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Combined DNA Methylation and Gastric Microbiome Marker Predicts Helicobacter pylori-Negative Gastric Cancer. DNA甲基化和胃微生物组标记物联合预测幽门螺旋杆菌阴性胃癌
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2024-03-21 DOI: 10.5009/gnl230348
Min-Jeong Kim, Han-Na Kim, Jonathan P Jacobs, Hyo-Joon Yang

Background/aims: While DNA methylation and gastric microbiome are each associated with gastric cancer (GC), their combined role in predicting GC remains unclear. This study investigated the potential of a combined DNA methylation and gastric microbiome signature to predict Helicobacter pylori-negative GC.

Methods: In this case-control study, we conducted quantitative methylation-specific polymerase chain reaction to measure the methylation levels of DKK3, SFRP1, EMX1, NKX6-1, MIR124-3, and TWIST1 in the gastric mucosa from 75 H. pylori-negative patients, including chronic gastritis (CG), intestinal metaplasia (IM), and GC. A combined analysis of DNA methylation and gastric microbiome, using 16S rRNA gene sequencing, was performed in 30 of 75 patients.

Results: The methylation levels of DKK3, SFRP1, EMX1, MIR124-3, and TWIST1 were significantly higher in patients with GC than in controls (all q<0.05). MIR124-3 and TWIST1 methylation levels were higher in patients with IM than those with CG and also in those with GC than in those with IM (all q<0.05). A higher methylation level of TWIST1 was an independent predictor for H. pylori-negative GC after adjusting for age, sex, and atrophy (odds ratio [OR], 15.15; 95% confidence interval [CI], 1.58 to 145.46; p=0.018). The combination of TWIST1 methylation and GC microbiome index (a microbiome marker) was significantly associated with H. pylori-negative GC after adjusting for age, sex, and atrophy (OR, 50.00; 95% CI, 1.69 to 1,476; p=0.024).

Conclusions: The combination of TWIST1 methylation and GC microbiome index may offer potential as a biomarker for predicting H. pylori-negative GC.

背景/目的:虽然DNA甲基化和胃微生物组各自与胃癌(GC)相关,但它们在预测GC中的联合作用仍不清楚。本研究调查了 DNA 甲基化和胃微生物组联合特征预测幽门螺旋杆菌阴性 GC 的潜力:在这项病例对照研究中,我们采用定量甲基化特异性聚合酶链反应测量了 75 例幽门螺杆菌阴性患者(包括慢性胃炎(CG)、肠化生(IM)和 GC)胃黏膜中 DKK3、SFRP1、EMX1、NKX6-1、MIR124-3 和 TWIST1 的甲基化水平。利用 16S rRNA 基因测序对 75 例患者中的 30 例进行了 DNA 甲基化和胃微生物组的联合分析:结果:与对照组相比,GC 患者中 DKK3、SFRP1、EMX1、MIR124-3 和 TWIST1 的甲基化水平明显更高(在调整年龄、性别和萎缩程度后,所有 qTWIST1 是幽门螺杆菌阴性 GC 的独立预测因子(几率比 [OR],15.15;95% 置信区间 [CI],1.58 至 145.46;P=0.018)。TWIST1甲基化与GC微生物组指数(一种微生物组标记物)的组合与幽门螺杆菌阴性GC显著相关(OR,50.00;95% CI,1.69至1,476;p=0.024):TWIST1甲基化与GC微生物组指数的结合可能成为预测幽门螺杆菌阴性GC的生物标志物。
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引用次数: 0
Toward a Functional Cure for Hepatitis B. 实现对乙型肝炎的功能性治疗。
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2024-03-27 DOI: 10.5009/gnl240023
Anna S F Lok

Current treatment of chronic hepatitis B virus (HBV) infection, pegylated interferon-α (pegIFN-α) and nucleos(t)ide analogue (NA), can suppress HBV replication, reverse liver inflammation and fibrosis, and decrease risks of cirrhosis and hepatocellular carcinoma, but hepatitis B surface antigen (HBsAg) loss is rare. Functional HBV cure is defined as undetectable HBsAg and unquantifiable serum HBV DNA for at least 24 weeks after a finite course of therapy. This requires suppression of HBV replication and viral protein production as well as restoration of immune response to HBV. Direct-acting antivirals targeting virus entry, capsid assembly, viral protein production and secretion are in clinical trials. In parallel, immune modulatory therapies to stimulate HBV-specific immune response and to remove immune blockade are being tested. Clinical trials of direct-acting antivirals alone or immune modulatory therapies alone have not been successful in achieving HBV cure. Recent combinations of direct-acting antivirals and immune modulatory therapies have shown promising results particularly with combinations that included pegIFN-α. These results need to be confirmed in larger studies with longer follow-up, and further work is needed to develop simpler regimens with fewer drugs that can be administered orally and safely. While there is a strong desire to develop finite therapies that can achieve HBV cure, safety is paramount and new therapies must provide incremental value compared to standard of care, which is predominantly long-term NA therapy.

目前治疗慢性乙型肝炎病毒(HBV)感染的聚乙二醇化干扰素-α(pegIFN-α)和核苷酸类似物(NA)可以抑制 HBV 复制,逆转肝脏炎症和纤维化,降低肝硬化和肝细胞癌的风险,但乙型肝炎表面抗原(HBsAg)丢失的情况非常罕见。功能性 HBV 治愈的定义是在一个有限疗程后至少 24 周检测不到 HBsAg 和无法量化的血清 HBV DNA。这需要抑制 HBV 复制和病毒蛋白生成,并恢复对 HBV 的免疫反应。针对病毒进入、囊壳组装、病毒蛋白生成和分泌的直接作用抗病毒药物正在临床试验中。与此同时,刺激 HBV 特异性免疫反应和消除免疫阻断的免疫调节疗法也在测试之中。单独使用直接作用抗病毒药物或单独使用免疫调节疗法的临床试验都未能成功治愈 HBV。最近,直接作用抗病毒药物和免疫调节疗法的组合显示出良好的效果,尤其是包括 pegIFN-α 的组合。这些结果需要在更大范围、更长时间的随访研究中得到证实,还需要进一步努力开发出更简单、药物用量更少、可安全口服的治疗方案。虽然人们强烈希望开发出能够治愈 HBV 的有限疗法,但安全性是最重要的,而且新疗法必须比以长期 NA 治疗为主的标准疗法更有价值。
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引用次数: 0
Long-term Outcomes of Ampullary Adenoma According to Resected Margin Status after Endoscopic Papillectomy. 根据内窥镜乳头状瘤切除术后的切除边缘状态确定杏仁腺瘤的长期预后
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2024-05-08 DOI: 10.5009/gnl230451
Junghwan Lee, Dongwook Oh, Dong-Wan Seo, Tae Jun Song, Do Hyun Park, Sung Koo Lee, Seung-Mo Hong

Background/aims: : Endoscopic papillectomy (EP) is increasingly used as an alternative to surgery for managing benign ampullary neoplasms. However, post-EP resection margins are often positive or indeterminate, and there is no consensus on the management of ampullary adenomas with positive or indeterminate margins after EP. This study was designed to compare the long-term outcomes between resected margin-negative (RMN) and resected margin-positive/indeterminate (RMPI) groups and to identify factors associated with clinical outcomes.

Methods: : This retrospective analysis included patients with ampullary adenoma without evidence of adenocarcinoma who underwent EP between 2004 and 2016. The RMN and RMPI groups were compared for recurrence rates and recurrence-free duration during a mean follow-up duration of 71.7±39.8 months. Factors related to clinical outcomes were identified using multivariate analysis.

Results: : Of the 129 patients who underwent EP, 82 were in the RMN group and 47 were in the RMPI group. The RMPI group exhibited a higher recurrence rate compared to the RMN group (14.6% vs 34.0%, p=0.019). However, the recurrence-free duration was not significantly different between the groups (34.7±32.6 months vs 36.2±27.4 months, p=0.900). Endoscopic treatment successfully managed recurrence in both groups (75% vs 75%). Submucosal injection was a significant risk factor for residual lesions (hazard ratio, 4.11; p=0.009) and recurrence (hazard ratio, 2.57; p=0.021).

Conclusions: : Although ampullary adenomas with positive or indeterminate margins after EP showed a higher rate of recurrence at long-term follow-up, endoscopic treatment was effective with favorable long-term outcomes. Submucosal injection prior to resection was associated with increased risk of recurrence and residual lesions.

背景/目的: :内镜乳头切除术(EP)越来越多地被用来替代手术治疗良性膀胱肿瘤。然而,内镜乳头切除术后的切除边缘往往是阳性或不确定的,而且对于内镜乳头切除术后切除边缘阳性或不确定的膀胱腺瘤的处理还没有达成共识。本研究旨在比较切除边缘阴性组(RMN)和切除边缘阳性/不确定组(RMPI)的长期疗效,并确定与临床疗效相关的因素:这项回顾性分析纳入了2004年至2016年间接受EP手术的无腺癌证据的胰腺腺瘤患者。在平均71.7±39.8个月的随访期间,比较了RMN组和RMPI组的复发率和无复发持续时间。通过多变量分析确定了与临床结果相关的因素:在接受 EP 治疗的 129 例患者中,82 例为 RMN 组,47 例为 RMPI 组。与 RMN 组相比,RMPI 组的复发率更高(14.6% 对 34.0%,P=0.019)。不过,两组的无复发持续时间无明显差异(34.7±32.6 个月 vs 36.2±27.4个月,P=0.900)。两组患者的内镜治疗都成功控制了复发(75% vs 75%)。粘膜下注射是残留病灶(危险比,4.11;P=0.009)和复发(危险比,2.57;P=0.021)的重要风险因素:尽管EP术后边缘阳性或不确定的膀胱腺瘤在长期随访中复发率较高,但内镜治疗效果显著,长期疗效良好。切除前粘膜下注射与复发和残留病灶风险增加有关。
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引用次数: 0
Public Fear of Pancreatic Diseases: Causes and Clinical Outcomes at a Single Korean Center. 公众对胰腺疾病的恐惧:韩国一家中心的病因和临床结果
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2024-06-28 DOI: 10.5009/gnl240241
Won Jae Yoon

Background/aims: The public fear of pancreatic diseases including pancreatic cancer (PC) appears to be growing. The aims of this study were to evaluate the causes of fear of pancreatic diseases and assess clinical outcomes of such individuals.

Methods: This was a retrospective study of 249 individuals who visited the Pancreatobiliary Diseases Center at Ewha Womans University Seoul Hospital due to the fear of pancreatic diseases between January 2019 and August 2021. Those referred from other departments or external medical facilities were excluded. Collected data included demographic details, comorbidities, causes of fear of pancreatic diseases, and the presence of pancreatic lesions in imaging studies.

Results: The median age was 55 years (range, 22 to 82 years). One hundred eleven subjects (44.6%) were male. The causes of fear of pancreatic diseases were abdominal pain (n=144, 57.8%), back pain (n=114, 45.8%), body weight change (n=35, 14.1%), family history of pancreatic diseases (n=32, 12.9%), and others (n=39, 15.7%). Within the group with family history of pancreatic diseases, 25 subjects had a first-degree relative with PC. Of the 200 subjects who underwent imaging, there was no evidence of pancreatic diseases in 182 (91.0%). Pancreatic lesions identified were cystic lesions (n=15, 7.5%), non-specific calcification (n=1, 0.5%), lipoma (n=1, 0.5%), and solid tumor (n=1, 0.5%), later diagnosed as unresectable PC.

Conclusions: Abdominal pain and back pain were the major causes of fear of pancreatic diseases. The prevalence of PC among those who underwent imaging was 0.5%. Such characteristics should be considered when consulting individuals with fear of pancreatic diseases.

背景/目的:公众对包括胰腺癌(PC)在内的胰腺疾病的恐惧似乎与日俱增。本研究旨在评估胰腺疾病恐惧的原因,并评估此类患者的临床结果:这是一项回顾性研究,研究对象为 2019 年 1 月至 2021 年 8 月期间因胰腺疾病恐惧而前往梨花女子大学首尔医院胰胆疾病中心就诊的 249 名患者。不包括从其他部门或外部医疗机构转诊的患者。收集的数据包括人口统计学细节、合并症、胰腺疾病恐惧的原因以及影像学检查中是否存在胰腺病变:中位年龄为 55 岁(22 至 82 岁)。111名受试者(44.6%)为男性。担心胰腺疾病的原因包括腹痛(144 人,占 57.8%)、背痛(114 人,占 45.8%)、体重变化(35 人,占 14.1%)、胰腺疾病家族史(32 人,占 12.9%)和其他(39 人,占 15.7%)。在有胰腺疾病家族史的人群中,有 25 名受试者的一级亲属患有 PC。在接受影像学检查的 200 名受试者中,有 182 人(91.0%)未发现胰腺疾病。发现的胰腺病变包括囊性病变(15 例,占 7.5%)、非特异性钙化(1 例,占 0.5%)、脂肪瘤(1 例,占 0.5%)和实体瘤(1 例,占 0.5%),后被诊断为无法切除的 PC:结论:腹痛和背痛是导致胰腺疾病恐惧的主要原因。结论:腹痛和背痛是胰腺疾病恐惧症的主要原因,接受影像学检查的患者中 PC 患病率为 0.5%。在对胰腺疾病恐惧症患者进行咨询时,应考虑到这些特征。
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引用次数: 0
Clinical Parameters Work Well as Predictive Factors for Atezolizumab and Bevacizumab Treatment in Hepatocellular Carcinoma. 临床参数可作为肝细胞癌患者接受阿特珠单抗和贝伐单抗治疗的预测因素
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 DOI: 10.5009/gnl240274
Ji Yeon Lee, Pil Soo Sung
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引用次数: 0
Associations among the Duodenal Ecosystem, Gut Microbiota, and Nutrient Intake in Functional Dyspepsia. 功能性消化不良患者十二指肠生态系统、肠道微生物群和营养摄入的关系。
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2023-11-30 DOI: 10.5009/gnl230130
Sang Hoon Kim, Yura Choi, Jihong Oh, Eui Yeon Lim, Jung Eun Lee, Eun-Ji Song, Young-Do Nam, Hojun Kim

Background/aims: : Functional dyspepsia (FD) has long been regarded as a syndrome because its pathophysiology is multifactorial. However, recent reports have provided evidence that changes in the duodenal ecosystem may be the key. This study aimed to identify several gastrointestinal factors and biomarkers associated with FD, specifically changes in the duodenal ecosystem that may be key to understanding its pathophysiology.

Methods: : In this case-control study, 28 participants (12 with FD and 16 healthy control individuals) were assessed for dietary nutrients, gastrointestinal symptom severity, immunological status of the duodenal mucosa, and microbiome composition from oral, duodenal, and fecal samples. Integrated data were analyzed using immunohistochemistry, real-time polymerase chain reaction, 16S rRNA sequencing, and network analysis.

Results: : Duodenal mucosal inflammation and impaired expression of tight junction proteins were confirmed in patients with FD. The relative abundance of duodenal Streptococcus (p=0.014) and reductions in stool Butyricicoccus (p=0.047) were confirmed. These changes in the gut microbiota were both correlated with symptom severity. Changes in dietary micronutrients, such as higher intake of valine, were associated with improved intestinal barrier function and microbiota.

Conclusions: : This study emphasizes the relationships among dietary nutrition, oral and gut microbiota, symptoms of FD, impaired function of the duodenal barrier, and inflammation. Assessing low-grade inflammation or increased permeability in the duodenal mucosa, along with changes in the abundance of stool Butyricicoccus, is anticipated to serve as effective biomarkers for enhancing the objectivity of FD diagnosis and monitoring.

背景/目的:功能性消化不良(FD)长期以来被认为是一种综合征,因为它的病理生理是多因素的。然而,最近的报告提供的证据表明,十二指肠生态系统的变化可能是关键。本研究旨在确定与FD相关的几个胃肠道因素和生物标志物,特别是十二指肠生态系统的变化,这可能是了解其病理生理的关键。方法:在这项病例对照研究中,对28名参与者(12名FD患者和16名健康对照者)的膳食营养、胃肠道症状严重程度、十二指肠黏膜免疫状态以及口腔、十二指肠和粪便样本中的微生物组组成进行了评估。综合数据采用免疫组织化学、实时聚合酶链反应、16S rRNA测序和网络分析进行分析。结果:证实FD患者存在十二指肠黏膜炎症及紧密连接蛋白表达受损。十二指肠链球菌的相对丰度(p=0.014)和粪便丁酸球菌的减少(p=0.047)得到证实。肠道菌群的这些变化都与症状严重程度相关。饮食微量营养素的改变,如缬氨酸摄入量的增加,与肠道屏障功能和微生物群的改善有关。结论:本研究强调膳食营养、口腔和肠道微生物群、FD症状、十二指肠屏障功能受损和炎症之间的关系。评估十二指肠黏膜的低级别炎症或通透性增加,以及粪便丁酸球菌丰度的变化,有望作为有效的生物标志物,提高FD诊断和监测的客观性。
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引用次数: 0
The Possible Preventative Role of Lactate- and Butyrate-Producing Bacteria in Colorectal Carcinogenesis. 产乳酸和丁酸细菌在结直肠癌发生中的可能预防作用。
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2023-11-30 DOI: 10.5009/gnl230385
Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Soo In Choi, Jae Young Jang, Eun Hye Kim, Jina Choi, Yonghoon Choi, Hyuk Yoon, Sun Min Lee, Yeong-Jae Seok

Background/aims: : The gut microbiome has emerged as a key player that mechanistically links various risk factors to colorectal cancer (CRC) etiology. However, the role of the gut microbiome in CRC pathogenesis remains unclear. This study aimed to characterize the gut microbiota in healthy controls (HCs) and patients with colorectal adenoma (AD) and CRC in subgroups based on sex and age.

Methods: : Study participants who visited the hospital for surveillance of CRC or gastrointestinal symptoms were prospectively enrolled, and the gut microbiome was analyzed based on fecal samples.

Results: : In terms of HC-AD-CRC sequence, commensal bacteria, including lactate-producing (Streptococcus salivarius) and butyrate-producing (Faecalibacterium prausnitzii, Anaerostipes hadrus, and Eubacterium hallii) bacteria, were more abundant in the HC group than in the AD and CRC groups. In the sex comparison, the female HC group had more lactate-producing bacteria (Bifidobacterium adolescentis, Bifidobacterium catenulatum, and Lactobacillus ruminis) than the male HC group. In age comparison, younger subjects had more butyrate-producing bacteria (Agathobaculum butyriciproducens and Blautia faecis) than the older subjects in the HC group. Interestingly, lactate-producing bacteria (B. catenulatum) were more abundant in females than males among younger HC group subjects. However, these sex- and age-dependent differences were not observed in the AD and CRC groups.

Conclusions: : The gut microbiome, specifically lactate- and butyrate-producing bacteria, which were found to be abundant in the HC group, may play a role in preventing the progression of CRC. In particular, lactate-producing bacteria, which were found to be less abundant in healthy male controls may contribute to the higher incidence of CRC in males.

背景/目的:肠道微生物组已成为将各种危险因素与结直肠癌(CRC)病因机制联系起来的关键因素。然而,肠道微生物组在结直肠癌发病机制中的作用尚不清楚。本研究旨在根据性别和年龄对健康对照(hc)和结直肠腺瘤(AD)和结直肠结直肠癌患者的肠道微生物群进行分类。方法:前瞻性地纳入到医院监测结直肠癌或胃肠道症状的研究参与者,并根据粪便样本分析肠道微生物组。结果:就HC-AD-CRC序列而言,HC组的共生菌,包括产乳酸(唾液链球菌)和产丁酸(prausnitzii粪杆菌、hadrus厌氧菌和哈利真杆菌)细菌,比AD和CRC组的数量要多。在性别比较中,女性HC组比男性HC组有更多的产乳酸菌(青少年双歧杆菌、连环双歧杆菌和反刍乳杆菌)。在年龄比较中,较年轻的受试者比HC组中较年长的受试者有更多的产丁酸菌(丁酸生产Agathobaculum butyliciciproducens和Blautia faecis)。有趣的是,在年轻的HC组受试者中,产生乳酸的细菌(B. catenulatum)在女性中比男性更丰富。然而,在AD和CRC组中没有观察到这些性别和年龄依赖性差异。结论:肠道微生物群,特别是产生乳酸和丁酸的细菌,在HC组中发现丰富,可能在预防结直肠癌的进展中发挥作用。特别是,在健康男性对照组中发现较少的产乳酸细菌可能导致男性CRC发病率较高。
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引用次数: 0
The Impact of Body Composition on the Prognosis of Nonalcoholic Fatty Liver Disease. 身体成分对非酒精性脂肪肝预后的影响
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 DOI: 10.5009/gnl240200
Do Seon Song
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引用次数: 0
Analysis of Recent Improvement of Survival Outcomes in Patients with Pancreatic Cancer Who Underwent Upfront Surgery. 对接受前期手术的胰腺癌患者生存率近期改善情况的分析
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2023-12-26 DOI: 10.5009/gnl230303
Jae Hyup Jung, Seung Hyun Won, Kwangrok Jung, Jun Suh Lee, Jong-Chan Lee, Jin Won Kim, Yoo-Seok Yoon, Jin-Hyeok Hwang, Ho-Seong Han, Jaihwan Kim

Background/aims: : Recently, patients with pancreatic cancer (PC) who underwent resection have exhibited improved survival outcomes, but comprehensive analysis is limited. We analyzed the trends of contributing factors.

Methods: : Data of patients with resected PC were retrospectively collected from the Korean Health Insurance Review and Assessment Service (HIRA) database and separately at our institution. Cox regression analysis was conducted with the data from our institution a survival prediction score was calculated using the β coefficients.

Results: : Comparison between the periods 2013-2015 (n=3,255) and 2016-2018 (n=3,698) revealed a difference in the median overall survival (25.9 months vs not reached, p<0.001) when analyzed with the HIRA database which was similar to our single-center data (2013-2015 [n=119] vs 2016-2018 [n=148], 20.9 months vs 32.2 months, p=0.003). Multivariable analyses revealed six factors significantly associated with better OS, and the scores were as follows: age >70 years, 1; elevated carbohydrate antigen 19-9 at diagnosis, 1; R1 resection, 1; stage N1 and N2, 1 and 3, respectively; no adjuvant treatment, 2; FOLFIRINOX or gemcitabine plus nab-paclitaxel after recurrence, 4; and other chemotherapy or supportive care only after recurrence, 5. The rate of R0 resection (69.7% vs 80.4%), use of adjuvant treatment (63.0% vs 74.3%), and utilization of FOLFIRINOX or gemcitabine plus nab-paclitaxel (25.2% vs 47.3%) as palliative chemotherapeutic regimen, all increased between the two time periods, resulting in decreased total survival prediction score (mean: 7.32 vs 6.18, p=0.004).

Conclusions: : Strict selection of surgical candidates, more use of adjuvant treatment, and adoption of the latest combination regimens for palliative chemotherapy after recurrence were identified as factors of recent improvement.

背景/目的: :最近,接受切除术的胰腺癌(PC)患者的生存率有所提高,但综合分析却很有限。我们分析了促成因素的趋势:我们从韩国健康保险审查和评估服务(HIRA)数据库中回顾性收集了切除胰腺癌患者的数据,并在本机构分别进行了分析。利用本院的数据进行了 Cox 回归分析,并使用 β 系数计算了生存预测得分:2013-2015年(n=3255)和2016-2018年(n=3698)期间的比较显示,中位总生存期存在差异(25.9个月 vs 未达到,p70岁,1人;诊断时碳水化合物抗原19-9升高,1人;R1切除,1人;N1和N2期,分别为1人和3人;未进行辅助治疗,2人;复发后进行FOLFIRINOX或吉西他滨加nab-紫杉醇,4人;复发后仅进行其他化疗或支持治疗,5人。R0切除率(69.7% vs 80.4%)、辅助治疗使用率(63.0% vs 74.3%)、FOLFIRINOX或吉西他滨加纳布紫杉醇(25.2% vs 47.3%)作为姑息化疗方案的使用率在两个时间段之间均有所上升,导致总生存预测评分下降(平均:7.32 vs 6.18,P=0.004):结论:严格选择手术对象、更多使用辅助治疗以及复发后采用最新的联合方案进行姑息化疗被认为是近期病情好转的因素。
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引用次数: 0
Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure. 静脉注射英夫利西单抗失败的溃疡性结肠炎患者改用皮下注射英夫利西单抗的效果。
IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-15 Epub Date: 2024-06-05 DOI: 10.5009/gnl230291
June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sung Wook Hwang

Background/aims: Studies on elective switching to the subcutaneous (SC) formulation of infliximab revealed comparable efficacy and safety and higher infliximab level than those exhibited by intravenous (IV) infliximab. However, no studies have reported on the effectiveness of SC switching in ulcerative colitis (UC) patients who experienced IV infliximab failure during maintenance treatment.

Methods: This retrospective study included UC patients who had been switched to SC infliximab because of IV infliximab failure, between January 2021 and January 2023. Group A was defined as having clinically and biochemically active UC (secondary loss of response), and group B consisted of patients with stable symptoms but biochemically active UC.

Results: Twenty-three patients met the inclusion criteria: 15 in group A and eight in group B. The serum infliximab levels significantly increased after SC switching in both groups. The electively switched group also exhibited increased infliximab levels after SC switching. Patients in group A showed improved partial Mayo score with a significant decrease in fecal calprotectin and C-reactive protein after switching. In group B, the fecal calprotectin level significantly decreased without clinical relapse after switching. A high proportion of patients (≥80%) in both groups achieved clinical and/or biochemical responses at the last follow-up. During the follow-up period, only two patients in group A discontinued SC infliximab, and only one complained of severe injection site reaction.

Conclusions: In UC patients who experience IV infliximab failure during maintenance treatment, switching to SC infliximab may be a promising option because of better efficacy and safety.

背景/目的:关于选择性改用英夫利西单抗皮下制剂的研究显示,与静脉注射英夫利西单抗相比,皮下制剂具有相似的疗效和安全性,且英夫利西单抗水平更高。然而,对于在维持治疗过程中静脉注射英夫利西单抗失败的溃疡性结肠炎(UC)患者,还没有关于皮下注射英夫利西单抗的有效性的研究报告:这项回顾性研究纳入了 2021 年 1 月至 2023 年 1 月期间因静脉注射英夫利西单抗失败而改用静脉注射英夫利西单抗的 UC 患者。A组定义为临床和生化活动性UC(继发性应答丧失),B组包括症状稳定但生化活动性UC患者:23名患者符合纳入标准:两组患者的血清英夫利西单抗水平在转换 SC 后均显著升高。选择性换药组在换药后也显示出英夫利西单抗水平的升高。A 组患者的部分梅奥评分有所改善,大便钙蛋白和 C 反应蛋白在换药后明显下降。在 B 组中,换药后粪便钙蛋白水平明显下降,但临床症状没有复发。在最后一次随访中,两组中都有很高比例的患者(≥80%)出现了临床和/或生化反应。在随访期间,A组只有两名患者停用了SC英夫利西单抗,只有一名患者抱怨出现了严重的注射部位反应:结论:对于在维持治疗期间静脉注射英夫利西单抗失败的 UC 患者,转用沙龙英夫利西单抗可能是一个很有前景的选择,因为它具有更好的疗效和安全性。
{"title":"Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure.","authors":"June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sung Wook Hwang","doi":"10.5009/gnl230291","DOIUrl":"10.5009/gnl230291","url":null,"abstract":"<p><strong>Background/aims: </strong>Studies on elective switching to the subcutaneous (SC) formulation of infliximab revealed comparable efficacy and safety and higher infliximab level than those exhibited by intravenous (IV) infliximab. However, no studies have reported on the effectiveness of SC switching in ulcerative colitis (UC) patients who experienced IV infliximab failure during maintenance treatment.</p><p><strong>Methods: </strong>This retrospective study included UC patients who had been switched to SC infliximab because of IV infliximab failure, between January 2021 and January 2023. Group A was defined as having clinically and biochemically active UC (secondary loss of response), and group B consisted of patients with stable symptoms but biochemically active UC.</p><p><strong>Results: </strong>Twenty-three patients met the inclusion criteria: 15 in group A and eight in group B. The serum infliximab levels significantly increased after SC switching in both groups. The electively switched group also exhibited increased infliximab levels after SC switching. Patients in group A showed improved partial Mayo score with a significant decrease in fecal calprotectin and C-reactive protein after switching. In group B, the fecal calprotectin level significantly decreased without clinical relapse after switching. A high proportion of patients (≥80%) in both groups achieved clinical and/or biochemical responses at the last follow-up. During the follow-up period, only two patients in group A discontinued SC infliximab, and only one complained of severe injection site reaction.</p><p><strong>Conclusions: </strong>In UC patients who experience IV infliximab failure during maintenance treatment, switching to SC infliximab may be a promising option because of better efficacy and safety.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"667-676"},"PeriodicalIF":3.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Gut and Liver
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