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Trends in the management of anorectal melanoma:A multiinstitutional retrospective study and review of the world literature

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World Journal of Gastroenterology 2021年第3期27卷 267-280页

作者： Josh Bleicher Jessica N Cohan Lyen C Huang William Peche T Bartley Pickron Courtney L Scaife Tawnya L Bowles John R Hyngstrom Elliot A Asare Department of Surgery Huntsman Cancer Institute at the University of UtahSalt Lake CityUT 84114United States Department of Surgery George E Wahlen Department of Veterans Affairs Medical CenterSalt Lake CityUT 84114United States Department of Surgery Intermountain Medical CenterMurrayUT 84107United States

BACKGROUND Anorectal melanoma(ARM)is a rare disease with a poor *** on optimal treatment is limited and surgical management varies *** hypothesized that the frequency of abdominoperineal resection used as primary treatment of ARM has decreased over the past several *** To update our understanding of outcomes for patients with ARM and analyze management trends around the *** This is a multi-institutional,retrospective study of patients treated for ARM at 7 *** included both large,academic,tertiary care centers and smaller,general community *** prospectively maintained institutional tumor registries,we identified 24 patients diagnosed with ARM between January 2000 and May *** analyzed factors prognostic for recurrence and *** then used Cox regression to measure overall survival(OS)and melanoma-specific *** also performed a literature review to assess trends in surgical management and *** Of the 24 patients diagnosed with ARM,12(50.0%)had local,8(33.3%)regional,and 4(16.7%)distant disease at *** time to recurrence was 10.4 mo[interquartile range(IQR)7.5-17.2]with only 2 patients(9.3%)not developing recurrence following surgical *** OS was 18.8 mo(IQR 13.5-33.9).One patient is still alive without recurrence at 21.4 mo from diagnosis;no other patient survived 5 *** surgical management with abdominoperineal resection(APR)vs wide excision(WE)did not lead to differences in OS[hazard ratio=1.4(95%CI:0.3-6.8)].Review of the literature revealed geographic differences in surgical management of ARM,with increased use of WE in the United States and Europe over time and more frequent use of APR in Asia and *** was no significant improvement in survival over *** There is wide variation in the management of ARM and survival outcomes remain poor regardless of *** management should aim to minimize morbidity.

关键词： Melanoma Anorectal melanoma Literature review Melanoma surgery Surgical oncology Colorectal surgery

Overview and comparison of guidelines for management of pancreatic cystic neoplasms

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World Journal of Gastroenterology 2019年第31期25卷 4405-4413页

作者： Aws Hasan Kavel Visrodia James J Farrell Tamas A Gonda Division of Digestive and Liver Diseases Department of MedicineColumbia UniversityNew YorkNY 10032United States Division of Digestive Diseases Department of MedicineYale UniversityNew HavenCT 06520United States

Pancreatic cysts are identified at an increasing *** mucinous cystic neoplasms represent a pre-malignant condition,the majority of these lesions do not progress to *** the last 10 years several societies have established guidelines for the diagnosis,initial evaluation and surveillance of these *** we provide an overview of five commonly used guidelines:2015 American Gastroenterological Association,2017 International Association of Pancreatology,American College of Gastroenterology 2018,European Study Group and American College of *** describe the similarities and differences between the methods used to formulate these guidelines,the population they target and their approaches towards initial evaluation and surveillance of cystic lesions.

关键词： Pancreatic cyst surveillance Cyst malignancy Guidelines

Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants

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World Journal of Pediatrics 2018年第3期14卷 269-273页

作者： Joseph B.Cantey Kelsey R.Anderson Ram R.Kalagiri Lea H.Mallett Department of Pediatrics University of Texas Health Science Center San Antonio7703 Floyd Curl DriveSan AntonioTX 78229USA Texas A&M Health Science Center College of Medicine BryanTXUSA Texas A&M Health Science Center Baylor/Scott&White HealthTempleTXUSA

Background Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality. Methods This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to exam-ine factors associated with morbidity and mortality. Results Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%),Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality (OR 0.6 (95% CI 0.2-2.6)), but sepsis with other organisms was (OR 4.5 (95% CI 2.6-8.0))CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hem-orrhage, or retinopathy of prematurity. Conclusion CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.

关键词： Morbidity Mortality Neonate Sepsis

Characterizing the patient experience during neoadjuvant therapy for pancreatic ductal adenocarcinoma:A qualitative study

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World Journal of Gastrointestinal Oncology 2022年第6期14卷 1175-1186页

作者： Lena Stevens Zachary J Brown Ryan Zeh Christina Monsour Sharla Wells-Di Gregorio Heena Santry Aslam M Ejaz Timothy Michael Pawlik Jordan M Cloyd Department of Surgery The Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of General Surgery University of Pittsburgh Medical CenterPittsburghPA 15213United States Department of Psychiatry Center for Palliative CareThe Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Neoadjuvant therapy(NT)has increasingly been utilized for patients with localized pancreatic ductal adenocarcinoma(PDAC).It is the recommended approach for borderline resectable(BR)and locally advanced(LA)cancers and an increasingly utilized option for potentially resectable(PR)*** its increased use,little research has focused on patient-centered metrics among patients undergoing NT,including patient experiences,preferences,and recommendations.A better understanding of all aspects of the patient experience during NT may identify opportunities to design interventions aimed at improving quality of life;it may also facilitate the completion of NT and receipt of surgery,ultimately optimizing long-term *** To understand the experience of patients initiating and receiving NT to identify opportunities to improve neoadjuvant cancer care *** Semi-structured interviews of patients with localized PDAC during NT were conducted to explore their experience initiating and receiving *** took place between August 2020 and October *** to the descriptive nature of the research,questions were open *** were conducted over the phone,audio recorded and then *** interviews were coded by two independent researchers using NVivo 12,iteratively identifying themes until thematic saturation was *** integrative approach to qualitative analysis was used,utilizing both inductive and deductive *** A total of 12 patients with localized PDAC were *** with BR(n=7),PR(n=2),and LA(n=3)cancers participated in the *** patients indicated that choosing NT was the doctor’s recommendation,while most reported not being familiar with the concept of NT(n=11)and that NT was presented as the only option(n=8).Five themes describing the patient experience emerged:physical symptoms,emotional symptoms,coping mechanisms,access to care,and life *** most commonly cited recommendation for

关键词： Pancreatic ductal adenocarcinoma Neoadjuvant therapy Patient experience Patient-centered care Quality of life Qualitative research

Microdissection testicular sperm extraction： an update

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Asian Journal of Andrology 2013年第1期15卷 35-39页

作者： Ali A Dabaja Peter N Schlegel Department of Urology Male Reproductive Medicine Weill Cornell Medical College New York NY 10065 USA

Patients with non-obstructive azoospermia （NOA） were once considered to be infertile with few treatment options due to the absence of sperm in the ejaculate. In the last two decades, the advent of intracytoplasmic sperm injection （ICSI）, and the application of various testicular sperm retrieval techniques, including fine needle aspiration （FNA）, conventional testicular sperm extraction （TESE） and microdissection testicular sperm extraction （micro-TESE） have revolutionized treatment in this group of men. Because most men with NOA will have isolated regions of spermatogenesis within the testis, studies have illustrated that sperm can be retrieved in most men with NOA, including Klinefelter＇s syndrome （KS）, prior history of chemotherapy and cryptorchidism. Micro-TESE, when compared with conventional TESE has a higher sperm retrieval rate （SRR） with fewer postoperative complications and negative effects on testicular function. In this article, we will compare the efficacy of the different procedures of sperm extraction, discuss the medical treatment and the role of testosterone optimization in men with NOA and describe the micro-TESE surgical technique. Furthermore, we will update our overall experience to allow counseling on the prognosis of sperm retrieval for the specific subsets of NOA.

关键词： azoospermia genetics male infertility microsurgery non-obstructive azoospermia sperm retrieval testicular sperm extraction

Genetic associations with adverse events from anti-tumor necrosis factor therapy in inflammatory bowel disease patients

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World Journal of Gastroenterology 2017年第40期23卷 7265-7273页

作者： Daniel Lew Soon Man Yoon Xiaofei Yan Lori Robbins Talin Haritunians Zhenqiu Liu Dalin Li Dermot PB McGovern Department of Medicine Cedars-Sinai Medical Center F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute Cedars-Sinai Medical Center Department of Gastroenterology Cedars-Sinai Medical Center

AIM To study the type and frequency of adverse events associated with anti-tumor necrosis factor(TNF)therapy and evaluate for any serologic and genetic *** This study was a retrospective review of patients attending the inflammatory bowel disease(IBD) centers at Cedars-Sinai IBD Center from 2005-2016. Adverse events were identified via chart review. IBD serologies were measured by ELISA. DNA samples were genotyped at Cedars-Sinai using Illumina Infinium Immunochipv1 array per manufacturer's protocol. SNPs underwent methodological review and were evaluated using several SNP statistic parameters to ensure optimal allele-calling. Standard and rigorous QC criteria were applied to the genetic data, which was generated using immunochip. Genetic association was assessed by logistic regression after correcting for population *** Altogether we identified 1258 IBD subjects exposed to anti-TNF agents in whom Immunochip data were available. 269/1258 patients(21%) were found to have adverse events to an anti-TNF-α agent that required the therapy to be discontinued. 25% of women compared to 17% of men experienced an adverse event. All adverse events resolved after discontinuing the antiTNF agent. In total: n = 66(5%) infusion reactions; n = 49(4%) allergic/serum sickness reactions; n = 19(1.5%) lupus-like reactions, n = 52(4%) rash, n = 18(1.4%) infections. In Crohn's disease, Ig A ASCA(P = 0.04) and Ig G-ASCA(P = 0.02) levels were also lower in patients with any adverse events, and anti-I2 level in ulcerative colitis was significantly associated with infusion reactions(P = 0.008). The logistic regression/human annotation and network analyses performed on the Immunochip data implicated the following five signaling pathways: JAK-STAT(Janus Kinase-signal transducer and activator of transcription), measles, IBD, cytokine-cytokine receptor interaction, and toxoplasmosis for any adverse event. CONCLUSION Our study shows 1 in 5 IBD patients experience an

关键词： Genetic associations Inflammatory bowel disease Anti-tumor necrosis factor Adverse events

Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies

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World Journal of Gastroenterology 2021年第15期27卷 1630-1642页

作者： Thiruvengadam Muniraj Harry R Aslanian Loren Laine Priya A Jamidar James F Farrell Kisha A Mitchell Ronald R Salem Section of Digestive Diseases Department of MedicineYale University School of MedicineNew HavenCT 06510United States Department of Pathology Yale University School of MedicineNew HavenCT 06510United States Department of Surgery Yale University School of MedicineNew HavenCT 06510United States

BACKGROUND Recurrent acute pancreatitis(RAP)may be a presenting feature of and an indication for resection of pancreatic cysts,including intra-ductal papillary mucinous neoplasm(IPMN).Few data are available regarding the prevalence of malignancy and post-operative RAP in this *** To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for *** This retrospective study assessed 172 patients who underwent surgical resection of pancreatic cystic neoplasms at a university hospital between 2002 and *** prevalence of preoperative high-risk cyst features,and of neoplasia was compared between patients with and without *** identify the cause of pancreatitis,all the patients had a detailed history of alcohol,smoking,medications obtained,and had cross-sectional imaging(contrast-enhanced computed tomography/magnetic resonance imaging)and endoscopic ultrasound to look for gallstone etiology and other structural causes for *** incidence of RAP post-resection was the primary *** IPMN accounted for 101 cases(58.7%){[branch duct(BD)59(34.3%),main duct(MD)42](24.4%)}.Twenty-nine(16.9%)presented with RAP(mean 2.2 episodes):15 had BD-IPMN,8 MD-IPMN,5 mucinous cystic neoplasm and 1 serous cystic *** was similar among those with vs without RAP for all patients[6/29(20.7%)vs 24/143(16.8%)]and IPMN patients[6/23(26.1%)vs 23/78(29.5%)],although tended to be higher with RAP in BD-IPMN,[5/15(33.3%)vs 3/44(6.8%),P=0.04].At mean follow-up of 7.2 years,1(3.4%)RAP patient had post-resection *** mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02(P<0.0001).CONCLUSION Malignancy was not increased in patients with pancreatic cystic neoplasms who have RAP compared to those without *** addition,specific cyst characteristics were not clearly associated with *** incidence of RAP was markedly decreased in almost all patients following cyst resect

关键词： Pancreatic cyst Pancreatic neoplasm Pancreatitis Malignancies

Gender and racial differences in nonalcoholic fatty liver disease

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World Journal of Hepatology 2014年第5期6卷 274-283页

作者： Jen-Jung Pan Michael B Fallon Division of Gastroenterology Hepatology and Nutrition Department of Internal Medicine The University of Texas Health Science Center at Houston Houston TX 77030 United States

Due to the worldwide epidemic of obesity, nonalcoholic fatty liver disease(NAFLD) has become the most com-mon cause of elevated liver enzymes. NAFLD represents a spectrum of liver injury ranging from simple steato-sis to nonalcoholic steatohepatitis(NASH) which may progress to advanced fibrosis and cirrhosis. Individuals with NAFLD, especially those with metabolic syndrome, have higher overall mortality, cardiovascular mortality, and liver-related mortality compared with the general population. According to the population-based studies, NAFLD and NASH are more prevalent in males and in Hispanics. Both the gender and racial ethnic differences in NAFLD and NASH are likely attributed to interaction between environmental, behavioral, and genetic fac-tors. Using genome-wide association studies, several genetic variants have been identified to be associated with NAFLD/NASH. However, these variants account for only a small amount of variation in hepatic steatosis among ethnic groups and may serve as modifiers of the natural history of NAFLD. Alternatively, these variants may not be the causative variants but simply markers representing a larger body of genetic variations. In this article, we provide a concise review of the gender and racial differences in the prevalence of NAFLD and NASHin adults. We also discuss the possible mechanisms for these disparities.

关键词： Nonalcoholic fatty liver disease Nonalcohol-ic steatohepatitis Race Gender Prevalence Genetic polymorphism

Combination strategies for pharmacologic treatment of nonalcoholic steatohepatitis

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World Journal of Gastroenterology 2022年第35期28卷 5129-5140页

作者： Jaspreet Suri Sebastian Borja Joseph K Lim Department of Gastroenterology Norwalk HospitalNorwalkCT 06856United States Department of Internal Medicine Norwalk HospitalNorwalkCT 06850United States Section of Digestive Diseases Yale University School of MedicineNew HavenCT 06520United States

Non-alcoholic steatohepatitis (NASH) is defined as hepatic steatosis, inflammation,and hepatocyte injury with or without fibrosis. It has emerged as thesecond leading indication for liver transplantation with a rising death rate in thenon-transplantable population. While there are many drugs in evaluation,currently no approved therapies are on the market for this condition. Given thisimportance, the Food and Drug Administration has provided formal guidanceregarding drug development for stopping or reversing NASH or NASH associatedfibrosis. The complex pathogenesis of NASH and its bidirectional relationshipwith metabolic syndrome has highlighted multiple drugs of interest thataddress metabolic, inflammatory, and fibrotic factors. A few promising liverspecific targets include farnesoid X receptor agonists and peroxisome proliferatoractivatedreceptor agonists. Previously studied drug classes such as glucagon-likepeptide-1 analogs or sodium/glucose transport protein 2 inhibitors have alsodemonstrated ability to improve hepatic steatosis. Here we discuss currentrationale, scientific work, and preliminary data in combining multiple drugs forthe purposes of a multimodal attack on the pathogenesis of NASH. We highlightmultiple Phase 2 and Phase 3 studies that demonstrate the potential to achieve aresponse rate higher than previously assessed monotherapies for this ***, one of these combination strategies may rise above in its safety andefficacy to become a part of a standardized approach to NASH.

关键词： Non-alcoholic steatohepatitis Fatty liver Combination treatment Drug therapy Pharmacologic treatment Clinical trials