BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admi...BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admissions.AIM To identify mortality trends of diverticular disease among adults in the United States,examining regional and demographic variations,as these have not been previously studied.These trends are highly beneficial to studying disease burden and vulnerable populations.METHODS Diverticular disease-related mortality data were extracted as age-adjusted mortality rates(AAMRs)from death certificate data of the CDC WONDER database using International Statistical Classification of Diseases and Related Health Problems-10th Revision codes K57.0 to K57.9 from 1999 to 2020 in adults≥45 years of age per 100000 population.These AAMRs were stratified by gender,ethnicity,and demographics and analyzed using Joinpoint regression to determine annual percent changes(APCs)and assess trend changes.RESULTS Between 1999 and 2020,a total of 114044 diverticular disease-related deaths were reported among adults≥45 years of age.Our analysis reports progressive decline in mortality with AAMR decreasing from 6.7 in 1999 to 6.1 in 2003[APC:-2.60;95%confidence interval(CI):-3.79 to-0.33],after which it further declined to 3.6 in 2013(APC:-5.16;95%CI:-7.26 to-4.74),with a minimal decrease to 3.5 in 2020(APC:-0.65;95%CI:-1.87 to 1.51).Women had a higher AAMR(4.8)than men(3.8)throughout the study period.The racial analysis reported the highest overall AAMR in non-Hispanic(NH)Whites(4.7),followed by NH Black or African American(3.9),Hispanic or Latino(3.1),and Asian or Pacific Islander(1.5),with unreliable data for the American Indian or Alaska Native population.States in the top 90th percentile,such as Wyoming and Vermont,had approximately double the AAMRs compared to states in the bottom 10th percentile.The mortality rate also exhibited regional disparities,with an overall AAMR higher in the Midwest and West regions(4.7)compared to the Northeast and South regions(4.2),and higher in nonmetropolitan areas(5.4)compared to metropolitan areas(4.2).CONCLUSION Although the annual mortality of diverticular disease has decreased since 1999,there are certain demographic and regional disparities,with mortality rates higher in women,NH White and NH Black adults,Western regions,and nonmetropolitan areas.Further research is needed to identify factors responsible for these disparities and plan appropriate interventions.展开更多
Rectal cancer is the second commonest cause of cancer death within the United Kingdom.Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease....Rectal cancer is the second commonest cause of cancer death within the United Kingdom.Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease.The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and,more recently,transanal minimally invasive surgery.Owing to the risks of local recurrence,the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer(T1N0M0 disease).The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established.However,results of high-quality research such as the GRECCAR II,TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future,when used in combination with oncological therapies.The aim of our review is to provide an overview in the current management of early rectal cancer,the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.展开更多
Pancreatic ductal adenocarcinoma(PDAC)represents a challenging pathology with very poor outcomes and is increasing in incidence within the general population.The majority of patients are diagnosed incidentally with in...Pancreatic ductal adenocarcinoma(PDAC)represents a challenging pathology with very poor outcomes and is increasing in incidence within the general population.The majority of patients are diagnosed incidentally with insidious symptoms and hence present late in the disease process.This significantly affects patient outcomes:the only cure is surgical resection but only up to 20%of patients present with resectable disease at the time of clinical presentation.The use of“omic”technology is expanding rapidly in the field of personalised medicine-using genomic,proteomic and metabolomic approaches allows researchers and clinicians to delve deep into the core molecular processes of this difficult disease.This review gives an overview of the current findings in PDAC using these“omic”approaches and summarises useful markers in aiding clinicians treating PDAC.Future strategies incorporating these findings and potential application of these methods are presented in this review article.展开更多
文摘BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admissions.AIM To identify mortality trends of diverticular disease among adults in the United States,examining regional and demographic variations,as these have not been previously studied.These trends are highly beneficial to studying disease burden and vulnerable populations.METHODS Diverticular disease-related mortality data were extracted as age-adjusted mortality rates(AAMRs)from death certificate data of the CDC WONDER database using International Statistical Classification of Diseases and Related Health Problems-10th Revision codes K57.0 to K57.9 from 1999 to 2020 in adults≥45 years of age per 100000 population.These AAMRs were stratified by gender,ethnicity,and demographics and analyzed using Joinpoint regression to determine annual percent changes(APCs)and assess trend changes.RESULTS Between 1999 and 2020,a total of 114044 diverticular disease-related deaths were reported among adults≥45 years of age.Our analysis reports progressive decline in mortality with AAMR decreasing from 6.7 in 1999 to 6.1 in 2003[APC:-2.60;95%confidence interval(CI):-3.79 to-0.33],after which it further declined to 3.6 in 2013(APC:-5.16;95%CI:-7.26 to-4.74),with a minimal decrease to 3.5 in 2020(APC:-0.65;95%CI:-1.87 to 1.51).Women had a higher AAMR(4.8)than men(3.8)throughout the study period.The racial analysis reported the highest overall AAMR in non-Hispanic(NH)Whites(4.7),followed by NH Black or African American(3.9),Hispanic or Latino(3.1),and Asian or Pacific Islander(1.5),with unreliable data for the American Indian or Alaska Native population.States in the top 90th percentile,such as Wyoming and Vermont,had approximately double the AAMRs compared to states in the bottom 10th percentile.The mortality rate also exhibited regional disparities,with an overall AAMR higher in the Midwest and West regions(4.7)compared to the Northeast and South regions(4.2),and higher in nonmetropolitan areas(5.4)compared to metropolitan areas(4.2).CONCLUSION Although the annual mortality of diverticular disease has decreased since 1999,there are certain demographic and regional disparities,with mortality rates higher in women,NH White and NH Black adults,Western regions,and nonmetropolitan areas.Further research is needed to identify factors responsible for these disparities and plan appropriate interventions.
文摘Rectal cancer is the second commonest cause of cancer death within the United Kingdom.Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease.The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and,more recently,transanal minimally invasive surgery.Owing to the risks of local recurrence,the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer(T1N0M0 disease).The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established.However,results of high-quality research such as the GRECCAR II,TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future,when used in combination with oncological therapies.The aim of our review is to provide an overview in the current management of early rectal cancer,the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.
文摘Pancreatic ductal adenocarcinoma(PDAC)represents a challenging pathology with very poor outcomes and is increasing in incidence within the general population.The majority of patients are diagnosed incidentally with insidious symptoms and hence present late in the disease process.This significantly affects patient outcomes:the only cure is surgical resection but only up to 20%of patients present with resectable disease at the time of clinical presentation.The use of“omic”technology is expanding rapidly in the field of personalised medicine-using genomic,proteomic and metabolomic approaches allows researchers and clinicians to delve deep into the core molecular processes of this difficult disease.This review gives an overview of the current findings in PDAC using these“omic”approaches and summarises useful markers in aiding clinicians treating PDAC.Future strategies incorporating these findings and potential application of these methods are presented in this review article.
