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Combination therapy is not associated with improved rates of clinical or endoscopic remission in patients with inflammatory bowel disease treated with ustekinumab or vedolizumab: a retrospective study. 联合治疗与使用ustekinumab或vedolizumab治疗的炎症性肠病患者的临床或内镜缓解率提高无关:一项回顾性研究。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0808
Angus W Jeffrey, Sherman Picardo, Shankar Menon, Kenji So, Kannan Venugopal

Background: Management of inflammatory bowel disease (IBD) involves biological agents, often in combination with thiopurines or methotrexate. The aim of our study was to compare clinical and endoscopic outcomes in IBD patients treated with vedolizumab or ustekinumab, as monotherapy or in combination with thiopurines or methotrexate.

Methods: We conducted a retrospective cohort study of all patients aged ≥18 years with a diagnosis of ulcerative colitis or Crohn's disease, commenced on vedolizumab or ustekinumab between October 2015 and March 2022. Primary outcome was clinical remission or response calculated by partial Mayo score (remission: <3; response: improvement >1) for ulcerative colitis or Harvey-Bradshaw index (<5, >2 respectively) for Crohn's disease over 1 year. Secondary endpoints were treatment failure, relapse, endoscopic remission at 1 year. Statistical analysis was done using 2-sample Student's t and chi-square tests.

Results: A total of 159 IBD patients were included in the study, 85 (53%) on vedolizumab and 74 (47%) on ustekinumab. For those on vedolizumab, 61 (72%) patients had ulcerative colitis, and 24 (28%) has Crohn's disease. All patients on ustekinumab had Crohn's disease. Mean disease duration in was 9.4 and 13.5 years respectively. There was no difference in clinical response or remission for vedolizumab or ustekinumab monotherapy compared to combination therapy at 1 year. There was also no difference in treatment failure, relapse or endoscopic remission.

Conclusion: Combining vedolizumab or ustekinumab with an immunomodulator is not superior to monotherapy in terms of clinical response or endoscopic remission up to 1 year in IBD.

背景:炎症性肠病(IBD)的治疗涉及生物制剂,通常与硫嘌呤或甲氨蝶呤联合使用。我们研究的目的是比较韦多珠单抗或ustekinumab单药治疗或与硫嘌呤或甲氨蝶呤联合治疗IBD患者的临床和内镜结果。方法:我们对所有年龄≥18岁、诊断为溃疡性结肠炎或克罗恩病的患者进行了一项回顾性队列研究,该研究于2015年10月至2022年3月期间开始使用维多利珠单抗或ustekinumab。主要结果是通过溃疡性结肠炎的部分Mayo评分(缓解:1)或克罗恩病的Harvey-Bradshaw指数(分别为2)计算1年以上的临床缓解或反应。次要终点为治疗失败、复发、1年时内镜缓解。使用两个样本的Student t和卡方检验进行统计分析。结果:共有159名IBD患者被纳入该研究,其中85名(53%)接受韦多利珠单抗治疗,74名(47%)接受ustekinumab治疗。在服用韦多利珠单抗的患者中,61名(72%)患者患有溃疡性结肠炎,24名(28%)患者患有克罗恩病。所有使用ustekinumab的患者都患有克罗恩病。年平均病程分别为9.4年和13.5年。与1年时的联合治疗相比,维多利珠单抗或ustekinumab单药治疗的临床反应或缓解没有差异。在治疗失败、复发或内镜缓解方面也没有差异。结论:就IBD的临床反应或内镜下长达1年的缓解而言,韦多利珠单抗或ustekinumab与免疫调节剂联合治疗并不优于单一疗法。
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引用次数: 1
Association of serum IgG4 and disease outcomes in patients with inflammatory bowel disease. 炎症性肠病患者血清IgG4与疾病转归的相关性。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0807
R Christopher Chase, Hani Tamim, Walaa G El Sheikh, Kristin Clift, David Bruining, Christina Ha, Francis A Farraye, Jana G Hashash

Background: The etiology of inflammatory bowel disease (IBD) is multifactorial and thought to be influenced by inappropriate activation of the gut mucosal immune system. As the only immunoglobulin G (IgG) subclass unable to activate the classical complement cascade, the role of IgG4 in IBD pathophysiology as an immunomodulator is controversial. This study aimed to determine the association of low, normal and high IgG4 levels with the outcomes of IBD patients.

Methods: This was a retrospective study of a multisite tertiary care center database evaluating patients with IBD who had an IgG4 level drawn between 2014 and 2021. Subjects were divided into low, normal, and high IgG4 level groups for evaluation of demographic and clinical indicators of IBD activity and severity.

Results: Of 284 patients with IBD, 22 had low (7.7%), 16 high (5.6%), and 246 (86.6%) normal IgG4 levels. There was no difference in IBD subtype, mean age, age at IBD diagnosis, or smoking between the 3 groups. There was no difference in number of hospitalizations (P=0.20), C-reactive protein levels, need for intestinal resection (P=0.85), or presence of primary sclerosing cholangitis (P=0.15), pancreatitis (P=0.70), or perianal disease (P=0.68) between the groups. Significantly more patients in the low IgG4 group had previous exposure to vedolizumab compared to the other groups and more patients in the low IgG4 group received vedolizumab (P=0.04), azathioprine (P=0.04) and prednisone (P=0.03) during the 5-year follow up.

Conclusion: In this study, a low serum IgG4 level was associated with higher rates of vedolizumab, azathioprine, and steroid use.

背景:炎症性肠病(IBD)的病因是多因素的,被认为是受肠道粘膜免疫系统不适当激活的影响。作为唯一不能激活经典补体级联的免疫球蛋白G(IgG)亚类,IgG4作为免疫调节剂在IBD病理生理学中的作用存在争议。本研究旨在确定低、正常和高IgG4水平与IBD患者预后的关系。方法:这是一项对多站点三级护理中心数据库的回顾性研究,该数据库评估了2014年至2021年间IgG4水平的IBD患者。受试者被分为低、正常和高IgG4水平组,以评估IBD活动和严重程度的人口统计学和临床指标。结果:284例IBD患者中,22例(7.7%)IgG4水平较低,16例(5.6%)IgG4246例(86.6%)正常。三组之间在IBD亚型、平均年龄、诊断IBD时的年龄或吸烟方面没有差异。两组之间的住院人数(P=0.20)、C反应蛋白水平、需要肠切除术(P=0.85)或原发性硬化性胆管炎(P=0.15)、胰腺炎(P=0.70)或肛周疾病(P=0.68)没有差异。与其他组相比,低IgG4组中有明显更多的患者曾接触过韦多利珠单抗,在5年随访期间,低IgG4组中有更多的患者接受了韦多利单抗(P=0.04)、硫唑嘌呤(P=0.04,P=0.03)和泼尼松(P=0.03)治疗。结论:在本研究中,低血清IgG4水平与维多利珠单抗、硫唑嘌呤和类固醇使用率较高有关。
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引用次数: 0
Outcome of inflammatory bowel disease patients with prior malignancy. 既往有恶性肿瘤的炎症性肠病患者的预后。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-25 DOI: 10.20524/aog.2023.0803
Uria Shani, Eyal Klang, Simon Lassman, Bella Ungar, Shomron Ben-Horin, Uri Kopylov

Background: Inflammatory bowel disease (IBD) treatment options, such as anti-tumor necrosis factor (TNF) agents and thiopurines, are associated with an increased risk of certain malignancies. However, the management of IBD patients with prior malignancy is not well defined and the literature is scarce. The main aim of this study was to describe the outcome of IBD patients with prior malignancy, or malignancy before first exposure to IBD-related biologic or immunosuppressive treatment.

Methods: The study cohort included adult IBD patients followed in a tertiary academic center, with at least one malignancy diagnosed before IBD diagnosis or before initiation of IBD-related treatment. The main outcome of interest was a relapse of the previous malignancy or development of a second malignancy.

Results: Our database included 1112 patients with both IBD and malignancy. Of these, 86 (9%) who had their malignancy diagnosed before IBD-related treatment initiation were identified, while 10/86 patients (9%) were further diagnosed with a second primary malignancy. Twenty patients, (20/86, 23%) had recurrence of a previous malignancy, most commonly non-melanoma skin cancer (NMSC), found in 9/20 patients (45%). Treatment with infliximab was found to be significantly associated with recurrence of NMSC (P=0.003).

Conclusions: Anti-TNF treatment may be associated with an increased risk of NMSC recurrence. This underscores the importance of rigorous dermatological follow up in IBD patients with previous NMSC treated with anti-TNFs.

背景:炎症性肠病(IBD)的治疗选择,如抗肿瘤坏死因子(TNF)药物和硫嘌呤,与某些恶性肿瘤的风险增加有关。然而,既往有恶性肿瘤的IBD患者的治疗尚不明确,文献也很少。本研究的主要目的是描述既往有恶性肿瘤或首次接受IBD相关生物或免疫抑制治疗前恶性肿瘤的IBD患者的结果。方法:研究队列包括在三级学术中心随访的成年IBD患者,他们在诊断IBD之前或开始IBD相关治疗之前至少诊断出一种恶性肿瘤。感兴趣的主要结果是先前恶性肿瘤复发或发展为第二种恶性肿瘤。结果:我们的数据库包括1112名IBD和恶性肿瘤患者。其中,86名(9%)患者在IBD相关治疗开始前被诊断为恶性肿瘤,而10/86名患者(9%)被进一步诊断为第二原发性恶性肿瘤。20名患者(20/86,23%)有既往恶性肿瘤复发,最常见的是非黏液瘤皮肤癌症(NMSC),在9/20名患者中发现(45%)。英夫利昔单抗治疗与NMSC的复发显著相关(P=0.003)。结论:抗TNF治疗可能与NMSC复发风险增加有关。这强调了对既往接受抗TNFs治疗的NMSC IBD患者进行严格的皮肤科随访的重要性。
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引用次数: 0
The role of endoscopy in malignant hilar obstruction. 内镜在恶性肝门梗阻中的作用。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0810
Jahnvi Dhar, Pankaj Gupta, Jayanta Samanta

Malignant hilar biliary obstruction (MHO) is a medical challenge as regards both forming a correct diagnosis and its adequate management, in terms of treatment alternatives and palliative options. Surgical resection is the only curative treatment for the underlying disease, but the majority of patients are not suitable candidates because of an unresectable tumor or poor performance status. Biliary drainage (BD) can be achieved through the percutaneous transhepatic route or endoscopically, and the choice depends on a host of factors, including biliary anatomy and comorbidity of the patient. Though there is no consensus, the endoscopic approach is usually preferred over the former. Endoscopy can aid in both diagnosis (collection of histological as well as cytological samples, direct visualization of suspected malignant pathology, or use of endoscopic ultrasound [EUS] for evaluation and locoregional staging), and in achieving internal BD. Advances in the development of various stents, accessories and, more recently, the use of EUS have in fact further expanded its application in MHO management. The choice of stents to be used (type, make, and number), palliation methods, deployment techniques and the use of local ablative strategy are still evolving and require more data. The complexity of management of MHO mandates that each patient should receive a "personalized approach", all the way from establishing a diagnosis until final treatment, with the help of a multidisciplinary team effort. Herein, we provide a comprehensive literature review of the current role of endoscopy for MHO, according to its applications in various clinical settings.

恶性肝门胆管梗阻(MHO)是一个医学挑战,无论是在治疗方案和姑息治疗方案方面,都需要形成正确的诊断和充分的管理。手术切除是治疗潜在疾病的唯一治疗方法,但由于肿瘤不可切除或表现不佳,大多数患者都不适合。胆道引流(BD)可以通过经皮肝穿刺或内镜下进行,选择取决于许多因素,包括胆道解剖和患者的合并症。尽管没有达成共识,但内窥镜方法通常比前者更可取。内窥镜检查既有助于诊断(收集组织学和细胞学样本,直接显示疑似恶性病理,或使用内窥镜超声[EUS]进行评估和局部分期),也有助于实现内部BD,事实上,EUS的使用进一步扩大了其在MHO管理中的应用。要使用的支架的选择(类型、品牌和数量)、缓解方法、部署技术和局部消融策略的使用仍在发展中,需要更多的数据。MHO管理的复杂性要求每个患者都应该在多学科团队的帮助下接受“个性化方法”,从确定诊断到最终治疗。在此,我们根据内镜在各种临床环境中的应用,对目前内镜在MHO中的作用进行了全面的文献综述。
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引用次数: 0
Aspartate aminotransferase-to-platelet ratio index can predict the outcome in patients with stable decompensated cirrhosis. 天冬氨酸转氨酶与血小板比值指数可以预测稳定失代偿期肝硬化患者的预后。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-25 DOI: 10.20524/aog.2023.0800
Theodora Oikonomou, Lampros Chrysavgis, Stefania Kiapidou, Magdalini Adamantou, Despoina Parastatidou, George V Papatheodoridis, Ioannis Goulis, Evangelos Cholongitas

Background: Platelet (PLT)-based biomarkers have been studied for the evaluation of liver fibrosis and cirrhosis. There are no data regarding their prognostic significance in decompensated cirrhosis.

Methods: We studied 525 stable decompensated patients from the 2 Greek transplant centers. We measured PLT values, mean PLT volume (MPV), red cell distribution width, γ-globulins, and calculated PLT-based scores: aspartate aminotransferase-to-PLT ratio index (APRI), γ-globulin-to-PLT model, and γ-glutamyl transpeptidase-to-PLT ratio (GPR).

Results: We followed our cohort for 12 (range: 1-84) months. Baseline mean model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were 15±6 and 8±2, respectively. On univariate analysis, MPV/PLT (hazard ratio [HR] 3.75, 95% confidence interval [CI] 1-14.5; P=0.05), APRI (HR 1.03, 95%CI 1.006-1.06; P=0.016), GPR (HR 1.096, 95%CI 1.016-1.182; P=0.017) were significantly associated with our patients' outcome (survival vs. death or liver transplantation). In a multivariate model without MELD and CTP scores, APRI was the only significant factor associated with the outcome (HR 1.054, 95%CI 1.009-1.101; P=0.018). APRI had good discriminative ability for the outcome (area under the curve 0.723 vs. 0.675 and 0.656 for MELD and CTP scores, respectively). The optimal cutoff point was 1.3 (sensitivity 71%, specificity 65%). There were 200 patients (38%) with APRI scores <1.3 who had better survival than patients with APRI >1.3 (log rank 22.4, P<0.001).

Conclusions: This study found a prognostic role for APRI in stable decompensated cirrhosis, regardless of the underlying etiology of chronic liver disease. This suggests new perspectives for PLT-based noninvasive scores to discriminate patients' outcomes.

背景:基于血小板(PLT)的生物标志物已被研究用于评估肝纤维化和肝硬化。目前尚无关于其在失代偿期肝硬化中的预后意义的数据。方法:我们研究了来自希腊两个移植中心的525名稳定的失代偿期患者。我们测量了PLT值、平均PLT体积(MPV)、红细胞分布宽度、γ-球蛋白,并计算了基于PLT的评分:天冬氨酸转氨酶与PLT比值指数(APRI)、γ球蛋白与PLT模型以及γ-谷氨酰转肽酶与PLT之比(GPR)。结果:我们对我们的队列进行了12个月的随访(范围:1-84)。终末期肝病(MELD)和Child-Turcotte-Pugh(CTP)的基线平均模型评分分别为15±6和8±2。在单变量分析中,MPV/PLT(危险比[HR]3.75,95%置信区间[CI]1-1.4.5;P=0.05)、APRI(HR 1.03,95%CI 1.006-1.06;P=0.016)、GPR(HR 1.096,95%CI 1.016-1.182;P=0.017)与我们患者的结果(生存与死亡或肝移植)显著相关。在没有MELD和CTP评分的多变量模型中,APRI是与结果相关的唯一显著因素(HR 1.054,95%CI 1.009-1.101;P=0.018)。最佳分界点为1.3(敏感性71%,特异性65%)。有200名患者(38%)的APRI评分为1.3(log rank 22.4,P结论:本研究发现,无论慢性肝病的潜在病因如何,APRI在稳定失代偿期肝硬化中的预后作用。这为基于PLT的无创评分区分患者的预后提供了新的视角。
{"title":"Aspartate aminotransferase-to-platelet ratio index can predict the outcome in patients with stable decompensated cirrhosis.","authors":"Theodora Oikonomou,&nbsp;Lampros Chrysavgis,&nbsp;Stefania Kiapidou,&nbsp;Magdalini Adamantou,&nbsp;Despoina Parastatidou,&nbsp;George V Papatheodoridis,&nbsp;Ioannis Goulis,&nbsp;Evangelos Cholongitas","doi":"10.20524/aog.2023.0800","DOIUrl":"10.20524/aog.2023.0800","url":null,"abstract":"<p><strong>Background: </strong>Platelet (PLT)-based biomarkers have been studied for the evaluation of liver fibrosis and cirrhosis. There are no data regarding their prognostic significance in decompensated cirrhosis.</p><p><strong>Methods: </strong>We studied 525 stable decompensated patients from the 2 Greek transplant centers. We measured PLT values, mean PLT volume (MPV), red cell distribution width, γ-globulins, and calculated PLT-based scores: aspartate aminotransferase-to-PLT ratio index (APRI), γ-globulin-to-PLT model, and γ-glutamyl transpeptidase-to-PLT ratio (GPR).</p><p><strong>Results: </strong>We followed our cohort for 12 (range: 1-84) months. Baseline mean model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were 15±6 and 8±2, respectively. On univariate analysis, MPV/PLT (hazard ratio [HR] 3.75, 95% confidence interval [CI] 1-14.5; P=0.05), APRI (HR 1.03, 95%CI 1.006-1.06; P=0.016), GPR (HR 1.096, 95%CI 1.016-1.182; P=0.017) were significantly associated with our patients' outcome (survival vs. death or liver transplantation). In a multivariate model without MELD and CTP scores, APRI was the only significant factor associated with the outcome (HR 1.054, 95%CI 1.009-1.101; P=0.018). APRI had good discriminative ability for the outcome (area under the curve 0.723 vs. 0.675 and 0.656 for MELD and CTP scores, respectively). The optimal cutoff point was 1.3 (sensitivity 71%, specificity 65%). There were 200 patients (38%) with APRI scores <1.3 who had better survival than patients with APRI >1.3 (log rank 22.4, P<0.001).</p><p><strong>Conclusions: </strong>This study found a prognostic role for APRI in stable decompensated cirrhosis, regardless of the underlying etiology of chronic liver disease. This suggests new perspectives for PLT-based noninvasive scores to discriminate patients' outcomes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/17/AnnGastroenterol-36-442.PMC10304533.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10104063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gut microbial metabolites and its impact on human health. 肠道微生物代谢产物及其对人类健康的影响。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0809
Shahrose Rahman, Amber L O'Connor, Sarah L Becker, Ranish K Patel, Robert G Martindale, Vassiliki Liana Tsikitis

One of the primary methods by which the gut microbiome interacts with its host is through the interactions that occur through the production of the metabolites produced, either directly, or indirectly, through microbial metabolism. Decades of research has demonstrated that these metabolic products play a vital role in human health, either for its benefit or detriment. This review article highlights the main metabolites produced by the interactions between diet and the gut microbiome, bile acids and the gut microbiome, and products produced by the gut microbiome alone. Additionally, this article reviews the literature on the effects that these metabolites play on human health.

肠道微生物组与其宿主相互作用的主要方法之一是通过产生直接或间接通过微生物代谢产生的代谢产物来进行相互作用。几十年的研究表明,这些代谢产物对人类健康起着至关重要的作用,无论是有益还是有害。这篇综述文章强调了饮食和肠道微生物组、胆汁酸和肠道微生物群之间相互作用产生的主要代谢产物,以及单独由肠道微生物组产生的产物。此外,本文还回顾了有关这些代谢产物对人类健康影响的文献。
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引用次数: 1
Combination therapies in nonalcoholic fatty liver disease using antidiabetic and disease-specific drugs. 使用抗糖尿病和疾病特异性药物联合治疗非酒精性脂肪肝。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0806
Evgenia Koureta, Evangelos Cholongitas

Nonalcoholic fatty liver disease (NAFLD) is one of the most common diseases in the world, affecting approximately one fourth of the worldwide population. Glucose metabolism dysregulation and type 2 diabetes mellitus (T2DM), as part of the metabolic syndrome, are important factors implicated in the pathogenesis and progression of NAFLD to nonalcoholic steatohepatitis (NASH) and cirrhosis. Although a great deal of research has already been conducted regarding possible therapeutic medications for NAFLD/NASH, no drugs have been approved until now. Combination therapies in NAFLD seem to represent an attractive approach concerning treatment of the disease, as multiple pathophysiologic pathways contribute to the development and advance of NAFLD. In this review we discuss the impact of combining antidiabetic drugs, focusing on pioglitazone, sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. We also include data from the literature concerning combinations of newer "NAFLD-specific" drugs.

非酒精性脂肪肝(NAFLD)是世界上最常见的疾病之一,影响着全球约四分之一的人口。作为代谢综合征的一部分,糖代谢失调和2型糖尿病(T2DM)是NAFLD向非酒精性脂肪性肝炎(NASH)和肝硬化的发病机制和进展的重要因素。尽管已经对NAFLD/NASH的可能治疗药物进行了大量研究,但到目前为止还没有药物获得批准。NAFLD的联合治疗似乎是一种有吸引力的疾病治疗方法,因为多种病理生理途径有助于NAFLD的发展和进步。在这篇综述中,我们讨论了联合抗糖尿病药物的影响,重点是吡格列酮、钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂。我们还包括文献中关于新型“NAFLD特异性”药物组合的数据。
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引用次数: 1
Challenges and future solutions for detection of Clostridioides difficile in adults. 成人艰难梭菌检测的挑战和未来解决方案。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-25 DOI: 10.20524/aog.2023.0802
Rima Biswas, Hemanshi Dudani, Praveen Lakhera, Arun Kumar Pal, Phibalari Kurbah, Dinesh Bhatia, Archana Dhok, Rajpal Singh Kashyap

There are no established standards for the diagnosis of Clostridioides difficile infection (CDI), even though the importance of this infection in humans is well known. The effectiveness of the commercially available techniques, which are all standardized for use with human feces, is also limited in terms of the accuracy of the tests. Furthermore, the current approach lacks a point-of-care diagnosis with an acceptable range of sensitivity and specificity. This article reviews the challenges and possible future solutions for the detection of CDI in adults. Existing diagnostic methods, such as enzyme-linked immunoassays and microbial culturing for the detection of toxins A and B, appear to work poorly in samples but exhibit great sensitivity for glutamate dehydrogenase. Real-time polymerase chain reaction and nucleic acid amplification tests have been investigated in a few studies on human samples, but so far have shown poor turnaround times. Thus, developing a multiplex point-of-care test assay with high sensitivity and specificity is required as a bedside approach for diagnosing this emerging infection.

尽管这种感染在人类中的重要性是众所周知的,但目前还没有确定的诊断艰难梭菌感染(CDI)的标准。商业上可用的技术都是标准化的,用于人类粪便,其有效性也受到测试准确性的限制。此外,目前的方法缺乏具有可接受的灵敏度和特异性范围的护理点诊断。本文综述了成人CDI检测的挑战和未来可能的解决方案。现有的诊断方法,如用于检测毒素A和B的酶联免疫测定和微生物培养,在样品中似乎效果不佳,但对谷氨酸脱氢酶表现出很大的敏感性。在一些对人类样本的研究中,已经对实时聚合酶链式反应和核酸扩增测试进行了研究,但到目前为止,它们的周转时间很差。因此,需要开发一种具有高灵敏度和特异性的多重护理点检测方法,作为诊断这种新发感染的床边方法。
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引用次数: 0
Bridging locoregional treatment prior to liver transplantation for cirrhotic patients with hepatocellular carcinoma within the Milan criteria: a systematic review and meta-analysis. 米兰标准范围内肝硬化肝细胞癌患者肝移植前桥接局部治疗:一项系统综述和荟萃分析。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-30 DOI: 10.20524/aog.2023.0812
Ioannis D Kostakis, Nikolaos Dimitrokallis, Satheesh Iype

Background: We performed a meta-analysis to assess the benefit of bridging locoregional treatment (LRT) before liver transplantation for cirrhotic patients with hepatocellular carcinoma (HCC) already within the Milan criteria at diagnosis.

Methods: We included original studies with HCC cases within the Milan criteria at diagnosis, comparing patients with and without bridging LRT before liver transplantation.

Results: Twenty-six retrospective original studies were included. Out of the 9068 patients within the Milan criteria, 6435 (71%) received bridging LRT and 2633 (29%) did not. The most frequent LRTs were transarterial chemoembolization, radiofrequency ablation, and microwave ablation. Most of the patient and tumor characteristics were similar between the 2 groups. Maximum tumor diameter on scans was slightly larger in the LRT arm (mean difference: 0.36 cm, 95% confidence interval [CI] 0.11-0.61; I2=79%). The LRT group also had multifocal disease slightly more frequently (risk ratio [RR] 1.21, 95%CI 1.04-1.41; I2=0%) and disease extent outside the Milan criteria (RR 1.3, 95%CI 1.03-1.66; I2=0%) on pathological examination of explanted livers. There was no difference between the 2 arms in the waiting time for transplant, dropout rates, disease-free survival at 1, 3, 5 years after transplant, or overall survival at 3 and 5 years after transplant. However, cases with LRT had better overall survival at 1 year after transplant (hazard ratio 0.54, 95%CI 0.35-0.86; I2=0%).

Conclusions: The precise benefit of bridging LRT for cirrhotic patients with HCC within the Milan criteria at diagnosis is unclear. There may be an advantage regarding short-term overall survival after liver transplantation.

背景:我们进行了一项荟萃分析,以评估肝移植前桥接局部治疗(LRT)对已符合米兰诊断标准的肝硬化肝细胞癌(HCC)患者的益处。方法:我们纳入了符合米兰诊断标准的HCC病例的原始研究,比较了肝移植前有无桥接LRT的患者。结果:纳入26项回顾性原始研究。在符合米兰标准的9068名患者中,6435名(71%)接受了桥接LRT,2633名(29%)未接受。最常见的LRT是经动脉化疗栓塞、射频消融和微波消融。两组之间的大多数患者和肿瘤特征相似。LRT组扫描的最大肿瘤直径略大(平均差异:0.36 cm,95%置信区间[CI]0.11-0.61;I2=79%)。LRT组的多灶性疾病发生率也略高(风险比[RR]1.21,95%CI 1.04-1.41;I2=0%),在移植肝脏的病理检查中,疾病程度超出米兰标准(RR 1.3,95%CI 1.05-1.66;I2=0%)。两组在等待移植的时间、脱落率、移植后1年、3年、5年的无病生存率或移植后3年和5年的总生存率方面没有差异。然而,LRT患者在移植后1年的总生存率更好(危险比0.54,95%CI 0.35-0.86;I2=0%)。结论:在米兰诊断标准范围内,桥接LRT对肝硬化HCC患者的确切益处尚不清楚。肝移植后的短期总生存率可能有优势。
{"title":"Bridging locoregional treatment prior to liver transplantation for cirrhotic patients with hepatocellular carcinoma within the Milan criteria: a systematic review and meta-analysis.","authors":"Ioannis D Kostakis,&nbsp;Nikolaos Dimitrokallis,&nbsp;Satheesh Iype","doi":"10.20524/aog.2023.0812","DOIUrl":"10.20524/aog.2023.0812","url":null,"abstract":"<p><strong>Background: </strong>We performed a meta-analysis to assess the benefit of bridging locoregional treatment (LRT) before liver transplantation for cirrhotic patients with hepatocellular carcinoma (HCC) already within the Milan criteria at diagnosis.</p><p><strong>Methods: </strong>We included original studies with HCC cases within the Milan criteria at diagnosis, comparing patients with and without bridging LRT before liver transplantation.</p><p><strong>Results: </strong>Twenty-six retrospective original studies were included. Out of the 9068 patients within the Milan criteria, 6435 (71%) received bridging LRT and 2633 (29%) did not. The most frequent LRTs were transarterial chemoembolization, radiofrequency ablation, and microwave ablation. Most of the patient and tumor characteristics were similar between the 2 groups. Maximum tumor diameter on scans was slightly larger in the LRT arm (mean difference: 0.36 cm, 95% confidence interval [CI] 0.11-0.61; <i>I</i><sup>2</sup>=79%). The LRT group also had multifocal disease slightly more frequently (risk ratio [RR] 1.21, 95%CI 1.04-1.41; <i>I</i><sup>2</sup>=0%) and disease extent outside the Milan criteria (RR 1.3, 95%CI 1.03-1.66; <i>I</i><sup>2</sup>=0%) on pathological examination of explanted livers. There was no difference between the 2 arms in the waiting time for transplant, dropout rates, disease-free survival at 1, 3, 5 years after transplant, or overall survival at 3 and 5 years after transplant. However, cases with LRT had better overall survival at 1 year after transplant (hazard ratio 0.54, 95%CI 0.35-0.86; <i>I</i><sup>2</sup>=0%).</p><p><strong>Conclusions: </strong>The precise benefit of bridging LRT for cirrhotic patients with HCC within the Milan criteria at diagnosis is unclear. There may be an advantage regarding short-term overall survival after liver transplantation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/9d/AnnGastroenterol-36-449.PMC10304529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perceived barriers to gluten-free diet adherence by people with celiac disease in Greece. 希腊乳糜泻患者坚持无麸质饮食的感知障碍。
IF 2.2 Q2 Medicine Pub Date : 2023-05-01 Epub Date: 2023-04-08 DOI: 10.20524/aog.2023.0798
Eirini Bathrellou, Aliki Georgopoulou, Meropi Kontogianni

Background: In people with celiac disease (CD), many factors affect adherence to a gluten-free diet (GFD), and these may well differ among countries. In Greece, such data for the adult population are lacking. Thus, the present study aimed to explore the perceived barriers to compliance with a GFD that are faced by people with CD living in Greece, also taking into account the impact of the COVID-19 pandemic.

Methods: Nineteen adults (14 females) with biopsy-proven CD, mean age 39±9 years and median time on GFD 7 (Q1-Q3: 4-10) years, participated in 4 focus groups, conducted through a video conference platform during the period October 2020 to March 2021. Data analysis followed the qualitative research methodology.

Results: Eating outside the home was reported as the domain where most difficulties were faced: these were related to a lack of confidence in finding safe gluten-free food and to the lack of social awareness about CD/GFD. All participants highlighted the high cost of gluten-free products, which was mostly managed by receiving state financial support. Regarding healthcare, the vast majority of participants reported little contact with dietitians and no follow up. The COVID-19 pandemic eased the burden of eating out, as staying at home and allocating more time to cooking was experienced as a positive effect, although the shift to online food retailing impacted food variability.

Conclusion: The main impediment to GFD adherence seems to stem from low social awareness, while the involvement of dietitians in the healthcare of people with CD warrants further investigation.

背景:在患有乳糜泻(CD)的人中,许多因素会影响对无麸质饮食(GFD)的坚持,并且这些因素在各国之间可能存在很大差异。在希腊,缺乏这样的成年人口数据。因此,本研究旨在探索居住在希腊的CD患者在遵守GFD方面面临的感知障碍,同时考虑到新冠肺炎大流行的影响。方法:在2020年10月至2021年3月期间,19名经活检证实为CD的成年人(14名女性),平均年龄39±9岁,GFD中位时间7(Q1-Q3:4-10)年,通过视频会议平台参与了4个焦点小组。数据分析采用定性研究方法。结果:据报道,在家外就餐是面临最大困难的领域:这与寻找安全无麸质食品缺乏信心以及缺乏对CD/GFD的社会意识有关。所有与会者都强调了无麸质产品的高成本,而无麸质食品主要是通过获得国家财政支持来管理的。关于医疗保健,绝大多数参与者报告说,他们很少与营养师接触,也没有跟进。新冠肺炎疫情缓解了外出就餐的负担,因为呆在家里并分配更多的时间做饭是一种积极的影响,尽管向在线食品零售的转变影响了食品的可变性。结论:GFD依从性的主要障碍似乎源于低社会意识,而营养师参与CD患者的医疗保健需要进一步调查。
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引用次数: 1
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Annals of Gastroenterology
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