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Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer

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World Journal of Gastroenterology 2012年第9期18卷 889-895页

作者： Stuart Paterson Fraser Duthie Adrian J Stanley Department of Gastroenterology Forth Valley Royal Hospital Department of Pathology Glasgow Royal Infirmary Department of Gastroenterology Glasgow Royal Infirmary

AIM： To assess quantitative endoscopic ultrasound （EUS）- guided elastography in the nodal staging of oesophago- gastric cancers.METHODS： This was a single tertiary centre study as- sessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy （FNAB） of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS charac- teristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.

关键词： Endoscopic ultrasound Oesophageal cancerLymph nodes Elastography Tumour staging

Simulating traumatic brain injury in vitro:developing high throughput models to test biomaterial based therapies

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Neural Regeneration Research 2023年第2期18卷 289-292页

作者： Raja Haseeb Basit Jessica Wiseman Farhana Chowdhury Divya Maitreyi Chari bradford royal infirmary BradfordWest YorkshireUK Sheffield Institute for Translational Neuroscience University of SheffieldSheffieldUK Labcorp Drug Development HarrogateUK Neural Tissue Engineering Keele Group School of MedicineKeele UniversityStaffordshireUK

Traumatic brain injuries are serious clinical incidents associated with some of the poorest outcomes in neurological *** with the limited regenerative capacity of the brain,this has significant implications for patients,carers,and healthcare systems,and the requirement for life-long care in some *** treatment currently focuses on limiting the initial neural damage with longterm care/support from multidisciplinary *** targeting neuroprotection and neural regeneration are not currently available but are the focus of intensive ***-based interventions are gaining popularity for a range of applications including biomolecule and drug delive ry,and to function as cellular *** investigations into the development of such novel therapeutics for traumatic brain injury will be critically underpinned by the availability of appropriate high thro ughput,facile,ethically viable,and pathomimetic biological model *** represents a significant challenge for researchers given the pathological complexity of traumatic brain ***,there is a concerted post-injury response mounted by multiple neural cell types which includes microglial activation and astroglial scarring with the expression of a range of growth inhibito ry molecules and cytokines in the lesion ***,we review common models used for the study of traumatic brain injury(ranging from live animal models to in vitro systems),focusing on penetrating traumatic brain injury *** discuss their relative advantages and drawbacks for the developmental testing of biomaterial-based therapies.

关键词： astroglial scar biomaterial cortical culture in vitro model microglial infiltration multicellular model penetrating injury scaffold traumatic brain injury

Radiofrequency ablation for early oesophageal squamous neoplasia:Outcomes form United Kingdom registry

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World Journal of Gastroenterology 2013年第36期19卷 6011-6019页

作者： Rehan J Haidry Mohammed A Butt Jason Dunn Matthew Banks Abhinav Gupta Howard Smart Pradeep Bhandari Lesley Ann Smith Robert Willert Grant Fullarton Morris John Massimo Di Pietro Ian Penman Marco Novelli Laurence B Lovat Department of Surgery and Interventional Science National Medical Laser Centre UCL Department Gastroenterology University College Hospital NHS Foundation Trust Department Gastroenterology Guy’s and St Thomas’ Hospitals NHS Trust Institute for Medical Informatics Oslo University Hospital Department Gastroenterology Royal Liverpool University Hospital Merseyside Department Gastroenterology Princess Alexandra Hospital Cosham Department Gastroenterology Bradford Royal Infirmary Bradford Department Gastroenterology Central Manchester University Hospital Department Gastroenterology Glasgow Royal Infirmary Department Gastroenterology Addenbrooke’s Hospital royal infirmary Edinburgh

AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National ***:A Prospective cohort study from 8 tertiary referral centres in the United *** with squamous high grade dysplasia(HGD)and early squamous cell carcinoma(ESCC)confined to the mucosa were *** lesions were removed by endoscopic mucosal resection(EMR)before *** initial RFA treatment,patients were followed up *** flat dysplasia was treated with RFA until complete reversal dysplasia(CR-D)was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or *** main outcome measures were CR-D at 12 mo from start of treatment,long term durability,progression to cancer and adverse ***:Twenty patients with squamous HGD/ESCC completed treatment *** patients(25%)had EMR before starting RFA ***-D was 50%at12 mo with a median of 1 RFA treatment,mean 1.5(range 1-3).Two further patients achieved CR-D with repeat RFA after this *** per cent with CR-D remain dysplasia free at latest biopsy,with median follow up 24 mo(IQR 17-54).Six of 20 patients(30%)progressed to invasive cancer at 1 *** patients(20%)required endoscopic dilatations for symptomatic structuring after *** of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per *** other 2 patients required only a single dilatation to achieve an adequate symptomatic *** patient developed cancer during follow up after end of treatment ***:The role of RFA in these patients re-mains *** our series 50%patients responded at12 *** figures are lower than limited published data.

关键词： Squamous neoplasia Oesophageal cancer Endoscopic mucosal resection High-grade dysplasia Radiofrequency ablation

Are “Straight to Test” Pathways Always Best for Patients? A Prospective Observational Study of Two-Week-Wait Colorectal Referrals

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Surgical Science 2013年第10期4卷 443-447页

作者： Frances Mosley Jon R. Ausobsky John P. Griffith bradford royal infirmary Bradford UK Yorkshire and the Humber Deanery Bradford UK

Aim: Many centres have adopted a straight to test approach to deliver a fast-track service for suspected lower GI cancer. We undertook a prospective comparison between patients having a straight to test (STT) flexible sigmoidoscopy and those attending an outpatient appointment (OPA). The study aimed to determine whether STT reduced diagnostic time without additional investigations. Methods: An observational study of 200 consecutive fast-track colorectal referrals was undertaken. Data collected included: patient demographics, whether STT or OPA, investigations undertaken (including dates) and final diagnosis. Outcomes were compared by adjusted linear regression and logistic regression, for numerical and binary outcomes respectively. Potential confounding factors included were: age, gender and whether NICE referral criteria were achieved. Results: 186 out of 200 referrals attended their appointment, 62% (116/186) went STT and 38% (70/186) had an OPA. No significant difference was seen in the number of days to final investigation, adjusted coefficient -3.71, 95% C.I. -8.92 to 1.50. The STT group had 0.4 more tests per patient, adjusted 95% C.I. 0.07 to 0.73, than the OPA group. Significantly more patients in the STT group had a flexible sigmoidoscopy in addition to whole colonic imaging (all modalities), compared to the OPA group, adjusted OR of 93.47 (95% C.I. 29.26 to 298.54). Conclusion: This study highlights the potential disadvantages of STT flexible sigmoidoscopy for patients referred under the two-week-rule with suspected lower GI cancer. Despite the previously published work highlighting the potential cost and time benefits, it may come at the sacrifice of exposing patients to additional investigations.

关键词： Colorectal Neoplasms (MeSH) Endoscopy Gastrointestinal (MeSH) Colorectal Surgery (MeSH) 2-Week-Wait Fast-Track Straight to Test (No MeSH Term)

Utility of faecal calprotectin analysis in adult inflammatory bowel disease

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World Journal of Gastroenterology 2012年第46期18卷 6782-6789页

作者： Lyn A Smith Daniel R Gaya Inflammatory Bowel Diseases Service Gastroenterology Unit Glasgow Royal Infirmary

The inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, are chronic relapsing, remitting disorders. Diagnosis, along with assessment of disease activity and prognosis present challenges to managing clinicians. Faecal biomarkers, such as faecal calprotectin, are a non-invasive method which can be used to aid these decisions. Calprotectin is a calcium and zinc binding protein found in the cytosol of human neutrophils and macrophages. It is released extracellularly in times of cell stress or damage and can be detected within faeces and thus can be used as a sensitive marker of intestinal inflammation. Faecal calprotectin has been shown to be useful in the diagnosis of IBD, correlates with mucosal disease activity and can help to predict response to treatment or relapse. With growing evidence supporting its use, over the last decade this faecal biomarker has significantly changed the way IBD is managed.

关键词： Faecal calprotectin Inflammatory bowel disease Crohn's disease Ulcerative colitis Faecal biomarker

Management of patients with a short bowel

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World Journal of Gastroenterology 2001年第6期7卷 741-751页

作者： Jeremy M D Nightingale Consultant Gastroenterologist Gastroenterology CentreLeicester Royal InfirmaryUnited Kingdom

There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.

关键词： Colon Digestive System Humans Jejunostomy Nutrition Disorders Risk Factors Short Bowel Syndrome

Cytokine profiles in patients receiving antioxidant therapy within the ANTICIPATE trial

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World Journal of Gastroenterology 2013年第25期19卷 4001-4006页

作者： Nehal Shah Ajith K Siriwardena Hepato-Pancreato-Biliary Surgery Unit Manchester Royal Infirmary

AIM: To measure a broad profile of pro-and anti-inflammatory cytokines in patients with clinically proven chronic pancreatitis (CP) taking either antioxidant therapy or placebo as part of the larger ANTICIPATE study. METHODS: Patients with chronic pancreatitis were recruited to the ANTICIPATE study following informed consent and were randomised to intervention with either antox version 1.2-based antioxidant therapy or placebo. After a separate ethics committee amendment a subgroup of 7 patients from either arm of the study were selected for additional analysis of cytokines. Cytokines were measured at baseline and after 6 mo of either antox therapy or placebo by biochip array and enzyme-linked immunosorbent assay. RESULTS: Antioxidant therapy and placebo groups were well-matched in terms of age, gender, aetiology of CP, opiate use and disease duration. Baseline antioxidant levels were similar in patients allocated to the antioxidant group as compared to the group al- located to placebo. After 6 mo of antioxidant therapythere was significant elevation in vitamin C levels in the intervention group: 17.6 μg/mL (12.8-29.3 μg/mL) compared to 4.8 μg/mL (1.6-9.1 μg/mL) in placebo (P < 0.001; 95%CI: 9.0-20.2) with similar trends in selenium levels. There was no elevation in a broad array of pro-and anti-inflammatory cytokines in the antioxidant group compared to placebo [interleukin (IL)-1B, IL-4, IL-6, IL-10, tumor necrosis factor-α] either at baseline or after 6 mo of antioxidant therapy. CONCLUSION: Cytokine levels were low at baseline and at 6 mo despite a significant elevation in plasma antioxidants. In patients with CP, with opiate-dependent abdominal pain, circulating cytokine levels are low suggesting that pain in this disease is not simply a manifestation of inflammation.

关键词： Chronic pancreatitis Antioxidant therapy Cytokine

Takayasu's arteritis following Crohn's disease in a young woman:Any evidence for a common pathogenesis?

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World Journal of Gastroenterology 2008年第25期14卷 4087-4090页

作者： Melissa AL Farrant Justin C Mason Newton ACS Wong Robert J Longman Department of Surgery Bristol Royal Infirmary Marlborough Street Rheumatology Unit Imperial College London Hammersmith Hospital Department of Histopathology Bristol Royal Infirmary Marlborough Street Colorectal Unit Bristol Royal Infi rmary Marlborough Street

Takayasu's arteritis and Crohn's disease are chronic in-flammatory diseases of uncertain aetiology. They rarely occur together, with only twenty nine cases of co-ex-istent Takayasu's arteritis and Crohn's disease reported in the literature. In 88% of these cases, Takayasu's arteritis was diagnosed simultaneously or following a diagnosis of Crohn's disease. We present a case of a young Caucasian medical student, incidentally found to have bilateral carotid bruits on auscultation by a colleague. Magnetic resonance angiography revealed stenoses of the common carotid arteries with estab-lished collaterals, and a diagnosis of Type 1 Takayasu's arteritis was made. An 18F-fluorodeoxyglucose positron emission tomography scan revealed no active disease. Nine months later, she presented with a short history of abdominal pain, vomiting and abdominal disten-sion. Barium follow-through and computer tomography revealed a terminal ileal stricture and proximal small bowel dilation. An extended right hemicoloectomy was performed and histopathology supported a diagnosis of Crohn's disease. This case report is presented with a particular focus on the temporal relationship between these two disease processes and explores whether their concurrence is more than just co-incidence.

关键词： Crohn's disease Granuloma Takayasu'sarteritis

Role of inflammation and infection in the pathogenesis of human acute liver failure: clinical implications for monitoring and therapy

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World Journal of Gastroenterology 2016年第26期22卷 5958-5970页

作者： Mhairi C Donnelly Peter C Hayes Kenneth J Simpson Department of Hepatology and Scottish Liver Transplant Unit Royal Infirmary of Edinburgh

Acute liver failure is a rare and devastating clinical condition. At present, emergency liver transplantation is the only life-saving therapy in advanced cases, yet the feasibility of transplantation is affected by the presence of systemic inflammation, infection and resultant multiorgan failure. The importance of immune dysregulation and acquisition of infection in the pathogenesis of acute liver failure and its associated complications is now recognised. In this review we discuss current thinking regarding the role of infection and inflammation in the pathogenesis of and outcome in human acute liver failure, the implications for the management of such patients and suggest directions for future research.

关键词： Inflammation Neuroinflammation Acute liver failure Biomarker Infection