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Hedges CP, Shetty B, Broome SC, MacRae C, Koutsifeli P, Buckels EJ, MacIndoe C, Boix J, Tsiloulis T, Matthews BG, Sinha S, Arendse M, Jaiswal JK, Mellor KM, Hickey AJR, Shepherd PR, Merry TL. Dietary supplementation of clinically utilized PI3K p110α inhibitor extends the lifespan of male and female mice. Nat Aging 2023; 3:162-172. [PMID: 37118113 DOI: 10.1038/s43587-022-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 04/30/2023]
Abstract
Diminished insulin and insulin-like growth factor-1 signaling extends the lifespan of invertebrates1-4; however, whether it is a feasible longevity target in mammals is less clear5-12. Clinically utilized therapeutics that target this pathway, such as small-molecule inhibitors of phosphoinositide 3-kinase p110α (PI3Ki), provide a translatable approach to studying the impact of these pathways on aging. Here, we provide evidence that dietary supplementation with the PI3Ki alpelisib from middle age extends the median and maximal lifespan of mice, an effect that was more pronounced in females. While long-term PI3Ki treatment was well tolerated and led to greater strength and balance, negative impacts on common human aging markers, including reductions in bone mass and mild hyperglycemia, were also evident. These results suggest that while pharmacological suppression of insulin receptor (IR)/insulin-like growth factor receptor (IGFR) targets could represent a promising approach to delaying some aspects of aging, caution should be taken in translation to humans.
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Affiliation(s)
- C P Hedges
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - B Shetty
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - S C Broome
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - C MacRae
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - P Koutsifeli
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - E J Buckels
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - C MacIndoe
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - J Boix
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - T Tsiloulis
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - B G Matthews
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - S Sinha
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - M Arendse
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - J K Jaiswal
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - K M Mellor
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - A J R Hickey
- Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - P R Shepherd
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - T L Merry
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand.
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.
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Tiscar J, Boix J, Mallol G, Pérez J, Gilabert F. Design of new industrial mould filling systems for the manufacture of ceramic tiles using a discrete element framework. POWDER TECHNOL 2022. [DOI: 10.1016/j.powtec.2022.117446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tiscar J, Llorens D, Mallol G, Boix J, Pérez J, Gilabert F. DEM-based modelling framework for spray-dried powders in ceramic tiles industry. Part III: Validation procedure. POWDER TECHNOL 2021. [DOI: 10.1016/j.powtec.2021.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tiscar J, Escrig A, Mallol G, Boix J, Gilabert F. DEM-based modelling framework for spray-dried powders in ceramic tiles industry. Part II: Solver implementation. POWDER TECHNOL 2021. [DOI: 10.1016/j.powtec.2020.08.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jiménez I, Carabia J, Bobillo S, Palacio C, Abrisqueta P, Nieto J, Castellví J, Martínez-Ricarte F, Escoda L, Perla C, Cespedes D, Boix J, Purroy N, Puigdefàbregas L, Seoane J, Bosch F, Crespo M. REVERSAL OF IMMUNE TOLERANCE AND INCREASED SURVIVAL AFTER XPO1 AND BTK INHIBITION IN MOUSE MODELS OF PRIMARY CNS LYMPHOMA (PCNSL). Hematol Oncol 2019. [DOI: 10.1002/hon.131_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I. Jiménez
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - J. Carabia
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - S. Bobillo
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - C. Palacio
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - P. Abrisqueta
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - J.C. Nieto
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - J. Castellví
- Department of Pathology; Vall d'Hebron University Hospital (HUVH), Universitat Autònoma de Barcelona; Barcelona Spain
| | - F. Martínez-Ricarte
- Department of Neurosurgery; Vall d'Hebron University Hospital (HUVH), Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Escoda
- Department of Hematology; Hospital Universitari Joan XIII; Tarragona Spain
| | - C. Perla
- Department of Neurosurgery; Hospital Universitari Joan XIII; Tarragona Spain
| | - D.H. Cespedes
- Department of Neurosurgery; Hospital Universitari Joan XIII; Tarragona Spain
| | - J. Boix
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - N. Purroy
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - L. Puigdefàbregas
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - J. Seoane
- Translational Research Program; Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Universitat Autònoma de Barcelona, CIBERONC; Barcelona Spain
| | - F. Bosch
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
| | - M. Crespo
- Laboratory of Experimental Hematology; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH); Barcelona Spain
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Bon I, Bartolí R, Cano-Sarabia M, de la Ossa N, de Vega VM, Marín I, Boix J, Lorenzo-Zúñiga V. Comparative study of electrical and rheological properties of different solutions used in endoscopic mucosal resection. Dig Endosc 2019; 31:276-282. [PMID: 30430648 DOI: 10.1111/den.13297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM The study of electrical and rheological properties of solutions to carry out endoscopic resection procedures could determinate the best candidate. An ex vivo study with porcine stomachs was conducted to analyze electrical resistivity (R) and rheological properties (temperature, viscosity, height and lasting of the cushion) of different substances used in these techniques. METHODS Tested solutions were: 0.9% saline (S), platelet-rich plasma (PRP), Gliceol (GC), hyaluronic acid 2% (HA), Pluronic-F127 20% (PL), saline with 10% glucose (GS), Gelaspan (GP), Covergel-BiBio (TB) and PRP with TB (PRP+TB). Measurements of electrical and rheological properties were done at 0, 15, 30, 45 and 60 min after submucosal injection. RESULTS Solutions showed a wide variability of transepithelial R after submucosal injection. Substances able to maintain the highest R 60 min postinjection were TB (7 × 104 Ω), HA (7 × 104 Ω) and PL (7 × 104 Ω). Protective solutions against deep thermal injury (Tª lower than 60°C) were PL (47.6°C), TB (55°C) and HA (56.63°C). Shortest time to carry out resections were observed with GC (17.66″), PRP (20.3″) and GS (23.45″). Solutions with less cushion decrease (<25%) after 60 min were TB (11.74%), PL (18.63%) and PRP (22.12%). CONCLUSIONS Covergel-BiBio, PL and HA were the best solutions with long-term protective effects (transepithelial R, lower thermal injury and less cushion decrease). Solutions with quicker resection time were GC, PRP and GS.
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Affiliation(s)
- Ignacio Bon
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Ramón Bartolí
- Network Biomedical Research Center of Hepathic and Digestive Diseases (CIBERehd), CSIC and The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Mary Cano-Sarabia
- Catalan Institute of Nanoscience and Nanotechnology, CSIC and The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Napoleón de la Ossa
- Department of Pathology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - Ingrid Marín
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jaume Boix
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Network Biomedical Research Center of Hepathic and Digestive Diseases (CIBERehd), CSIC and The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Network Biomedical Research Center of Hepathic and Digestive Diseases (CIBERehd), CSIC and The Barcelona Institute of Science and Technology, Barcelona, Spain
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Lorenzo-Zúñiga V, de Vega VM, Bartolí R, Marín I, Caballero N, Bon I, Boix J. Submucosal injection of platelet-rich plasma in endoscopic resection of large sessile lesions. World J Gastrointest Endosc 2018; 10:348-353. [PMID: 30487945 PMCID: PMC6247099 DOI: 10.4253/wjge.v10.i11.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/08/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively evaluate the efficacy of submucosal injection of platelet-rich plasma (PRP) on endoscopic resection of large sessile lesions. METHODS Eleven patients were submitted to endoscopic mucosal resection (EMR) with prior injection of PRP, obtained at the time of endoscopy. Patients were followed during 1 mo. The incidence of adverse events (delayed bleeding or perforation) and the percentage of mucosal healing (MHR) after 4 wk were registered. RESULTS EMR was performed in 11 lesions (46.4 mm ± 4 mm, range 40-70 mm). Delayed bleeding or perforation was not observed in any patient. Mean ulcerated area at baseline was 22.7 cm2 ± 11.7 cm2 whereas at week 4 were 2.9 cm2 ± 1.5 cm2. Patients treated with PRP showed a very high MHR after 4 wk (87.5%). CONCLUSION PRP is an easy-to-obtain solution with proven and favourable biological activities that could be used in advanced endoscopic resection.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Vicente Moreno de Vega
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Ramón Bartolí
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Ingrid Marín
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Noemí Caballero
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Ignacio Bon
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
| | - Jaume Boix
- Department of Gastrointestinal Endoscopy, University Hospital Germans Trias/CIBERehd, Barcelona 08916, Spain
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Lorenzo-Zúñiga V, Boix J, Moreno de Vega V, Bon I, Marín I, Bartolí R. Endoscopic shielding technique with a newly developed hydrogel to prevent thermal injury in two experimental models. Dig Endosc 2017; 29:702-711. [PMID: 28294423 DOI: 10.1111/den.12864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM A newly developed hydrogel, applied through the endoscope as an endoscopic shielding technique (EndoSTech), is aimed to prevent deep thermal injury and to accelerate the healing process of colonic induced ulcers after therapeutic endoscopy. METHODS Lesions were performed in rats (n = 24) and pigs (n = 8). Rats were randomized to receive EndoSTech (eight rats each) with: saline (control), hyaluronic acid and product. In pigs, three ulcer sites were produced in each pig: endoscopic mucosal resection (EMR)-ulcer with prior saline injection (A; EMR-saline), EMR-saline plus EndoSTech with product (B; EMR-saline-P), and EMR with prior injection of product plus EndoSTech-P (C; EMR-P-P). At the end of the 14-day study, the same lesions were performed again in healthy mucosa to assess acute injury. Animals were sacrificed after 7 (rats) and 14 (pigs) days. Ulcers were macroscopically and histopathologically evaluated. Thermal injury (necrosis) was assessed with a 1-4 scale. RESULTS In rats, treatment with product improved mucosal healing comparing with saline and hyaluronic acid (70% vs 30.3% and 47.2%; P = 0.003), avoiding mortality (0% vs 50% and 25%; P = 0.038), and perforation (0% vs 100% and 33.3%; P = 0.02); respectively. In pigs, submucosal injection of product induced a marked trend towards a less deep thermal injury (C = 2.25-0.46 vs A and B = 2.75-0.46; P = 0.127). Mucosal healing rate was higher with product (B = 90.2-3.9%, C = 91.3-5.5% vs A = 73.1-12.6%; P = 0.002). CONCLUSIONS This new hydrogel demonstrates strong healing properties in preclinical models. In addition, submucosal injection of this product is able to avoid high thermal load of the gastrointestinal wall.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jaume Boix
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio Bon
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Ramón Bartolí
- Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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Lorenzo-Zúñiga V, Boix J, Moreno de Vega V, Bon I, Marín I, Bartolí R. Endoscopic shielding technique with a newly developed hydrogel to prevent thermal injury in two experimental models. Dig Endosc 2017. [PMID: 28294423 DOI: 10.111/den.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
BACKGROUND AND AIM A newly developed hydrogel, applied through the endoscope as an endoscopic shielding technique (EndoSTech), is aimed to prevent deep thermal injury and to accelerate the healing process of colonic induced ulcers after therapeutic endoscopy. METHODS Lesions were performed in rats (n = 24) and pigs (n = 8). Rats were randomized to receive EndoSTech (eight rats each) with: saline (control), hyaluronic acid and product. In pigs, three ulcer sites were produced in each pig: endoscopic mucosal resection (EMR)-ulcer with prior saline injection (A; EMR-saline), EMR-saline plus EndoSTech with product (B; EMR-saline-P), and EMR with prior injection of product plus EndoSTech-P (C; EMR-P-P). At the end of the 14-day study, the same lesions were performed again in healthy mucosa to assess acute injury. Animals were sacrificed after 7 (rats) and 14 (pigs) days. Ulcers were macroscopically and histopathologically evaluated. Thermal injury (necrosis) was assessed with a 1-4 scale. RESULTS In rats, treatment with product improved mucosal healing comparing with saline and hyaluronic acid (70% vs 30.3% and 47.2%; P = 0.003), avoiding mortality (0% vs 50% and 25%; P = 0.038), and perforation (0% vs 100% and 33.3%; P = 0.02); respectively. In pigs, submucosal injection of product induced a marked trend towards a less deep thermal injury (C = 2.25-0.46 vs A and B = 2.75-0.46; P = 0.127). Mucosal healing rate was higher with product (B = 90.2-3.9%, C = 91.3-5.5% vs A = 73.1-12.6%; P = 0.002). CONCLUSIONS This new hydrogel demonstrates strong healing properties in preclinical models. In addition, submucosal injection of this product is able to avoid high thermal load of the gastrointestinal wall.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jaume Boix
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio Bon
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Ramón Bartolí
- Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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Lorenzo-Zúñiga V, Boix J, Moreno de Vega V, Bon I, Marín I, Bartolí R. Efficacy of platelet-rich plasma as a shielding technique after endoscopic mucosal resection in rat and porcine models. Endosc Int Open 2016; 4:E859-64. [PMID: 27540573 PMCID: PMC4988838 DOI: 10.1055/s-0042-109170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/23/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The aims were to assess the efficacy of endoscopic application of Platelet-rich plasma (PRP) to prevent delayed perforation and to induce mucosal healing after endoscopic resections. PATIENTS AND METHODS Colonic induced lesions were performed in rats (n = 16) and pigs (n = 4). Animals were randomized to receive onto the lesions saline (control) or PRP. Animals underwent endoscopic follow-up. Thermal injury was assessed with a 1 - 4 scale: (1) mucosal necrosis; (2) submucosal necrosis; (3) muscularis propria necrosis; and (4) serosal necrosis RESULTS Saline treatment showed 50 % of mortality in rats (P = 0.02). Mean ulcerated area after 48 hours and 7 days was significantly smaller with PRP than with saline (0.27 ± 0.02 cm(2) and 0.08 ± 0.01 cm(2) vs. 0.56 ± 0.1 cm(2) and 0.40 ± 0.06 cm(2); P < 0.001). The incidence of thermal injury was significantly lower with PRP (1.25 ± 0.46) than in controls (2.25 ± 0.50); P = 0.006. The porcine model showed a trend toward higher mucosal restoration in animals treated with PRP than with saline at weeks 1 and 2 (Median area in cm(2): 0.55 and 0.40 vs. 1.32 and 0.79) CONCLUSIONS: Application of PRP to colonic mucosal lesions showed strong healing properties in rat and porcine models.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jaume Boix
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio Bon
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ramón Bartolí
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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Lorenzo-Zúñiga V, Moreno de Vega V, Marín I, Barberá M, Boix J. Improving the quality of colonoscopy bowel preparation using a smart phone application: a randomized trial. Dig Endosc 2015; 27:590-5. [PMID: 25708251 DOI: 10.1111/den.12467] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/21/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Getting ready for a colonoscopy is difficult and involves many steps. Information given to patients is very important for adherence to treatment. We created a novel smart phone application (SPA) aimed to increase bowel preparation quality and patient satisfaction. METHODS We carried out a prospective, endoscopist-blinded, randomized, controlled trial. We enrolled 260 outpatient (58% female, age range 21-75 years) owners of a smartphone. Patients were allocated to two different protocols: instructions provided by SPA (SPA group; n = 108) or written instructions with visual aids (control group; n = 152). All procedures were carried out in the afternoon and patients received the same purgative regimen (2 L polyethylene glycol (PEG) solution plus ascorbic acid), in a full-dose same-day regimen. The study was designed to detect an improvement in quality of bowel preparation using the Harefield Cleansing Scale (HCS) scale. Effect of protocol on patient satisfaction was assessed with a specific questionnaire at the time of colonoscopy. RESULTS Proportion of patients who obtained successful bowel preparation for colonoscopy (HCS A or B) was significantly higher in the SPA group than in the control group (100% vs 96.1%, respectively; P = 0.037). Mean global HCS scores were similar in both groups. Patient-reported tolerability and overall experience with the prescribed bowel preparation were significantly higher for the SPA group than for the control group. CONCLUSION Successful cleansing and patient acceptability with the use of SPA were superior to written instructions in outpatients submitted for colonoscopy using 2 L PEG solution plus ascorbic acid.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Digest Center, Barcelona, Spain.,Endoscopy Unit, University Hospital Germans Trias i Pujol, Barcelona, Spain.,Center for Biomedical Research Network on Liver and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Digest Center, Barcelona, Spain.,Endoscopy Unit, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Jaume Boix
- Endoscopy Unit, Digest Center, Barcelona, Spain.,Endoscopy Unit, University Hospital Germans Trias i Pujol, Barcelona, Spain
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Zabana Y, Mañosa M, Cabré E, Bernal I, Marín L, Lorenzo-Zúñiga V, Moreno V, Boix J, Domènech E. Addition of mesalazine for subclinical post-surgical endoscopic recurrence of Crohn's disease despite preventive thiopurine therapy: A case-control study. J Gastroenterol Hepatol 2014; 29:1413-7. [PMID: 24627958 DOI: 10.1111/jgh.12579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Thiopurines prevent Crohn's disease (CD) endoscopic recurrence (ER) at least in 50% of patients 1 year after surgery. This study aimed to evaluate the value of adding mesalazine in patients with subclinical ER despite preventive thiopurine therapy. METHODS Crohn's disease patients with ileocecal resection treated with thiopurines for postsurgical recurrence prevention in whom mesalazine was added (cases) to treat ER without clinical recurrence (CR) were identified and compared with those in whom no treatment was added to thiopurines (controls). All patients were followed up for at least 1 year from the index endoscopy. Development of CR as well as evolution of mucosal lesions was evaluated. RESULTS Thirty-seven patients were included (19 cases and 18 controls). Initial Rutgeerts' score was i2 in 16 patients (9 cases and 7 controls), and i3 in 21 patients (10 cases and 11 controls). After a median clinical follow-up of 59 months (interquartile range 22-100) from the index endoscopy, six cases (32%) and two controls (11%) developed CR (P = 0.2). After a median time to last endoscopic follow-up of 23 months (interquartile range 17-71), 18 patients (49%) showed improvement in Rutgeerts' score, 11 patients (30%) demonstrated progression of mucosal lesions, and 8 (22%) had no changes, with no differences between study groups. CONCLUSIONS The addition of mesalazine seems to be of no benefit in patients with subclinical endoscopic recurrence while on thiopurine prevention. Moderate endoscopic postsurgical recurrence while on thiopurines may even revert with no additional therapy in some patients.
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Affiliation(s)
- Yamile Zabana
- Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Catalonia, Spain
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Lorenzo-Zúñiga V, Moreno-de-Vega V, Marín I, Boix J. Biodegradable stents in gastrointestinal endoscopy. World J Gastroenterol 2014; 20:2212-2217. [PMID: 24605020 PMCID: PMC3942826 DOI: 10.3748/wjg.v20.i9.2212] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/22/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs. Otherwise, the price of these stents therefore it is nowadays an important limitation.
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Lorenzo-Zúñiga V, Boix J, Moreno-de-Vega V, de-la-Ossa ND, Òdena G, Bartolí R. Microperforation of the colon: animal model in rats to reproduce mucosal thermal damage. J Surg Res 2014; 188:415-8. [PMID: 24560429 DOI: 10.1016/j.jss.2014.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/07/2013] [Accepted: 01/24/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of the present study was to develop a rat model of colonic microperforation secondary to thermal injury for future studies to assess new treatments. METHODS Twenty-four male Sprague-Dawley rats were used in this study. Hot biopsy forceps were used for all treatments. All lesions were created in proximal left colon using the soft coagulation setting. The power setting tested was 40 W, and the durations of monopolar soft coagulation application evaluated were 2, 3, and 4 s. RESULTS In the acute phase, 48 h after thermal injury, durations of cautery of 2 and 3 s resulted in transmural necrosis, whereas with 4 s microperforation was obtained. In the late phase, 7 d after the damage, only duration of cautery of 4 s showed deep cautery effects, with signs of peritonitis. CONCLUSIONS We determined optimal power settings and duration of therapy in a rat model for producing electrocautery that involves transmural necrosis with microperforation.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
| | - Jaume Boix
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicente Moreno-de-Vega
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Napoleón D de-la-Ossa
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gemma Òdena
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Institut Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Ramon Bartolí
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Institut Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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Bartolí R, Boix J, Òdena G, De la Ossa ND, de Vega VM, Lorenzo-Zúñiga V. Colonoscopy in rats: An endoscopic, histological and tomographic study. World J Gastrointest Endosc 2013; 5:226-230. [PMID: 23678375 PMCID: PMC3653021 DOI: 10.4253/wjge.v5.i5.226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 03/05/2013] [Accepted: 03/15/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To describe colon anatomy with colonoscopy and computed tomography (CT) to develop a rat model for future studies of therapeutic colonoscopy.
METHODS: Eighteen male Sprague-Dawley rats, on average 400-420 g, underwent total colonoscopy, CT and histological examination. Colonoscopy was performed after bowel preparation with a baby upper gastrointestinal endoscopy with an outer diameter of 6.7 mm. CT obtained a 3D image of total colon after a rectal enema with radiological contrast. Macroscopic and microscopic examinations were examined with a conventional technique (hematoxylin and eosin). Colonic wall thickness, length and diameter measurements were taken from the anus, 3, 7, 14 and 20 cm from the anal margin.
RESULTS: The median colonoscope depth was 24 cm (range 20-28 cm). Endoscopic and tomographic study of colon morphology showed an easy access with tubular morphology in the entire left colon (proximal left colon and rectum). Transverse colon was unapparent on colonoscopy. Right colon, proximal to the splenic flexure, was the largest part of the colon and assumed saccular morphology with tangential trabecula. Radiological measurements of the colonic length and diameter substantiate a subdivision of the right colon into two parts, the cecum and distal right colon. In addition, histological measurement of the colonic wall thickness confirmed a progressive decrease from rectum to cecum. The muscular layer was thinner in the proximal left colon.
CONCLUSION: The combination of colonoscopy, tomography and histology leads to a better characterization of the entire colon. These data are important for deciding when to perform endoscopic resections or when to induce perforations to apply endoscopic treatments.
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Oller B, Haetta HH, Lorenzo-Zúñiga V, Julián JF, de Vega VM, Fernández-Llamazares J, Boix J. Double somatostatinoma and double papillectomy in a patient with type 1 neurofibromatosis (von Recklinghausen's disease). Endoscopy 2013; 44 Suppl 2 UCTN:E344-5. [PMID: 23012013 DOI: 10.1055/s-0032-1309912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- B Oller
- Endoscopy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Lorenzo-Zúñiga V, Boix J, Mañosa M, Lezcano C, Cabré E, Moreno de Vega V, Domènech E. Local injection of infliximab in symptomatic isolated mucosal lesions: a novel scenario for endoscopic therapy? Inflamm Bowel Dis 2013; 19:E59-61. [PMID: 22605623 DOI: 10.1002/ibd.23018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Lorenzo-Zúñiga V, Moreno-de-Vega V, Boix J. Preparation for colonoscopy: types of scales and cleaning products. Rev esp enferm dig 2012; 104:426-31. [DOI: 10.4321/s1130-01082012000800006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Naves JE, Lorenzo-Zúñiga V, Marín L, Mañosa M, Oller B, Moreno V, Zabana Y, Boix J, Cabré E, Domènech E. Long-term outcome of patients with distal ulcerative colitis and inflammation of the appendiceal orifice. J Gastrointestin Liver Dis 2012. [PMID: 22187699 DOI: 10.1016/s0016-5085(98)80095-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Skip inflammation of the appendiceal orifice has been described in distal UC (UC-IAO) but long-term clinical outcomes are poorly established. Our aim was to evaluate the long-term clinical outcomes of UC-IAO as compared to classic distal UC. METHODS Patients with UC-IAO were identified from the local IBD database. Disease outcome and therapeutic requirements during follow-up were accurately collected, and compared with a control group of patients with distal UC without peri-appendiceal involvement matched by disease extent (proctitis/distal), smoking habit, and date and age at diagnosis. RESULTS Fourteen UC patients were found to have UC-IAO, most of them with initial extent of UC limited to the rectum. All patients were initially managed with mesalazine administered orally (28.5%), topically (28.5%), or in combination (43%). After a median follow-up of 78 months (interquartile range--IQR 45-123) most UC-IAO patients were successfully managed with oral and/or topical aminosalicylates. Only one of them developed proximal disease progression. As compared to controls, no differences in clinical outcomes or therapeutic requirements were found. CONCLUSIONS Patients with UC-IAO tend to present a mild course, with a low probability to develop proximal progression of disease extent or to require immunosuppressive therapy or colectomy.
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Affiliation(s)
- Juan E Naves
- Germans Trias i Pujol University Hospital, Centro de Investigación Biomédica en red en Enfermedades Hepatica y Digestivas, Badalona, Spain
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Lorenzo-Zúñiga V, García-Planella E, Moreno De Vega V, Domènech E, Boix J. [Endoscopic management of luminal stenosis in inflammatory bowel disease]. Gastroenterol Hepatol 2012; 35:404-10. [PMID: 22341673 DOI: 10.1016/j.gastrohep.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/09/2011] [Indexed: 11/27/2022]
Abstract
Luminal stenosis is frequent in Crohn's disease (CD) due to transmural involvement. Before any endoscopic treatment, the presence of neoplastic stenosis should always be excluded. Endoscopic balloon dilatation has been used in several series to treat benign stenosis, mainly in CD with involvement of the distal ileon, colon or surgical anastomosis, with success rates of 51% to 85%, although recurrence is high. The concomitant use of injected steroids (triamcinolone) after endoscopic dilatation produces longer-lasting results, but there are few published reports. In patients with luminal stenosis refractory to conventional endoscopy, three emerging techniques may be useful: self-expanding metallic stents, biodegradable endoprostheses and intralesional infliximab injection.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Unidad de Endoscopias, Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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Boix J, Lorenzo-Zúñiga V. Radiation dose to patients during endoscopic retrograde cholangiopancreatography. World J Gastrointest Endosc 2011; 3:140-4. [PMID: 21860683 PMCID: PMC3159502 DOI: 10.4253/wjge.v3.i7.140] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/23/2011] [Accepted: 07/31/2011] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of the hepatobiliary system. The use of fluoroscopy to aid ERCP places both the patient and the endoscopy staff at risk of radiation-induced injury. Radiation dose to patients during ERCP depends on many factors, and the endoscopist cannot control some variables, such as patient size, procedure type, or fluoroscopic equipment used. Previous reports have demonstrated a linear relationship between radiation dose and fluoroscopy duration. When fluoroscopy is used to assist ERCP, the shortest fluoroscopy time possible is recommended. Pulsed fluoroscopy and monitoring the length of fluoroscopy have been suggested for an overall reduction in both radiation exposure and fluoroscopy times. Fluoroscopy time is shorter when ERCP is performed by an endoscopist who has many years experience of performing ERCP and carried out a large number of ERCPs in the preceding year. In general, radiation exposure is greater during therapeutic ERCP than during diagnostic ERCP. Factors associated with prolonged fluoroscopy have been delineated recently, but these have not been validated.
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Affiliation(s)
- Jaume Boix
- Jaume Boix, Vicente Lorenzo-Zúñiga, Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona 08916, Spain
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García-Castellanos R, López R, de Vega VM, Ojanguren I, Piñol M, Boix J, Domènech E, Cabré E. Idiopathic myointimal hyperplasia of mesenteric veins and pneumatosis intestinalis: a previously unreported association. J Crohns Colitis 2011; 5:239-44. [PMID: 21575888 DOI: 10.1016/j.crohns.2010.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 02/08/2023]
Abstract
Idiopathic myointimal hyperplasia of mesenteric veins is a very rare disease occurring in young male patients, with no more than eight cases reported in the world literature. It causes venous ischemia in the sigmoid colon and rectum that clinically resembles inflammatory bowel disease. Pneumatosis intestinalis is also a rare condition usually associated to a wide range of diseases including bowel ischemia. We herein report on a case of pneumatosis intestinalis associated to idiopathic myointimal hyperplasia of mesenteric veins. To our knowledge, this is the first report of such an association, and the first one of idiopathic myointimal hyperplasia of mesenteric veins occurring in a female patient as well.
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Affiliation(s)
- Raquel García-Castellanos
- G-I Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona. Catalonia, Spain
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Abstract
AIM This study analysed trends in polypoid colorectal cancer (PCRC) diagnosed by colonoscopy during the period 1995-2008 and compared the patterns observed in the years 2005-2008 with 1995-1998. METHOD In the period 1995-2008, 24,245 colonoscopies were performed and 1041 patients with PCRC were diagnosed: pediculated (n = 220) or sessile (n = 821). RESULTS The mean age at diagnosis was 68.3 ± 11.6 years. Males were more likely to have PCRC (males 62.6%vs females 37.4%; P < 0.0001). Significantly more pediculated PCRCs were located in the distal colon (P < 0.001). In the 2005-2008 period the prevalence of PCRC among patients undergoing colonoscopy decreased, the number of polypectomies increased significantly (P < 0.0001) and the pediculated PCRC location changed, with a significant increase in right-sided lesions. CONCLUSION The prevalence of PCRC in patients undergoing colonoscopy decreased, with a significant increase in the number of polypectomies in the last decade. Pediculated PCRCs were more often located in the left colon and sessile PCRCs in the right colon. From the period 1995-1998 to 2005-2008 the location of pediculated PCRCs changed, with an increase in right-sided lesions.
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Affiliation(s)
- V Lorenzo-Zúñiga
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Abstract
AIM We aimed to determine the incidence of colonic perforation (CP) following colonoscopy and postpolypectomy bleeding (PPB) in a teaching hospital, assessing the influence of endoscopist experience as a risk factor. METHOD All colonoscopies performed between 1995 and 2008 were reviewed. Demographic data, endoscopic procedure information, incidence of CP and PPB, and endoscopist experience were recorded. RESULTS In the 14-year period, 25,214 endoscopic colonic procedures were performed, and 3991 patients underwent polypectomy. The overall CP risk was 0.51/1000 procedures; and PPB 14.7/1000. The relative risk (RR) ratio of complications was 2.8/1000 procedures. The RR rate was highest for endoscopists performing less than 591 procedures per year (4.0/1000 [95% CI, 3.7-4.3] vs 2.9/1000 [95% CI, 2.6-3.2]), P < 0.001). CONCLUSION The complication rate after colonoscopy was comparable to that previously reported. Colonoscopy carried out by a low-volume endoscopist was independently associated with bleeding and perforation.
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Affiliation(s)
- V Lorenzo-Zúñiga
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Carrión S, Marín I, Lorenzo-Zúñiga V, Moreno De Vega V, Boix J. Adecuación de la indicación de la colonoscopia según los nuevos criterios de EPAGE II. Gastroenterología y Hepatología 2010; 33:484-9. [DOI: 10.1016/j.gastrohep.2010.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/05/2010] [Accepted: 05/06/2010] [Indexed: 12/13/2022]
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Boix J, Cauli O, Felipo V. Developmental exposure to polychlorinated biphenyls 52, 138 or 180 affects differentially learning or motor coordination in adult rats. Mechanisms involved. Neuroscience 2010; 167:994-1003. [PMID: 20223283 DOI: 10.1016/j.neuroscience.2010.02.068] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 02/08/2010] [Accepted: 02/24/2010] [Indexed: 11/28/2022]
Abstract
Exposure to polychlorinated biphenyls (PCBs) during pregnancy and lactation leads to cognitive impairment and motor disorders in children by mechanisms which remain unknown. It also remains unclear whether different non-dioxin-like PCBs have similar or different mechanisms of neurotoxicity. The main aims of this work were: (1) to assess whether developmental exposure to non-dioxin-like-PCBs 52, 138 or 180 affect cognitive function or motor coordination in 3-4 months-old rats; (2) to shed light on the underlying mechanisms. Female rats were treated with PCBs (1 mg/kg day) in food from gestational-day 7 to postnatal-day 21. The ability to learn a Y maze conditional discrimination task was reduced in rats exposed to PCBs 138 or 180, but not in rats exposed to PCB52. The function of the glutamate-nitric oxide-cGMP pathway (NMDA-induced increase in extracellular cGMP) in cerebellum in vivo was reduced by 33-59% in rats exposed to PCBs 138 or 180, but not by PCB52. The amount of NR1 subunit of NMDA receptors was reduced by 41-49% in rats exposed to PCBs 138 or 180, but not by PCB 52. PCB52 but not 138 or 180 increases extracellular GABA in cerebellum and impairs motor coordination. The effects were similar in males and females. Developmental exposure to different non-dioxin-like PCBs induces different behavioural alterations by different mechanisms. PCB52 impairs motor coordination but not learning while PCB138 or 180 impair learning but not motor coordination. These data are consistent with the following possible mechanisms: (1) developmental exposure to PCBs 138 or 180 reduces the amount of NMDA receptors in cerebellum, which would contribute to reduced function of the glutamate-NO-cGMP pathway, which, in turn, would be a main contributor to the impairment of the ability to learn the Y maze task. (2) Developmental exposure to PCB52 increases extracellular GABA in cerebellum, which would contribute to motor coordination impairment.
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Affiliation(s)
- J Boix
- Laboratory of Neurobiology, Centro de Investigacion Principe Felipe, Avda Autopista del Saler, 16, 46012 Valencia, Spain
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Mañosa M, Naves JE, Leal C, Cabré E, Moreno V, Lorenzo-Zuñiga V, Boix J, Domènech E. Does methotrexate induce mucosal healing in Crohn's disease? Inflamm Bowel Dis 2010; 16:377-8. [PMID: 19575354 DOI: 10.1002/ibd.21015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Boix J, Lorenzo-Zúñiga V. [Seeking for the quality in colonoscopy]. Med Clin (Barc) 2010; 134:68-9. [PMID: 19896148 DOI: 10.1016/j.medcli.2009.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 09/23/2009] [Indexed: 11/28/2022]
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Boix J, Lorenzo-Zúñiga V, Añaños F, Moreno de Vega V, Planas R. A 2-rooms-per-endoscopist model enhances efficiency in GI endoscopy. Gastrointest Endosc 2009; 70:1047-8; author reply 1048-9. [PMID: 19879412 DOI: 10.1016/j.gie.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 03/05/2009] [Indexed: 02/08/2023]
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De Boever P, Boix J, Hollanders K, Felipo V, Schoeters G. Gene expression profiling in rat cerebellum and striatum following in utero and lactational exposure to non-dioxin-like polychlorinated biphenyls. Toxicol Lett 2009. [DOI: 10.1016/j.toxlet.2009.06.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lorenzo-Zúñiga V, Moreno de Vega V, Moreno P, Muchard J, Boix J. Endoscopic placement of postpyloric nasoenteric feeding tubes: the importance of the guidewire used. Clin Nutr 2009; 28:355-6. [PMID: 19286289 DOI: 10.1016/j.clnu.2009.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/17/2009] [Indexed: 10/21/2022]
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Lorenzo-Zúñiga V, Moreno De Vega V, Domènech E, Boix J. [Diagnosis and treatment of ampullary tumors]. Gastroenterol Hepatol 2009; 32:101-8. [PMID: 19231683 DOI: 10.1016/j.gastrohep.2008.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 02/19/2008] [Indexed: 01/04/2023]
Abstract
Tumors of the ampulla of Vater are called ampullary tumors and can arise from any of the three epithelia (duodenal, pancreatic and biliary) that delimit the papilla. These tumors are clinically important and early identification, appropriate staging and proper treatment are essential. The symptoms of these tumors are non-specific and not always evident. All ampullary tumors must be resected but opinions differ on the optimal method of excision. Currently, controlled trials are lacking and consequently the treatment chosen must be individually tailored according to the characteristics of the patient and the tumor. Curative treatment may be endoscopic or surgical. In patients who are not candidates for curative treatment, palliative treatment through drainage can be performed.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Unidad de Endoscopias, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD).
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Domènech E, Vega R, Ojanguren I, Hernández A, Garcia-Planella E, Bernal I, Rosinach M, Boix J, Cabré E, Gassull MA. Cytomegalovirus infection in ulcerative colitis: a prospective, comparative study on prevalence and diagnostic strategy. Inflamm Bowel Dis 2008; 14:1373-9. [PMID: 18452205 DOI: 10.1002/ibd.20498] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection has been reported in ulcerative colitis (UC), especially in severe, steroid-refractory disease. However, its role in steroid-refractoriness remains unknown. Our goals were to evaluate the prevalence of CMV disease in UC, the best diagnostic strategy, and the influence of disease activity and/or treatment in its development. METHODS Prospective, observational study including 114 subjects with active UC requiring intravenous steroids, steroid-refractory UC, inactive UC on mesalamine, inactive UC on azathioprine, and healthy controls. CMV antibodies, pp65-antigenemia, and rectal biopsies for hematoxylin and eosin staining, immunohistochemistry, and CMV-pp67 mRNA were performed. These procedures were repeated after medical treatment only in patients with active UC. CMV disease was defined by the presence of inclusion bodies and/or positive immunohistochemistry in colonic biopsies. RESULTS CMV disease was found in 6 steroid-refractory, CMV-IgG-positive UC patients but not among controls, inactive UC, or steroid-responding UC patients. In 5 out of the 6 patients, CMV disease was diagnosed after 7-10 days on cyclosporine. CONCLUSIONS CMV disease in UC only affects seropositive, steroid-refractory UC patients. Steroid/cyclosporine treatment together with disease activity may predispose to latent colonic CMV reactivation. The impact of antiviral therapy on the clinical outcome of these patients remains to be elucidated.
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Affiliation(s)
- Eugeni Domènech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain.
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Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Domènech E, Gassull MA. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc 2008; 23:45-9. [DOI: 10.1007/s00464-008-9866-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 01/01/2008] [Indexed: 12/18/2022]
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Domènech E, Mañosa M, Bernal I, Garcia-Planella E, Cabré E, Piñol M, Lorenzo-Zúñiga V, Boix J, Gassull MA. Impact of azathioprine on the prevention of postoperative Crohn's disease recurrence: results of a prospective, observational, long-term follow-up study. Inflamm Bowel Dis 2008; 14:508-13. [PMID: 18183602 DOI: 10.1002/ibd.20359] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postoperative recurrence (PR) occurs early after intestinal resection in >75% of Crohn's disease (CD) patients. No well-established strategy for long-term PR prevention is available. The aim was to prospectively evaluate the long-term endoscopic and clinical outcomes of postoperative CD on maintenance treatment with azathioprine (AZA), especially in patients who developed endoscopic lesions confined to the ileocolic anastomosis. METHODS Long-term AZA therapy (2-2.5 mg/kg/day) was initiated immediately after surgery in 56 consecutive patients who underwent a curative intestinal resection. Clinical and biological assessments every 3 months, as well as yearly endoscopic evaluation, were performed until the end of the study or clinical PR (CPR). RESULTS Thirty-seven patients (70%) showed mucosal lesions at endoscopy after a median of 12 months (range 12-60); however, in 15 of these patients lesions were confined to the anastomosis and only 6 showed endoscopic progression, but none of them developed CPR. Among the remaining 22 patients with endoscopic PR (EPR), 23% suffered a CPR during follow-up. Thirty percent of patients remained free of EPR after a median follow-up of 33 months (range 12-84). The cumulative probability of EPR was 44%, 53%, 69%, and 82%, at 1, 2, 3, and 5 years, respectively. No predictive factors of EPR were found. CONCLUSIONS Early postoperative use of AZA seems to delay EPR development in comparison to historical series or placebo groups in randomized controlled trials. Although usually considered as endoscopic recurrence, those lesions confined to the ileocolonic anastomosis are not likely to progress or to become symptomatic in the short term.
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Affiliation(s)
- Eugeni Domènech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.
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Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Gassull MA. Acute appendicitis diagnosed with high-resolution endoscopy plus narrow-band imaging. Endoscopy 2008; 38 Suppl 2:E45. [PMID: 17366404 DOI: 10.1055/s-2006-944677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J Boix
- Endoscopy Unit, Dept. of Gastroenterology, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
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Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Cabré E, Añaños FE, Domènech E, Gassull MA. Identification of significant difficulty of selective deep cannulation by a simple predictive model: an endoscopic scale for teaching ERCP. Surg Endosc 2007; 22:1678-85. [DOI: 10.1007/s00464-007-9690-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 10/15/2007] [Indexed: 11/29/2022]
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Fernández-Bañares F, Esteve-Comas M, Mañé J, Navarro E, Bertrán X, Cabré E, Bartolí R, Boix J, Pastor C, Gassull MA. Changes in mucosal fatty acid profile in inflammatorybowel disease and in experimental colitis: a common response to bowel inflammation. Clin Nutr 2007; 16:177-83. [PMID: 16844596 DOI: 10.1016/s0261-5614(97)80003-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/1997] [Accepted: 05/05/1997] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Plasma polyunsaturated fatty acid profile in patients with inflammatory bowel disease is abnormal. We aimed to assess the mucosal fatty acid pattern in patients with ulcerative colitis and Crohn's disease, and in rats with trinitrobenzene-sulfonic acid (TNB) induced colitis. METHODS Fatty acids were measured in colonic mucosa of patients with ulcerative colitis (n = 30), Crohn's disease (n = 21), and healthy controls (n = 13). Likewise, they were assessed in the colonic mucosa of rats with TNB- and sham-colitis. RESULTS There was an increase of the end-products (C22:5n3, C22:6n3, C20:4n6, C22:5n6) and a decrease of the precursors (C18:3n3, C18:2n6) of both n3 and n6 polyunsaturated fatty acids in the mucosa of active ulcerative colitis and TNB-colitis. Also, high values of saturated (C16:0, C18:0) and low values of monounsaturated fatty acids (C18:1n9) were observed. Furthermore, the mucosa of active Crohn's disease showed substantial changes in saturated, monounsaturated and essential fatty acids, but not in polyunsaturated fatty acids. Mucosa of patients with inactive disease showed intermediate fatty acid values between the mucosa of active patients and healthy controls. CONCLUSIONS Colonic inflammation causes a characteristic modification of the mucosal fatty acid profile which appears to be common to different aetiologies and seems to be related to the degree of inflammation.
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Affiliation(s)
- F Fernández-Bañares
- Department of Gastroenterology, Research Unit, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
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Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Domènech E, Gassull MA. Sclerotherapy and esophageal variceal bleeding: time to forget it, or not? Endoscopy 2007; 39:478; author reply 478. [PMID: 17516360 DOI: 10.1055/s-2007-966259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Navarro-Llavat M, Domènech E, Masnou H, Ojanguren I, Mañosa M, Lorenzo-Zúñiga V, Boix J, Gassull MA. Collagenous duodeno-ileo-colitis with transient IgG deficiency preceded by Yersinia enterocolitica intestinal infection: case report and review of literature. Gastroenterología y Hepatología 2007; 30:219-21. [PMID: 17408550 DOI: 10.1157/13100588] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case-report of a man with chronic diarrhoea is presented. After an unsuccessful treatment of an intestinal yersioniosis, the diagnosis of collagenous intestinal disease affecting duodenum, ileum and colon was made. In addition, a IgG transient deficiency was observed. The literature about gastrointestinal involvement, concomintant infection by Yersinia and IgG deficiency in collagenous colitis is reviewed.
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Affiliation(s)
- Mercè Navarro-Llavat
- Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Font A, Arellano A, Fernández-Llamazares J, Casas D, Boix J, Cardenal J, Margelí M, Manzano JL, Abad A, Rosell R. Weekly docetaxel with concomitant radiotherapy in patients with inoperable oesophageal cancer. Clin Transl Oncol 2007; 9:177-82. [PMID: 17403629 DOI: 10.1007/s12094-007-0032-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To evaluate the efficacy and tolerability of weekly docetaxel concurrent with radiotherapy in inoperable oesophageal cancer patients. MATERIAL AND METHODS Thirty-four oesophageal cancer patients with co-morbid medical conditions, locally advanced tumours (T4) or advanced age (older than 75 years) received docetaxel (20 mg/m2 weekly) plus concurrent radiotherapy (2 Gy daily, to a total dose of 66 Gy). Twenty-two patients (64%) were stage III, 19 of whom had T4 tumours. RESULTS Twenty-seven patients (79%) completed the planned chemoradiotherapy treatment. Nine patients (26%) achieved a complete response and 8 (24%) achieved a partial response, for an overall response rate of 50%. Median survival was 6 months, and 1-year survival was 35%. Patients with T4 tumours had significantly shorter survival than other patients: 5 months for T4 tumours vs. 11 months for T1-3 (p=0.04). Grade 3-4 oesophagitis occurred in 6 patients (17%). There were two treatment-related deaths due to radiation pneumonitis. CONCLUSIONS Docetaxel plus concurrent radiotherapy is active in poor-prognosis oesophageal cancer patients, with a lower incidence of severe oesophagitis than with cisplatin-based chemoradiotherapy regimens. This schedule can be considered, especially in patients with non-T4 tumours who are not candidates for oesophageal resection.
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Affiliation(s)
- A Font
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Añaños FE, Domènech E, Ojanguren I, Gassull MA. Endoscopic removal of large sessile colorectal adenomas: is it safe and effective? Dig Dis Sci 2007; 52:840-4. [PMID: 17253129 DOI: 10.1007/s10620-006-9617-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 09/14/2006] [Indexed: 12/28/2022]
Abstract
Large sessile colorectal polyps represent a treatment challenge. Nowadays there are discrepancies regarding how to proceed with them because of morbidity, the possibility of incomplete endoscopic resection, and the high possibility of a coexisting malignancy. This study was performed to determine the safety and effectiveness of endoscopic removal of sessile colorectal adenomas larger than 4 cm. Seventy-four patients with a total of 74 sessile polyps larger than 4 cm in diameter were treated endoscopically. Polyps were removed using argon plasma coagulation (APC) as an adjunct to piecemeal technique. Surgery was recommended in patients with invasive neoplasia. Patients with favorable histology (low-grade dysplasia [LDG] or high-grade dysplasia [HGD]) were followed up with monthly endoscopies untill total ablation of the lesion, and then at 3- to 6-month intervals. LGD was found in 38 patients, HGD in 24, and invasive neoplasia in the remaining 12 patients. A total of 54 patients were followed up for at least 6 months. Recurrence rate of polyps with favorable histology was 9.2% (5/54). Postpolypectomy bleeding was the only complication, observed in 10 patients (13.5%). We conclude that piecemeal polypectomy plus APC without saline injection, performed by an expert endoscopist, is a safe and effective treatment for all LGD or HGD large sessile colorectal polyps.
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Affiliation(s)
- Jaume Boix
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain
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Boix J, Lorenzo-Zúñiga V, Añaños F, Domènech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech 2007; 16:208-11. [PMID: 16921297 DOI: 10.1097/00129689-200608000-00002] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS To propose a classification schema to describe periampullary duodenal diverticula (PDD) found at endoscopic retrograde cholangiopancreatography (ERCP), and to study the characteristics of these diverticula. MATERIALS AND METHODS Among 400 consecutive patients in whom an ERCP was performed, PDD were present in 131 (32.8%), being these patients significantly older than the remaining, served as controls. RESULTS PDD were classified in 3 different types according to the position of the major duodenal papilla: type I (16.3%), inside the diverticulum; type II (10.2%), in the margin of the diverticulum; and type III (6.5%), near the diverticulum. PDD were not associated with a more difficult cannulation of the biliary tract. CONCLUSIONS PDD are common, especially in older patients, and do not significantly increase the difficulty of deep cannulation.
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Affiliation(s)
- Jaume Boix
- Endoscopy Unit, Departments of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Lorenzo-Zúñiga V, Moreno de Vega V, Mañosa M, Domènech E, Boix J. The utility of wireless capsule endoscopy, as compared with barium contrast study, in a case of Peutz-Jeghers syndrome. Acta Gastroenterol Belg 2006; 69:423. [PMID: 17343087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Lorenzo-Zúñiga V, Boix J. Endoscopic mucosal resection and mucosa ablation with argon-plasma coagulation in a high-risk patient with Barrett's oesophagus and oesophageal adenocarcinoma. Dig Liver Dis 2006; 38:713-4. [PMID: 16787771 DOI: 10.1016/j.dld.2006.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 05/10/2006] [Accepted: 05/10/2006] [Indexed: 12/11/2022]
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Ribas J, Bettayeb K, Ferandin Y, Knockaert M, Garrofé-Ochoa X, Totzke F, Schächtele C, Mester J, Polychronopoulos P, Magiatis P, Skaltsounis AL, Boix J, Meijer L. 7-Bromoindirubin-3'-oxime induces caspase-independent cell death. Oncogene 2006; 25:6304-18. [PMID: 16702956 DOI: 10.1038/sj.onc.1209648] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Indirubin, an isomer of indigo, is a reported inhibitor of cyclin-dependent kinases (CDKs) and glycogen synthase kinase-3 (GSK-3) as well as an agonist of the aryl hydrocarbon receptor (AhR). Indirubin is the active ingredient of a traditional Chinese medicinal recipe used against chronic myelocytic leukemia. Numerous indirubin analogs have been synthesized to optimize this promising kinase inhibitor scaffold. We report here on the cellular effects of 7-bromoindirubin-3'-oxime (7BIO). In contrast to its 5-bromo- and 6-bromo- isomers, and to indirubin-3'-oxime, 7BIO has only a marginal inhibitory activity towards CDKs and GSK-3. Unexpectedly, 7BIO triggers a rapid cell death process distinct from apoptosis. 7-Bromoindirubin-3'-oxime induces the appearance of large pycnotic nuclei, without classical features of apoptosis such as chromatin condensation and nuclear fragmentation. 7-Bromoindirubin-3'-oxime-induced cell death is not accompanied by cytochrome c release neither by any measurable effector caspase activation. Furthermore, the death process is not altered either by the presence of Q-VD-OPh, a broad-spectrum caspase inhibitor, or the overexpression of Bcl-2 and Bcl-XL proteins. Neither AhR nor p53 is required during 7BIO-induced cell death. Thus, in contrast to previously described indirubins, 7BIO triggers the activation of non-apoptotic cell death, possibly through necroptosis or autophagy. Although their molecular targets remain to be identified, 7-substituted indirubins may constitute a new class of potential antitumor compounds that would retain their activity in cells refractory to apoptosis.
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Affiliation(s)
- J Ribas
- CNRS, Cell Cycle Group and UPS2682, Station Biologique, Bretagne, France
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Domènech E, Scala L, Bernal I, García-Planella E, Casalots A, Piñol M, Esteve-Comas M, Cabré E, Boix J, Gassull MA. Azatioprina y mesalazina en la prevención de la recurrencia posquirúrgica en la enfermedad de Crohn: estudio retrospectivo. Gastroenterología y Hepatología 2004; 27:563-7. [PMID: 15574279 DOI: 10.1016/s0210-5705(03)70533-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Surgical resection is still a mainstay of the treatment of Crohn's disease (CD). However, recurrence is the rule. The aim of the present study was to evaluate CD recurrence in a series of patients who underwent surgical resection with subsequent treatment with azathioprine (AZA) or mesalazine (5-ASA) and to identify the factors associated with recurrence. METHODS The medical records of patients with CD who underwent bowel resection during a 4-year period were reviewed. Only patients who received AZA or 5-ASA as prophylaxis for recurrence were included. RESULTS Thirty-three patients treated with AZA and 16 treated with 5-ASA were included. Endoscopic recurrence was found in 8.6% of the AZA group and in 87.5% of the 5-ASA group (p <0.001). Clinical recurrence occurred in 31.2% of patients in the 5-ASA group and in none in the AZA group (p=0.004). The accumulated probability of both clinical and endoscopic recurrence was significantly lower in the AZA group (p=0.0025 and p=0.005, respectively). Factors associated with a greater risk of endoscopic recurrence were termino-terminal anastomosis and 5-ASA treatment. The only factor associated with clinical recurrence was 5-ASA treatment. CONCLUSION AZA seems to be more effective than 5-ASA in the prevention of postsurgical endoscopic recurrence of CD. Prospective studies with long-term follow-up are required to establish the true utility of AZA in the prophylaxis of CD recurrence.
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Affiliation(s)
- E Domènech
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Garcia-Planella E, Domènech E, Esteve-Comas M, Bernal I, Cabré E, Boix J, Gassull MA. Development of antinuclear antibodies and its clinical impact in patients with Crohn's disease treated with chimeric monoclonal anti-TNFalpha antibodies (infliximab). Eur J Gastroenterol Hepatol 2003; 15:351-4. [PMID: 12655253 DOI: 10.1097/00042737-200304000-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Although the efficacy of infliximab in Crohn's disease (CD) has been demonstrated, its safety profile has yet to be established. Autoimmune adverse events such as human anti-chimeric antibodies and the development of antinuclear antibodies (ANAs) have been notified, but the true incidence and clinical relevance of the latter is still unknown. OBJECTIVE To evaluate the changes in ANA status in CD patients treated with infliximab and the clinical evolution of those who are ANA positive. METHODS The ANA status of 36 CD patients treated with infliximab was determined at baseline and 6 weeks after the initial infliximab infusion. Patients were followed up monthly. In the case of infliximab re-treatment, ANA status was again evaluated. Twenty-eight patients (78%) were treated concomitantly with immunosuppressants. RESULTS Eight patients (22%) were ANA positive at baseline; none developed anti-double-stranded DNA antibodies (aDNAds) at week 6. Three of them were re-treated: there were increasing ANA titres in all cases and developing aDNAds in two. Only six of 28 patients who were ANA negative at baseline changed their ANA status at week 6, but none developed aDNAds. One of them was retreated showing a further increase in ANA titre and developing aDNAds at high titre. No patient presented lupus-like syndrome. CONCLUSIONS Only a few CD patients treated with infliximab and immunosuppressants develop ANAs. This condition is not associated with aDNAds and/or lupus-like syndrome in the majority of cases.
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Affiliation(s)
- Esther Garcia-Planella
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
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Domènech E, Garcia-Planella E, Bernal I, Rosinach M, Cabré E, Fluvià L, Boix J, Gassull MA. Azathioprine without oral ciclosporin in the long-term maintenance of remission induced by intravenous ciclosporin in severe, steroid-refractory ulcerative colitis. Aliment Pharmacol Ther 2002; 16:2061-5. [PMID: 12452938 DOI: 10.1046/j.1365-2036.2002.01385.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intravenous ciclosporin is considered to be the only alternative to avoid surgery in severe, steroid-refractory ulcerative colitis. In responders, some authors recommend a switch to oral ciclosporin to act as a 'bridge' until the therapeutic action of azathioprine is achieved for maintenance treatment. AIM To report the short- and long-term outcome of intravenous ciclosporin-responsive ulcerative colitis patients treated with oral azathioprine without oral ciclosporin. METHODS The records of all patients treated with intravenous ciclosporin for severe, steroid-refractory ulcerative colitis were reviewed. Responders following treatment with azathioprine but without oral ciclosporin as maintenance therapy were included. Patients with colonic cytomegalovirus infection and/or follow-up of less than 1 year were excluded. RESULTS Twenty-seven patients were included. Steroids were discontinued in 24 (89%). The median follow-up was 36 months. Eighteen (75%) patients presented mild or moderate relapses, which were easily managed with salicylates or steroids. Cumulative probabilities of relapse were 42%, 72% and 77% at 1, 3 and 5 years, respectively. Eleven (40.7%) patients underwent elective colectomy. Cumulative probabilities of colectomy were 29%, 35% and 42% at 1, 3 and 5 years, respectively. No opportunistic infections were observed. CONCLUSIONS Oral azathioprine seems to be enough to maintain long-term remission induced by intravenous ciclosporin in patients with steroid-refractory ulcerative colitis. The 'bridging step' with oral ciclosporin may not be necessary in this subset of patients, although a randomized controlled trial is warranted to confirm this hypothesis.
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Affiliation(s)
- E Domènech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
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Yuste VJ, Bayascas JR, Llecha N, Sánchez-López I, Boix J, Comella JX. The absence of oligonucleosomal DNA fragmentation during apoptosis of IMR-5 neuroblastoma cells: disappearance of the caspase-activated DNase. J Biol Chem 2001; 276:22323-31. [PMID: 11294834 DOI: 10.1074/jbc.m100072200] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Caspase-activated DNase is responsible for the oligonucleosomal DNA degradation during apoptosis. DNA degradation is thought to be important for multicellular organisms to prevent oncogenic transformation or as a mechanism of viral defense. It has been reported that certain cells, including some neuroblastoma cell lines such as IMR-5, enter apoptosis without digesting DNA in such a way. We have analyzed the causes for the absence of DNA laddering in staurosporine-treated IMR-5 cells, and we have found that most of the molecular mechanisms controlling apoptosis are well preserved in this cell line. These include degradation of substrates for caspases, blockade of cell death by antiapoptotic genes such as Bcl-2 or Bcl-X(L), or normal levels and adequate activation of caspase-3. Moreover, these cells display normal levels of caspase-activated DNase and its inhibitory protein, inhibitor of caspase-activated DNase, and their cDNA sequences are identical to those reported previously. Nevertheless, IMR-5 cells lose caspase-activated DNase during apoptosis and recover their ability to degrade DNA when human recombinant caspase-activated DNase is overexpressed. Our results lead to the conclusion that caspase-activated DNase is processed during apoptosis of IMR-5 cells, making these cells a good model to study the relevance of this endonuclease in physiological or pathological conditions.
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Affiliation(s)
- V J Yuste
- Grup de Neurobiologia Molecular, Departament de Ciències Mèdiques Bàsiques, Universitat de Lleida, 25198 Lleida, Spain
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