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Alizadeh M, Sampaio Moura N, Schledwitz A, Patil SA, El-Serag H, Ravel J, Raufman JP. A Practical Guide to Evaluating and Using Big Data in Digestive Disease Research. Gastroenterology 2024; 166:240-247. [PMID: 38052336 PMCID: PMC10872385 DOI: 10.1053/j.gastro.2023.11.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Madeline Alizadeh
- The Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalia Sampaio Moura
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alyssa Schledwitz
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Seema A Patil
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hashem El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jacques Ravel
- The Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-Pierre Raufman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland; VA Maryland Healthcare System, Baltimore, Maryland; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland; Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland.
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Du RC, Ouyang YB, Hu Y. Research trends on artificial intelligence and endoscopy in digestive diseases: A bibliometric analysis from 1990 to 2022. World J Gastroenterol 2023; 29:3561-3573. [PMID: 37389238 PMCID: PMC10303508 DOI: 10.3748/wjg.v29.i22.3561] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Recently, artificial intelligence (AI) has been widely used in gastrointestinal endoscopy examinations.
AIM To comprehensively evaluate the application of AI-assisted endoscopy in detecting different digestive diseases using bibliometric analysis.
METHODS Relevant publications from the Web of Science published from 1990 to 2022 were extracted using a combination of the search terms “AI” and “endoscopy”. The following information was recorded from the included publications: Title, author, institution, country, endoscopy type, disease type, performance of AI, publication, citation, journal and H-index.
RESULTS A total of 446 studies were included. The number of articles reached its peak in 2021, and the annual citation numbers increased after 2006. China, the United States and Japan were dominant countries in this field, accounting for 28.7%, 16.8%, and 15.7% of publications, respectively. The Tada Tomohiro Institute of Gastroenterology and Proctology was the most influential institution. “Cancer” and “polyps” were the hotspots in this field. Colorectal polyps were the most concerning and researched disease, followed by gastric cancer and gastrointestinal bleeding. Conventional endoscopy was the most common type of examination. The accuracy of AI in detecting Barrett’s esophagus, colorectal polyps and gastric cancer from 2018 to 2022 is 87.6%, 93.7% and 88.3%, respectively. The detection rates of adenoma and gastrointestinal bleeding from 2018 to 2022 are 31.3% and 96.2%, respectively.
CONCLUSION AI could improve the detection rate of digestive tract diseases and a convolutional neural network-based diagnosis program for endoscopic images shows promising results.
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Affiliation(s)
- Ren-Chun Du
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yao-Bin Ouyang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States
| | - Yi Hu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China
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Reizine E, Meurgey A, Amaddeo G, Laurent A, Calderaro J, Mule S, Luciani A. Fat in mass in primary liver lesions: are usual MRI diagnostic criteria of both malignant and benign liver lesions still applicable? Abdom Radiol (NY) 2022; 47:2347-2355. [PMID: 35672475 DOI: 10.1007/s00261-022-03561-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the accuracy of the usual MRI diagnostic patterns of primary liver lesions applied to the diagnosis of pathologically proven fat-containing liver lesions. MATERIALS AND METHODS This monocentric IRB approved retrospective study included all patients with pathologically proven focal liver lesions and documented intra-tumoral fat on pathology and who underwent preoperative liver MRI for characterization. Both liver morphology and usual lesion MRI features were analyzed and their distribution correlated to the final pathological result (Khi-2 or Fisher exact tests, Student t-test or Mann-Whitney U test, as appropriate). The Sensitivity (Se) and Specificity (Sp) of MRI patterns known to be associated to both Hepatocellular Carcinoma (HCC), Focal Nodular Hyperplasia (FNH), and Hepatocellular Adenoma (HCA) subtypes were evaluated. RESULTS Between March 2014 and November 2021, 66 lesions were included, corresponding to: 26 HCC, 32 HCA, 6 FNH and 2 hepatic angiomyolipoma (HAML). All lesions developed on a dysmorphic liver were HCC. A non-rim arterial phase hyperenhancement with a washout and an enhancing capsule had a 98% specificity for HCC diagnosis; A homogeneous dropout of signal on the opposed phase had a sensitivity of 92% and a specificity of 89% for the diagnosis of HNF1alpha inactivated subtype of HCA (HHCA). The FNH pattern was specific at 100% for the diagnosis of FNH with a 40% Se. Finally, the accuracy of inflammatory hepatocellular adenoma (IHCA) pattern had a low 60% Se but a high 89% Sp for IHCA diagnosis. CONCLUSION Known MRI patterns remain reliable for the accurate diagnosis of primary liver tumors on MRI even in fat-containing lesions.
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Affiliation(s)
- Edouard Reizine
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France.
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France.
| | - Azure Meurgey
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Giuliana Amaddeo
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Hepatology, APHP, HU Henri Mondor, Créteil, France
| | - Alexis Laurent
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Departement of Liver Surgery, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Julien Calderaro
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Pathology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Sebastien Mule
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
| | - Alain Luciani
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
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Abstract
After nearly 40 years of development, digestive endoscopy in children has been widely applied, and it has helped to expand the spectrum of pediatric digestive system diseases and greatly improve the diagnosis and treatment of pediatric digestive system diseases. Pediatric digestive endoscopy has become a subject. However, there are some problems such as the unbalanced development of pediatric digestive endoscopy across China, the lack of homogeneity in diagnosis and treatment system, the tendency of adult-oriented diagnosis and treatment techniques, and the localization of training quality, which affect the standardized and healthy development of pediatric digestive endoscopy. The diagnosis and treatment with digestive endoscopy in children should adhere to both pediatric characteristics and technological innovation to propose the concept of comfort, emphasize the importance of standardization (including the space and process for endoscopic diagnosis and treatment, perioperative evaluation, training mode, and access qualification), standardize the minimally invasive techniques, and develop artificial intelligence. It is of great importance to formulate related consensus statements and guidelines on the basis of medical safety and the features of the growth and development of children, so as to achieve the high-quality development of pediatric digestive endoscopy, effectively improve the diagnosis and treatment levels of pediatric digestive endoscopy, and bring benefits to more pediatric patients.
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Affiliation(s)
- Mi-Zu Jiang
- Department of Gastroenterology and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health/National Children's Regional Medical Center, Hangzhou 310052, China
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Zeidler H. Henri Matisse's medical history: Multiple health problems and impact on creativity. J Med Biogr 2021; 29:63-70. [PMID: 31533520 DOI: 10.1177/0967772018820763] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Matisse (1869-1954) is regarded-along with Pablo Picasso-as one of the most influential contemporary artists of the 20th century. Books, biographies and illustrations often show the artist in a wheelchair or in bed, producing cut-papers with a pair of scissors or painting with a specially extended brush. Usually it is reported that abdominal surgery left Matisse chair- and bed-bound. The life of Matisse was marked by various further health problems that have never been considered in full in a medical journal. Moreover, his biography is full of examples of the reverse interaction between health and art, whereby not only health problems influenced his art but also how his artistic activity had an impact on his health and mental condition. Therefore, a comprehensive view on the relationship between health and art in the life and art of Matisse is attempted here. Matisse's medical history not only provides an instructive example of life-long multiple somatic and psychosomatic health issues, but also contributes to the humanistic view of medicine by demonstrating how he impressively captured the problems of his artistic work and life through vitality and creative power.
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Wang P, Tan X, Li Q, Qian M, Cheng A, Ma B, Wan P, Zhang X, Guo C, Sheng M, Yi M, Yu M. Extra-pulmonary complications of 45 critically ill patients with COVID-19 in Yichang, Hubei province, China: A single-centered, retrospective, observation study. Medicine (Baltimore) 2021; 100:e24604. [PMID: 33655925 PMCID: PMC7939178 DOI: 10.1097/md.0000000000024604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/26/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.
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Affiliation(s)
- Peng Wang
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Xiang Tan
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Qian Li
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Yichang, China Three Gorges University Third People's Hospital
| | - Min Qian
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Aiguo Cheng
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Yichang, China Three Gorges University Third People's Hospital
| | - Baohua Ma
- Medical Department, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang, Yichang, Hubei, China
| | - Peng Wan
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Xinli Zhang
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Changyun Guo
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Mengting Sheng
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Mengqiu Yi
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
| | - Min Yu
- Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang
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Arce-López B, Lizarraga E, López de Mesa R, González-Peñas E. Assessment of Exposure to Mycotoxins in Spanish Children through the Analysis of Their Levels in Plasma Samples. Toxins (Basel) 2021; 13:toxins13020150. [PMID: 33672088 PMCID: PMC7919644 DOI: 10.3390/toxins13020150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022] Open
Abstract
In this study, we present, for the first time in Spain, the levels of 19 mycotoxins in plasma samples from healthy and sick children (digestive, autism spectrum (ASD), and attention deficit hyperactivity (ADHD) disorders) (n = 79, aged 2–16). The samples were analyzed by liquid chromatography-mass spectrometry (triple quadrupole) (LC-MS/MS). To detect Phase II metabolites, the samples were reanalyzed after pre-treatment with β-glucuronidase/arylsulfatase. The most prevalent mycotoxin was ochratoxin A (OTA) in all groups of children, before and after enzyme treatment. In healthy children, the incidence of OTA was 92.5% in both cases and higher than in sick children before (36.7% in digestive disorders, 50% in ASD, and 14.3% in ADHD) and also after the enzymatic treatment (76.6 % in digestive disorders, 50% in ASD, and 85.7% in ADHD). OTA levels increased in over 40% of healthy children after enzymatic treatment, and this increase in incidence and levels was also observed in all sick children. This suggests the presence of OTA conjugates in plasma. In addition, differences in OTA metabolism may be assumed. OTA levels are higher in healthy children, even after enzymatic treatment (mean OTA value for healthy children 3.29 ng/mL, 1.90 ng/mL for digestive disorders, 1.90 ng/mL for ASD, and 0.82 ng/mL for ADHD). Ochratoxin B appears only in the samples of healthy children with a low incidence (11.4%), always co-occurring with OTA. Sterigmatocystin (STER) was detected after enzymatic hydrolysis with a high incidence in all groups, especially in sick children (98.7% in healthy children and 100% in patients). This supports glucuronidation as a pathway for STER metabolism in children. Although other mycotoxins were studied (aflatoxins B1, B2, G1, G2, and M1; T-2 and HT-2 toxins; deoxynivalenol, deepoxy-deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol; zearalenone; nivalenol; fusarenon-X; neosolaniol; and diacetoxyscirpenol), they were not detected either before or after enzymatic treatment in any of the groups of children. In conclusion, OTA and STER should be highly considered in the risk assessment of mycotoxins. Studies concerning their sources of exposure, toxicokinetics, and the relationship between plasma levels and toxic effects are of utmost importance in children.
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Affiliation(s)
- Beatriz Arce-López
- Department of Pharmaceutical Technology and Chemistry, Research Group MITOX, School of Pharmacy and Nutrition, Universidad de Navarra, 31008 Pamplona, Spain; (B.A.-L.); (E.G.-P.)
| | - Elena Lizarraga
- Department of Pharmaceutical Technology and Chemistry, Research Group MITOX, School of Pharmacy and Nutrition, Universidad de Navarra, 31008 Pamplona, Spain; (B.A.-L.); (E.G.-P.)
- Correspondence:
| | - Reyes López de Mesa
- Department of Pediatrics, Clínica Universidad de Navarra, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Elena González-Peñas
- Department of Pharmaceutical Technology and Chemistry, Research Group MITOX, School of Pharmacy and Nutrition, Universidad de Navarra, 31008 Pamplona, Spain; (B.A.-L.); (E.G.-P.)
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Madrazo Z, Osorio J, Otero A, Biondo S, Videla S. Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic: A multicenter collaborative retrospective cohort study protocol (COVID-CIR). Medicine (Baltimore) 2021; 100:e24409. [PMID: 33592888 PMCID: PMC7870207 DOI: 10.1097/md.0000000000024409] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
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Affiliation(s)
- Zoilo Madrazo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Javier Osorio
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Aurema Otero
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Bellvitge University Hospital
| | - Sebastian Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/Bellvitge Biomedical Research Institute (IDIBELL)
- Department of Pathology and Experimental Therapeutics, Faculty of Medicine, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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9
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Abstract
Objective Methods Results Conclusion
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Affiliation(s)
| | - Daniela Castillo-Garcia
- Emergency Department, Hospital Infantil de México Federico Gómez, Mexico. Correspondence to: Dr Daniela Castillo-García, 162 Doctor Marquez Street , Col Doctores, Mexico City, Postal Code 06400,
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Zhang Y, Ma P, Zhang X, Pei Z, Wang H, Dou X. Association of digestive symptoms with severity and mortality of COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22736. [PMID: 33120773 PMCID: PMC7581056 DOI: 10.1097/md.0000000000022736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gastrointestinal manifestations are common in patients with COVID-19, but the association between specific digestive symptoms and COVID-19 prognosis remains unclear. This study aims to assess whether digestive symptoms are associated with COVID-19 severity and mortality. METHODS We will search PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to September, 2020, to identify studies that compared the prevalence of at least one specific digestive symptom between severe and non-severe COVID-19 patients or between non-survivors and survivors. Two independent reviewers will assess the risk of bias of the included cohort studies using the modified Newcastle-Ottawa Scale. Meta-analyses will be conducted to estimate the pooled prevalence of individual symptoms using the inverse variance method with the random-effects model. We will conduct subgroup analyses, sensitivity analyses, and meta-regression analyses to explore the sources of heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the evidence. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION Our meta-analysis will comprehensively evaluate the association between different digestive symptoms and the severity and mortality of patients infected with COVID-19. This study will provide evidence to help determine whether special protective measures and treatment options are needed for patients with digestive system comorbidities during the COVID-19 pandemic. INPLASY REGISTRATION NUMBER INPLASY202090055.
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Affiliation(s)
| | | | - Xiu Zhang
- The Second Ward of Orthopedics Department
| | | | - Haixia Wang
- The First Ward of Cardiovascular Medicine Department, Lanzhou University Second Hospital, Lanzhou, China
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Benites-Goñi H, Alférez-Andía J, Barreda-Bolaños F. The forgotten victims of the COVID-19 pandemic. Dig Liver Dis 2020; 52:1085-1086. [PMID: 32605867 PMCID: PMC7293462 DOI: 10.1016/j.dld.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stacey Prenner
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael L. Kochman
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Crespo J, Andrade R, Alberca de Las Parras F, Balaguer F, Barreiro-de Acosta M, Bujanda L, Gutiérrez A, Jorquera F, Iglesias-García J, Sánchez-Yagüe A, Calleja JL. Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG. Gastroenterol Hepatol 2020; 43:332-347. [PMID: 32409107 PMCID: PMC7183290 DOI: 10.1016/j.gastrohep.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: (a)To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. (b)To protect all healthcare professionals against the risks of infection with SARS-CoV-2. (c)To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2.
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Affiliation(s)
- Javier Crespo
- Presidente de la SEPD. Jefe del Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla. Instituto de Investigación Valdecilla (IDIVAL). Facultad de Medicina, Universidad de Cantabria, Santander, España.
| | - Raúl Andrade
- Presidente de la AEEH. Jefe del Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | - Francesc Balaguer
- Secretario de la Asociación Española de Gastroenterología (AEG). Servicio de Gastroenterología, Hospital Clínic, Barcelona, España
| | - Manuel Barreiro-de Acosta
- Presidente de GETECCU. Unidad EII. Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Luís Bujanda
- Presidente de la Asociación Española de Gastroenterología (AEG). Instituto Biodonostia. CIBERehd. Universidad del País Vasco (UPV/EHU), San Sebastián, España
| | - Ana Gutiérrez
- Vicepresidenta de GETECCU. Servicio de Medicina Digestiva, Hospital General Universitario de Alicante. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, Alicante, España
| | - Francisco Jorquera
- Jefe del Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León. IBIOMED. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, León, España
| | - Julio Iglesias-García
- Jefe de la Sección de Endoscopia, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Andrés Sánchez-Yagüe
- Facultativo Especialista de Área, Servicio de Aparato Digestivo, Hospital Costa del Sol, Marbella. Jefe del Servicio de Aparato Digestivo, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, España
| | - José Luis Calleja
- Vicepresidente de la AEEH. Jefe del Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda. Instituto de Investigación Biomédica IDIPHIM. Universidad Autónoma de Madrid, Majadahonda, Madrid, España
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Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, Zhang L, Lin R, Liu J, Ding Z, Hou X. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115:916-923. [PMID: 32301761 PMCID: PMC7172493 DOI: 10.14309/ajg.0000000000000664] [Citation(s) in RCA: 363] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. METHODS We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. RESULTS There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. DISCUSSION We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.
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Affiliation(s)
- Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Caihan Duan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Shengyan Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Brennan Spiegel
- Department of Medicine, Divisions of Gastroenterology and Health Services Research, Cedars-Sinai Medical Center, Los Angles, California, USA
| | - Huiying Shi
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Weijun Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Jun Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
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15
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Huvé R, O'Toole E, Gara-Boivin C, Fontaine P, Bélanger MC. Bile composition of healthy cats and cats with suspected hepatobiliary disease using point-of-care analyzers: A prospective preliminary study. Can J Vet Res 2020; 84:138-145. [PMID: 32255909 PMCID: PMC7088509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/21/2019] [Indexed: 06/11/2023]
Abstract
Although hepatobiliary disease is common in cats, little is known about the bile composition in either these diseased states or in healthy cats. The objectives of this study were to evaluate several analytes from the bile of healthy cats and to investigate the usefulness of measuring these variables to predict bacterial cholangitis. Cats were prospectively enrolled and divided into 3 groups: 21 healthy cats (group 1) and 14 cats with suspected hepatobiliary disease: 9 without bacterial biliary infection (group 2) and 5 with bacterial biliary infection (group 3). Percutaneous ultrasound-guided cholecystocentesis was conducted on each cat. Bile cytology and culture were carried out and bile was analyzed for pH, lactate, and glucose levels using several point-of-care (POC) devices. Reference values for several bile analytes in healthy cats were calculated and are presented in this study. Neither the pH (P = 0.88) nor the lactate concentration (P = 0.85) was significantly different among the 3 groups. Sodium concentration was significantly higher in group 3 than in group 2 (P < 0.05). Bile pH, lactate, and glucose levels were unable to predict the presence of a bacterial infection in the bile.
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Affiliation(s)
- Romain Huvé
- Department of Clinical Sciences (Huvé, O'Toole, Fontaine, Bélanger) and Department of Pathology and Microbiology (Gara-Boivin), Faculty of Veterinary Medicine, University of Montreal, C.P. 5000, Saint-Hyacinthe, Quebec J2S 7C6
| | - Elizabeth O'Toole
- Department of Clinical Sciences (Huvé, O'Toole, Fontaine, Bélanger) and Department of Pathology and Microbiology (Gara-Boivin), Faculty of Veterinary Medicine, University of Montreal, C.P. 5000, Saint-Hyacinthe, Quebec J2S 7C6
| | - Carolyn Gara-Boivin
- Department of Clinical Sciences (Huvé, O'Toole, Fontaine, Bélanger) and Department of Pathology and Microbiology (Gara-Boivin), Faculty of Veterinary Medicine, University of Montreal, C.P. 5000, Saint-Hyacinthe, Quebec J2S 7C6
| | - Pascal Fontaine
- Department of Clinical Sciences (Huvé, O'Toole, Fontaine, Bélanger) and Department of Pathology and Microbiology (Gara-Boivin), Faculty of Veterinary Medicine, University of Montreal, C.P. 5000, Saint-Hyacinthe, Quebec J2S 7C6
| | - Marie-Claude Bélanger
- Department of Clinical Sciences (Huvé, O'Toole, Fontaine, Bélanger) and Department of Pathology and Microbiology (Gara-Boivin), Faculty of Veterinary Medicine, University of Montreal, C.P. 5000, Saint-Hyacinthe, Quebec J2S 7C6
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16
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Li LY, Wu W, Chen S, Gu JW, Li XL, Song HJ, Du F, Wang G, Zhong CQ, Wang XY, Chen Y, Shah R, Yang HM, Cai Q. Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective. J Dig Dis 2020; 21:199-204. [PMID: 32267098 PMCID: PMC7262069 DOI: 10.1111/1751-2980.12862] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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] [Received: 04/01/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.
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Affiliation(s)
- Lian Yong Li
- Department of GastroenterologyPLA Strategic Support Force Characteristic Medical CenterBeijingChina
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and HealthBeijingChina
- Prevention and Control Group of SARS‐CoV‐2, PLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Wei Wu
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and HealthBeijingChina
| | - Sheng Chen
- Department of GastroenterologyPLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Jian Wen Gu
- Prevention and Control Group of SARS‐CoV‐2, PLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Xin Lou Li
- Prevention and Control Group of SARS‐CoV‐2, PLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Hai Jing Song
- Prevention and Control Group of SARS‐CoV‐2, PLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Feng Du
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and HealthBeijingChina
| | - Gang Wang
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and HealthBeijingChina
| | - Chang Qing Zhong
- Department of GastroenterologyPLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Xiao Ying Wang
- Department of GastroenterologyPLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Yan Chen
- Department of GastroenterologyPLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Rushikesh Shah
- Division of Digestive Diseases, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - He Ming Yang
- Prevention and Control Group of SARS‐CoV‐2, PLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Qiang Cai
- Division of Digestive Diseases, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
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Abstract
BACKGROUND Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.
AIM To identify recent advances in diagnostic EGDs to improve diagnostic yield.
METHODS We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.
RESULTS We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.
CONCLUSION There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.
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Affiliation(s)
- Jun-Liang Teh
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
| | - Soon Yuen
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, National University of Singapore, Singapore 119074, Singapore
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18
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Liao JY, Lee CTC, Lin TY, Liu CM. Exploring prior diseases associated with incident late-onset Alzheimer's disease dementia. PLoS One 2020; 15:e0228172. [PMID: 31978130 PMCID: PMC6980504 DOI: 10.1371/journal.pone.0228172] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
Studies have identified prior conditions associated with late-onset Alzheimer's disease dementia (LOAD), but all prior diseases have rarely been screened simultaneously in the literature. Our objective in the present study was to identify prior conditions associated with LOAD and construct pathways for them. We conducted a population-based matched case-control study based on data collected in the National Health Insurance Research database of Taiwan and the Catastrophic Illness Certificate database for the years 1997-2013. Prior diseases definitions were based on the first three digits of the codes listed in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Inclusion criteria required that each ICD-code existed for at least 1 year and incurred at least 2 outpatient visits or inpatient diagnosis. The case group comprised 4,600 patients newly diagnosed with LOAD in 2007-2013. The LOAD patients were matched by sex and age to obtain 4,600 controls. Using stepwise multivariate logistic regression analysis, diseases were screened for 1, 2 …, 9 years prior to the first diagnosis of LOAD. Path analysis was used to construct pathways between prior diseases and LOAD. Our results revealed that the following conditions were positively associated with the incidence of LOAD: anxiety (ICD-code 300), functional digestive disorder (ICD code 564), psychopathology-specific symptoms (ICD-code 307), disorders of the vestibular system (ICD-code 386), concussion (ICD-code 850), disorders of the urethra and urinary tract (ICD-code 599), disorders of refraction and accommodation (ICD-code 367), and hearing loss (ICD-code 389). A number of the prior diseases have previously been described in the literature in a manner identical to that in the present study. Our study supports the assertion that mental, hearing, vestibular system, and functional digestive disorders may play an important role in the pathogenesis of LOAD.
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Affiliation(s)
- Jung-Yu Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Tsung-Yi Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Department of Marketing and Distribution Management, Hsing Wu University, New Taipei City, Taiwan
| | - Chin-Mei Liu
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Taiwan Centers for Disease Control, Taipei, Taiwan
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Mak MHW, Low JK, Junnarkar SP, Huey TCW, Shelat VG. A prospective validation of Sepsis-3 guidelines in acute hepatobiliary sepsis: qSOFA lacks sensitivity and SIRS criteria lacks specificity (Cohort Study). Int J Surg 2019; 72:71-77. [PMID: 31678690 DOI: 10.1016/j.ijsu.2019.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/31/2019] [Revised: 09/19/2019] [Accepted: 10/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since its introduction in 2016, the Sepsis-3 guidelines, with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score, have generated much debate and controversy. It is recognised that the new definitions require validation in specific clinical settings and have yet to be universally adopted. We aim to validate new Sepsis-3 guidelines in acute hepatobiliary infection. MATERIAL AND METHODS A prospective cohort of patients admitted with acute hepatobiliary infection from the emergency department from July 2016 to June 2017 was studied. The Systemic Inflammatory Response Syndrome (SIRS) criteria, SOFA and qSOFA scores were calculated and predictive performance evaluated with area under the receiver operating characteristic (AUROC) curves for predictive ability of these indices for critical care unit admission and morbidity. RESULTS 124 patients with a median age of 64.5 years and majority males (n = 75, 60.5%) were admitted with acute hepatobiliary infection during the study period. Acute cholecystitis was the most common admission diagnosis (n = 83, 66.9%) and most patients were managed in general ward (n = 91, 73.3%) with median length of stay of 6 days (range 1-40). On multivariate analysis, diabetes mellitus (p = 0.003) predicted high dependency unit (HDU) admission, while age (p = 0.001), positive blood culture (p = 0.012), positive fluid culture (p = 0.015) and SOFA score (p = 0.002) predicted length of hospital stay. The sensitivity of SIRS in predicting HDU admission (60% vs. 4%), intensive care unit (ICU) admission (62.5% vs. 0%) and morbidity (66.7% vs. 0%) was higher than qSOFA score. The specificity of qSOFA in predicting HDU admission (100% vs. 49.5%), ICU admission (99.1% vs. 53.3%) and morbidity (99.2% vs. 47.9%) was higher than SIRS criteria. CONCLUSION The SIRS criteria has high sensitivity and the qSOFA score has high specificity in predicting outcomes of patients with acute hepatobiliary infection.
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Affiliation(s)
- Malcolm Han Wen Mak
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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20
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Goupy F, Supiot S, Pasquier D, Latorzeff I, Schick U, Monpetit E, Martinage G, Hervé C, Le Proust B, Castelli J, de Crevoisier R. Intensity-modulated radiotherapy for prostate cancer with seminal vesicle involvement (T3b): A multicentric retrospective analysis. PLoS One 2019; 14:e0210514. [PMID: 30682036 PMCID: PMC6347455 DOI: 10.1371/journal.pone.0210514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES No study has reported clinical results of external-beam radiotherapy specifically for T3b prostate cancer. The possibility of escalating the dose to the involved seminal vesicles (ISV) while respecting the dose constraints in the organs at risk is thus so far not clearly demonstrated. The objective of the study was to analyze the dose distribution and the clinical outcome in a large series of patients who received IMRT for T3b prostate cancer. MATERIALS AND METHODS This retrospective analysis included all patients who received IMRT and androgen deprivation therapy for T3b prostate cancer, between 2008 and 2017, in six French institutions, with available MRI images and dosimetric data. RESULTS A total of 276 T3b patients were included. The median follow-up was 26 months. The median (range) prescribed doses (Gy) to the prostate and to the ISV were 77 (70-80) and 76 (46-80), respectively. The dose constraint recommendations were exceeded in less than 12% of patients for the rectum and the bladder. The 5-year risks of biochemical and clinical recurrences and cancer-specific death were 24.8%, 21.7%, and 10.3%, respectively. The 5-year risks of local, pelvic lymph node, and metastatic recurrences were 6.4%, 11.3%, and 15%, respectively. The number of involved lymph nodes (≤ 2 or ≥ 3) on MRI was the only significant prognostic factor in clinical recurrence (HR 9.86) and death (HR 2.78). Grade ≥ 2 acute and 5-year late toxicity rates were 13.2% and 12% for digestive toxicity, and 34% and 31.5% for urinary toxicity, respectively. The dose to the pelvic lymph node and the age were predictive of late digestive toxicity. CONCLUSION IMRT for T3b prostate cancer allows delivery of a curative dose in the ISV, with a moderate digestive toxicity but a higher urinary toxicity. Lymph node involvement increases the risk of recurrence and death.
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Affiliation(s)
- Flora Goupy
- Radiation Department, CLCC Eugène Marquis,Rennes, France
| | | | | | - Igor Latorzeff
- Radiation Department, Clinique Pasteur, Toulouse, France
| | - Ulrike Schick
- Radiation Department, University Hospital Cavale Blanche, Brest, France
| | - Erik Monpetit
- Radiation Department, Clinique Saint-Yves, Vannes, France
| | | | - Chloé Hervé
- Radiation Department, CLCC Eugène Marquis,Rennes, France
| | | | - Joel Castelli
- Radiation Department, CLCC Eugène Marquis,Rennes, France
- University Rennes 1, LTSI (Laboratoire Traitement du Signal et de l'Image), Inserm U1099, Rennes, France
| | - Renaud de Crevoisier
- Radiation Department, CLCC Eugène Marquis,Rennes, France
- University Rennes 1, LTSI (Laboratoire Traitement du Signal et de l'Image), Inserm U1099, Rennes, France
- * E-mail:
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21
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Bukhari M, Kowalski T, Nieto J, Kunda R, Ahuja NK, Irani S, Shah A, Loren D, Brewer O, Sanaei O, Chen YI, Ngamruengphong S, Kumbhari V, Singh V, Aridi HD, Khashab MA. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88:486-494. [PMID: 29730228 DOI: 10.1016/j.gie.2018.04.2356] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. METHODS Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. RESULTS A total of 60 patients (mean age, 57.2 ± 13.2; 75% women) were included, of whom 30 (50%) underwent EUS-GG-ERCP and 30 (50%) underwent e-ERCP (double-balloon enteroscope ERCP, 19; single-balloon enteroscope ERCP, 11). The technical success rate was significantly higher in the EUS-GG-ERCP versus the e-ERCP group (100% vs 60.0%, P < .001). Total procedure time was significantly shorter in patients who underwent EUS-GG-ERCP (49.8 minutes vs 90.7 minutes, P < .001). Postprocedure median length of hospitalization was shorter in the EUS-GG group (1 vs 10.5 days, P = .02). Rate of AEs was similar in both groups (10% vs 6.7%, P = 1). CONCLUSIONS EUS-GG-ERCP may be superior to e-ERCP in patients with RYGB anatomy in terms of a higher technical success and shorter procedural times and offers a similar safety profile.
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Affiliation(s)
- Majidah Bukhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Division of Medicine and Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, Florida, USA
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Nitin K Ahuja
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Apeksha Shah
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Loren
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Olaya Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yen-I Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vikesh Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Hanaa Dakour Aridi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Helsel BC, Williams JE, Lawson K, Liang J, Markowitz J. Telemedicine and Mobile Health Technology Are Effective in the Management of Digestive Diseases: A Systematic Review. Dig Dis Sci 2018; 63:1392-1408. [PMID: 29663265 DOI: 10.1007/s10620-018-5054-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 11/30/2017] [Accepted: 03/31/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mobile applications and interactive websites are an increasingly used method of telemedicine, but their use lacks evidence in digestive diseases. AIM This study aims to explore digestive disease studies that use telemedicine to effectively manage disease activity, help monitor symptoms, improve compliance to the treatment protocol, increase patient satisfaction, and enhance the patient-to-provider communication. METHODS EBSCO, PubMed, and Web of Science databases were searched using Medical Subject Headings and other keywords to identify studies that utilized telemedicine in patients with digestive disease. The PRISMA guidelines were used to identify 20 research articles that had data aligning with 4 common overlapping themes including, patient compliance (n = 13), patient satisfaction (n = 11), disease activity (n = 15), and quality of life (n = 13). The studies focused on digestive diseases including inflammatory bowel disease (n = 7), ulcerative colitis (n = 4), Crohn's Disease (n = 1), irritable bowel syndrome (n = 6), and colorectal cancer (n = 2). RESULTS From the studies included in this systematic review, patient compliance and patient satisfaction ranged between 25.7-100% and 74-100%, respectively. Disease activity, measured by symptom severity scales and physiological biomarkers, showed improvements following telemedicine interventions in several, but not all, studies. Similar to disease activity, general and disease-specific quality of life showed improvements following telemedicine interventions in as little as 12 weeks in some studies. CONCLUSION Telemedicine and mobile health technology may be effective in managing disease activity and improving quality of life in digestive diseases. Future studies should explore both gastrointestinal and gastroesophageal diseases using these types of interventions.
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Affiliation(s)
- Brian C Helsel
- Department of Public Health Sciences, Clemson University, P.O. Box 340745, Clemson, SC, 29634-0745, USA.
| | - Joel E Williams
- Department of Public Health Sciences, Clemson University, P.O. Box 340745, Clemson, SC, 29634-0745, USA
| | - Kristen Lawson
- Department of Nursing, Clemson University, Clemson, SC, USA
| | - Jessica Liang
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan Markowitz
- Department of Pediatric Gastroenterology, Greenville Health System, Greenville, SC, USA
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Wu TC, Wu KL, Hu WL, Sheen JM, Lu CN, Chiang JY, Hung YC. Tongue diagnosis indices for upper gastrointestinal disorders: Protocol for a cross-sectional, case-controlled observational study. Medicine (Baltimore) 2018; 97:e9607. [PMID: 29480863 PMCID: PMC5943858 DOI: 10.1097/md.0000000000009607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/06/2023] Open
Abstract
BACKGROUND Upper gastrointestinal disorders are common in clinical practice, for example, gastritis, peptic ulcer disease, and gastroesophageal reflux disease. Panendoscopy or upper gastrointestinal endoscopy is viewed as the primary tool for examining the upper gastrointestinal mucosa, and permitting biopsy and endoscopic therapy. Although panendoscopy is considered to be a safe procedure with minimal complications, there are still some adverse effects, and patients are often anxious about undergoing invasive procedures. Traditional Chinese medicine tongue diagnosis plays an important role in differentiation of symptoms because the tongue reflects the physiological and pathological condition of the body. The automatic tongue diagnosis system (ATDS), which noninvasively captures tongue images, can provide objective and reliable diagnostic information. METHODS This protocol is a cross-sectional, case-controlled observational study investigating the usefulness of the ATDS in clinical practice by examining its efficacy as a diagnostic tool for upper gastrointestinal disorders. Volunteers over 20 years old with and without upper gastrointestinal symptoms will be enrolled. Tongue images will be captured and the patients divided into 4 groups according to their panendoscopy reports, including a gastritis group, peptic ulcer disease group, gastroesophageal reflux disease group, and healthy group. Nine primary tongue features will be extracted and analyzed, including tongue shape, tongue color, tooth mark, tongue fissure, fur color, fur thickness, saliva, ecchymosis, and red dots. OBJECTIVES The aim of this protocol is to apply a noninvasive ATDS to evaluate tongue manifestations of patients with upper gastrointestinal disorders and examine its efficacy as a diagnostic tool.
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Affiliation(s)
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine
- Fooyin University College of Nursing
- Kaohsiung Medical University College of Medicine
| | | | | | - John Y. Chiang
- Department of Computer Science & Engineering, National Sun Yat-sen University
| | - Yu-Chiang Hung
- Department of Chinese Medicine
- School of Chinese Medicine for Post Baccalaureate I-Shou University, Kaohsiung, Taiwan
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Sierra Quintana E, Martínez Caballero CM, Batista Pardo SA, Abella Barraca S, de la Vieja Soriano M. [Nontraumatic medical emergencies in mountain rescues]. Emergencias 2017; 29:339-342. [PMID: 29077294] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the clinical and epidemiologic characteristics of patients with nontraumatic medical problems rescued by a Spanish mountain emergency response service (061 Aragon). MATERIAL AND METHODS Retrospective observational analysis of records of mountain rescues completed between July 2010 and December 2016. RESULTS A total of 164 patients with nontraumatic medical emergencies were rescued; 82.3% were males. Most patients were between the ages of 50 and 59 years. Environmentally related problems, most often hypothermia, accounted for 36.6% of the emergencies. Cardiac problems led to 20.7% and digestive problems to 12.8%. Eighty-two percent of the patients were hiking or engaged in general mountain activities (other than rock climbing, canyoning, hunting, or skiing). CONCLUSION Recent years have seen a rise in the number of patients requiring rescue from mountains for nontraumatic medical emergencies, particularly heart problems. The typical patient to expect would be a man between the ages of 50 and 59 years who is hiking in the summer.
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Affiliation(s)
| | | | | | | | - María de la Vieja Soriano
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitaria de Manresa, Barcelona España
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Jia L, Jiang SM, Liu J. Behavioral gastroenterology: An emerging system and new frontier of action. World J Gastroenterol 2017; 23:6059-6064. [PMID: 28970721 PMCID: PMC5597497 DOI: 10.3748/wjg.v23.i33.6059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/28/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023] Open
Abstract
Behavioral gastroenterology is a new interdisciplinary science that explores the influence of unhealthy lifestyles and psychological factors on the digestive system and addresses the prevention, diagnosis, treatment, and rehabilitation of digestive diseases. Moreover, the concept of whole-course intervention with a focus on disease prevention and a new model of integrated therapy based on alterations of lifestyle and psychology are being gradually established. This paradigm may substantively impact the prevention and treatment of digestive diseases.
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Affiliation(s)
- Lin Jia
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou 510180, Guangdong Province, China
| | - Shu-Man Jiang
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou 510180, Guangdong Province, China
| | - Jing Liu
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
- Department of Gastroenterology, The Second Affiliated Hospital, South China University of Technology, Guangzhou 510180, Guangdong Province, China
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Andrews A, Franklin L, Rush N, Witts R, Blanco D, Pall H. Age, Sex, Health Insurance, and Race Associated With Increased Rate of Emergent Pediatric Gastrointestinal Procedures. J Pediatr Gastroenterol Nutr 2017; 64:907-910. [PMID: 27513695 PMCID: PMC5303193 DOI: 10.1097/mpg.0000000000001377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Few studies have examined the role health disparities play in pediatric gastrointestinal (GI) procedures. We hypothesized that health disparity factors affect whether patients undergo an emergent versus nonemergent GI procedure. The aims were to characterize the existing pediatric population undergoing GI procedures at our institution and assess specific risk factors associated with emergent versus nonemergent care. METHODS We retrospectively reviewed the medical records of 2110 patients undergoing GI procedures from January 2012 to December 2014. Emergent procedures were performed on an urgent inpatient basis. All other procedures were considered nonemergent. Health disparity factors analyzed included age, sex, insurance type, race, and language. Logistic regression analysis identified the odds of undergoing emergent procedures for each factor. RESULTS Most study patients were boys (58.2%), primarily insured by Medicaid (63.8%), white (44.0%), and spoke English (91.7%). Ten percent of all patients had an emergent procedure. Logistic regression analysis showed significant odds ratios (P value) for ages 18 years older (2.16, 0.003), females (0.62, 0.001), commercial insurance users (0.49, <0.0001), African Americans (1.94, <0.0001), and other race (1.72, 0.039). CONCLUSIONS Health disparities in age, sex, insurance, and race appear to exist in this pediatric population undergoing GI procedures. Patients older than 18 years, African Americans, and other races were significantly more likely to have an emergent procedure. Girls and commercial insurance users were significantly less likely to have an emergent procedure. More research is necessary to understand why these relations exist and how to establish appropriate interventions.
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Affiliation(s)
- Ashley Andrews
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Linda Franklin
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Natasha Rush
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Robin Witts
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - David Blanco
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Harpreet Pall
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States
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Careyva B, Stello B. Diabetes Mellitus: Management of Gastrointestinal Complications. Am Fam Physician 2016; 94:980-986. [PMID: 28075092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gastrointestinal disorders are common complications of diabetes mellitus and include gastroparesis, nonalcoholic fatty liver disease, gastroesophageal reflux disease, and chronic diarrhea. Symptoms of gastroparesis include early satiety, postprandial fullness, nausea, vomiting of undigested food, bloating, and abdominal pain. Gastroparesis is diagnosed based on clinical symptoms and a delay in gastric emptying in the absence of mechanical obstruction. Gastric emptying scintigraphy is the preferred diagnostic test. Treatment involves glucose control, dietary changes, and prokinetic medications when needed. Nonalcoholic fatty liver disease and its more severe variant, nonalcoholic steatohepatitis, are becoming increasingly prevalent in persons with diabetes. Screening for nonalcoholic fatty liver disease is not recommended, and most cases are diagnosed when steatosis is found incidentally on imaging or from liver function testing followed by diagnostic ultrasonography. Liver biopsy is the preferred diagnostic test for nonalcoholic steatohepatitis. Clinical scoring systems are being developed that, when used in conjunction with less invasive imaging, can more accurately predict which patients have severe fibrosis requiring biopsy. Treatment of nonalcoholic fatty liver disease involves weight loss and improved glycemic control; no medications have been approved for treatment of this condition. Diabetes is also a risk factor for gastroesophageal reflux disease. Patients may be asymptomatic or present with atypical symptoms, including globus sensation and dysphagia. Diabetes also may exacerbate hepatitis C and pancreatitis, resulting in more severe complications. Glycemic control improves or reverses most gastrointestinal complications of diabetes.
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Affiliation(s)
- Beth Careyva
- Leigh Valley Health Network/University of South Florida Morsani School of Medicine, Allentown, PA, USA
| | - Brian Stello
- Leigh Valley Health Network/University of South Florida Morsani School of Medicine, Allentown, PA, USA
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Zhang AZ, Wang QC, Huang KM, Huang JG, Zhou CH, Sun FQ, Wang SW, Wu FT. Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study. World J Gastroenterol 2016; 22:9437-9444. [PMID: 27895432 PMCID: PMC5107708 DOI: 10.3748/wjg.v22.i42.9437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/31/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.
METHODS A total of 1736 patients with chronic digestive system diseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A self-designed General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient’s general information, which included demographic data (including age, sex, marital status, and education) and disease characteristics (including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).
RESULTS The overall detection rate was 31.11% (540/1736) for depression symptoms alone, 27.02% (469/1736) for anxiety symptoms alone, 20.68% (359/1736) for both depression and anxiety symptoms, and 37.44% (650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression (44.06%) and anxiety symptoms (33.33%). χ2 trend test showed: the higher the body mass index (BMI), the lower the detection rate of depression and anxiety symptoms (χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms (χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms (χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression (57.55%) and anxiety (55.19%), followed by patients with liver cirrhosis (41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease.
CONCLUSION Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.
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Acute Abdominal Pain (AAP) Study group. Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain. Br J Surg 2016; 103:1343-9. [PMID: 27465409 DOI: 10.1002/bjs.10232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 02/07/2016] [Accepted: 05/16/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. METHODS Patients with acute abdominal pain were included in a prospective cohort study. A surgical trainee and a surgeon made independent assessments in the emergency department, recording the clinical diagnosis and proposed diagnostic investigations. A reference standard diagnosis was established by an expert panel, and the proportion of correct diagnoses was calculated. Diagnostic accuracy was expressed in terms of sensitivity, specificity, positive predictive value and negative predictive value. Interobserver agreement for the diagnosis and elements of history-taking and physical examination were expressed by means of Cohen's κ. Certainty of diagnosis was recorded using a visual analogue scale. RESULTS A trainee and a surgeon independently assessed 126 patients. Trainees made a correct diagnosis in 44·4 per cent of patients and surgeons in 42·9 per cent (P = 0·839). Surgeons, however, recorded a higher level of diagnostic certainty. Diagnostic accuracy was comparable in distinguishing urgent from non-urgent diagnoses, and for the most common diseases. Interobserver agreement for the clinical diagnosis varied from fair to moderate (κ = 0·28-0·57). CONCLUSION The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department.
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Ghrenassia E, Mekinian A, Chapelon-Albric C, Levy P, Cosnes J, Sève P, Lefèvre G, Dhôte R, Launay D, Prendki V, Morell-Dubois S, Sadoun D, Mehdaoui A, Soussan M, Bourrier A, Ricard L, Benamouzig R, Valeyre D, Fain O. Digestive-tract sarcoidosis: French nationwide case-control study of 25 cases. Medicine (Baltimore) 2016; 95:e4279. [PMID: 27442665 PMCID: PMC5265782 DOI: 10.1097/md.0000000000004279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Received: 05/03/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 12/21/2022] Open
Abstract
Digestive tract sarcoidosis (DTS) is rare and case-series are lacking. In this retrospective case-control study, we aimed to compare the characteristics, outcome, and treatment of patients with DTS, nondigestive tract sarcoidosis (NDTS), and Crohn disease.We included cases of confirmed sarcoidosis, symptomatic digestive tract involvement, and noncaseating granuloma in any digestive tract. Each case was compared with 2 controls with sarcoidoisis without digestive tract involvement and 4 with Crohn disease.We compared 25 cases of DTS to 50 controls with NDTS and 100 controls with Crohn disease. The major digestive clinical features were abdominal pain (56%), weight loss (52%), nausea/vomiting (48%), diarrhea (32%), and digestive bleeding (28%). On endoscopy of DTS, macroscopic lesions were observed in the esophagus (9%), stomach (78%), duodenum (9%), colon, (25%) and rectum (19%). As compared with NDTS, DTS was associated with weight loss (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.44-23.3) and the absence of thoracic adenopathy (OR 5.0; 95% CI 1.03-25). As compared with Crohn disease, DTS was associated with Afro-Caribbean origin (OR 27; 95% CI 3.6-204) and the absence of ileum or colon macroscopic lesions (OR 62.5; 95% CI 10.3-500). On the last follow-up, patients with DTS showed no need for surgery (versus 31% for patients with Crohn disease; P = 0.0013), and clinical digestive remission was frequent (76% vs. 35% for patients with Crohn disease; P = 0.0002).The differential diagnosis with Crohn disease could be an issue with DTS. Nevertheless, the 2 diseases often have different clinical presentation and outcome.
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Affiliation(s)
- Etienne Ghrenassia
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Catherine Chapelon-Albric
- APHP, Hôpital Pitié-Salpétrière, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne
| | - Pierre Levy
- APHP, Hôpital Tenon, Sorbonne Universités, UPMC Université Paris 06, Public health department
| | - Jacques Cosnes
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Pascal Sève
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, department of internal medicine, F-Lyon. University Claude Bernard Lyon 1, F-69100, Villeurbanne
| | | | - Robin Dhôte
- APHP, Hôpital Avicenne, service de médecine interne, université Paris 13, Bobigny, France
| | - David Launay
- Hôpital Claude Huriez, service de médecine interne, Lille, France
| | - Virginie Prendki
- Department of internal medicine, Division of internal medicine and rehabilitation, rehabilitation and geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Danielle Sadoun
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | | | - Michael Soussan
- APHP, Hôpital Avicenne, Université Paris 13, service de médecine nucléaire
| | - Anne Bourrier
- APHP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de gastro-entérologie, Paris
| | - Laure Ricard
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
| | - Robert Benamouzig
- APHP, Hôpital Avicenne, Université Paris 13, service de gastro-entérologie, Bobigny, France
| | - Dominique Valeyre
- APHP, Hôpital Avicenne, Université Paris 13, service de pneumologie, Bobigny
| | - Olivier Fain
- AP-HP, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B)
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Abstract
Fibrin sealant has been used with increasing frequency in a variety of surgical field for its unique hemostatic and adhesive abilities. Fibrin sealant mimics the last step of the coagulation cascade and takes place independently of the patient's coagulation status. With rapid advances in minimally invasive surgery, the potential uses for this type of biologic and synthetic material are expanding exponentially. This article reviews the data associated with the application of fibrin sealant in various surgical procedures. From reinforcing gastrointestinal anastomosis to repair perforated duodenal ulcers to mesh fixation in laparoscopic inguinal hernia repair, fibrin sealant is gaining increasing acceptance among surgeons. The applications of fibrin sealant are expanding, and new preparations of fibrin sealant are currently being evaluated.
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Affiliation(s)
- Meng-G Martin Lee
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Abstract
Although conventional esophagogastroduodenoscopy has become widespread in its applications and availability, it is constrained by the requirement for patient sedation. This requirement contributes to morbidity, time lost from work, and additional resource utilization in personnel and facilities. Small-caliber endoscopy is an emerging technology that enables transnasal evaluation of the upper gastrointestinal tract in a unsedated patient. This procedure can be performed in a wider range of settings, including the clinic setting where a dedicated conscious sedation suite is not available and can be incorporated into the office visit. The applications of small-caliber endoscopy include general diagnostic upper endoscopy, screening and surveillance of Barrett esophagus, and intraoperative diagnostics or postoperative evaluation of the upper gastrointestinal tract. Therapeutic applications include the placement of nasoduodenal feeding tubes, esophageal pH catheters, and impedance catheters. When used in the sedated patient, small-caliber endoscopy can also facilitate esophageal stricture dilation and transnasal placement of a percutaneous endoscopic gastrostomy tube. This review discusses the techniques, equipment, and applications of small-caliber endoscopy of the upper gastrointestinal tract.
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Affiliation(s)
- Charles Y Kim
- Department of Surgery, Oregon Health and Science University, Portland Veteran's Administration Medical Center, Portland, Oregon 97207, USA
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Jimenez Rodriguez RM, Segura-Sampedro JJ, Flores-Cortés M, López-Bernal F, Martín C, Diaz VP, Ciuro FP, Ruiz JP. Laparoscopic approach in gastrointestinal emergencies. World J Gastroenterol 2016; 22:2701-2710. [PMID: 26973409 PMCID: PMC4777993 DOI: 10.3748/wjg.v22.i9.2701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/24/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.
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Mandrioli M, Inaba K, Piccinini A, Biscardi A, Sartelli M, Agresta F, Catena F, Cirocchi R, Jovine E, Tugnoli G, Di Saverio S. Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol 2016; 22:668-680. [PMID: 26811616 PMCID: PMC4716068 DOI: 10.3748/wjg.v22.i2.668] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/10/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a laparoscopic approach to the treatment of the most common emergency surgical conditions.
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Zambrana-García JL, Montoro-Caba MI, Chicano-Gallardo M, Monrobel-Lancho A, Pérez-de-Luque DJ, Peña-Ojeda JA, Recio-Ramírez JM. Efficacy of a high-resolution consultation system in gastroenterology at an Andalusian hospital center. Rev Esp Enferm Dig 2016; 108:3-7. [PMID: 26765228 DOI: 10.17235/reed.2015.3885/2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND By high resolution consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established and recorded. OBJECTIVE To assess to which extent patients with digestive conditions may benefit from a single consultation system. MATERIAL A descriptive study of 179 first visit events, randomly selected as high-resolution consultations in gastroenterology. We discuss the percentage of patients who benefited from HRC and the complementary tests performed. RESULTS Most common conditions included dyspepsia (16%), a family history of colon cancer (16%) and gastroesophageal reflux disease (GERD) (16%). Seventy-nine (44%) of all first visits became HRCs and 80 (45%) required a diagnostic test (100% abdominal ultrasound) that was reviewed on the same day. Performing a test on the same day significantly increased the percentage of HRCs (57% vs. 34%, p < 0.002). GERD, dyspepsia, cholelithiasis and chronic liver disease were the subjects most commonly leading to HRC. CONCLUSIONS Gastroenterology consultations may largely benefit from an HRC system with only organizational changes and no additional costs.
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Takikawa H. [The 57(th) Annual Meeting of the JSGE]. Nihon Shokakibyo Gakkai Zasshi 2016; 113:917-918. [PMID: 27264422 DOI: 10.11405/nisshoshi.113.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Hajime Takikawa
- Department of Medicine, Teikyo University School of Medicine
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Volovar OS. [THE MANIFESTATIONS OF THE PATHOLOGICAL CHANGES OF THE INTERNAL ORGANS IN PATIENTS WITH DISEASES OF TEMPOROMANDIBULAR JOINT]. Lik Sprava 2015:112-117. [PMID: 27491162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The results of a survey of 248 patients (mean age--26.0 years +/- 7.4 years), from which 222 patients (mean age--26.3 years +/- 8.0 years) with diseases of temporomandibular joint. Identified and visceral connection between the local changes in the iris, the state of the body's connective tissue, the presence of visceral disease (cardiovascular, respiratory, digestive, urinary system), diseases of the temporomandibular joints. Key words: temporomandibular joint, connective tissue, iris, iridodiagnostic, internal organs, concomitant diseases, topical. diagnostics.
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Roman S, Panduro A. Genomic medicine in gastroenterology: A new approach or a new specialty? World J Gastroenterol 2015; 21:8227-37. [PMID: 26217074 PMCID: PMC4507092 DOI: 10.3748/wjg.v21.i27.8227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/24/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Throughout history, many medical milestones have been achieved to prevent and treat human diseases. Man's early conception of illness was naturally holistic or integrative. However, scientific knowledge was atomized into quantitative and qualitative research. In the field of medicine, the main trade-off was the creation of many medical specialties that commonly treat patients in advanced stages of disease. However, now that we are immersed in the post-genomic era, how should we reevaluate medicine? Genomic medicine has evoked a medical paradigm shift based on the plausibility to predict the genetic susceptibility to disease. Additionally, the development of chronic diseases should be viewed as a continuum of interactions between the individual's genetic make-up and environmental factors such as diet, physical activity, and emotions. Thus, personalized medicine is aimed at preventing or reversing clinical symptoms, and providing a better quality of life by integrating the genetic, environmental and cultural factors of diseases. Whether using genomic medicine in the field of gastroenterology is a new approach or a new medical specialty remains an open question. To address this issue, it will require the mutual work of educational and governmental authorities with public health professionals, with the goal of translating genomic medicine into better health policies.
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Yamauchi H, Kida M, Okuwaki K, Miyazawa S, Iwai T, Tokunaga S, Takezawa M, Imaizumi H, Koizumi W. Passive-bending, short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients. World J Gastroenterol 2015; 21:1546-1553. [PMID: 25663773 PMCID: PMC4316096 DOI: 10.3748/wjg.v21.i5.1546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/29/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate short-type-single-balloon enteroscope (SBE) with passive-bending, high-force transmission functions for endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis.
METHODS: Short-type SBE with this technology (SIF-Y0004-V01; working length, 1520 mm; channel diameter, 3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis. The rate of reaching the blind end, time required to reach the blind end, diagnostic and therapeutic success rates, and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology (SIF-Y0004; working length, 1520 mm; channel diameter, 3.2 mm) in 25 patients.
RESULTS: The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004 (P = 0.59). The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004 (16 min vs 24 min, P = 0.04). The diagnostic success rate was 93% with SIF-Y0004-V01 and 84% with SIF-Y0004 (P = 0.17). The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004 (P = 0.68). The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004 (P = 0.50). The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group (P = 0.723). The incidence of pancreatitis was 0% in the SIF-Y0004-V01 group and 5.9% in the SIF-Y0004 group (P > 0.999). The incidence of gastrointestinal perforation was 2.0% (1/50) in the SIF-Y0004-V01 group and 2.9% (1/34) in the SIF-Y0004 group (P > 0.999).
CONCLUSION: SIF-Y0004-V01 is useful for ERCP in patients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.
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Pirogov SS, Sokolov VV, Kaprin AD, Sokolov DV, Volchenko NN, Karpova ES, Pavlov PV, Telegina LV, Sukhin DG, Pogorelov NN, Ryabov AB, Khomyakov VM, Chulikov IA. [ENDOCYTOSCOPY--NEW TYPE OF ENDOSCOPIC EXAMINATION OF LOWER GASTROINTESTINAL AND RESPIRATORY TRACT]. Eksp Klin Gastroenterol 2015:58-66. [PMID: 26387172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Majority of published data describing endocytoscopic examination of upper gastrointestinal tract mucosa, but in recent publications, it is reported, that endocytoscopy is suitable for small bowel, colon, respiratory tract and even peritoneum "optical biopsy". In number of articles possibilities of celiac sprue diagnostics with endocytoscopy is discussed, but small-bowel endocytoscopy is limited, due to absence of endocytoscopes, compatible with enteroscopes. More widely endocytoscopy is used in colon, mostly in lateral-spreading adenomas diagnostics. Prof. S-E. Kudo developed endocytoscopic classification of colonic mucosa changes, used for differential diagnostics and lesion mapping, describing hyperplasia, adenomas with different grades of intraepithelial neoplasia, non-invasive and invasive cancer. Some authors reported about good possibilities of endocytoscopy in inflammatory bowel disease diagnostics. Most of data, related to respiratory tract endocytoscopic examination, focused on precancerous conditions and early pharyngeal and lung cancer, and the preliminary results are promising, but, unfortunately, for now, endocytoscopy in bronchial tree is limited, due to lack of thin endocytoscopes. According to some article data, it is possible to use endocytoscopy not only in gastrointestinal and respiratory tract, but also in optical confirmation of peritoneal tumor dissemination in gastric and ovarian cancer patients, and--in bladder mucosa examination.
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Izimbergenov NI, Karimova BZ, Koishibaev AS, Izimbergenova GN, Imanbaev KS, Saduov MA, Mukhamedgalieva BM. [ORGANIZATIONAL AND TACTICAL FEATURES OF EMERGENCY SURGERY PERFORMANCE FOR PREGNANT WOMEN AND PUERPERAS]. Vestn Khir Im I I Grek 2015; 174:93-97. [PMID: 26983269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The results of treatment of acute surgical diseases are worse in pregnant women, than in ordinary people, because of changes in patient's organism. However, these patients would be treated the same way as ordinary patient according to conventional standards. The authors launched the special centre for treatment of acute surgical diseases of abdominal cavity for pregnant women and puerperas in order to provide the adequacy of treatment to the changes of patient's organism. There was suggested a new standard of diagnostics, based on limited term (4-5 hours) with the following diagnostic laparoscopy or laparotomy in obscure cases. The experience of treatment of 171 patients with acute pancreatitis proved the high efficacy of the new strategy and developed standard of diagnostics. The main part of the patients were operated at the first 2-4 hours (105 patients--61.4%) after hospitalization and 43 (25.1%) patients--within 4-6 hours. The cattaral form (92 patients--53.8%) and phlegmonous (74 patients--43.3%) form of the appendix changes were revealed in majority of patients. The gangrenous appendicitis was detected in 5 cases (2%). All the patients recovered. There wasn't maternal or perinatal mortality.
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Abstract
Gastrointestinal endoscopy has a major diagnostic and therapeutic role in most gastrointestinal disorders; however, limited information is available about clinical efficacy and safety in pregnant patients. The major risks of endoscopy during pregnancy include potential harm to the fetus because of hypoxia, premature labor, trauma and teratogenesis. In some cases, endoscopic procedures may be postponed until after delivery. When emergency or urgent indications are present, endoscopic procedures may be considered with some precautions. United States Food and Drug Administration category B drugs may be used in low doses. Endoscopic procedures during pregnancy may include upper gastrointestinal endoscopy, percutaneous endoscopic gastrostomy, sigmoidoscopy, colonoscopy, enteroscopy of the small bowel or video capsule endoscopy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. All gastrointestinal endoscopic procedures in pregnant patients should be performed in hospitals by expert endoscopists and an obstetrician should be informed about all endoscopic procedures. The endoscopy and flexible sigmoidoscopy may be safe for the fetus and pregnant patient, and may be performed during pregnancy when strong indications are present. Colonoscopy for pregnant patients may be considered for strong indications during the second trimester. Although therapeutic endoscopic retrograde cholangiopancreatography may be considered during pregnancy, this procedure should be performed only for strong indications and attempts should be made to minimize radiation exposure.
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Küper MA, Eisner F, Königsrainer A, Glatzle J. Laparoscopic surgery for benign and malign diseases of the digestive system: Indications, limitations, and evidence. World J Gastroenterol 2014; 20:4883-4891. [PMID: 24803799 PMCID: PMC4009519 DOI: 10.3748/wjg.v20.i17.4883] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/23/2013] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.
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Smallman DP, Hu Z, Rohrbeck P. U.S. Armed Forces air crew: incident illness and injury diagnosis during the 12 months prior to retirement, 2003-2012. MSMR 2014; 21:8-12. [PMID: 24885877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
U.S. Armed Services retirees are eligible for disability compensation for medical illness/injury incurred during their service. This analysis of recently retired U.S. active component air crew/aviation service members from all Services evaluated incident diagnoses among aviation retirees during the 12 months prior to retirement and assessed trends in first-time diagnoses by major diagnostic category and aviation component stratification. Most aviation retirees were in their 40s, Air Force, male, white, and senior officers and warrant officers. Among the study population, 14,191 (88%) of aviation retirees had at least one first-time diagnosis recorded during the 12 months prior to retirement. During 2003-2012, 63.8% of all diagnoses in aviation retirees during the 12 months prior to retirement were new. The highest proportions of new diagnoses were for "other disorders of the ear," "organic sleep disorders," and "general symptoms." Among the four subtypes of aviators, general air crew/air craft crew had the lowest proportion of new diagnoses (60.2%).
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Du X, Zhang SQ, Cheng Z, Li Y, Tian HM, Hu JK, Zhou ZG. Preoperative Cardiac, Pulmonary and Digestive Comorbidities of Morbidly Obese Patients Undergoing Bariatric Surgery: Morbidity, Assessment and Management. Hepatogastroenterology 2014; 61:683-688. [PMID: 26176057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS To investigate a proper preoperative assessment and management of preoperative cardiac, pulmonary and digestive comorbidities in morbidly obese patients undergoing bariatric surgery. METHODOLOGY A general description of comorbidities in bariatric patients was reviewed and a clinical practice path in assessment and management of comorbidities was summarized. RESULTS Morbidly obese patients frequently carried serious comorbidities in cardiovascular, pulmonary and digestive systems. The most common abnormalities included hypertension, left ventricular wall hypertrophy, ST and T wave abnormalities, obstructive sleep apnea, ventilatory dysfunction, and nonalcoholic fatty liver disease. A routine specialized preoperative evaluation could find the potential abnormality and screen the appropriate patients. Prophylactic treatments obviously reduced the morbidity of peri-operative complications CONCLUSION Comprehensive preoperative evaluation and proper management is essential to appropriately select and prepare bariatric patients, and minimize surgical risk.
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Is it a food intolerance, allergy, or something else? Learn how to tell the difference, and what to do if you're reacting to wheat, milk, or other foods. Harv Womens Health Watch 2014; 21:4-5. [PMID: 25097941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Deleanu B, Prejbeanu R, Vermesan D, Haragus H, Icma I, Predescu V. Acute abdominal complications following hip surgery. Chirurgia (Bucur) 2014; 109:218-222. [PMID: 24742414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 06/03/2023]
Abstract
Hip surgeries are some of the most common and successful orthopedic procedures. Although rarely, abdominal complications do occur and are associated with unfavorable outcomes.We aimed to identify and describe the severe abdominal complications that appear in patients under-going elective or traumatic hip surgery. A four year retrospective electronic database research identified 408 elective primary hip replacements,51 hip revisions and 1040 intra and extracapsular proximal femur fractures. Out of these, three males and 4 females between 64 - 84 years old were identified to have developed acute abdominal complications: perforated acute ulcer (3),acute cholecystitis (2), volvulus (1), toxic megacolon with peritonitis (1) and acute colonic pseudo-obstruction (1).Complications debuted 3 - 10 days after index orthopedic surgery. Acute perioperative abdominal complications are rarely encountered during orthopedic surgery. When these do occur, they do so almost exclusively in patients with hippathology, comorbidities and most often lead to life threatening situations. We thus emphasize the need for early identification and appropriate management by both orthopedic and general surgery doctors in order to improve patient safety.
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Feng-bin L, Yong-xing J, Yu-hang W, Zheng-kun H, Xin-lin C. Translation and psychometric evaluation of the Chinese version of functional digestive disorders quality of life questionnaire. Dig Dis Sci 2014; 59:390-420. [PMID: 24202648 PMCID: PMC3924031 DOI: 10.1007/s10620-013-2897-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Received: 02/14/2013] [Accepted: 09/23/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Few useful patient-reported outcomes scales for functional dyspepsia exist in China. AIMS The purpose of this work was to translate and cross-culturally adapt the Functional Digestive Disorders Quality of Life Questionnaire (FDDQL) from the English version to Chinese (in Mandarin). METHODS The following steps were performed: forward translations, synthesis of the translations, backward translations, pre-testing and field testing of FDDQL. Reliability, validity, responsiveness, confirmatory factor analysis, item response theory and differential item functioning of the scale were analyzed. RESULTS A total of 300 functional dyspepsia patients and 100 healthy people were included. The total Cronbach's alpha was 0.932, and split-half reliability coefficient was 0.823 with all test-retest coefficients greater than 0.9 except Coping With Disease domain. In construct validity analysis, every item correlated higher with its own domain than others. The comparative fit index of FDDQL was 0.902 and root mean square error of approximation was 0.076. Functional dyspepsia patients and healthy people had significant differences in all domains. After treatment, all domains had significant improvements except diet. Item response theory analysis showed the Person separation index of 0.920 and the threshold estimator of items was normally distributed with a mean of 0 and standard deviation of 1.27. The residuals of each item were between -2.5 and 2.5, without statistical significance. Differential item functioning analysis found that items had neither uniform nor non-uniform differential item functioning in different genders and age groups. CONCLUSIONS The Chinese version of FDDQL has good psychometric properties and is suitable for measuring the health status of Chinese patients with functional dyspepsia.
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Affiliation(s)
- Liu Feng-bin
- Gastroenterology Department, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong China
| | - Jin Yong-xing
- Gastroenterology Department, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong China
| | - Wu Yu-hang
- Wuyi Hospital of Chinese Medicine, Jiangmen, 529111 Guangdong China
| | - Hou Zheng-kun
- Gastroenterology Department, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong China
| | - Chen Xin-lin
- Department of Preventive Medicine and Health Statistics, College of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006 Guangdong China
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Trukhan DI, Tarasova LV, Lebedev OI, Safonov AD. [Eyes' symptoms of the digestive diseases]. Eksp Klin Gastroenterol 2014:83-87. [PMID: 25911937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Substantial part of the eye disease manifestations constitute general or systemic diseases. Accordingly, the dosage systemic therapy of these diseases can affect the condition of the eye. Changes of the vision and the appropriate advice ophthalmologist can help the gastroenterologist in the diagnosis and adequate treatment of the patient. The article discusses the possible changes in the organ of vision in diseases of the digestive system and a number of infectious diseases, as well as changes occurring under the influence of drug therapy of these diseases.
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