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Hepatic epithelioid hemangioendothelioma: how fast does it grow and which findings could have prevented diagnostic delay?-a case report. 肝上皮样血管内皮瘤:它的生长速度有多快,哪些发现可以防止诊断延误?-一份病例报告。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-48
Michele Costa de Oliveira Ribeiro, Juliana Viana Baião Lemos, Marcelo Padovani de Toledo Moraes, Felipe Aguera Oliver, Matheus Alvarez, Giovanni Faria Silva, Xingshun Qi, Fernando Gomes Romeiro

Background: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare neoplastic disease of varied presentation and unspecific radiological signs in the early stages. The diagnostic delay can lead to metastatic disease, thus increasing the tumor burden and reducing the treatment options. HEHE is usually deemed a slow-growing tumor, but its speed of growth is poorly reported and still unknown.

Case description: In this case report, we documented a HEHE diagnosed in a young woman who had complaints of abdominal pain, weight loss and bloating for a long time. The typical findings observed in histological studies were not promptly recognized in the histological analyzes, even after two laparoscopic-guided liver biopsies, delaying the diagnosis until extrahepatic tumor spreading. Findings observed in computed tomography, magnetic resonance imaging and histological studies are presented. The coalescence of nodules and the rising of giant masses, occupying large parts of the liver in a specific time span, were registered and quantified. As opposed to prior reports, the results show that hepatic HEHE can grow rapidly, reinforcing the need of early diagnosis, thus avoiding the complications presented herein.

Conclusions: The findings observed via radiological and histological imaging that could have avoided the diagnosis delay are depicted and discussed, showing that HEHE can rise faster than previously documented.

背景:肝上皮样血管内皮瘤(HEHE)是一种罕见的肿瘤疾病,早期表现多样,影像学征象不明确。诊断延迟可能导致转移性疾病,从而增加肿瘤负担并减少治疗选择。HEHE通常被认为是一种生长缓慢的肿瘤,但其生长速度报道很少,至今仍不清楚。病例描述:在本病例报告中,我们记录了一位年轻女性诊断为HEHE,她长期抱怨腹痛,体重减轻和腹胀。组织学研究中观察到的典型表现在组织学分析中未能及时发现,即使在两次腹腔镜指导下的肝脏活检后也未能及时发现,导致诊断延迟至肝外肿瘤扩散。本文介绍了计算机断层扫描、磁共振成像和组织学研究的结果。在特定的时间跨度内,结节的合并和巨大肿块的上升占据了肝脏的大部分,被记录和量化。与以往的报道相反,结果表明肝脏HEHE可以快速生长,因此需要早期诊断,从而避免本文所述的并发症。结论:通过放射学和组织学成像观察到的结果可以避免诊断延误,并对其进行了描述和讨论,表明HEHE的上升速度比以前文献记载的要快。
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引用次数: 1
EoE behaves as a unique Th2 disease: a narrative review. EoE表现为一种独特的Th2疾病:叙述性回顾。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-15
Simon S Rabinowitz, Liwei Yu, Patrick Geraghty

Background and objective: To highlight and interpret two significant differences between eosinophilic esophagitis (EoE), a type 2 helper cell (Th2) disease, and three other representative Th2 diseases. EoE, asthma, atopic dermatitis (AD), chronic rhinosinusitis (CRS) and other Th2 diseases employ epithelial alarmins to recognize triggers, share a prototypical inflammatory cascade, and respond to glucocorticoids. However, EoE also has several distinguishing characteristics which may be explained by a distinct pathophysiologic mechanism.

Methods: The following report consist of four related narrative reviews which combine comprehensive PubMed and Google searches. Two reviews were performed to identify and contrast all eligible studies describing serologic markers in EoE compared to asthma, AD, and CRS. Two additional reviews then compare the responses to parenteral biological therapies in EoE and in the same representative Th2 diseases.

Key content and findings: Comprehensive literature searches definitively differentiate the absence of serologic markers in EoE compared to their identification in the other representative Th2 diseases. Similarly, a summary of therapeutic trials demonstrates that while EoE is unable to clinically respond to a variety of parenteral biological therapies, asthma, AD and CRS are very effectively treated with this same approach. A novel pathophysiology for EoE is proposed, and the emerging literature that support its existence is summarized.

Conclusions: The fundamental properties described in this narrative regarding serologic signaling and response to parenteral therapy in EoE could be explained if EoE employs a unique application of the Th2 pathway. One potential mechanism consistent with these observations is that EoE employs exclusively esophageal mucosal constituents to initiate and generate the prototypical Th2 cascade and the fibrostenotic changes that follow.

背景与目的:强调并解释嗜酸性粒细胞性食管炎(EoE),一种2型辅助细胞(Th2)疾病,以及其他三种具有代表性的Th2疾病之间的两个显著差异。EoE、哮喘、特应性皮炎(AD)、慢性鼻窦炎(CRS)和其他Th2疾病利用上皮警报器识别诱因,共享一个典型的炎症级联,并对糖皮质激素做出反应。然而,EoE也有几个不同的特征,这些特征可以用不同的病理生理机制来解释。方法:以下报告由四个相关的叙述性评论组成,这些评论结合了综合PubMed和Google搜索。我们进行了两项综述,以确定和对比所有描述EoE与哮喘、AD和CRS的血清学标志物的符合条件的研究。另外两篇综述比较了EoE和同样具有代表性的Th2疾病对肠外生物治疗的反应。关键内容和发现:综合文献检索明确区分了EoE中血清学标志物的缺失,而不是其他代表性Th2疾病中血清学标志物的缺失。同样,治疗试验的总结表明,虽然EoE不能对各种肠外生物疗法产生临床反应,但哮喘、AD和CRS可以用同样的方法非常有效地治疗。提出了一种新的EoE病理生理学,并总结了支持其存在的新兴文献。结论:如果EoE采用了一种独特的Th2通路应用,那么本文中描述的关于EoE血清学信号传导和肠外治疗反应的基本特性可以得到解释。与这些观察结果一致的一个潜在机制是,EoE仅利用食管粘膜成分来启动和产生典型的Th2级联以及随后的纤维狭窄改变。
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引用次数: 1
Impact of baseline abnormal liver enzymes in the outcome of COVID-19 infection. 基线肝酶异常对COVID-19感染结局的影响
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-41
João Pedro Farias, Liana Codes, Diana Vinhaes, Ana Paula Amorim, Ricardo Cruz D'Oliveira, Alberto Queiroz Farias, Paulo Lisboa Bittencourt

Background: Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation.

Methods: All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization.

Results: A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS.

Conclusions: LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.

背景:目前对COVID-19患者肝功能检查(LFT)异常的意义及其对疾病结局的影响知之甚少。本研究的目的是评估COVID-19患者LFT异常及其对疾病严重程度、死亡率的影响,以及与白细胞炎症标志物的相关性。方法:回顾性分析单一参考中心急诊科收治的所有COVID-19患者。使用电子医疗数据库收集数据,包括以下变量:人口统计学、基线全血细胞计数(CBC)和比率、中性粒细胞-淋巴细胞(NLR)和单核细胞-淋巴细胞比率(MLR)、全身免疫炎症指数(SII)、天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)水平。疾病严重程度由器官衰竭(of)或需要重症监护病房(ICU)支持来定义。死亡率被认为是病人在住院期间的死亡。结果:共纳入新冠肺炎1539例(女性799例,平均年龄57±18岁)。50%的患者出现AST和/或ALT异常,其频率和幅度与白细胞计数和比值显著相关。两种LFT均与住院和ICU住院需求及死亡率显著相关。高AST水平与OFs的存在、数量和类型以及住院时间(LOS)显著相关。除了OFs存在、循环衰竭和LOS外,ALT升高也与上述变量显著相关。结论:LFT异常在COVID-19患者中常见,反映了SARS-CoV-2相关炎症,可能预测不良结局。LFT可能有助于急诊科对住院或门诊再评估的决策。
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引用次数: 0
Effect modification of hepatitis B viral load on the association between metabolic risk factors and hepatic steatosis. 乙型肝炎病毒载量改变对代谢危险因素与肝脂肪变性关系的影响。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-44
Michelle Y Shi, Christopher Wong, Tai-Ping Lee

Background: It is not clear if chronic hepatitis B (CHB) infection potentiates the severity of hepatic steatosis (HS) in patients with metabolic risk factors. We tested for the effect modification of hepatitis B viral load on the association between metabolic risk factors and HS.

Methods: In this retrospective cross-sectional study, we included adult subjects, who had non-cirrhotic nonalcoholic fatty liver disease and CHB infection with positive hepatitis B envelope antibody. We reported descriptive statistics, stratified by detectable and undetectable hepatitis B viral load, by Kruskal-Wallis Rank Sum Test and chi-square. We reported coefficients of two multivariate regression predicting odds of HS > stage 2, testing for interaction between metabolic risk factors and hepatitis B viral load.

Results: When controlled for age, sex, and hepatitis B treatment, the odds of HS > stage 2 increased significantly by 77% for each additional metabolic risk factor [odds ratio (OR) 1.77, 95% confidence interval (CI): 1.20-2.69, P=0.005]. The odds of HS > stage 2 was not associated with detectable hepatitis B viral load (OR 1.00, 95% CI: 0.83-1.19, P=0.986). The association between the odds of HS > stage 2 and metabolic risk factors did not significantly change as hepatitis B viral load increased [ratio of odds ratio (ROR) 1.01, 95% CI: 0.94-1.08, P=0.839].

Conclusions: Our study does not find evidence of effect modification of hepatitis B viral load on the association between metabolic risk factors and HS in non-cirrhotic and hepatitis B envelope antibody positive patients with CHB viral infection. It suggests that the odds of HS in CHB infected patients is affected by metabolic risk factors and not by hepatitis B viremia.

背景:目前尚不清楚慢性乙型肝炎(CHB)感染是否会增强具有代谢危险因素的患者肝脂肪变性(HS)的严重程度。我们测试了乙型肝炎病毒载量对代谢危险因素与HS之间关系的影响。方法:在这项回顾性横断面研究中,我们纳入了患有非肝硬化非酒精性脂肪性肝病和CHB感染且乙型肝炎包膜抗体阳性的成人受试者。我们报告了描述性统计数据,通过Kruskal-Wallis秩和检验和卡方,按可检测和不可检测的乙型肝炎病毒载量分层。我们报告了预测HS > 2期几率的两个多变量回归系数,测试了代谢危险因素与乙型肝炎病毒载量之间的相互作用。结果:在控制年龄、性别和乙肝治疗的情况下,每增加一个代谢危险因素,HS > 2期的几率显著增加77%[比值比(OR) 1.77, 95%可信区间(CI): 1.20-2.69, P=0.005]。HS > 2期的几率与可检测到的乙型肝炎病毒载量无关(OR 1.00, 95% CI: 0.83-1.19, P=0.986)。随着乙型肝炎病毒载量的增加,HS > 2期与代谢危险因素的比值没有显著变化[比值比(ROR) 1.01, 95% CI: 0.94-1.08, P=0.839]。结论:本研究未发现乙型肝炎病毒载量改变对非肝硬化和乙型肝炎包膜抗体阳性CHB病毒感染患者代谢危险因素与HS相关性的影响。提示CHB感染患者发生HS的几率受代谢危险因素影响,而不受乙型肝炎病毒血症影响。
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引用次数: 0
Esophageal carcinoma cuniculatum: a narrative review to understand this rare and commonly misdiagnosed variant of well-differentiated esophageal squamous cell carcinoma. 食管癌:了解这种罕见且常被误诊的高分化食管鳞状细胞癌。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-37
Ikponmwosa Enofe, Harish Venkataraj, Paul Hong, Xianzhong Ding, Abdul Haseeb

Background and objective: Esophageal carcinoma cuniculatum (CC) is a rare variant of a well-differentiated squamous cell carcinoma (SCC). Unlike other forms of esophageal cancers, CC of the esophagus is difficult to diagnose on endoscopic biopsies. This can lead to a delay in the diagnosis and increases morbidity. We reviewed the available literature to shed light on the etiopathogenesis, diagnosis, treatment, and outcomes of this disease. Our aim is to create a better understanding of this rare disease entity and contribute to a timely diagnosis to reduce the associated morbidity and mortality.

Methods: Extensive review of PubMed, Embase, Scopus, Google Scholar was conducted. We identified the published literature on Esophageal CC from inception till date. We report epidemiological trends, clinical presentation, diagnostic and treatment strategies to correctly identify the cases to reduce the likelihood of a missed diagnosis of esophageal CC.

Key content and findings: Associated risk factors for esophageal CC are chronic reflux esophagitis, smoking, alcohol consumption, immunosuppression, and achalasia. Dysphagia is the most common presentation. Primary diagnostic modality is an esophagogastroduodenoscopy (EGD), but diagnosis can be easily missed. To favor an early diagnosis, a histological scoring system has been proposed by Chen et al. where authors describe specific histological features that appear to be common based on the numerous mucosal biopsies examined from patients with CC.

Conclusions: A high clinical suspicion for the disease along with close endoscopic follow-up with repeat biopsies is needed for an early diagnosis. Surgery remains the gold standard for treatment and is associated with a favorable prognosis when the patients are diagnosed early.

背景与目的:网状食管癌是一种罕见的高分化鳞状细胞癌。与其他形式的食管癌不同,食道CC很难通过内窥镜活检诊断。这可能导致诊断延误并增加发病率。我们回顾了现有的文献来阐明该病的发病机制、诊断、治疗和预后。我们的目标是更好地了解这种罕见的疾病,并有助于及时诊断,以减少相关的发病率和死亡率。方法:广泛查阅PubMed、Embase、Scopus、Google Scholar等文献。我们检索了从食道CC开始至今发表的文献。我们报告流行病学趋势、临床表现、诊断和治疗策略,以正确识别病例,以减少漏诊的可能性。主要内容和发现:食管CC的相关危险因素是慢性反流性食管炎、吸烟、饮酒、免疫抑制和贲门失弛缓症。吞咽困难是最常见的表现。主要诊断方式是食管胃十二指肠镜检查(EGD),但诊断很容易被遗漏。为了便于早期诊断,Chen等人提出了一种组织学评分系统,作者根据对cc患者进行的大量粘膜活检,描述了一些常见的组织学特征。结论:早期诊断需要对该疾病进行高度的临床怀疑,并进行密切的内镜随访和重复活检。手术仍然是治疗的金标准,如果患者得到早期诊断,手术与良好的预后有关。
{"title":"Esophageal carcinoma cuniculatum: a narrative review to understand this rare and commonly misdiagnosed variant of well-differentiated esophageal squamous cell carcinoma.","authors":"Ikponmwosa Enofe,&nbsp;Harish Venkataraj,&nbsp;Paul Hong,&nbsp;Xianzhong Ding,&nbsp;Abdul Haseeb","doi":"10.21037/tgh-22-37","DOIUrl":"https://doi.org/10.21037/tgh-22-37","url":null,"abstract":"<p><strong>Background and objective: </strong>Esophageal carcinoma cuniculatum (CC) is a rare variant of a well-differentiated squamous cell carcinoma (SCC). Unlike other forms of esophageal cancers, CC of the esophagus is difficult to diagnose on endoscopic biopsies. This can lead to a delay in the diagnosis and increases morbidity. We reviewed the available literature to shed light on the etiopathogenesis, diagnosis, treatment, and outcomes of this disease. Our aim is to create a better understanding of this rare disease entity and contribute to a timely diagnosis to reduce the associated morbidity and mortality.</p><p><strong>Methods: </strong>Extensive review of PubMed, Embase, Scopus, Google Scholar was conducted. We identified the published literature on Esophageal CC from inception till date. We report epidemiological trends, clinical presentation, diagnostic and treatment strategies to correctly identify the cases to reduce the likelihood of a missed diagnosis of esophageal CC.</p><p><strong>Key content and findings: </strong>Associated risk factors for esophageal CC are chronic reflux esophagitis, smoking, alcohol consumption, immunosuppression, and achalasia. Dysphagia is the most common presentation. Primary diagnostic modality is an esophagogastroduodenoscopy (EGD), but diagnosis can be easily missed. To favor an early diagnosis, a histological scoring system has been proposed by Chen <i>et al.</i> where authors describe specific histological features that appear to be common based on the numerous mucosal biopsies examined from patients with CC.</p><p><strong>Conclusions: </strong>A high clinical suspicion for the disease along with close endoscopic follow-up with repeat biopsies is needed for an early diagnosis. Surgery remains the gold standard for treatment and is associated with a favorable prognosis when the patients are diagnosed early.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"20"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/a6/tgh-08-22-37.PMC10184030.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating stress signals-XBP1 as a novel mediator of intercellular crosstalk in non-alcoholic steatohepatitis. 整合应激信号- xbp1作为非酒精性脂肪性肝炎细胞间串扰的新介质。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-73
Junjie Yu, Utpal B Pajvani
© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2023;8:13 | https://dx.doi.org/10.21037/tgh-22-73 Non-alcoholic steatohepatitis (NASH), the most advanced form of non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease and will soon be the most common reason for liver transplantation as NASH has no approved pharmacotherapy. This unmet need is due in part to an incomplete understanding of mechanistic determinants of various aspects of NASH pathogenesis, and uncertain progression between a prevalent pre-NASH state (lipid accumulation) to the hepatocyte injury, inflammation and fibrosis that defines NASH (1). NASH develops in the context of obesity, but people of similar body weight and adiposity do not have identical risk of NASH development. This discordance highlights a genetic component to the disease, well-established for hepatic lipid accumulation from genome-wide association studies (GWAS), but less so for liver inflammation and fibrosis. One possibility is that heterogeneity in NASH arises from altered transcriptional regulation that may not be easily uncovered by GWAS, as multiple metabolic and developmental signaling pathways are preferentially dysregulated in NASH but not pre-NASH states (2). These and other studies have suggested that two or more “hits” are necessary for NASH development (3,4). In this conceptual framework, lipid accumulation in hepatocytes, termed steatosis, may (but not necessarily) prompt a second hit, for example, oxidative stress, which will trigger hepatocyte death, immune cell activation, and eventually, the deposition of collagen fibrils by activated hepatic stellate cells (HSCs). Other work suggests that NASH development is augmented by extrahepatic mechanisms, including gutand adipose tissue-derived proinflammatory factors, which may be synergetic. In fact, inflammation may theoretically precede or even provoke steatosis. Chronic endoplasmic reticulum (ER) stress is linked to pathogenesis of multiple diseases (5-7), including obesity-induced metabolic diseases such as type 2 diabetes (T2D) and NASH, suggesting a possible pathogenic role. ER stress is often associated with the accumulation of unfolded proteins in the ER, which bind to the binding immunoglobulin protein (BIP), and triggers three, parallel signaling pathways—inositol-requiring enzyme 1α (IRE1α), which activates c-Jun NH2-terminal kinase (JNK), causing apoptosis, and induces splicing of X-box binding protein 1 (XBP1), leading to transcriptional upregulation of genes involved in lipogenesis, folding and ER-associated degradation (ERAD); PKR-like ER kinase (PERK)-induced phosphorylation of eukaryotic translation initiation factor 2α (eIF2α), which leads to increased activating transcription factor (ATF4), and upregulated gene expression associated with amino acid metabolism, anti-oxidative stress and apoptosis; and activating transcription factor 6α (ATF6α), which is furthe
{"title":"Integrating stress signals-XBP1 as a novel mediator of intercellular crosstalk in non-alcoholic steatohepatitis.","authors":"Junjie Yu,&nbsp;Utpal B Pajvani","doi":"10.21037/tgh-22-73","DOIUrl":"https://doi.org/10.21037/tgh-22-73","url":null,"abstract":"© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2023;8:13 | https://dx.doi.org/10.21037/tgh-22-73 Non-alcoholic steatohepatitis (NASH), the most advanced form of non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease and will soon be the most common reason for liver transplantation as NASH has no approved pharmacotherapy. This unmet need is due in part to an incomplete understanding of mechanistic determinants of various aspects of NASH pathogenesis, and uncertain progression between a prevalent pre-NASH state (lipid accumulation) to the hepatocyte injury, inflammation and fibrosis that defines NASH (1). NASH develops in the context of obesity, but people of similar body weight and adiposity do not have identical risk of NASH development. This discordance highlights a genetic component to the disease, well-established for hepatic lipid accumulation from genome-wide association studies (GWAS), but less so for liver inflammation and fibrosis. One possibility is that heterogeneity in NASH arises from altered transcriptional regulation that may not be easily uncovered by GWAS, as multiple metabolic and developmental signaling pathways are preferentially dysregulated in NASH but not pre-NASH states (2). These and other studies have suggested that two or more “hits” are necessary for NASH development (3,4). In this conceptual framework, lipid accumulation in hepatocytes, termed steatosis, may (but not necessarily) prompt a second hit, for example, oxidative stress, which will trigger hepatocyte death, immune cell activation, and eventually, the deposition of collagen fibrils by activated hepatic stellate cells (HSCs). Other work suggests that NASH development is augmented by extrahepatic mechanisms, including gutand adipose tissue-derived proinflammatory factors, which may be synergetic. In fact, inflammation may theoretically precede or even provoke steatosis. Chronic endoplasmic reticulum (ER) stress is linked to pathogenesis of multiple diseases (5-7), including obesity-induced metabolic diseases such as type 2 diabetes (T2D) and NASH, suggesting a possible pathogenic role. ER stress is often associated with the accumulation of unfolded proteins in the ER, which bind to the binding immunoglobulin protein (BIP), and triggers three, parallel signaling pathways—inositol-requiring enzyme 1α (IRE1α), which activates c-Jun NH2-terminal kinase (JNK), causing apoptosis, and induces splicing of X-box binding protein 1 (XBP1), leading to transcriptional upregulation of genes involved in lipogenesis, folding and ER-associated degradation (ERAD); PKR-like ER kinase (PERK)-induced phosphorylation of eukaryotic translation initiation factor 2α (eIF2α), which leads to increased activating transcription factor (ATF4), and upregulated gene expression associated with amino acid metabolism, anti-oxidative stress and apoptosis; and activating transcription factor 6α (ATF6α), which is furthe","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"13"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/3e/tgh-08-22-73.PMC10184033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9841116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Quantitative imaging tests for non-alcoholic fatty liver disease: which, when and why. 非酒精性脂肪性肝病的定量影像学检查:是哪一种、何时发生以及为什么发生。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-85
Andrea Dennis
{"title":"Quantitative imaging tests for non-alcoholic fatty liver disease: which, when and why.","authors":"Andrea Dennis","doi":"10.21037/tgh-22-85","DOIUrl":"https://doi.org/10.21037/tgh-22-85","url":null,"abstract":"","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"1"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/37/tgh-08-22-85.PMC9813660.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Clinical outcomes: endoscopic resection of duodenal ampullary lesions. 临床结果:内镜下十二指肠壶腹部病变切除术。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-87
Stephanie M Woo, Mark J Real, Brett M Will, Eric J Kim, Jiling Chou, Ahmed A Alsaiari, Ahmad Nakshabandi, Walid M Chalhoub, Nadim G Haddad

Background: Ampullary adenomas are lesions at the duodenum's major papilla commonly associated with familial adenomatous polyposis (FAP) but may also occur sporadically. Historically, ampullary adenomas were removed surgically, however endoscopic resection has become the preferred method of resection. Most of the literature on management of ampullary adenomas are small single-center retrospective reviews. The objective of this study is to describe endoscopic papillectomy outcomes to further refine management guidelines.

Methods: This is a retrospective study of patients who underwent endoscopic papillectomy. Demographic data were included. Details regarding lesions and procedures were also collected, including endoscopic impression, size, resection method and adjunctive therapies. Chi-square, Kruskal-Wallis rank-sum, and t-tests were performed.

Results: A total of 90 patients were included. 60% patients (54 of 90) had pathology-proven adenomas. 14.4% of all lesions (13 of 90) and 18.5% of adenomas (10 of 54) were treated with APC. Among APC-treated lesions, 36.4% developed recurrence (4 of 11) vs. 7.1% developed residual lesion (1 of 14) (P=0.019). 15.6% of all lesions (14 of 90) and 18.5% of adenomas (10 of 54) reported complications, and the most common was pancreatitis (11.1% and 5.6%). Median follow-up time was 8 months for all lesions and 14 months (range, 1-177 months) for adenomas, with time to recurrence 30 and 31 months (range, 1-137 months), respectively. Recurrence was observed in 16.7% of all lesions (15 of 90) and 20.4% of adenomas (11 of 54). Endoscopic success was observed in 69.2% of all lesions (54 of 78) and 71.4% of adenomas (35 of 49) after removing patients lost to follow-up.

Conclusions: Endoscopic papillectomy is an effective method for managing duodenal adenomas. Pathology-proven adenoma should undergo surveillance for at least 31 months. Lesions treated with APC may require closer follow-up and for a prolonged period.

背景:壶腹腺瘤是十二指肠主要乳头的病变,通常与家族性腺瘤性息肉病(FAP)有关,但也可能零星发生。从历史上看,壶腹腺瘤是通过手术切除的,但内镜切除已成为首选的切除方法。大多数关于壶腹腺瘤治疗的文献都是小的单中心回顾性综述。本研究的目的是描述内窥镜乳头切除术的结果,以进一步完善治疗指南。方法:这是一项对内镜下乳头切除术患者的回顾性研究。包括人口统计数据。还收集了有关病变和手术的详细信息,包括内镜印象、大小、切除方法和辅助治疗。进行卡方检验、Kruskal-Wallis秩和检验和t检验。结果:共纳入90例患者。60例患者(90例中的54例)有病理证实的腺瘤。14.4%的病变(90例中的13例)和18.5%的腺瘤(54例中的10例)接受了APC治疗。在apc治疗的病变中,36.4%复发(11例中有4例),7.1%出现残留病变(14例中有1例)(P=0.019)。15.6%的病变(14 / 90)和18.5%的腺瘤(10 / 54)报告了并发症,最常见的是胰腺炎(11.1%和5.6%)。所有病变的中位随访时间为8个月,腺瘤的中位随访时间为14个月(范围1-177个月),复发时间分别为30个月和31个月(范围1-137个月)。复发率为16.7%(15 / 90),腺瘤为20.4%(11 / 54)。内镜下切除后,69.2%的病变(78例中的54例)和71.4%的腺瘤(49例中的35例)患者随访失败。结论:内镜下乳头切除术是治疗十二指肠腺瘤的有效方法。病理证实的腺瘤应接受至少31个月的监测。用APC治疗的病变可能需要更密切的随访和更长的时间。
{"title":"Clinical outcomes: endoscopic resection of duodenal ampullary lesions.","authors":"Stephanie M Woo,&nbsp;Mark J Real,&nbsp;Brett M Will,&nbsp;Eric J Kim,&nbsp;Jiling Chou,&nbsp;Ahmed A Alsaiari,&nbsp;Ahmad Nakshabandi,&nbsp;Walid M Chalhoub,&nbsp;Nadim G Haddad","doi":"10.21037/tgh-22-87","DOIUrl":"https://doi.org/10.21037/tgh-22-87","url":null,"abstract":"<p><strong>Background: </strong>Ampullary adenomas are lesions at the duodenum's major papilla commonly associated with familial adenomatous polyposis (FAP) but may also occur sporadically. Historically, ampullary adenomas were removed surgically, however endoscopic resection has become the preferred method of resection. Most of the literature on management of ampullary adenomas are small single-center retrospective reviews. The objective of this study is to describe endoscopic papillectomy outcomes to further refine management guidelines.</p><p><strong>Methods: </strong>This is a retrospective study of patients who underwent endoscopic papillectomy. Demographic data were included. Details regarding lesions and procedures were also collected, including endoscopic impression, size, resection method and adjunctive therapies. Chi-square, Kruskal-Wallis rank-sum, and <i>t-</i>tests were performed.</p><p><strong>Results: </strong>A total of 90 patients were included. 60% patients (54 of 90) had pathology-proven adenomas. 14.4% of all lesions (13 of 90) and 18.5% of adenomas (10 of 54) were treated with APC. Among APC-treated lesions, 36.4% developed recurrence (4 of 11) <i>vs</i>. 7.1% developed residual lesion (1 of 14) (P=0.019). 15.6% of all lesions (14 of 90) and 18.5% of adenomas (10 of 54) reported complications, and the most common was pancreatitis (11.1% and 5.6%). Median follow-up time was 8 months for all lesions and 14 months (range, 1-177 months) for adenomas, with time to recurrence 30 and 31 months (range, 1-137 months), respectively. Recurrence was observed in 16.7% of all lesions (15 of 90) and 20.4% of adenomas (11 of 54). Endoscopic success was observed in 69.2% of all lesions (54 of 78) and 71.4% of adenomas (35 of 49) after removing patients lost to follow-up.</p><p><strong>Conclusions: </strong>Endoscopic papillectomy is an effective method for managing duodenal adenomas. Pathology-proven adenoma should undergo surveillance for at least 31 months. Lesions treated with APC may require closer follow-up and for a prolonged period.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"15"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/44/tgh-08-22-87.PMC10184035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Withdrawal time in colonoscopy, past, present, and future, a narrative review. 结肠镜检查的退出时间,过去,现在和未来,叙述回顾。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-23-8
Hossein Haghbin, Nuruddinkhodja Zakirkhodjaev, Muhammad Aziz

Background and objective: Colonoscopy is a time proven, safe, and gold standard screening method for colorectal cancer (CRC). In order to achieve its objectives, quality markers have been defined for colonoscopy, including withdrawal time (WT). WT is defined as the time spent from reaching the cecum or terminal ileum till the end of procedure in colonoscopies without any additional interventions. This review aims to provide evidence on WT efficacy and future directions.

Methods: We conducted a comprehensive literature search of articles evaluating WT. Search was limited to English language articles from all peer-reviewed journals.

Key content and findings: The seminal study by Barclay et al., led to setting of a minimum WT of 6 minutes as the recommended amount for colonoscopy, per 2006 American College of Gastroenterology (ACG) taskforce. Since then, many observational studies have confirmed the efficacy of 6 minutes. Recently, multiple large multicenter trials suggest WT of 9 minutes as the alternative for better outcomes. Recently, novel Artificial Intelligence (AI) models have shown promise in improving WT and other outcomes and proved an exciting tool in the armamentarium of gastroenterologists. Some of these tools encourage the endoscopists to check the blind spots and clean the residual stool. This has shown to improve both WT and ADR. We recommend an improvement of these models to consider risk factors like adenoma detection in current and prior scopes to guide endoscopists spend time in each segment.

Conclusions: In conclusion, new evidence demonstrates that WT of 9 minutes is better than 6 minutes. Future trends point toward an individualized AI-based approach combining real time and baseline data and guiding the endoscopist on how much time to spend in every segment of the colon in every colonoscopy procedure.

背景和目的:结肠镜检查是一种经过时间验证的、安全的、金标准的结直肠癌筛查方法。为了实现其目标,定义了结肠镜检查的质量标记,包括停药时间(WT)。WT定义为在没有任何额外干预的情况下,从到达盲肠或回肠末端到结肠镜检查过程结束所花费的时间。这篇综述旨在为野生植物的功效和未来发展方向提供证据。方法:我们对评价WT的文章进行了全面的文献检索。检索仅限于来自所有同行评议期刊的英文文章。关键内容和发现:Barclay等人的开创性研究,根据2006年美国胃肠病学学会(ACG)工作组的建议,将最小WT设定为6分钟作为结肠镜检查的推荐时间。此后,许多观察性研究证实了6分钟的疗效。最近,多个大型多中心试验表明,WT为9分钟可获得更好的结果。最近,新的人工智能(AI)模型在改善WT和其他结果方面显示出希望,并被证明是胃肠病学家的一个令人兴奋的工具。其中一些工具鼓励内窥镜医师检查盲点并清理残留的粪便。这已被证明可以改善WT和ADR。我们建议对这些模型进行改进,以考虑当前和先前内镜中腺瘤检测等风险因素,以指导内镜医师在每个节段上花费时间。结论:总之,新的证据表明,WT为9分钟优于6分钟。未来的趋势是一种个性化的基于人工智能的方法,结合实时和基线数据,并指导内镜医生在每次结肠镜检查过程中在结肠的每个部分花费多少时间。
{"title":"Withdrawal time in colonoscopy, past, present, and future, a narrative review.","authors":"Hossein Haghbin,&nbsp;Nuruddinkhodja Zakirkhodjaev,&nbsp;Muhammad Aziz","doi":"10.21037/tgh-23-8","DOIUrl":"https://doi.org/10.21037/tgh-23-8","url":null,"abstract":"<p><strong>Background and objective: </strong>Colonoscopy is a time proven, safe, and gold standard screening method for colorectal cancer (CRC). In order to achieve its objectives, quality markers have been defined for colonoscopy, including withdrawal time (WT). WT is defined as the time spent from reaching the cecum or terminal ileum till the end of procedure in colonoscopies without any additional interventions. This review aims to provide evidence on WT efficacy and future directions.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search of articles evaluating WT. Search was limited to English language articles from all peer-reviewed journals.</p><p><strong>Key content and findings: </strong>The seminal study by Barclay <i>et al.</i>, led to setting of a minimum WT of 6 minutes as the recommended amount for colonoscopy, per 2006 American College of Gastroenterology (ACG) taskforce. Since then, many observational studies have confirmed the efficacy of 6 minutes. Recently, multiple large multicenter trials suggest WT of 9 minutes as the alternative for better outcomes. Recently, novel Artificial Intelligence (AI) models have shown promise in improving WT and other outcomes and proved an exciting tool in the armamentarium of gastroenterologists. Some of these tools encourage the endoscopists to check the blind spots and clean the residual stool. This has shown to improve both WT and ADR. We recommend an improvement of these models to consider risk factors like adenoma detection in current and prior scopes to guide endoscopists spend time in each segment.</p><p><strong>Conclusions: </strong>In conclusion, new evidence demonstrates that WT of 9 minutes is better than 6 minutes. Future trends point toward an individualized AI-based approach combining real time and baseline data and guiding the endoscopist on how much time to spend in every segment of the colon in every colonoscopy procedure.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"19"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c8/4f/tgh-08-23-8.PMC10184034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9541341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Association between body mass index and liver stiffness measurement using transient elastography in patients with non-alcoholic fatty liver disease in a hepatology clinic: a cross sectional study. 肝内科门诊非酒精性脂肪肝患者瞬态弹性成像测量体重指数与肝脏硬度之间的关系:一项横断面研究
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-1
Harish Gopalakrishna, Oluwaseun E Fashanu, Gayatri B Nair, Natarajan Ravendhran

Background: Transient elastography (TE) is an FDA approved, non-invasive tool to estimate liver stiffness measurement (LSM) in patients with non-alcoholic fatty liver disease (NAFLD). Our aim was to analyze if body mass index (BMI) would predict the severity of liver stiffness using TE scores.

Methods: We performed a cross-sectional study of patients with NAFLD who presented to the hepatology clinic between January 2019 through January 2021. Fibrosis severity was divided into the following categories: F0 to F1 (2-7 kPa), F2 (>7 to 10 kPa), F3 (>10 to 14 kPa) and F4 (>14 kPa). We used ordered logistic regression models to determine the odds ratio (OR) and 95% confidence interval (CI) of having a higher LSM severity compared to lower associated with BMI. Models were adjusted for patient demographics and comorbidities.

Results: Among 284 patients, 56.7% were females, and the median (interquartile range, IQR) age was 62 [51-68] years and BMI 31.9 (28.1, 36.2) kg/m2; 47% of patients were in the F0 to F1 stage, 24% F2, 16% F3, and 13% F4. The correlation between BMI and TE score was 0.31 (P<0.001). With 1 kg/m2 increase in BMI there was 1.10 times higher odds of having a higher LSM severity (adjusted OR, 1.10; 95% CI: 1.05-1.14). Compared to patients with BMI <25 kg/m2, the adjusted OR (95% CI) of having a higher fibrosis stage was 1.82 (0.61-5.44), 5.93 (2.05-17.13), and 8.56 (2.51-29.17) for patients with BMI of 25 to <30, 30 to <40, and ≥40 respectively.

Conclusions: BMI correlates with the severity of LSM using TE scores in NAFLD patients even after adjusting for potential confounding variables. This suggests TE as an appreciable study for liver stiffness even in obese individuals.

背景:瞬时弹性成像(TE)是FDA批准的非酒精性脂肪性肝病(NAFLD)患者肝脏硬度测量(LSM)的非侵入性工具。我们的目的是分析身体质量指数(BMI)是否可以用TE评分预测肝脏僵硬的严重程度。方法:我们对2019年1月至2021年1月期间在肝病学诊所就诊的NAFLD患者进行了横断面研究。纤维化严重程度分为F0 ~ F1 (2 ~ 7 kPa)、F2 (>7 ~ 10 kPa)、F3 (>10 ~ 14 kPa)、F4 (>14 kPa)。我们使用有序逻辑回归模型来确定与BMI相关的低LSM严重程度相比,LSM严重程度较高的比值比(OR)和95%置信区间(CI)。模型根据患者人口统计学和合并症进行了调整。结果:284例患者中,女性占56.7%,年龄中位数(四分位间距,IQR)为62[51-68]岁,BMI为31.9 (28.1,36.2)kg/m2;F0 ~ F1期占47%,F2期占24%,F3期占16%,F4期占13%。BMI与TE评分的相关性为0.31 (BMI增加P2, LSM严重程度高的几率为1.10倍(调整OR为1.10;95% ci: 1.05-1.14)。与BMI为2的患者相比,BMI为25的患者纤维化分期较高的调整OR (95% CI)分别为1.82(0.61-5.44)、5.93(2.05-17.13)和8.56(2.51-29.17)。结论:即使在校正了潜在的混杂变量后,使用NAFLD患者TE评分,BMI与LSM严重程度相关。这表明TE是一项有价值的研究,即使在肥胖个体中也是如此。
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引用次数: 1
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Translational gastroenterology and hepatology
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