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Joseph A, Vantanasiri K, Draganov PV, King W, Maluf-Filho F, Al-Haddad M, Albunni H, Fukami N, Mohapatra S, Aihara H, Sharma NR, Chak A, Yang D, Singh R, Jang S, Kamath S, Raja S, Murthy S, Yang Q, Iyer P, Bhatt A. Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer: a multicenter retrospective study. Gastrointest Endosc 2023:S0016-5107(23)03123-1. [PMID: 38042205 DOI: 10.1016/j.gie.2023.11.047] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIMS Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC. METHODS Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs. RESULTS A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008). CONCLUSION Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kornpong Vantanasiri
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - William King
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Fauze Maluf-Filho
- Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil; Department of Gastroenterology of University of Sao Paulo, Sao Paulo, São Paulo, Brazil; National Council for Scientific and Technological Development, Lago Sul, Brazil
| | | | - Hashem Albunni
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Neil R Sharma
- Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Dennis Yang
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA
| | - Rituraj Singh
- Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Qijun Yang
- Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Prasad Iyer
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amit Bhatt
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Zhang X, Olesinski EA, Duong Q, Truong MT, Lee S, Jang S, Mak KS, Parekh A, Hirsch AE. Development and Assessment of a Multi-Purpose Knowledge-Based Planning Model (RapidPlan) for Prostate Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e497. [PMID: 37785565 DOI: 10.1016/j.ijrobp.2023.06.1737] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) RapidPlan (RP) is a knowledge-based planning (KBP) tool to improve plan quality, planning speed, and reduce inter-patient plan variability. For small to medium institutions, it is difficult to find sufficient patient numbers to configure a reliable KBP-RP model. This study aimed to build a multi-purpose KBP-RP model for prostate cancers. MATERIALS/METHODS A total of 124 prostate plans from 2018-2022 at our institution were selected to configure the initial RP model. After model training, outliers were removed. 77 patients were used for the final RP model. Three fine-tuned RP sub-models with different optimized constraints corresponding to prostate bed, prostate + seminal vesicles (SV), and prostate boost plans were generated. RP models were validated by comparing plan quality with the original manually optimized plans (MP). 54 independent plans were selected to validate the RP models. Validation included: dose to 99% and 2% of PTV (D99%, D2%), PTV conformity index (CI); for organs at risk (OARs), volume receiving >70Gy and >60Gy (V70Gy, V60Gy) to bladder and rectum, maximum dose (Dmax) to femur heads (FHs) and small bowel. Statistical t-test analysis was performed with a significance of p<0.05. RESULTS A total of 48/54 model-based plans were clinically approved after single RP optimization. 6/54 failed plans were prostate bed plans and were deemed acceptable after additional minor constraint adjustments. For PTV, D99%, D2%, and CI were comparable (p>0.05) to MP. Bladder and rectum V70Gy were comparable (p>0.05), and V60Gy were significantly lower to MP (p<0.05), with an average Dmean of 23.21±14.58Gy and 16.41±10.63Gy vs 26.36±16.89Gy and 18.24±12.81Gy for RP and MP. RP significantly reduced Dmax to FHs and small bowel (p<0.05), with average Dmax of 34.95±6.06Gy and 35.62±18.99Gy vs 36.81±7.05Gy and 38.14±17.81Gy, respectively. CONCLUSION Multi-purpose prostate RP model was configured and approved plans were generated after single optimization. Prostate RP plans had equivalent PTV coverage with better or comparable OAR constraints.
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Affiliation(s)
- X Zhang
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | | | - Q Duong
- Boston Medical Center, Boston, MA
| | - M T Truong
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - S Lee
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - S Jang
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - K S Mak
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - A Parekh
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - A E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
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Yoo IK, Cho YK, Kim SW, Choi SY, Noh DS, Jang JY, Baik GH, Jang S, Vargo J, Cho JY. Is it enough to observe less than 2 cm sized gastric SET? Surg Endosc 2023; 37:6798-6805. [PMID: 37264226 DOI: 10.1007/s00464-023-10110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/30/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS The recent surge in demand for screening endoscopy has led to an increased detection of gastric subepithelial tumors (SETs). According to current guideline, SETs less than 2 cm in size are recommended for periodic surveillance. In light of recent advancement in therapeutic endoscopy in resection of small SET, we analyzed the histopathological features and the effectiveness of endoscopic resection for these small SETs. METHODS Retrospectively study was performed on 74 patients who underwent endoscopic resection of gastric small (≤ 2 cm) upper gastrointestinal tract SETs. The outcomes including histopathology and en bloc resection were analyzed. RESULTS The mean SET size was 11.69 ± 5.11 mm. The mean procedure time was 81.26 ± 42.53 min. Of the 74 patients, 28 patients had leiomyomas, 26 had gastrointestinal stromal tumors (GISTs), 14 had ectopic pancreas, 4 had lipomas, and 2 had neuroendocrine tumors. Among those with GIST, two patients exhibited high-risk histology. All patients underwent successful and uneventful endoscopy. CONCLUSIONS Endoscopic resection can be recommended even for the small gastric SETs. In our study, we found that SETs with a size of less than 2 cm have significant proportion of GISTs which harbor malignant transformation potential.
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Affiliation(s)
- In Kyung Yoo
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Young Kwan Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea
| | - Seong Whan Kim
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea
| | - Seung Yoon Choi
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Dae Suk Noh
- Division of Gastroenterology, Department of Internal Medicine, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, South Korea
| | - Jae Young Jang
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Gwang Ho Baik
- Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Cha Medical Center, Cha University College of Medicine, 569, Nonhyon-ro Gangnam-gu, Seoul, South Korea.
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Garg R, Mohammed A, Singh A, Siddiki H, Bhatt A, Sanaka MR, Jang S, Simons-Linares CR, Stevens T, Vargo J, Chahal P. Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study. Dig Dis Sci 2023; 68:2674-2682. [PMID: 37097368 DOI: 10.1007/s10620-023-07945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. METHODS The National Inpatient Sample database was utilized to identify the adult patients (≥ 18 years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. RESULTS Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. CONCLUSION PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Abdul Mohammed
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Alqahtani SA, Ausloos F, Park JS, Jang S. The Role of Endoscopic Ultrasound in Hepatology. Gut Liver 2023; 17:204-216. [PMID: 36457262 PMCID: PMC10018300 DOI: 10.5009/gnl220071] [Citation(s) in RCA: 1] [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: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/21/2022] [Indexed: 12/05/2022] Open
Abstract
Endoscopic ultrasound (EUS) has been an indispensable and widely used diagnostic tool in several medical fields, including gastroenterology, cardiology, and urology, due to its diverse therapeutic and diagnostic applications. Many studies show that it is effective and safe in patients with liver conditions where conventional endoscopy or cross-sectional imaging are inefficient or when surgical interventions pose high risks. In this article, we present a review of the current literature for the different diagnostic and therapeutic applications of EUS in liver diseases and their complications and discuss the potential future application of artificial intelligence analysis of EUS.
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Affiliation(s)
- Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA.,Liver Transplant Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Floriane Ausloos
- Department of Gastroenterology and Hepatology, CHU Liège, Sart-Tilman, Liège, Belgium
| | - Ji Seok Park
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Kim M, Park D, Kim D, Lee M, Jeon D, Jang S, Kim J, Kim E, Yoon K, Lim S, Lee K, Choi S. Discovery of an allosteric small molecule inhibitor that can potently target SHP2 in vitro and in vivo. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00894-2] [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: 11/03/2022]
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Joseph A, Draganov PV, Maluf-Filho F, Aihara H, Fukami N, Sharma NR, Chak A, Yang D, Jawaid S, Dumot J, Alaber O, Chua T, Singh R, Mejia-Perez LK, Lyu R, Zhang X, Kamath S, Jang S, Murthy S, Vargo J, Bhatt A. Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study. Gastrointest Endosc 2022; 96:445-453. [PMID: 35217020 PMCID: PMC9488538 DOI: 10.1016/j.gie.2022.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC. METHODS We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates. RESULTS Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). CONCLUSIONS EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter V. Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Neil R. Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - John Dumot
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Omar Alaber
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rituraj Singh
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | | | - Ruishen Lyu
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xuefeng Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Yoon H, Jeong J, Lee H, Jang S. More than a single effect by a single point mutation: molecular dynamics simulation of NPC1. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322094086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Park M, Jang S, Chung J, Kim K, Kwon O, Jo S. 702 Inhibition of class I HDACs preserves hair follicle inductivity in postnatal dermal cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.714] [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: 11/27/2022]
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Joseph A, Raja S, Kamath S, Jang S, Allende D, McNamara M, Videtic G, Murthy S, Bhatt A. Esophageal adenocarcinoma: A dire need for early detection and treatment. Cleve Clin J Med 2022; 89:269-279. [PMID: 35500930 DOI: 10.3949/ccjm.89a.21053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related death worldwide. Esophageal adenocarcinoma is the most common subtype of esophageal cancer in the United States, and its incidence has risen dramatically in the last few decades. Modern endoscopic and surgical techniques have significantly improved morbidity and mortality rates of patients undergoing treatment for esophageal cancer. However, most cases are diagnosed at a late stage when the prognosis is poor, emphasizing the need for an effective screening strategy. This clinical overview focuses on screening, multidisciplinary evaluation, and treatment of early esophageal adenocarcinoma.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Suneel Kamath
- Department of Hematology and Medical Oncology, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Daniela Allende
- Department of Pathology, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Mike McNamara
- Department of Hematology and Medical Oncology, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Gregory Videtic
- Department of Radiation Oncology, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Mejia Perez LK, Yang D, Draganov PV, Jawaid S, Chak A, Dumot J, Alaber O, Vargo JJ, Jang S, Mehta N, Fukami N, Chua T, Gabr M, Kudaravalli P, Aihara H, Maluf-Filho F, Ngamruengphong S, Pourmousavi Khoshknab M, Bhatt A. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study. Endoscopy 2022; 54:439-446. [PMID: 34450667 DOI: 10.1055/a-1541-7659] [Citation(s) in RCA: 6] [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: 12/27/2022]
Abstract
BACKGROUND The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia. METHODS We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan-Meier curve was used to compare the groups. RESULTS 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75-30) and 8 (2-18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001). CONCLUSIONS ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.
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Affiliation(s)
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - John Dumot
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Omar Alaber
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neal Mehta
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Moamen Gabr
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Praneeth Kudaravalli
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Saowanee Ngamruengphong
- Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Gonzalez A, Wadhwa V, Singh H, Khan S, Gupta K, Liang H, Hussain I, Vargo J, Jang S, Chahal P, Bhatt A, Siddiki H, Erim T, Sanaka MR. Endoscopic ultrasound with combined fine needle aspiration plus biopsy improves diagnostic yield in solid pancreatic masses. Scand J Gastroenterol 2022; 57:610-617. [PMID: 34991430 DOI: 10.1080/00365521.2021.2024249] [Citation(s) in RCA: 1] [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] [Indexed: 02/04/2023]
Abstract
GOALS Our aim was to compare the diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) versus combined fine needle aspiration and fine needle biopsy (EUS-FNA + FNB) in the evaluation of solid pancreatic masses (SPMs). BACKGROUND EUS-FNA and EUS-FNB are established methods to diagnose SPMs. No studies have evaluated the efficacy of combination of both (EUS-FNA + FNB). Our senior author (MRS) hypothesized that combining the two techniques by using a single FNB needle improves diagnostic yield and started combination technique in October 2016. STUDY Patients who underwent EUS for SPMs by MRS during January 2014-September 2019 were included. They were divided into the EUS-FNA group and EUS-FNA + FNB group. EUS-FNA was performed using a 22 or 25 gauge Expect Slimline needle (Boston Scientific, Marlborough, MA) and EUS-FNA + FNB was performed using a single 22 or 25 gauge Shark-core needle (Medtronics, Minneapolis, MN, USA). Our primary outcome was to compare the diagnostic yield in the two groups. RESULTS Among 105 patients included, 58 were in the EUS-FNA group and 47 were in the EUS-FNA + FNB group. EUS-FNA + FNB group had significantly higher diagnostic yield and required fewer needle passes compared to EUS-FNA group, 95.7% vs. 77.6%, p = .01: and 4 vs. 5, p = .002; respectively. Procedural duration was similar in both groups but the combined technique required less number of needles per procedure. There was no difference in adverse events in the two groups. CONCLUSION Our study showed that combined EUS-FNA + FNB had higher diagnostic yield compared to EUS-FNA in SPMs along with less number of needle passes and needles required. Further prospective studies are needed to validate these findings and cost-effectiveness of this strategy.
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Affiliation(s)
- Adalberto Gonzalez
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Vaibhav Wadhwa
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Harjinder Singh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Sikandar Khan
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Kapil Gupta
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hong Liang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Ishtiaq Hussain
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Tolga Erim
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
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Ko Y, Oh K, Kim C, Park G, Kang S, Jang S. W111 Assessment of synergistic effect of various antimicrobial combinations on extensively drug-resistant (XDR) acinetobacter baumannii clinical isolates. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.849] [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: 11/17/2022]
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14
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Yoon WJ, Shah ED, Lee TH, Jang S, Law R, Park DH. Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage in Patients With Malignant Biliary Obstruction: Which Is the Optimal Cost-Saving Strategy After Failed ERCP? Front Oncol 2022; 12:844083. [PMID: 35280826 PMCID: PMC8914424 DOI: 10.3389/fonc.2022.844083] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/04/2022] [Indexed: 01/29/2023] Open
Abstract
Background and Aim Although endoscopic ultrasound-guided biliary drainage (EUS-BD) after failed primary ERCP in malignant distal biliary obstruction has similar clinical outcomes compared to percutaneous transhepatic biliary drainage (PTBD), little is known about optimal cost-saving strategy after failed ERCP. We performed a cost analysis of EUS-BD and PTBD after failed ERCP in two countries with different health care systems in the East and West. Methods From an unpublished database nested in a randomized controlled trial, we compared the cost between EUS-BD and PTBD in Korea. The total cost was defined as the sum of the total biliary drainage costs plus the cost of hospital stay to manage adverse events. We also performed a cost-minimization analysis using a decision-analytic model of a US Medicare population. Results In Korea, the median total costs for the biliary intervention ($1,203.36 for EUS-BD vs. $1,517.83 for PTBD; P=.0015) and the median total costs for the entire treatment were significantly higher in PTBD ($4,175.53 for EUS-BD vs. $5,391.87 for PTBD; P=.0496) due to higher re-intervention rate in PTBD. In cost-minimization analysis of US Medicare population, EUS-BD would cost $9,497.03 and PTBD $13,878.44 from a Medicare insurance perspective (average cost-savings in choosing EUS-BD of $4,381.41 in the US). In sensitivity analysis, EUS-BD was favored over PTBD regardless of the expected re-intervention rate in EUS-BD and PTBD. Conclusions EUS-BD may have an impact on cost-savings due to better clinical outcomes profile compared to PTBD after failed ERCP, even in different medical insurance programs.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Eric D. Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Do Hyun Park
- Digestive Diseases Research Center, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- *Correspondence: Do Hyun Park,
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Jang S, Stevens T, Parsi MA, Bhatt A, Kichler A, Vargo JJ. Superiority of Self-Expandable Metallic Stents Over Plastic Stents in Treatment of Malignant Distal Biliary Strictures. Clin Gastroenterol Hepatol 2022; 20:e182-e195. [PMID: 33346140 DOI: 10.1016/j.cgh.2020.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/22/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Treatment of malignant biliary strictures with endoscopic retrograde cholangiopancreatography (ERCP) guided stent placement is highly effective. Our objective was to compare the efficacy and adverse outcomes between plastic stents (PS) and self-expandable metallic stents (SEMS). METHODS A cohort study was performed of all consecutive patients who underwent ERCP with stent placement for the management of malignant biliary stricture. Comparisons on clinical success, patency duration, stent dysfunction, unplanned reintervention and adverse outcomes were performed. Univariate and multivariable analyses were performed to identify factors associated with clinical success, need for reintervention, and stent dysfunction. RESULTS From 2012 to 2019, 1139 patients underwent ERCP with PS placement while 1008 patients received SEMS for the management of malignant biliary stricture. In distal strictures, SEMS reported a significantly higher rate of clinical success compared with PS (94.1% vs 87.4%, P < 0.001) and a lower rate of unplanned reintervention (17.1% vs 27.4%, P < 0.001). In hilar strictures, the rates of clinical success and unplanned intervention were comparable. The patency duration and time to unplanned reintervention were significantly longer with SEMS than PS, irrespective of stricture location. In distal stricture, PS was associated with a significantly higher rate of cholangitis than SEMS (6.9% vs 2.4%; P < .001) but a lower rate of pancreatitis (3.6% vs 6%; P = 0.021). CONCLUSION Given superior efficacy, durability and lower rates of cholangitis, SEMS should be offered as the first line endoscopic treatment option for malignant distal biliary stricture. For malignant hilar stricture, SEMS is an attractive alternative to PS in some cases by offering a comparable efficacy with a superior durability.
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Affiliation(s)
- Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Mansour A Parsi
- Department of Gastroenterology, Tulane University, New Orleans, Louisiana
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Adam Kichler
- Division of Gastroenterology, Geisinger Medicine Institute, Danville, Pennsylvania
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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16
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Franco MC, Jang S, Martins BDC, Stevens T, Jairath V, Lopez R, Vargo JJ, Barkun A, Maluf-Filho F. Risk Stratification in Cancer Patients with Acute Upper Gastrointestinal Bleeding: Comparison of Glasgow-Blatchford, Rockall and AIMS65, and Development of a New Scoring System. Clin Endosc 2022; 55:240-247. [PMID: 35052025 PMCID: PMC8995992 DOI: 10.5946/ce.2021.115] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Aims Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care.
Methods A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score.
Results From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality.
Conclusions The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.
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Affiliation(s)
- Matheus Cavalcante Franco
- Hospital Sírio-Libanês, Brasília, Distrito Federal, Brazil
- Correspondence: Matheus Cavalcante Franco SCES trecho 4, Brasília - DF 70200-004, Brazil Tel: +55-61-99913-2032, Fax: +55-61-99913-2032, E-mail:
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Rocio Lopez
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John J. Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, QC, Canada
| | - Fauze Maluf-Filho
- Endoscopy Unit, Cancer Institute of the University of São Paulo, São Paulo, Brazil
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17
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Aurisano N, Huang L, Jang S, Chiu W, Judson R, Jolliet O, Fantke P. Broadening the chemical coverage to derive human toxicity dose-response factors for non-cancer endpoints. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00799-2] [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: 11/24/2022]
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18
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Shenderov E, Mallesara G, Wysocki P, Xu W, Ramlau R, Weickhardt A, Zolnierek J, Spira A, Joshua A, Powderly J, Antonarakis E, Jang S, Aragon-Ching J, Shen J, Paller C, Vogelzang N, Leu K, Cortés J, Bohac C, Lugowska I. 620P MGC018, an anti-B7-H3 antibody-drug conjugate (ADC), in patients with advanced solid tumors: Preliminary results of phase I cohort expansion. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1133] [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: 11/26/2022] Open
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Abstract
Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.
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Affiliation(s)
- Kihyun Ryu
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Sunguk Jang
- Digestive Disease Institute, Cleveland Clinic., Cleveland, OH, USA
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20
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Sekine R, Hirata M, Ikezoe R, Jang S, Kubota Y, Kayano H, Sugata K, Aizawa T, Noguchi D, Kim D, Sugimoto Y, Matsuura R, Yamazaki H, Ichimura M, Yoshikawa M, Kohagura J, Nakashima Y, Ezumi N, Sakamoto M. Measurement of axial phase difference of density fluctuations owing to spontaneously excited waves by using microwave reflectometer on GAMMA 10/PDX. Rev Sci Instrum 2021; 92:053506. [PMID: 34243319 DOI: 10.1063/5.0043821] [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: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 06/13/2023]
Abstract
In the GAMMA 10/PDX tandem mirror, plasma with strong ion-temperature anisotropy is produced by using the ion cyclotron range of frequency waves. This anisotropy of ion temperature causes several Alfvén-Ion-Cyclotron (AIC) waves to spontaneously excite in the frequency range just below the ion cyclotron frequency. In addition, difference-frequency (DF) waves are excited in the radial inner region of the plasma by wave-wave coupling among the AIC waves. The radial density profiles were measured at multi-axial positions using a frequency-modulation reflectometer with an axial array of microwave antennas, and an axial variation of the density was found to be significant. In addition, a relative phase difference of the DF wave between axially separated two points was first obtained by finely choosing the probing frequency of the reflectometers with a maximum coherence used as a measure, indicating that the DF wave is a propagating wave, while the pump AIC waves are standing waves in the axial region of measurement.
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Affiliation(s)
- R Sekine
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - M Hirata
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - R Ikezoe
- Research Institute for Applied Mechanics, Kyushu University, Kasuga 816-8580, Japan
| | - S Jang
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Y Kubota
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - H Kayano
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - K Sugata
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - T Aizawa
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - D Noguchi
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - D Kim
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Y Sugimoto
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - R Matsuura
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - H Yamazaki
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - M Ichimura
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - M Yoshikawa
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - J Kohagura
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Y Nakashima
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - N Ezumi
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
| | - M Sakamoto
- Plasma Research Center, University of Tsukuba, Tsukuba 305-8577, Japan
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21
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Guenter R, Aweda T, Carmona Matos DM, Jang S, Whitt J, Cheng YQ, Liu XM, Chen H, Lapi SE, Jaskula-Sztul R. Corrigendum to: Overexpression of somatostatin receptor type 2 in neuroendocrine tumors for improved Ga68-DOTATATE imaging and treatment [Surgery. 2020 Jan;167(1):189-196. doi: 10.1016/j.surg.2019.05.092. Epub 2019 Oct 16.PMID: 31629542]. Surgery 2021; 170:351. [PMID: 33875251 PMCID: PMC10166185 DOI: 10.1016/j.surg.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R Guenter
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - T Aweda
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - D M Carmona Matos
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL; San Juan Bautista School of Medicine, Caguas, PR
| | - S Jang
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - J Whitt
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Y Q Cheng
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX
| | - X M Liu
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL
| | - H Chen
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - S E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - R Jaskula-Sztul
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
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22
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Jung HS, Jang S, Chung HY, Park SY, Kim HY, Ha YC, Lee YK, Nho JH. Incidence of subsequent osteoporotic fractures after distal radius fractures and mortality of the subsequent distal radius fractures: a retrospective analysis of claims data of the Korea National Health Insurance Service. Osteoporos Int 2021; 32:293-299. [PMID: 32876712 DOI: 10.1007/s00198-020-05609-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED A better understanding of the features of subsequent fractures after distal radius fracture (DRF) is important for the prevention of further osteoporotic fractures. This study found that the cumulative incidence of subsequent osteoporotic fractures in South Korea increased over time and that the mortality rates of subsequent DRFs were lower than those of first-time DRFs. INTRODUCTION We examined the incidence of osteoporotic fractures following distal radius fractures (DRFs) and the mortality rate after subsequent DRFs using claims data from the Korea National Health Insurance (KNHI) Service. METHODS We identified records for 41,417 patients with first-time DRFs in 2012. The occurrence of osteoporotic fractures of the spine, hip, wrist, and humerus at least 6 months after the index DRF was tracked through 2016. All fractures were identified by specific diagnosis and procedure codes. One-year mortality rates and standardized mortality ratios (SMRs) for initial and subsequent DRFs were calculated for all patients. RESULTS The 4-year cumulative incidence of all subsequent osteoporotic fractures was 14.74% (6105/41,417; 9.47% in men, 15.9% in women). The number of associated subsequent fractures was 2850 for the spine (46.68%), 2271 for the wrist (37.2%), 708 for the hip (11.6%), and 276 for the humerus (4.52%). The cumulative mortality rate 1 year after the first-time and subsequent DRF was 1.47% and 0.71%, respectively, and the overall SMR was 1.48 (95% CI: 1.37-1.61) and 0.71 (95% CI: 0.42-1.21), respectively. CONCLUSION The cumulative incidence of osteoporotic fractures following DRFs increased over the study period and was higher among women. The cumulative mortality rates and SMRs of subsequent DRFs were lower than those of first-time DRFs at the 1-year follow-up. Given the increasing incidence rate of DRFs, the incidence of subsequent osteoporotic fractures may also increase.
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Affiliation(s)
- H-S Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - S Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - H-Y Chung
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S Y Park
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - H-Y Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Y-C Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Y-K Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J-H Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Simons-Linares CR, Yadav D, Lopez R, Bhatt A, Jang S, El-Khider F, Sanaka M, Stevens T, Vargo J, Chahal P. The utility of intracystic glucose levels in differentiating mucinous from non-mucinous pancreatic cysts. Pancreatology 2020; 20:1386-1392. [PMID: 32919884 DOI: 10.1016/j.pan.2020.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Differentiating benign non-mucinous from potentially malignant mucinous pancreatic cysts is still a challenge. This study aims to improve this distinction with cyst fluid analysis. METHODS A cohort study of pancreatic cyst undergoing EUS/FNA was performed from a prospectively maintained database between 2014 and 2018 was performed. RESULTS 113 patients were analyzed (40 non-mucinous and 73 mucinous). For differentiating mucinous from non-mucinous cyst: intracyst glucose ≤41 mg/dl had a sensitivity of 92% and a specificity of 92%; positive predictive value (PPV) of 96 and negative predictive value (NPV) of 86. Glucose ≤21 mg/dl had a sensitivity of 88%, specificity of 97%, PPV of 98 and NPV of 81. CEA ≥192 ng/mL had a sensitivity of 50% and a specificity of 92%; PPV of 92 and NPV of 50. Glucose ≤21 mg/dl or CEA ≥192 ng/mL combined had a sensitivity of 93%, specificity of 92%, PPV of 96 and NPV of 87 (Fig. 1, Table 1). CONCLUSION Intra-cyst glucose levels (≤41 mg/dl) outperforms classic CEA testing for differentiation of mucinous from non-mucinous pancreatic cysts. It was found to be an excellent diagnostic test with an AUC of 0.95 (95% CI: 0.81, 0.97).
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Divya Yadav
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Faris El-Khider
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Madhusudan Sanaka
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Perry BI, Upthegrove R, Crawford O, Jang S, Lau E, McGill I, Carver E, Jones PB, Khandaker GM. Cardiometabolic risk prediction algorithms for young people with psychosis: a systematic review and exploratory analysis. Acta Psychiatr Scand 2020; 142:215-232. [PMID: 32654119 DOI: 10.1111/acps.13212] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Cardiometabolic risk prediction algorithms are common in clinical practice. Young people with psychosis are at high risk for developing cardiometabolic disorders. We aimed to examine whether existing cardiometabolic risk prediction algorithms are suitable for young people with psychosis. METHODS We conducted a systematic review and narrative synthesis of studies reporting the development and validation of cardiometabolic risk prediction algorithms for general or psychiatric populations. Furthermore, we used data from 505 participants with or at risk of psychosis at age 18 years in the ALSPAC birth cohort, to explore the performance of three algorithms (QDiabetes, QRISK3 and PRIMROSE) highlighted as potentially suitable. We repeated analyses after artificially increasing participant age to the mean age of the original algorithm studies to examine the impact of age on predictive performance. RESULTS We screened 7820 results, including 110 studies. All algorithms were developed in relatively older participants, and most were at high risk of bias. Three studies (QDiabetes, QRISK3 and PRIMROSE) featured psychiatric predictors. Age was more strongly weighted than other risk factors in each algorithm. In our exploratory analysis, calibration plots for all three algorithms implied a consistent systematic underprediction of cardiometabolic risk in the younger sample. After increasing participant age, calibration plots were markedly improved. CONCLUSION Existing cardiometabolic risk prediction algorithms cannot be recommended for young people with or at risk of psychosis. Existing algorithms may underpredict risk in young people, even in the face of other high-risk features. Recalibration of existing algorithms or a new tailored algorithm for the population is required.
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Affiliation(s)
- B I Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - O Crawford
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S Jang
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - E Lau
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - I McGill
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - E Carver
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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25
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Jang S, Cho G, Choi S, Jung Y, Han J, Kim E. 744 A study of skin-age analysis method using five parameters and skin characteristics of subjects using First Care Activation Serum for long-term period. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.758] [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: 10/24/2022]
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26
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Sooklal S, Raja S, Jang S, Robertson S, Bhatt A. Endoscopic submucosal dissection of a large pedunculated gastric polyp causing gastric outlet obstruction using clip-snare traction technique. VideoGIE 2020; 5:407-408. [PMID: 32954100 PMCID: PMC7482246 DOI: 10.1016/j.vgie.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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27
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Jang S, Suto Y, Liu J, Liu Q, Zuo Y, Duy PN, Miura T, Abe Y, Hamasaki K, Suzuki K, Kodama S. CORRIGENDUM TO: CAPABILITIES OF THE ARADOS-WG03 REGIONAL NETWORK FOR LARGE-SCALE RADIOLOGICAL AND NUCLEAR EMERGENCY SITUATIONS IN ASIA. Radiat Prot Dosimetry 2020; 188:270. [PMID: 32459335 DOI: 10.1093/rpd/ncaa079] [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] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/13/2020] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- S Jang
- Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, South Korea
| | - Y Suto
- National Institute of Radiological Sciences (NIRS), National Institute for Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - J Liu
- National Institute of Radiation Protection (NIRP), China CDC, Beijing, China
| | - Q Liu
- National Institute of Radiation Protection (NIRP), China CDC, Beijing, China
| | - Y Zuo
- China Institute of Radiation Protection (CIRP), China National Nuclear Corporation (CNNC), Taiyuen, China
| | - P N Duy
- Nuclear Research Institute (NRI), Viet Nam Atomic Energy Commission, VINATOM, Dalat, Viet Nam
| | - T Miura
- Hirosaki University, Hirosaki, Japan
| | - Y Abe
- Fukushima Medical University, Fukushima, Japan
| | - K Hamasaki
- Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - K Suzuki
- agasaki University, Nagasaki, Japan
| | - S Kodama
- Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, South Korea
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Jang S, Stevens T, Kou L, Vargo JJ, Parsi MA. Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture. Gastrointest Endosc 2020; 91:385-393.e1. [PMID: 31541625 DOI: 10.1016/j.gie.2019.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/21/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Indeterminate biliary stricture remains a significant diagnostic challenge. The current method of ERCP with bile duct brush cytology has substantial room for improvement. We aimed to determine the efficacy of a digital single-operator cholangioscopy (DSOC) in evaluation of indeterminate biliary stricture. METHODS An observational cohort study was conducted among the patients who underwent DSOC for the indication of indeterminate biliary stricture at a tertiary academic medical center. The outcomes of interests were the accuracy of DSOC in visual interpretation and bile duct sample and identification of any factor(s) that could influence its effectiveness. RESULTS One hundred five patients were included. The overall accuracy of DSOC in visual interpretation was 89.5%, whereas the accuracy of bile duct sample was 83.2%. The sensitivities of visual impression and bile duct sample were 89.1% and 69.8% and their specificities were 90% and 97.9%, respectively. The degree of endoscopists' experience with fewer than 25 cases and the severity of hyperbilirubinemia negatively impacted the accuracy of DSOC. Among 55 patients with definitive diagnosis of malignant stricture, the sensitivity of combined intraductal forceps biopsy sampling and brush cytology was 80.6%, whereas the sensitivity of brush cytology alone was 47.1%. CONCLUSIONS DSOC augments ERCP in evaluating indeterminate biliary stricture. The acquisition of intraductal forceps biopsy samples should be a requisite in evaluation of indeterminate biliary stricture with DSOC. Discovery of modifiable factors such as the degree of endoscopists' expertise and the severity of hyperbilirubinemia, which can influence the accuracy of DSOC, warrants further studies on patient preprocedure optimization and an endoscopic training program that will cultivate procedural competency.
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Affiliation(s)
- Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lei Kou
- Department of Quantitative Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mansour A Parsi
- Department of Gastroenterology and Hepatology, Tulane University, New Orleans, Louisiana, USA
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Jang S, Stevens T, Lopez R, Chahal P, Bhatt A, Sanaka M, Vargo JJ. Self-Expandable Metallic Stent Is More Cost Efficient Than Plastic Stent in Treating Anastomotic Biliary Stricture. Dig Dis Sci 2020; 65:600-608. [PMID: 31104197 DOI: 10.1007/s10620-019-05665-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/10/2019] [Accepted: 05/07/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Anastomotic bile duct stricture (ABS) is one of the most common complications after liver transplantation. Current practice of endoscopic retrograde cholangiopancreatography (ERCP) with multiple plastic stent (MPS) insertion often requires multiple sessions before achieving stricture resolution. We aimed to compare the efficacy of fully covered self-expandable metallic stent (FCSEMS) with MPS method while simultaneously analyzing the relative healthcare cost between the two methods in the management of ABS. METHODS Liver transplant patients with ABS who received ERCP with stent placement were identified by query of our endoscopic database. Comparative analyses between the group of patients treated with ERCP with MPS and the group treated with FCSEMS were performed. The costs to achieve stricture resolution, and the rates of stricture resolution, recurrence and complications were also compared. RESULTS A total of 158 patients underwent ERCP with stent insertion for the management of ABS. Of those, 49 patient received FCSEMS for their ABS while 109 patients were treated with MPS only. Our cost analysis showed early utilization of FCSEMS can deliver up to 25% savings in the total procedure cost while providing comparable rates of stricture resolution. The rates of technical success, stricture recurrence and adverse outcomes, and stricture free durations were also comparable between the two groups. CONCLUSION While providing efficacy and safety rates comparable to ERCP-MPS, the incorporation of FCSEMS at early stage of ABS management could provide a substantial savings by reducing the number of ERCP session to achieve stricture resolution. Optimization of the timing and duration of FCSEMS indwelling time needs further validation.
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Affiliation(s)
- Sunguk Jang
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA.
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA
| | - Rocio Lopez
- Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA
| | - Madhu Sanaka
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA
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30
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Parikh MP, Garg R, Chittajallu V, Gupta N, Sarvepalli S, Lopez R, Thota PN, Siddiki H, Bhatt A, Chahal P, Jang S, Stevens T, Vargo J, McCullough A, Sanaka MR. Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database. Surg Endosc 2020; 35:223-231. [PMID: 31950275 DOI: 10.1007/s00464-020-07384-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Acute cholangitis (AC) can be associated with significant mortality and high risk of readmissions, if not managed promptly. We used national readmission database (NRD) to identify trends and risk factors associated with 30-day readmissions in patients with AC. METHODS We conducted a retrospective cohort study of adult patients admitted with AC from 2010-2014 and Q1-Q3 of 2015 by extracting data from NRD. Initial admission with a primary diagnosis of acute cholangitis (ICD-9 code: 576.1) was considered as the index admission and any admission after index admission was considered a readmission regardless of the primary diagnosis. Multivariable regression analyses were performed to assess the association. RESULTS From 52,906 AC index admissions, overall 30-day readmission rate was 21.48% without significant differences in the readmission rates across the study period. There was significant increase in the overall hospital charges for readmissions, while a significant reduction in the death rate was observed during the first readmission. Recurrent cholangitis (14%), septicemia (6.4%), and mechanical complication of bile duct prosthesis (3%) were the most common reasons for readmissions. The risk of readmission was significantly higher in patients with pancreatic neoplasm (OR 1.6, 95% CI 1.4-1.8), those who underwent percutaneous biliary procedures (OR 1.4, 95% CI 1.2-1.6), and who had an acute respiratory failure (OR 1.2, 95% CI 1.0-1.15). Other factors contributing to increased risk of readmissions included patients with Charleston comorbidity index > 3, diabetes, and length of stay > 3 days. Readmission risk was significantly lower in patients who underwent ERCP (OR 0.80, 95% CI 0.73-0.88) or cholecystectomy (OR 0.54, 95% CI 0.43-0.69). CONCLUSIONS AC is associated with a high 30-day readmission rate of over 21%. Patients with malignant biliary obstruction, increased comorbidities, and those who undergo percutaneous drainage rather than ERCP seem to be at the highest risk.
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Affiliation(s)
- Malav P Parikh
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Rajat Garg
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Vibhu Chittajallu
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Niyati Gupta
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Shashank Sarvepalli
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Rocio Lopez
- Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, USA
| | - Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Hassan Siddiki
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Arthur McCullough
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA. .,Department of Gastroenterolgy, Cleveland Clinic Foundation, Desk Q39500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Simons-Linares CR, Romero-Marrero C, Jang S, Bhatt A, Lopez R, Vargo J, Stevens T, Carey W, Chahal P. Clinical outcomes of acute pancreatitis in patients with cirrhosis. Pancreatology 2020; 20:44-50. [PMID: 31734110 DOI: 10.1016/j.pan.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/31/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis. METHODS The National Inpatient Sample (NIS) database (2003-2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics. RESULTS Over 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001). CONCLUSION AP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Carey
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Jang S, Suto Y, Liu J, Liu Q, Zuo Y, Duy PN, Miura T, Abe Y, Hamasaki K, Suzuki K, Kodama S. CAPABILITIES OF THE ARADOS-WG03 REGIONAL NETWORK FOR LARGE-SCALE RADIOLOGICAL AND NUCLEAR EMERGENCY SITUATIONS IN ASIA. Radiat Prot Dosimetry 2019; 186:139-142. [PMID: 30576530 DOI: 10.1093/rpd/ncy279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
In 2015, the Asian Radiation Dosimetry Group established a regional network of biological dosimetry laboratories known as the ARADOS-WG03 (Working Group 03; Biological Dosimetry). A survey was conducted in 2017 to evaluate the capabilities and capacities of the participating laboratories for emergency preparedness and responses in large-scale nuclear and/or radiological incidents. The results of this survey were identified and assessed. The data provide important information on the current state of emergency cytogenetic biological dosimetry capabilities in the Asian region.
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Affiliation(s)
- S Jang
- Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, South Korea
| | - Y Suto
- National Institute of Radiological Sciences (NIRS), National Institute for Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - J Liu
- National Institute of Radiation Protection (NIRP), China CDC, Beijing, China
| | - Q Liu
- National Institute of Radiation Protection (NIRP), China CDC, Beijing, China
| | - Y Zuo
- China Institute of Radiation Protection (CIRP), China National Nuclear Corporation (CNNC), Taiyuen, China
| | - P N Duy
- Nuclear Research Institute (NRI), Viet Nam Atomic Energy Commission, VINATOM, Dalat, Viet Nam
| | - T Miura
- Hirosaki University, Hirosaki, Japan
| | - Y Abe
- Fukushima Medical University, Fukushima, Japan
| | - K Hamasaki
- Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - K Suzuki
- Nagasaki University, Nagasaki, Japan
| | - S Kodama
- Osaka Prefacture University, Osaka, Japan
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Tawbi H, Forsyth P, Hodi F, Lao C, Moschos S, Hamid O, Atkins M, Lewis K, Thomas R, Glaspy J, Jang S, Algazi A, Khushalani N, Postow M, Pavlick A, Ernstoff M, Reardon D, Balogh A, Rizzo J, Margolin K. Efficacité et tolérance de l’association du nivolumab (NIVO) et de l’ipilimumab (IPI) chez des patients atteints d’un mélanome et présentant des métastases cérébrales symptomatiques. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.561] [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: 10/25/2022]
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Backhaus I, Kawachi I, Ramirez A, Jang S, Khoo S, Al-Shamli A, Po-Hsiu L, Begotaraj E, Fischer F, Torre GL. Social capital and students’ health: results of the splash study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Universities around the world are challenged with rising rates of mental health problems among their students. Cumulative evidence demonstrated that aspects of the social environment, including social capital, play an important role in mental health. This study aimed to determine the prevalence of depressive symptoms among university students from across the globe and to investigate whether social capital was associated with depressive symptoms in university students.
Methods
A cross-sectional study was conducted in Albania, Brazil, Germany, Italy, Malaysia Oman, South Korea, Switzerland, Taiwan and the USA in 2018/2019. Data were obtained through self-administered questionnaire, including questions on sociodemographic characteristics and depressive symptoms. The BDI-S was used to assess the presence of depressive symptoms. Multilevel analyses were conducted to assess the relationship between social capital and depressive, adjusting for individual covariates (e.g. perceived stress and health behaviours) and country-level characteristics (e.g. democracy type).
Results
A total 3894 students participated. Out of all participants almost 47% presented clinically relevant depressive symptoms. The prevalence of depressive symptoms was highest among students identifying as other than male or female (48.7%), among students with low socioeconomic status (59.5%) and among students with low levels of cognitive (65.3%) and behavioural social capital (57.0%). Even after adjustment in multilevel logistic regression analyses, depressive symptoms remained significantly associated with low levels of cognitive social capital (OR = 1.49, 95% CI: 1.06 to 2.10) and low level of behavioural social capital (OR = 1.36, 95% CI: 1.08 to 1.71).
Conclusions
Social capital may play an important role in mental health problems in the university setting. The study identified significant opportunities for future research and health promotion strategies among students.
Key messages
Key factors associated with depressive symptoms among university students were low levels of behavioural and cognitive social capital. Health promotion programs targeting young persons with depressive symptoms should include effective components of social epidemiology such as social capital.
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Affiliation(s)
- I Backhaus
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - I Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - A Ramirez
- Center for Epidemiology Research, Federal University of Pelotas, Pelotas, Brazil
| | - S Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - S Khoo
- Sports Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - A Al-Shamli
- Physical Education Department, Sohar University, Sohar, Oman
| | - L Po-Hsiu
- Graduate Institute of Sports,Leisure,Hostipality Management, National Taiwan Normal University, Taipei, Taiwan
| | - E Begotaraj
- Department of Clinical Psychology, Sapienza University, Rome, Italy
| | - F Fischer
- Faculty of Health Sciences, Bielefeld University, Bielefeld, Germany
| | - G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Jang SH, Lim JS, Jang S, Lee M, Chi SG. XAF1 assembles a destructive complex to induce BRCA1-mediated apoptosis via suppressing ERa and switching estrogen function. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.022] [Citation(s) in RCA: 1] [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] [Indexed: 11/14/2022] Open
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Ishida K, Ohara N, Ercan A, Jang S, Trinh T, Kavvas ML, Carr K, Anderson ML. Impacts of climate change on snow accumulation and melting processes over mountainous regions in Northern California during the 21st century. Sci Total Environ 2019; 685:104-115. [PMID: 31174110 DOI: 10.1016/j.scitotenv.2019.05.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
A point-location-based analysis of future climate change impacts on snow accumulation and melting processes was conducted over three study watersheds in Northern California during a 90-year future period by means of snow regime projections. The snow regime projections were obtained by means of a physically-based snow model with dynamically downscaled future climate projections. Then, atmospheric and snow-related variables, and their interrelations during the 21st century were investigated to reveal future climate change impacts on snow accumulation and melting processes. The analysis shows large reductions in snow water equivalent (SWE), snowfall to precipitation (S/P) ratio, and snowmelt through the 21st century. Timing of the peak of the SWE and snowmelt will also change in the future. Meanwhile, the analysis in this study shows that air temperature rise will affect, but will not dominate the future change in snowmelt over the study watersheds. This result implies the importance of considering atmospheric variables other than air temperature, such as precipitation, shortwave radiation, relative humidity, and wind speed even if these variables will not clearly change during the 21st century.
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Affiliation(s)
- K Ishida
- Faculty of Advanced Science and Technology, Kumamoto University, 2-39-1 Kurokami, Kumamoto 860-8555, Japan.
| | - N Ohara
- Civil and Architectural Engineering, University of Wyoming, Laramie, WY 82071, USA.
| | - A Ercan
- J.Amorocho Hydraulics Laboratory, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - S Jang
- Korea Institute of Water and Environment, Korea Water Resources Corporation, Daejeon 305-730, South Korea.
| | - T Trinh
- Hydrologic Research Laboratory, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - M L Kavvas
- J.Amorocho Hydraulics Laboratory, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA; Hydrologic Research Laboratory, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - K Carr
- J.Amorocho Hydraulics Laboratory, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - M L Anderson
- California Department of Water Resources, Division of Flood Management, 3310 El Camino Ave Rm 200, Sacramento, CA 95821, USA.
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Jang S, Lee KW, Magdalene T, Ahn J, Lee MG, Chi SG. XAF1 and ZNF313 complex stimulates ER stress-induced apoptosis via direct GRP78 inhibition. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.021] [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: 11/13/2022] Open
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Jang S. Endoscopic management of ampullary neoplasm. Int J Gastrointest Interv 2019. [DOI: 10.18528/ijgii190007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to blood loss from the gastrointestinal tract proximal to the ligament of Treitz due to lesions that are non-variceal in origin. The distinction of the bleeding source as non-variceal is important in numerous aspects, but none more so than endoscopic approaches for successful hemostasis. When a patient presents with acute overt blood loss, NVUGIB is a medical emergency, which requires immediate intervention. There have been major strides in pharmacologic and endoscopic interventions for successful induction and remission of hemostasis in the last two decades. Despite achieving tangible improvements, the burden of the disease and the consequent mortality remain high. To address endoscopic outcomes better, several new technologies have emerged and have been subsequently incorporated to the armamentarium of hemostatic tools. This study aims to provide a succinct review on novel technologies for endoscopic hemostasis.
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Affiliation(s)
- Adam Kichler
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Kim E, Jeon H, Choi S, Kim S, Lee J, Choi H, Keum B, Chun H, Lee H, Kim C, Jang S. Endoscopic submucosal dissection using an detachable robotic assitive device in a live porcine model. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.294] [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: 11/14/2022] Open
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41
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Kim B, Jang S, Lee YJ, Park N, Cho YU, Park CJ. The rivaroxaban-adjusted normalized ratio: use of the prothrombin time to monitor the therapeutic effect of rivaroxaban. Br J Biomed Sci 2019; 76:122-128. [DOI: 10.1080/09674845.2019.1605648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B Kim
- Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea (South Korea)
| | - S Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea (South Korea)
- Asan Clinical Research Center, Seoul, Republic of Korea (South Korea)
| | - YJ Lee
- Asan Clinical Research Center, Seoul, Republic of Korea (South Korea)
| | - N Park
- Asan Clinical Research Center, Seoul, Republic of Korea (South Korea)
| | - YU Cho
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea (South Korea)
| | - CJ Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea (South Korea)
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Jang S, Stevens T, Lopez R, Bhatt A, Vargo JJ. Superiority of Gastrojejunostomy Over Endoscopic Stenting for Palliation of Malignant Gastric Outlet Obstruction. Clin Gastroenterol Hepatol 2019; 17:1295-1302.e1. [PMID: 30391433 DOI: 10.1016/j.cgh.2018.10.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 09/13/2018] [Revised: 10/21/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastric outlet obstruction (GOO) in patients with malignancies causes nausea, vomiting, abdominal pain, malnutrition, and dehydration. Endoscopic placement of self-expandable metallic stent (SEMS) and gastrojejunostomy are the 2 main palliative options. We aimed to compare the outcomes of endoscopic SEMS placement with gastrojejunostomy in a propensity score matched study and identified factors associated with clinical success. METHODS We performed a retrospective analysis of patients with malignant GOO who underwent endoscopic SEMS placement (n = 183) or gastrojejunostomy (n = 127) from 2011 through 2017 at a tertiary academic medical center. Clinical success was defined as successful resumption of oral intake and relief of obstructive symptoms after either procedure. A propensity score matched analysis was conducted to compare clinical success rate, luminal patency duration, survival length, and adverse outcomes. We performed multivariable analyses to identify factors associated with clinical success. RESULTS Proportions of patients with clinical success did not differ significantly between the SMES group (79.4%) and the gastrojejunostomy group (80.1%) (P = .83). The mean patency duration and survival lengths were significantly longer in the gastrojejunostomy group (169.2 and 193.4 days respectively), compared to the endoscopic stenting group (96.5 and 119.9 days respectively). Poor performance status, presence of ascites and low albumin were independent risk factors for failure of enteral stenting and gastrojejunostomy. CONCLUSIONS In a retrospective analysis of patients with GOO, due to cancer, who underwent endoscopic SEMS placement or gastrojejunostomy, we found gastrojejunostomy to provide significant increases in patency duration and survival time. Gastrojejunostomy should therefore be considered the primary treatment option for patients with good performance status and reasonable survival expectancy. Nutritional status, the absence of ascites, and pre-procedure performance status are associated with clinical success.
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Affiliation(s)
- Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Rocio Lopez
- Department of Quantitative Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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Chen YI, Yang J, Friedland S, Holmes I, Law R, Hosmer A, Stevens T, Franco MC, Jang S, Pawa R, Mathur N, Sejpal DV, Inamdar S, Trindade AJ, Nieto J, Berzin TM, Sawhney M, DeSimone ML, DiMaio C, Kumta NA, Gupta S, Yachimski P, Anderloni A, Baron TH, James TW, Jamil LH, Ona MA, Lo SK, Gaddam S, Dollhopf M, Bukhari MA, Moran R, Gutierrez OB, Sanaei O, Fayad L, Ngamruengphong S, Kumbhari V, Singh V, Repici A, Khashab MA. Lumen apposing metal stents are superior to plastic stents in pancreatic walled-off necrosis: a large international multicenter study. Endosc Int Open 2019; 7:E347-E354. [PMID: 30834293 PMCID: PMC6395102 DOI: 10.1055/a-0828-7630] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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: 03/05/2018] [Accepted: 07/31/2018] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 - 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery. Results A total of 189 patients (mean age 55.2 ± 15.6 years, 34.9 % female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100 % in LAMS and 98.9 % in PS ( P = 0.28). Clinical success was attained in 80.4 % of LAMS and 57.5 % of PS ( P = 0.001). Rate of PCD was similar (13.7 % LAMS vs. 16.3 % PS, P = 0.62), while PS was associated with a greater need for surgery (16.1 % PS vs. 5.6 % LAMS, P = 0.02). Adverse events (AEs) were observed in 9.8 % of LAMS and 10.3 % of PS ( P = 0.90) and were rated as severe in 2.0 % and 6.9 %, respectively ( P = 0.93). After excluding patients with < 6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9 % PS vs. 5.6 % LAMS, P = 0.04). Conclusions When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shai Friedland
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian Holmes
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Amy Hosmer
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Matheus C. Franco
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Pawa
- Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Nihar Mathur
- Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Divyesh V. Sejpal
- Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
| | - Sumant Inamdar
- Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
| | - Arvind J. Trindade
- Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
| | - Jose Nieto
- Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, FL, USA
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Mandeep Sawhney
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Michael L. DeSimone
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Christopher DiMaio
- Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
| | - Nikhil A. Kumta
- Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
| | - Sanchit Gupta
- Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
| | - Patrick Yachimski
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University, Nashville, TN, USA
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Theodore W. James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Laith H. Jamil
- Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mel A. Ona
- Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Simon K. Lo
- Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Srinivas Gaddam
- Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Markus Dollhopf
- Division of Gastroenterology and Hepatology, Klinikum Neuperlach, Munich, Germany
| | - Majidah A. Bukhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Robert Moran
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Olaya Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vikesh Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alessandro Repici
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA,Corresponding author Mouen A. Khashab, MD Johns Hopkins Hospital1800 Orleans StreetSheikh Zayed TowerBaltimoreMD 21287USA+1-514-934-8547
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Simons-Linares CR, Jang S, Sanaka M, Bhatt A, Lopez R, Vargo J, Stevens T, Chahal P. The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?: A 10-year analysis of the National Inpatient Sample. Medicine (Baltimore) 2019; 98:e14378. [PMID: 30762737 PMCID: PMC6408121 DOI: 10.1097/md.0000000000014378] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only.Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes. Adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.Over 2.8 million AP patients were analyzed. When compared with patients with AP-only, patients with the triad of AP + DKA + HTG had higher inpatient mortality (aOR 2.8, P < .001; CI: 1.9 - 4.2), Acute Kidney Injury (AKI) (aOR 4.1, P < .001; CI: 3.6-4.6), Systemic Inflammatory Response Syndrome (SIRS) (aOR 4.9, P < .001), Shock (aOR 4.3, P < .001), Acute Respiratory Distress Syndrome (ARDS) (aOR 3.0, P < .001), sepsis (aOR 2.6, P < .001), ileus (aOR 2.1, P < .001), parenteral nutrition requirement (aOR 1.8, P < .001), inflation-adjusted hospital charges (US$ 17,704.1), and had longer length of stay (LOS) (aOR 2.0, P < .001; CI 1.8-2.3). Furthermore, when compared to AP-only, patients with AP + HTG had lower mortality, which is different from the current AP knowledge. Finally, it appears that the driving force for the increased in mortality of patients with the triad (AP, DKA, HTG) is the DKA rather than the HTG.Patients with the triad of AP, DKA, and HTG constitute a unique subgroup of patients that has higher inpatient mortality, multi-organ failure, hospital charges, and longer hospital length of stay. Therefore, hospital protocols targeting this subgroup of AP patients could improve mortality and outcomes.
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Affiliation(s)
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Madhusudan Sanaka
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Rocio Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute
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Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH. The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West. Endosc Ultrasound 2019; 8:188-193. [PMID: 30719996 PMCID: PMC6590002 DOI: 10.4103/eus.eus_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD. Patients and Methods A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale. Results All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement. Conclusions EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Samarasena
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - John G Lee
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - William R Brugge
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kulka U, Wojcik A, Di Giorgio M, Wilkins R, Suto Y, Jang S, Quing-Jie L, Jiaxiang L, Ainsbury E, Woda C, Roy L, Li C, Lloyd D, Carr Z. BIODOSIMETRY AND BIODOSIMETRY NETWORKS FOR MANAGING RADIATION EMERGENCY. Radiat Prot Dosimetry 2018; 182:128-138. [PMID: 30423161 DOI: 10.1093/rpd/ncy137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 06/09/2023]
Abstract
Biological dosimetry enables individual dose reconstruction in the case of unclear or inconsistent radiation exposure situations, especially when a direct measurement of ionizing radiation is not or is no longer possible. To be prepared for large-scale radiological incidents, networking between well-trained laboratories has been identified as a useful approach for provision of the fast and trustworthy dose assessments needed in such circumstances. To this end, various biodosimetry laboratories worldwide have joined forces and set up regional and/or nationwide networks either on a formal or informal basis. Many of these laboratories are also a part of global networks such as those organized by World Health Organization, International Atomic Energy Agency or Global Health Security Initiative. In the present report, biodosimetry networks from different parts of the world are presented, and the partners, activities and cooperation actions are detailed. Moreover, guidance for situational application of tools used for individual dosimetry is given.
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Affiliation(s)
- U Kulka
- Bundesamt für Strahlenschutz, Salzgitter, Germany
| | - A Wojcik
- Stockholm University, Centre for Radiation Protection Research, Stockholm, Sweden
| | - M Di Giorgio
- Autoridad Regulatoria Nuclear, C1429BNP CABA, Buenos Aires, Argentina
| | - R Wilkins
- Health Canada, Radiation Protection Bureau, Ottawa, Canada
| | - Y Suto
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - S Jang
- Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - L Quing-Jie
- National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, China
| | - L Jiaxiang
- National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, China
| | - E Ainsbury
- Public Health England, Centre for Radiation Chemical and Environmental Hazards, Chilton, UK
| | - C Woda
- HelmholtzZentrum München, Institute of Radiation Protection, Oberschleissheim, Germany
| | - L Roy
- Institut de Radioprotection et de Surete Nucleaire, Fontenay-aux-Roses, France
| | - C Li
- Health Canada, Radiation Protection Bureau, Ottawa, Canada
| | - D Lloyd
- Public Health England, Centre for Radiation Chemical and Environmental Hazards, Chilton, UK
| | - Z Carr
- World Health Organization, Department of Public Health, Environmental and Social Determinants of Health, Geneva-27, Switzerland
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Hwang M, Jang S, Lalonde R, Heron D, Huq S. Normal Brain Dose and Treatment Efficiency of Coplanar-Only IMRT/VMAT plans for Glioblastoma Multiforme using a Novel Ring Gantry Linac Delivery System. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1401] [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: 11/17/2022]
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48
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Schub M, Dohopolski M, Horne Z, Burton S, Christie N, Jang S, Heron D. Lung Stereotactic Body Radiation Therapy: Is There a Difference in Outcome Based on Respiratory Gating? Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1846] [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: 10/28/2022]
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49
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Jang S, Rosenberg S, Hullett C, Bradley K, Kimple R. Beyond Charting Outcomes in the Radiation Oncology Match: Analysis of Self-reported Applicant Data. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1158] [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: 10/28/2022]
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50
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Lee J, Jang S, Cho S. THE LONG-TERM EFFECT OF DEPRESSIVE SYMPTOMS ON ALL-CAUSE MORTALITY IN THE ELDERLY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1905] [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: 11/13/2022] Open
Affiliation(s)
- J Lee
- Graduate School of Public Administration, Seoul National University
| | - S Jang
- Red Cross College of Nursing, Chung-Ang Univerisity
| | - S Cho
- Graduate School of Public Health, Seoul National University
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