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Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

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World Journal of Gastroenterology 2017年第7期23卷 1278-1288页

作者： Harsha Moole Harsha Tathireddy Sirish Dharmapuri Vishnu Moole Raghuveer Boddireddy Pratyusha Yedama sowmya Dharmapuri Achuta Uppu naveen Bondalapati Abhiram Duvvuri Department of Medicine University of Illinois College of Medicine Department of Medicine Wilkes-Barre Veterans Affairs Medical Center Department of Medicine NTR University of Health Sciences Department of Medicine Albert Einstein College of Medicine Department of Medicine Barnes Jewish Christian Medical GroupChristian Hospital Division of Gastroenterology and Hepatology Kansas City Veteran Affairs Medical Center

To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable *** studies compared outcomes with photodynamic therapy and biliary stenting (PDT group) vs biliary stenting only (BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLInE, PubMed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 *** studies (n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage (decrease in bilirubin level > 50% within 7days after stenting) in PDT vs BS group was 4.39 (95%CI: 2.35-8.19). Survival period in PDT and BS groups were 413.04 d (95%CI: 349.54-476.54) and 183.41 (95%CI: 136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99 (95%CI: 4.15-9.82) and -3.93 (95%CI: -8.63-0.77) respectively. Odds ratio for post-intervention cholangitis in PDT vs BS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both *** palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.

关键词： Photodynamic therapy Biliary stenting Unresectable cholangiocarcinoma Outcome Systematic review Meta-analysis

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nonselective beta‐blockers reduce mortality in patients with acute‐on‐chronic liver failure

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Portal Hypertension & Cirrhosis 2022年第1期1卷 15-22页

作者： Anand V.Kulkarni Madhumita Premkumar Karan Kumar Juned A.Khan Baqar A.Gora sowmya Tirumalle Sameer Shaik Mithun Sharma Rajesh Gupta nageshwar D.Reddy Padaki n.Rao Department of Hepatology AIG HospitalsHyderabadIndia Department of Hepatology PGIMERChandigarhIndia Department of Hepatology Mahatma Gandhi HospitalsJaipurIndia Department of Hepatology Hopewell HospitalLucknowIndia

Aim:nonselective beta‐blockers(nSBBs)can reduce the incidence of complications in patients with cirrhosis and prolong *** safety and efficacy of nSBBs in real‐world settings in patients with acute‐on‐chronic liver failure(ACLF)identified by the Asian Pacific Association for the Study of Liver criteria are *** study aimed to assess the safety and efficacy of nSBBs in patients with Asian Pacific Association for the Study of Liver(APASL)‐defined ACLF Methods:In this retrospective,multicenter study,patients with ACLF with complete 30 days follow‐up from January 2019 to December 2021 were *** primary objective was to compare 30‐day mortality among standard of care(SOC)and nSBB(+SOC)*** secondary objectives were to compare the incidence of infection,variceal bleed,and recompensation among both the ***:A total of 346 patients were *** 26%(n=89)of them received nSBBs,while 74%(n=257)received only *** Kaplan-Meier analysis,the incidence of mortality was 21%(95%confidence interval[CI]:16.20-26.50)in SOC group compared to only 8%(95%CI:3.22-15.53)in nSBB group at Day 30(p=0.005).Similarly,mortality in SOC group was 63%(95%CI:56.81-69.00)compared to 46%(95%CI:35.44-57.00)in nSBB group at 1 year(p=0.001).nSBB therapy could not reduce the incidence of infections or variceal ***‐seven percent of patients in the SOC group and 73%of patients in the nSBB group(pn 77.5%and propranolol in 22.5%of ***:nSBBs reduce mortality without any effect on infection or variceal bleed in patients with ***,only one in four ACLF patients are suitable for nSBB therapy.

关键词： ACLF infection portal hypertension variceal bleed

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Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

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World Journal of Gastroenterology 2016年第39期22卷 8831-8843页

作者： Harsha Moole Jaymon Patel Zohair Ahmed Abhiram Duvvuri Sreekar Vennelaganti Vishnu Moole sowmya Dharmapuri Raghuveer Boddireddy Pratyusha Yedama naveen Bondalapati Achuta Uppu Prashanth Vennelaganti Srinivas Puli Department of Medicine University of Illinois College of Medicine at Peoria Division of Gastro-enterology and Hepatology Kansas City Veteran Affairs Medical Center Department of Medicine Apogee Medical Group Department of Medicine NTR University of Health Sciences Department of Medicine Barnes Jewish Christian Medical Group Christian Hospital Department of Medicine Albert Einstein College of Medicine Division of Gastroenterology and Hepatology University of Kansas Medical Center Division of Gastroenterology and Hepatology University of Illinois College of Medicine at Peoria

AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert *** Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to no-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). COnCLUSIOn When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

关键词： Barrett’s esophagus Low grade dysplasia High grade dysplasia Esophageal adenocarcinoma Annual incidence of progression Systematic review Meta-analysis

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Impact of an HIV Prevention Intervention on HIV Risk Behavior and Sexually Transmitted Infection among Female Sex Workers in Tamil nadu, India

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World Journal of AIDS 2017年第3期7卷 166-178页

作者： Joseph D. Williams Arumugam Vijayaraman Priya Krishnaswamy niranjan Saggurti sowmya Ramesh Deepika Ganju Voluntary Health Services Chennai India Population Council New Delhi India

Background: In 2003 a large-scale HIV prevention program was launched for key populations in six high HIV prevalence states of India. This paper assesses the effect of exposure to the intervention on condom use with commercial clients and experiences of sexually transmitted infection (STI) among female sex workers (FSWs) in Tamilnadu, a southern Indian state, between 2006 and 2009. Methods: Data were drawn from two rounds of cross-sectional surveys conducted in 2006 (n = 2010) and 2009 (n = 2500) among FSWs in Tamilnadu, recruited through probability-based sampling. A series of multivariate logistic regression models were constructed to examine the association between exposure to the intervention and change over time with condom use and self-reported STI. All the analyses were performed using STATA 11.1. Results: Overall, 48% of FSWs in 2006 and 90% in 2009 reported exposure to the intervention. Compared to 2006, there was a considerable increase in the proportion of FSWs reporting consistent condom use with regular and occasional clients at follow-up (2009). Further, the increase in consistent condom use over time with occasional (adjusted OR = 3.53, 95% CI: 2.47 - 5.05) and regular clients (adjusted OR = 4.97, 95% CI: 3.43 - 7.16) was significantly higher among FSWs exposed to the intervention than those not exposed. Additionally, a significant decline was observed in self-reported STI overtime among FSWs exposed to the intervention compared to their counterparts (adjusted OR = 0.39, 95% CI: 0.26 - 0.59). Conclusion: The HIV prevention program in Tamilnadu resulted in increased consistent condom use and a decrease in self-reported STI among FSWs exposed to intervention. These findings suggest that HIV prevention programs should aim to saturate coverage among key populations to sustain the gains achieved.

关键词： HIV Intervention Exposure Female Sex Workers STI Tamilnadu Condom Use

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Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection

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World Journal of Critical Care Medicine 2018年第1期7卷 16-23页

作者： Gunasekaran Karthik Thomas Isaiah Sudarsan John Victor Peter Thambu Sudarsanam George M Varghese Paul Kundavaram sowmya Sathyendra Ramya Iyyadurai Kishore Pichamuthu Department of Medicine Christian Medical College Medical Intensive Care Unit Christian Medical College Department of Infectious Diseases Christian Medical College

AIM To study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to *** Demographic data, electrocardiographic(ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. Myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. The relationship between myocarditis and outcomes was assessed using logistic regression analysis and expressed as odds ratio(OR) with 95%*** The cohort(n = 81; 35 males) aged 49.4 ± 16.1 years(mean, SD) presented 8.1 ± 3.1 d after symptom onset. The APACHE-Ⅱ score was 15.7 ± 7.0. Fortyeight (59%) patients were ventilated, and 46 (56%) required vasoactive agents. Mortality was 9.9%. ECG changes were non-specific; sinus tachycardia was the most common finding. Myocardial injury was evident in 61.7% of patients and LV systolic dysfunction in 30.9%. A diagnosis of myocarditis was made in 12.3%. In addition, seven patients with regional wall motion abnormalities had LV systolic dysfunction and elevated cardiac enzymes. Mild diastolic dysfunction was observed in 18 (22%) patients. Mild to moderate pericardial effusion was seen in 51%. On multivariate logistic regression analysis, patients with myocarditis tended to be older (OR = 1.04, 95%CI: 0.99-1.09), had shorter symptom duration (OR = 0.69, 95%CI: 0.49-0.98), and tended to stay longer in hospital(OR = 1.17, 95%CI: 0.98-1.40). Myocarditis was not associated with increased *** In scrub typhus infection, cardiac manifestations are frequent and associated with increased morbidity but not mortality.

关键词： Scrub typhus Myocarditis Outcome

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Atypical manifestation of herpes esophagitis in an immunocompetent patient: Case report and literature review

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World Journal of Clinical Infectious Diseases 2017年第3期7卷 46-49页

作者： Fabiola C Rios de Choudens Sajiv Sethi Shuchi Pandya sowmya nanjappa John n Greene Department of Internal Medicine Morsani College of Medicine University of South Florida Department of Infectious Disease University of South Florida Department of Internal Hospital Medicine Department of Oncologic Sciences H. Lee Moffitt Cancer Center and Research Institute Department of Internal Hospital Medicine Moffitt Cancer Center and Research Institute

Herpes simplex virus(HSV) is known to cause esophagitis in immunosuppressed patients; however, it is rarely seen in immunocompetent patients. We present a unique case of HSV esophagitis in a healthy male, without any immunocompromising conditions or significant comorbidities. The patient presented with a two-week history of dysphagia, odynophagia and epigastric pain. Physical exam revealed oral hyperemia without any visible ulcers or vesicles. He underwent esophagogastroduodenoscopy which noted severe esophagitis with ulceration. Esophageal biopsies were positive for HSV. Serology was positive for HSV as well. After initiating treatment with Famciclovir 250 mg 3 times/d, high dose proton pump inhibitor and sucralfate, patient had complete resolution of symptoms at his 2.5 wk follow up appointment. Subsequent workup did not reveal any underlying immune disorders. While HSV is a known causative of esophagitis in the immunocompromised, its presentation in healthy patients without any significant comorbidity is uncommon. Presentation with a systemic viral prodrome further makes this case unique.

关键词： Immunocompromised Herpes Esophagitis

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nature：大规模研究揭示生命所必需的基因

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现代生物医学进展 2016年第31期16卷 I0002-I0003页

作者： Dickinson, Mary E. Flenniken, Ann M. Ji, Xiao Teboul, Lydia Wong, Michael D. White, Jacqueline K. Meehan, Terrence F. Weninger, Wolfgang J. Westerberg, Henrik Adissu, Hibret Baker, Candice n. Bower, Lynette Brown, James M. Caddle, L. Brianna Chiani, Francesco Clary, Dave Cleak, James Daly, Mark J. Denegre, James M. Doe, Brendan Dolan, Mary E. Edie, Sarah M. Fuchs, Helmut Gailus-Durner, Valerie Galli, Antonella Gambadoro, Alessia Gallegos, Juan Guo, Shiying Horner, neil R. Hsu, Chih-Wei Johnson, Sara J. Kalaga, sowmya Keith, Lance C. Lanoue, Louise Lawson, Thomas n. Lek, Monkol Mark, Manuel Arschall, Susan M. Mason, Jeremy McElwee, Melissa L. newbigging, Susan nutter, Lauryl M. J. Peterson, Kevin A. Ramirez-Solis, Ramiro Rowland, Douglas J. Ryder, Edward Samocha, Kaitlin E. Seavitt, John R. Selloum, Mohammed Szoke-Kovacs, Zsombor Tamura, Masaru Trainor, Amanda G. Tudose, Ilinca Wakana, Shigeharu Warren, Jonathan Wendling, Olivia West, David B. Wong, Leeyean Yoshiki, Atsushi MacArthur, Daniel G. Tocchini-Valentini, Glauco P. Gao, Xiang Flicek, Paul Bradley, Allan Skarnes, William C. Justice, Monica J. Parkinson, Helen E. Moore, Mark Wells, Sara Braun, Robert E. Svenson, Karen L. de Angelis, Martin Hrabe Herault, Yann Mohun, Tim Mallon, Ann-Marie Henkelman, R. Mark Brown, Steve D. M. Adams, David J. Lloyd, K. C. Kent McKerlie, Colin Beaudet, Arthur L. Bucan, Maja Murray, Stephen A. Dept Mol Physiol & Biophys Houston TX 77030 USA Toronto Ctr Phenogen Toronto ON M5T 3H7 Canada Mt Sinai Hosp Toronto ON M5G 1X5 Canada Univ Penn Perelman Sch Med Genom & Computat Biol Program Philadelphia PA 19104 USA Med Res Council Harwell Mammalian Genet Unit Harwell OX11 0RD Oxon England Mary Lyon Ctr Harwell OX11 0RD Oxon England Hosp Sick Children Mouse Imaging Ctr Toronto ON M5T 3H7 Canada Wellcome Trust Sanger Inst Wellcome Trust Genome Campus Cambridge CB10 1SA England European Bioinformat Inst European Mol Biol Lab Wellcome Trust Genome Campus Cambridge CB10 1SD England Med Univ Vienna Ctr Anat & Cell Biol A-1090 Vienna Austria Hosp Sick Children 555 Univ Ave Toronto ON M5G 1X8 Canada Jackson Lab 600 Main St Bar Harbor ME 04609 USA Univ Calif Davis Mouse Biol Program Davis CA 95618 USA Italian natl Res Council CnR Inst Cell Biol & Neurobiol Monterotondo Mouse Clin I-00015 Monterotondo Italy Massachusetts Gen Hosp Analyt & Translat Genet Unit Boston MA 02114 USA Broad Inst MIT & Harvard Program Med & Populat Genet Cambridge MA 02142 USA German Res Ctr Environm Hlth Helmholtz Zentrum Munchen Inst Expt Genet D-85764 Neuherberg Germany German Mouse Clin D-85764 Neuherberg Germany Baylor Coll Med Dept Mol & Human Genet Houston TX 77030 USA nanjing Univ Nanjing Biomed Res Inst Collaborat Innovat Ctr Genet & Dev SKL Pharmaceut Biotechnol & Model Anim Res Ctr Nanjing 210061 Jiangsu Peoples R China Univ Strasbourg ICS Infrastruct Natl PHENOMIN F-67404 Illkirch Graffenstaden France Univ Strasbourg INSERM CNRS IGBMC F-67404 Illkirch Graffenstaden France RIKEn BioResource Ctr Tsukuba Ibaraki 3050074 Japan Childrens Hosp Oakland Res Inst Oakland CA 94609 USA IMPC San Anselmo CA 94960 USA Tech Univ Munich Sch Life Sci Weihenstephan Chair Expt Genet D-81675 Freising Weihenstephan Germany German Ctr Diabet Res DZD D-85764 Neuherberg Germany Francis Crick Inst Mill Hill Lab Mill Hill London NW1 1AT England Univ Penn Perlman

在哺乳动物基因组中。大约三分之一的基因是生命所必需的。在一项新的研究中，来自美国贝勒医学院等多个机构的研究人员描述了这些基因的大规模发现。以及它将如何影响对哺乳动物发育和人类疾病的理解。相关研究结果在线发表在nature期... 详细信息

在哺乳动物基因组中。大约三分之一的基因是生命所必需的。在一项新的研究中，来自美国贝勒医学院等多个机构的研究人员描述了这些基因的大规模发现。以及它将如何影响对哺乳动物发育和人类疾病的理解。相关研究结果在线发表在nature期刊上，论文标题为“High—throughput discovery of novel developmental phenotypes”。

关键词：动物基因组生命哺乳动物研究人员人类疾病医学院

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