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Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration

World Journal of gastroenterology 2015年第8期21卷 2367-2373页

作者： Augustin Attwell Sharon Sams Norio Fukami Division of gastroenterology Department of Medicine University of Colorado-Denver School of Medicine department of Pathology University of Colorado-Denver School of Medicine

AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two *** review board approval was *** referred to the university Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were *** in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after *** with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final ***:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with *** patient was ***(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)*** wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)*** showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric *** endoscopic biopsies were taken in 2 patients and diagnostic in *** patient(10%)dev

关键词： Endoscopic ultrasound Pancreatitis Ectopic pancrea

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Necroptosis:An emerging type of cell death in liver diseases

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World Journal of gastroenterology 2014年第35期20卷 12526-12532页

作者： Waqar Khalid Saeed Dae Won Jun department of gastroenterology Hanyang University School of Medicine

Cell death has been extensively evaluated for decades and it is well recognized that pharmacological interventions directed to inhibit cell death can prevent significant cell loss and can thus improve an organ’s physiological function. For long, only apoptosis was considered as a sole form of programmed cell death. Recently necroptosis, a RIP1/RIP3-dependent programmed cell death, has been identified as an apoptotic backup cell death mechanism with necrotic morphology. The evidences of necroptosis and protective effects achieved by blocking necroptosis have been extensively reported in recent past. However, only a few studies reported the evidence of necroptosis and protective effects achieved by inhibiting necroptosis in liver related disease conditions. Although the number of necroptosis initiators is increasing; however, interestingly, it is still unclear that what actually triggers necroptosis in different liver diseases or if there is always a different necroptosis initiator in each specific disease condition followed by specific downstream signaling molecules. Understanding the precise mechanism of necroptosis as well as counteracting other cell death pathways in liver diseases could provide a useful insight towards achieving extensive therapeutic significance. By targeting necroptosis and/or other parallel death pathways, a significant cell loss and thus a decrement in an organ’s physiological function can be prevented.

关键词： Necroptosis Programmed necrosis Apoptosis Cell death Liver disease

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Preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after curative intent surgical resection

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 450-455页

作者： Nam Hee Kim Hong Joo Kim Division of gastroenterology Department of Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

Background: Postoperative early recurrence(ER) in patients with pancreatic ductal adenocarcinoma(PDAC) is frequently encountered after curative intent surgery. Nonetheless, clinical significance and risk factors of ER after surgery for PDAC have not been extensively investigated. The aim of this study was to determine preoperative risk predictors for ER in patients with PDAC after upfront surgery. Methods: Eighty-one consecutive patients with PDAC who underwent curative intent surgical resection at Kangbuk Samsung Hospital between January 2004 and May 2015 were enrolled. ER was defined as tumor relapse within 6 months after surgery. Results: ER occurred in 26 patients(32.1%), whereas 49 patients(60.5%) had late recurrence( ≥ 6 months after surgery), and 6 patients had no recurrence(7.4%). Univariate analysis showed that C-reactive protein(CRP) > 3.0 mg/dL, modified Glasgow prognostic score(mGPS) = 2, decrease of total lymphocyte count by > 50% of baseline value in the preoperative period, prognostic nutritional index(PNI) 3.0 mg/dL, decrease of total lymphocyte count by > 50% of baseline value, and preoperative SUVmax were significant and independent contributors of ER in patients with resectable PDAC who underwent curative intent surgery. Conclusions: Postoperative ER for resectable PDAC was frequent with poor prognosis after curative intent upfront surgery. It is reasonable to suggest that there is a subgroup of resectable PDAC patients at highrisk of ER and neoadjuvant therapy should be considered in these patients in a clinical trial setting.

关键词： Early recurrence Pancreatic ductal adenocarcinoma Preoperative risk factors C-reactive protein Maximum standardized uptake value

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Challenge to overcome: Nonstructural protein 5A-P32 deletion in direct-acting antiviral-based therapy for hepatitis C virus

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World Journal of gastroenterology 2018年第38期24卷 4304-4310页

作者： Ken Sato Toshio Uraoka department of gastroenterology and Hepatology Gunma University Graduate School of Medicine

Interferon(IFN)-based therapy for hepatitis C virus(HCV) infection has recently been replaced by IFNfree direct-acting antiviral(DAA)-based therapy, which has been established as a 1^(st) line therapy with high efficacy and tolerability due to its reasonable safety profile. Resistance-associated substitutions(RASs) have been a weakness of DAA-based therapy. For example, combination therapy with daclatasvir and asunaprevir(DCV/ASV) is less effective for HCV genotype 1-infected patients with Y93H as a nonstructural protein 5A RAS. However, the problem regarding RASs has been gradually overcome with the advent of recently developed DAAs, such as sofosbuvir-based regimens or combination therapy with glecaprevir and pibrentasvir. Despite the high efficiency of DAA-based therapy, some cases fail to achieve viral eradication. P32 deletion, an NS5A RAS, has been gradually noticed in patients with DCV/ASV failure. P32 deletion has been sporadically reported and the prevalence of this RAS has been considered to be low in patients with DCV/ASV failure. Thus, the picture of P32 deletion has not been fully evaluated. Importantly, currently-commercialized DAA-based combination therapy was not likely to be effective for patients with P32 deletion. Exploring and overcoming this RAS is essential for antiviral therapy for chronic hepatitis C.

关键词： Chronic hepatitis C Direct-acting antivirals Resistant-associated substitution P32 deletion Nonstructural protein 5A

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Androgen receptor signaling in hepatocellular carcinoma and pancreatic cancers

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World Journal of gastroenterology 2014年第28期20卷 9229-9236页

作者： Tatsuo Kanda Xia Jiang Osamu Yokosuka department of gastroenterology and Nephrology Chiba UniversityGraduate School of Medicine

Hepatocellular carcinoma (HCC) and pancreatic cancer remain difficult to treat, and despite the ongoing development of new treatments, the overall survival rate has only modestly improved over the past decade. Liver and pancreatic progenitors commonly develop from endoderm cells in the embryonic foregut. A previous study showed that HCC and pancreatic cancer cell lines variably express androgen receptor (AR), and these cancers and the surrounding tissues also express AR. AR is a ligand-dependent transcription factor that belongs to the nuclear receptor superfamily. Androgen response element is present in regulatory elements on the AR-responsive target genes, such as transforming growth factor beta-1 (TGF beta-1) and vascular endothelial growth factor (VEGF). It is well known that the activation of AR is associated with human carcinogenesis in prostate cancer as well as HCC and pancreatic cancer and that GRP78, TGF beta, and VEGF all play important roles in carcinogenesis and cancer development in these cancers. HCC is a male-dominant cancer irrespective of its etiology. Previous work has reported that vertebrae forkhead box A 1/2 are involved in estrogen receptors and/or AR signaling pathways, which may contribute to the gender differences observed with HCC. Our recent work also showed that AR has a critical role in pancreatic cancer development, despite pancreatic cancer not being a male dominant cancer. Aryl hydrocarbon (or dioxin) receptor is also involved in both HCC and pancreatic cancer through the formation of complex with AR. It is possible that AR might be involved in their carcinogenesis through major histocompatibility complex class I chain-related gene A/B. This review article describes AR and its role in HCC and pancreatic cancer and suggests that more specific AR signaling-inhibitors may be useful in the treatment of these “difficult to treat” cancers.

关键词： Androgen receptor Gender difference Hepatocellular carcinoma Male-dominant Pancreas

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Endoscopic ultrasonographic features of gastric linitis plastica in fifty-five Chinese patients

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Journal of Zhejiang university-Science B(Biomedicine & Biotechnology) 2013年第9期14卷 844-848页

作者： Guo-dong SHAN Guo-qiang XU You-ming LI department of gastroenterology the First Affiliated HospitalSchool of MedicineZhejiang University

The objective of this study was to investigate the endosonographic appearance of gastric linitis plastica(GLP) and to study the usefulness of endoscopic ultrasonography(EUS) for the T and N staging of *** examinations of 55 patients with histologically proven GLP were retrospectively *** all patients,EUS showed that lesions involved at least one-third of the circumference of the *** on the findings of the EUS,the 55 patients were divided into two *** were 32(58.2%) patients in the first *** of this group showed that the five sonographic layers had disappeared and had been replaced by a hypoechogenic thickening of the gastric *** were 23(41.8%) patients in the second *** of this group showed that the first three sonographic layers were blurred and thickened,and the fourth layer was significantly *** full thickness of the gastric wall was significantly thicker in first than in the second group of patients(P<0.01).The incidence of perigastric lesions was significantly higher in the first than in the second group of patients(P<0.01).Results for the 15 patients following preoperative EUS were compared postoperatively with histopathologic findings for T and N *** overall diagnostic accuracy of the T stage was 73.3% and of the N stage was 60.0%.In eight patients,we used EUS to assess a therapeutic *** response was observed in five patients and a partial response in *** images of GLP are *** is helpful in diagnosing GLP and for assessing the T and N stages.

关键词： Gastric linitis plastica Endoscopic ultrasonography Diagnosis Differentiation Follow-up

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Nonalcoholic fatty liver disease and liver transplantation-Where do we stand?

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World Journal of gastroenterology 2018年第14期24卷 1491-1506页

作者： Ivana Mikolasevic Tajana Filipec-Kanizaj Maja Mijic Ivan Jakopcic Sandra Milic Irena Hrstic Nikola Sobocan Davor Stimac Patrizia Burra department of gastroenterology UHC Rijeka School of Medicine University of Rijeka department of gastroenterology University Hospital MerkurSchool of Medicine University of Zagreb department of Internal medicine General Hospital Pula Pula School of Medicine University of Rijeka and Zagreb Multivisceral Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis(NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation(LT), on patients on the waiting list for transplant, on posttransplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome(Met S) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of Met S and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population.

关键词： nonalcoholic steatohepatitis chronic liver disease liver transplantation nonalcoholic fatty liver disease outcome

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Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

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World Journal of Clinical Cases 2025年第10期13卷 59-61页

作者： Hussein Hassan Okasha Mohammed Tag-Adeen Hossam Eldin Shaaban Division of gastroenterology and Hepatology Department of Internal MedicineKasr Al-Aini School of MedicineCairo UniversityCairo 11562Egypt Division of gastroenterology and Hepatology Department of Internal MedicineQena Faculty of MedicineSouth Valley UniversityQena 83523Egypt department of Internal medicine and gastroenterology National Hepatology and Tropical Medicine Research InstituteCairo 11796Egypt

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.

关键词： High-grade pancreatic intraepithelial neoplasia Pancreatic cancer Magnetic resonance cholangiopancreatography Endoscopic retrograde pancreatography Pancreatic juice cytology Pancreatic ductal adenocarcinoma

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Effect of tumor necrosis factor-α antagonists on oxidative stress in patients with Crohn's disease

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World Journal of gastroenterology 2015年第35期21卷 10208-10214页

作者： Kazunari Yamamoto Toshimi Chiba Takayuki Matsumoto Division of gastroenterology Department of Internal MedicineSchool of MedicineIwate Medical University

AIM: To investigate changes in oxidative stress in Crohn's disease(CD) before and after anti-tumor necrosis factor(TNF)-α ***: A total of 42 patients with active CD, who were scheduled to be treated by anti-TNF-α antibodies, were enrolled. Serum levels of diacron-reactive oxygen metabolites(d-ROM), biological antioxidant potential(BAP), and modified ratio of oxidative stress and antioxidant capacity(m-OA) were measured using the Free Radical Analytical System before and 8 wk after induction of therapy with infliximab or adalimumab. The values for oxidative stress were correlated with disease activity and clinical response as determined by the CD activity index(CDAI) at 8 and 54 wk after the ***: Prior to treatment, d-ROM showed significant correlations with CDAI(r = 0.42, P < 0.01). There was a significant negative correlation between m-OA and CDAI before and after treatment(r =-0.48 vs r =-0.42, P < 0.01). CDAI and d-ROM had decreased significantly by 8 wk after treatment(CDAI; 223.3 ± 113.2 vs 158.3 ± 73.4, P < 0.01, d-ROM; 373 ± 133 vs 312 ± 101, P < 0.05). However, neither BAP nor m-OA had changed significantly. In patients who had responded to the treatment at 8 wk, d-ROM, BAP, and m-OA levels before treatment did not differ significantly between patients with and without loss of ***: Anti-TNF-α therapy decreases oxi-dative stress in patients with CD, but does not alter the production of antioxidants. Dysregulation of antioxidants may be associated with the disease.

关键词： Crohn’s disease Severity Oxidative stress Anti-tum

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Management of the late effects of disconnected pancreatic duct syndrome: A case report

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World Journal of Clinical Cases 2019年第9期7卷 1053-1059页

作者： Reiko Yamada Yuhei Umeda Yasunori Shiono Hiroaki Okuse Naoki Kuroda Junya Tsuboi Hiroyuki Inoue Yasuhiko Hamada Kyosuke Tanaka Noriyuki Horiki Yoshiyuki Takei department of gastroenterology and Hepatology Mie University Graduate School of Medicine department of Endoscopy Mie University Graduate School of Medicine

BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome(DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years ***, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis(WON) with pancreatic transection 7 years *** SUMMARY An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm(AAA),hypertension, dyslipidemia, and chronic kidney disease. Computed tomography(CT) scan showed that the pancreatic fluid collection(PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the *** This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.

关键词： Case report Endoscopy Necrosis Pancreas Walled-off necrosis Disconnected pancreatic duct syndrome

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