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Diagnosis of gastric intraepithelial neoplasia by narrow-band imaging and confocal laser endomicroscopy

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World Journal of Gastroenterology 2012年第34期18卷 4771-4780页

作者： Shu-Fang Wang Yun-Sheng Yang Li-Xin Wei Zhong-Sheng Lu Ming-Zhou Guo Jin Huang Li-Hua Peng Gang Sun En-Qiang Ling-Hu Jiang-Yun Meng departments of Gastroenterology and hepatology Chinese PLA General Hospital Beijing 100853 China departments of Pathology Chinese PLA GeneralHospital Beijing 100853 China

AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear v

关键词： Gastric intraepithelial neoplasia Histologicaldiagnosis Confocal laser endomicroscopy Magnifica-tion endoscopy Narrow-band imaging Gastric intraepi-thelial neoplasia lesion

Is it relevant that intra-arterial chemotherapy may be effective for advanced pancreatic cancer?

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World Journal of Gastroenterology 2007年第32期13卷 4306-4309页

作者： Toru Ishikawa departments of Gastroenterology and hepatology Saiseikai Niigata Second HospitalNiigataJapan

Unresectable pancreatic cancers have an extremely dismal prognosis and chemoresistant nature. The treatment of pancreatic cancer is still problematic. Gemcitabine is a promising new agent that has been studied recently for palliation of advanced pancreatic cancer. However,the response rates have been highly variable,and are often irreproducible. To improve this low response rate,various treatments are needed because no standard treatment exists. Intra-arterial chemotherapy is considered to take advantage of the first pass effect of the drug,generating higher local drug concentrations in tumor cells with lower toxicity. Regional intra-arterial chemotherapy may provide high levels of cytostatic concentrations within the tumor and,simultaneously,a low rate of systemic side effects compared with systemic administration of anti-neoplastic drugs. Intra-arterial chemotherapy has been introduced as an alternative treatment for advanced pancreatic cancer. Further clinical trials of this method should be subjected to a prospective randomized controlled study for advanced pancreatic cancer.

关键词： Pancreatic cancer Intra-arterial chemotherapy Systemic chemotherapy

Endoscopic management of postcholecystectomy biliary leakage

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Hepatobiliary & Pancreatic Diseases International 2010年第4期9卷 409-413页

作者： Virendra Singh Gurpreet Singh Ganga R Verma Rajesh Gupta departments of hepatology Postgraduate Institute of Medical Education and Research departments of Surgery Postgraduate Institute of Medical Education and Research

BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known. METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated. RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients Four developed mild pancreatitis which improved with conservative ***: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.

关键词： biliary fistulae endoscopic retrograde cholangiopancreatography sphincterotomy biliary stent nasobiliary drain biliary strictures

Cytokine Storm of COVID-19 and Its Impact on Patients with and without Chronic Liver Disease

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Journal of Clinical and Translational hepatology 2021年第2期9卷 256-264页

作者： Madhumita Premkumar Chandan Kumar Kedarisetty departments of hepatology Postgraduate Institute of Medical Education and ResearchChandigarhIndia Department of hepatology and Liver transplantation Gleneagles Global HospitalHyderabadIndia

The coronavirus pandemic has resulted in increased rates of hepatic decompensation,morbidity and mortality in patients suffering from existing liver disease,and deranged liver biochemistries in those without liver *** patients with cirrhosis with coronavirus disease 2019(COVID-19),new onset organ failures manifesting as acute-onchronic liver failure have also been *** severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)also directly binds to enterocytes and cholangiocytes via the angiotensin converting enzyme receptor 2,although the lung remains the portal of *** with the COVID-19 related bystander hepatitis,a systemic inflammatory response is noted due to unregulated macrophage activation syndrome and cytokine ***,the exact definition and diagnostic criteria of the‘cytokine storm’in COVID-19 are yet *** addition,inflammatory markers like C-reactive protein,ferritin,D-dimer and procalcitonin are frequently *** in turn leads to disease progression,activation of the coagulation cascade,vascular microthrombi and immune-mediated injury in different organ *** liver chemistries are also noted due to the cytokine storm,and synergistic hypoxic or ischemic liver injury,drug-induced liver injury,and use of hepatotoxic antiviral agents all contribute to deranged liver *** of an unregulated cytokine storm at an early stage may avert disease morbidity and *** immunomodulator drugs and repurposed immunosuppressive agents have been used in COVID-19 with varying degrees of success.

关键词： Chronic liver disease COVID-19 Cytokines Hepatitis Gut-liver axis

Are faecal markers good indicators of mucosal healing in inflammatory bowel disease?

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World Journal of Gastroenterology 2015年第40期21卷 11469-11480页

作者： Gudula JAM Boon Andrew S Day Chris J Mulder Richard B Gearry departments of Paediatrics University of Otago Department of Gastroente-rology and hepatology VU University Medical CenterUniversity of Amsterdam departments of Medicine University of Otago

AIM: To review the published literature concerning the accuracy of faecal inflammatory markers for identifying mucosal healing. METHODS: Bibliographical searches were performed in MEDLINE electronic database up to February 2015,using the following terms: "inflammatory bowel disease","Crohn′s disease","ulcerative colitis","faecal markers","calprotectin","lactoferrin","S100A12","endoscop*","mucosal healing","remission". In addition,relevant references from these studies were also included. Data were extracted from the published papers including odds ratios with 95%CI,P values and correlation coefficients. Data were grouped together according to each faecal marker,Crohn's disease or ulcerative colitis,and paediatric compared with adult study populations. Studies included in this review assessed mucosal inflammation by endoscopic and/or histological means and compared these findings to faecal marker concentrations in inflammatory bowel diseases(IBD) patient cohorts. Articles had to be published between 1990 and February 2015 and written in English. Papers excluded from the review were those where the faecal biomarker concentration was compared between patients with IBD and controls or other disease groups,those where serum biomarkers were used,those with a heterogeneous study population and those only assessing post-operative disease. RESULTS: The available studies show that faecal markers,such as calprotectin and lactoferrin,are promising non-invasive indicators of mucosal healing. However,due to wide variability in study design,especially with regard to the definition of mucosal healing and evaluation of marker cut offs,the available data do not yet indicate the optimal roles of these markers. Thirty-six studies published between 1990 and 2014 were included. Studies comprised variable numbers of study participants,considered CD(15-164 participants) or UC(12-152 participants) separately or as a combined group(11-252 participants). Eight reports included paediatric pati

关键词： Crohn’s disease Ulcerative colitis Mucosal healing

Contrast-free air cholangiography-assisted unilateral plastic stenting in malignant hilar biliary obstruction

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 88-92页

作者： Virendra Singh Gurpreet Singh Vikas Gupta Rajesh Gupta Rakesh Kapoor departments of hepatology Postgraduate Institute of Medical Education and Research departments of Surgery Postgraduate Institute of Medical Education and Research departments of Radiotherapy Postgraduate Institute of Medical Education and Research

BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to ***-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are *** have been no reports on the use of air ***:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical ***:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were *** cholangiography detected type Ⅱ obstruction in all patients,similar to *** patients underwent unilateral *** endoscopic drainage was achieved in all *** mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major *** cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal ***:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.

关键词： air cholangiogram hilar obstruction malignant plastic stent metal stent unilateral

Frequency and risk factors of low immunoglobulin levels in patients with inflammatory bowel disease

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Gastroenterology Report 2015年第2期3卷 115-121页

作者： Tarun Rai Xianrui Wu Bo Shen departments of General Internal Medicine and Gastroenterology/hepatology the Cleveland Clinic FoundationClevelandOHUSA

Background and aims:Inflammatory bowel diseases(IBD)are considered to be dysregulated,immune-mediated disorders;and immunosuppressive medications are the mainstay of their ***,we have often observed low serum immunoglobulin(Ig)levels in these *** aim of this study was to assess the frequency and risk factors of secondary humoral immunodeficiency in IBD ***:We conducted a cross-sectional study of eligible IBD patients with Crohn’s disease(CD),ulcerative colitis(UC),indeterminate colitis(IC)or restorative proctocolectomy with ileal pouch,who having serum Ig *** and clinical variables were *** and multivariate analyses were ***:A total of 324 patients was included,with a mean age of 38.8 years and 158(48.8%)being *** IgG,IgG1,IgA,and IgM were found in 22.7%,23.4%,7.9%,and 10.9%of patients,*** shared risk factors for a low IgG or IgM level were increasing age[odds ratio(OR)=1.13;95%confidence interval(CI)1.03–1.23 for low IgG level and OR=1.33;95%CI 1.15–1.56 for low IgM level]and hypoalbuminemia(OR=1.83;95%CI 1.01–3.33 for low IgG level and OR=3.17;95%CI 1.23–8.15 for low IgM level).In addition,thioprine use was associated with low IgA level(OR=2.76;95%CI 1.03–7.39).IBD disease duration was a risk factor for low IgG1 level(OR=1.40;95%CI 1.12–1.76).The presence of concurrent primary sclerosing cholangitis(OR=0.064;95%CI 0.007–0.60)and the use of biologics(OR=0.16;95%CI 0.033–0.79)were associated with normal IgG1 *** level was lower in CD patients than that in UC/IC and ileal pouch patients(P=0.042).IgG and IgA levels were elevated in patients with inflammatory conditions of the pouch(P=0.01;P=0.003,respectively).Conclusions:Low Ig level appears to be common in IBD *** age,disease duration and hypoalbuminemia appeared to be risk *** findings may provide rationale for targeted therapy to boost humoral immunity in selected patients with IBD.

关键词： inflammatory bowel disease immunoglobulins biologics Crohn’s disease ulcerative colitis ileal pouch

Gender disparities and woman-specific trends in Barrett’s esophagus in the United States:An 11-year nationwide populationbased study

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World Journal of Methodology 2025年第1期15卷 60-71页

作者： Karina Fatakhova Faisal Inayat Hassam Ali Pratik Patel Attiq Ur Rehman Arslan Afzal Muhammad Sarfraz Shiza Sarfraz Gul Nawaz Ahtshamullah Chaudhry Rubaid Dhillon Arthur Dilibe Benjamin Glazebnik Lindsey Jones Emily Glazer Division of Gastroenterology and hepatology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Division of Gastroenterology and hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Division of Gastroenterology and hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Gastroenterology Hepatologyand NutritionCleveland Clinic FoundationClevelandOH 44195United States Department of Internal Medicine Mather Hospital and Hofstra University ZuckerSchool of MedicinePort JeffersonNY 11777United States

BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not *** practice guidelines include male gender as a predisposing factor for BE and *** population-based clinical evidence regarding female gender remains *** To study comparative trends of gender disparities in patients with BE in the United *** A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)*** with a primary or secondary diagnosis code of BE were *** major outcome of interest was determining the gender disparities in patients with *** analysis for respective outcomes for females was also reported to ascertain any time-based *** We identified 1204190 patients with BE for the study *** the included patients,717439(59.6%)were men and 486751(40.4%)were *** mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(***),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of *** and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among

关键词： Barrett’s esophagus Gender disparity Epidemiological trends Esophageal adenocarcinoma Screening endoscopy Female gender Risk factors

Direct ex vivo analysis of dendritic cells in patients with hepatocellular carcinoma

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World Journal of Gastroenterology 2006年第20期12卷 3275-3282页

作者： Lars A Ormandy Anatol Frber Tobias Cantz Susanne Petrykowska Heiner Wedemeyer Monique Hrning Frank Lehner Michael P Manns Firouzeh Korangy Tim F Greten Department of Gastroenterology hepatology and Endocrinology Hannover Medical SchoolGermany departments of Visceral and Transplantation Surgery Hannover Medical School Germany

AIM： To analyze the phenotype and function of dendritic cells （DC） from patients with hepatocellular carcinoma （HCC） in order to understand their role in this disease. METHODS： Myeloid dendritic cells were enumerated in peripheral blood of HCC patients. CD80, CD83, CD86 and HLA-DR expression on naive and stimulated myeloid dendritic cells from peripheral blood were analyzed. Myeloid dendritic cells were isolated from peripheral blood and their function was tested. Phagocytosis was analyzed using FITC-dextran beads, peptide specific stimulation, the capacity to stimulate allogeneic T cells and secretion of cytokines upon poly dZ：dC was tested. RESULTS： Myeloid dendritic cells were reduced in patients with HCC. No differences in CD80, CD83, CD86 and HLA-DR expression were found on naive and stimulated myeloid dendritic cells from HCC patients and healthy controls. Normal phagocytosis or stimulation of peptide specific T cells was observed in contrast to an impaired allo-stimulatory capacity and a reduced IL-12 secretion. CONCLUSION： Impaired IL-12 production of mDCs in patients could lead to an impaired stimulatory capacity of naive T cells suggesting that IL-12 directed therapies may enhance tumor specific immune responses in HCC patients.

关键词： Myeloid DC Hepatocellular carcinoma CD80 CD83 CD86