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Prognostic relevance of minimal residual disease in colorectal cancer

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World Journal of Gastroenterology 2014年第30期20卷 10296-10304页

作者： Ulrich Bork Robert Grützmann Nuh N Rahbari Sebastian Schlch Marius Distler Christoph Reissfelder Moritz Koch Jürgen Weitz department of GI Thoracic and Vascular SurgeryUniversity Hospital DresdenTU Dresden01307 DresdenGermany

Presence of occult minimal residual disease in patients with colorectal cancer(CRC)has a strong prognostic impact on *** residual disease plays a major role in disease relapse and formation of metastases in *** of circulating tumor cells(CTC)in the blood is increasingly used in clinical practice for disease monitoring of CRC *** this review article the role of CTC,disseminated tumor cells(DTC)in the bone marrow and micrometastases and isolated tumor cells(ITC)in the lymph nodes will be discussed,including literature published until September *** disease is a strong prognostic marker for patient survival in CRC and defined by the presence of CTC in the blood,DTC in the bone marrow and/or micrometastases and ITC in the lymph *** residual disease could be used in the future to identify patient groups at risk,who might benefit from individualized treatment options.

关键词： Colorectal cancer Circulating tumor cells Disseminated tumor cells Isolated tumor cells Micrometastases Occult disease Minimal residual disease

Reactivity against microsatellite instability-induced frameshift mutations in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2015年第1期21卷 221-228页

作者： Florian Kuehn Ernst Klar Anja Bliemeister Michael Linnebacher department of General ThoracicVascular and Transplantation SurgeryMolecular Oncology and ImmunotherapyUniversity of Rostock18057 RostockGermany

AIM: To analyze the cellular immune response towards microsatellite-instability(MSI)-induced frameshift-peptides(FSPs) in patients suffering from inflammatory bowel disease(IBD) with and without thiopurine-based immunosuppressive ***: Frequencies of peripheral blood T cell responses of IBD patients(n = 75) against FSPs derived from 14 microsatellite-containing candidate genes were quantified by interferon-γ enzyme-linked immunospot.T cells derived from 20 healthy individuals served as ***: Significant T cell reactivities against MSIinduced FSPs were observed in 59 of 75 IBD patients(78.7%).This was significantly more as we could observe in 20 healthy controls(P = 0.001).Overall,the reactivity was significantly influenced by thiopurine treatment(P = 0.032) and duration of disease(P = 0.002) but not by duration or cumulative amount of thiopurine therapy(P = 0.476).Unexpected,15 of 24(62.5%) IBD patients without prior thiopurine treatment also showed increased FSP-specific immune responses(P = 0.001).CONCLUSION: These findings propose FSPs as potential novel class of inflammation-associated antigens and this in turn may have implications for screening,diagnosis as well as clinical management of patients suffering from IBD and other inflammatory conditions.

关键词： Microsatellite-instability Inflammatory bowel dise

Update on cardiomyopathies and sudden cardiac death

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Forensic Sciences Research 2019年第3期4卷 202-210页

作者： Stefania Rizzo Elisa Carturan Monica De Gaspari Kalliopi Pilichou Gaetano Thiene Cristina Basso cardiovascular Pathology Department of Cardio-Thoracic-Vascular Sciences&Public Health and Azienda OspedalieraUniversity of Padua Medical SchoolPaduaItaly

Sudden cardiac death (SCD) remains a leading mode of death in western *** SCD can be the first and last clinical presentation of the underlying disease,autopsy could be the only medical examination available for early diagnosis and it should be performed according to the guidelines of the Association for European cardiovascular *** the vast majority of SCD are due to coronary artery disease,non-ischemic causes of SCD do exist and are prevalent in young people with structural (***,hypertrophic and inflammatory cardiomyopathy) and non-structural (ion channel diseases)cardiomyopathies,accounting for up to one half of cases.A standardized autopsy protocol,in combination with blood sampling to ensure feasibility of postmortem molecular testing if needed,is *** pathologist is called to provide the correct diagnosis and to advice the relatives on the need of a cascade clinical and genetic screening in the presence of a heredo-familial disease.

关键词： Forensic sciences forensic pathology autopsy cardiomyopathies genetics sudden death

Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy

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World Journal of Gastroenterology 2015年第38期21卷 10915-10925页

作者： Dirk R Bulian Jurgen Knuth Kai S Lehmann Axel Sauerwald Markus M Heiss department of Abdominal Vascular and Transplant SurgeryCologne-Merheim Medical CenterWitten/Herdecke University department of General VisceralVascular and Thoracic SurgeryHospital of Kempten department of General Visceral and Vascular SurgeryCharite? University Medical Center BerlinCampus Benjamin Franklin department for Obstetrics and Gynaecology Holweide Holweide Hospital

AIM: To evaluate transvaginal hybrid-NOTES cholecystectomy(TVC) during its clinical establishment and compare it with the traditional laparoscopic technique(LC).METHODS: The specific problems and benefits of TVC were reviewed using a registry analysis,a comparative cohort study and a randomized clinical trial. At first,feasibility,safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry(GNR). Hereafter,we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LCpatients matched by age,BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index(FSFI-d). Consequently,we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies(NC) also concerning the early postoperative results as well as pain,satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index(GIQLI) in the later course. Finally,we discussed the results in accordance with other published ***: The complication(3.5%) and conversion rates(4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder(n = 4; 0.8%) and bowel(n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery(NRS,1.5/10 vs 3.1/10,P = 0.003),in the morning(NRS,1.9/10 vs 2.8/10,P = 0.047) and in the evening(NRS,1.1/10 vs 1.8/10,P = 0.025) of postoperative day(POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2(NRS,8/40 vs 14/40,P = 0.043),as well as until POD 10(NRS,22/190 vs 41/190,P = 0.010)

关键词： NOTES Cholecystolithiasis Postoperative complicati

Proton pump inhibitors and dysbiosis: Current knowledge and aspects to be clarified

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World Journal of Gastroenterology 2019年第22期25卷 2706-2719页

作者： Giovanni Bruno Piera Zaccari Giulia Rocco Giulia Scalese Cristina Panetta Barbara Porowska Stefano Pontone Carola Severi department of Internal Medicine and Medical Specialties Gastroenterology UnitSapienza University of RomeRome 00161Italy department of Surgical Sciences Sapienza University of RomeRome 00161Italy department of cardio-thoracic Vascular Surgery and TransplantsSapienza University of RomeRome 00161Italy

Proton pump inhibitors (PPIs) are common medications within the practice of gastroenterology. These drugs, which act through the irreversible inhibition of the hydrogen/potassium pump (H+/K+-ATPase pump) in the gastric parietal cells, are used in the treatment of several acid-related disorders. PPIs are generally well tolerated but, through the long-term reduction of gastric acid secretion, can increase the risk of an imbalance in gut microbiota composition (i.e., dysbiosis). The gut microbiota is a complex ecosystem in which microbes coexist and interact with the human host. Indeed, the resident gut bacteria are needed for multiple vital functions, such as nutrient and drug metabolism, the production of energy, defense against pathogens, the modulation of the immune system and support of the integrity of the gut mucosal barrier. The bacteria are collected in communities that vary in density and composition within each segment of the gastrointestinal (GI) tract. Therefore, every change in the gut ecosystem has been connected to an increased susceptibility or exacerbation of various GI disorders. The aim of this review is to summarize the recently available data on PPI-related microbiota alterations in each segment of the GI tract and to analyze the possible involvement of PPIs in the pathogenesis of several specific GI diseases.

关键词： Proton pump inhibitors Hypochloridria Gut microbiota Dysbiosis Gastrointestinal tract Cancer Helicobacter pylori Gastrointestinal infections

Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report

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Case Reports in Clinical Medicine 2015年第6期4卷 222-226页

作者： Amarjit Singh Kuldip Singh Sidhu Shivaji Rai department of cardio-thoracic and vascular surgery Government Medical College Amritsar India

An 18 years old female patient was given a test dose of Benzyl penicillin in the Antecubital Area on the right forearm by a staff nurse of the department. After the injection, the patient complained of severe pain in the right forearm distal to the injection site. This was followed by blanching of the right forearm and hand. She was immediately heparinised followed by other symptomatic treatments. After 12 hours, a bluish discoloration developed on the hand, both on dorsal and palmar aspect, sparing the thumb. This recovered with medication, except the late development of dry gangrene of the tip of distal phalanx of the little finger which got shrivelled later on. Color Doppler flow study, echocardiography, and CT angiography of the right upper limb were done. Understanding of the pathogenesis and prompt action can help in saving a limb. Education of the medical professionals involved in administering injection is necessary so that they become aware of abnormal course or anomalous anatomy of vessels of upper limb. This can help to prevent the complications.

关键词： Intra-Arterial Injection Gangrene Anomalous Anatomy

Risk factors and outcomes for patients with pancreatic cancer undergoing surgical exploration without resection due to metastatic disease:A national cohort study

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 279-284页

作者： Emil Sahlstrom Paulina Bereza-Carlson Johan Nilsson Bobby Tingstedt Bodil Andersson department of Clinical Sciences Lund SurgeryLund UniversitySweden department of surgery Central Hospital KristianstadSweden department of Translational Medicine Cardiothoracic surgery and bioinformaticsLund UniversitySweden department of thoracic and vascular surgery Skane University hospitalLundSweden department of surgery Skane University HospitalLundSweden

Background:Unresectable disease is sometimes diagnosed during surgery in patients with pancreatic ductal adenocarcinoma(PDAC).This study aimed to identify preoperative risk factors for metastatic disease diagnosed at surgical exploration and to investigate and compare survival in resected and nonresected ***:Patients were identified from the Swedish National Pancreatic and Periampullary Cancer Registry *** of metastatic disease were evaluated with a multivariable logistic regression model,and survival was evaluated with Kaplan-Meier estimates and log-rank ***:In total,1938 patients with PDAC were scheduled for *** unresectable situation was diagnosed intraoperatively in 399 patients(20.6%),including 234(12.1%)with metastasized *** risk factors for metastasis were involuntary weight loss(OR=1.72;95%CI:1.27-2.33)and elevated carbohydrate antigen 19-9(CA19-9)(35-599 U/m L,OR=1.79,95%CI:1.11-2.89;≥600 U/m L,OR=3.24,95%CI:2.04-5.17).Overall survival was lower among patients with metastasized disease than that among patients with a resectable tumor(P<0.001).Conclusions:Involuntary weight loss and an elevation of CA19-9 are preoperative risk factors for diagnosing metastasized disease during surgical exploration.

关键词： Pancreatic cancer surgery Metastasized Exploration

Extracorporeal membrane oxygenation in lung transplantation:Indications,techniques and results

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World Journal of Transplantation 2021年第7期11卷 290-302页

作者： Eleonora Faccioli Stefano Terzi Alessandro Pangoni Ivan Lomangino Sara Rossi Andrea Lloret Giorgio Cannone Carlotta Marino Chiara Catelli Andrea Dell'Amore thoracic surgery Unit Department of Cardiothoracic and Vascular SciencesUniversity of PadovaPadova 35128Italy

The use of extracorporeal membrane oxygenation(ECMO)in the field of lung transplantation has rapidly expanded over the past 30 *** has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative *** is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the *** example,patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous(VV)ECMO or peripheral veno-arterial(VA)ECMO in the case of hemodynamic ***,in an intraoperative setting,VV ECMO can be maintained or switched to a VA *** routine use of intra-operative ECMO and its eventual prolongation in the postoperative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion *** review will assess the current evidence on the role of ECMO in the different phases of lung transplantation,while analyzing different studies on pre,intra-and post-operative utilization of this extracorporeal support.

关键词： Lung transplantation Extracorporeal membrane oxygenation Bridge to transplantation Support Primary graft dysfunction Ischemia-reperfusion injury

Personalized Management of Anastomotic Leak after surgery for Esophageal Carcinoma

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Chinese Medical Sciences Journal 2012年第1期27卷 35-40页

作者： Hong-yu Ye Wei-zhao Huang Yin-meng Wu Yi Liang Jun-meng Zheng Hai-ming Jiang department of cardio-thoracic surgery Zhongshan Hospital of Sun Yat-sen University(Zhongshan People's Hospital)Zhongshan 528403China

Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. Results A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0±31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. Conclusions Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective *** efficacy of stent implantation needs further investigation to confirm.

关键词： esophageal surgery anastomotic leak resurgery stent