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Analysis of causality assessment methods in suspected HILI cases shows relevant gaps as assessed for accuracy, bias and transparency using data provided through the Freedom of Information Act (FOIA) 对疑似HILI病例因果关系评估方法的分析显示,使用《信息自由法》提供的数据评估的准确性、偏见和透明度存在相关差距。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-05-18 DOI: 10.21037/TGH-20-148
C. Willson
Causality Assessment Methods (CAMs) are employed to assess adverse effects from various agents. The use of the United States based Drug Induced Liver Injury Network (DILIN) method, which relies on global introspection (GI) or expert opinion (EO) for causality assessment in the case of herbinduced or drug-induced liver injury (HILI/DILI) is examined for bias. The accuracy of the Roussel Uclaf Causality Assessment Method (RUCAM) as used by the DILIN, overall transparency of the DILIN’s use of both CAMs and the ability of the RUCAM to resist bias are also assessed. Data obtained from a Freedom of Information Act (FOIA) production by the National Institutes of Health (NIH) for material related to a publication by the US DILIN were analyzed to determine if any of 10 chosen forms of cognitive dispositions to respond (CDRs) or cognitive bias were present in an investigation of a dietary supplement, OxyELITE Pro (OEP). Data not originally included for publication were also utilized to assess the accuracy of the DILIN’s RUCAM scoring and transparency. To assess the RUCAM’s possible resistance to bias, mean RUCAM scores were calculated to evaluate those produced by a Primary Investigator (PI) versus computer for OEP and non-OEP products. A minimum of 4 and up to 10 CDRs were present. The data also showed the RUCAM may resist bias as there was no difference in causality grading between the mean PI and computer-based RUCAM scores. However, the lack of inferential analyses and small sample size are limitations. RUCAM scores by DILIN authors for OEP consisted of 1 as “unlikely” 4 as “possible” and 2 as “probable.” However, when scores were recalculated based upon previously unreported data, RUCAM scores decreased substantially with 3 that should have been “excluded” and 4 as “possible,” indicating inaccurate scoring. Discrepancies between published data and those obtained via FOIA showed a lack of transparency. It is concluded that the DILIN method lacks transparency while being prone to bias. The RUCAM is the most appropriate method for evidence-based medicine but requires data to be reported objectively and transparently in order to avoid inaccurate scoring, misdiagnoses and incorrect causality attribution.
因果关系评估方法(CAMs)用于评估各种药物的不良反应。使用基于美国的药物性肝损伤网络(DILIN)方法,该方法依赖于全局自省(GI)或专家意见(EO)来评估草药性或药物性肝损伤(HILI/DILI)的因果关系,以检查是否存在偏差。还评估了DILIN使用的Roussel Uclaf因果关系评估方法(RUCAM)的准确性,DILIN使用CAMs的总体透明度以及RUCAM抵抗偏见的能力。美国国立卫生研究院(NIH)根据《信息自由法》(Freedom of Information Act, FOIA)对美国DILIN出版的一份出版物相关材料进行了数据分析,以确定在对一种膳食补充剂OxyELITE Pro (OEP)的调查中,是否存在10种选择的认知倾向或认知偏见。最初未纳入发表的数据也被用于评估DILIN的RUCAM评分的准确性和透明度。为了评估RUCAM可能的抗偏倚性,计算了RUCAM的平均分数,以评估由主要研究者(PI)与计算机对OEP和非OEP产品产生的分数。至少有4个,最多10个存托凭证。数据还显示RUCAM可以抵抗偏倚,因为平均PI和基于计算机的RUCAM评分之间的因果关系分级没有差异。然而,缺乏推理分析和小样本量是局限性。DILIN作者对OEP的RUCAM评分包括1为“不太可能”,4为“可能”,2为“可能”。然而,当基于先前未报告的数据重新计算分数时,RUCAM分数大幅下降,本应“排除”的分数为3分,而“可能”的分数为4分,表明评分不准确。公布的数据与通过《信息自由法》获得的数据之间的差异表明缺乏透明度。结论是DILIN方法缺乏透明度,容易产生偏差。RUCAM是最适合循证医学的方法,但需要客观透明地报告数据,以避免不准确的评分、误诊和不正确的因果归因。
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引用次数: 0
Immunotherapy and radiation therapy for gastrointestinal malignancies: hope or hype? 胃肠道恶性肿瘤的免疫治疗和放射治疗:希望还是炒作?
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.10.07
Shahed Badiyan, Adeel Kaiser, Bory Eastman, Matthew Forsthoefel, Jing Zeng, Keith Unger, Michael Chuong

Immunotherapy represents the newest pillar in cancer care. Although there are increasing data showing the efficacy of immunotherapy there is a spectrum of response across unselected populations of cancer patients. In fact, response rates can be poor even among patients with immunogenic tumors for reasons that remain poorly understood. A promising clinical strategy to improve outcomes, which is supported by an abundance of preclinical data, is combining immunotherapy with radiation therapy. Here we review the existing evidence and future directions for combining immunotherapy and radiation therapy for patients with gastrointestinal cancers.

免疫疗法是癌症治疗的最新支柱。尽管有越来越多的数据显示免疫疗法的疗效,但在未经选择的癌症患者群体中存在一系列反应。事实上,即使在免疫原性肿瘤患者中,反应率也可能很低,原因尚不清楚。一种有希望改善疗效的临床策略是将免疫疗法与放射疗法相结合,这一策略得到了大量临床前数据的支持。在这里,我们回顾了胃肠道癌症患者联合免疫治疗和放射治疗的现有证据和未来方向。
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引用次数: 0
Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease. 无创诊断:非酒精性脂肪性肝病和酒精性肝病。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.11.14
Jose Altamirano, Qiaochu Qi, Sabina Choudhry, Mohamed Abdallah, Ashwani K Singal, Abhinav Humar, Ramón Bataller, Amir Ali Borhani, Andrés Duarte-Rojo

Non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) are becoming the leading causes of chronic liver disease worldwide, significantly impacting public health and healthcare cost. The development of fibrosis is the main factor leading to early mortality and morbidity in NAFLD and ALD. Thus, it is important to timely and reliably evaluate these diseases at early stages, when fibrosis is not advanced or when steatosis predominates. Liver biopsy has been the standard of reference for fibrosis and steatosis, however, its invasiveness precludes its widespread use. There is growing research on non-invasive methods for diagnosing and stratifying fibrosis and steatosis in NAFLD and ALD. This review presents clinical evidence on the use of non-invasive assessment of liver disease (blood-based and imaging-based) in patients with NALFD and ALD, and proposes algorithms incorporating these tests into their management.

非酒精性脂肪性肝病(NAFLD)和酒精性肝病(ALD)正在成为世界范围内慢性肝病的主要原因,严重影响公众健康和医疗保健成本。纤维化的发展是导致NAFLD和ALD早期死亡和发病的主要因素。因此,在纤维化未进展或脂肪变性占主导地位的早期,及时可靠地评估这些疾病是很重要的。肝活检一直是肝纤维化和脂肪变性的参考标准,然而,它的侵袭性阻碍了它的广泛应用。对NAFLD和ALD中纤维化和脂肪变性的无创诊断和分层方法的研究越来越多。本综述介绍了在非alfd和ALD患者中使用无创肝脏疾病评估(基于血液和基于影像学)的临床证据,并提出了将这些测试纳入其管理的算法。
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引用次数: 25
Inherited iron overload disorders. 遗传性铁超载失调。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.11.15
Alberto Piperno, Sara Pelucchi, Raffaella Mariani

Hereditary iron overload includes several disorders characterized by iron accumulation in tissues, organs, or even single cells or subcellular compartments. They are determined by mutations in genes directly involved in hepcidin regulation, cellular iron uptake, management and export, iron transport and storage. Systemic forms are characterized by increased serum ferritin with or without high transferrin saturation, and with or without functional iron deficient anemia. Hemochromatosis includes five different genetic forms all characterized by high transferrin saturation and serum ferritin, but with different penetrance and expression. Mutations in HFE, HFE2, HAMP and TFR2 lead to inadequate or severely reduced hepcidin synthesis that, in turn, induces increased intestinal iron absorption and macrophage iron release leading to tissue iron overload. The severity of hepcidin down-regulation defines the severity of iron overload and clinical complications. Hemochromatosis type 4 is caused by dominant gain-of-function mutations of ferroportin preventing hepcidin-ferroportin binding and leading to hepcidin resistance. Ferroportin disease is due to loss-of-function mutation of SLC40A1 that impairs the iron export efficiency of ferroportin, causes iron retention in reticuloendothelial cell and hyperferritinemia with normal transferrin saturation. Aceruloplasminemia is caused by defective iron release from storage and lead to mild microcytic anemia, low serum iron, and iron retention in several organs including the brain, causing severe neurological manifestations. Atransferrinemia and DMT1 deficiency are characterized by iron deficient erythropoiesis, severe microcytic anemia with high transferrin saturation and parenchymal iron overload due to secondary hepcidin suppression. Diagnosis of the different forms of hereditary iron overload disorders involves a sequential strategy that combines clinical, imaging, biochemical, and genetic data. Management of iron overload relies on two main therapies: blood removal and iron chelators. Specific therapeutic options are indicated in patients with atransferrinemia, DMT1 deficiency and aceruloplasminemia.

遗传性铁超载包括几种以铁在组织、器官、甚至单细胞或亚细胞区室积聚为特征的疾病。它们是由直接参与hepcidin调节、细胞铁摄取、管理和输出、铁运输和储存的基因突变决定的。全身形式的特点是血清铁蛋白升高,伴或不伴高转铁蛋白饱和度,伴或不伴功能性缺铁性贫血。血色素沉着病包括五种不同的遗传形式,它们都以高转铁蛋白饱和度和血清铁蛋白为特征,但具有不同的外显率和表达。HFE、HFE2、HAMP和TFR2突变导致hepcidin合成不足或严重减少,进而诱导肠道铁吸收和巨噬细胞铁释放增加,导致组织铁过载。hepcidin下调的严重程度决定了铁超载的严重程度和临床并发症。4型血色素沉着症是由转运铁蛋白的显性功能获得性突变引起的,阻止了hepcidin-ferroportin结合并导致hepcidin耐药。运铁蛋白疾病是由于SLC40A1的功能缺失突变,损害了运铁蛋白的铁输出效率,导致网状内皮细胞中的铁潴存和正常转铁蛋白饱和度的高铁蛋白血症。尖质纤溶酶血症是由储存的铁释放缺陷引起的,可导致轻度小细胞贫血、低血清铁和包括脑在内的几个器官中的铁潴留,引起严重的神经系统症状。转铁蛋白血症和DMT1缺乏症的特征是红细胞缺铁,严重的小细胞贫血伴高转铁蛋白饱和度和继发性hepcidin抑制导致的实质铁超载。不同形式的遗传性铁超载疾病的诊断涉及结合临床、影像学、生化和遗传数据的顺序策略。铁超载的管理主要依靠两种疗法:血液清除和铁螯合剂。对于转铁蛋白血症、DMT1缺乏症和尖状纤溶酶血症患者,有特定的治疗选择。
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引用次数: 46
Significance of nodal dissection and nodal positivity in gastric cancer. 胃癌淋巴结清扫及淋巴结阳性的意义。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.09.13
Yue-Xin Zhang, Kun Yang

Lymphadenectomy is a central component of surgery for gastric cancer. However, controversies over the optimal extent of lymphadenectomy in gastric cancer surgery have persisted for several decades. In Eastern countries where the incidence of gastric cancer is high, surgeons have performed extensive lymphadenectomy (D2 lymphadenectomy) with low morbidity and mortality, while most Western surgeons have advocated for more limited lymphadenectomies according to the results of Dutch trial and MRC trial. Initially, these trials had failed to show survival benefit of D2 procedure and instead, found pancreaticosplenectomy performed as part of the D2 procedure associated with high incidence of morbidity and mortality. Subsequently, superiority of D2 lymphadenectomy on survival was demonstrated based on updated results. Moreover, spleen and pancreas preserving D2 lymphadenectomy are being performed safely in Western countries. Today, there is an international consensus on performing D2 lymphadenectomy as the standard procedure for advanced gastric cancer and is widely accepted as the standard procedure for gastric cancer surgery. The significance of the extent of lymphadenectomy is intimately associated with the prognostic importance of nodal metastases as the most powerful indicator of recurrence and survival for patients after curative gastrectomy. Maruyama computer program could be used to estimate the risk of lymph node metastasis in each nodal station. The Maruyama Index could be used to assess the adequacy of lymphadenectomy in gastric cancer. Positive lymph node ratio is calculated as the ratio of positive lymph nodes to all harvested lymph nodes, which might be a more precise predictor of prognosis than the absolute number of positive lymph nodes. While D2 lymphadenectomy enables the accurate staging of the disease, reduces the incidence of locoregional recurrences and thus contribute to an improved overall survival; performing lymphadenectomy beyond D2 is unlikely to improve survival. Therapeutic D2+ lymphadenectomy for advanced gastric cancer requires further evaluations, especially for patients receiving neo-adjuvant or conversion treatments.

淋巴结切除术是胃癌手术的核心组成部分。然而,关于胃癌手术中淋巴结切除的最佳范围的争论已经持续了几十年。在胃癌发病率高的东方国家,外科医生进行了广泛的淋巴结切除术(D2淋巴结切除术),发病率和死亡率低,而根据荷兰试验和MRC试验的结果,大多数西方外科医生主张进行更有限的淋巴结切除术。最初,这些试验未能显示D2手术的生存益处,相反,发现胰脾切除术作为D2手术的一部分与高发病率和死亡率相关。随后,根据最新的结果,D2淋巴结切除术对生存率的优势得到了证实。此外,在西方国家,保留脾脏和胰腺的D2淋巴结切除术是安全的。目前,D2淋巴结切除术作为晚期胃癌的标准手术已成为国际共识,并被广泛接受为胃癌手术的标准手术。淋巴结转移的重要性与淋巴结切除术的重要性密切相关,淋巴结转移是治疗性胃切除术后患者复发和生存的最有力指标。Maruyama计算机程序可用于估计每个淋巴结站的淋巴结转移风险。Maruyama指数可用于评价胃癌淋巴结切除术是否足够。阳性淋巴结比是根据阳性淋巴结占所有淋巴结的比例来计算的,这可能比阳性淋巴结的绝对数量更准确地预测预后。D2淋巴结切除术使疾病的准确分期,减少局部复发的发生率,从而有助于提高总生存率;D2以上行淋巴结切除术不太可能提高生存率。D2+淋巴结切除术治疗晚期胃癌需要进一步评估,特别是接受新辅助治疗或转换治疗的患者。
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引用次数: 11
Clinical presentation of alcoholic liver disease and non-alcoholic fatty liver disease: spectrum and diagnosis. 酒精性肝病和非酒精性脂肪肝的临床表现:频谱和诊断
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.10.02
Praveen Sharma, Anil Arora

Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are commonest causes of chronic liver disease in developing as well as developed countries. Their incidence has increased due to widespread easy availability of alcohol and sedentary life style of people. NAFLD is a spectrum which includes fatty liver (NAFL) which is considered benign disease, steatohepatitis (NASH) which indicates ongoing injury to liver and cirrhosis of liver. Similarly, ALD spectrum comprises simple steatosis, alcoholic hepatitis, and cirrhosis and its complications. Most of the time there is significant overlap between these diseases and clinical presentation depends upon the stage of liver disease. Most of the NAFLD patients are asymptomatic and diagnosed to have fatty liver while undergoing routine health check up. ALD requires significant history of alcohol intake which is supportive by radiological and biochemical tests. In both NAFLD and ALD patients, liver enzymes are seldom raised beyond five times the upper limit of normal. Liver biopsy is required for diagnosis of NASH as it is a histological diagnosis and sometimes in alcoholic hepatitis for confirmation if diagnosis is in doubt. Non-invasive markers and prognostic scores have been developed for avoiding liver biopsy in assessment and treatment response of NASH and alcoholic hepatitis patients.

酒精性肝病(ALD)和非酒精性脂肪性肝病(NAFLD)是发展中国家和发达国家慢性肝病的最常见原因。由于普遍容易获得酒精和人们久坐不动的生活方式,其发病率有所增加。NAFLD是一个谱系,包括被认为是良性疾病的脂肪肝(NAFL),表明肝脏和肝硬化持续损伤的脂肪性肝炎(NASH)。同样,ALD谱包括单纯性脂肪变性、酒精性肝炎、肝硬化及其并发症。大多数情况下,这些疾病之间有明显的重叠,临床表现取决于肝病的分期。大多数NAFLD患者无症状,在常规健康检查时诊断为脂肪肝。ALD需要有明显的酒精摄入史,放射学和生化试验支持这一点。在NAFLD和ALD患者中,肝酶很少升高超过正常上限的5倍。肝活检是诊断NASH的必要条件,因为它是一种组织学诊断,有时在酒精性肝炎中,如果诊断有疑问,也需要肝活检进行确认。在NASH和酒精性肝炎患者的评估和治疗反应中,已经开发了非侵入性标志物和预后评分,以避免肝活检。
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引用次数: 44
Contrast enhanced ultrasound: comparing a novel modality to MRI to assess for bowel disease in pediatric Crohn's patients. 对比增强超声:比较一种新的模式,以评估肠道疾病的儿童克罗恩病患者的MRI。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.11.02
Kiran Mudambi, Jesse Sandberg, Dorsey Bass, Erika Rubesova

Background: To demonstrate the feasibility and reliability of a novel imaging modality, contrast enhanced ultrasound (CEUS), in evaluating for distal small bowel inflammation in pediatric Crohn's disease (CD), and compare this to concurrently obtained magnetic resonance imaging (MRI) findings.

Methods: Pediatric patients diagnosed with or having suspicion of CD with small bowel involvement, whose disease merited imaging with an MRI, concurrently underwent imaging with CEUS. We assessed the ability of CEUS to demonstrate distal small bowel disease by evaluating wall thickness, enhancement pattern, mucosal disruption and pericolonic inflammation. Concordance between imaging modalities was then assessed.

Results: Twenty patients were recruited for the study, 16 with known CD, 3 with concern for CD, and one with known colitis, but unknown bowel disease status. Six patients (3 with prior diagnosis of CD, 3 without) had absence of bowel enhancement on both ultrasound and MRI. Eleven patients with findings of inflammation and enhancement on MRI also had concurrent evidence of enhancement on CEUS. Three patients who had no evidence of inflammation on MRI, with known CD, had prominent bowel enhancement on CEUS. One patient with known colitis, whom we enrolled to evaluate for small bowel disease, had no evidence on either MRI or CEUS, however CEUS showed significant fat stranding around the colon, supporting the diagnosis of CD.

Conclusions: The sensitivity of CEUS to detect bowel inflammation when seen on MRI was 100%. In addition, CEUS may also have the ability to detect bowel inflammation, even in the presence of a normal MRI.

背景:为了证明一种新型成像方式的可行性和可靠性,对比增强超声(CEUS)评估儿童克罗恩病(CD)远端小肠炎症,并将其与同时获得的磁共振成像(MRI)结果进行比较。方法:诊断为或怀疑为乳糜泻伴小肠受累的儿童患者,其疾病值得MRI成像,同时进行超声造影成像。我们通过评估肠壁厚度、增强模式、粘膜破坏和结肠周围炎症来评估超声造影显示远端小肠疾病的能力。然后评估成像方式之间的一致性。结果:研究招募了20名患者,其中16名患有已知的乳糜泻,3名患有乳糜泻,1名患有已知的结肠炎,但肠道疾病状况未知。6例患者(3例既往诊断为乳糜泻,3例未诊断为乳糜泻)超声和MRI均未见肠道强化。11例MRI显示炎症和增强的患者也同时有超声造影增强的证据。3例在MRI上没有炎症证据的患者,已知CD,在超声造影上有明显的肠道强化。我们招募了一名已知结肠炎的患者,对其进行小肠疾病评估,该患者在MRI或超声造影上均未发现证据,但超声造影显示结肠周围有明显的脂肪滞留,支持cd的诊断。结论:超声造影在MRI上检测肠道炎症的敏感性为100%。此外,超声造影也可能具有检测肠道炎症的能力,即使在MRI正常的情况下也是如此。
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引用次数: 10
Nonalcoholic steatohepatitis recurrence after liver transplant. 肝移植后非酒精性脂肪性肝炎复发。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.10.12
Sunil Taneja, Akash Roy

Nonalcoholic steatohepatitis (NASH) is the fastest growing indication for liver transplant (LT)worldwide and is deemed to be the foremost indication in the near future. Recurrence of NASH can occur post LT and has been observed to be a common phenomenon. Baseline metabolic co-morbidities and worsening of metabolic profile post LT are the principal drivers of NASH recurrence. Liver biopsy remains the gold standard for establishing the diagnosis. However, noninvasive methods including transient elastography (TE) and magnetic resonance imaging (MRI) seem to be promising. The implications of recurrent NASH on post LT outcomes, graft steatosis, progression to fibrosis, overall survival, and cardiovascular associations warrant careful evaluation. Control of metabolic parameters and weight gain along with tailored immunosuppression remain the cornerstone of management. Extrapolation of the ever-increasing armamentarium of NASH pharmacotherapy specifically in this population of recurrent NAFLD remains a challenge for the future.

非酒精性脂肪性肝炎(NASH)是世界范围内增长最快的肝移植适应症,并被认为是不久的将来最重要的适应症。NASH复发可发生在肝移植后,并且已被观察到是一种常见现象。基线代谢合并症和LT后代谢谱恶化是NASH复发的主要驱动因素。肝活检仍然是确定诊断的金标准。然而,包括瞬态弹性成像(TE)和磁共振成像(MRI)在内的非侵入性方法似乎很有前途。复发性NASH对肝移植后预后、移植物脂肪变性、纤维化进展、总生存率和心血管相关性的影响值得仔细评估。控制代谢参数和体重增加以及量身定制的免疫抑制仍然是治疗的基石。推断不断增加的NASH药物治疗手段,特别是在复发性NAFLD人群中,仍然是未来的挑战。
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引用次数: 18
Endocytoscopy: technology and clinical application in upper gastrointestinal tract. 上消化道内吞镜检查技术及临床应用。
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.11.12
Mary Raina Angeli Abad, Yuto Shimamura, Yusuke Fujiyoshi, Stefan Seewald, Haruhiro Inoue

Over the past few years, the innovative field of magnifying endoscopy has been expanding with various cutting-edge technologies, one of which is endocytoscopy, to facilitate improvement in the detection and diagnosis of gastrointestinal lesions. Endocytoscopy is a novel ultra-high magnification endoscopic technique enabling high-quality in-vivo assessment of lesions found in the gastrointestinal tract with the use of intraprocedural stains. The main scope of this review article is to offer a closer look at the latest endocytoscopic technology and its clinical application in the upper gastrointestinal tract, especially in the esophagus and stomach, as well as to introduce readers to our simplified and up-to-date endocytoscopic classification, specifically developed for the esophagus and stomach, for the in-vivo assessment and diagnosis of esophageal and gastric lesions. Despite the good accuracy of endocytoscopy in the diagnosis of esophageal and gastric lesions in recent studies, some challenges still remain (e.g., staining method and standardized endocytoscopic classification). Through continuous evaluation and improvement of methods and skills, these challenges may be overcome thus establishing current techniques and classification, paving the way for further advances in the field of endocytoscopy and magnifying endoscopy. In all, endocytoscopy seems to aid in the in-vivo diagnosis of gastrointestinal tract lesions and may, in the future, revolutionize the field of in-vivo endoscopic diagnosis of gastrointestinal cancer, representing another step towards the so-called optical biopsy.

在过去的几年里,放大内镜的创新领域不断扩大,各种前沿技术,其中之一是内吞镜检查,以促进胃肠道病变的检测和诊断的提高。内吞镜检查是一种新型的超高放大内镜技术,可以通过术中染色对胃肠道病变进行高质量的体内评估。本文综述了最新的内吞镜技术及其在上消化道,特别是食管和胃中的临床应用,并向读者介绍了我们专门为食管和胃开发的简化的最新内吞镜分类,用于食管和胃病变的体内评估和诊断。尽管近年来的研究表明,内吞镜对食管和胃病变的诊断具有较好的准确性,但仍存在一些挑战(如染色方法、内吞镜分类标准化等)。通过对方法和技术的不断评估和改进,可以克服这些挑战,从而建立现有的技术和分类,为内吞镜检查和放大内窥镜检查领域的进一步发展铺平道路。总之,内吞镜检查似乎有助于胃肠道病变的体内诊断,并可能在未来彻底改变胃肠道肿瘤的体内内镜诊断领域,代表着所谓的光学活检的又一步。
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引用次数: 19
The prevalence of diabetes and metabolic syndrome and associated risk factors in Sudanese individuals with gallstones: a cross sectional survey. 苏丹胆结石患者糖尿病和代谢综合征患病率及相关危险因素:一项横断面调查
IF 3 4区 医学 Q1 Medicine Pub Date : 2020-04-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.10.09
Ahmed Omer Almobarak, Ayat Jervase, Aza Abdelrahman Fadl, Nur Ibrahim Ali Garelnabi, Suzan Al Hakem, Tarig Mohamed Hussein, Amro Ahmad Aljack Ahmad, Inas Salah El-den Ahmed, Safaa Badi, Mohamed H Ahmed

Background: The gallstones are common health problem across the world with huge financial burden on health authorities. Obesity and insulin resistance are associated with risk of gallstones disease (GSD). The aim of this study was to assess the prevalence of metabolic syndrome (MetS) and diabetes and associated risk factors in Sudanese patients with gallstones.

Methods: A prospective cross-sectional study, enrolled patients with gallstones attending Ibn Sina Specialized Teaching Hospital for gastrointestinal and hepatobiliary diseases. A structured questionnaire was applied, anthropometric measures were taken, and blood tested for HbA1c, fasting glucose and lipid profile. Data was analysed using SPSS version 23.

Results: A total number of 151 participants were recruited in the study, 71 of them were ultrasound confirmed GSD patients, and the other 80 were controls without GSD over a period of six months. The prevalence of the MetS and diabetes was 30% and 23.9% respectively. Borderline diabetes was 16.9% and overweight and obesity constituted more than half of the sample 59.6%. Using Chi-Square test, a statistically significant association was found between MetS and HDL, TG, LDL level, waist circumference and blood pressure (BP). Absolute predictors and the risk factors for gallstone disease were waist circumference, age, HbA1c and LDL.

Conclusions: The prevalence of MetS and diabetes among gallstone patients was 30% and 23.9% respectively. Absolute predictors and the risk factors for gallstone disease were waist circumference, age, HbA1c and LDL.

背景:胆结石是世界范围内常见的健康问题,给卫生当局带来了巨大的经济负担。肥胖和胰岛素抵抗与胆结石疾病(GSD)的风险相关。本研究的目的是评估苏丹胆结石患者中代谢综合征(MetS)和糖尿病的患病率及相关危险因素。方法:一项前瞻性横断面研究,纳入在伊本新浪胃肠及肝胆疾病专科教学医院就诊的胆结石患者。采用结构化问卷,进行人体测量,血液检测HbA1c、空腹血糖和血脂。数据分析使用SPSS version 23。结果:本研究共招募151名参与者,其中超声确诊GSD患者71人,对照组80人,均为6个月无GSD的对照组。met和糖尿病的患病率分别为30%和23.9%。边缘型糖尿病占16.9%,超重和肥胖占一半以上,占59.6%。经卡方检验,met与HDL、TG、LDL水平、腰围、血压(BP)存在显著相关性。腰围、年龄、HbA1c和LDL是胆结石疾病的绝对预测因子和危险因素。结论:胆结石患者中met和糖尿病的患病率分别为30%和23.9%。腰围、年龄、HbA1c和LDL是胆结石疾病的绝对预测因子和危险因素。
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引用次数: 5
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Translational gastroenterology and hepatology
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