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Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas

World Journal of Gastrointestinal Oncology 2024年第4期16卷 1374-1383页

作者： Laura Sahyoun Kay Chen Cynthia Tsay George Chen Petr Protiva Department of gastroenterology and hepatology Weill Cornell MedicineNew YorkNY 10065United States gastroenterology Section Jennifer Moreno VA San Diego Healthcare SystemSan DiegoCA 92161United States division of gastroenterology Department of MedicineUniversity of California San DiegoLa JollaCA 92093United States Department of gastroenterology and hepatology John Hopkins HospitalBaltimoreMD 21287United States Department of Digestive Diseases Yale New Haven HospitalNew HavenCT 06520United States Department of gastroenterology VA Connecticut Health Care SystemWest HavenCT 06516United States

BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival ***,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer *** from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to ***-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban *** was calculated with Cox proportional hazards models for death in the 5-year period following *** Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma *** analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,P<0.05].Similarly,counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.

关键词： Biliary tract cancers Survival Outcomes research Socioeconomic factors Healthcare disparities

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Serum ferritin and the risk of early-onset colorectal cancer

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World Journal of Gastrointestinal Oncology 2024年第8期16卷 3496-3506页

作者： Adam L Urback Kylee Martens Hannah Stowe McMurry Emerson Y Chen Caitlin Citti Anil Sharma Adel Kardosh Joseph J Shatzel division of Internal Medicine Oregon Health&Science UniversityPortlandOR 97239United States division of Hematology and Medical Oncology Knight Cancer InstituteOregon Health&Science UniversityPortlandOR 97239United States division of gastroenterology&hepatology Oregon Health&Science UniversityPortlandOR 97239United States

BACKGROUND The incidence of early-onset colorectal cancer(EO-CRC)is rising in the United States,and is often diagnosed at advanced *** serum ferritin is often incidentally discovered in young adults,however,the indication for endoscopy in EO-CRC is *** To compare serum ferritin between patients with EO-CRC and healthy controls(HCs),and examine the association of serum ferritin in EO-CRC with patient-and disease-specific *** A retrospective study of patients<50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/*** were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic *** supplement the analysis,a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison.A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of *** Among 85 patients identified with EO-CRC(48 females),the median serum ferritin level was 26 ng/mL(range<1-2759 ng/mL).Compared to HCs(n=80211),there were a higher proportion of individuals with EO-CRC with serum ferritin<20 ng/mL(female 65%,male 40%)versus HCs(female 32.1%,male 7.2%)age 29-39 years(P=0.002 and P<0.00001,respectively).Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages(P<0.001).Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after *** findings were confirmed in the sensitivity *** Severe iron deficiency may indicate an increased risk of EO-CRC,particularly at earlier *** studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.

关键词： Early-onset Young-onset Colorectal cancer Age Ferritin Iron deficiency

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Emerging role of regulated cell death in intestinal failure-associated liver disease

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hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 228-233页

作者： Si-Yang Cheng Lu Jiang Ying Wang Wei Cai Department of Pediatric Surgery Xinhua HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200092China Shanghai Key Laboratory of Pediatric gastroenterology and Nutrition Shanghai 200092China Shanghai Institute for Pediatric Research Shanghai 200092China division of Pediatric gastroenterology and Nutrition Xinhua HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200092China

Intestinal failure-associated liver disease(IFALD)is a common complication of long-term parenteral nutrition that is associated with significant morbidity and *** is mainly characterized by cholestasis in children and steatohepatitis in ***,there is no effective approach to prevent or reverse the *** cell death(RCD)represents a fundamental biological paradigm that determines the outcome of a variety of liver *** cell death is reclassified into several types,based on the mechanisms and morphological *** evidence has linked different modes of RCD,such as apoptosis,necroptosis,ferroptosis,and pyroptosis to the pathogenesis of liver *** studies have shown that different modes of RCD are present in animal models and patients with *** the pathogenic roles of cell death may help uncover the underlying mechanisms and develop novel therapeutic strategies in *** this review,we discuss the current knowledge on how RCD may link to the pathogenesis of *** highlight examples of cell death-targeted interventions aiming to attenuate the disease,and provide perspectives for future basic and translational research in the field.

关键词： Parenteral nutrition Apoptosis Necroptosis Cholestasis Steatosis

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Previously undiagnosed Morgagni hernia with bowel perforation detected during repeat screening colonoscopy: A case report

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World Journal of Clinical Cases 2024年第14期12卷 2389-2395页

作者： Said Al Alawi Alan N Barkun Sara Najmeh division of gastroenterology McGill UniversityMontrealQC H4A 3J1Canada division of Thoracic surgery McGill UniversityMontrealQC H4A 3J1Canada

BACKGROUND Morgagni hernia(MH)is a form of congenital diaphragmatic hernia(CDH)characterized by an incomplete formation of diaphragm,resulting in the protru-sion of abdominal organs into the thoracic *** estimated incidence of CDH is between 1 in 2000 and 1 in 5000 live births,although the true incidence is *** typically presents in childhood and can be diagnosed either pre-natally or ***,it can also be asymptomatic and carry the risk of developing into a life-threatening condition in *** SUMMARY A 76-year-old female with no history of prior abdominal surgeries presented for an elective colonoscopy for polyp *** the procedure,when approaching the hepatic flexure,the scope could not be advanced further despite multiple *** patient experienced mild abdominal discomfort,leading to the abortion of the *** in the recovery area,she developed increa-sing abdominal pains and *** abdominal imaging revealed her-niation of the proximal transverse colon through a MH into the chest with evi-dence of *** patient underwent laparoscopic urgent colonic resection and primary hernia repair and was discharged uneventfully 2 d *** A MH is a rare condition in adults that can present as a life-threatening compli-cation of colonoscopy,even in patients with a history of uneventful *** case highlights the importance of considering congenital and internal hernias when faced with sudden and unexplained difficulties during *** there is a suspicion of MH,the endoscopist should halt the procedure and immediately obtain abdominal imaging to confirm the diagnosis.

关键词： Bowel perforation Colonoscopy Adverse event Congenital diaphragmatic

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Transjugular Intrahepatic Portosystemic Shunt Linked to Increased Risk of hepatocellular Carcinoma:A VA Matched Cohort Study

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Journal of Clinical and Translational hepatology 2024年第5期12卷 534-538页

作者： Shalini Bansal Tamar Taddei Rebecca Wells Marina Serper Theresa Bittermann Nadim Mahmud David E.Kaplan Sidney Kimmel Medical College at Thomas Jefferson University PhiladelphiaPAUSA division of gastroenterology and hepatology Perelman School of Medicine University of PennsylvaniaPhiladelphiaPAUSA Corporal Michael J.Crescenz VA Medical Center PhiladelphiaPAUSA division of gastroenterology and hepatology Yale University School of MedicineNew HavenCTUSA VA Connecticut Healthcare System West HavenCTUSA

hepatocellular carcinoma(HCC)is the most common primary tumor of the liver and often evolves from regenerating nodules in liver *** there have been significant advances in the treatment of HCC,the overall prognosis in patients with a large tumor burden,vascular invasion,or extrahepatic spread remains poor.1 The magnitude of liver stiffness in cirrhosis has been consistently associated with an increased risk of development of HCC.

关键词： Carcinoma invasion cirrhosis

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Digesting gluten with oral endopeptidases to improve the management of celiac disease

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World Journal of gastroenterology 2024年第26期30卷 3201-3205页

作者： Katelin Durham Mirac Nedim Ince Department of Internal Medicine Division of Gastroenterology and HepatologyUniversity of IowaCarver College of Medicineand the Iowa City Veterans Affairs Medical CenterIowa CityIA 52242United States

In our editorial,we want to comment on the article by Stefanolo et al titled“Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet”.Celiac disease is an immune-mediated disorder triggered by dietary gluten in genetically predisposed *** avoiding gluten can permit patients to live symptom-free,ongoing voluntary or involuntary exposure to gluten is common and associated with persistent villous atrophy in small bowel *** villous atrophy predisposes patients to life threatening complications,such as osteoporotic fractures or malignancies,therapeutic adjuncts to gluten-free diet become important to improve patients’quality of life and,if these adjuncts can be shown to improve villous atrophy,avoid *** administration of enzyme preparations,such as endopeptidases that digest gluten and mitigate its antigenicity to trigger inflam-mation,is one clinical strategy under *** article is about the utility of one endopeptidase isolated from Aspergillus *** critique findings of this clinical trial and also summarize endopeptidase-based as well as other strategies and how they can complement gluten-free diet in the management of celiac disease.

关键词： Celiac disease Gluten-free diet Endopeptidase Villous atrophy Aspergillus niger Adjunct therapy

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Association of Omega-3 Polyunsaturated Fatty Acids with Sarcopenia in Liver Cirrhosis Patients with hepatocellular Carcinoma

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Journal of Clinical and Translational hepatology 2024年第7期12卷 613-624页

作者： Akitoshi Sano Jun Inoue Eiji Kakazu Masashi Ninomiya Mio Tsuruoka Kosuke Sato Masazumi Onuki Satoko Sawahashi Keishi Ouchi Atsushi Masamune division of gastroenterology Tohoku University Graduate School of MedicineSendaiMiyagiJapan Department of Liver Disease The Research Center for Hepatitis and ImmunologyNational Center for Global Health and MedicineIchikawaChibaJapan

Background and Aims:Sarcopenia is associated with the prognosis of patients with liver cirrhosis and hepatocellular carcinoma(HCC).Given their diverse physiological activities,we hypothesized that plasma fatty acids might influence the progression of *** study aimed to clarify the association between fatty acids and sarcopenia in cirrhotic patients with ***:In this singlecenter retrospective study,we registered 516 cases and analyzed 414 cases of liver cirrhosis and *** skeletal muscle mass index was measured using a transverse computed tomography scan image at the third lumbar *** cutoff value for sarcopenia followed the criteria set by the Japan Society of *** acid concentrations were measured by gas ***:Fatty acid levels,particularly omega-3(n-3)polyunsaturated fatty acid(PUFA),were lower in patients with poor liver function(Child-Pugh grade B/C)and were negatively correlated with the albumin-bilirubin score(p<0.0001).The prognosis of HCC patients with low PUFA levels was significantly *** the different fatty acid fractions,only n-3 PUFAs significantly correlated with skeletal muscle mass index(p=0.0026).In the multivariate analysis,the n-3 PUFA level was an independent variable associated with sarcopenia(p=0.0006).Conclusions:A low level of n-3 PUFAs was associated with sarcopenia in patients with liver cirrhosis and HCC.

关键词： Liver cirrhosis hepatocellular carcinoma Sarcopenia Skeletal Muscle Fatty Acids Omega-3 polyunsaturated fatty acids

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Alcohol associated liver disease and bariatric surgery:Current perspectives and future directions

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 650-657页

作者： Katherine M Cooper Alessandro Colletta Nicholas Hebda Deepika Devuni Department of Medicine UMass Chan Medical SchoolWorcesterMA 01655United States division of gastroenterology UMass Chan Medical SchoolWorcesterMA 01655United States

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with ***,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical *** patients are at increased risk of alcohol associated liver disease and,in some cases,require liver *** this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.

关键词： Obesity medicine Alcohol use disorder Roux-en-Y gastric bypass Vertical sleeve gastrectomy Liver transplant Simultaneous liver transplant and bariatric surgery

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Identification of breath volatile organic compounds to distinguish pancreatic adenocarcinoma,pancreatic cystic neoplasm,and patients without pancreatic lesions

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 894-906页

作者： Kasenee Tiankanon Nuttanit Pungpipattrakul Thanikan Sukaram Roongruedee Chaiteerakij Rungsun Rerknimitr division of gastroenterology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand

BACKGROUND Volatile organic compounds(VOCs)are a promising potential biomarker that may be able to identify the presence of *** To identify exhaled breath VOCs that distinguish pancreatic ductal adenocar-cinoma(PDAC)from intraductal papillary mucinous neoplasm(IPMN)and healthy *** We collected exhaled breath from histologically proven PDAC patients,radiological diagnosis IPMN,and healthy volunteers using the ReCIVA®device between 10/2021-11/*** were identified by thermal desorption-gas chromatography/field-asymmetric ion mobility spectrometry and compared between *** A total of 156 participants(44%male,mean age 62.6±10.6)were enrolled(54 PDAC,42 IPMN,and 60 controls).Among the nine VOCs identified,two VOCs that showed differences between groups were dimethyl sulfide[0.73 vs 0.74 vs 0.94 arbitrary units(AU),respectively;P=0.008]and acetone dimers(3.95 vs 4.49 vs 5.19 AU,respectively;P<0.001).After adjusting for the imbalance parameters,PDAC showed higher dimethyl sulfide levels than the control and IPMN groups,with adjusted odds ratio(aOR)of 6.98(95%CI:1.15-42.17)and 4.56(1.03-20.20),respectively(P<0.05 both).Acetone dimer levels were also higher in PDAC compared to controls and IPMN(aOR:5.12(1.80-14.57)and aOR:3.35(1.47-7.63),respectively(P<0.05 both).Acetone dimer,but not dimethyl sulfide,performed better than CA19-9 in PDAC diagnosis(AUROC 0.910 vs 0.796).The AUROC of acetone dimer increased to 0.936 when combined with CA19-9,which was better than CA19-9 alone(P<0.05).CONCLUSION Dimethyl sulfide and acetone dimer are VOCs that potentially distinguish PDAC from IPMN and healthy *** prospective studies are required to validate these findings.

关键词： Volatile organic compound Pancreas Adenocarcinoma Pancreatic intraductal neoplasms Breathing

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Beyond the gluten-free diet:Innovations in celiac disease therapeutics

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World Journal of gastroenterology 2024年第38期30卷 4194-4210页

作者： Sara Massironi Marianna Franchina Alessandra Elvevi Donatella Barisani division of gastroenterology Fondazione IRCCS San Gerardo dei TintoriUniversity of Milano-BicoccaMonza 20900Italy Department of gastroenterology IRCCS San Gerardo dei TintoriMonza 20900LombardyItaly School of Medicine and Surgery University of Milano-BicoccaMonza 20900Italy

Celiac disease(CD)is an autoimmune disorder exacerbated by the ingestion of gluten in genetically susceptible individuals,leading to intestinal inflammation and *** chronic disease affects approximately 1%of the world’s po-pulation and is a growing health challenge due to its increasing *** development of CD is a complex interaction between genetic predispositions and environmental factors,especially gluten,culminating in a dysregulated immune *** only effective treatment at present is a strict,lifelong gluten-free ***,adherence to this diet is challenging and often incomplete,so research into alternative therapies has *** advances in under-standing the molecular and immunological aspects of CD have spearheaded the development of novel pharmacologic strategies that should provide more effec-tive and manageable treatment *** review examines the latest inno-vations in CD *** focus is on drugs in advanced clinical phases and targeting specific signaling pathways critical to the disease *** dis-cuss both quantitative strategies such as enzymatic degradation of gluten,and qualitative approaches including immunomodulation and induction of gluten *** treatments currently under investigation include transglu-taminase inhibitors,which prevent the modification of gluten peptides,and nano-particle-based therapies to recalibrate the immune *** new therapies not only promise to improve patient outcomes but are also expected to improve quality of life by reducing the burden of dietary *** integration of these new therapies could revolutionize the treatment of CD and shift the para-digm from strict dietary restrictions to a more flexible and patient-friendly thera-peutic *** review provides a comprehensive overview of the future prospects of CD treatment and emphasizes the importance of continued research and multidisciplinary collab-oration to inte

关键词： Celiac disease Gluten tolerance Enzymatic degradation Therapeutic advances Transglutaminase inhibitors Tight junction modulators

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