35851
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Discrepant serum and urine β-hCG results due to production of β-hCG by a cribriform-morular variant of thyroid papillary carcinoma. Clin Chim Acta 2014; 438:181-5. [PMID: 25181612 DOI: 10.1016/j.cca.2014.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although patients with medullary thyroid cancer are known to present with paraneoplastic hormone production, this is much less common with papillary thyroid cancer. METHODS We present a patient with the cribriform morular variant of papillary thyroid cancer in association with familial adenomatous polyposis who developed a positive pregnancy test in the absence of known pregnancy. The patient had developed vaginal bleeding, and her laboratory testing was characterized by elevated serum human chorionic gonadotropin (β-hCG) concentrations, but negative qualitative urine results. After a thorough gynecological evaluation to exclude unexpected normal, ectopic, or molar pregnancy, we pursued an evaluation for other sources of β-hCG production. RESULTS We showed that the elevated serum β-hCG concentrations were not the result of heterophile antibody interferences, and ultimately we proved that her recurrent tumor produced the ectopic β-hCG. This is the first report of β-hCG production by papillary thyroid cancer. Thus, the possibility of ectopic production of β-hCG by papillary thyroid cancer needs to be included in the differential diagnosis of elevated hCG concentration in the absence of pregnancy. CONCLUSIONS This study of an unusual paraneoplastic syndrome highlights the importance of investigating discrepancies in the clinical laboratory.
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35852
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Garcia C, Gutmann DH. Using the neurofibromatosis tumor predisposition syndromes to understand normal nervous system development. SCIENTIFICA 2014; 2014:915725. [PMID: 25243094 PMCID: PMC4163293 DOI: 10.1155/2014/915725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/07/2014] [Indexed: 06/03/2023]
Abstract
Development is a tightly regulated process that involves stem cell self-renewal, differentiation, cell-to-cell communication, apoptosis, and blood vessel formation. These coordinated processes ensure that tissues maintain a size and architecture that is appropriate for normal tissue function. As such, tumors arise when cells acquire genetic mutations that allow them to escape the normal growth constraints. In this regard, the study of tumor predisposition syndromes affords a unique platform to better understand normal development and the process by which normal cells transform into cancers. Herein, we review the processes governing normal brain development, discuss how brain cancer represents a disruption of these normal processes, and highlight insights into both normal development and cancer made possible by the study of tumor predisposition syndromes.
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Affiliation(s)
- Cynthia Garcia
- Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - David H. Gutmann
- Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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35853
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Lozovaya N, Gataullina S, Tsintsadze T, Tsintsadze V, Pallesi-Pocachard E, Minlebaev M, Goriounova NA, Buhler E, Watrin F, Shityakov S, Becker AJ, Bordey A, Milh M, Scavarda D, Bulteau C, Dorfmuller G, Delalande O, Represa A, Cardoso C, Dulac O, Ben-Ari Y, Burnashev N. Selective suppression of excessive GluN2C expression rescues early epilepsy in a tuberous sclerosis murine model. Nat Commun 2014; 5:4563. [PMID: 25081057 PMCID: PMC4143949 DOI: 10.1038/ncomms5563] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/30/2014] [Indexed: 01/06/2023] Open
Abstract
Tuberous sclerosis complex (TSC), caused by dominant mutations in either
TSC1 or
TSC2 tumour
suppressor genes is characterized by the presence of brain malformations, the
cortical tubers that are thought to contribute to the generation of
pharmacoresistant epilepsy. Here we report that tuberless heterozygote
Tsc1+/− mice show
functional upregulation of cortical GluN2C-containing N-methyl-D-aspartate receptors (NMDARs) in an
mTOR-dependent manner and exhibit recurrent, unprovoked seizures during early
postnatal life (<P19). Seizures are generated intracortically in the granular
layer of the neocortex. Slow kinetics of aberrant GluN2C-mediated currents in spiny stellate cells promotes
excessive temporal integration of persistent NMDAR-mediated recurrent excitation and
seizure generation. Accordingly, specific GluN2C/D antagonists block seizures in Tsc1+/− mice in vivo
and in vitro. Likewise, GluN2C expression is upregulated in TSC human surgical
resections, and a GluN2C/D
antagonist reduces paroxysmal hyperexcitability. Thus, GluN2C receptor constitutes a promising
molecular target to treat epilepsy in TSC patients. Tuberous sclerosis complex (TSC) is a rare genetic condition
characterized by epileptic seizures that start in infancy. Here, the authors show that
these seizures are modulated by GluN2C-containing NMDA receptors in the cortex of a
mouse model of TSC, and that suppressing their activity attenuates seizures.
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Affiliation(s)
- N Lozovaya
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [4]
| | - S Gataullina
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [4]
| | - T Tsintsadze
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3]
| | - V Tsintsadze
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - E Pallesi-Pocachard
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - M Minlebaev
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France [3] Laboratory of Neurobiology, Kazan Federal University, Kremlevskaya street 18, 420000 Kazan, Russia
| | - N A Goriounova
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - E Buhler
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - F Watrin
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - S Shityakov
- Department of Anaesthesia and Critical Care, University of Würzburg, Josef-Schneider-Street 2, 97080 Würzburg, Germany
| | - A J Becker
- Department of Neuropathology, University of Bonn Medical Center, Sigmund Freud Street 25, D-53105 Bonn, Germany
| | - A Bordey
- Neurosurgery, and Cellular and Molecular Physiology Departments, Yale University School of Medicine, PO Box 208082, New Haven, Connecticut 06520-8082, USA
| | - M Milh
- APHM, Department of Pediatric Neurosurgery and Neurology, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - D Scavarda
- APHM, Department of Pediatric Neurosurgery and Neurology, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille Cedex 5, France
| | - C Bulteau
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - G Dorfmuller
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - O Delalande
- Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France
| | - A Represa
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - C Cardoso
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - O Dulac
- 1] INSERM U1129; University Paris Descartes, CEA, Gif sur Yvette, 149 Rue de Sèvres, 75015 Paris, France [2] Department of Pediatric Neurosurgery, Foundation Rothschild, 29 Rue Manin, 75019 Paris, France [3] APHP, Necker Hospital, 149 Rue de Sèvres, 75015 Paris, France
| | - Y Ben-Ari
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
| | - N Burnashev
- 1] INSERM U901, INMED, Parc Scientifique et Technologique de Luminy 163, route de Luminy-BP 13, 13273 Marseille Cedex 09, France [2] UMR901, Aix-Marseille University, 58 Boulevard Charles Livon, 13284 Marseille, France
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35854
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Gordon M, Taylor K, Akobeng AK, Thomas AG. Azathioprine and 6-mercaptopurine for maintenance of surgically-induced remission in Crohn's disease. Cochrane Database Syst Rev 2014; 2014:CD010233. [PMID: 25081347 PMCID: PMC6486089 DOI: 10.1002/14651858.cd010233.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic relapsing inflammatory condition. Many patients fail to achieve remission with medical management and require surgical interventions. Purine analogues have been used to maintain surgically-induced remission in CD, but the effectiveness of these agents is unclear. OBJECTIVES The objectives were to evaluate the efficacy and safety of purine analogues for maintenance of surgically-induced remission in CD. SEARCH METHODS We searched the following databases from inception to 30 April 2014: PubMed, MEDLINE, EMBASE, CENTRAL, and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register). We also searched the reference lists of all included studies, and contacted personal sources and drug companies to identify additional studies. The searches were not limited by language. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared purine analogues to placebo or another intervention, with treatment durations of at least six months were considered for inclusion. Participants were patients of any age with CD in remission following surgery. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and extracted data. Methodological quality was assessed using the Cochrane risk of bias tool. The primary outcome measures were clinical and endoscopic relapse as defined by the primary studies. Secondary outcomes included adverse events, withdrawal due to adverse events and serious adverse events. Data were analysed on an intention-to-treat basis where patients with missing final outcomes were assumed to have relapsed. We calculated the risk ratio (RR) and corresponding 95% confidence interval (95% CI) for dichotomous outcomes. The Chi(2) and I(2) statistics were used to assess heterogeneity. The overall quality of the evidence supporting the primary outcomes and selected secondary outcomes was assessed using the GRADE criteria. MAIN RESULTS Seven RCTs (n = 584 patients) were included in the review. Three studies compared azathioprine to 5-aminosalicylic acid (5-ASA). One small study compared azathioprine to both 5-ASA and adalimumab. One study compared azathioprine to placebo and another study compared 6-mercaptopurine to 5-ASA and placebo. One small study compared azathioprine to infliximab. Three studies were judged to be at low risk of bias. Four studies were judged to be at high risk of bias due to blinding. The study (n = 22) comparing azathioprine to infliximab found that the effects on the proportion of patients who had a clinical (RR 2.00, 95% CI 0.21 to 18.98) or endoscopic relapse (RR 4.40, 95% CI 0.59 to 3.07) were uncertain. One study (n = 33) found decreased clinical (RR 5.18, 95% CI 1.35 to 19.83) and endoscopic relapse (RR 10.35, 95% CI 1.50 to 71.32) rates favouring adalimumab over azathioprine. A pooled analysis of two studies (n = 168 patients) showed decreased clinical relapse rates at one or two years favouring purine analogues over placebo. Forty-eight per cent of patients in the purine analogue group experienced a clinical relapse compared to 63% of placebo patients (RR 0.74, 95% CI 0.58 to 0.94). A GRADE analysis indicated that the overall quality of the evidence supporting this outcome was low due to high risk of bias (one study was single-blind) and sparse data (93 events). One study (87 patients) found a reduction in endoscopic relapse rates favouring 6-mercaptopurine over placebo. Seventeen per cent of 6-mercaptopurine patients had an endoscopic relapse at two years compared to 42% of placebo patients (RR 0.40, 95% CI 0.19 to 0.83). A GRADE analysis indicated that the overall quality of the evidence for this outcome was low due to very sparse data (25 events). A pooled analysis of five studies (n = 425 patients) showed no difference in clinical relapse rates at one or two years between purine analogues and 5-ASA agents. Sixty-three per cent of patients in the purine analogues group experienced a clinical relapse compared to 54% of 5-ASA patients (RR 1.15, 95% CI 0.99 to 1.34). A GRADE analysis indicated that the overall quality of the evidence supporting this outcome was very low due to high risk of bias (two open-label studies), sparse data (249 events) and moderate heterogeneity (I(2) = 45%). There was no difference in endoscopic relapse at 12 months between azathioprine and 5-ASA (RR 0.78, 95% CI 0.52 to 1.17; 1 study, 35 patients). A GRADE analysis indicated that the overall quality of the evidence for this outcome was very low due to high risk of bias (open-label study) and very sparse data (26 events). There was a reduction in endoscopic relapse at 24 months favouring 6-mercaptopurine over 5-ASA patients. Seventeen per cent of 6-mercaptopurine patients had an endoscopic relapse compared to 48% of 5-ASA patients (RR 0.36, 95% CI 0.18 to 0.72; 1 study, 91 patients). A GRADE analysis indicated that the overall quality of the evidence for this outcome was low due to very sparse data (29 events). Adverse events that required withdrawal were more common in the purine analogue group compared to 5-ASA. Twenty per cent of patients in the purine analogue group withdrew due to adverse events compared to 10% of 5-ASA patients (RR 2.07, 95% CI 1.26 to 3.39; 5 studies, 423 patients).The results for withdrawal due to adverse events between purine analogues and placebo or for other comparisons were uncertain. Commonly reported adverse events across all studies included leucopenia, arthralgia, abdominal pain or severe epigastric intolerance, elevated liver enzymes, nausea and vomiting, pancreatitis, anaemia, exacerbation of Crohn's disease, nasopharyngitis, and flatulence. AUTHORS' CONCLUSIONS Purine analogues may be superior to placebo for maintenance of surgically-induced remission in patients with CD, although this is based on two small studies. The results for efficacy outcomes between purine analogues and 5-ASA agents were uncertain. However, patients taking purine analogues were more likely than 5-ASA patients to discontinue therapy due to adverse events. No firm conclusions can be drawn from the two small studies that compared azathioprine to infliximab or adalimumab. Adalimumab may be superior to azathioprine but further research is needed to confirm these results. Further research investigating the efficacy and safety of azathioprine and 6-mercaptopurine in comparison to other active medications in patients with surgically-induced remission of CD is warranted.
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Affiliation(s)
| | - Kelly Taylor
- North Manchester General HospitalDepartment of PaediatricsCrumpsallUK
| | | | - Adrian G Thomas
- Royal Manchester Children's HospitalOxford RoadManchesterUKM13 9WL
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35855
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Active smoking, environmental tobacco smoke and bronchitic symptoms among adolescents in Taiwan: a prospective cohort study. Prev Med 2014; 65:116-21. [PMID: 24823904 DOI: 10.1016/j.ypmed.2014.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/19/2014] [Accepted: 05/05/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The study investigates the association between active smoking, exposure to environmental tobacco smoke (ETS) and the development of bronchitis and bronchitic symptoms among adolescents. METHODS A prospective cohort study was conducted with 4134 adolescents aged 12-14 from the Taiwan Children Health Study in 14 communities in Taiwan since 2007. Parents or guardians completed written questionnaires regarding demographic information, household ETS and respiratory symptoms at baseline. The adolescents themselves completed identical questionnaires on respiratory outcomes in the 2009 survey. Associations between active smoking, exposure to ETS and the 2-year incidence of respiratory outcomes were analyzed by multiple Poisson regression models, taking overdispersion into account. RESULTS Active smoking was associated with an increased risk of developing chronic cough and chronic phlegm. We found significant dose-response associations between the duration of smoking, the numbers of cigarettes and the onset of bronchitic symptoms. Exposure to ETS was a significant risk factor for the development of chronic cough. Among asthmatic adolescents, exposure to ETS was associated with an additional risk for the onset of chronic phlegm. CONCLUSION This study demonstrates that active smoking and exposure to ETS are associated with higher risks for developing bronchitic symptoms among adolescents.
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35856
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The effect of nitrous oxide inhalation on the hypotensive response to propofol: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:166-73. [PMID: 23743209 DOI: 10.1016/j.oooo.2013.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/11/2013] [Accepted: 03/27/2013] [Indexed: 01/02/2023]
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35857
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Shimizu T, Marusawa H, Matsumoto Y, Inuzuka T, Ikeda A, Fujii Y, Minamiguchi S, Miyamoto S, Kou T, Sakai Y, Crabtree JE, Chiba T. Accumulation of somatic mutations in TP53 in gastric epithelium with Helicobacter pylori infection. Gastroenterology 2014; 147:407-17.e3. [PMID: 24786892 DOI: 10.1053/j.gastro.2014.04.036] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Helicobacter pylori infection is a risk factor for gastric cancer. To explore the genetic basis of gastric cancer that develops in inflamed gastric mucosa, we investigated genetic aberrations that latently accumulate in nontumorous gastric epithelium with H pylori infection. METHODS We performed whole-exome sequencing of gastric tumors, noncancerous tissues with gastritis, and peripheral lymphocytes from 5 patients. We performed additional deep-sequencing analyses of selected tumor-related genes using 34 gastritis mucosal samples from patients with or without gastric cancer. We also performed deep sequencing analyses of gastric mucosal tissues from mice that express transgenic human TP53 and constitutively express activation-induced cytidine deaminase (AICDA or AID) (human TP53 knock-in/AID-transgenic mice). RESULTS Whole-exome sequencing revealed that somatic mutations accumulated in various genes in inflamed gastric tissues. Additional deep-sequencing analyses of tissues from regions of gastritis confirmed nonsynonymous low-abundance mutations in TP53 in 15 cases (44.1%) and ARID1A in 5 cases (14.7%). The mutations that accumulated in gastric mucosal tissues with H pylori-induced gastritis, as well as gastric tumors, were predominantly C:G>T:A transitions in GpCpX motifs-a marker of cytidine deamination induced by AID. Constitutive expression of AID in the gastric mucosa of mice led to mutations in the human TP53, at amino acid coding positions identical to those detected in human gastric cancers. CONCLUSIONS Studies of gastric tumors and tissues from humans and mice indicate that somatic mutations accumulate in various genes in gastric mucosal tissues with H pylori infection. Increased cytidine deaminase activity in these tissues appears to promote the accumulation of these mutations and might promote gastric carcinogenesis in patients with H pylori infection.
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Affiliation(s)
- Takahiro Shimizu
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Marusawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yuko Matsumoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadashi Inuzuka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuyuki Ikeda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Fujii
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin'ichi Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadayuki Kou
- Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yoshiharu Sakai
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jean E Crabtree
- Leeds Institute Molecular Medicine, University of Leeds, Leeds, United Kingdom
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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35858
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Braat AJAT, Huijbregts JE, Molenaar IQ, Borel Rinkes IHM, van den Bosch MAAJ, Lam MGEH. Hepatic radioembolization as a bridge to liver surgery. Front Oncol 2014; 4:199. [PMID: 25126539 PMCID: PMC4115667 DOI: 10.3389/fonc.2014.00199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/15/2014] [Indexed: 12/11/2022] Open
Abstract
Treatment of oncologic disease has improved significantly in the last decades and in the future a vast majority of cancer types will continue to increase worldwide. As a result, many patients are confronted with primary liver cancers or metastatic liver disease. Surgery in liver malignancies has steeply improved and curative resections are applicable in wider settings, leading to a prolonged survival. Simultaneously, radiofrequency ablation (RFA) and liver transplantation (LTx) have been applied more commonly in oncologic settings with improving results. To minimize adverse events in treatments of liver malignancies, locoregional minimal invasive treatments have made their appearance in this field, in which radioembolization (RE) has shown promising results in recent years with few adverse events and high response rates. We discuss several other applications of RE for oncologic patients, other than its use in the palliative setting, whether or not combined with other treatments. This review is focused on the role of RE in acquiring patient eligibility for radical treatments, like surgery, RFA, and LTx. Inducing significant tumor reduction can downstage patients for resection or, through attaining stable disease, patients can stay on the LTx waiting list. Hereby, RE could make a difference between curative of palliative intent in oncologic patient management. Prior to surgery, the future remnant liver volume might be inadequate in some patients. In these patients, forming an adequate liver reserve through RE leads to prolonged survival without risking post-operative liver failure and minimizing tumor progression while inducing hypertrophy. In order to optimize results, developments in procedures surrounding RE are equally important. Predicting the remaining liver function after radical treatment and finding the right balance between maximum tumor irradiation and minimizing the chance of inducing radiation-related complications are still challenges.
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Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
| | - Julia E Huijbregts
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht , Utrecht , Netherlands
| | | | | | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
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35859
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Basso PJ, Fonseca MTC, Bonfá G, Alves VBF, Sales-Campos H, Nardini V, Cardoso CRB. Association among genetic predisposition, gut microbiota, and host immune response in the etiopathogenesis of inflammatory bowel disease. ACTA ACUST UNITED AC 2014; 47:727-37. [PMID: 25075576 PMCID: PMC4143199 DOI: 10.1590/1414-431x20143932] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/24/2014] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic disorder that affects thousands of people around the world. These diseases are characterized by exacerbated uncontrolled intestinal inflammation that leads to poor quality of life in affected patients. Although the exact cause of IBD still remains unknown, compelling evidence suggests that the interplay among immune deregulation, environmental factors, and genetic polymorphisms contributes to the multifactorial nature of the disease. Therefore, in this review we present classical and novel findings regarding IBD etiopathogenesis. Considering the genetic causes of the diseases, alterations in about 100 genes or allelic variants, most of them in components of the immune system, have been related to IBD susceptibility. Dysbiosis of the intestinal microbiota also plays a role in the initiation or perpetuation of gut inflammation, which develops under altered or impaired immune responses. In this context, unbalanced innate and especially adaptive immunity has been considered one of the major contributing factors to IBD development, with the involvement of the Th1, Th2, and Th17 effector population in addition to impaired regulatory responses in CD or UC. Finally, an understanding of the interplay among pathogenic triggers of IBD will improve knowledge about the immunological mechanisms of gut inflammation, thus providing novel tools for IBD control.
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Affiliation(s)
- P J Basso
- Departamento de Imunologia e Bioquímica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M T C Fonseca
- Departamento de Imunologia e Bioquímica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G Bonfá
- Departamento de Imunologia e Bioquímica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V B F Alves
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H Sales-Campos
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V Nardini
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C R B Cardoso
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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35860
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Qu C, Zheng Z, Liu W, Jiao J, Zhu J. A case of chronic hepatitis C patient of myocardial ischemia accompanied with interstitial pneumonia induced by pegylated interferon alpha-2a. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:5232-5235. [PMID: 25197402 PMCID: PMC4152092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
After 3 months of combination treatment using interferon α-2a and Ribavirin, a case of 59-year-old female patient with chronic viral hepatitis C demonstrated symptoms such as headache, dizziness accompanied by nausea, vomiting, dry cough, breathing difficulty, and shortness of breath. Dynamic electrocardiogram showed occasional atrial premature beats, paroxysmal tachycardia, and abnormal ST-T (T wave inversion and prolongation of the QT interval). Ambulatory blood pressure indicated that mean blood pressure was elevated than before. Myocardial radionuclide scan showed focal myocardial ischemia in left ventricular inferior wall. Pulmonary function tests showed that pulmonary diffusion function was decreased, indicating the possibility of interstitial pneumonia. The patient had no history of coronary heart disease or chest X-ray abnormalities before medication, but had hypertensive medical history for 8 years with good blood pressure control. After withdrawal of antiviral drugs, symptoms such as dry cough, breathing difficulty and T wave inversion were gradually relieved. This case indicated that myocardial ischemia and pulmonary lesions were associated with the application of pegylated interferon α-2a.
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Affiliation(s)
- Caihong Qu
- Deparment of Pharmacy, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou City, Guangdong Province, China
| | - Zhenda Zheng
- Deparment of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou City, Guangdong Province, China
| | - Weimin Liu
- Deparment of Radiology, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou City, Guangdong Province, China
| | - Ju Jiao
- Deparment of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou City, Guangdong Province, China
| | - Jieming Zhu
- Deparment of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou City, Guangdong Province, China
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35861
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López-Medina G, Castillo Díaz de León R, Heredia-Salazar AC, Hernández-Salcedo DR. Gastric emphysema a spectrum of pneumatosis intestinalis: a case report and literature review. Case Rep Gastrointest Med 2014; 2014:891360. [PMID: 25093129 PMCID: PMC4100401 DOI: 10.1155/2014/891360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2014] [Indexed: 12/27/2022] Open
Abstract
The finding of gas within the gastric wall is not a disease by itself, rather than a sign of an underlying condition which could be systemic or gastric. We present the case of a woman identified with gastric emphysema secondary to the administration of high doses of steroids, with the purpose of differentiating emphysematous gastritis versus gastric emphysema due to the divergent prognostic implications. Gastric emphysema entails a more benign course, opposed to emphysematous gastritis which often presents as an acute abdomen and carries a worse prognosis. Owing to the lack of established diagnostic criteria, computed tomography is the assessment method of choice. Currently no guidelines are available for the management of this entity, since the evidence is limited to a few case series and a considerable number of single case reports.
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Affiliation(s)
- Guillermo López-Medina
- Hospital Angeles Clinica Londres, Durango No. 50, Roma Norte, Cuauhtémoc, 06700 Ciudad de México, DF, Mexico
| | - Roxana Castillo Díaz de León
- Hospital Angeles Mocel, Gregorio V. Gelati 29, San Miguel Chapultepec, Miguel Hidalgo, 11850 Ciudad de México, DF, Mexico
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35862
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Hirai F, Beppu T, Takatsu N, Yano Y, Ninomiya K, Ono Y, Hisabe T, Matsui T. Long-term outcome of endoscopic balloon dilation for small bowel strictures in patients with Crohn's disease. Dig Endosc 2014; 26:545-51. [PMID: 24528293 DOI: 10.1111/den.12236] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Endoscopic balloon dilation (EBD) is an alternative to surgery for small bowel strictures of patients with Crohn's disease (CD). However, little is known about the long-term efficacy of EBD. The aim of the present study was to clarify the long-term outcome of EBD for small bowel strictures in patients with CD. METHODS Subjects comprised 65 patients with CD who underwent EBD for small intestinal strictures and were followed up for at least 6 months. All subjects had obstructive symptoms as a result of small bowel strictures. Short-term success was defined as technical success and the disappearance of obstructive symptoms. The short-term success rate of EBD, its safety profile, the cumulative surgery-free rate and the cumulative redilation-free rate were investigated. RESULTS Short-term success rate was 80.0% (52/65). Complications were encountered in six of the 65 patients (9.2%). Seventeen patients (26.2%) underwent surgery during the observation period of this study. Cumulative surgery-free rate after initial EBD was 79% at 2 years and 73% at 3 years, respectively. EBD successful cases showed significantly higher surgery-free rates than unsuccessful cases (P < 0.0001). In 52 of the successful cases, the cumulative redilation-free rate after initial EBD was 64% at 2 years and 47% at 3 years, respectively. CONCLUSION EBD for small bowel strictures secondary to CD provides not only short-term success but also long-term efficacy. However, the high redilation rate is one of the clinical problems of this procedure.
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Affiliation(s)
- Fumihito Hirai
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
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35863
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Abstract
BACKGROUND Crohn's disease (CD) requires surgical management in up to two-thirds of patients. Few studies have addressed the issue of ileal recurrence after colectomy and permanent ileostomy. The aims of our study were to assess the rate and predictors of postoperative recurrence of CD in patients with permanent ileostomy. METHODS In a retrospective study from a tertiary referral center, we analyzed the natural history of patients with CD who underwent total colectomy and permanent ileostomy. Our primary outcomes were (1) overall disease recurrence including luminal recurrence, perianal disease or peristomal lesions requiring therapy, and (2) luminal recurrence alone defined as endoscopic and clinical recurrence within the terminal ileum. We examined if patient characteristics predicted recurrence using multivariate Cox proportional hazard models. RESULTS Our study included 73 patients with CD followed for a mean of 28 months (range, 0-168 mo) after total colectomy and permanent ileostomy. Twenty patients had overall disease recurrence within 10 years after surgery, at rates of 15% and 50% at 1 and 5 years, respectively. Rate of luminal recurrence was 8% and 35% at 1 and 5 years, respectively. Diagnosis at age less than 18 years (hazard ratio, 2.94; 95% confidence interval, 1.14-7.62) and anti-tumor necrosis factor therapy before surgery (hazard ratio, 4.75; 95% confidence interval, 1.25-18.13) were the only independent predictive factors for overall disease recurrence. CONCLUSIONS Up to one-third of patients with CD have overall recurrence of disease after treatment with total colectomy and permanent ileostomy. There is need to develop algorithms for surveillance and management of this select subgroup of patients.
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35864
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Kuehnle D. The causal effect of family income on child health in the U.K. JOURNAL OF HEALTH ECONOMICS 2014; 36:137-150. [PMID: 24794502 DOI: 10.1016/j.jhealeco.2014.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
Recent studies examining the effect of family income on child health have been unable to account for the endogeneity of income. Using data from a British cohort study, we address this gap by exploiting exogenous variation in local labour market characteristics to instrument for family income. We estimate the causal effect of family income on different measures of child health and explore the role of potential transmission mechanisms. We find that income has a very small but significant causal effect on subjective child health and no significant effect on chronic health conditions, apart from respiratory illnesses. Using the panel structure, we show that the timing of income does not matter for young children. Moreover, our results provide further evidence that parental health does not drive a spurious relationship between family income and child health. Our study implies that financial transfers are unlikely to deliver substantial improvements in child health.
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Affiliation(s)
- Daniel Kuehnle
- Department of Economics, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
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35865
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Abstract
BACKGROUND While therapeutic strategies able to change the natural history of inflammatory bowel diseases (IBD) are being developed, factors predicting aggressive disease are needed to be able to choose the appropriate therapeutic strategy for the individual patient based on the risk/benefit ratio. The aim of this review is to focus on the tools assisting the clinician in routine practice regarding the prediction of disease evolution. METHODS A literature review was performed, which was mainly based on PubMed search, using the following terms: Crohn's disease, ulcerative colitis, inflammatory bowel disease, genetics, serology, biomarkers, endoscopy, C-reactive protein, faecal calprotectin, disease evolution and complications. RESULTS For the prediction of disease evolution, clinical characteristics, particularly disease location and behaviour, are probably currently the most useful. In addition, a series of biomarkers, including genetic, serological and inflammatory markers, as well as characteristics of endoscopic lesions may have an added value. CONCLUSIONS Simple clinical, biological and endoscopic tools may help the clinician in predicting disease evolution in IBD. However, these tools are still insufficient, and prospective evaluation of new genetic and biological markers are needed.
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Affiliation(s)
- Jose-Manuel Benitez
- Department of Gastroenterology, CHU Liège, and GIGA Research, Liège University, Liège, Belgium
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35866
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Vuitton L, Koch S, Peyrin-Biroulet L. Preventing postoperative recurrence in Crohn's disease: what does the future hold? Drugs 2014; 73:1749-59. [PMID: 24132799 DOI: 10.1007/s40265-013-0128-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite an increasing use of immunosuppressants and anti-tumor necrosis factor (TNF) agents, approximately half of the patients with Crohn's disease will require surgery within 10 years after diagnosis. Postoperative relapse is frequent and should be systematically assessed within the first year by endoscopy. Absence of prophylactic treatment is associated with a higher risk of relapse. Other risk factors include smoking, prior intestinal surgery, penetrating disease behavior, perianal location, and extensive small bowel resection. Pooled data indicate that 5-aminosalicylic acid and thiopurines have only slight efficacy to prevent postoperative recurrence in Crohn's disease. Nitroimidazole antibiotics are modestly effective, but long-term toxicity limits their use in clinical practice. Recently, anti-TNF agents in this setting have demonstrated efficacy and dramatically contrast with other interventions, but rising costs are concerning. Anti-TNF agents are highly effective in the prevention of postoperative recurrence in these patients. A therapeutic strategy based on a risk stratification of patients, with further treatment step-up and adjustment if relapse occurs on the basis of ileocolonoscopy, is recommended in clinical practice. Should we move towards top-down strategies based on a wider use of anti-TNF agents even in patients who are not at high risk of postoperative recurrence? Ongoing clinical trials addressing this issue will dramatically change our clinical practice.
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Affiliation(s)
- Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, 3 Bd Fleming, 25030, Besançon Cedex, France
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35867
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Kasraianfard A, Watt KD, Lindberg L, Alexopoulos S, Rezaei N. HBIG Remains Significant in the Era of New Potent Nucleoside Analogues for Prophylaxis Against Hepatitis B Recurrence After Liver Transplantation. Int Rev Immunol 2014; 35:312-324. [DOI: 10.3109/08830185.2014.921160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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35868
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Senthilnathan P, Inamdar S, Nalankilli VP, Vijay A, Rajapandian S, Parthsarathi R, Raj P, Palanivelu C. Long-term results of hepatic hydatid disease managed using palanivelu hydatid system: Indian experience in tertiary center. Surg Endosc 2014; 28:2832-9. [PMID: 24902813 DOI: 10.1007/s00464-014-3570-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incidence of hepatic hydatid disease is increasing due to globalization. Surgery is the gold standard treatment. Laparoscopy has gained enough evidence regarding its safety and efficacy. Complete evacuation of hydatid contents without spillage remains a challenge. We aimed to determine long-term results of hepatic hydatid disease managed laparoscopically using palanivelu hydatid system (PHS) at our institution. METHODS One hundred and five patients underwent laparoscopic surgical management using the PHS at our institute from May 1997 to May 2013. Clinical presentations, surgical strategy, postoperative morbidity, and long-term recurrence rate were evaluated. RESULTS Of the 105 patients, 76 were male and 29 female with a mean age of 32 years (range 14-71 years). The most common presentation was abdominal pain in 61 patients (58%). Sixteen patients had multiple cysts of which nine had involvement of both lobes. Seventy-seven (73.3%) cysts were uncomplicated. Nineteen (18.09%) had a cyst-biliary communication, two were ruptured cysts, and seven were recurrent cysts. All patients underwent successful laparoscopic management where conservative surgery was performed in 94 patients and radical surgery in 11 patients. Post-operative morbidity was seen in 18 (17.14 %) patients, which included deep cavity infection in two cases, post-operative bile leak in 13 cases, and duodenal injury in one case without any mortality. Mean long-term follow-up was 36 months (range 6 months-5 years) with recurrence in two cases. CONCLUSION Our long-term results with PHS showed good outcomes in the laparoscopic management of hepatic hydatid disease with conservative surgery as the preferred approach reserving radical surgery only in selected cases.
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Affiliation(s)
- P Senthilnathan
- HPB Department, GEM Hospital and Research Center, Pankaja Mill Road, Ramnathpuram, Coimbatore, 641045, Tamil Nadu, India,
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35869
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Monoacylglycerol lipase inhibition blocks chronic stress-induced depressive-like behaviors via activation of mTOR signaling. Neuropsychopharmacology 2014; 39:1763-76. [PMID: 24476943 PMCID: PMC4023150 DOI: 10.1038/npp.2014.24] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 12/22/2022]
Abstract
The endocannabinoid (eCB) system regulates mood, emotion, and stress coping, and dysregulation of the eCB system is critically involved in pathophysiology of depression. The eCB ligand 2-arachidonoylglycerol (2-AG) is inactivated by monoacylglycerol lipase (MAGL). Using chronic unpredictable mild stress (CUS) as a mouse model of depression, we examined how 2-AG signaling in the hippocampus was altered in depressive-like states and how this alteration contributed to depressive-like behavior. We report that CUS led to impairment of depolarization-induced suppression of inhibition (DSI) in mouse hippocampal CA1 pyramidal neurons, and this deficiency in 2-AG-mediated retrograde synaptic depression was rescued by MAGL inhibitor JZL184. CUS induced depressive-like behaviors and decreased mammalian target of rapamycin (mTOR) activation in the hippocampus, and these biochemical and behavioral abnormalities were ameliorated by chronic JZL184 treatments. The effects of JZL184 were mediated by cannabinoid CB1 receptors. Genetic deletion of mTOR with adeno-associated viral (AAV) vector carrying the Cre recombinase in the hippocampus of mTORf/f mice recapitulated depressive-like behaviors induced by CUS and abrogated the antidepressant-like effects of chronic JZL184 treatments. Our results suggest that CUS decreases eCB-mTOR signaling in the hippocampus, leading to depressive-like behaviors, whereas MAGL inhibitor JZL184 produces antidepressant-like effects through enhancement of eCB-mTOR signaling.
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35870
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Teschke R. Traditional Chinese Medicine Induced Liver Injury. J Clin Transl Hepatol 2014; 2:80-94. [PMID: 26357619 PMCID: PMC4521264 DOI: 10.14218/jcth.2014.00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/27/2014] [Accepted: 03/02/2014] [Indexed: 12/12/2022] Open
Abstract
Traditional Chinese Medicine (TCM) is popular around the world and encompasses many different practices with particular emphasis on herbal TCM. Using the PubMed database, a literature search was undertaken to assess the extent herbal TCM products exert rare hepatotoxicity. Analysis of reported cases revealed numerous specified herbal TCM products with potential hepatotoxicity. Among these were An Shu Ling, Bai Fang, Bai Xian Pi, Ban Tu Wan, Bo He, Bo Ye Qing Niu Dan, Bofu Tsu Sho San, Boh Gol Zhee, Cang Er Zi, Chai Hu, Chaso, Chi R Yun, Chuan Lian Zi, Ci Wu Jia, Da Chai Hu Tang, Da Huang, Du Huo, Gan Cao, Ge Gen, Ho Shou Wu, Hu Bohe You, Hu Zhang, Huang Qin, Huang Yao Zi, Hwang Geun Cho, Ji Gu Cao, Ji Ji, Ji Xue Cao, Jiguja, Jin Bu Huan, Jue Ming Zi, Kamishoyosan, Kudzu, Lei Gong Teng, Long Dan Xie Gan Tang, Lu Cha, Ma Huang, Mao Guo Tian Jie Cai, Onshido, Polygonum multiflorum, Qian Li Guang, Ren Shen, Sairei To, Shan Chi, Shen Min, Shi Can, Shi Liu Pi, Shou Wu Pian, Tian Hua Fen, White flood, Wu Bei Zi, Xi Shu, Xiao Chai Hu Tang, Yin Chen Hao, Zexie, Zhen Chu Cao, and various unclassified Chinese herbal mixtures. Causality was firmly established for a number of herbal TCM products by a positive reexposure test result, the liver specific scale of CIOMS (Council for International Organizations of Medical Sciences), or both. Otherwise, the quality of case data was mixed, especially regarding analysis of the herb ingredients because of adulteration with synthetic drugs, contamination with heavy metals, and misidentification. In addition, non-herbal TCM elements derived from Agaricus blazei, Agkistrodon, Antelope, Bombyx, Carp, Fish gallbladder, Phellinus, Scolopendra, Scorpio, and Zaocys are also known or potential hepatotoxins. For some patients, the clinical course was severe, with risks for acute liver failure, liver transplantation requirement, and lethality. In conclusion, the use of few herbal TCM products may rarely be associated with hepatotoxicity in some susceptible individuals, necessitating a stringent pretreatment evaluation of the risk/benefit ratio, based on results of multicenter, randomized, double-blind, placebo-controlled clinical trials.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany
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35871
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Jones GR, Kennedy NA, Lees CW, Arnott ID, Satsangi J. Systematic review: The use of thiopurines or anti-TNF in post-operative Crohn's disease maintenance--progress and prospects. Aliment Pharmacol Ther 2014; 39:1253-65. [PMID: 24738574 DOI: 10.1111/apt.12743] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-operative recurrence of Crohn's disease is an important management challenge, with 2-year recurrence rates defined by clinical, endoscopic and radiological parameters of up to 77%, 64% and 49%. Clinical and severe endoscopic recurrence vary widely in controlled trials from 13% to 36% and 22% to 56% with thiopurine treatment or 0% and 9% with infliximab treatment respectively at 1 year. AIMS To provide a review of the evidence for thiopurine or anti-TNF use in post-operative Crohn's disease, and to assess the ability to identify those patients at highest risk of recurrent disease. METHODS A literature search was undertaken using Medline, Embase and Cochrane databases to identify studies using search terms 'thiopurine', 'azathioprine', 'mercaptopurine', 'Infliximab', 'adalimumab', 'Anti-TNF', 'Crohn's disease', 'post-operative' and 'recurrence'. RESULTS Trials to examine this important area have proved difficult to execute, with recruitment and retention of patients posing major challenges to randomised clinical trials. There have been four RCTs of 433 patients of thiopurine therapy (with three meta-analyses of these data), and one of anti-TNF therapy involving 24 patients. Overall the efficacy data for thiopurine use in this setting are inconclusive, and other than smoking, there are no consistent predictors of post-operative relapse. CONCLUSIONS At present, evidence for routine use of thiopurine treatment in post-operative Crohn's disease is heterogeneous and unconvincing. Stratification by risk of relapse emerges as a key challenge in post-operative management that needs to be addressed, using clinical parameters and emerging biomarkers. The evidence for prophylactic anti-TNF use is limited though promising, with its routine use guided by early assessment of relapse.
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Affiliation(s)
- G R Jones
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
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35872
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Sagarra Cebolla E, Rodriguez-Bachiller Villaronga L, Carrasco Muñoz S, Gregorio Morales Taboada Á, García Sabrido JL. Thyroid metastasis of a colonic adenocarcinoma. Cir Esp 2014; 93:43-4. [PMID: 24862681 DOI: 10.1016/j.ciresp.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Elena Sagarra Cebolla
- Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Sergio Carrasco Muñoz
- Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - José Luis García Sabrido
- Servicio de Cirugía General III, Hospital General Universitario Gregorio Marañón, Madrid, España
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35873
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Yoshii H, Mita T, Sato J, Kodama Y, Choi JB, Komiya K, Matsumoto K, Kanno R, Kawasumi M, Koyano H, Hirose T, Onuma T, Kawamori R, Watada H. Comparison of effects of azelnidipine and trichlormethiazide in combination with olmesartan on blood pressure and metabolic parameters in hypertensive type 2 diabetic patients. J Diabetes Investig 2014; 2:490-6. [PMID: 24843534 PMCID: PMC4014909 DOI: 10.1111/j.2040-1124.2011.00135.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED Aims/Introduction: Angiotensin II type 1 receptor blockers (ARB) are regarded as first-line treatment for type 2 diabetes with hypertension. However, lowering blood pressure to the target level often requires more than one antihypertensive agent as recommended by the guideline. In this open-label, prospective, crossover clinical trial, we compared the effects of combination treatment of ARB with a calcium channel blocker (CCB) or with a low-dose thiazide diuretic on blood pressure (BP) and various metabolic parameters in hypertensive patients with type 2 diabetes. MATERIALS AND METHODS A total of 39 Japanese type 2 diabetics with hypertension treated with olmesartan (20 mg/day) for at least 8 weeks were recruited to this study. At study entry, treatment was switched to either olmesartan (20 mg/day)/azelnidipine (16 mg/day) or olmesartan (20 mg/day)/trichlormethiazide (1 mg/day) and continued for 12 weeks. Then, the drugs were switched and treatment was continued for another 12 weeks. We measured clinical blood pressure and various metabolic parameters before and at the end of each study arm. RESULTS Compared with the olmesartan/trichlormethiazide treatment, treatment with olmesartan/azelnidipine achieved superior clinical blood pressure and pulse rate control. In contrast, the treatment with olmesartan/trichlormethiazide resulted in increased HbA1c, serum uric acid and worsening of estimated glomerular filtration rate, though there were no differences in other metabolic parameters including urine 8-hydroxy-2'-deoxyguanosine, C-reactive protein and adiponectin between the two treatments. CONCLUSIONS Our results show that the combination of ARB with azelnidipine is more beneficial with regard to blood pressure control and metabolic outcome than the combination of olmesartan with low dose trichlormethiazide. This trial was registered with UMIN clinical trial registry (no. UMIN000005064). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00135.x, 2011).
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Affiliation(s)
- Hidenori Yoshii
- Department of Medicine, Diabetes and Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center
| | - Tomoya Mita
- Department of Medicine, Metabolism and Endocrinology
| | - Junko Sato
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Juntendo Urayasu Hospital, Urayasu
| | - Yuuki Kodama
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Juntendo Urayasu Hospital, Urayasu
| | - Jong Bock Choi
- Department of Diabetes and Endocrinology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Koji Komiya
- Department of Medicine, Metabolism and Endocrinology
| | - Kazuhisa Matsumoto
- Department of Medicine, Diabetes and Endocrinology, Juntendo University Nerima Hospital, Tokyo
| | - Rei Kanno
- Department of Medicine, Metabolism and Endocrinology
| | - Masahiko Kawasumi
- Department of Medicine, Diabetes and Endocrinology, Juntendo University Nerima Hospital, Tokyo
| | - Hajime Koyano
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Juntendo Urayasu Hospital, Urayasu
| | | | - Tomio Onuma
- Department of Medicine, Diabetes and Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center
| | | | - Hirotaka Watada
- Department of Medicine, Metabolism and Endocrinology ; Sportology Center ; Center for Therapeutic Innovations in Diabetes ; Center for Beta Cell Biology and Regeneration, Juntendo University Graduate School of Medicine
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35874
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Dale RT, Bidnur S, Nguan CYC. Late renal vein aneurysm following living related renal transplant. Can Urol Assoc J 2014; 8:E253-5. [PMID: 24839493 DOI: 10.5489/cuaj.1769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Renal vein aneurysms are rare; there are less than 10 reported cases. As of yet there have been no reported cases of renal vein aneurysm following renal transplantation. We present a case of an incidentally discovered renal vein aneurysm following uncomplicated living related renal transplant. The lesion was discovered 4 years after the transplant through abdominal ultrasound investigation of new right lower quadrant discomfort. Magnetic resonance imaging confirmed the presence of a 2.3-cm thrombosed renal vein aneurysm of the main renal vein. This case report highlights the rare nature of these events, the diagnostic challenges and the lack of satisfactory management guidelines in these cases.
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Affiliation(s)
- Robert T Dale
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Samir Bidnur
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Christopher Y C Nguan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC
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35875
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Eisner F, Küper MA, Ziegler F, Zieker D, Königsrainer A, Glatzle J. Impact of perioperative immunosuppressive medication on surgical outcome in Crohn's Disease (CD). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2014; 52:436-40. [PMID: 24824908 DOI: 10.1055/s-0033-1356347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Patients with Crohn's disease [CD] carry an 80 - 90 % lifetime risk of undergoing surgery. Many of these patients are on immunosuppressive medication at the time of surgery. The aim of this study was to evaluate the effect of immunosuppression on the surgical outcome in CD patients. METHODS We retrospectively analyzed 484 consecutive abdominal operations for CD from 1995 to 2008 for surgical complications. RESULTS A total of 241 operations (= 49.8 %) were performed under perioperative immunosuppression (corticoids and thiopurine). The overall complication rate was 18.6 %, the major complication rate was 8.7 % and the anastomotic leakage rate was 3.3 %. No differences were observed between patients without immunosuppression compared to those with immunosuppression. Patients with colo-rectal resections showed a higher complication rate than patients with small bowel resection independently of immunosuppression. CONCLUSION Nearly 50 % of the patients undergoing abdominal surgery for CD are receiving immunosuppressive medication during surgery. However, perioperative immunosuppression with corticoids, thiopurine or the combination of both does not significantly alter the surgical complication rate. Therefore the decision of a required surgery should not be delayed due to the fact that the patient is under immunosuppressive medication.
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Affiliation(s)
- F Eisner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen
| | - M A Küper
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin
| | - F Ziegler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen
| | - D Zieker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen
| | - A Königsrainer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen
| | - J Glatzle
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen
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35876
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Koning L, de Knegt RJ, Metselaar HJ. Living donor liver transplantation in HCV-infected patients: improvement of the donor risk-recipient benefit ratio is around the corner. Transpl Int 2014; 27:765-6. [PMID: 24811090 DOI: 10.1111/tri.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Ludi Koning
- Erasmus MC Liver Center, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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35877
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Bartley CM, O’Keefe RA, Bordey A. FMRP S499 is phosphorylated independent of mTORC1-S6K1 activity. PLoS One 2014; 9:e96956. [PMID: 24806451 PMCID: PMC4013076 DOI: 10.1371/journal.pone.0096956] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/08/2014] [Indexed: 11/18/2022] Open
Abstract
Hyperactive mammalian target of rapamycin (mTOR) is associated with cognitive deficits in several neurological disorders including tuberous sclerosis complex (TSC). The phosphorylation of the mRNA-binding protein FMRP reportedly depends on mTOR complex 1 (mTORC1) activity via p70 S6 kinase 1 (S6K1). Because this phosphorylation is thought to regulate the translation of messages important for synaptic plasticity, we explored whether FMRP phosphorylation of the S6K1-dependent residue (S499) is altered in TSC and states of dysregulated TSC-mTORC1 signaling. Surprisingly, we found that FMRP S499 phosphorylation was unchanged in heterozygous and conditional Tsc1 knockout mice despite significantly elevated mTORC1-S6K1 activity. Neither up- nor down-regulation of the mTORC1-S6K1 axis in vivo or in vitro had any effect on phospho-FMRP S499 levels. In addition, FMRP S499 phosphorylation was unaltered in S6K1-knockout mice. Collectively, these data strongly suggest that FMRP S499 phosphorylation is independent of mTORC1-S6K1 activity and is not altered in TSC.
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Affiliation(s)
- Christopher M. Bartley
- Departments of Neurosurgery, and Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Rachel A. O’Keefe
- Departments of Neurosurgery, and Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Angélique Bordey
- Departments of Neurosurgery, and Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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35878
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Shirinde J, Wichmann J, Voyi K. Association between wheeze and selected air pollution sources in an air pollution priority area in South Africa: a cross-sectional study. Environ Health 2014; 13:32. [PMID: 24885606 PMCID: PMC4018977 DOI: 10.1186/1476-069x-13-32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 04/28/2014] [Indexed: 05/16/2023]
Abstract
BACKGROUND An association between wheeze (a symptom of asthma) and environmental tobacco smoke (ETS), types of fuel used for residential heating or cooking and the frequency of trucks passing near homes, has been reported mainly in developed countries. Little is known about the strength of such associations in developing countries. This study was conducted in residential areas situated in Ekurhuleni Metropolitan Municipality, namely Tembisa and Kempton Park, which form part of the Highveld region, a priority area in terms of air pollution in South Africa. METHODS From 3764 eligible school children, aged between 13 and 14 years, from 16 selected high schools in the study area, 3468 completed a modified questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC). Data were analysed using multiple logistic regression models. RESULTS The results are based on data from 3424 children. In the adjusted models, exposure to ETS at school was associated with wheeze ever (OR 1.22 95% CI: 1.03 - 1.45) and current wheeze (OR 1.33 95% CI: 1.08 - 1.64). When gas was most frequently used for residential heating the likelihood of wheeze ever increased by 47% (OR 1.47 95% CI: 1.15 - 1.88). Trucks passing near homes for almost the whole day during weekdays, increased the likelihood of wheeze ever (OR 1.32 95% CI: 1.01 - 1.73), current wheeze (OR 1.61 95% CI: 1.15 - 2.24) and current severe wheeze (OR 2.22 95% CI: 1.28 - 3.77). When data were stratified according to residential area, for children living in Tembisa, ETS exposure at home was associated with current wheeze (OR 1.36 95% CI: 1.06 - 1.77); gas most frequently used for residential heating was associated with wheeze ever (OR 1.68 95% CI: 1.23 - 2.28) and current wheeze (OR 1.61 95% CI: 1.08 - 2.39); paraffin most frequently used for residential heating was associated with current severe wheeze (OR 1.85 95% CI: 1.04 - 3.28). CONCLUSION It was concluded that children living in one of the air pollution priority areas of South Africa, have an increased risk of wheezing due to exposure to both indoor and outdoor air pollution sources.
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Affiliation(s)
- Joyce Shirinde
- Department of Environmental Health, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
| | - Janine Wichmann
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
| | - Kuku Voyi
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
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35879
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Malignant Skin and Subcutaneous Neoplasms in Adults: Multimodality Imaging With CT, MRI, and18F-FDG PET/CT. AJR Am J Roentgenol 2014; 202:W422-38. [DOI: 10.2214/ajr.13.11424] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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35880
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Karbasi-Afshar R. Treatment of hepatitis C virus infection and associated vascular complications: a literature review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2014; 39:238-46. [PMID: 24850980 PMCID: PMC4027002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/20/2013] [Accepted: 09/01/2013] [Indexed: 11/04/2022]
Abstract
Interferon (IFN)-based therapy, the cornerstone for treatment of hepatitis C virus (HCV) infection, is generally considered to be the single most effective treatment strategy for this infection. Although most adverse effects of IFN therapy respond very well to the cessation of this drug, there are reports of serious irreversible adverse effects. This review article evaluates the adverse effects of IFN therapy in HCV-infected patients. We have undertaken an extensive search for articles regarding IFN and pegylated-IFN (PEG-IFN) therapy and their vascular complications using multiple sources that include PubMed, publishers' websites, and Google Scholar. The prevalence of ocular disorders in the early period (first 8 weeks) after IFN administration was high with over half of the patients experiencing these adverse effects. Several authors strongly propose screening programs for retinopathy in the early period after IFN administration. Pulmonary hypertension due to IFN therapy is a serious side effect due to its irreversible nature in most patients. Patients who develop signs of acute abdomen up to months after IFN administration should be rapidly assessed for potential adverse effects of IFN. The literature suggests a broad spectrum of vascular injuries to different organs in humans as adverse effects of IFN therapy in HCV-infected patients.
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35881
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Abstract
The expanding knowledge of the role of genetic variants involved in the susceptibility to IBD heralds an era of disease categorization beyond Crohn's disease and ulcerative colitis. A more robust molecular definition of the spectrum of IBD subtypes is likely to be based on specific molecular pathways that determine not only disease susceptibility but also disease characteristics such as location, natural history and therapeutic response. Evolving diagnostic panels for IBD will include clinical variables and genetic markers as well as other indicators of gene function and interaction with environmental factors, such as the microbiome. Multimodal algorithms that combine clinical, serologic and genetic information are likely to be useful in predicting disease course. Variation in IBD-susceptibility and drug-related pathway genes seems to influence the response to anti-TNF therapy. Furthermore, gene expression signatures and composite models have both shown promise as predictors of therapeutic response. Ultimately, models based on combinations of genotype and gene expression data with clinical, biochemical, serological, and microbiome data for clinically meaningful subgroups of patients should permit the development of tools for individualized risk stratification and treatment selection.
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35882
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Kim HM. Peroral endoscopic myotomy is expanding its indications: (j am coll surg 2013;217:598-605). J Neurogastroenterol Motil 2014; 20:276-7. [PMID: 24840383 PMCID: PMC4015209 DOI: 10.5056/jnm.2014.20.2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 11/30/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Hee Man Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
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35883
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Labgaa I, Lachenal Y, Allemann P, Demartines N, Schäfer M. Giant extra-hepatic thrombosed portal vein aneurysm: a case report and review of the literature. World J Emerg Surg 2014; 9:35. [PMID: 24795777 PMCID: PMC4008416 DOI: 10.1186/1749-7922-9-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Extrahepatic Portal vein aneurysm (EPVA) is a rare finding that may be associated with different complications, e.g. thrombosis, rupture, portal hypertension and compression of adjacent structures. It is being diagnosed more frequently with the advent of modern cross-sectional imaging. Our review of the English literature disclosed 13 cases of thrombosed EPVA. CASE PRESENTATION A 50-years-old woman presented with acute abdominal pain but no other symptom. She had no relevant medical history. Palpation of the right upper quadrant showed tenderness. Laboratory tests were unremarkable. A computed tomography showed portal vein aneurysm measuring 88 × 65 mm with thrombosis extending to the superior mesenteric and splenic vein. The patient was treated conservatively with anticoagulation therapy. She was released after two weeks and followed on an outpatient basis. At two months, she reported decreased abdominal pain and her physical examination was normal. A computed tomography was performed showing a decreased thrombosis size and extent, measuring 80 × 55 mm. CONCLUSIONS Although rare, surgeons should be made aware of this entity. Complications are various. Conservative therapy should be chosen in first intent in most cases. We reported the case of the second largest thrombosed extra-hepatic PVA described in the literature, treated by anticoagulation therapy with a good clinical and radiological response.
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Affiliation(s)
- Ismaïl Labgaa
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Yann Lachenal
- Department of Radiology and Interventional Radiology, CHUV University Hospital, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, CHUV University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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35884
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Takei N, Nawa H. mTOR signaling and its roles in normal and abnormal brain development. Front Mol Neurosci 2014; 7:28. [PMID: 24795562 PMCID: PMC4005960 DOI: 10.3389/fnmol.2014.00028] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/30/2014] [Indexed: 11/15/2022] Open
Abstract
Target of rapamycin (TOR) was first identified in yeast as a target molecule of rapamycin, an anti-fugal and immunosuppressant macrolide compound. In mammals, its orthologue is called mammalian TOR (mTOR). mTOR is a serine/threonine kinase that converges different extracellular stimuli, such as nutrients and growth factors, and diverges into several biochemical reactions, including translation, autophagy, transcription, and lipid synthesis among others. These biochemical reactions govern cell growth and cause cells to attain an anabolic state. Thus, the disruption of mTOR signaling is implicated in a wide array of diseases such as cancer, diabetes, and obesity. In the central nervous system, the mTOR signaling cascade is activated by nutrients, neurotrophic factors, and neurotransmitters that enhances protein (and possibly lipid) synthesis and suppresses autophagy. These processes contribute to normal neuronal growth by promoting their differentiation, neurite elongation and branching, and synaptic formation during development. Therefore, disruption of mTOR signaling may cause neuronal degeneration and abnormal neural development. While reduced mTOR signaling is associated with neurodegeneration, excess activation of mTOR signaling causes abnormal development of neurons and glia, leading to brain malformation. In this review, we first introduce the current state of molecular knowledge of mTOR complexes and signaling in general. We then describe mTOR activation in neurons, which leads to translational enhancement, and finally discuss the link between mTOR and normal/abnormal neuronal growth during development.
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Affiliation(s)
- Nobuyuki Takei
- Department of Molecular Neurobiology, Brain Research Institute, Niigata University Niigata, Japan
| | - Hiroyuki Nawa
- Department of Molecular Neurobiology, Brain Research Institute, Niigata University Niigata, Japan
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35885
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Tuxun T, Zhang JH, Zhao JM, Tai QW, Abudurexti M, Ma HZ, Wen H. World review of laparoscopic treatment of liver cystic echinococcosis--914 patients. Int J Infect Dis 2014; 24:43-50. [PMID: 24747089 DOI: 10.1016/j.ijid.2014.01.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/12/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst. METHODS We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated. RESULTS A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients). CONCLUSIONS The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Hui Zhang
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Ming Zhao
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Qin-Wen Tai
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Mierxiati Abudurexti
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hai-Zhang Ma
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hao Wen
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China.
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35886
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Abnormal FHIT protein expression may be correlated with poor prognosis in gastric cancer: a meta-analysis. Tumour Biol 2014; 35:6815-21. [PMID: 24729090 DOI: 10.1007/s13277-014-1936-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/03/2014] [Indexed: 01/11/2023] Open
Abstract
Our current meta-analysis is aimed to investigate the relationships between fragile histidine triad (FHIT) protein expression and prognosis in gastric cancer patients. We searched MEDLINE (1966 ~ 2013), the Cochrane Library Database (Issue 12, 2013), EMBASE (1980 ~ 2013), CINAHL (1982 ~ 2013), Web of Science (1945 ~ 2013), and the Chinese Biomedical Database (CBM) (1982 ~ 2013) without any language restrictions. The meta-analysis was conducted using the STATA 12.0 software. Crude hazard ratios (HR) with its 95 % confidence interval (95 % CI) were calculated. Eight clinical cohort studies with a total of 1,361 gastric cancer patients were involved in our meta-analysis. Our results revealed that FHIT-negative patients exhibited a shorter overall survival (OS) time than FHIT-positive patients (HR = 1.23, 95 % CI = 1.01 ~ 1.44, P < 0.001). Ethnicity-stratified analysis demonstrated that FHIT-negative patients have significantly poorer prognosis than FHIT-positive patients among both Caucasians and Asians (all P < 0.05). In conclusion, our meta-analysis provides evidences that negative expression of FHIT protein may be correlated with poor prognosis in patients with gastric cancer. Thus, FHIT expression level may be utilized as an independent prognostic marker for gastric cancer.
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35887
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Modha K, Navaneethan U. Advanced therapeutic endoscopist and inflammatory bowel disease: Dawn of a new role. World J Gastroenterol 2014; 20:3485-3494. [PMID: 24707131 PMCID: PMC3974515 DOI: 10.3748/wjg.v20.i13.3485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/16/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopy plays a key role in the diagnosis and treatment of patients with inflammatory bowel disease (IBD). Colonoscopy has been traditionally used in the diagnosis of IBD and helps in determination of an important end point in patient management, “mucosal healing”. However, the involvement of an advanced endoscopist has expanded with innovations in therapeutic and newer imaging techniques. Endoscopists are increasingly being involved in the management of anastomotic and small bowel strictures in these patients. The advent of balloon enteroscopy has helped us access areas not deemed possible in the past for dilations. An advanced endoscopist also plays an integral part in managing ileal pouch-anal anastomosis complications including management of pouch strictures and sinuses. The use of rectal endoscopic ultrasound has been expanded for imaging of perianal fistulae in patients with Crohn’s disease and appears much more sensitive than magnetic resonance imaging and exam under anesthesia. Advanced endoscopists also play an integral part in detection of dysplasia by employing advanced imaging techniques. In fact the paradigm for neoplasia surveillance in IBD is rapidly evolving with advancements in endoscopic imaging technology with pancolonic chromoendoscopy becoming the main imaging modality for neoplasia surveillance in IBD patients in most institutions. Advanced endoscopists are also called upon to diagnose primary sclerosing cholangitis (PSC) and also offer options for endoscopic management of strictures through endoscopic retrograde cholangiopancreatography (ERCP). In addition, PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk. Brush cytology obtained during ERCP and use of fluorescence in situ hybridization which assesses the presence of chromosomal aneuploidy (abnormality in chromosome number) are established initial diagnostic techniques in the investigation of patients with biliary strictures. Thus advanced endoscopists play an integral part in the management of IBD patients and our article aims to summarize the current evidence which supports this role and calls for developing and training a new breed of interventionalists who specialize in the management of IBD patients and complications specific to those patients.
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35888
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Oshrine BR, Olsen MN, Heneghan M, Wertheim G, Daber R, Wilmoth DM, Biegel JA, Pawel B, Aplenc R, King RL. Acquired isochromosome 12p, somatic TP53 and PTEN mutations, and a germline ATM variant in an adolescent male with concurrent acute megakaryoblastic leukemia and mediastinal germ cell tumor. Cancer Genet 2014; 207:153-9. [PMID: 24831771 DOI: 10.1016/j.cancergen.2014.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/24/2014] [Accepted: 03/27/2014] [Indexed: 01/21/2023]
Abstract
Previous reports have described an association between hematologic malignancies (HMs) and extragonadal germ cell tumor (GCT). Most patients have been adolescent males with mediastinal nonseminomatous GCT. Although a variety of HMs have been reported, there is a striking predilection toward acute megakaryoblastic leukemia (AMKL). Shared cytogenetic anomalies--particularly isochromosome 12p [i(12p)]--have suggested common clonal origins to the tumors. We report the case of a 17-year-old boy presenting with AMKL and a synchronous mediastinal GCT, with the characteristic i(12p) in both neoplasms. The common clonal origin of the AMKL and GCT was further confirmed with massively parallel sequencing, which identified somatic TP53 and PTEN mutations, as well as a rare germline ATM variant. Although these represent commonly mutated genes in cancer, this combination of mutations is not typically associated with either GCT or AMKL, suggesting that these tumors may represent unique biologic entities when they co-occur.
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Affiliation(s)
- Benjamin R Oshrine
- Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Molly N Olsen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mallorie Heneghan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gerald Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Daber
- Department of Pathology and Lab Medicine, Center for Personalized Diagnostics, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna M Wilmoth
- Department of Pathology and Lab Medicine, Center for Personalized Diagnostics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaclyn A Biegel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bruce Pawel
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard Aplenc
- Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca L King
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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35889
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Vermeer NCA, Elshof JWM, Vriens PWHE. Clinical presentation, diagnosis, and treatment of venous aneurysms. J Vasc Surg Venous Lymphat Disord 2014; 2:349-353.e3. [PMID: 26993399 DOI: 10.1016/j.jvsv.2014.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
Venous aneurysms have been reported in most major veins and are often asymptomatic but can cause serious complications. Three patients with symptomatic venous aneurysms of the internal jugular vein, portal vein, and popliteal vein are presented, and their treatment and outcomes are discussed. Furthermore, presentation and management of the most frequent venous aneurysms, based on available literature, are evaluated. The literature supports conservative treatment of asymptomatic and nonthrombotic jugular, subclavian, thoracic, and visceral venous aneurysms. Surgery should be considered only for symptomatic venous aneurysms or in case of progressive expansion on follow-up. Prophylactic surgery is recommended for all patients with lower extremity deep venous aneurysms, by means of tangential aneurysmectomy with lateral venorrhaphy, because of the increased risk of pulmonary embolization. Postoperative anticoagulation is recommended for a period of at least 3 months after operative treatment.
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Affiliation(s)
- Nina C A Vermeer
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
| | - Jan Willem M Elshof
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Patrick W H E Vriens
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
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35890
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Nam JH, Choi IJ, Kook MC, Lee JY, Cho SJ, Nam SY, Kim CG. OLGA and OLGIM stage distribution according to age and Helicobacter pylori status in the Korean population. Helicobacter 2014; 19:81-9. [PMID: 24617667 DOI: 10.1111/hel.12112] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Operative Link for Gastritis Assessment (OLGA) and the Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) staging systems have been suggested to provide risk assessment for gastric cancer. This study aimed to evaluate the distribution of OLGA and OLGIM staging by age and Helicobacter pylori status. MATERIALS AND METHODS We studied 632 subjects who underwent esophagogastroduodenoscopy for gastric cancer screening. Helicobacter pylori status and histologic changes were assessed using the updated Sydney system. Stage III and IV OLGA or OLGIM stages were considered as high-risk stages. RESULTS The rate of H. pylori infection was 59.0% (373/632). Overall, the proportion of high OLGA and OLGIM stages was significantly increased with older age (p < .001 for both). Old age (OR = 5.17, 6.97, and 12.23 for ages in the 40's, 50's, and 60's, respectively), smoking (OR = 2.54), and H. pylori infection (OR = 8.46) were independent risk factors for high-risk OLGA stages. These risk factors were the same for high-risk OLGIM stages. In the H. pylori-positive subgroup, the proportion of high-risk OLGA stages was low (6.9%) before the age of 40, but increased to 23.0%, 29.1%, and 41.1% for those in their 40s, 50s, and 60s, respectively (p < .001). High-risk OLGIM stages showed a similar trend of 2.8% before the age of 40 and up to 30.1% for those in their 60s. High-risk OLGA and OLGIM stages were uncommon in the H. pylori-negative group, with a respective prevalence of 10.3% and 3.4% even among those in their 60s. CONCLUSIONS Because high-risk OLGA and OLGIM stages are uncommon under the age of 40, H. pylori treatment before that age may reduce the need for endoscopic surveillance for gastric cancer.
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Affiliation(s)
- Ji Hyung Nam
- National Cancer Center, Center for Cancer Prevention and Detection, Goyang, Korea
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35891
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35892
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Abstract
Several reports of estimates for precancerous conditions for gastric adenocarcinoma can be found in the current literature. Our aim was to systematically review and estimate the prevalence of gastric precancerous conditions. Four databases (PubMed, Scopus, Web of Knowledge and EBSCO Academic Search Complete) were searched for original manuscripts addressing the presence of chronic atrophic gastritis (CAG) or intestinal metaplasia (IM). Subgroup analysis was carried out on methods of diagnosis, type of population, incidence of gastric cancer, sex, Helicobacter pylori status, age and extent of conditions. Overall, 107 studies were included. The worldwide prevalence of CAG in the general population was 33% (95% confidence interval: 26-41%) when considering biopsies (n=20 912) and 24% (19-29%) if serology (n=51 886) was used, whereas IM was found in 25% (19-30%) (n=30 960). Estimates for CAG were higher in countries with a high incidence of gastric cancer (42 vs. 23%), men (32 vs. 28%), H. pylori positive (46 vs. 17%) and if aged 40 years or older (48 vs. 22%). The prevalence of extensive conditions was 16% (12-20%) for CAG and 13% (9.0-17%) for IM. When comparing countries with high versus low to moderate incidence of gastric cancer, significant differences were achieved for CAG: 27% (12-36%) versus 7.3% (5.6-9.0%). Worldwide, one-third and one-fourth of individuals may harbour CAG and IM, respectively. In countries with a high incidence of gastric cancer, the prevalence of extensive conditions may increase up to 27% and these patients represent a high-risk population to whom endoscopic surveillance should be offered according to recent guidelines.
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35893
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Rosen LJ, Myers V, Hovell M, Zucker D, Ben Noach M. Meta-analysis of parental protection of children from tobacco smoke exposure. Pediatrics 2014; 133:698-714. [PMID: 24664094 DOI: 10.1542/peds.2013-0958] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE. METHODS Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed. RESULTS Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20). CONCLUSIONS Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.
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35894
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Lindsay RP, Shin SS, Garfein RS, Rusch MLA, Novotny TE. The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES. PLoS One 2014; 9:e93137. [PMID: 24664240 PMCID: PMC3963991 DOI: 10.1371/journal.pone.0093137] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children. METHODS We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI. RESULTS LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI. CONCLUSIONS Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.
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Affiliation(s)
- Ryan P. Lindsay
- University of California San Francisco, Center for Tobacco Control Research and Education, San Francisco, California, United States of America
| | - Sanghyuk S. Shin
- University of California Los Angeles, David Geffen School of Medicine, Program in Global Health, Los Angeles, California, United States of America
| | - Richard S. Garfein
- University of California San Diego, Department of Medicine, Division of Global Public Health, San Diego, California, United States of America
| | - Melanie L. A. Rusch
- Vancouver Island Health Authority and University of Victoria, School of Public Health and Social Policy, Victoria, British Columbia, Canada
| | - Thomas E. Novotny
- San Diego State University, Graduate School of Public Health, San Diego, California, United States of America
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35895
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Talebi A, Mohammadizadeh F, Hani M, Bagheri M, Bagheri A. Signet ring carcinoma of ampulla of vater. Adv Biomed Res 2014; 3:30. [PMID: 24592377 PMCID: PMC3928835 DOI: 10.4103/2277-9175.124680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/15/2013] [Indexed: 11/14/2022] Open
Abstract
Signet ring carcinoma is a common type of adenocarcinoma of stomach but its occurrence in ampulla of Vater is extremely rare. There are only a few previous reported cases of signet ring carcinoma of ampulla of Vater. Here we reported a 61-year-old woman with obstructive jaundice. Ultrasonography and computed tomography (CT scan) examination showed intra- and extrahepatic bile duct dilatation. Endoscopic examination with biopsies revealed a small-size mass in ampulla of Vater with diagnosis of signet ring carcinoma. On consequent pancreatoduodenectomy the tumor was diagnosed as T2N0M0, stage IB. Because of the specific site of signet ring carcinoma of ampulla of Vater, the tumor seems to present itself at an early stage of disease. We review in the literature to suggest our idea.
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Affiliation(s)
- Ardeshir Talebi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fareshteh Mohammadizadeh
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Hani
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Bagheri
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Bagheri
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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35896
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The impact of timing and duration of thiopurine treatment on first intestinal resection in Crohn's disease: national UK population-based study 1989-2010. Am J Gastroenterol 2014; 109:409-16. [PMID: 24469612 DOI: 10.1038/ajg.2013.462] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The efficacy of thiopurines (TPs) in altering the risk of surgery in Crohn's disease (CD) remains controversial. We evaluated the impact of TP therapy, optimal timing, and duration of TP therapy on first intestinal resection rates using a population-based cohort. METHODS We constructed a population-based cohort of incident cases of CD between 1989 and 2005. We used the Kaplan-Meier analysis to calculate time trends in TP use and first intestinal resection in three groups defined by time period of diagnosis: 1989-1993, 1994-1999, and 2000-2005 groups A, B, and C, respectively. We quantified impact of duration and timing of TP treatment on likelihood of surgery using Cox regression and propensity score matching. RESULTS We identified 5,640 eligible patients with CD. The 5-year cumulative probability of TP use increased from 12, 18, to 25% ( P<0.0001) while probability of first intestinal resection decreased from 15, 12 to 9% (P<0.001) in groups A, B, and C, respectively. Patients treated with at least 6 months of TP therapy had a 44% reduction in the risk of surgery (hazards ratio (HR): 0.56; 95% confidence interval (CI): 0.37-0.85) and those receiving at least 12 months of TP therapy had a 69% reduction in the risk of surgery (HR: 0.31; 95% CI: 0.22-0.44). Early treatment (<12 months from diagnosis) vs. late treatment with TP showed no additional benefit in reducing risk of surgery (HR: 0.41; 95% CI: 0.27-0.61 vs. 0.21; 95% CI: 0.13-0.34). CONCLUSIONS Over the past 20 years, TP use has doubled, whereas intestinal surgery has fallen by one-third among the UK population of Crohn's patients. Prolonged exposure is associated with a reduced likelihood of surgery whereby more than 12 months TP therapy reduces the risk of first intestinal surgery two-fold; however, early initiation of TP treatment offered no apparent additional benefit.
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35897
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Bertocchini A, d'Ambrosio G, Grimaldi C, del Prete L, di Francesco F, Falappa P, Monti L, de Ville de Goyet J. Prehepatic portal hypertension with aneurysm of the portal vein: unusual but treatable malformative pattern. J Pediatr Surg 2014; 49:436-40. [PMID: 24650473 DOI: 10.1016/j.jpedsurg.2013.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Portal vein aneurysms (PVAs) are usually located at the vein trunk or at its bifurcation, rarely intra-hepatic, or at the umbilical portion. Etiology remains unclear. METHODS Three children with PVA were identified over a 5-year period. PVA anatomy was assessed by Doppler Ultrasound, Angio CT/MRI, and trans-jugular retrograde portography. RESULTS Three children with intrahepatic PVA (including the umbilical portion) were identified during assessment for pre-hepatic portal hypertension: all had splenomegaly and hypersplenism. One presented with massive variceal bleeding. In two cases, a portal vein cavernoma was found, and in the third a severe stricture at the portal bifurcation was observed. Restoration of portal venous flow was achieved by a meso-Rex bypass in two cases and transposing the PV into the Rex in one. High hepatopetal portal flow was restored immediately, with follow-up confirming long-term patency and resolution of signs of portal hypertension with time. CONCLUSIONS These original observations suggest a common initial malformative pattern consisting of a portal venous stricture/web causing a post-stenotic aneurysmal dilatation of the intrahepatic portal branches complicated by thrombosis and cavernomatous transformation of the portal vein trunk. Importantly, the Meso-Rex bypass allows restoring a normal portal flow and cures the portal hypertension.
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Affiliation(s)
- Arianna Bertocchini
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy.
| | - Giuseppe d'Ambrosio
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Chiara Grimaldi
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Laura del Prete
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Fabrizio di Francesco
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Piergiorgio Falappa
- Interventional Radiology Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Lidia Monti
- Hepato-biliary Radiology Unit, Department of Imaging, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Jean de Ville de Goyet
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
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35898
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Sun P, Yang X, He RQ, Hu QG, Song ZF, Xiong J, Zheng QC. Antiviral therapy after curative treatment of hepatitis B/C virus-related hepatocellular carcinoma: A systematic review of randomized trials. Hepatol Res 2014; 44:259-69. [PMID: 23607290 DOI: 10.1111/hepr.12115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/10/2013] [Accepted: 03/18/2013] [Indexed: 01/27/2023]
Abstract
AIM Available published work on the benefit of adjuvant antiviral therapy after curative treatment of hepatocellular carcinoma (HCC) reports controversial results. The objective of this systematic review was to evaluate the effect of adjuvant antiviral therapy on recurrence and survival after curative treatment of HCC. METHODS We conducted an extensive search strategy. All randomized controlled trials comparing adjuvant antiviral therapy versus placebo or no treatment were considered for this review. Results were expressed as hazard ratio for time-to-event outcomes with 95% confidence intervals using RevMan 5. RESULTS We included nine trials (three of low risk of bias and six of unclear risk of bias) with 954 patients. All the included studies used conventional interferon (IFN) as adjuvant antiviral therapy; none of them used pegylated IFN or nucleoside analogs. There were significant improvements for recurrence-free survival and overall survival in the adjuvant IFN group compared with the control group. Subgroup analysis also showed a significant difference favoring IFN therapy in hepatitis C virus (HCV)-related HCC patients, but for hepatitis B virus (HBV)-related patients, the difference failed to reach statistical significance. A dose reduction was needed in 28.3% of patients and discontinuation of IFN therapy happened in 8.2% of patients due to moderate to severe side-effects. CONCLUSION Our study suggested potential benefits of adjuvant IFN therapy following curative treatment of HCC, especially for HCV-related HCC. Further high-quality randomized controlled trials of more effective adjuvant antiviral regimens, either used alone or in combination, for virus-related HCC, especially HBV-related HCC, are needed.
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Affiliation(s)
- Ping Sun
- Hepatobiliary Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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35899
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Wu CS, Morgan D, Jew CP, Haskins C, Andrews MJ, Leishman E, Spencer CM, Czyzyk T, Bradshaw H, Mackie K, Lu HC. Long-term consequences of perinatal fatty acid amino hydrolase inhibition. Br J Pharmacol 2014; 171:1420-34. [PMID: 24730060 PMCID: PMC3954482 DOI: 10.1111/bph.12500] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/27/2013] [Accepted: 09/10/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Fatty acid amide hydrolase inhibitors show promise as a treatment for anxiety, depression and pain. Here we investigated whether perinatal exposure to URB597, a fatty acid amide hydrolase inhibitor, alters brain development and affects behaviour in adult mice. EXPERIMENTAL APPROACH Mouse dams were treated daily from gestational day 10.5 to 16.5 with 1, 3 or 10 mg kg−1 URB597. MS was used to measure a panel of endocannabinoids and related lipid compounds and brain development was assessed at embryonic day 16.5. Separate cohorts of mouse dams were treated with 10 mg kg−1 URB597, from gestational day 10.5 to postnatal day 7, and the adult offspring were assessed with a battery of behavioural tests. KEY RESULTS Perinatal URB597 exposure elevated anandamide and related N-acyl amides. URB597 did not induce signs of toxicity or affect dam weight gain, neurogenesis or axonal development at embryonic day 16.5. It did lead to subtle behavioural deficits in adult offspring, manifested by reduced cocaine-conditioned preference, increased depressive behaviours and impaired working memory. Anxiety levels, motor function and sensory-motor gating were not significantly altered. CONCLUSIONS AND IMPLICATIONS Taken together, the present results highlight how exposure to elevated levels of anandamide and related N-acyl amides during brain development can lead to subtle alterations in behaviour in adulthood. LINKED ARTICLES This article is part of a themed section on Cannabinoids 2013. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-6
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Affiliation(s)
- Chia-Shan Wu
- The Cain Foundation Laboratories, Baylor College of MedicineHouston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Baylor College of MedicineHouston, TX, USA
- Department of Pediatrics, Baylor College of MedicineHouston, TX, USA
| | - Daniel Morgan
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Chris P Jew
- The Cain Foundation Laboratories, Baylor College of MedicineHouston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Baylor College of MedicineHouston, TX, USA
- Department of Pediatrics, Baylor College of MedicineHouston, TX, USA
- Program in Developmental Biology, Baylor College of MedicineHouston, TX, USA
| | - Chris Haskins
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Mary-Jeanette Andrews
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Emma Leishman
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Corinne M Spencer
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Baylor College of MedicineHouston, TX, USA
- Department of Genetics, Baylor College of MedicineHouston, TX, USA
| | - Traci Czyzyk
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Heather Bradshaw
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Ken Mackie
- Department of Psychological & Brain Sciences, Indiana UniversityBloomington, IN, USA
| | - Hui-Chen Lu
- The Cain Foundation Laboratories, Baylor College of MedicineHouston, TX, USA
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Baylor College of MedicineHouston, TX, USA
- Department of Pediatrics, Baylor College of MedicineHouston, TX, USA
- Program in Developmental Biology, Baylor College of MedicineHouston, TX, USA
- Department of Neuroscience, Baylor College of MedicineHouston, TX, USA
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35900
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Moran GW, Dubeau MF, Kaplan GG, Yang H, Seow CH, Fedorak RN, Dieleman LA, Barkema HW, Ghosh S, Panaccione R. Phenotypic features of Crohn's disease associated with failure of medical treatment. Clin Gastroenterol Hepatol 2014; 12:434-42.e1. [PMID: 23978351 DOI: 10.1016/j.cgh.2013.08.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/08/2013] [Accepted: 08/13/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is conflicting evidence on the effects of thiopurines (azathioprine or mercaptopurine) and anti-tumor necrosis factor (TNF) therapies on rates of surgery among patients with Crohn's disease (CD). We aimed to identify factors that identify patients who are unlikely to respond to medical therapy and will therefore require surgery. METHODS We performed a retrospective study using the Alberta Inflammatory Bowel Disease Consortium registry to identify 425 patients diagnosed with CD who received a prescription of a thiopurine and/or an anti-TNF agent from a referral center, from July 1, 1975, through September 13, 2012. We collected data on CD-related abdominal surgery after therapy and disease features when therapy was instituted. Cox proportional regression models were used to associate disease features with outcomes after adjusting for potential confounders. Risk estimates were presented as hazard rate ratios (HRRs) with 95% confidence intervals (CIs). RESULTS Among patients given thiopurines, stricturing disease (adjusted HR, 4.63; 95% CI, 2.00-10.71), ileal location (adjusted HR, 6.20; 95% CI, 1.64-23.42), and ileocolonic location (adjusted HR, 3.71; 95% CI, 1.08-12.74) at the time of prescription were associated significantly with the need for surgery. Prescription of an anti-TNF agent after prescription of a thiopurine reduced the risk for surgery, compared with patients prescribed only a thiopurine (adjusted HR, 0.41; 95% CI, 0.22-0.75). Among patients given anti-TNF agents, stricturing (adjusted HR, 6.17; 95% CI, 2.81-13.54) and penetrating disease (adjusted HR, 3.39; 95% CI, 1.45-7.92) at the time of prescription were associated significantly with surgery. Older age at diagnosis (17-40 y) reduced the risk for abdominal surgery (adjusted HR, 0.41; 95% CI, 0.21-0.80) compared with a younger age group (≤16 y). Surgery before drug prescription reduced the risk for further surgeries among patients who received thiopurines (adjusted HR, 0.33; 95% CI, 0.13-0.68) or anti-TNF agents (adjusted HR, 0.49; 95% CI, 0.25-0.96). Terminal ileal disease location was not associated with a stricturing phenotype. CONCLUSIONS Based on a retrospective database analysis, patients prescribed thiopurine or anti-TNF therapy when they have a complicated stage of CD are more likely to require surgery. Better patient outcomes are achieved by treating CD at early inflammation stages; delayed treatment increases rates of treatment failure.
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Affiliation(s)
- Gordon W Moran
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada; Nottingham Digestive Diseases Centre, Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Marie-France Dubeau
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Hong Yang
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Cynthia H Seow
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada
| | - Richard N Fedorak
- Division of Gastroenterology, Department of Medicine University of Alberta, Edmonton, Alberta, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine University of Alberta, Edmonton, Alberta, Canada
| | - Herman W Barkema
- Department of Community Health Sciences, University of Calgary, Alberta, Canada; Department of Production Animal Health, University of Calgary, Alberta, Canada
| | - Subrata Ghosh
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Alberta, Canada; Division of Gastroenterology, University of Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Alberta, Canada.
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