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The Transitioning From Pediatric to Adult Inflammatory Bowel Disease Services: A Qualitative Study of Adolescents and Their Parents. 从儿科向成人炎症性肠病服务过渡:青少年及其父母的定性研究》。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1724
Mohamed Bakry, Peta Hoffmann, Rajivi Prematunga, Philip Keightley, Kavitha Subramaniam

Background: Inflammatory bowel disease (IBD) often has its onset during late childhood and adolescence, a time of significant change. Young people may be required to transition from a pediatric to an adult IBD service during this time. The transition from pediatric to adult services can be a high-risk period for poor outcomes for emerging adults with IBD. We seek to understand the concerns of patients and carers during this period.

Methods: Semi-structured interview and interpretative phenomenological analysis were used to explore the experiences of 16 young persons and 10 of their parents during transition.

Results: The narrative analysis reflected the importance of three aspects of transition to the young people and their parents during transition. The process of adjusting to illness, parents letting go, and the young person "growing up" were key themes.

Conclusion: In addition to patient needs, parental grief and adjustment may be easily overlooked in the transition period: children who only recently needed intensive parental care and involvement may now be seeking higher degrees of autonomy. These findings indicate a role for including psychological interventions addressing the well-being of parents in transition programs.

背景:炎症性肠病(IBD)通常在儿童晚期和青春期发病,这是一个发生重大变化的时期。在此期间,年轻人可能需要从儿科IBD服务过渡到成人IBD服务。从儿科服务过渡到成人服务可能是新发成人 IBD 患者病情恶化的高危期。我们试图了解患者和照护者在这一时期的担忧:方法:采用半结构式访谈和解释性现象学分析,探讨 16 名年轻人及其 10 名父母在过渡时期的经历:结果:叙事分析反映了过渡时期三个方面对青少年及其父母的重要性。适应疾病的过程、父母的放手和年轻人的 "成长 "是关键主题:除了病人的需求外,父母的悲伤和适应在过渡时期也很容易被忽视:不久前还需要父母密集照顾和参与的孩子,现在可能正在寻求更高的自主权。这些研究结果表明,在过渡时期的项目中,可以加入针对父母福祉的心理干预措施。
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引用次数: 0
The Potential of Narrow-Band Imaging as a Novel Light Source for Photodynamic Therapy for Superficial Cancers via Endoscopes. 窄带成像作为通过内窥镜对浅表癌症进行光动力疗法的新型光源的潜力。
IF 1.5 Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.14740/gr1694
Yusuke Nakada, Takaaki Sugihara, Maria Tanaka, Wataru Hamamoto, Tsutomu Kanda, Takuki Sakaguchi, Hiroki Kurumi, Takumi Onoyama, Yuichiro Ikebuchi, Tomoaki Takata, Hajime Isomoto, Naoyuki Yamaguchi

Background: Photodynamic therapy (PDT) has advanced through the utilization of photosensitizers and specific-wavelength light (≥ 600 nm). However, the widespread adoption of PDT is still impeded by high equipment costs and stringent laser safety requirements. Porphyrins, crucial in PDT, have another absorbance peak of blue light (λ = 380 - 500 nm). This peak corresponds to the wavelength of narrow-band imaging (NBI) (λ = 390 - 445 nm), an image-enhancement technology integrated into endoscopes by Olympus Medical Systems. The study aimed to investigate the potential of widely adopted NBI as a PDT light source for superficial cancers via endoscopes.

Methods: Esophageal and biliary cancers were selected for investigation. Human esophageal cancer cell lines (KYSE30, KYSE70, KYSE170) and cholangiocarcinoma cell lines (HuCCT-1, KKU-213) were subjected to verteporfin-mediated PDT under NBI light (λ = 390 - 445 nm). Assessments included spectrometry, crystal violet staining, and fluorescein imaging of singlet oxygen generation and apoptosis.

Results: Verteporfin exhibited a peak (λ = 436 nm) consistent with the NBI spectrum, suggesting compatibility with NBI light. NBI light significantly inhibited the growth of esophageal and biliary cancer cells. The half-maximum effective concentration (EC50) values (5 J/cm2) for KYSE30, KYSE70, KYSE170, HuCCT-1, and KKU-213 were calculated as 2.78 ± 0.37µM, 1.76 ± 1.20 µM, 0.77 ± 0.16 µM, 0.65 ± 0.18 µM, and 0.32 ± 0.04 µM, respectively. Verteporfin accumulation in mitochondria, coupled with singlet oxygen generation and observed apoptotic changes, suggests effective PDT under NBI light.

Conclusions: NBI is a promising PDT light source for superficial cancers via endoscopes.

背景:通过利用光敏剂和特定波长的光(≥ 600 纳米),光动力疗法(PDT)取得了进展。然而,高昂的设备成本和严格的激光安全要求仍阻碍着光动力疗法的广泛应用。卟啉是光动力疗法的关键,它有另一个蓝光吸收峰(λ = 380 - 500 nm)。这个峰值与窄带成像(NBI)的波长(λ = 390 - 445 nm)相对应,后者是奥林巴斯医疗系统公司集成到内窥镜中的一种图像增强技术。该研究旨在探讨广泛采用的 NBI 作为通过内窥镜治疗浅表癌症的 PDT 光源的潜力:方法:选择食管癌和胆道癌作为研究对象。人食管癌细胞株(KYSE30、KYSE70、KYSE170)和胆管癌细胞株(HuCCT-1、KKU-213)在 NBI 光源(λ = 390 - 445 nm)下接受了verteporfin 介导的 PDT 治疗。评估包括光谱分析、水晶紫染色以及单线态氧生成和细胞凋亡的荧光素成像:结果:Verteporfin显示出与NBI光谱一致的峰值(λ = 436 nm),表明它与NBI光兼容。NBI 光能明显抑制食管癌和胆道癌细胞的生长。经计算,KYSE30、KYSE70、KYSE170、HuCCT-1 和 KKU-213 的半数最大有效浓度 (EC50) 值(5 J/cm2)分别为 2.78 ± 0.37 µM、1.76 ± 1.20 µM、0.77 ± 0.16 µM、0.65 ± 0.18 µM 和 0.32 ± 0.04 µM。Verteporfin在线粒体中的积累,加上单线态氧的产生和观察到的凋亡变化,表明在NBI光下PDT是有效的:结论:NBI 是通过内窥镜治疗浅表癌症的一种很有前景的光导治疗光源。
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引用次数: 0
Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn's Patients. 克罗恩病患者肠切除术后非炎症性小肠梗阻的预测因素
IF 1.5 Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.14740/gr1635
Mir Zulqarnain, Fouad Jaber, Vinay Jahagirdar, Saqr Alsakarneh, Jose Gomez, Aditi Stanton, Nedhi Patel, Poonam Beniwal-Patel, Daniel Stein, Mary Otterson, Andres J Yarur

Background: The aim of the study was to investigate the risk factors associated with the development of small bowel obstruction (SBO) in Crohn's disease (CD) after small bowel resection (SBR) that are not due to active/recurrent inflammation.

Methods: We conducted a retrospective cohort study of patients who had SBR for active or complicated CD. Abstracted data included demographics, phenotype, therapies for CD, endoscopic disease recurrence, and several surgical variables. The primary outcome was the development of non-inflammatory SBO (NI-SBO) within 5 years after SBR.

Results: A total of 335 patients were included. The cumulative rates of NI-SBO at 6 months, 1 year, and 5 years were 5 (1.5%), 8 (2.4%), and 29 (8.9%), respectively. Variables associated with the development of NI-SBO were active macroscopic or microscopic inflammation in the surgical margins (13 (56%) vs. 65 (27%), P = 0.004), open resection (vs. laparoscopic resection) (12 (41.4%) vs. 60 (19.5%), P = 0.0006) and a higher median number of previous resections (2 (interquartile range (IQR) 2 - 3) vs. 1 (IQR 1 - 2), P = 0.0002). Only 21% of patients who developed NI-SBO required surgical intervention.

Conclusions: The incidence of NI-SBO after SBR in CD is low and associated with inflammation at the margins of the resected bowel, previous bowel resections, and an open laparotomy approach. Most NI-SBOs resolve with medical management.

研究背景本研究旨在探讨克罗恩病(CD)患者小肠切除术(SBR)后发生非活动性/复发性炎症引起的小肠梗阻(SBO)的相关风险因素:我们对因活动性或复杂性 CD 而接受 SBR 的患者进行了一项回顾性队列研究。摘录的数据包括人口统计学特征、表型、CD 治疗方法、内镜下疾病复发以及几个手术变量。主要结果是SBR术后5年内出现非炎症性SBO(NI-SBO):结果:共纳入 335 例患者。6个月、1年和5年的NI-SBO累积率分别为5(1.5%)、8(2.4%)和29(8.9%)。与NI-SBO发生相关的变量有:手术边缘活动性宏观或微观炎症(13(56%)对 65(27%),P = 0.004)、开腹切除(对腹腔镜切除)(12(41.4%)对 60(19.5%),P = 0.0006)以及既往切除次数中位数较高(2(四分位间距(IQR)2 - 3)对 1(IQR 1 - 2),P = 0.0002)。只有21%的NI-SBO患者需要手术干预:结论:CD患者SBR术后NI-SBO发生率较低,与切除肠道边缘炎症、既往肠道切除术和开腹手术方式有关。大多数 NI-SBO 可通过药物治疗缓解。
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引用次数: 0
A Comprehensive Study on the Diagnostic Value of Multi-Slice Computed Tomography for Peripancreatic Infection in Elderly With Severe Acute Pancreatitis. 多切片计算机断层扫描对老年重症急性胰腺炎患者胰周感染诊断价值的综合研究
IF 1.5 Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.14740/gr1679
Rui Hao, Yu Sun, Yang Hu

Background: This study investigated the diagnostic efficacy of multi-slice spiral computed tomography (MSCT) perfusion imaging in evaluating peripancreatic infection in elderly patients with severe acute pancreatitis (SAP).

Methods: A retrospective analysis was conducted on the clinical data of 110 elderly SAP patients treated at our hospital from March 2018 to August 2019. The study correlated MSCT perfusion imaging characteristics with peripancreatic infection in elderly SAP patients. Additionally, receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of MSCT perfusion imaging parameters in evaluating peripancreatic infection in elderly SAP patients.

Results: The results indicated that among all 110 elderly SAP patients, the incidence rate of peripancreatic infection was 20.91%, with a mortality rate of 0.91%. MSCT perfusion imaging revealed that after peripancreatic infection in elderly SAP patients, there was a decrease in pancreatic density, local enlargement of the pancreas, blurring of the pancreatic margins, and associated ascites. Compression/narrowing/occlusion of the splenic vein was observed in 22 patients, compression/narrowing/occlusion of the superior mesenteric vein in 17 patients, thickening/thrombosis of the portal vein in 19 patients, and collateral circulation in 21 patients. Compared to elderly SAP patients without peripancreatic infection, those with the infection showed prolonged peak times, reduced peak heights, and decreased blood flow. ROC analysis indicated that the combination of the three parameters (peak time, peak height, and blood flow) had higher specificity and area under the curve (AUC) than single parameters, with no significant difference in sensitivity between the combination and single parameters.

Conclusions: In conclusion, combining the three key MSCT perfusion imaging parameters (peak time, peak height, and blood flow) can significantly enhance the predictive efficacy for the risk of peripancreatic infection in elderly SAP patients.

背景:本研究探讨了多层螺旋计算机断层扫描(MSCT)灌注成像在评估老年重症急性胰腺炎(SAP)患者胰周感染中的诊断效果:对我院2018年3月至2019年8月收治的110例老年SAP患者的临床资料进行回顾性分析。该研究将MSCT灌注成像特征与老年SAP患者胰周感染相关联。此外,研究还构建了接收者操作特征曲线(ROC),以评估MSCT灌注成像参数在评估老年SAP患者胰周感染中的诊断性能:结果显示,在所有110例老年SAP患者中,胰周感染的发生率为20.91%,死亡率为0.91%。MSCT 灌注成像显示,老年 SAP 患者胰腺周围感染后,胰腺密度下降,胰腺局部肿大,胰腺边缘模糊,并伴有腹水。在 22 例患者中观察到脾静脉受压/狭窄/闭塞,在 17 例患者中观察到肠系膜上静脉受压/狭窄/闭塞,在 19 例患者中观察到门静脉增粗/血栓形成,在 21 例患者中观察到侧支循环。与未患胰周感染的 SAP 老年患者相比,患胰周感染的患者表现出峰值时间延长、峰值高度降低和血流量减少。ROC分析表明,与单一参数相比,三个参数(峰时、峰高和血流)的组合具有更高的特异性和曲线下面积(AUC),而组合参数与单一参数的敏感性没有显著差异:总之,将 MSCT 的三个关键灌注成像参数(峰值时间、峰值高度和血流量)结合起来,可显著提高对老年 SAP 患者胰周感染风险的预测效果。
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引用次数: 0
Mucosa-Associated Lymphoid Tissue Surgeries as a Possible Risk for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. 粘膜相关淋巴组织手术可能导致炎症性肠病:系统回顾与元分析》。
IF 1.5 Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.14740/gr1672
Rutvi Amin, Aditya Mansabdar, Hyundam Gu, Bhavani Gangineni, Neev Mehta, Harini Patel, Neel Patel, Srishti Laller, Suprada Vinayak, Mohammed Ali Abdulqader, Hardik Jain, Amitjeet Singh Rekhraj, Harshini Adimoulame, Gurinder Singh, Jose Moonjely Davis, Urvish Patel, Harmeet Gill

Background: Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal disorders that are caused by genetic susceptibility and environmental factors and affects a significant portion of the global population. The gut-associated lymphoid tissue (GALT) is known to play a crucial role in immune modulation and maintaining gut microbiota balance. Dysbiosis in the latter has a known link to IBD. Therefore, the increasing prevalence of adenoidectomy in children should be explored for its potential association with IBD. The objective of this paper was to assess the association between adenoid tissue removal and the risk of developing Crohn's disease (CD) and ulcerative colitis (UC).

Methods: We conducted a pooled meta-analysis to evaluate the extended clinical outcomes in patients who underwent appendicectomy and tonsillectomy compared to those who did not. Our approach involved systematically searching the PubMed database for relevant observational studies written in English. We followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines to collect data from various time periods, and to address the diversity in study results; we employed a random-effects analysis that considered heterogeneity. For outcomes, odds ratios (ORs) were pooled using a random-effects model.

Results: Seven studies, out of a total of 114,537, met our inclusion criteria. Our meta-analysis revealed a significant association between appendicectomy and CD (OR: 1.57; 95% confidence interval (CI): 1.01 - 2.43; heterogeneity I2 = 93%). Similarly, we found a significant association between tonsillectomy and CD (OR: 1.93; 95% CI: 0.96 - 3.89; I2 = 62%). However, no significant association was observed between appendicectomy and UC (OR: 0.60; 95% CI: 0.24 - 1.47; I2 = 96%), while a modest association was found between tonsillectomy and UC (OR: 1.24; 95% CI: 1.18 - 1.30; I2 = 0%).

Conclusions: In summary, we found that the trend of appendicectomy is linked to higher odds of CD, and tonsillectomy is more likely associated with increased odds for both CD and UC, with a risk of bias present.

背景:炎症性肠病(IBD)是由遗传易感性和环境因素引起的一组慢性炎症性胃肠道疾病,影响着全球相当一部分人口。众所周知,肠道相关淋巴组织(GALT)在免疫调节和维持肠道微生物群平衡方面发挥着至关重要的作用。众所周知,后者的菌群失调与肠道疾病有关。因此,随着儿童腺样体切除术的日益普遍,应探讨其与 IBD 的潜在联系。本文旨在评估腺样体组织切除与克罗恩病(CD)和溃疡性结肠炎(UC)发病风险之间的关系:我们进行了一项汇总荟萃分析,以评估接受阑尾切除术和扁桃体切除术的患者与未接受阑尾切除术和扁桃体切除术的患者相比所获得的更多临床结果。我们在PubMed数据库中系统搜索了相关的英文观察性研究。我们遵循流行病学观察性研究元分析(MOOSE)指南,收集不同时期的数据,并处理研究结果的多样性;我们采用了考虑异质性的随机效应分析。对于结果,采用随机效应模型对几率比(ORs)进行汇总:在总共 114,537 项研究中,有 7 项研究符合我们的纳入标准。我们的荟萃分析表明,阑尾切除术与 CD 有显著相关性(OR:1.57;95% 置信区间 (CI):1.01 - 2.43;异质性 I2 = 93%)。同样,我们还发现扁桃体切除术与 CD 有显著相关性(OR:1.93;95% CI:0.96 - 3.89;I2 = 62%)。然而,在阑尾切除术与 UC 之间未观察到明显的关联(OR:0.60;95% CI:0.24 - 1.47;I2 = 96%),而在扁桃体切除术与 UC 之间发现了适度的关联(OR:1.24;95% CI:1.18 - 1.30;I2 = 0%):总之,我们发现阑尾切除术的趋势与较高的 CD 发生几率有关,而扁桃体切除术更有可能与 CD 和 UC 发生几率的增加有关,但存在偏倚风险。
{"title":"Mucosa-Associated Lymphoid Tissue Surgeries as a Possible Risk for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Rutvi Amin, Aditya Mansabdar, Hyundam Gu, Bhavani Gangineni, Neev Mehta, Harini Patel, Neel Patel, Srishti Laller, Suprada Vinayak, Mohammed Ali Abdulqader, Hardik Jain, Amitjeet Singh Rekhraj, Harshini Adimoulame, Gurinder Singh, Jose Moonjely Davis, Urvish Patel, Harmeet Gill","doi":"10.14740/gr1672","DOIUrl":"10.14740/gr1672","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal disorders that are caused by genetic susceptibility and environmental factors and affects a significant portion of the global population. The gut-associated lymphoid tissue (GALT) is known to play a crucial role in immune modulation and maintaining gut microbiota balance. Dysbiosis in the latter has a known link to IBD. Therefore, the increasing prevalence of adenoidectomy in children should be explored for its potential association with IBD. The objective of this paper was to assess the association between adenoid tissue removal and the risk of developing Crohn's disease (CD) and ulcerative colitis (UC).</p><p><strong>Methods: </strong>We conducted a pooled meta-analysis to evaluate the extended clinical outcomes in patients who underwent appendicectomy and tonsillectomy compared to those who did not. Our approach involved systematically searching the PubMed database for relevant observational studies written in English. We followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines to collect data from various time periods, and to address the diversity in study results; we employed a random-effects analysis that considered heterogeneity. For outcomes, odds ratios (ORs) were pooled using a random-effects model.</p><p><strong>Results: </strong>Seven studies, out of a total of 114,537, met our inclusion criteria. Our meta-analysis revealed a significant association between appendicectomy and CD (OR: 1.57; 95% confidence interval (CI): 1.01 - 2.43; heterogeneity I<sup>2</sup> = 93%). Similarly, we found a significant association between tonsillectomy and CD (OR: 1.93; 95% CI: 0.96 - 3.89; I<sup>2</sup> = 62%). However, no significant association was observed between appendicectomy and UC (OR: 0.60; 95% CI: 0.24 - 1.47; I<sup>2</sup> = 96%), while a modest association was found between tonsillectomy and UC (OR: 1.24; 95% CI: 1.18 - 1.30; I<sup>2</sup> = 0%).</p><p><strong>Conclusions: </strong>In summary, we found that the trend of appendicectomy is linked to higher odds of CD, and tonsillectomy is more likely associated with increased odds for both CD and UC, with a risk of bias present.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Overview of Sarcopenia, Frailty, and Malnutrition in Patients With Liver Cirrhosis. 肝硬化患者骨质疏松、虚弱和营养不良的临床概况。
IF 1.5 Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.14740/gr1707
Alexander Kusnik, Amulya Penmetsa, Farooq Chaudhary, Keerthi Renjith, Gopal Ramaraju, Marie Laryea, Johane P Allard

Sarcopenia, frailty, and malnutrition in patients with liver cirrhosis are commonly observed and are associated with higher long-term mortality. Therefore, recognizing patients with increased nutritional risk and providing recommended interventions are essential in the long- and short-term management of cirrhosis, especially as alcoholic and non-alcoholic fatty liver disease continues to rise. Various assessment tools are available to gauge frailty and malnutrition but are infrequently used. Given the global burden of liver cirrhosis, periodic screening for malnutrition, sarcopenia, and frailty is desperately needed as it improves liver transplantation outcomes. Necessary steps include addressing knowledge gaps in professional healthcare workers and patients and using standardized assessment tools to counteract physical deconditioning as early as possible. One potential method for assessing sarcopenia involves using computed tomography to evaluate the skeletal muscle index. Regarding frailty, useful tools for longitudinal assessment include the liver frailty index and the Karnofsky performance status. Addressing educational requirements related to malnutrition involves seeking guidance from dieticians, who can provide counseling on achieving sufficient calorie and protein intake to combat the progression of malnutrition.

肝硬化患者普遍存在肌营养不良、体质虚弱和营养不良等问题,并且与较高的长期死亡率有关。因此,识别营养风险增加的患者并提供建议的干预措施对于肝硬化的长期和短期治疗至关重要,尤其是在酒精性和非酒精性脂肪肝持续增加的情况下。目前有多种评估工具可用于衡量虚弱和营养不良程度,但很少被使用。鉴于肝硬化给全球带来的负担,我们迫切需要定期筛查营养不良、肌肉疏松症和虚弱,以改善肝移植的预后。必要的步骤包括解决专业医护人员和患者的知识缺口,并使用标准化的评估工具来尽早应对身体机能减退。评估肌肉疏松症的一种潜在方法是使用计算机断层扫描评估骨骼肌指数。关于虚弱,纵向评估的有用工具包括肝脏虚弱指数和卡诺夫斯基表现状态。要满足与营养不良有关的教育要求,就需要寻求营养师的指导,他们可以就如何摄入足够的卡路里和蛋白质提供咨询,以防止营养不良的恶化。
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引用次数: 0
Fulminant Emphysematous Pancreatitis: Diagnosis Time Counts. 暴发性气肿性胰腺炎:诊断时间至关重要。
IF 1.5 Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1671
Basel Darawsha, Subhi Mansour, Tawfik Fahoum, Naseem Azzam, Yoram Kluger, Ahmad Assalia, Safi Khuri

Emphysematous pancreatitis (EP), a severe form of necrotizing infection of the pancreas, is an extremely rare medical emergency with high rates of mortality. It is characterized by intraparenchymal pancreatic or peri-pancreatic air due to either monomicrobial or polymicrobial infection with gas-forming bacteria or due to entero-pancreatic fistula. EP is classified according to timing from disease onset when air bubble signs were detected on computed tomography (CT) scan, as early onset (within 2 weeks from disease onset) or late (more than 2 weeks from disease onset). While most cases of acute pancreatitis are resolved with supportive care alone, clinical outcomes of EP, especially the early onset subtype, are very poor with high rates of morbidity and mortality. These two case reports present the clinical features, diagnostic investigations, and management of two patients admitted to our hospital with early onset fulminant EP, each investigated and managed with different approaches. The first patient underwent a more conservative treatment, with diagnosis being made 52 h following admission, and thus, intensive care unit (ICU) admission and surgery were postponed, while the second patient was diagnosed a few hours following presentation with earlier ICU admission. In this article, we will present the critical importance of early diagnosis of the aforementioned rare entity of severe pancreatitis and will consider the consequences of rapid diagnosis on disease course, morbidity and mortality.

气肿性胰腺炎(EP)是一种严重的胰腺坏死性感染,是一种极为罕见的急症,死亡率很高。其特点是胰腺实质内或胰腺周围充气,原因是单微生物或多微生物感染产气细菌,或者是肠胰瘘。急性胰腺炎根据计算机断层扫描(CT)发现气泡征象的起病时间分为早期起病(起病两周内)和晚期起病(起病两周以上)。虽然大多数急性胰腺炎病例仅通过支持性治疗即可缓解,但 EP(尤其是早发亚型)的临床预后非常差,发病率和死亡率都很高。这两份病例报告介绍了我院收治的两名早发暴发性急性胰腺炎患者的临床特征、诊断检查和治疗情况,他们分别接受了不同的检查和治疗。第一例患者接受了更为保守的治疗,在入院 52 小时后才确诊,因此推迟了入住重症监护室(ICU)和手术的时间;而第二例患者在发病数小时后才确诊,并提前入住重症监护室。在本文中,我们将介绍早期诊断上述罕见重症胰腺炎的重要性,并探讨快速诊断对病程、发病率和死亡率的影响。
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引用次数: 0
Alcohol Relapse After Early Liver Transplantation in Patients With Alcoholic Liver Disease: A Meta-Analysis. 酒精性肝病患者早期肝移植后酒精复发:一项 Meta 分析。
IF 1.5 Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1674
Yousaf Zafar, Ahmed Kamal Siddiqi, Nafhat Shaikh, Maria Imran, Syed Sarmad Javaid, Laila Manzoor, Arsalan Zafar Iqbal, Jan Petrasek

Background: Alcohol use disorder (AUD) is a significant source of end-stage liver disease and liver failure and an indication for liver transplant (LT). Historically, LT for alcoholic liver disease (ALD) required 6 months of alcohol abstinence. Recently, it has been demonstrated that early LT (< 6 months of abstinence) in strictly selected group of patients provides survival benefit while keeping the relapse to harmful drinking at acceptable levels. This practice has been reflected in the Dallas consensus, but more data are needed to appropriately risk stratify the patient from the perspective of return to harmful alcohol drinking post-transplant. This "6-month rule" has been highly debated and recent data demonstrated that the duration of pre-transplant sobriety is not related with an increased risk of relapse to alcohol post-transplant. We performed a meta-analysis to compare the rate of alcohol relapse in individuals having standard vs. early LT.

Methods: MEDLINE and SCOPUS were searched for randomized controlled trials (RCTs), observational studies, and case-control studies from their inception through June 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMSA) 2009 checklist guidelines were followed for this meta-analysis. Studies comparing post-transplant outcomes, such as alcohol relapse, in individuals following standard vs. early LT, were included. Reviews, case studies, conference abstracts, clinical trials with only an abstract, and studies with inadequate data for extraction were all disqualified. The data were retrieved, gathered, and examined. The random effects model was used to generate forest plots. For the analysis, a P-value of 0.05 was considered significant.

Results: Thirty-four studies were discovered in the initial search. Three studies were included in this systematic review and meta-analysis incorporating 367 patients. Mean age was 51.7 years. Out of 367 patients, 173 (47%) underwent early LT. Out of three studies included, one study demonstrated decreased probability of alcohol relapse in patients undergoing early LT, whereas the other two showed the opposite result. All of the included studies were analyzed and had minimal risk of bias. Pooled analysis demonstrates that the difference in alcohol relapse between early vs. standard LT was insignificant (odds ratio: 1.24, 95% confidence interval: 0.75 - 2.06, P = 0.40).

Conclusion: Our results show that early LT is not associated with increased risk of alcohol relapse post-transplant when compared with a mandatory 6-month abstinence period. Hence, individuals with ALD should not be categorically rejected from LT merely on the criteria of 6 months of abstinence. Other selection criteria based on the need and post-transplant outcomes should be utilized.

背景:酒精使用障碍(AUD)是终末期肝病和肝功能衰竭的重要原因,也是肝移植(LT)的适应症之一。一直以来,酒精性肝病(ALD)的肝移植需要戒酒 6 个月。最近的研究表明,严格筛选出的早期 LT(戒酒时间小于 6 个月)患者可获得生存益处,同时将有害饮酒的复发率控制在可接受的水平。这种做法已在达拉斯共识中得到反映,但还需要更多的数据,以便从移植后复发有害饮酒的角度对患者进行适当的风险分层。这一 "6 个月规则 "一直备受争议,最近的数据表明,移植前戒酒时间的长短与移植后复酒风险的增加无关。我们进行了一项荟萃分析,以比较标准 LT 与早期 LT 患者的酒精复发率:方法:在 MEDLINE 和 SCOPUS 中检索了从开始到 2022 年 6 月的随机对照试验 (RCT)、观察性研究和病例对照研究。本荟萃分析遵循了 2009 年系统综述和荟萃分析首选报告项目(PRISMSA)核对表指南。纳入的研究比较了标准 LT 与早期 LT 患者移植后的结果,如酒精复发。综述、病例研究、会议摘要、仅有摘要的临床试验以及提取数据不充分的研究均被取消资格。对数据进行检索、收集和检查。采用随机效应模型生成森林图。在分析中,P 值为 0.05 即为显著:初步搜索发现了 34 项研究。本系统综述和荟萃分析纳入了三项研究,共纳入 367 名患者。平均年龄为 51.7 岁。在 367 名患者中,173 人(47%)接受了早期 LT。在纳入的三项研究中,一项研究表明接受早期LT治疗的患者酒精复发的概率降低,而另外两项研究的结果则相反。所有纳入的研究均经过分析,偏倚风险极低。汇总分析表明,早期 LT 与标准 LT 在酒精复发率方面的差异并不显著(几率比:1.24,95% 置信区间:0.75 - 2.06,P = 0.40):我们的研究结果表明,与强制戒酒 6 个月相比,早期 LT 与移植后酒精复发风险增加无关。因此,不应仅以戒酒 6 个月为标准,断然拒绝 ALD 患者接受 LT。应根据需要和移植后的结果采用其他选择标准。
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引用次数: 0
Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer. 拉丁裔患者大肠癌筛查的延迟:移民医疗在遏制全球结直肠癌发病率上升中的作用》(The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer)。
IF 1.5 Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1697
Eleazar E Montalvan-Sanchez, Renato Beas, Ahmad Karkash, Ambar Godoy, Dalton Argean Norwood, Michael Dougherty

The significant global burden of colorectal cancer accentuates disparities in access to preventive healthcare in most low- and middle-income countries (LMICs) as well as large sections of underserved populations within high-income countries. The barriers to colorectal cancer screening in economically transitioning Latin America are multiple. At the same time, immigration from these countries to the USA continues to increase. This case highlights the delays in diagnosis experienced by a recent immigrant from a country with no established colorectal cancer screening program, to an immigrant population in the USA with similar poor screening coverage. We discuss common challenges faced by Latinos in their home countries and the USA, as well as strategies that could be implemented to improve screening coverage in US immigrant populations.

结直肠癌给全球带来的沉重负担加剧了大多数中低收入国家(LMICs)以及高收入国家中大部分得不到充分服务的人群在获得预防保健方面的差距。在经济转型期的拉丁美洲,结直肠癌筛查面临多重障碍。与此同时,从这些国家移民到美国的人数持续增加。本病例重点介绍了一位来自没有建立结直肠癌筛查计划的国家的新移民,在筛查覆盖率同样较低的美国移民人口中所经历的诊断延误。我们讨论了拉美人在本国和美国面临的共同挑战,以及为提高美国移民筛查覆盖率可采取的策略。
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引用次数: 0
Clinicopathological Aspects and Inflammation-Immune Markers in Alcohol and/or Hepatitis C Virus-Induced Hepatocellular Carcinoma Patients Treated With Sorafenib. 用索拉非尼治疗酒精和/或丙型肝炎病毒诱导的肝细胞癌患者的临床病理方面和炎症-免疫标记物
IF 1.5 Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1689
Thiago Alexandre Martins Pinto, Helena Paes Almeida Saito, Carolina Lopes Nourani, Elaine Cristina Ataide, Ilka Fatima Santana Ferreira Boin, Gustavo Jacob Lourenco, Carmen Silvia Passos Lima

Background: Tyrosine kinase inhibitors have been used to treat hepatocellular carcinoma (HCC), but the outcomes of patients under treatment vary. Since the roles of clinicopathological aspects and markers of chronic inflammation/immune homeostasis in the outcome of HCC patients treated with sorafenib are still unclear, these were the aims of this study.

Methods: Patients with alcohol-induced and/or hepatitis C virus (HCV)-induced HCC (n = 182) uniformly treated with sorafenib were included in the study. Baseline clinicopathological aspects of patients were computed from the medical records. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) were obtained from the hematological exam performed before the administration of sorafenib. Overall survival (OS) was analyzed using Kaplan-Meier probabilities, log-rank test, and univariate and multivariate Cox proportional hazard ratio (HR) analyses.

Results: In multivariate analysis, alpha-foetoprotein (AFP) level and Child-Pugh score were predictors of OS. Patients with AFP levels higher than 157 ng/mL and Child-Pugh B or C had 1.40 (95% confidence interval (CI): 1.03 - 1.91, P = 0.03) and 1.64 (95% CI: 1.07 - 2.52, P = 0.02) more chances of evolving to death than the remaining patients, respectively. NLR, PLR, LMR, SIRI, and SII did not alter the OS of HCC patients.

Conclusions: AFP level and Child-Pugh score act as independent prognostic factors in patients with alcohol and/or HCV-induced HCC treated with sorafenib, but markers of chronic inflammation/immune homeostasis seem not to alter the outcome of patients with HCC induced by alcohol and/or HCV.

背景:酪氨酸激酶抑制剂已被用于治疗肝细胞癌(HCC),但接受治疗的患者的预后各不相同。由于临床病理学方面和慢性炎症/免疫平衡标志物在接受索拉非尼治疗的 HCC 患者的预后中的作用尚不明确,因此这些是本研究的目的:研究纳入了接受索拉非尼治疗的酒精诱导和/或丙型肝炎病毒(HCV)诱导的HCC患者(182人)。根据病历计算患者的临床病理基线。中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、全身炎症反应指数(SIRI)和全身免疫炎症指数(SII)来自索拉非尼治疗前的血液学检查。采用卡普兰-梅耶概率、对数秩检验、单变量和多变量考克斯比例危险比(HR)分析对总生存期(OS)进行了分析:在多变量分析中,甲胎蛋白(AFP)水平和Child-Pugh评分是预测OS的因素。甲胎蛋白水平高于157纳克/毫升和Child-Pugh B或C的患者比其他患者演变为死亡的几率分别高1.40(95%置信区间(CI):1.03 - 1.91,P = 0.03)和1.64(95% CI:1.07 - 2.52,P = 0.02)。NLR、PLR、LMR、SIRI和SII不会改变HCC患者的OS:结论:AFP水平和Child-Pugh评分是酒精和/或HCV诱发的HCC患者接受索拉非尼治疗的独立预后因素,但慢性炎症/免疫稳态标志物似乎不会改变酒精和/或HCV诱发的HCC患者的预后。
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引用次数: 0
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Gastroenterology Research
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