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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

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Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular Neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Philip Appleton Lisa J Woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark Dixon Timothy J England Kailash Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey L Saver Angela Shone Aloysius Niroshan Siriwardena Joanna M Wardlaw Nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK institute of Applied Healthresearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George institute China at Peking University Health Science Center BeijingChina Neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service nhs trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK institute of Neurology and Psychology University of GlasgowGlasgowUK Bob Champion research and Education Building University of East AngliaNorwichUK institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and NIHR Leicester Biomedical research Centre University of LeicesterLeicesterUK Stroke research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurology Oslo University HospitalOsloNorway research and Development Norwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA research and Graduate Services University of NottinghamNottinghamUK Community and Health research Unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is ***,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of *** primary outcome was a shift in scores on the modified Rankin scale(mRS)at day *** outcomes included death;a global analysis(Wei-Lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’*** were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%*** 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]***‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe *** In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital *** IS ALREADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those w

关键词： Glasgow nitrate random

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Enhancing the clinical relevance of haemorrhage prediction models in trauma

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Military Medical research 2024年第3期11卷 467-468页

作者： Sankalp Tandle Jared M.Wohlgemut Max E.R.marsden Erhan Pisirir Evangelia Kyrimi Rebecca S.Stoner William Marsh Zane B.Perkins Nigel R.M.Tai Centre for Trauma Sciences Blizard InstituteQueen Mary University of LondonLondon E12ATUK The royal London Hospital Barts Health NHS TrustLondon E11FRUK Academic Department of Military Surgery and Trauma Research and Clinical InnovationThe Royal Centre for Defence MedicineBirmingham B152WBUK Department of Electronic Engineering and Computer Science Queen Mary University of LondonLondon E14NSUK

We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of trau... 详细信息

关键词： Trauma Injury Blood transfusion Massive transfusion Prediction Artificial intelligence Machine learning

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Colorectal cancer with liver metastases:Neoadjuvant chemotherapy,surgical resection first or palliation alone?

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World Journal of Gastroenterology 2014年第35期20卷 12391-12406页

作者： Khurum Khan Anita Wale Gina Brown Ian Chau Gastrointestinal Unit the Royal Marsden NHS Foundation Trust Department of Radiology the Royal Marsden NHS Foundation Trust

Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.

关键词： Colorectal cancer Colorectal liver metastases Surgical resection Neo-adjuvant chemotherapy Radiofrequency ablation Disappearing liver metastases

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Dermatofibrosarcoma protuberans: from translocation to targeted therapy

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cancer Biology & Medicine 2015年第4期12卷 375-384页

作者： Jonathan Noujaim Khin Thway Cyril Fisher Robin L.Jones Sarcoma Unit Royal Marsden NHS Foundation Trust

Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.

关键词： Dermatofibrosarcoma protuberans(DFSP) imatinib Mohs micrographic surgery(MMS) translocation targeted therapy

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Is Helicobacter pylori infection protective against esophageal cancer?

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World Journal of Gastroenterology 2024年第38期30卷 4168-4174页

作者： Rick Maity Arkadeep Dhali Jyotirmoy Biswas General Medicine Institute of Post Graduate Medical Education and ResearchKolkata 700020India Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire HospitalSheffield S102JFUnited Kingdom School of Medicine and Population Health University of SheffieldSheffield S102HQUnited Kingdom Deanery of Clinical Sciences University of EdinburghEdinburgh EH164SBUnited Kingdom Department of General Medicine College of Medicine and Sagore Dutta HospitalKolkata 700058India

Helicobacter pylori(***)infection affects a substantial proportion of the global population and causes various gastric disorders,including gastric *** studies have found an inverse relationship between *** infection and eso-phageal cancer(EC),suggesting a protective role against *** editorial focuses on the possible mechanisms underlying the role of *** infection in EC and explores the role of gut microbiota in esophageal carcinogenesis and the prac-ticality of *** *** has two major subtypes:Esophageal squamous cell carcinoma(ESCC)and esophageal adenocarcinoma(EAC),which have different etiologies and risk *** microbiota can contribute to EC via inflammation-induced carcinogenesis,immunomodulation,lactagenesis,and genotoxin *** infection is said to be inversely related to EAC,protecting against EAC by inducing atrophic gastritis,altering serum ghrelin levels,and triggering cancer cell *** *** infection has no significant association with ESCC,COX-2-1195 polymorphisms and endogenous nitrosamine production can impact the risk of ESCC in ***-infected *** are concerns regarding a plausible increase in EC after *** eradication ***,*** eradication is not associated with an increased risk of EC,making it safe from an EC perspective.

关键词： Helicobacter pylori Helicobacter pylori infection Esophageal cancer Esophageal squamous cell carcinoma Esophageal adenocarcinoma Barrett’s esophagus Microbiota Dysbiosis Eradication

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Perfusion magnetic resonance imaging of the liver

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World Journal of Gastroenterology 2010年第13期16卷 1598-1609页

作者： Choon Hua Thng Tong San Koh David J Collins Dow Mu Koh Department of Oncologic Imaging National Cancer Centre Department of Radiology Royal Marsden NHS Foundation Trust CR UK-EPSRC cancer Imaging Centre Institute of Cancer Research

Perfusion magnetic resonance imaging (MRI) studies quantify the microcirculatory status of liver parenchyma and liver lesions, and can be used for the detection of liver metastases, assessing the effectiveness of antiangiogenic therapy, evaluating tumor viability after anticancer therapy or ablation, and diagnosis of liver cirrhosis and its severity. In this review, we discuss the basic concepts of perfusion MRI using tracer kinetic modeling, the common kinetic models applied for analyses, the MR scanning techniques, methods of data processing, and evidence that supports its use from published clinical and research studies. Technical standardization and further studies will help to establish and validate perfusion MRI as a clinical imaging modality.

关键词： Magnetic resonance imaging Dynamic contrast-enhanced magnetic resonance imaging Liver Tracer kinetic modeling

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Confocal laser endomicroscopy for gastric neoplasm

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World Journal of Gastrointestinal Endoscopy 2024年第9期16卷 540-544页

作者： Arkadeep Dhali Rick Maity Roger B Rathna Jyotirmoy Biswas Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire HospitalSheffield S102JFUnited Kingdom School of Medicine and Population Health University of SheffieldSheffield S102HQUnited Kingdom General Medicine Institute of Post Graduate Medical Education and ResearchKolkata 700020India Department of Internal Medicine University Hospitals Leicester NHS TrustLeicester Royal InfirmaryLeicester LE15WWUnited Kingdom General Medicine College of Medicine and Sagore Dutta HospitalKolkata 700058India

Confocal laser endomicroscopy(CLE)is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the *** has a higher sensitivity,specificity,and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band *** can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit *** may have some advantages over the standard biopsy protocol,such as higher diagnostic yield and fewer biopsy *** diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light *** limitations,such as a narrow field of vision,can be surpassed by technological advancements and integration with other detection *** intelligence holds promise in automated analysis of histopathological ***,CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies,such as mucosal damage,bleeding,and infection.

关键词： Confocal laser endomicroscopy Gastric cancer Narrow band imaging Diagnostic yield

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Immunohistochemical assessment of NY-ESO-1 expression in esophageal adenocarcinoma resection specimens

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World Journal of Gastroenterology 2014年第14期20卷 4011-4016页

作者： Stephen J Hayes Keng Ngee Hng Peter Clark Fiona Thistlethwaite Robert E Hawkins Yeng Ang Department of Histopathology Salford Royal NHS Foundation Trust Faculty of Medical and Human Sciences University of Manchester Department of Gastroenterology Salford Royal NHS Foundation Trust Department of Medical Oncology The Christie NHS Foundation Trust Department of Medical Oncology Paterson Institute of Cancer ResearchUniversity of Manchester

AIM: To assess NY-ESO-1 expression in a cohort of esophageal adenocarcinomas.

关键词： Esophageal adenocarcinoma Immunohistochemistry NY-ESO-1 Stem cells Vesicle trafficking

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Impact of tumour histological subtype on chemotherapy outcome in advanced oesophageal cancer

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World Journal of Gastrointestinal Oncology 2017年第8期9卷 333-340页

作者： Michael Davidson Ian Chau David Cunningham Komel Khabra Timothy Iveson Tamas Hickish Matthew Seymour Naureen Starling royal marsden Hospital nhs foundation trust London and Surrey Southampton University Hospital nhs trust and Salisbury Hospital nhs foundation trust Department of Haematology and Oncology Bournemouth University and Poole Hospital NHS Trust St James’s institute of Oncology St James’s Hospital

To investigate the impact of histology on outcome in advanced oesophageal cancer treated with first-line fluoropyrimidine-based chemotherapy. METHODSIndividual patient data were pooled from three randomised phase III trials of fluoropyrimidine-based chemotherapy ± platinum/anthracycline in patients with advanced, untreated gastroesophageal adenocarcinoma or squamous cell carcinoma (SCC) randomised between 1994 and 2005. The primary endpoint was overall survival of oesophageal cancer patients according to histology. Secondary endpoints were response rates and a toxicity composite endpoint. RESULTSOf the total 1836 randomised patients, 973 patients (53%) were eligible (707 patients with gastric cancer were excluded), 841 (86%) had adenocarcinoma and 132 (14%) had SCC. There was no significant difference in survival between patients with adenocarcinoma and SCC, with median overall survivals of 9.5 mo vs 7.6 mo (HR = 0.85, 95%CI: 0.70-1.03, P = 0.09) and one-year survivals of 38.8% vs 28.2% respectively. The overall response rate to chemotherapy was 44% for adenocarcinoma vs 33% for SCC (P = 0.01). There was no difference in the frequency of the toxicity composite endpoint between the two groups. CONCLUSIONThere was no significant difference in survival between adenocarcinoma and SCC in patients with advanced oesophageal cancer treated with fluoropyrimidine-based chemotherapy despite a trend for worse survival and less chemo-sensitivity in SCC. Tolerance to treatment was similar in both groups. This analysis highlights the unmet need for SCC-specific studies in advanced oesophageal cancer and will aid in the design of future trials of targeted agents.

关键词： Oesophageal cancer Adenocarcinoma Chemotherapy Squamous Pooled analysis

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