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Application and effectiveness of an improved endoscopically guided nasojejunal tube placement technique in critically ill patients: a retrospective cohort study 一种改进的内镜引导下鼻空肠置管技术在危重病人中的应用和效果:一项回顾性队列研究
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-87
Wei-Ling Liang, Ming-Zhe Ma, Xiao-Hui Min, Xia Ouyang, Jie Liu, Hai-Hua Wu, Chun-Xia Zhan, Xiao-Mei Li
Background: The endoscopic nasojejunal (NJ) placement plays a pivotal role in the nutritional support of critically ill patients. However, the conventional endoscopy-guided tube insertion method presents issues of excessive procedural duration. We have enhanced the traditional endoscopy-guided catheter placement method, enabling a faster and more convenient catheter insertion.
背景:内镜下鼻空肠(NJ)放置在危重病人的营养支持中起着关键作用。然而,传统的内窥镜引导下的管插入方法提出了过多的程序时间的问题。我们对传统的内窥镜引导下的置管方法进行了改进,使置管更快、更方便。
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引用次数: 0
Colorectal cancer screening—what does the recent NordICC trial mean for the U.S. population? 结直肠癌筛查——最近的NordICC试验对美国人群意味着什么?
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-20
Taranika Sarkar Das, Jessica Rauch, Aasma Shaukat
: The incidence of colorectal cancer (CRC) has declined over time, though it remains a significant cause of morbidity and mortality in the U.S. It has the third highest incidence in incidence among all cancers and is the second leading cause of cancer death in both men and women. Screening reduces the incidence and mortality from CRC. There are several modalities for CRC screening, but the most common ones are a choice between a non-invasive stool-based test, such as fecal immunochemical testing (FIT) or an invasive endoscopic modality, such as colonoscopy. In the U.S. colonoscopy is the predominant CRC screening modality, with observational studies reporting large reductions in CRC incidence and mortality. Recently, a large randomized controlled trial (RCT) on effectiveness of colonoscopy reported smaller than expected reduction in CRC incidence and no reduction in CRC mortality with colonoscopy screening. Explanations of the lower than expected benefit include low uptake of colonoscopy, short follow-up for mortality endpoints and quality indicators (QIs) for some of the endoscopists participating in the screening colonoscopies. The findings of the study need to be taken in context with other literature on effectiveness of colonoscopy, with the overall message of reassuring patients of the benefits of screening, and colonoscopy. Here, we discuss the latest evidence on colonoscopy screening and it in the context of other screening modalities and the landscape.
结肠直肠癌(CRC)的发病率随着时间的推移而下降,尽管它仍然是美国发病率和死亡率的重要原因。在所有癌症中,它的发病率排名第三,是男性和女性癌症死亡的第二大原因。筛查可降低结直肠癌的发病率和死亡率。CRC筛查有几种方式,但最常见的是在非侵入性粪便检测(如粪便免疫化学检测(FIT))或侵入性内窥镜检查(如结肠镜检查)之间进行选择。在美国,结肠镜检查是主要的CRC筛查方式,观察性研究报告CRC发病率和死亡率大幅降低。最近,一项关于结肠镜检查有效性的大型随机对照试验(RCT)报告,结肠镜筛查对CRC发病率的降低小于预期,并且没有降低CRC死亡率。对低于预期收益的解释包括结肠镜检查使用率低,对一些参与结肠镜筛查的内窥镜医师的死亡率终点和质量指标(QIs)随访时间短。这项研究的结果需要与其他关于结肠镜检查有效性的文献结合起来考虑,其总体信息是让患者确信筛查和结肠镜检查的好处。在这里,我们讨论结肠镜筛查的最新证据及其在其他筛查方式和景观的背景下。
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引用次数: 0
Analysis of prognostic germline polymorphisms in patients with advanced hepatocellular carcinoma 晚期肝细胞癌患者预后种系多态性分析
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-22
Michael Herman, Benjamin H. Lok, Steven Gallinger, Laura Dawson, Raymond Kim, Dangxiao Cheng, Tara Paton, Roxana Bucur, Devalben Patel, Rouhi Fazelzad, Katrina Hueniken, Geoffrey Liu
Background The prognosis of hepatocellular carcinoma (HCC) is influenced by both tumor and patient specific factors. Current therapies of advanced HCC target angiogenesis and immune evasion, however there are no clinically useful biomarkers to guide clinicians. Methods Our aim in this retrospective cohort study was to validate single nucleotide polymorphisms (SNPs) prognostic of outcome in advanced HCC from the literature, and to analyze exploratory SNPs chosen from evaluation of the HCC tumor immune microenvironment. Using a database of patients with HCC treated with sorafenib, blood samples were genotyped, clinical variables were retrospectively collected, and SNPs were analyzed for association with progression-free survival (PFS) and overall survival (OS). A subsequent analysis was conducted to determine if identified SNPs were prognostic in trans arterial chemoembolization (TACE) treated patients. Results Literature review identified 7 SNPs in vascular endothelial growth factor (VEGF), eNOS, angiopoietin 2 (ANGPT2) and vascular endothelial growth factor receptor 2 (VEGFR2), however none were externally validated in our dataset. Of the 35 exploratory immunomodulatory SNPs, the following were associated with PFS or OS: CCL2 C-C motif ligand 2 (CCL2) (rs1024611), interleukin-10 (IL-10) (rs1800896), cytotoxic T-lymphocyte antigen-4 (CTLA-4) (rs231775) and NFKB1 (rs28362491). Conclusions SNPs identified by literature review to be prognostic in sorafenib treated patients with advanced HCC were not validated in our dataset. Our findings suggest potentially important prognostic implications of SNPs in VEGFR2, CCL2, IL-10, CTLA-4 and NFKB1 that deserve further study.
{"title":"Analysis of prognostic germline polymorphisms in patients with advanced hepatocellular carcinoma","authors":"Michael Herman, Benjamin H. Lok, Steven Gallinger, Laura Dawson, Raymond Kim, Dangxiao Cheng, Tara Paton, Roxana Bucur, Devalben Patel, Rouhi Fazelzad, Katrina Hueniken, Geoffrey Liu","doi":"10.21037/tgh-23-22","DOIUrl":"https://doi.org/10.21037/tgh-23-22","url":null,"abstract":"Background The prognosis of hepatocellular carcinoma (HCC) is influenced by both tumor and patient specific factors. Current therapies of advanced HCC target angiogenesis and immune evasion, however there are no clinically useful biomarkers to guide clinicians. Methods Our aim in this retrospective cohort study was to validate single nucleotide polymorphisms (SNPs) prognostic of outcome in advanced HCC from the literature, and to analyze exploratory SNPs chosen from evaluation of the HCC tumor immune microenvironment. Using a database of patients with HCC treated with sorafenib, blood samples were genotyped, clinical variables were retrospectively collected, and SNPs were analyzed for association with progression-free survival (PFS) and overall survival (OS). A subsequent analysis was conducted to determine if identified SNPs were prognostic in trans arterial chemoembolization (TACE) treated patients. Results Literature review identified 7 SNPs in vascular endothelial growth factor (VEGF), eNOS, angiopoietin 2 (ANGPT2) and vascular endothelial growth factor receptor 2 (VEGFR2), however none were externally validated in our dataset. Of the 35 exploratory immunomodulatory SNPs, the following were associated with PFS or OS: CCL2 C-C motif ligand 2 (CCL2) (rs1024611), interleukin-10 (IL-10) (rs1800896), cytotoxic T-lymphocyte antigen-4 (CTLA-4) (rs231775) and NFKB1 (rs28362491). Conclusions SNPs identified by literature review to be prognostic in sorafenib treated patients with advanced HCC were not validated in our dataset. Our findings suggest potentially important prognostic implications of SNPs in VEGFR2, CCL2, IL-10, CTLA-4 and NFKB1 that deserve further study.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials 急性胆囊切除术术前抗生素预防:随机对照试验的系统回顾和荟萃分析
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-48
Anurag Singh, Mandeep Kaur, Christie Swaminathan, Atreya Subramanian, Krishna K. Singh, Muhammad S. Sajid
Background: Laparoscopic cholecystectomy (LC) in patients admitted with acute cholecystitis is considered the preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single-dose pre-operative prophylactic antibiotics in patients undergoing emergency LC for mild to moderate acute cholecystitis.
背景:急性胆囊炎患者行腹腔镜胆囊切除术(LC)被认为是治疗胆结石疾病的首选、可行和安全的方式。本研究的目的是评估单剂量术前预防性抗生素在轻中度急性胆囊炎急诊LC患者中的作用。
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引用次数: 0
Long-term impact of sarcopenia in older patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis 老年胃癌患者行胃切除术后肌肉减少症的长期影响:一项系统回顾和荟萃分析
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-34
Masayoshi Terayama, Manabu Ohashi, Motonari Ri, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Koshi Kumagai, Takeshi Sano, Souya Nunobe
Background Sarcopenia is an inevitable problem in older patients. After gastrectomy, patients often have an inadequate dietary intake and easily fall into sarcopenia. However, the impact of preoperative sarcopenia on long-term outcomes after gastrectomy has not been analyzed. Methods A systematic review was conducted for all relevant articles identified on PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until April 2023. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed or random effects model according to the heterogeneity. The Newcastle-Ottawa Scale was used to quantify study quality. Results Seven studies involving 1,831 patients aged ≥65 years who underwent gastrectomy for gastric cancer were analyzed. Four hundred twelve patients (22.5%) were diagnosed with sarcopenia. The analysis showed that preoperative sarcopenia was significantly associated with poor overall survival (OS) (HR =1.93; 95% CI:1.60–2.34; P<0.001). Two of the included studies also showed that preoperative sarcopenia was significantly correlated with disease-related survival: one with disease-specific survival (DSS) (HR =4.00; 95% CI: 1.20–13.3, P=0.024) and the other with non-cancer specific survival (HR =3.27; 95% CI: 1.61–6.67; P=0.001). Furthermore, sarcopenic patients experienced more severe complications than non-sarcopenic patients (OR =1.80; 95% CI: 1.10–2.95; P=0.019). Conclusions This meta-analysis suggested that preoperative sarcopenia is useful as a prognostic factor of impaired OS in older patients after gastrectomy. Preoperative evaluation and intervention for skeletal muscle loss should be considered. Further studies of sarcopenic impact on disease-related survival are required.
{"title":"Long-term impact of sarcopenia in older patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis","authors":"Masayoshi Terayama, Manabu Ohashi, Motonari Ri, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Koshi Kumagai, Takeshi Sano, Souya Nunobe","doi":"10.21037/tgh-23-34","DOIUrl":"https://doi.org/10.21037/tgh-23-34","url":null,"abstract":"Background Sarcopenia is an inevitable problem in older patients. After gastrectomy, patients often have an inadequate dietary intake and easily fall into sarcopenia. However, the impact of preoperative sarcopenia on long-term outcomes after gastrectomy has not been analyzed. Methods A systematic review was conducted for all relevant articles identified on PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until April 2023. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed or random effects model according to the heterogeneity. The Newcastle-Ottawa Scale was used to quantify study quality. Results Seven studies involving 1,831 patients aged ≥65 years who underwent gastrectomy for gastric cancer were analyzed. Four hundred twelve patients (22.5%) were diagnosed with sarcopenia. The analysis showed that preoperative sarcopenia was significantly associated with poor overall survival (OS) (HR =1.93; 95% CI:1.60–2.34; P<0.001). Two of the included studies also showed that preoperative sarcopenia was significantly correlated with disease-related survival: one with disease-specific survival (DSS) (HR =4.00; 95% CI: 1.20–13.3, P=0.024) and the other with non-cancer specific survival (HR =3.27; 95% CI: 1.61–6.67; P=0.001). Furthermore, sarcopenic patients experienced more severe complications than non-sarcopenic patients (OR =1.80; 95% CI: 1.10–2.95; P=0.019). Conclusions This meta-analysis suggested that preoperative sarcopenia is useful as a prognostic factor of impaired OS in older patients after gastrectomy. Preoperative evaluation and intervention for skeletal muscle loss should be considered. Further studies of sarcopenic impact on disease-related survival are required.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"216 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136159846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A fucoidan plant drink reduces Helicobacter pylori load in the stomach: a real-world study 岩藻聚糖植物饮料减少胃中幽门螺杆菌的负荷:一项真实世界的研究
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-63
Qing-Liang Teng, Shu-Jing Sui, Zhen Zhu, Qing Gao, Hui Ge, Ke-Qiang Wang, Leonardo S. Lino-Silva, Michael Sigal, Jonathan R. White, Qi-Hui Peng, You-Zhen Wei
Background: Helicobacter pylori (Hp) infection is highly prevalent globally and is predominantly managed by antibiotics. Recently, the anti-adhesive, antioxidant, antitoxin, immunomodulatory, anti-coagulant, and anti-infective activities of fucoidan, a polysaccharide extracted from brown seaweeds, have been widely studied, and the results showed promise. Fucoidan has the potential to be utilized in Hp eradication therapy. Our present clinical study was designed to evaluate the efficiency of Lewuyou®, a fucoidan plant drink (FPD) in eradicating Hp in humans.
背景:幽门螺杆菌(Hp)感染在全球范围内非常普遍,主要通过抗生素治疗。近年来,褐藻多糖的抗黏附、抗氧化、抗毒素、免疫调节、抗凝血和抗感染活性得到了广泛的研究,其研究结果显示出良好的前景。岩藻聚糖有潜力用于Hp根除治疗。我们目前的临床研究旨在评估乐乌游®,一种岩藻聚糖植物饮料(FPD)根除人类Hp的效率。
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引用次数: 0
The real efficacy of microbiota restoration following standard of care antimicrobial in patients with recurrent Clostridiodes difficile 复发性难辨梭菌患者在标准护理抗菌素治疗后微生物群恢复的真实疗效
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-46
Kanika Sehgal, Paul Feuerstadt
{"title":"The real efficacy of microbiota restoration following standard of care antimicrobial in patients with recurrent Clostridiodes difficile","authors":"Kanika Sehgal, Paul Feuerstadt","doi":"10.21037/tgh-23-46","DOIUrl":"https://doi.org/10.21037/tgh-23-46","url":null,"abstract":"","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapeutic advancement in inflammatory bowel disease by incorporating plant-based diet 结合植物性饮食治疗炎症性肠病的进展
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-6
Mitsuro Chiba, Tsuyotoshi Tsuji, Masafumi Komatsu
: Identification and recognition of the ubiquitous environmental factor are prerequisite for treatment and prevention of the disease. The biggest problem with current practice in inflammatory bowel disease (IBD) is the lack of a widely appreciated ubiquitous environmental factor for the disease. The incidence of IBD is associated with dietary transition from a traditional diet to the current (westernized) diet. Prospective cohort studies and case-control studies indicate that the current diet is a risk factor for IBD. The current diet tends to cause gut microbial dysbiosis resulting in a pro-inflammatory state. Therefore, we regard our current diet as this factor. Even nutritionally balanced meals are unable to suppress relapse, particularly in Crohn’s disease (CD). Therefore, we developed a plant-based diet (PBD) (lacto-ovo-semi-vegetarian diet) to counter the current diet. By incorporating the PBD into practice, we achieved far better outcomes in both ulcerative colitis (UC) and CD in both the induction and quiescent phases compared to the current standard therapy. All patients were treated on an inpatient basis and provided with a PBD. CD is far more untenable than UC and is destined to follow a disabling course. Therefore, infliximab was indicated in all patients with CD, but only in severe cases with UC. This infliximab and PBD as first-line (IPF) therapy broke the barrier of primary nonresponders to biologics (around 30%): the remission rate was 96% (44/46) in CD and 76% (13/17) in severe UC. A PBD can induce remission without medication in approximately one-third of mild cases of UC. All patients were advised to adhere PBD after discharge. In CD, a relapse-free outcome was achieved in nearly a half of patients (52%) at 10-year follow-up without biologics or immunosuppressants. Cumulative relapse rates for 51 initial episode cases of UC (18 mild, 30 moderate, 3 severe) at 1 and 5 years were 14% and 27%, respectively. We believe our assertion that the current diet is the ubiquitous environmental factor underlying IBD is correct and a PBD is right diet for the disease.
识别和认识无处不在的环境因素是治疗和预防疾病的先决条件。目前治疗炎症性肠病(IBD)的最大问题是缺乏一种普遍存在的环境因素。IBD的发病率与从传统饮食到当前(西方化)饮食的转变有关。前瞻性队列研究和病例对照研究表明,目前的饮食是IBD的一个危险因素。目前的饮食往往会导致肠道微生物失调,导致促炎状态。因此,我们认为我们目前的饮食是这个因素。即使营养均衡的膳食也无法抑制复发,尤其是克罗恩病(CD)。因此,我们开发了一种植物性饮食(PBD)(乳蛋半素食饮食)来对抗目前的饮食。通过将PBD纳入实践,与目前的标准治疗相比,我们在诱导期和静止期对溃疡性结肠炎(UC)和CD都取得了更好的结果。所有患者均在住院基础上接受治疗,并提供PBD。CD远比UC站不住脚,注定要走一条致残的道路。因此,英夫利昔单抗适用于所有CD患者,但仅适用于重症UC患者。英夫利昔单抗和PBD作为一线(IPF)治疗打破了对生物制剂无反应的障碍(约30%):CD的缓解率为96%(44/46),严重UC的缓解率为76%(13/17)。在大约三分之一的轻度UC病例中,PBD可以诱导缓解而无需药物治疗。所有患者出院后均建议坚持PBD。在未使用生物制剂或免疫抑制剂的10年随访中,近一半(52%)的CD患者无复发。51例UC首发病例(轻度18例,中度30例,重度3例)1年和5年的累计复发率分别为14%和27%。我们相信我们关于当前饮食是IBD普遍存在的环境因素的断言是正确的,PBD是适合该疾病的饮食。
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引用次数: 0
Risk of second cancer in esophageal squamous cell carcinoma and adenocarcinoma survivors: a population-based analysis in SEER dataset 食管鳞状细胞癌和腺癌幸存者的第二癌风险:基于SEER数据集的人群分析
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-29
Xiaona Qi, Xiaoying Su, Changhong Wang, Qiang Yao, Yuying Fan
Background: Previous studies have reported increased risk of second cancer in both esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EAC) survivors. This study aimed to examine the risk and influential factors of second cancer in ESCC and EAC patients.
背景:先前的研究报道了食管鳞状细胞癌(ESCC)和食管腺癌(EAC)幸存者患第二癌的风险增加。本研究旨在探讨ESCC和EAC患者发生第二癌的危险及影响因素。
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引用次数: 0
Arterial resection during operative management of pancreatic head and uncinate process adenocarcinoma: a systematic review 胰头及钩突腺癌手术治疗中的动脉切除:系统回顾
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-33
Alexander A. Dermanis, James Halle-Smith, Sarah Powell-Brett, J. Keith Roberts, Robert P. Sutcliffe, Nikolaos Chatzizacharias
Background: Surgical resection is a part of the treatment pathways for the management of pancreatic cancer with arterial involvement. Arterial resection in this context is however not widely supported due to the paucity and diversity of the reported evidence in the literature. The aim of this systematic review is the presentation and analysis of the current evidence in the field.
背景:手术切除是动脉受累胰腺癌治疗途径的一部分。然而,由于文献中报道的证据的缺乏和多样性,在这种情况下动脉切除术并没有得到广泛的支持。本系统综述的目的是介绍和分析该领域的现有证据。
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引用次数: 0
期刊
Translational gastroenterology and hepatology
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