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Gastrointestinal Mucormycosis: A Clinical Review. 胃肠道毛霉菌病:临床综述。
IF 1.5 Pub Date : 2023-10-01 Epub Date: 2023-10-21 DOI: 10.14740/gr1662
Yazan Addasi, Anny H Nguyen, Ahmed Sabri, Faran Ahmad, Rajani Rangray, Manasa Velagapudi

Mucormycosis is a devastating fungal infection that is usually seen in immunocompromised hosts. It is caused by fungi of the subphylum Mucoromycotina, order Mucorales, with most cases caused by Mucor, Rhizopus, or Rhizomucor species. It can involve any organ system and can disseminate in severe cases. Lately, there has been an increased number of reports for mucormycosis infection in immunocompetent patients. Gastrointestinal system involvement is rare compared to other organ systems but has been increasingly reported in the literature. Mucormycosis can affect any part of the gastrointestinal tract and lead to different presentations depending on the area of involvement. Due to the paucity of the condition, there has been no specific guidelines on how to treat gastrointestinal mucormycosis. In this review, we discuss the risk factors of gastrointestinal mucormycosis, clinical presentation, approach to diagnosis, and most recent treatment modalities for gastrointestinal mucormycosis.

毛霉菌病是一种破坏性真菌感染,通常见于免疫功能低下的宿主。它是由毛霉目毛霉菌亚门的真菌引起的,大多数情况下由毛霉、根霉或根毛霉菌引起。它可以涉及任何器官系统,并在严重病例中传播。最近,有越来越多的关于免疫功能患者感染毛霉菌病的报道。与其他器官系统相比,胃肠系统受累是罕见的,但文献中的报道越来越多。毛霉菌病可以影响胃肠道的任何部位,并根据涉及的区域导致不同的表现。由于这种情况很少,目前还没有关于如何治疗胃肠道毛霉菌病的具体指南。在这篇综述中,我们讨论了胃肠道毛霉菌病的危险因素、临床表现、诊断方法以及胃肠道毛真菌病的最新治疗方法。
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引用次数: 0
Safety and Efficacy of Powered Non-Thermal Endoscopic Resection Device for Removal of Colonic Polyps: A Systematic Review and Meta-Analysis. 动力非热内镜结肠息肉切除装置的安全性和有效性:系统评价和荟萃分析。
IF 1.5 Pub Date : 2023-10-01 Epub Date: 2023-10-21 DOI: 10.14740/gr1638
Zohaib Ahmed, Daryl Ramai, Nooraldin Merza, Joyce Badal, Umair Iqbal, Syeda F Arif, Alsadiq Al-Hillan, Tony Varughese, Wade Lee-Smith, Ali Nawras, Yaseen Alastal, Harshit S Khara, Bradley D Confer, David L Diehl, Douglas G Adler

Background: Endoscopic mucosal resection is a frequently employed method for removing colonic polyps. Nonetheless, the recurrence of these polyps over a healed submucosal base can complicate the extraction of leftover lesions through standard procedures. EndoRotor®, a non-thermal device specifically designed for endoscopic mucosal resection, has recently been assessed for its utility in removing colonic polyps, non-dysplastic Barrett's esophagus, and pancreatic necrosis. We conducted a systematic review and meta-analysis to ascertain the safety and efficacy of EndoRotor® in resecting scared or recurrence colonic polyps.

Methods: We conducted an exhaustive review of existing literature using databases such as Medline, Embase, Web of Science, and the Cochrane Library until January 2023. Our aim was to find all studies that assessed the safety of non-thermal endoscopic resection devices in removing colonic polyps. The primary outcome we focused on was the rate of technical success. Secondary outcomes that we considered included the frequency of remaining lesions and instances of adverse events. To analyze these data, we used comprehensive meta-analysis software.

Results: Our analysis incorporated three studies comprising 54 patients who underwent resection of 60 lesions. The combined technical success rate was 93.9% (95% confidence interval (CI): 77.7-98.6%, I2 = 25.5%). In patients who had another endoscopic examination, 20 were found to have a residual lesion. After the initial session, the combined rate of remaining lesions was 39.8% (95% CI: 15.3-70.8%, I2 = 74.5%). There were eight occurrences of intraoperative bleeding and four instances of bleeding post-procedure. The combined rate of intraoperative bleeding was 13.2% (95% CI: 6.7-24.3%, I2 = 0%), and post-procedure bleeding stood at 8.5% (95% CI: 3.4-19.8%, I2 = 0%). Only one major bleeding event was recorded, and no cases of perforation were reported.

Conclusion: Our research indicates that the EndoRotor® effectively removes scarred colonic polyps, though the rate of remaining lesions is significant, potentially necessitating several sessions for a thorough removal. There is a need for broader prospective studies, mainly randomized controlled trials, to further assess EndoRotor®'s efficiency and safety in eliminating colonic polyps.

背景:内镜下黏膜切除术是切除结肠息肉的常用方法。尽管如此,这些息肉在愈合的黏膜下基底复发可能会使通过标准程序提取残留病变变得复杂。EndoRotor®是一种专门为内镜黏膜切除术设计的非热设备,最近被评估其在去除结肠息肉、非发育异常巴雷特食管和胰腺坏死方面的效用。我们进行了一项系统综述和荟萃分析,以确定EndoRotor®切除惊恐或复发结肠息肉的安全性和有效性。方法:我们使用Medline、Embase、Web of Science和Cochrane Library等数据库对现有文献进行了详尽的综述,直到2023年1月。我们的目的是寻找所有评估非热内镜切除装置在切除结肠息肉中的安全性的研究。我们关注的主要结果是技术成功率。我们考虑的次要结果包括残留病变的频率和不良事件的发生率。为了分析这些数据,我们使用了全面的荟萃分析软件。结果:我们的分析纳入了三项研究,包括54名患者,他们接受了60个病灶的切除。综合技术成功率为93.9%(95%置信区间(CI):77.7-98.6%,I2=25.5%)。在再次进行内镜检查的患者中,发现20例有残余病变。初次治疗后,残余病变的综合发生率为39.8%(95%CI:15.3-70.8%,I2=74.5%)。术中出血8例,术后出血4例。术中出血的综合发生率为13.2%(95%CI:6.7-24.3%,I2=0%),术后出血为8.5%(95%CI:3.4-19.8%,I2=0%)。只记录了一次大出血事件,没有穿孔病例报告。结论:我们的研究表明,EndoRotor®可以有效地去除结疤的结肠息肉,尽管残留病变的发生率很高,可能需要几次手术才能彻底去除。需要进行更广泛的前瞻性研究,主要是随机对照试验,以进一步评估EndoRotor®在消除结肠息肉方面的有效性和安全性。
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引用次数: 0
Primary Squamous Cell Biliary Carcinoma With Liver Metastasis Is Rare but Malicious. 原发性胆管鳞状细胞癌伴肝转移是罕见但恶性的。
IF 1.5 Pub Date : 2023-10-01 Epub Date: 2023-10-21 DOI: 10.14740/gr1637
Mohamad Khaled Almujarkesh, Anirudh R Damughatla, Jasdeep Bathla, Kyle Sugg, Dana LaBuda, Samer Alkassis, Mohammed Najeeb Al Hallak

Primary squamous cell carcinoma (SCC) of the liver is quite rare, and to our knowledge, very few cases have been reported in the literature. The exact pathogenesis of the disease is unestablished; however, it is mostly reported to be associated with hepatic cyst, Caroli's disease, hepatolithiasis, hepatic cirrhosis, and hepatic teratoma. We report a case of a 50-year-old woman with no prior medical history initially, who presented with postprandial epigastric and right upper quadrant pain that continued to worsen and was associated with early satiety, nausea, and weight loss of 25 pounds over 2 months, which prompted further evaluation by her primary care physician. Magnetic resonance imaging (MRI) examination a month later revealed a large heterogeneous area measuring 8.5 × 2.4 × 7.4 cm in the inferior right hepatic lobe with heterogeneous enhancement and involvement of the gallbladder, concerning for cholangiocarcinoma. Given radiographic findings, she underwent a computed tomography (CT)-guided core biopsy of the liver, which showed a necrotic malignant tumor favoring adenocarcinoma and was also found to have germline BRCA mutation. A positron emission tomography (PET) scan revealed a large partially necrotic fluorodeoxyglucose (FDG) avid mass, possibly arising from the gallbladder fossa with an invasion of both lobes of the liver and probable involvement of a portion of the ascending colon. There was no gross evidence of distant metastatic disease. The patient underwent staging laparoscopy prior to initiating chemotherapy, and another biopsy was done, which returned in favor of SCC, with immunohistochemical stains being positive for cytokeratin (CK)19, Ber-EP4 (epithelial antigen recognized by Ber-EP4 antibody), and P40 (DeltaNp63); while negative for CK7, CK20, caudal-type homeobox 2 (CDX-2), paired box 8 (PAX-8), and mucicarmine. The patient started platinum-based chemotherapy due to germline BRCA mutation. However, due to complications associated with therapy and the progression of the disease, the patient eventually chose hospice. Primary SSC remains an unexplored aggressive malignancy that carries an overall poor prognosis. Diagnosis can be challenging and requires high clinical suspicion due to the scarcity in specific laboratory workup. Pathological diagnosis remains the gold standard; however, it also carries its own challenges. Treatment is usually case-oriented, and definitive protocols have yet to be established.

原发性肝鳞状细胞癌(SCC)非常罕见,据我们所知,文献中报道的病例很少。这种疾病的确切发病机制尚不清楚;然而,据报道,它大多与肝囊肿、Caroli病、肝结石、肝硬化和肝畸胎瘤有关。我们报告了一名50岁女性的病例,她最初没有病史,餐后上腹部和右上腹疼痛持续恶化,并伴有早期饱腹感、恶心和2个月内体重减轻25磅,这促使她的初级保健医生进行进一步评估。一个月后的磁共振成像(MRI)检查显示,右肝下叶有一个8.5×2.4×7.4 cm的大面积不均匀区域,胆囊有不均匀增强和受累,与胆管癌有关。根据放射学检查结果,她接受了计算机断层扫描(CT)引导的肝脏核心活检,结果显示坏死的恶性肿瘤有利于腺癌,还发现有种系BRCA突变。正电子发射断层扫描(PET)显示一个大的部分坏死的氟脱氧葡萄糖(FDG)肿块,可能来自胆囊窝,侵犯了肝脏的两个叶,可能累及了升结肠的一部分。没有明显的证据表明存在远处转移性疾病。患者在开始化疗前接受了分期腹腔镜检查,并进行了另一次活检,结果显示SCC,细胞角蛋白(CK)19、Ber-EP4(Ber-EP4抗体识别的上皮抗原)和P40(DeltaNp63)的免疫组织化学染色呈阳性;而CK7、CK20、尾侧型同源盒2(CDX-2)、配对盒8(PAX-8)和粘液胺呈阴性。由于种系BRCA突变,患者开始了基于铂的化疗。然而,由于与治疗和疾病进展相关的并发症,患者最终选择了临终关怀。原发性SSC仍然是一种未经探索的侵袭性恶性肿瘤,总体预后较差。由于缺乏特定的实验室检查,诊断可能具有挑战性,需要高度的临床怀疑。病理诊断仍然是金标准;然而,它也有自己的挑战。治疗通常以病例为导向,最终方案尚未制定。
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引用次数: 0
A Significant Effect of Pemafibrate on Hepatic Steatosis and Fibrosis Indexes in Patients With Hypertriglyceridemia. 培马贝特对高甘油三酯血症患者肝脏脂肪变性和纤维化指数的显著影响
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-01 Epub Date: 2023-08-26 DOI: 10.14740/gr1656
Hisayuki Katsuyama, Hidekatsu Yanai, Hiroki Adachi, Mariko Hakoshima

Background: We previously reported that the selective peroxisome proliferator-activated receptor alpha modulator, pemafibrate, significantly reduced serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) and significantly increased serum albumin levels at 3, 6 and 12 months after the start of pemafibrate, with an improvement of atherogenic dyslipidemia, in patients with hypertriglyceridemia.

Methods: We performed a post hoc analysis of our previous data obtained from patients with hypertriglyceridemia who had been prescribed pemafibrate continuously for 1 year or longer. We compared the indexes for hepatic steatosis (hepatic steatosis index (HSI)) and fibrosis (nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS), AST to platelet ratio index (APRI) and FIB-4 index) at baseline with the data at 1 year after the start of pemafibrate.

Results: Pemafibrate significantly reduced HSI at 1 year after the start of pemafibrate. NFS did not show a significant change after 1 year. However, APRI was significantly reduced by pemafibrate after 1 year. FIB-4 index significantly decreased in patients with baseline FIB-4 index ≥ 1.45 at 1 year after the start of pemafibrate. HSI at baseline tended to be negatively correlated with change in HSI after 1 year. There was no significant correlation between NFS at baseline and change in this score after 1 year. APRI and FIB-4 index at baseline were significantly and negatively correlated with changes in APRI and FIB-4 index at 1 year after the start of pemafibrate.

Conclusions: The 1-year pemafibrate treatment improved hepatic steatosis and fibrosis indexes in patients with hypertriglyceridemia.

背景:我们以前曾报道过,选择性过氧化物酶体增殖体激活受体α调节剂--培马贝特能显著降低高甘油三酯血症患者血清中天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和γ-谷氨酰转移酶(GGT)的水平,并在开始服用培马贝特3、6和12个月后显著提高血清白蛋白水平,同时改善动脉粥样硬化性血脂异常:我们对之前从连续服用培马贝特 1 年或更长时间的高甘油三酯血症患者处获得的数据进行了事后分析。我们将基线时的肝脂肪变性指数(肝脂肪变性指数(HSI))和纤维化指数(非酒精性脂肪肝纤维化评分(NFS)、谷草转氨酶与血小板比值指数(APRI)和FIB-4指数)与开始服用培马贝特1年后的数据进行了比较:结果:开始服用培马贝特一年后,培马贝特能明显降低HSI。1年后,NFS未出现明显变化。然而,培马贝特在 1 年后明显降低了 APRI。开始服用培马贝特一年后,基线FIB-4指数≥1.45的患者的FIB-4指数明显下降。基线时的HSI与1年后的HSI变化呈负相关。基线时的 NFS 与 1 年后该评分的变化无明显相关性。基线时的APRI和FIB-4指数与开始服用培马贝特1年后APRI和FIB-4指数的变化呈显著负相关:结论:培马贝特治疗1年可改善高甘油三酯血症患者的肝脏脂肪变性和纤维化指数。
{"title":"A Significant Effect of Pemafibrate on Hepatic Steatosis and Fibrosis Indexes in Patients With Hypertriglyceridemia.","authors":"Hisayuki Katsuyama, Hidekatsu Yanai, Hiroki Adachi, Mariko Hakoshima","doi":"10.14740/gr1656","DOIUrl":"10.14740/gr1656","url":null,"abstract":"<p><strong>Background: </strong>We previously reported that the selective peroxisome proliferator-activated receptor alpha modulator, pemafibrate, significantly reduced serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) and significantly increased serum albumin levels at 3, 6 and 12 months after the start of pemafibrate, with an improvement of atherogenic dyslipidemia, in patients with hypertriglyceridemia.</p><p><strong>Methods: </strong>We performed a <i>post hoc</i> analysis of our previous data obtained from patients with hypertriglyceridemia who had been prescribed pemafibrate continuously for 1 year or longer. We compared the indexes for hepatic steatosis (hepatic steatosis index (HSI)) and fibrosis (nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS), AST to platelet ratio index (APRI) and FIB-4 index) at baseline with the data at 1 year after the start of pemafibrate.</p><p><strong>Results: </strong>Pemafibrate significantly reduced HSI at 1 year after the start of pemafibrate. NFS did not show a significant change after 1 year. However, APRI was significantly reduced by pemafibrate after 1 year. FIB-4 index significantly decreased in patients with baseline FIB-4 index ≥ 1.45 at 1 year after the start of pemafibrate. HSI at baseline tended to be negatively correlated with change in HSI after 1 year. There was no significant correlation between NFS at baseline and change in this score after 1 year. APRI and FIB-4 index at baseline were significantly and negatively correlated with changes in APRI and FIB-4 index at 1 year after the start of pemafibrate.</p><p><strong>Conclusions: </strong>The 1-year pemafibrate treatment improved hepatic steatosis and fibrosis indexes in patients with hypertriglyceridemia.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/1b/gr-16-240.PMC10482606.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218184","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
Trends in Colorectal Cancer Mortality in the United States, 1999 - 2020. 1999 - 2020年美国结直肠癌死亡率趋势
IF 1.5 Pub Date : 2023-08-01 DOI: 10.14740/gr1631
Alexander Kusnik, Sarath Lal Mannumbeth Renjithlal, Ari Chodos, Sanjana Chetana Shanmukhappa, Mohamed Magdi Eid, Keerthi Mannumbeth Renjith, Richard Alweis

Background: The United States faces a significant public health issue with colorectal cancer (CRC), which remains the third leading cause of cancer-related fatalities despite early diagnosis and treatment progress.

Methods: This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to investigate trends in CRC mortality and location of death from 1999 to 2020. Additionally, the study utilized the annual percent change (APC) to estimate the average annual rate of change over the specific time period for the given health outcome. Incorporating the location of death in this study served the purpose of identifying patterns related to CRC and offering valuable insights into the specific locations where deaths occurred.

Results: Between 1999 and 2020, there were 1,166,158 CRC-related deaths. The age-adjusted mortality rates (AAMRs) for CRC consistently declined from 20.7 in 1999 to 12.5 in 2020. Men had higher AAMR (18.8) than women (13.4) throughout the study. Black or African American patients had the highest AAMR (21.1), followed by White (15.4), Hispanic/Latino (11.8), American Indian or Alaska native (11.4), and Asian or Pacific Islanders (10.2). The location of death varied, with 41.99% at home, 28.16% in medical facilities, 16.6% in nursing homes/long-term care facilities, 7.43% in hospices, and 5.80% at other/unknown places.

Conclusion: There has been an overall improvement in AAMR among most ethnic groups, but an increase in AAMR has been observed among white individuals below the age of 55. Notably, over one-quarter of CRC-related deaths occur in medical facilities.

背景:美国面临着结直肠癌(CRC)的重大公共卫生问题,尽管早期诊断和治疗取得了进展,但结直肠癌仍然是癌症相关死亡的第三大原因。方法:本研究利用来自疾病控制和预防中心广泛在线流行病学研究数据(CDC WONDER)数据库的死亡证明数据,调查1999年至2020年结直肠癌死亡率和死亡地点的趋势。此外,该研究利用年变化百分比(APC)来估计给定健康结果的特定时间段内的平均年变化率。将死亡地点纳入本研究的目的是确定与CRC相关的模式,并为死亡发生的具体地点提供有价值的见解。结果:1999年至2020年间,有1,166,158例与crc相关的死亡。结直肠癌的年龄调整死亡率(AAMRs)持续下降,从1999年的20.7下降到2020年的12.5。在整个研究过程中,男性的AAMR(18.8)高于女性(13.4)。黑人或非裔美国人患者的AAMR最高(21.1),其次是白人(15.4),西班牙裔/拉丁裔(11.8),美洲印第安人或阿拉斯加本地人(11.4),亚洲或太平洋岛民(10.2)。死亡地点各不相同,41.99%在家中,28.16%在医疗机构,16.6%在养老院/长期护理机构,7.43%在临终关怀机构,5.80%在其他/未知地点。结论:在大多数种族群体中,AAMR总体上有所改善,但在55岁以下的白人群体中,AAMR有所增加。值得注意的是,四分之一以上与crc有关的死亡发生在医疗设施内。
{"title":"Trends in Colorectal Cancer Mortality in the United States, 1999 - 2020.","authors":"Alexander Kusnik,&nbsp;Sarath Lal Mannumbeth Renjithlal,&nbsp;Ari Chodos,&nbsp;Sanjana Chetana Shanmukhappa,&nbsp;Mohamed Magdi Eid,&nbsp;Keerthi Mannumbeth Renjith,&nbsp;Richard Alweis","doi":"10.14740/gr1631","DOIUrl":"https://doi.org/10.14740/gr1631","url":null,"abstract":"<p><strong>Background: </strong>The United States faces a significant public health issue with colorectal cancer (CRC), which remains the third leading cause of cancer-related fatalities despite early diagnosis and treatment progress.</p><p><strong>Methods: </strong>This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to investigate trends in CRC mortality and location of death from 1999 to 2020. Additionally, the study utilized the annual percent change (APC) to estimate the average annual rate of change over the specific time period for the given health outcome. Incorporating the location of death in this study served the purpose of identifying patterns related to CRC and offering valuable insights into the specific locations where deaths occurred.</p><p><strong>Results: </strong>Between 1999 and 2020, there were 1,166,158 CRC-related deaths. The age-adjusted mortality rates (AAMRs) for CRC consistently declined from 20.7 in 1999 to 12.5 in 2020. Men had higher AAMR (18.8) than women (13.4) throughout the study. Black or African American patients had the highest AAMR (21.1), followed by White (15.4), Hispanic/Latino (11.8), American Indian or Alaska native (11.4), and Asian or Pacific Islanders (10.2). The location of death varied, with 41.99% at home, 28.16% in medical facilities, 16.6% in nursing homes/long-term care facilities, 7.43% in hospices, and 5.80% at other/unknown places.</p><p><strong>Conclusion: </strong>There has been an overall improvement in AAMR among most ethnic groups, but an increase in AAMR has been observed among white individuals below the age of 55. Notably, over one-quarter of CRC-related deaths occur in medical facilities.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/77/gr-16-217.PMC10482602.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211664","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
Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis. COVID-19住院患者艰难梭菌感染:全国分析
IF 1.5 Pub Date : 2023-08-01 DOI: 10.14740/gr1639
Xheni Deda, Khaled Elfert, Mustafa Gandhi, Alexander Malik, Esraa Elromisy, Nehemias Guevara, Suresh Nayudu, Matthew Bechtold

Background: Clostridioides difficile infection (CDI) is a significant healthcare-associated infection with implications for patient morbidity, mortality, and healthcare costs. However, the connection between CDI and coronavirus disease 2019 (COVID-19) infection and its influence on patient outcomes remain uncertain. This study aimed to examine the association between CDI and COVID-19, specifically investigating whether CDI worsens outcomes in patients with COVID-19. By utilizing the extensive National Inpatient Sample (NIS) database and analyzing pertinent factors, this research endeavored to enhance our understanding of CDI within the context of COVID-19.

Methods: The NIS database was searched for adult patients hospitalized with a primary diagnosis of COVID-19 infection in 2020. Patients with a secondary diagnosis of CDI were identified and separated into two groups based on CDI status. Baseline characteristics, Charlson Comorbidity Index (CCI), and outcomes were compared between the two groups using Chi-square and t-tests. Multivariate logistic and linear regressions were performed for the identification of independent predictors of CDI and mortality.

Results: A total of 1,045,125 COVID-19 hospitalizations were included, of which 4,920 had a secondary diagnosis of CDI. Patients with CDI and COVID-19 were older (mean age 69.9 vs. 64.2 years; P < 0.001), more likely to be female (54.1% vs. 47.1%; P < 0.001) and white (60% vs. 52.4%; P < 0.001). The CDI and COVID-19 group had a longer length of stay (14.1 vs. 7.42 days; P < 0.001), higher total hospital costs ($42,336 vs. $18,974; P < 0.001), and higher inpatient mortality (21.6% vs. 11%; P < 0.001) compared to the COVID-19 group without CDI. Patients in the CDI and COVID-19 group had a higher CCI score (51.7% with a score of 3 or more vs. 27.7%; P < 0.001), indicating a higher comorbidity burden. Multivariate logistic regression analysis revealed CDI was independently associated with increased mortality (odds ratio (OR) 1.37; P = 0.001) and showed that the female gender and several pre-existing comorbidities were associated with a higher likelihood of CDI.

Conclusion: CDI is independently associated with increased mortality in patients admitted with COVID-19 infection. Female gender and several pre-existing comorbidities are independent predictors of CDI in COVID-19 patients.

背景:艰难梭菌感染(CDI)是一种重要的卫生保健相关感染,对患者的发病率、死亡率和卫生保健费用都有影响。然而,CDI与2019冠状病毒病(COVID-19)感染之间的联系及其对患者预后的影响仍不确定。本研究旨在研究CDI与COVID-19之间的关系,特别是调查CDI是否会恶化COVID-19患者的预后。通过利用广泛的国家住院患者样本(NIS)数据库并分析相关因素,本研究旨在加强我们对COVID-19背景下CDI的理解。方法:检索NIS数据库中2020年初步诊断为COVID-19感染的住院成人患者。对继发诊断为CDI的患者进行鉴定,并根据CDI状态分为两组。采用卡方检验和t检验比较两组患者的基线特征、Charlson共病指数(CCI)和结果。对CDI和死亡率的独立预测因素进行多变量logistic和线性回归分析。结果:共纳入1045125例COVID-19住院病例,其中4920例继发诊断为CDI。合并CDI和COVID-19的患者年龄较大(平均年龄69.9岁vs. 64.2岁;P < 0.001),更有可能是女性(54.1% vs. 47.1%;P < 0.001)和白色(60% vs. 52.4%;P < 0.001)。CDI组和COVID-19组的住院时间更长(14.1天vs. 7.42天;P < 0.001),医院总费用较高(42,336美元对18,974美元;P < 0.001)和更高的住院死亡率(21.6%比11%;P < 0.001),与没有CDI的COVID-19组相比。CDI和COVID-19组患者的CCI评分较高(51.7%,评分为3分及以上);P < 0.001),表明合并症负担较高。多因素logistic回归分析显示CDI与死亡率增加独立相关(优势比(OR) 1.37;P = 0.001),并显示女性性别和几种已有的合并症与CDI的较高可能性相关。结论:CDI与入院的COVID-19感染患者死亡率升高独立相关。女性性别和一些已存在的合并症是COVID-19患者CDI的独立预测因素。
{"title":"<i>Clostridioides difficile</i> Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis.","authors":"Xheni Deda,&nbsp;Khaled Elfert,&nbsp;Mustafa Gandhi,&nbsp;Alexander Malik,&nbsp;Esraa Elromisy,&nbsp;Nehemias Guevara,&nbsp;Suresh Nayudu,&nbsp;Matthew Bechtold","doi":"10.14740/gr1639","DOIUrl":"https://doi.org/10.14740/gr1639","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) is a significant healthcare-associated infection with implications for patient morbidity, mortality, and healthcare costs. However, the connection between CDI and coronavirus disease 2019 (COVID-19) infection and its influence on patient outcomes remain uncertain. This study aimed to examine the association between CDI and COVID-19, specifically investigating whether CDI worsens outcomes in patients with COVID-19. By utilizing the extensive National Inpatient Sample (NIS) database and analyzing pertinent factors, this research endeavored to enhance our understanding of CDI within the context of COVID-19.</p><p><strong>Methods: </strong>The NIS database was searched for adult patients hospitalized with a primary diagnosis of COVID-19 infection in 2020. Patients with a secondary diagnosis of CDI were identified and separated into two groups based on CDI status. Baseline characteristics, Charlson Comorbidity Index (CCI), and outcomes were compared between the two groups using Chi-square and <i>t</i>-tests. Multivariate logistic and linear regressions were performed for the identification of independent predictors of CDI and mortality.</p><p><strong>Results: </strong>A total of 1,045,125 COVID-19 hospitalizations were included, of which 4,920 had a secondary diagnosis of CDI. Patients with CDI and COVID-19 were older (mean age 69.9 vs. 64.2 years; P < 0.001), more likely to be female (54.1% vs. 47.1%; P < 0.001) and white (60% vs. 52.4%; P < 0.001). The CDI and COVID-19 group had a longer length of stay (14.1 vs. 7.42 days; P < 0.001), higher total hospital costs ($42,336 vs. $18,974; P < 0.001), and higher inpatient mortality (21.6% vs. 11%; P < 0.001) compared to the COVID-19 group without CDI. Patients in the CDI and COVID-19 group had a higher CCI score (51.7% with a score of 3 or more vs. 27.7%; P < 0.001), indicating a higher comorbidity burden. Multivariate logistic regression analysis revealed CDI was independently associated with increased mortality (odds ratio (OR) 1.37; P = 0.001) and showed that the female gender and several pre-existing comorbidities were associated with a higher likelihood of CDI.</p><p><strong>Conclusion: </strong>CDI is independently associated with increased mortality in patients admitted with COVID-19 infection. Female gender and several pre-existing comorbidities are independent predictors of CDI in COVID-19 patients.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/2e/gr-16-234.PMC10482604.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211665","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
Coma With Hyperammonemia in a Patient With Kwashiorkor. 虚营养不良患者昏迷伴高氨血症1例。
IF 1.5 Pub Date : 2023-08-01 DOI: 10.14740/gr1634
Thibault Vieille, Francois Feillet, Arnaud Wiedemann, Hadrien Winiszewski, Gael Piton

We describe a case of coma-related hyperammonemia in a woman presenting with severe edematous malnutrition (Kwashiorkor-like), without underlying hepatic disease. Our main hypothesis is that the patient developed a functional urea cycle disorder, due to the inability to synthesize N-acetylglutamate which is the activator of the first enzymes (carbamoyl phosphate synthetase) of urea cycle, in a context of severe deficiency of essential amino acids and of acetyl-CoA. Severe hyperammonemia is a medical emergency exposing to the risk of cerebral edema. Urgent treatment should interrupt protein intake, stimulate protein anabolism, and remove ammonia from the blood using renal replacement therapy and ammonia scavengers. Hyperammonemia should be searched in case of unexplained coma, even among patients without hepatic disorder, in particular among young patients. Hyperammonemia should also be searched among patients with severe protein-calorie malnutrition.

我们描述一个昏迷相关的高氨血症的情况下,一名妇女表现为严重的水肿性营养不良(夸希奥尔克样),没有潜在的肝脏疾病。我们的主要假设是,在严重缺乏必需氨基酸和乙酰辅酶a的情况下,由于无法合成n -乙酰谷氨酸(尿素循环的第一酶(磷酸氨基甲酰合成酶)的激活剂),患者出现了功能性尿素循环障碍。严重高氨血症是一种医学紧急情况,暴露于脑水肿的风险。紧急治疗应中断蛋白质摄入,刺激蛋白质合成代谢,并使用肾脏替代疗法和氨清除剂从血液中清除氨。如果出现不明原因的昏迷,即使是没有肝脏疾病的患者,特别是年轻患者,也应检查高氨血症。高氨血症也应在严重蛋白质-热量营养不良的患者中寻找。
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引用次数: 0
Sex and Race Disparities in Hepatocellular Carcinoma Surveillance in Patients With Chronic Hepatitis B During COVID-19: A Single-Center Retrospective Review. COVID-19期间慢性乙型肝炎患者肝细胞癌监测的性别和种族差异:一项单中心回顾性研究
IF 1.5 Pub Date : 2023-08-01 DOI: 10.14740/gr1614
William S Reiche, Stephen Cooper, Christopher J Destache, Suhail Sidhu, Bryce Schutte, Darby Keirns, Elezabeth Mac, Ian Ng, Haitam Buaisha, Manasa Velagapudi

Background: The management of patients with chronic hepatitis B (CHB) is complex and spans multiple medical specialties. As a result of this complexity, patients with CHB often do not receive adequate monitoring including hepatocellular carcinoma (HCC) surveillance with abdominal ultrasonography. Previous studies have identified multiple factors associated with decreased HCC surveillance. We aimed to identify the impact of race and sex on HCC surveillance in patients with CHB.

Methods: We performed a single health system chart review between January 2018 and January 2022. Differences between sex and race were evaluated using the Chi-square test and Fisher's exact test, and continuous variables were analyzed using analysis of variance (ANOVA).

Results: A total of 248 patient records between January 2018 and January 2022 were evaluated. In total 37% of females were adequately screened for HCC in any of the 6-month time frames compared to 26% of males. During the coronavirus disease 2019 (COVID-19) surge, surveillance rates were reduced in both men and women. During the first 6 months of the COVID-19 surge, there was a significant difference in screening between men and women (19% vs. 35%, P = 0.026). There was a decrease in HCC screening across all races during the COVID-19 surge; however, no significant difference when comparing races was found.

Conclusion: Men received less HCC surveillance compared to women. These differences were more pronounced during the COVID-19 pandemic surge. Obtaining appropriate surveillance is important and retrospective evaluations can help us determine the presence of health-related social needs so that progress can be made toward achieving health equity.

背景:慢性乙型肝炎(CHB)患者的管理是复杂的,涉及多个医学专业。由于这种复杂性,慢性乙型肝炎患者通常没有得到足够的监测,包括肝细胞癌(HCC)的腹部超声检查。先前的研究已经确定了与HCC监测下降相关的多种因素。我们的目的是确定种族和性别对慢性乙型肝炎患者HCC监测的影响。方法:我们对2018年1月至2022年1月间的单一卫生系统图表进行了回顾。性别和种族之间的差异采用卡方检验和Fisher精确检验,连续变量采用方差分析(ANOVA)进行分析。结果:2018年1月至2022年1月共评估248例患者病历。总共有37%的女性在任何6个月的时间框架内进行了充分的HCC筛查,而男性的这一比例为26%。在2019年冠状病毒病(COVID-19)激增期间,男性和女性的监测率都有所下降。在COVID-19激增的前6个月,男性和女性在筛查方面存在显着差异(19%对35%,P = 0.026)。在COVID-19激增期间,所有种族的HCC筛查都有所减少;但在种族间无显著差异。结论:与女性相比,男性接受的HCC监测较少。这些差异在2019冠状病毒病大流行期间更为明显。获得适当的监测很重要,回顾性评估可以帮助我们确定是否存在与健康有关的社会需求,从而在实现健康公平方面取得进展。
{"title":"Sex and Race Disparities in Hepatocellular Carcinoma Surveillance in Patients With Chronic Hepatitis B During COVID-19: A Single-Center Retrospective Review.","authors":"William S Reiche,&nbsp;Stephen Cooper,&nbsp;Christopher J Destache,&nbsp;Suhail Sidhu,&nbsp;Bryce Schutte,&nbsp;Darby Keirns,&nbsp;Elezabeth Mac,&nbsp;Ian Ng,&nbsp;Haitam Buaisha,&nbsp;Manasa Velagapudi","doi":"10.14740/gr1614","DOIUrl":"https://doi.org/10.14740/gr1614","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with chronic hepatitis B (CHB) is complex and spans multiple medical specialties. As a result of this complexity, patients with CHB often do not receive adequate monitoring including hepatocellular carcinoma (HCC) surveillance with abdominal ultrasonography. Previous studies have identified multiple factors associated with decreased HCC surveillance. We aimed to identify the impact of race and sex on HCC surveillance in patients with CHB.</p><p><strong>Methods: </strong>We performed a single health system chart review between January 2018 and January 2022. Differences between sex and race were evaluated using the Chi-square test and Fisher's exact test, and continuous variables were analyzed using analysis of variance (ANOVA).</p><p><strong>Results: </strong>A total of 248 patient records between January 2018 and January 2022 were evaluated. In total 37% of females were adequately screened for HCC in any of the 6-month time frames compared to 26% of males. During the coronavirus disease 2019 (COVID-19) surge, surveillance rates were reduced in both men and women. During the first 6 months of the COVID-19 surge, there was a significant difference in screening between men and women (19% vs. 35%, P = 0.026). There was a decrease in HCC screening across all races during the COVID-19 surge; however, no significant difference when comparing races was found.</p><p><strong>Conclusion: </strong>Men received less HCC surveillance compared to women. These differences were more pronounced during the COVID-19 pandemic surge. Obtaining appropriate surveillance is important and retrospective evaluations can help us determine the presence of health-related social needs so that progress can be made toward achieving health equity.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/3a/gr-16-203.PMC10482603.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211662","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
Effects of Helicobacter pylori Infection on the Prognosis of Chronic Atrophic Gastritis by Inducing the Macrophage Polarization. 幽门螺杆菌感染诱导巨噬细胞极化对慢性萎缩性胃炎预后的影响。
IF 1.5 Pub Date : 2023-08-01 DOI: 10.14740/gr1636
Chun Na Zhao, Li Li Xiao, Ying Zhang

Background: Recently, the effects of Helicobacter pylori (H. pylori) infection on the prognosis of chronic atrophic gastritis (CAG) are still unclear. The aim of our study was to discuss the role of H. pylori infection on the prognosis of CAG by inducing the M1/M2 macrophage polarization.

Methods: A total of 180 subjects as control (group 1), CAG patients without H. pylori infection (group 2) and H. pylori-associated CAG patients (group 3) were respectively recruited for this cross-sectional investigation in Daqing Oilfield General Hospital from May 2019 to July 2020. Their serum samples were collected to determine the concentrations of pro-inflammatory and anti-inflammatory cytokines. Meanwhile, the gastric mucosa was excised to determine the related gene expressions on the M1/M2 macrophage polarization. Then the prognosis of CAG was evaluated according to the status of clinical manifestations and endoscopic examination after the follow-up.

Results: Notably, it was proved that compared with the control group, the expressions and concentrations of pro-inflammatory cytokines (M1 macrophage: inducible nitric oxide synthase (iNOS), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin-6 (IL-6)) were significantly higher, while the anti-inflammatory cytokines (M2 macrophage: arginase-1 (Arg-1), IL-4 and IL-10) were apparently reduced in the group 2 and group 3 (P < 0.05). Moreover, more days were needed for the prognosis of CAG in group 3 than those in group 2, which was accompanied by higher expressions of pro-inflammatory and lower anti-inflammatory cytokines at the baseline (P < 0.05). Furthermore, negative correlations were shown between the concentrations of iNOS, TNF-α, IFN-γ and IL-6, and the prognosis of CAG (P < 0.05), while positive correlations were observed between the contents of IL-4 and IL-10, and prognosis of CAG (P < 0.05).

Conclusion: These above results indicated that H. pylori infection-induced disorders of M1/M2 macrophage polarization could affect the prognosis of CAG.

背景:目前,幽门螺杆菌(h.p ylori)感染对慢性萎缩性胃炎(CAG)预后的影响尚不清楚。本研究旨在探讨幽门螺杆菌感染通过诱导M1/M2巨噬细胞极化对CAG预后的影响。方法:选取2019年5月至2020年7月大庆油田总医院CAG患者180例,分别为对照组(1组)、未感染幽门螺杆菌CAG患者(2组)和幽门螺杆菌相关CAG患者(3组)。收集他们的血清样本,测定促炎和抗炎细胞因子的浓度。同时,切除胃黏膜,检测巨噬细胞M1/M2极化的相关基因表达。随访后根据临床表现及内镜检查情况评价CAG的预后。结果:值得注意的是,与对照组相比,2组和3组促炎因子(M1巨噬细胞:诱导型一氧化氮合酶(iNOS)、肿瘤坏死因子-α (TNF-α)、干扰素-γ (IFN-γ)、白细胞介素-6 (IL-6))的表达和浓度显著升高,抗炎因子(M2巨噬细胞:精氨酸酶-1 (Arg-1)、IL-4、IL-10)的表达和浓度明显降低(P < 0.05)。3组CAG预后所需天数较2组延长,且促炎细胞因子在基线水平上表达升高,抗炎细胞因子在基线水平上表达降低(P < 0.05)。iNOS、TNF-α、IFN-γ、IL-6浓度与CAG预后呈负相关(P < 0.05), IL-4、IL-10含量与CAG预后呈正相关(P < 0.05)。结论:幽门螺杆菌感染引起的M1/M2巨噬细胞极化紊乱可影响CAG的预后。
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引用次数: 0
Fecal Microbiota Transplantation in Human Immunodeficiency Virus-Infected Patient Population: A Systematic Review and Meta-Analysis. 人类免疫缺陷病毒感染人群的粪便微生物群移植:系统回顾与元分析》。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-01 Epub Date: 2023-08-26 DOI: 10.14740/gr1624
Adnan Malik, Muhammad Imran Malik

Background: Patients with human immunodeficiency virus (HIV) infection suffer from alterations in gut microbiota due to recurrent gastrointestinal infections and systemic inflammation. Fecal microbiota transplantation (FMT) appears to be a potential therapy; however, there are concerns about its safety. Likewise, no previous meta-analysis evaluated FMT efficacy in HIV-infected patients.

Methods: We conducted a thorough electronic search on PubMed, Scopus, OVID, Web of Science, and Cochrane CENTRAL for clinical studies assessing the safety and efficacy of FMT in patients with HIV and gastrointestinal dysbiosis, where FMT was indicated to restore the disrupted microbiota.

Results: FMT significantly restored the typical microbiome in patients with Clostridium difficile (C. difficile) and non-C. difficile and reduced the risk of gastrointestinal infections in HIV patients receiving antiretroviral therapy (odds ratio (OR) = 0.774, 95% confidence interval (CI): (0.62, 0.966)). Furthermore, adverse events, such as distention and bloating, associated with FMT were comparable between HIV and health controls (OR = 0.60, 95% CI: (0.07, 4.6)), with no statistical difference.

Conclusions: Current evidence demonstrated that FMT is safe and effective in HIV patients suffering from alterations in gut microbiota. We recommend further multi-centric clinical studies to address the optimal transplant amount and source for FMT. To the best of our knowledge, this is the first meta-analysis to assess the safety and efficacy of FMT in patients with HIV.

背景:人类免疫缺陷病毒(HIV)感染患者因反复胃肠道感染和全身炎症而导致肠道微生物群改变。粪便微生物群移植(FMT)似乎是一种潜在的疗法,但其安全性令人担忧。同样,以前也没有荟萃分析评估过粪便微生物群移植在艾滋病病毒感染者中的疗效:我们在 PubMed、Scopus、OVID、Web of Science 和 Cochrane CENTRAL 上进行了一次全面的电子检索,以评估 FMT 在 HIV 感染者和胃肠道菌群失调患者中的安全性和有效性:结果:FMT 能明显恢复艰难梭菌(C. difficile)和非艰难梭菌患者的典型微生物群,降低接受抗逆转录病毒治疗的艾滋病患者的胃肠道感染风险(几率比(OR)= 0.774,95% 置信区间(CI):(0.62, 0.966))。此外,与 FMT 相关的不良事件,如腹胀和腹胀,在 HIV 感染者和健康对照组之间具有可比性(OR = 0.60,95% 置信区间:(0.07,4.6)),无统计学差异:目前的证据表明,FMT 对肠道微生物群发生变化的 HIV 患者是安全有效的。我们建议进一步开展多中心临床研究,以确定 FMT 的最佳移植量和来源。据我们所知,这是第一项评估 FMT 在艾滋病患者中的安全性和有效性的荟萃分析。
{"title":"Fecal Microbiota Transplantation in Human Immunodeficiency Virus-Infected Patient Population: A Systematic Review and Meta-Analysis.","authors":"Adnan Malik, Muhammad Imran Malik","doi":"10.14740/gr1624","DOIUrl":"10.14740/gr1624","url":null,"abstract":"<p><strong>Background: </strong>Patients with human immunodeficiency virus (HIV) infection suffer from alterations in gut microbiota due to recurrent gastrointestinal infections and systemic inflammation. Fecal microbiota transplantation (FMT) appears to be a potential therapy; however, there are concerns about its safety. Likewise, no previous meta-analysis evaluated FMT efficacy in HIV-infected patients.</p><p><strong>Methods: </strong>We conducted a thorough electronic search on PubMed, Scopus, OVID, Web of Science, and Cochrane CENTRAL for clinical studies assessing the safety and efficacy of FMT in patients with HIV and gastrointestinal dysbiosis, where FMT was indicated to restore the disrupted microbiota.</p><p><strong>Results: </strong>FMT significantly restored the typical microbiome in patients with <i>Clostridium difficile</i> (<i>C. difficile</i>) and non-<i>C. difficile</i> and reduced the risk of gastrointestinal infections in HIV patients receiving antiretroviral therapy (odds ratio (OR) = 0.774, 95% confidence interval (CI): (0.62, 0.966)). Furthermore, adverse events, such as distention and bloating, associated with FMT were comparable between HIV and health controls (OR = 0.60, 95% CI: (0.07, 4.6)), with no statistical difference.</p><p><strong>Conclusions: </strong>Current evidence demonstrated that FMT is safe and effective in HIV patients suffering from alterations in gut microbiota. We recommend further multi-centric clinical studies to address the optimal transplant amount and source for FMT. To the best of our knowledge, this is the first meta-analysis to assess the safety and efficacy of FMT in patients with HIV.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/f4/gr-16-209.PMC10482600.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211667","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
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