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Era of Barrett’s surveillance: Does equipment matter?

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World Journal of Gastroenterology 2010年第37期16卷 4640-4645页

作者： Jayan Mannath Krish Ragunath nottingham digestive diseases centre and nihr biomedical research unit Nottingham University Hospitals NHS Trust

Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett’s surveillance.

关键词： Barrett’s esophagus Endoscopy Autofluorescence imaging Narrowband imaging Early diagnosis of cancer

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

Impact of mechanical bowel preparation in elective colorectal surgery:A meta-analysis

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World Journal of Gastroenterology 2018年第4期24卷 519-536页

作者： Katie E Rollins Hannah Javanmard-Emamghissi Dileep N Lobo Gastrointestinal Surgery Nottingham Digestive Diseases Centre National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of Nottingham Queen’s Medical Centre

AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal *** Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. RESULTS A total of 36 studies(23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates(OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection(OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intraabdominal collection(OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality(OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation(OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay(overall mean difference 0.11 d, 95%CI:-0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlledtrials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. CONCLUSION In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

关键词： bowel preparation Mechanical antibiotics morbidity mortality surgery outcome complications meta-analysis

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

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World Journal of Gastroenterology 2017年第23期23卷 4252-4261页

作者： W Kyle Mitchell Pradeep F Thomas Abed M Zaitoun Adam J Brooks Dileep N Lobo Gastrointestinal Surgery Nottingham Digestive Diseases CentreNational Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of NottinghamQueen's Medical Centre Cellular Pathology Nottingham Digestive Diseases CentreNational Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of NottinghamQueen's Medical Centre

To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of *** lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also ***-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PP

关键词： Pancreas preserving distal duodenectomy Duodenojejunostomy Duodenal disease Surgical technique Adults Indications Treatment Outcome

Development of a telehealth monitoring service after colorectal surgery:A feasibility study

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World Journal of Gastrointestinal Surgery 2017年第9期9卷 193-199页

作者： Damian D Bragg Helena Edis Sian Clark Simon L Parsons Binoy Perumpalath Dileep N Lobo Charles A Maxwell-Armstrong Gastrointestinal Surgery Nottingham Digestive Diseases Centre and National Institute of Health Research(NIHR)Nottingham Biomedical Research CentreNottingham University Hospitals and University of NottinghamQueen’s Medical CentreNottingham NG7 2UHUnited Kingdom

AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery *** Florence(FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions,such as hypertension,using *** were designed to monitor the well-being,basic physiological observations and any patient-reported symptoms,and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after *** interactions with FLO and physiological readings were recorded and patients were invited to provide *** Over a four-week period,16 out of 17 patients used the FLO telehealth service at *** patients did not receive telephone follow-up at three days,as per our standard protocol,unless they reported being unwell or did not make use of the *** patients were readmitted within 30 d,and two of these were identified as being unwell by FLO prior to *** adverse events attributable to the use of the technology were *** The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is *** use of this technology may assist in the early recognition and management of complications after discharge.

关键词： Telehealth Remote monitoring Colorectalsurgery Telephone follow up Readmission

Caspase-cleaved cytokeratin-18 and tumour regression in gastro-oesophageal adenocarcinomas treated with neoadjuvant chemotherapy

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World Journal of Gastroenterology 2012年第16期18卷 1915-1920页

作者： Khaleel R Fareed Irshad N Soomro Khalid Hameed Arvind Arora Dileep N Lobo Simon L Parsons Srinivasan Madhusudan Laboratory of Molecular Oncology Academic Unit of OncologySchool of Molecular Medical SciencesFaculty of Medicine and Health SciencesUniversity of Nottingham nottingham University Hospitals Nottingham NG5 1PBUnited Kingdom Department of Pathology Nottingham University HospitalsNottingham NG5 1PBUnited Kingdom Division of Gastrointestinal Surgery Nottingham Digestive Diseases CentreNIHR Biomedical Research UnitNottingham University HospitalsNottingham NG7 2UHUnited Kingdom Department of Surgery Nottingham University HospitalsNottingham NG5 1PBUnited Kingdom

AIM:To examine cytokeratin-18(CK-18) and caspasecleaved CK-18 expression in tumours and correlate with clinicopathological outcomes including tumour regression grade(TRG) ***:Formalin-fixed human gastro-oesophageal cancers were constructed into tissue *** first set consisted of 122 gastric/gastro-oesophageal cancer cases not exposed to neoadjuvant chemotherapy and the second set consisted of 97 gastric/gastrooesophageal cancer cases exposed to pre-operative platinum-based *** of CK-18 and caspase-cleaved CK-18 was investigated using ***:CK18 was commonly expressed in gastrooesophageal tumours(92.6%).Fifty-six point seven percent of tumours previously exposed to neoadjuvant chemotherapy were positive for caspase-cleaved CK-18 expression compared to only 24.6% of tumours not previously exposed to neoadjuvant chemotherapy(P = 0.009).In patients who received neoadjuvant chemotherapy,caspase-cleaved cytokeratin-18 expression correlated with favourable TRG response(TRG 1,2 or 3,P = 0.043).CONCLUSION:This is the largest study to date of CK-18 and caspase-cleaved CK-18 expression in gastrooesophageal *** provide the first evidence that caspase-cleaved CK-18 predicts tumour regression with neoadjuvant chemotherapy.

关键词： Tumour regression grade Gastro-oesophageal cancers Chemotherapy Full length cytokeratin-18 Caspase-cleaved cytokeratin-18

Retrospective cohort study of statin therapy effect on resected colorectal liver metastases

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World Journal of Gastrointestinal Surgery 2020年第2期12卷 34-44页

作者： Edward Alabraba Hussain Ibrahim Adina Olaru Iain Cameron Dhanny Gomez nottingham HPB Surgery Group Department of Hepatobiliary Surgery and Pancreatic Surgery Queen’s Medical CentreNottingham University Hospitals NHS TrustNottingham NG72UHUnited Kingdom nihr nottingham digestive Disease biomedical research unit University of NottinghamNottingham NG72UHUnited Kingdom 不详

BACKGROUND Above and beyond their role in cardiovascular risk reduction,statins appear to have a chemopreventive role in some gastro-intestinal *** the quest for new chemopreventive agents,some existing established drugs such as statins have shown potential for re-purposing as *** existing drugs,whose pharmacodynamics are familiar,for novel beneficial effects offers a more cost-effective and less time-consuming strategy than establishing brand new drugs whose pharmacodynamic profile is *** studies show statins decrease the risk of developing colorectal cancer but there are no published studies exploring the potential impact of statins on carcinogenesis in colorectal liver metastases(CRLM).AIM To evaluate impact of statins on outcomes of CRLM resection,and secondarily to assess if statins influence CRLM *** We conducted a retrospective cohort study of patients operated for CRLM over a 13-year period from 2005 to *** were identified from a prospective database maintained in our Tertiary care *** 586 patients included the study had undergone resection of CRLM following discussion at multidisclipinary team meeting,some patients requiring neoadjuvant chemotherapy to downstage CRLM prior to *** analysed patient demographics,operative details,CRLM histopathology,Index of Deprivation,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio and chemotherapy use in relation to clinical *** were performed using SPSS version 16.0;significance taken at 5%.RESULTS Liver resection for CRLM was undertaken in 586 patients at a median age of 68(range 19 to 88)*** therapy was used by 181 *** follow-up time was 23(range 12-96)mo and further colorectal cancer metastases developed in 267 patients.A total of 131 patients ***-variate analysis identified 6 independent predictors of poorer disease-free survival:Synchronous presentation,multiple tumours,t

关键词： Colorectal liver metastases Statin Liver resection Chemoprevention Tumour biology Survival

Impact of pre-existing cardiometabolic diseases on metastatic cancer stage at diagnosis:a prospective multinational cohort study

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Cancer Communications 2024年第5期44卷 593-597页

作者： Anna Jansana Aviane Auguste Marina Kvaskoff Agnès Fournier Emma Fontvieille Laia Peruchet-Noray Carine Biessy Reynalda Cordova Kristina Elin Nielsen Petersen Anne Tjoneland Verena Katzke Rudolf Kaaks Fulvio Ricceri Salvatore Panico Paolo Contiero Maria-Jose Sánchez Jesus Castilla Marta Crous-Bou Alicia Heath Elom Kouassivi Aglago Elisabete Weiderpass Marc James Gunter Pietro Ferrari Elio Riboli Vivian Viallon Heinz Freisling International Agency for research on Cancer(IARC-WHO) LyonFrance Paris-Saclay University University of Versailles-Saint-Quentin-en-YvelineUniversity Paris-SudFrench National Institute for Health and Medical Research(Inserm)Gustave Roussy“Exposome and Heredity”TeamCESPVillejuifFrance Department of Nutritional Sciences University of ViennaViennaAustria Danish Cancer Society research Center CopenhagenDenmark Department of Public Health University of CopenhagenCopenhagenDenmark Division of Cancer Epidemiology German Cancer Research CentreHeidelbergGermany Department of Clinical and Biological Sciences University of TurinTurinItaly unit of Epidemiology Regional Health Service ASL TO3GrugliascoTurinItaly Department of Clinical Medicine and Surgery Federico II UniversityNaplesItaly Environmental Epidemiology unit Istituto di Ricovero e Cura a Carattere Scientifico(IRCCS)-Istituto Nazionale dei TumoriMilanItaly Cancer Registry of Granada Institute for Biosanitary Research of Granada(ibs.GRANADA)GranadaSpain Epidemiology and Control of Chronic diseases Group Epidemiology and Public Health Networking Biomedical Research CentreMadridSpain Navarra Public Health Institute PamplonaSpain unit of Nutrition and Cancer Cancer Epidemiology Research ProgramCatalan Institute of Oncology(ICO)-Bellvitge Biomedical Research Institute(IDIBELL)L’Hospitalet de LlobregatBarcelonaSpain Department of Epidemiology Harvard Tseng-Hsi Chan School of Public HealthBostonMassachusettsUSA Department of Epidemiology and Biostatistics School of Public HealthImperial College LondonSt Mary’s CampusNorfolk PlaceLondonUK

Owing to shared risk factors between cardiometabolic diseases(CMDs)and cancer,coupled with population aging,the lifetime risk of an individual developing cancer after a CMD is ***,biological mechanisms such as insulin resistance or inflammation may not only predispose individuals withCMDto an elevated risk of certain types of cancer but also to a diagnosis of cancer at an advanced stage[1,2].

关键词： diagnosis diseases cancer

A systematic review of patient reported outcome measures (PROMs) and quality of life reporting in patients undergoing laparoscopic cholecystectomy

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 228-245页

作者： Prita Daliya Elizabeth H.Gemmill Dileep N.Lobo Simon L.Parsons Gastrointestinal Surgery Nottingham Digestive Diseases Centre and National Institute for Health Research(NIHR)Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamQueen’s Medical CentreNottingham NG72UHUK Department of General Surgery Sherwood Forest Hospitals NHS TrustKing’s Mill HospitalSutton-in-Ashfield NG174JLUK MRC/ARUK centre for Musculoskeletal Ageing research School of Life SciencesUniversity of NottinghamQueen’s Medical CentreNottingham NG72UKUK Trent Oesophago-Gastric unit City Hospital CampusNottingham University Hospitals NHS TrustNottingham NG51PBUK

Patient reported outcome measures(PROMs)provide a valuable means of measuring outcomes subjectively from a patient's perspective,facilitating the assessment of service quality across healthcare providers,and assisting patients and clinicians in shared decision *** primary aim of this systematic review was to critically appraise all historic studies evaluating patient reported quality of life,in adult patients undergoing laparoscopic cholecystectomy for symptomatic *** secondary aim was to perform a quality assessment of cholecystectomy-specific PROM-validation studies.A literature review was performed in PubMed,Google ScholarTM,the Cochrane Library,Medline,CINAHL,EMBASE and PsychINFO databases up to September *** characteristics,PROM-specific details and a bias assessment were summarised for non-validation studies.A COnsensus-based Standards for the selection of health Measurement INstruments(COSMIN)analysis was performed to assess the methodological quality of identified PROM-validation *** one studies were found to evaluate health-related quality of life(HRQoL)after laparoscopic *** 94.1%of these studies included PROMs as a primary outcome measure,<20%provided level 1 evidence through randomised controlled trials(RCTs).There was significant variation in the selection and reporting of PROMs,with no studies declaring patient involvement in PROM selection,and 88.2%of studies failing to document the management of missing data points,or non-returned surveys(33.3%).In the 6 PROM-validation studies identified,only 5 psychometric properties were evaluated,the findings of which were limited due to the small number of *** systematic review identifies a lack in consistency of study design and PRO reporting in clinical *** an increasing number of studies are being performed to evaluate PROs,a lack of adherence to existing PRO administration and reporting guidelines is continuing to negatively affect st

关键词： Cholecystectomy patient reported outcomes(PROs) patient reported outcome measures(PROMs) quality of life(QoL) COnsensus-based Standards for the selection of health Measurement INstruments(COSMIN)