Hepato-gastroenterology最新文献

Background/aims: Egypt has the highest prevalence of HCV worldwide (15%) with a high morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma. The Aim of this study was to investigate the associations between IL-28B single nucleotide polymorphisms (SNP rs12979860) and treatment outcome among Egyptian patients infected with HCV genotype 4.

Methodology: HCV patients were genotyped as CC, CT, or TT at the polymorphic site, rs12979860 in unrelated case control of Egyptian population with HCV.

Results: By using univariate regression analysis, the minor allele of IL28B (p < 0.0001), high serum level of HCV-RNA (p = 0.035), and advanced fibrosis (p = 0.02) were associated with (NRs) (Odds ratio, 3.75 with 95% confidence nterval (2.308-6.1067). While, in multivariate logistic regression analysis, rs12979860 CC genotype was the strongest predictive of SVR (OR = 20.83, 95% CI = 11.63- 37.04, p < 0.0001).

Conclusion: The IL28B rs12979860 SNP is the strongest predictor of an SVR among Egyptian patients infected with HCV-4.

Background/aims: Transanal minimally invasive surgery (TAMIS) has received attention as an alternative to transanal endoscopic microsurgery for rectal lesions. We review the effectiveness and safety of TAMIS for the treatment of rectal lesions.

Methodology: The MEDLINE, Web of Science, and Cochrane Library databases were searched using predefined inclusion criteria. The primary outcomes were positive margin rate, recurrence rate, conversion rate, range of applications, and complication rates. To derive pooled estimates of proportions with 95% Confidence Interval (CI) for the outcomes, a random effect model was used.

Results: Twelve studies including 155 patients were identified. The weighted mean size of rectal lesions was 3.3 cm (range 0.2-10 cm) and the weighted mean distance from the anal verge was 7.4 cm (range 0-20 cm). Six studies enrolled only the patients with low and mid rectal lesions mainly to avoid peritoneal entrance during excision.

Conclusions: Based on the evidence from this limited number of studies, TAMIS appears to be an effective and safe treatment for rec tal lesions. However, the clinical outcome of TAMIS according to the location of the rectal lesions needs to be clarified. Comparison with other established surgical treatments are also mandatory.

Background/aims: Sufficient suppression of perioperative nociception is important for ensuring favorable postoperative outcomes. Although the level of nociception during laparoscopic surgery is generally lower than during laparotomy, there is insufficient evidence to support this for hepatic resection.

Methodology: To develop a method to retrospectively evaluate the intraoperative nociceptive level, we collected data of intraoperative averaged values of heart rate, perfusion index, systolic blood pressure during three surgeries with different levels of intraoperative nociception. After we validated the utility of discriminant analysis using these variables for the retrospective evaluation of nociception during surgery, we performed this analysis in patients who underwent either laparoscopic or open hepatic resection.

Results: Although there was a significant difference in discriminant score between the open and the laparoscopic hepatic resection groups before propensity score matching, discriminant score showed no significant difference between two groups after matching.

Conclusions: The level of nociception during laparoscopic hepatic resection is likely similar to that during open hepatic resection. An assertive anti-nociceptive strategy might be required for laparoscopic procedures under general anesthesia, as with open procedures.