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Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

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Chinese Journal of Cancer Research 2013年第1期25卷 22-31页

作者： Romano Demicheli Ilaria Ardoino Federico Ambrogi Roberto Agresti Elia Biganzoli Scientific Directorate IRCCS National Cancer Institute medical Statistics and biometry University of Milan Breast Surgery IRCCS National Cancer Institute medical Statistics and biometry IRCCS National Cancer Institute

Objective： To analyze the pattern over time （dynamics） of further recurrence and death after ipsilateral breast tumor recurrence （IBTR） in breast cancer patients undergoing breast conserving treatment （BCT）. Methods： A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results： In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern （peaks at the second and at the sixth year）. Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive （N＋） patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions： The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N＋ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.

关键词： Breast cancer IBTR recurrence dynamics effects of surgery conservative surgery tumor homeostasis

Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation

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World Journal of Gastroenterology 2005年第8期11卷 1182-1186页

作者： Ahmed Madisch Stephan Miehike Ekkehard Bayerdoerffer Birgit Wiedemann David Antos Anke Sievert Michael Vieth Manfred Stolte Heinrich Schulz medical Department Ⅰ Department of Hematology and Oncology institute of medical Statistics and biometry Clinic for Pediatric Diseases Gastroenterologist in private practice institute of Pathology

AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).

关键词： Barrett's esophagus Argon plasma coagulation Esophageal adenocarcinoma

Performance of tacrolimus in hospitalized patients with steroid-refractory acute severe ulcerative colitis

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World Journal of Gastroenterology 2019年第13期25卷 1603-1617页

作者： Peter Hoffmann Cyrill Wehling Johannes Krisam Jan Pfeiffenberger Nina Belling Annika Gauss Department of Gastroenterology and Hepatology Heidelberg University Hospital institute of medical biometry and Informatics University of Heidelberg

BACKGROUND Acute severe ulcerative colitis unresponsive to systemic steroid treatment is a lifethreatening medical condition requiring hospitalization and often *** the increasing choice of medical therapy options for ulcerative colitis, the condition remains a great challenge in the field of inflammatory bowel diseases(IBD). The performance of the calcineurin inhibitor tacrolimus in this clinical setting is insufficiently *** To evaluate the short and long-term outcomes of tacrolimus therapy in adult inpatients with steroid-refractory acute severe ulcerative *** We conducted a retrospective monocentric study enrolling 22 patients at a tertiary care center for the treatment of IBD. All patients who were admitted to one of the wards of the Department of Gastroenterology and Hepatology of the Heidelberg University Hospital with acute severe ulcerative colitis between 2007 and 2018, and who received oral or intravenous tacrolimus for steroid-refractory disease were included. Baseline characteristics and data on the disease courses were retrieved from entirely computerized patient charts. The primary study endpoint was clinical response to tacrolimus therapy, resulting in discharge from the hospital. Secondary study endpoints were colectomy rate and time to colectomy, achievement of clinical remission under tacrolimus therapy, and the occurrence of side *** the majority of the 22 included patients(68.2%), tacrolimus therapy was initiated intravenously and subsequently converted to oral administration. The treatment duration was 128 ± 28.5 d(mean ± SEM), and the patients were followed up for 705 ± 110 d after treatment initiation. Among all patients, 86.4%were discharged from the hospital under continued oral tacrolimus therapy. In36.4% of the patients, the administration of tacrolimus resulted in clinical remission at some point during the treatment. Thirty-two percent of the patients underwent colectomy between 5 and 1

关键词： Acute severe ulcerative colitis Steroid-refractory Tacrolimus Rescue therapy Calcineurin inhibitor Inflammatory bowel disease Hospitalized

Comparative effectiveness of medical treatment *** surgery for histologically proven non-alcoholic steatohepatitis and fibrosis:a matched network meta-analysis

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 696-708,I0008-I0011页

作者： Adrian T.Billeter Beatrice Reiners Svenja E.Seide Pascal Probst Eva Kalkum Christian Rupp Beat P.Müller-Stich Department of General Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany institute of medical biometry and Informatics University of HeidelbergHeidelbergGermany The Study Center of the German Surgical Society(SDGC) HeidelbergGermany Department of Gastroenterology and Hepatology University of HeidelbergHeidelbergGermany

Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related *** new drugs for NASH-treatment are currently *** study thus far directly compared surgical and non-surgical therapies for *** network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical ***:The study was conducted according to the PRISMA guidelines for network ***,CENTRAL and Web of Science were searched without restriction of time or language using a validated search *** investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were *** with liver cirrhosis were *** of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was *** outcomes were NASH-resolution and improvement of ***:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were ***-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after *** network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).Surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between *** results did not change when only new drugs specifically developed for the treatment of NASH were ***:Metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of *** d

关键词： Non-alcoholic fatty liver disease(NAFLD) non-alcoholic steatohepatitis(NASH) metabolic surgery fatty liver

Risk factors for major gastrointestinal bleeding in the general population in Finland

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World Journal of Gastroenterology 2022年第18期28卷 2008-2020页

作者： Pareen Vora Ronald Herrera Arto Pietila Ulrich Mansmann Gunnar Brobert Markku Peltonen Veikko Salomaa Integrated Evidence Generation Bayer AGBerlin 13353Germany institute for medical Information Processing Biometryand EpidemiologyLudwig Maximilians UniversitätMunich 81337Germany Pettenkofer School of Public Health Ludwig Maximilians UniversitätMunich 81337Germany Department of Public Health and Welfare National Institute for Health and Welfare(THL)Helsinki FI-00271Finland medical Affairs Bayer ABSolna 17165Sweden

BACKGROUND Data on non-drug related risk-factors for gastrointestinal bleeding(GIB)in the general population are limited,especially for life-style factors,clinical measurements and laboratory *** To identify and investigate non-drug risk factors for major GIB in the general population of *** We performed a retrospective cohort study using data from the FINRISK health examination surveys,which have been conducted every 5 years across Finland from 1987 to *** were adults aged 25 years to 74 years,excluding those with a previous hospitalization for ***-up from enrollment was performed through linkage to national electronic health registers and ended at an event of GIB that led to hospitalization/death,death due to any other cause,or after 10 *** included demographics,socioeconomic and lifestyle factors,clinical measurements,laboratory parameters and *** selection was undertaken using Least Absolute Shrinkage and Selection Operator(LASSO)and factors associated with GIB were identified using Cox *** Among 33,508 participants,403(1.2%)experienced GIB[256 men(63.5%);mean age,56.0 years(standard deviation(SD)±12.1)]and 33105 who did not experience GIB[15768 men(47.6%);mean age,46.8(SD±13)years],within 10 years of *** associated with a significantly increased risk of GIB were baseline age[per 10-year increase;hazard ratio(HR)1.62,95%confidence interval(CI):1.42-1.86],unemployment(HR:1.70,95%CI:1.11-2.59),body mass index(BMI)(HR:1.15,95%CI:1.01-1.32),gamma-glutamyl transferase(GGT)(HR:1.05,95%CI:1.02-1.09),precursors of GIB(HR:1.90,95%CI:1.37-2.63),cancer(HR:1.47,95%CI:1.10-1.97),psychiatric disorders(HR:1.32,95%CI:1.01-1.71),heart failure(HR:1.46,95%CI:1.04-2.05),and liver disorders(HR:3.20,95%CI:2.06-4.97).Factors associated with a significantly decreased risk of GIB were systolic blood pressure(SBP)(HR:0.78,95%CI:0.64-0.96),6-10 cups of coffee a day(HR:0.67,95%CI:0.46-0

关键词： Risk factors Gastrointestinal hemorrhage General population Finland Life style Population health

Effects of Resistant Starch on Symptoms,Fecal Markers,and Gut Microbiota in Parkinson’s Disease—The RESISTA-PD Trial

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Genomics, Proteomics & Bioinformatics 2022年第2期20卷 274-287页

作者： Anouck Becker Georges Pierre Schmartz Laura Groger Nadja Grammes Valentina Galata Hannah Philippeit Jacqueline Weiland Nicole Ludwig Eckart Meese Sascha Tierling Jorn Walter Andreas Schwiertz Jorg Spiegel Gudrun Wagenpfeil Klaus Faßbender Andreas Keller Marcus M.Unger Department of Neurology Saarland UniversityD-66421 HomburgGermany Chair for Clinical Bioinformatics Saarland UniversityD-66123 SaarbruckenGermany Department of Human Genetics Saarland UniversityD-66421 HomburgGermany Department of Genetics/Epigenetics Saarland UniversityD-66123 SaarbruckenGermany institute of Microecology D-35745 HerbornGermany institute of medical biometry Epidemiology and Medical InformaticsSaarland UniversityD-66421 HomburgGermany Department of Neurology Stanford UniversityPalo AltoCA 94305USA

The composition of the gut microbiota is linked to multiple diseases,including Parkinson’s disease(PD).Abundance of bacteria producing short-chain fatty acids(SCFAs)and fecal SCFA concentrations are reduced in *** exert various beneficial functions in *** the interventional,monocentric,open-label clinical trial “Effects of Resistant Starch on Bowel Habits,Short Chain Fatty Acids and Gut Microbiota in Parkinson’s Disease”(RESISTA-PD;ID:NCT02784145),we aimed at altering fecal SCFAs by an 8-week prebiotic intervention with resistant starch(RS).We enrolled 87 subjects in three study-arms:32 PD patients received RS(PD+RS),30 control subjects received RS,and 25 PD patients received solely dietary *** performed paired-end 100 bp length metagenomic sequencing of fecal samples using the BGISEQ platform at an average of 9.9 *** was *** the PD+RS group,fecal butyrate concentrations increased significantly,and fecal calprotectin concentrations dropped significantly after 8 weeks of RS ***,we observed a reduction in non-motor symptom load in the PD+RS *** reference-based analysis of metagenomes highlighted stable alpha-diversity and beta-diversity across the three groups,including bacteria producing ***-free analysis suggested punctual,yet pronounced differences in the metagenomic signature in the PD+RS ***-PD highlights that a prebiotic treatment with RS is safe and well-tolerated in *** stable alpha-diversity and beta-diversity alongside altered fecal butyrate and calprotectin concentrations call for long-term studies,also investigating whether RS is able to modify the clinical course of PD.

关键词： Parkinson’s disease Short-chain fatty acid Microbiota Metagenomics Intestinal inflammation

Increased liver stiffness in alcoholic liver disease:Differentiating fibrosis from steatohepatitis

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World Journal of Gastroenterology 2010年第8期16卷 966-972页

作者： Sebastian Mueller Gunda Millonig Lucie Sarovska Stefanie Friedrich Frank M Reimann Maria Pritsch Silke Eisele Felix Stickel Thomas Longerich Peter Schirmacher Helmut Karl Seitz Department of Medicine and Center for Alcohol Research Salem Medical Center University of Heidelberg institute of medical biometry and Informatics University of Heidelberg institute of Clinical Pharmacology University of Bern Department of Pa-thology University of Heidelberg

AIM:To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).METHODS:We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of trans-aminases. RESULTS:Of the serum transaminases,the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant chang-es in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels,we applied the rule of GOT 100 U/L at the time of LS assessment from this cohort,the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of ***:Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL signif icantly improves the diagnostic accuracy.

关键词： Alcoholic liver disease Alcoholic steatohep-atitis Liver cirrhosis Bilirubin Tissue elasticity imaging FibroScan

Application of artifcial intelligence in cataract management:current and future directions

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Eye and Vision 2024年第1期10卷 21-30页

作者： Laura Gutierrez Jane Sujuan Lim Li Lian Foo Wei Yan Ng Michelle Yip Gilbert Yong San Lim Melissa Hsing Yi Wong Allan Fong Mohamad Rosman Jodhbir Singth Mehta Haotian Lin Darren Shu Jeng Ting Daniel Shu Wei Ting Singapore Eye Research institute SingaporeSingapore Singapore National Eye Center 11 Third Hospital AvenueSingapore 168751Singapore Academic Ophthalmology School of MedicineUniversity of NottinghamNottinghamUK Zhongshan Ophthalmic Center Sun Yet Sen UniversityGuangzhouChina

The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of *** ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of *** management is another feld that can beneft from greater AI *** is the leading cause of reversible visual impairment with a rising global clinical *** diagnosis,monitoring,and surgical management are necessary to address this *** addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 *** on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical ***,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus *** utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts ***,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional ***,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical ***,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser *** advances in AI could transform cataract management and enable delivery of efcient ophthalmic *** key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of e

关键词： Artifcial intelligence Telemedicine Cataract Cataract screening Cataract surgery IOL calculations biometry Machine learning

Predictors of functional benefit of hepatitis C therapy in a‘real-life’cohort

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World Journal of Gastroenterology 2018年第7期24卷 852-861页

作者： Niels Steinebrunner Kerstin Stein Catharina Sandig Thomas Bruckner Wolfgang Stremmel Anita Pathil Department of Internal Medicine IV University Hospital HeidelbergHeidelberg 69120Germany Department of Gastroenterology Hepatology and Infectious DiseasesUniversity Hospital of MagdeburgMagdeburg 39120Germany Department of medical biometry Institute of Medical Biometry and Informatics(IMBI)Heidelberg 69120Germany

AIM To define predictors of functional benefit of direct-acting antivirals(DAAs) in patients with chronic hepatitis C virus(HCV) infection and liver *** We analysed a cohort of 199 patients with chronic HCV genotype 1, 2, 3 and 4 infection involving previously treated and untreated patients with compensated(76%) and decompensated(24%) liver cirrhosis at two tertiary centres in Germany. Patients were included withtreatment initiation between February 2014 and August 2016. All patients received a combination regimen of one or more DAAs for either 12 or 24 wk. Predictors of functional benefit were assessed in a univariable as well as multivariable model by binary logistic regression *** Viral clearance was achieved in 88%(175/199) of patients. Sustained virological response(SVR) 12 rates were as follows: among 156 patients with genotype 1 infection the SVR 12 rate was 90%(n = 141); among 7 patients with genotype 2 infection the SVR 12 rate was 57%(n = 4); among 30 patients with genotype 3 infection the SVR 12 rate was 87%(n = 26); and among 6 patients with genotype 4 infection the SVR 12 rate was 67%(n = 4). Follow-up MELD scores were available for 179 patients. A MELD score improvement was observed in 37%(65/179) of patients, no change of MELD score in 41%(74/179) of patients, and an aggravation was observed in 22%(40/179) of patients. We analysed predictors of functional benefit from antiviral therapy in our patients beyond viral eradication. We identified the Child-Pugh score, the MELD score, the number of platelets and the levels of albumin and bilirubin as significant factors for functional *** Our data may contribute to the discussion of potential risks and benefits of antiviral therapy with individual patients infected with HCV and with advanced liver disease.

关键词： functional benefit direct acting antiviral hepatitis C cirrhosis real-life data