazil School of Ocean Sciences Bangor UniversityMenai BridgeAnglesey LL595 ABUK International Laboratory for Air Quality and Health Science and Engine

The combination of urbanization and global warming leads to urban overheating and compounds the frequency and intensity of extreme heat events due to climate change.Yet,the risk of urban overheating can be mitigated by urban green-blue-grey infrastructure(GBGI),such as parks,wetlands,and engineered greening,which have the potential to effectively reduce summer air temperatures.despite many reviews,the evidence bases on quantified GBGI cooling benefits remains partial and the practical recommendations for implementation are unclear.This systematic literature review synthesizes the evidence base for heat mitigation and related co-benefits,identifies knowledge gaps,and proposes recommendations for their implementation to maximize their benefits.After screening 27,486 papers,202 were reviewed,based on 51 GBGI types categorized under 10 main divisions.Certain GBGI(green walls,parks,street trees)have been well researched for their urban cooling capabilities.However,several other GBGI have received negligible(zoological garden,golf course,estuary)or minimal(private garden,allotment)attention.The most efficient air cooling was observed in botanical gardens(5.0±3.5℃),wetlands(4.9±3.2℃),green walls(4.1±4.2℃),street trees(3.8±3.1℃),and vegetated balconies(3.8±2.7℃).Under changing climate conditions(2070–2100)with consideration of RCP8.5,there is a shift in climate subtypes,either within the same climate zone(e.g.,Dfa to Dfb and Cfb to Cfa)or across other climate zones(e.g.,Dfb[continental warm-summer humid]to BSk[dry,cold semi-arid]and Cwa[temperate]to Am[tropical]).These shifts may result in lower efficiency for the current GBGI in the future.Given the importance of multiple services,it is crucial to balance their functionality,cooling performance,and other related co-benefits when planning for the future GBGI.This global GBGI heat mitigation inventory can assist policymakers and urban planners in prioritizing effective interventions to reduce the risk of urban overheating,filling research gaps,and promoting community resi

关键词： estuary walls extreme

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Global trends in hepatitis C-related hepatocellular carcinoma mortality:A public database analysis(1999-2019)

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World Journal of Virology 2024年第1期13卷 69-83页

作者： Hassam Ali Fnu Vikash Vishali Moond fatima Khalid Abdur Rehman Jamil Dushyant Singh Dahiya Amir Humza Sohail Manesh Kumar Gangwani Pratik Patel Sanjaya K Satapathy department of Internal Medicine/Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States department of Internal Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States department of Internal Medicine Saint Peter's University Hospital/Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States department of Internal Medicine Quaid-e-Azam Medical CollegeBahawalpur 63100PunjabPakistan department of Internal Medicine Samaritan Medical CentreWatertownMA 13601United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States department of Surgery New York University Winthrop HospitalNew YorkMineloaNY 11501United States department of Internal Medicine The University of ToledoToledoOH 43606United States department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY 11777United States Division of Hepatology Department of MedicineNorth Shore University HospitalManhassetNY 11030United States

BACKGROUND Hepatitis C is the leading cause of chronic liver disease worldwide and it significantly contributes to the burden of hepatocellular carcinoma(HCC).However,there are marked variations in the incidence and mortality rates of HCC across different geographical regions.With the advent of new widely available treatment modalities,such as direct-acting antivirals,it is becoming increasingly imperative to understand the temporal and geographical trends in HCC mortality associated with Hepatitis C.Furthermore,gender disparities in HCC mortality related to Hepatitis C are a crucial,yet underexplored aspect that adds to the disease's global impact.While some studies shed light on gender-specific trends,there is a lack of comprehensive data on global and regional mortality rates,particularly those highlighting gender disparities.This gap in knowledge hinders the development of targeted interventions and resource allocation strategies.DISCUSSION The results of our study show an overall decline in the mortality rates of patients with hepatitis C-related HCC over the last two decades.Notably,females exhibited a remarkable decrease in mortality compared to males.Regionally,East Asia and the Pacific displayed a significant decline in mortality,while Europe and Central Asia witnessed an upward trend.Latin America and the Caribbean also experienced an increase in mortality rates.However,no significant difference was observed in the Middle East and North Africa.North America exhibited a notable upward trend.South Asia and Sub-Saharan Africa significantly declined throughout the study period.This raises the hope of identifying areas for implementing more targeted resources.despite some progress,multiple challenges remain in meeting the WHO 2030 goal of eliminating viral hepatitis[24].

关键词： Carcinoma Hepatocellular Antiviral agents Global Burden of Disease Quality indicators Health care Liver neoplasms Hepatitis C Chronic hepatitis C

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A grain-size correction for metal pollution indexes in river sediments

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International Journal of Sediment Research 2021年第3期36卷 362-372页

作者： Thomas Vincent Gloaguen Paula Núbia Soares Dalto Motta carolina Fonseca couto Federal University of Reconcavo of Bahia Federal University of Minas Gerais

According to the List of Hazardous Substances of the Agency of the Toxic Substances and Disease Registry(ATSDR 2017), some metallic elements such as Pb or Cd are still considered as the most polluting elements in the world. These elements accumulate in sediments, and there are various methods available that differentiate lithogenic sources from anthropogenic sources. For that, the natural geochemical background is required, however, its definition is far from unanimous: it can be a global or local value,single or statistically estimated value, depending on the studies. Our study is focused on the Subae River in the state of Bahia, Northeastern Brazil, which was historically contaminated by lead metallurgy. The river sediments were sampled at 21 locations: one at the discharge point of the plant’s rainwater basin,ten upstream, and ten downstream. The total contents of Fe, Ti, Mn, Pb, Zn, Cu, Cr, particle-size distribution, and organic matter were analyzed. The conventional geochemical indexes, i.e., the pollution degree(m Cd), pollution load index, and enrichment factor indicated contamination by Zn, Pb, Cr, and Cu.Then, a new enrichment factor is introduced, assuming that the sediments come from erosion of soils in the watershed. After obtaining the natural concentrations of metals in the clay, silt, and sand fractions of uncontaminated reference soils, we corrected the pollution indexes by calculating a new individual background in each sediment sample, according to its grain size distribution. This new approach provided more precise indexes in the assessment of sediment pollution, by highlighting higher contamination of Zn and Pb(around 50%) and at the same time the absence of Cr and Cu contamination, two metals not involved with the metallurgical activity.

关键词： Enrichment factor Estimated background Particle-size distribution

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Intraoperative Glycaemia Following Paracetamol with and without Glucose: A Randomized-Controlled Trial

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International Journal of Clinical Medicine 2013年第9期4卷 409-416页

作者： Ricardo Mota Pereira fatima Goncalves Joao Costa Filomena couto carolina Sa Isabel Neves Lucindo Ormonde department of Anaesthesiology Santa Maria University HospitalLisbonPortugal Laboratory of Clinical Pharmacology and Therapeutics Faculty of MedicineUniversity of LisbonLisbonPortugal Evidence-Based Medicine Centre Faculty of MedicineUniversity of LisbonLisbonPortugal Instituto de Medicina Molecular(IMM) Faculty of MedicineUniversity of LisbonLisbonPortugal department of Gynaecology Santa Maria University HospitalLisbonPortugal

Background: Hyperglycaemia is conversely a risk factor for perioperative complications. We are currently using a generic 3.3 g glucose containing formula of intravenous 1000 mg paracetamol for perioperative analgesia. Our main goal was to compare the trends of glycaemic values after administration of a generic 3.3 g glucose containing formula with a non-glucose containing branded formula of intravenous 1000 mg paracetamol. Methods: A exploratory proof-of-concept randomized clinical trial was conducted with 150 patients scheduled for elective gynaecologic. Patients were randomly assigned into three groups: control group (saline);active-control group: intraoperative administration of a branded non-glucose containing 1000 mg paracetamol formula;experimental group: intraoperative administration of a generic 3.3 g glucose containing 1000 mg paracetamol formula. The primary outcome was mean change from baseline in glaucoma. In case significant differences were found, the following secondary outcomes were explored: the proportion of patients with high glycaemia values (>150 mg/dL) and the proportion of patients with negative glycaemic variation. Results: Mean glycaemia change was higher after generic 3.3 g glucose containing paracetamol formula both in comparison to placebo (16.3 mg/dL [95% CI: 6.1 to 26.6]) and active-control (19.1 mg/dL [8.2 to 30.0] groups. Similar results were found in the intention-to-treat analysis. In only the experimental group, patients had high glycaemic values (11.3%). Conclusions: This study showed that in non-diabetic, under non-cardiac surgery, administration of a generic glucose-containing formula of intravenous 1000 mg paracetamol was associated with poorer glycaemic control. These results raise the question of a possible increased risk among these patients. Further studies using diabetic patients are recommended.

关键词： Paracetamol Hyperglycaemia Gyneacologic Surgical Procedures Randomized Controlled Trial

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A Genome-Wide Scenario of Terpene Pathways in Self-pollinated Artemisia annua

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Molecular Plant 2015年第11期8卷 1580-1598页

作者： Dong-Ming Ma Zhilong Wang Liangjiang Wang fatima Alejos-Gonzales1 Ming-An Sun de-Yu Xie department of Plant and Microbial Biology North Carolina State University Raleigh NC 27695 USA department of Genetics and Biochemistry Clemson University Clemson SC 29634 USA Virginia Bioinformatics Institute Virginia Polytechnic Institute and State University Blacksburg VA 24061 USA Present address: Hunan Provincial Key Laboratory of Crop Germplasm Innovation and Utilization Hunan Agricultural University Changsha Hunan 410128 China

Scenarios of genes to metabolites in Artemisia annua remain uninvestigated. Here, we report the use of an integrated approach combining metabolomics, transcriptomics, and gene function analyses to charac- terize gene-to-terpene and terpene pathway scenarios in a self-pollinating variety of this species. Eightyeight metabolites including 22 sesquiterpenes （e.g., artemisinin）, 26 monoterpenes, two triterpenes, one diterpene and 38 other non-polar metabolites were identified from 14 tissues. These metabolites were differentially produced by leaves and flowers at lower to higher positions. Sequences from cDNA libraries of six tissues were assembled into 18 871 contigs and genome-wide gene expression profiles in tissues were strongly associated with developmental stages and spatial specificities. Sequence mining identified 47 genes that mapped to the artemisinin, non-amorphadiene sesquiterpene, monoterpene, triterpene, 2-C- methyl-D-erythritol 4-phosphate and mevalonate pathways. Pearson correlation analysis resulted in network integration that characterized significant correlations of gene-to-gene expression patterns and gene expression-to-metabolite levels in six tissues simultaneously. More importantly, manipulations of amorpha-4,11-diene synthase gene expression not only affected the activity of this pathway toward artemisinin, artemisinic acid, and arteannuin b but also altered non-amorphadiene sesquiterpene and genome-wide volatile profiles. Such gene-to-terpene landscapes associated with different tissues are fundamental to the metabolic engineering of artemisinin.

关键词： Artemisia annua artemisinin terpene metabolic profiling pyrosequencing

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Assessing Cleaner Energy Alternatives for Bus Transit in Rio de Janeiro:A Life Cycle Inventory Analysis

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Journal of Environmental Protection 2015年第11期6卷 1197-1218页

作者： Marcio de Almeida D’Agosto Cintia Machado de Oliveira Fabiana do couto Assumpcao Ana carolina Peixoto deveza Programa de Engenharia de Transportes Instituto Alberto Luiz Coimbra de Pos-Graduacao e Pesquisa em Engenharia(COPPE)Universidade Federal do Rio de JaneiroRio de JaneiroBrazil Centro Federal de Educacao Tecnologica Celso Suckow da Fonseca Engenharia Industrial MecanicaUnedItaguaiBrazil

From 2003 to 2009 in Brazilian municipalities of over 60,000 inhabitants, buses accounted for more than 25% of urban trips. This trend is not expected to change in the medium term. Worldwide, buses rely on petroleum diesel as fuel. In Brazil, alternative fuels such as biodiesel, natural gas and ethanol are available and the choice among them should depend on the assessment of the entire life cycle of such fuels. This paper uses a Life Cycle Inventory, which is essential to the implementation of a Life Cycle Assessment, to assess six energy alternatives: petroleum diesel, biodiesel, petroleum diesel with 5% of biodiesel, compressed natural gas, additivated hydrous ethanol and dual-fuel system composed by petroleum diesel with 5% of biodiesel and compressed natural gas. In saving total energy consumption, pure petroleum diesel or mixed with 5% biodiesel and dual-fuel systems stand out, in that order. If renewable energy use and net carbon dioxide emissions reduction are the goals, ethanol and biodiesel should be given preference. The addition of 5% of biodiesel in petroleum diesel increases the share of renewable energy in the supply chain of petroleum diesel by 47.5% with an increase of 0.58% in total energy consumption and a reduction of 3.8% in net CO2 emissions during the life cycle. In the case of biodiesel, the addition of 5% of biodiesel in petroleum diesel increases the share of renewable energy in the supply chain by 51.15% with an increase of 0.03% in the total energy consumption and a decrease of 7% in net CO2 emissions in the life cycle. The use of 5% of biodiesel in petroleum diesel does not significantly affect the use of renewable energy (+0.69%) or total energy consumption (+0.04%) in ethanol supply chain, which already shows a great use of renewable energy input. However, a decrease of 9.29% in the net CO2 emissions in the supply chain occurs, which reaches 5.28% in the life cycle.

关键词： Renewable Energy Total Energy Public Transportation Biofuels Life Cycle

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Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer

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Cancer Biology & Medicine 2020年第2期17卷 444-457页

作者： Juan Moreno-Rubio Santiago Ponce Rosa Alvarez Maria Eugenia Olmedo Sandra Falagan Xabier Mielgo fatima Navarro Patricia Cruz Luis Cabezon-Gutierrez Carlos Aguado Gonzalo Colmenarejo Marta Munoz-Fernandez de Leglaria Ana Belen Enguita Maria Cebollero Amparo Benito Isabel Alemany carolina del Castillo Ricardo Ramos Ana Ramirez de Molina Enrique Casado Maria Sereno Ana Ramirez de Molina1 Enrique Casado5Maria Sereno5 XIMDEA Food InstituteCEI UAM+CSICMadrid 28702Spain 12 de Octubre University Hospital Madrid 28041Spain Gregorio Maranon University Hospital Madrid 28009Spain Ramon y Cajal University Hospital Madrid 28034Spain Infanta Sofia University Hospital San Sebastian De Los ReyesMadrid 28702Spain Fundacion Alcorcon University Hospital AlcorconMadrid 28922Spain Prlncipe de Asturias University Hospital Alcala De HenaresMadrid 28805Spain La Paz University Hospital Madrid 28046Spain University Hospital of Torrejon Torrejon De ArdozMadrid 28850Spain Clinico San Carlos University Hospital Madrid 28040Spain Parque Cientifico de Madrid Foundation Madrid 28049Spain

Objective:Long-term survivors(LS)of non-small cell lung cancer(NSCLC)without driver alterations,displaying an overall survival(OS)of more than 3 years,comprise around 10%of cases in several series treated with chemotherapy.There are classical prognosis factors for these cases[stage,Eastern Cooperative Oncology Group(ECOG),etc.],but more data are required in the literature.In this multi-center study,we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization.Methods:In the first step,we conducted a clinical-pathological characterization of the patients.Afterwards,we carried out a genetic analysis by comparing LS to a sample of short-term survivors(SS)(with an OS less than 9 months).We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS,and later confirmed these with reverse transcription-polymerase chain reaction(RT-PCR)for the rest of the samples.Results:A total of 94 patients were included,who were mainly men,former smokers,having adenocarcinoma(AC)-type NSCLC with an ECOG of 0-1.We obtained an initial differential transcriptome expression,displaying 5 over-and 33 under-expressed genes involved in different pathways:namely,the secretin receptor,surfactant protein,trefoil factor 1(T FF1),serpin,Ca-channels,and Tolllike receptor(TLRs)families.Finally,RT-PCR analysis of 40(20 LS/20 SS)samples confirmed that four genes(surfactant proteins and SFTP)were significantly down-regulated in SS compared to LS by using an analysis of covariance(ANCOVA)model:SFTPA1(P=0.023),SFTPA2(P=0.027),SFTPB{P=0.02),and SFT PC(P=0.047).Conclusions:We present a sequential genetic analysis of a sample of NSCLCLS with no driver alterations,obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

关键词： Long-term survivors non-small cell lung cancer surfactant proteins

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Efficient Somatic Embryogenesis and Organogenesis of Self-Pollination <i>Artemisia annua</i>Progeny and Artemisinin Formation in Regenerated Plants

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American Journal of Plant Sciences 2013年第11期4卷 2206-2217页

作者： fatima Alejos-Gonzalez Kelly Perkins Malcolm Isaiah Winston de-Yu Xie department of Plant and Microbial Biology North Carolina State Univer-sity Raleigh USA

To enhance the understanding of artemisinin biosynthesis, we have successfully bred self-pollination Artemisia annua plants. Here, we report efficient somatic embryogenesis and organogenesis of self-pollination plants and artemisinin formation in regenerated plants. The first through sixth nodal leaves of seedlings are used as explants. On agar-solidified MS basal medium supplemented with TDZ (0.6 mg/l) and IBA (0.1 mg/l), all explants after inoculation of less than 3 weeks start to form embryogenic calli, which further produce globular, torpedo, heart and early cotyledon embryos. In all six positional leaves, explants from the sixth leaf show the rapidest responses to induction of embryogenic calli and somatic embryos. On this medium, somatic embryos continuously develop into adventitious buds, which can form adventitious roots on a rooting medium containing NAA (0.5 mg/l). Meanwhile, on agar-solidified MS basal medium supplemented with BAP (1 mg/l) and NAA (0.05 mg/l), approximately 100% of explants from leaves #3-6 form calli in less than 3 weeks of inoculation and adventitious buds via organogenesis in 3-4 weeks. In all six positional leaves, explants from the sixth leaf exhibit the rapidest response to induction of calli and adventitious buds. Nearly 100% adventitious buds can form adventitious roots on the rooting medium. Regenerated plants from both somatic embryogenesis and organogenesis complete self-pollination to produce seeds in 80-90 days of growth in growth chamber. LC-ESI-MS analysis demonstrates that regenerated plants biosynthesize artemisinin. These results show the highly efficient regeneration capacity of self-pollination A. annua plants that can form a new platform to enhance the understanding of artemisinin biosynthesis and metabolic engineering.

关键词： Artemisia annua Artemisinin Biosynthesis Self-Pollination Somatic Embryogenesis Organogenesis HPLC-MS

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Outcomes of submucosal(T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 763-769页

作者： Darren D Ballard Neel Choksi Jingmei Lin Eun-Young Choi B Joseph Elmunzer Henry Appelman Douglas K Rex Hala fatima William Kessler John M deWitt Division of Gastroenterology and Hepatology Medical College of Wisconsin Division of Gastroenterology University of Michigan department of Pathology Indiana University department of Pathology University of Michigan Division of Gastroenterology and Hepatology University of South Carolina Division of Gastroenterology and Hepatology Indiana University

AIM To investigate the outcomes and recurrences of p T1 b esophageal adenocarcinoma(EAC) following endoscopic mucosal resection(EMR) and associated treatments.METHODS Patients undergoing EMR with pathologically confirmed T1 b EAC at two academic referral centers were retrospectively identified.Patients were divided into 4 groups based on treatment following EMR:Endoscopic therapy alone(group A),endoscopic therapy with either chemotherapy,radiation or both(group B),surgicalresection(group C) or no further treatment/lost to follow-up(demic centers,primary care physicians and/or referring physicians.Univariate analysis was performed to identify factors predicting recurrence of EAC.RESULTS Fifty-three patients with T1 b EAC underwent EMR,of which 32(60%) had adequate follow-up ≥ 12 mo(median 34 mo,range 12-103).There were 16 patients in group A,9 in group B,7 in group C and 21 in group D.Median follow-up in groups A to C was 34 mo(range 12-103).Recurrent EAC developed overall in 9 patients(28%) including 6(38%) in group A(median:21 mo,range:6-73),1(11%) in group B(median:30 mo,range:30-30) and 2(29%) in group C(median 21 mo,range:7-35.Six of 9 recurrences were local;of the 6 recurrences,5 were treated with endoscopy alone.No predictors of recurrence of EAC were identified.CONCLUSION Endoscopic therapy of T1 b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.

关键词： Esophageal cancer Submucosal T1b Endoscopic mucosal resection Chemotherapy Esophagectomy

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