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Time to detoxify medical literature from guideline overdose

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World Journal of Gastroenterology 2012年第26期18卷 3331-3335页

作者： dinesh Vyas arpita K Vyas Department of Surgery Nanomedical OncoSepsis LabInstitute of International HealthCollege of Human MedicineMichigan State UniversityEast LansingMI 48824United States Pediatric Endocrinology Department of Pediatrics and Human DevelopmentMichigan State UniversityEast LansingMI 48824United States

The current financial turmoil in the United States has been attributed to multiple reasons including healthcare *** care spending has increased from 5.7 percent of the gross domestic product(GDP) in 1965 to 16 percent of the GDP in *** is driven with a goal to provide best possible care available at that period of *** are generally assumed to have the high level of certainty and security as conclusions generated by the conventional scientific method leading many clinicians to use guidelines as the final arbiters of *** provide the standard of care,physicians follow guidelines,proposed by either groups of physicians or various medical societies or government organizations like National Comprehensive Cancer *** has lead to multiple tests for the patient and has not survived the test of *** independence leads to lacunae in the standardization of guidelines,hence flooding of literature with multiple guidelines and confusion to patients and physicians and eventually overtreatment,inefficiency,and patient *** is an urgent need to restrict articles with Guidelines and develop some strategy like have an intermediate stage of pre-guidelines and after 5-10 years of trials,a systematic launch of the *** can be better ways than this for putting together guidelines as has been suggested by multiple authors and researchers.

关键词：医学文献时间国内生产总值医疗保健临床医生解毒科学方法政府机构

Fecal transplant policy and legislation

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World Journal of Gastroenterology 2015年第1期21卷 6-11页

作者： dinesh Vyas Apoorva Aekka arpita Vyas College of Human Medicine Michigan State UniversityEast LansingMI 48912United States Department of Pediatrics Heart Failure Research LabEast LansingMI 48912United States

Fecal microbiota transplantation(FMT) has garnered significant attention in recent years in the face of a reemerging Clostridium difficile(***) *** results from the first randomized control trial evaluating FMT have encouraged the medical community to explore the process further and expand its application beyond *** infections and even the gastrointestinal *** promising and numerous the prospects of FMT appear,the method remains limited in scope today due to several important barriers,most notably a poorly defined federal regulatory *** Food and Drug Administrationhas found it difficult to standardize and regulate the administration of inherently variable,metabolically active,and ubiquitously available fecal *** current cumbersome policy,which classifies human feces as a drug,has prevented physicians from providing FMT and deserving patients from accessing FMT in a timely fashion,and subsequent modifications seem only to be *** argument for reclassifying fecal material as human tissue is well ***,this would allow for a regulatory framework that is sufficiently flexible to expand access to care and facilitate research,but also appropriately restrictive and centralized to ensure patient *** an approach can facilitate the advancement of FMT to a more refined,controlled,and aesthetic process,perhaps in the form of a customized and wellcharacterized stool substitute therapy.

关键词： Stool therapy Clostridium difficile Fecal microbio

Harnessing the potential of gene editing technology using CRISPR in inflammatory bowel disease

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World Journal of Gastroenterology 2019年第18期25卷 2177-2187页

作者： Viktor Limanskiy arpita Vyas Lakshmi Shankar Chaturvedi dinesh Vyas Department of Surgery San Joaquin General Hospital College of Medicine CNSU College of Medicine and College of Pharmacy California Northstate University

The molecular scalpel of clustered regularly interspersed short palindromic repeats/CRISPR associated protein 9(CRISPR/Cas9) technology may be sharp enough to begin cutting the genes implicated in inflammatory bowel disease(IBD) and consequently decrease the 6.3 billion dollar annual financial healthcare burden in the treatment of IBD. For the past few years CRISPR technology has drastically revolutionized DNA engineering and biomedical research field. We are beginning to see its application in gene manipulation of sickle cell disease,human immunodeficiency virus resistant embryologic twin gene modification and IBD genes such as Gatm(Glycine amidinotransferase, mitochondrial),nucleotide-binding oligomerization domain-containing protein 2, KRT12 and other genes implicated in adaptive immune convergence pathways have been subjected to gene editing, however there are very few publications. Furthermore,since Crohn's disease and ulcerative colitis have shared disease susceptibility and share genetic gene profile, it is paramount and is more advantageous to use CRISPR technology to maximize impact. Although, currently CRISPR does have its limitations due to limited number of specific Cas enzymes, off-target activity,protospacer adjacent motifs and crossfire between different target sites. However,these limitations have given researchers further insight on how to augment and manipulate enzymes to enable precise gene excision and limit crossfire between target sites.

关键词： Clustered regularly interspersed short palindromic repeats Inflammatory bowel disease Crohn’s disease Ulcerative colitis Gene excision Gene editing Gene therapy Financial impact of inflammatory bowel disease on healthcare Clustered regularly interspersed short palindromic repeats crossfire

Stool therapy may become a preferred treatment of recurrent Clostridium difficile?

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World Journal of Gastroenterology 2013年第29期19卷 4635-4637页

作者： dinesh Vyas Heidi E L'Esperance arpita Vyas Department of Surgery College of Human Medicine Michigan State University East Lansing MI 48912 United States Department of Pediatrics College of Human Medicine Michigan State University East Lansing MI 48912 United States

Fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat Clostridium difficile (C. difficile ) infection has remained esoteric and not well investigated until recently. In the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent C. difficile infection have become available and validate use of fecal transplant for C. difficile enterocolitis. Methods of fecal transplant reported in the literature include: nasogastric tube, gastroscope, duodenal tube, colonoscopy, rectal tube, and fecal enemas administered at home; no method has been shown to be superior. A recent randomized study published in New England Journal of Medicine found fecal transplant to be superior to oral vancomycin alone in treatment of recurrent C. difficile enterocolitis. The significance of this trial cannot be underestimated as it lends credibility to the idea of intentionally using microbes to combat disease, providing an alternative to the older paradigm of disease eradication through use of antimicrobials.

关键词： Clostridium difficile Enterocolitis Pseudomembranous Fecal transplantation Vancomycin

Pharmacological cyclin dependent kinase inhibitors: Implications for colorectal cancer

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World Journal of Gastroenterology 2016年第7期22卷 2159-2164页

作者： Archana Balakrishnan arpita Vyas Kaivalya Deshpande dinesh Vyas College of Human Medicine Michigan State University Texas Tech University at the Permian Basin

Colorectal cancer accounts for a significant proportion of cancer deaths worldwide. The need to develop more chemotherapeutic agents to combat this disease is critical. Cyclin dependent kinases(CDKs), along with its binding partner cyclins, serve to control the growth of cells through the cell cycle. A new class of drugs, termed CDK inhibitors, has been studied in preclinical and now clinical trials. These inhibitors are believed to act as an anti-cancer drug by blocking CDKs to block the uncontrolled cellular proliferation that is hallmark of cancers like colorectal cancer. CDK article provides overview of the emerging drug class of CDK inhibitors and provides a list of ones that are currently in clinical trials.

关键词： Colorectal cancer Cyclin Cyclin dependentkinase inhibitor

Nuclear factor kappa B role in inflammation associated gastrointestinal malignancies

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World Journal of Gastroenterology 2015年第11期21卷 3174-3183页

作者： Sahil Gambhir dinesh Vyas Michael Hollis Apporva Aekka arpita Vyas Department of Surgery College of Human MedicineMichigan State University Department of Pediatrics College of Human Medicine - Michigan State University

Nuclear factor kappa B(NF-κB) has an established role in the regulation of innate immunity and ***-κB is also involved in critical mechanisms connecting inflammation and cancer *** investigations suggest that the NF-κB signaling cascade may be the central mediator of gastrointestinal malignancies including esophageal,gastric and colorectal *** review will explore NF-κB's function in inflammation-associated gastrointestinal malignancies,highlighting its oncogenic contribution to each step of ***-κB's role in the inflammation-to-carcinoma sequence in gastrointestinal malignancies warrants stronger emphasis upon targeting this pathway in achieving greater therapeutic efficacy.

关键词： Gastrointestinal cancer Inflammation Nuclear facto

Micro RNAs potential utility in colon cancer: Early detection, prognosis, and chemosensitivity

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World Journal of Gastroenterology 2015年第27期21卷 8284-8292页

作者： Michael Hollis Kavitha Nair arpita Vyas Lakshmi Shankar Chaturvedi Sahil Gambhir dinesh Vyas Department of Surgery College of Human Medicine Michigan State University Department of Medicine Emory University Pediatrics College of Human Medicine Michigan State University

Over the past decade, research has shown that aberrant expression of micro RNA(mi RNA) is involved in colorectal cancer development and progression. Micro RNAs are small sequences of non-coding RNA that regulate expression of genes involved in important cellular functions, such as cell differentiation, multiplication, and apoptosis. A specific mi RNA may display the effects of a tumor suppressor or oncogene. Altered mi RNA expression is found in colorectal cancer(CRC) and patterns of mi RNA expression correlate with CRC detection and outcome. Studies also have examined the use of circulating serum mi RNA and fecal mi RNA expression as non-invasive markers for early detection. Here, we review recent evidence demonstrating the potential role of mi RNA in CRC and the implications of its use in the diagnosis, prognosis, and management of CRC.

关键词： Colorectal cancer Microrna Expression Serum microRNA Fecal microRNA Diagnostic Prognostic Therapeutic