Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and repre...Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.展开更多
Ectropion is an outward turning of the eyelid margin, as a result the conjunctiva is permanently irritated, thickened and dry. Since the lacrimal puncta are moved away from the eyeball, the tear elimination is difficu...Ectropion is an outward turning of the eyelid margin, as a result the conjunctiva is permanently irritated, thickened and dry. Since the lacrimal puncta are moved away from the eyeball, the tear elimination is difficult, tears are always present. Materials and Methods: This study includes patients suffering from senile ectropion, who were treated surgically at Polyclinic “SHOSHI” in Prishtina. Our study includes 19 patients suffering from senile ectropion, out of which, 17 were older than 75 years old and in those patients the ectropion was preset on both lower eyelids, while 2 patients were under 75 years old and the ectropion was present only on one side lower eyelid. Prior to surgery, patients have undergone laboratory examinations. The surgery was performed under local anesthesia. The suturing was done in three layers using 6.0 vicryl sutures. No operative or post-operative complications were encountered. Purpose: The purpose of this case report study is to show the success of the surgical treatment of ectropion, a procedure that is mainly performed so the tear elimination is enabled, and there are no tears present constantly. Conclusion: In old patients where the eyelid is turned outwards its margin, conjunctiva is constantly irritated, thickened and dry, the best method of treatment is the surgical treatment, making it possible for the tears to drain properly.展开更多
Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) durin...Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p Conclusion: Mortality is high in patients with AKI during COVID-19 infection.展开更多
Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated th...Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated three-dimensional(3D)models have been proposed as a valuable tool to enhance this understanding.However,a systematic comparison of different display modalities across professional groups has not yet been performed.Methods:In this prospective,monocentric randomized trial,we compared high-resolution twodimensional(2D)CT images of liver malignancies with their corresponding standardized,non-colored 3D virtual and printed models in facilitating anatomical and spatial understanding as well as surgical decision-making.A total of 91 participants,including 40 surgeons,10 radiologists,and 41 students,evaluated six clinical cases(three centrally and three peripherally located liver malignancies).Each participant assessed one central and one peripheral case per display modality,presented in a random order.Results:Compared to 2D CT images,both 3D virtual and printed models significantly improved the identification of tumor location(P<0.001),enhanced the comprehension of spatial relationships with adjacent liver and portal veins(P<0.001 and P=0.019,respectively),and facilitated clinical decisionmaking(P<0.001).No significant difference was observed between virtual and printed models in terms of effectiveness.Within the different groups,surgeons and students,but not radiologists,more accurately identified tumor location and spatial relationships with adjacent liver and portal veins using 3D models.Subjectively,most surgeons and students preferred 3D printed models over virtual models and 2D CT images.Conclusions:This study demonstrated that standardized,non-colored 3D virtual and printed models equally help preoperative anatomical understanding and decision-making,particularly for surgeons and students.By isolating the influence of display modality,our findings clarify prior inconsistent results and support the integration of cost-effective 3D visualization by applying virtual models into surgical planning and education.Preference for printed models despite comparable efficacy highlights the importance of user-centered implementation strategies.展开更多
Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progressi...Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective,but unsafe,drugs as well as invasive surgical treatments.This aim can be achieved by detecting its first signal represented by the gastric emptying(GE)delay,by using,among the tests to measure GE,the simple,safe,reliable,and easily available one,that is realtime ultrasonography,possibly done annually.Once the GE delay has been identified,it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm,which should be treated by means of non-surgical endoscopic therapies.If,instead,it depends on initial gastropathy,detected by electrogastrograhic body surface gastric mapping,it should be treated with the safest prokinetic drugs and with the newly emerging treatments,thus distancing heavy medical and surgical treatments,while waiting for future solutions.展开更多
As prepubertal boys do not yet produce spermatozoa,they cannot rely on sperm cryopreservation for fertility preservation before gonadotoxic therapy,such as high-dose alkylating agents or radiotherapy in the case of ch...As prepubertal boys do not yet produce spermatozoa,they cannot rely on sperm cryopreservation for fertility preservation before gonadotoxic therapy,such as high-dose alkylating agents or radiotherapy in the case of childhood cancers.According to the current guidelines,cryopreservation of testicular biopsies containing spermatogonial stem cells(SSCs)may be proposed to high-risk patients for potential later therapeutic use to fulfill the patients’wish for a biological child.One promising technique for human in vitro spermatogenesis and in vitro propagation of human SSCs is microfluidic(MF)culture,in which cells or tissues are subjected to a continuous flow of medium.This provides exact control over such parameters as nutrient content and gradients,as well as the removal of waste metabolites.While MF has been shown to maintain tissues and cell populations of organs for longer than conventional in vitro culture techniques,it has not been widely used for testicular in vitro culture.MF could advance human testicular in vitro culture and is also applicable to reprotoxicity studies.This review summarizes the findings and achievements of testis-on-chip(ToC)setups to date and discusses the benefits and limitations of these for spermatogenesis in vitro and toxicity assessment.展开更多
Background Globally,suicide is the third leading cause of death among girls aged 15-19 years.However,there is a growing concern that suicide research has paid lttle attention to pregnant adolescent girls,particularly ...Background Globally,suicide is the third leading cause of death among girls aged 15-19 years.However,there is a growing concern that suicide research has paid lttle attention to pregnant adolescent girls,particularly in lowincome and middle-income countries,including Ghana,where nearly one in seven adolescents experiences(unwanted)pregnancy.Aims To assess the prevalence and correlates of suicidal ideation and suicide attempt and the self-reported reasons for attempted suicide among pregnant adolescent girls in Ghana.Methods We collected cross-sectional data(between August 2022 and December 2023)using structured anonymous questionnaires from a sample of 449 pregnant adolescent girls(aged 14-19 years)drawn from the three geographical zones of Ghana.We applied bivariable and multivariable analysis techniques to the data.Results Overall,28.51%(95%confidence interval(Cl)24.37%to 32.93%)reported suicidal ideation,and 18.04%(95%Cl 14.59%to 21.91%)reported suicide attempt during the current pregnancy.Participants who reported attempted suicide endorsed more interpersonal reasons(eg,to communicate distress,to seek help or to influence others)than intrapersonal reasons for their attempted suicide.In the final adjusted logistic regression models,food insecurity(adjusted odds ratio(aOR)=2.69;95%Cl 1.34 to 5.41;p=0.005)was uniquely associated with increased odds of suicidal ideation.Adverse childhood experiences(a0R=3.04;95%CI 1.33 to 6.97;p=0.008),history of attempted suicide before current pregnancy(a0R=3.47;95%CI 1.27 to 9.47;p=0.015)and depression(measured by the 5-item World Health Organization Well-Being Index;aOR=0.31;95%CI 0.12 to 0.77;p=0.012)were uniquely associated with increased odds of suicide attempt.Five variables were commonly associated with increased odds of both suicidal ideation and suicide attempt:conflict with parents,alcohol use,pregnancy-related anxiety,history of attempted suicide and intimate partner violence.While being in junior high school was uniquely associated with reduced odds of suicidal ideation,intimate partner's acceptance of paternity was commonly associated with reduced odds of both suicidal ideation and suicide attempt.Conclusions Although the prevalence estimates of suicidal ideation and suicide attempt in this study are comparable with known rates among non-pregnant adolescent girls in Ghana,additional research is needed to nuance our understanding of the correlates identified in this study.The evidence aiso highlights a need for both routine antepartum primary care mental health screening for suicidality and related risks and targeted prevention and intervention programmes.展开更多
BACKGROUND Patients with inflammatory bowel diseases(IBD)often miss the scheduled vaccines and have a higher risk of infection susceptibility,including vaccineprevented diseases.AIM To evaluate the vaccine coverage an...BACKGROUND Patients with inflammatory bowel diseases(IBD)often miss the scheduled vaccines and have a higher risk of infection susceptibility,including vaccineprevented diseases.AIM To evaluate the vaccine coverage and levels of the post-vaccine antibodies against measles,mumps,rubella,and hepatitis B in children with IBD.METHODS Total 98 patients:46 females(47.2%)and 52 males(52.8%)with IBD(Crohn’s disease-75%and ulcerative colitis-25%)with disease onset age-11.0(6.0;14.0)years whom clinical data,vaccination status and levels of the postvaccination antibodies(IgG)for measles,rubella,mumps,hepatitis B,measured with ELISA were prospectively evaluated.The control group consisted of 88 healthy peers from the biobank data.RESULTS Patients with IBD had lower levels of measles,rubella,and hepatitis B,except mumps,compared to controls.Incomplete vaccination/non-protective titer of the antibodies against measles,mumps rubella,and hepatitis B had 33(33.7%)/52.3%,21(21.4%)/50.4%,26(25.8)/25.6%and 26(25.8%)/55.2%,respectively.Patients with incomplete vaccination had a lower age at the diagnosis for all vaccines.The age of the IBD diagnosis≤6 years was the predictor of incomplete vaccination for measles[odds ratio(OR)=4.6,P=0.001],mumps(OR=5.0,P=0.001),rubella(OR=5.4,P=0.0005)and hepatitis B(OR=5.4,P=0.0005)and corticosteroid treatment for measles(OR=2.2,P=0.074)and mumps(OR=3.0,P=0.047)vaccines.Incomplete vaccination was the predictor of nonprotective titer of antibodies against rubella(OR=6.8,95%CI:2.3-19.9,P=0.0002)/mumps(OR=7.0,95%CI:2.4-20.8;P=0.0002).CONCLUSION Patients with IBD had low vaccine coverage and lower levels of anti-vaccine antibodies against measles,rubella,and hepatitis B.Nearly half of the IBD patients require revaccination.展开更多
BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.A...BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.AIM To compare scheduled vaccination coverage and the levels of post-vaccine antibodies against measles,mumps,rubella(MMR)and hepatitis B in pediatric patients with IBD and JIA.METHODS A comparative cohort study included 97 patients with IBD and 170 patients with JIA.Vaccination history was obtained from medical records,while post-vaccination immunity was assessed prospectively by measuring specific IgG antibody titers using enzyme-linked immunosorbent assays(Vector-Best JSC,Russia;IBL International,Germany)during routine visits between January 2022 and April 2023.RESULTS A complete two-dose MMR course had been administered to 66.3%of IBD patients and 55.9%of JIA patients(P=0.121).By contrast,the three-dose hepatitis B schedule was completed in 74.2%of IBD and 100%of JIA patients(P<0.001).Protective level of anti-vaccine antibodies against measles(47.7%vs 57.7%;P=0.168);mumps(75.3%vs 80.0%;P=0.366);rubella(74.4%vs 98.2%;P<0.0001);and hepatitis B(44.8%vs 50.0%;P=0.514)were detected in IBD and JIA patients,respectively.CONCLUSION Patients with IBD and JIA demonstrated different vaccination coverage patterns and levels of anti-vaccine antibodies.Routine baseline serology and timely booster vaccination should be implemented for all pediatric patients receiving chronic immunosuppression.展开更多
BACKGROUND The gut microbiota displays pronounced compositional differences between pediatric and adult populations,both under normal conditions and during the development of inflammatory bowel disease(IBD).These stru...BACKGROUND The gut microbiota displays pronounced compositional differences between pediatric and adult populations,both under normal conditions and during the development of inflammatory bowel disease(IBD).These structural variations are accompanied by substantial changes in microbial metabolic activity.AIM To identify novel early diagnostic biomarkers of IBD,we performed an integrated multi-omics analysis that included assessing microbial community structure and profiling microbial metabolic activity in pediatric and adult cohorts with ulcerative colitis(UC)and Crohn’s disease(CD).METHODS The study cohort consisted of two distinct age groups with confirmed IBD diagnoses:Adult patients(aged 45 to 70)and pediatric patients(aged 5 to 15),each diagnosed with either CD or UC.16S rRNA gene sequencing was performed using the MinION^(TM)Mk1B platform,with data acquisition carried out via Min-KNOW software version 22.12.7(Oxford Nanopore Technologies).Stool samples were analyzed using a Shimadzu QP2010 Ultra GC/MS system equipped with a Shimadzu HS-20 headspace extractor.RESULTS Comparative analysis revealed significant age-related differences in the abundance of Bacteroidota,with pediatric IBD patients showing a lower prevalence compared to adults.Microbial profiling identified Streptococcus salivarius and Escherichia coli as potential biomarkers for assessing IBD risk in children.Furthermore,metagenomic analysis uncovered five microbial signatures with diagnostic potential for CD:Ralstonia insidiosa,Stenotrophomonas maltophilia,Erysipelatoclostridium ramosum,Blautia spp.,and Coprococcus comes.Using comprehensive metabolomic profiling,we developed and validated novel risk prediction algorithms for pediatric IBD.The CD risk stratification model identifies high-risk patients based on two key biomarkers:An elevated IBD risk coefficient score and reduced levels of 1H-indole-3-methyl.The UC risk prediction model incorporates three metabolic biomarkers indicative of increased disease risk:An elevated risk coefficient score,increased acetate levels,decreased pentanoic acid,and altered excretion of p-cresol(4-methylphenol).CONCLUSION Functional metabolomics holds transformative potential for IBD diagnostics across all age groups,with especially significant implications for pediatric patients.The distinct metabolic and metagenetic profiles observed in the pediatric cohort may represent primary alterations in IBD,providing valuable insights for exploring novel mechanisms underlying disease pathogenesis.展开更多
BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with t...BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with the possibility of extending the induction period to 16 weeks.The maintenance dose of tofacitinib is either 5 mg or 10 mg bid.AIM To assess predictors for clinical remission and drug persistence in patients with UC receiving the extended induction tofacitinib protocol.METHODS This was a real-world multicenter retrospective study in patients with moderateto-severe UC.Patients received physician-directed extended induction tofacitinib treatment.We collected clinical and demographic data at baseline and data regarding clinical,laboratory,and endoscopic evaluations,therapeutic modifications,and adverse events at the 52-week follow-up.Possible predictors for clinical remission at week 52 was the primary endpoint.Differences between patients receiving 5 mg bid vs 10 mg bid at week 52 and identification of predictors for treatment persistence were secondary endpoints.RESULTS Thirty-seven consecutive patients from 11 medical centers were included[51.4%males with median age 39(17-64)years].Twenty-eight patients continued treatment until week 52(75.7%)with 67.9%receiving 10 mg tofacitinib;all had prior history of biologic use.We observed that 57.1%of patients achieved clinical remission(66.7%in the 5 mg tofacitinib group and 52.6%in the 10 mg tofacitinib group,P=0.483).De-escalation to 5 mg tofacitinib was attempted in 17 patients with a success rate of 52.9%.Prior biologic use was significantly more frequent in patients treated with 10 mg tofacitinib.Active smoking was significantly associated with treatment discontinuation at week 52.We identified eight adverse events,and only one led to treatment discontinuation.CONCLUSION Our results supported the extended induction strategy with tofacitinib in selected patients with UC.Patients with prior failure of advanced therapies particularly benefitted,highlighting the importance of personalized maintenance regimens.展开更多
The liver has a central role in regulating inflammation by its capacity to secrete a number of proteins that control both local and systemic inflammatory responses. Chronic inflammation or an exaggerated inflammatory ...The liver has a central role in regulating inflammation by its capacity to secrete a number of proteins that control both local and systemic inflammatory responses. Chronic inflammation or an exaggerated inflammatory response can produce detrimental effects on target organs. Chronic hepatitis C virus(HCV) infection causes liver inflammation by complex and not yet well-understood molecular pathways, including direct viral effects and indirect mechanisms involving cytokine pathways,oxidative stress and steatosis induction. An increasing body of evidence recognizes the inflammatory response in chronic hepatitis C as pathogenically linked to the development of both liver-limited injury(fibrosis, cirrhosis and hepatocellular carcinoma) and extrahepatic HCV-related diseases(lymphoproliferative disease,atherosclerosis, cardiovascular and brain disease). Defining the complex mechanisms of HCV-induced inflammation could be crucial to determine the global impact of infection, to estimate progression of the disease, and to explore novel therapeutic approaches to avert HCVrelated diseases. This review focuses on HCV-related clinical conditions as a result of chronic liver and systemic inflammatory states.展开更多
AIM： To investigate the results of radiofrequency ablation （RFA） in obtaining the necrosis of hepatocellular carcinoma （HCC） in cirrhotic patients and to assess the results of RFA in relation to recurrence of HCC...AIM： To investigate the results of radiofrequency ablation （RFA） in obtaining the necrosis of hepatocellular carcinoma （HCC） in cirrhotic patients and to assess the results of RFA in relation to recurrence of HCC and survival of the treated patients.METHODS： Fifty-six consecutive cirrhotic patients with 63 HCCs were treated with RFA between May 2000 and May 2004. The diameter of the HCCs ranged from 1 cm to 5 cm （mean 2.8 cm）. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable needle electrode （LeVeen needle）. Treatment efficacy and recurrence were evaluated with dual-phase spiral computed tomography （CT）.RESULTS： Complete necrosis after single or multiple treatment was achieved in 96.8% （61/63） tumors. We observed recurrence after complete necrosis in 23 patients （41%） during a mean follow-up of 32.3 months. The recurrences were local in 2 patients （8.6%） and in different segments in 21 （91.4%）. Major complications occurred in 3 patients （4%）. During follow-up period, 32 （57.1%） patients died; 15 due to progression of HCC, 11 from liver failure, 3 from esophageal varices bleeding and 3 from the causes not related to liver disease.CONCLUSION： RFA with LeVeen needle is an effective and safe treatment for HCC 〈 5cm in cirrhotic patients. It has yet to be established how far this treatment influences the survival rate of patients. It becomes important to establish treatments to prevent recurrences in different segments, such as interferon therapy.展开更多
Osteoporosis is a systemic bone disease that affects more than 200 million people worldwide and is caused by the disruption of the equilibrium between osteoclastic bone resorption and osteoblastic bone formation. Sphi...Osteoporosis is a systemic bone disease that affects more than 200 million people worldwide and is caused by the disruption of the equilibrium between osteoclastic bone resorption and osteoblastic bone formation. Sphingosine-1-phosphate(S1 P) is a natural,bioactive sphingolipid that has been shown to play a major role in cardiovascular and immunological pathologies by regulating biological and cellular processes, including migration, differentiation, proliferation and survival. Recent studies also suggest a central role for S1 P in bone diseases, including osteoporosis;however, the effects of S1 P, particularly in bone metabolism, remain to be further elucidated. In this review, we summarize the available literature on the role of S1 P in bone metabolism with a focus on osteoporosis. On the cellular level, S1 P acts as an osteoclast-osteoblast coupling factor to promote osteoblast proliferation and bone formation. Moreover, the recruitment of osteoclast precursors to resorption sites is regulated by the interplay of S1 P gradients and S1 P receptor expression. From a clinical perspective, increasing evidence suggests that systemically elevated S1 P blood levels may serve as an independent risk factor for osteoporosis-related fractures. Taken together, S1 P signaling is a potential therapeutic target and may serve as a novel biomarker in patients with systemic bone disease.展开更多
The pandemic of coronavirus disease 2019(COVID-19),caused by a newly identifiedβ-coronavirus(SARS-CoV-2)has emerged as a dire health problem,causing a massive crisis for global health.Primary method of transmission w...The pandemic of coronavirus disease 2019(COVID-19),caused by a newly identifiedβ-coronavirus(SARS-CoV-2)has emerged as a dire health problem,causing a massive crisis for global health.Primary method of transmission was firstly thought to be animal to human transmission.However,it has been observed that the virus is transmitted from human to human via respiratory droplets.Interestingly,SARS-CoV-2 ribonucleic acid(RNA)has been isolated from patient stools,suggesting a possible gastrointestinal(GI)involvement.Most commonly reported clinical manifestations are fever,fatigue and dry cough.Interestingly,a small percentage of patients experience GI symptoms with the most common being anorexia,diarrhea,nausea and vomiting.The presence of viral RNA in stools is also common and fecal tests can be positive even after negative respiratory samples.The exact incidence of digestive symptoms is a matter of debate.The distribution of Angiotensin converting enzyme type 2 receptors in multiple organs in the body provides a possible explanation for the digestive symptoms’mechanism.Cases with solely GI symptoms have been reported in both adults and children.Viral RNA has also been detected in stool and blood samples,indicating the possibility of liver damage,which has been reported in COVID-19 patients.The presence of chronic liver disease appears to be a risk factor for severe complications and a poorer prognosis,however data from these cases is lacking.The aim of this review is firstly,to briefly update what is known about the origin and the transmission of SARS-CoV-2,but mainly to focus on the manifestations of the GI tract and their pathophysiological background,so that physicians on the one hand,not to underestimate or disregard digestive symptoms due to the small number of patients exhibiting exclusively this symptomatology and on the other,to have SARS-CoV-2 on their mind when the“gastroenteritis”type symptoms predominate.展开更多
Epidemiological studies have found that low 25-hydroxyvitamin D levels may be associated with coronary risk factors and adverse cardiovascular outcomes.Additionally,vitamin D deficiency causes an increase in parathyro...Epidemiological studies have found that low 25-hydroxyvitamin D levels may be associated with coronary risk factors and adverse cardiovascular outcomes.Additionally,vitamin D deficiency causes an increase in parathyroid hormone,which increases insulin resistance and is associated with diabetes,hypertension,inflammation,and increased cardiovascular risk.In this review,we analyze the association between vitamin D supplementation and the reduction in cardiovascular disease.The role of vitamin D deficiency in cardiovascular morbidity and mortality is still controversial,and larger scale,randomized placebo controlled trials are needed to investigate whether oral vitamin D supplementation can reduce cardiovascular risk.Given the low cost,safety,and demonstrated benefit of higher 25-hydroxyvitamin D levels,vitamin D supplementation should become a public health priority for combating common and costly chronic cardiovascular diseases.展开更多
AIM:To profile protein expression in mucosal biopsies from patients with chronic refractory pouchitis following antibiotic or probiotic treatment,using a comparative proteomic approach. METHODS:Two-dimensional polyacr...AIM:To profile protein expression in mucosal biopsies from patients with chronic refractory pouchitis following antibiotic or probiotic treatment,using a comparative proteomic approach. METHODS:Two-dimensional polyacrylamide gel electrophoresis and matrix-assisted laser desorption/ ionization-time of flight mass spectrometry were used to characterize the changes related to antibiotic therapy in the protein expression profiles of biopsy samples from patients with chronic refractory pouchitis.The same proteomic approach was applied to identify differentially expressed proteins in the non-inflamed pouch before and after probiotic administration. RESULTS:In the first set of 2D gels,26 different proteins with at least 2-fold changes in their expression levels between the pouchitis condition and antibiotic-induced remission were identified.In the second set of analysis,the comparison between mucosal biopsy proteomes in the normal and probiotic-treated pouch resulted in 17 significantly differently expressed proteins.Of these,8 exhibited the same pattern of deregulation as in the pouchitis/pouch remission group. CONCLUSION:For the first time,2D protein maps of mucosal biopsies from patients with ileal pouch-anal anastomosis were provided,and differentially expressed proteins following antibiotic/probiotic treatment were identified.展开更多
We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia,which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropath...We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia,which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropathy. The patient presented with a grand mal seizure caused by malabsorption-derived electrolytes and a protein disorder. Signs of the disease, including chronic diarrhea and peripheral edema, manifested10 years ago, but a diagnosis was never made. The diagnosis was suspected because of the clinical manifestations, laboratory tests, imaging and endoscopic findings. Hyperemic and edematous mucosa of the small intestine corresponded to scattered white spots with dilated intestinal lymphatics and whitish villi in the histological specimen of the biopsied jejunal mucosa.Although numerous therapeutic strategies are available,only octreotide therapy proved to be an effective means of therapeutic resolution in this patient. Although the patient had a partial remission following the use of a slow release formula of octreotide, his prognosis, clinical course, and future treatment challenges are yet to be determined.展开更多
AIM： To investigate the efficacy of combination treatment of IFN-α and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAgnegative hepatitis B patients. METHODS： Fifty consecutive ...AIM： To investigate the efficacy of combination treatment of IFN-α and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAgnegative hepatitis B patients. METHODS： Fifty consecutive patients were randomly assigned to receive IFN-α-2b （5 MU thrice per week, n = 24） plus lamivudine （100 mg daily） or lamivudine only （n = 26） for 24 mo. Patients were followed up for further 6 mo. The primary outcome was the proportion with sustained virological response （undetectable serum HBV DNA concentrations） and or sustained biochemical response （transaminase levels within normal range） at 30 mo （6 mo after the end of therapy）. Secondary end-points were timed from initial virological （biochemical） response to VBR （BBR, respectively） and the emergence of YMDD mutants across the two arms. RESULTS： Five of twenty-four （21%） patients in the combination arm vs 3/26 （12%） in the lamivudine arm had sustained response （i.e., normal serum transaminase levels and undetectable HBV DNA by PCR assay） 6 mo after treatment discontinuation. A reduction in the emergence of YMDD mutants and in the development of virological breakthroughs was observed in patients receMng combination treatment （10% vs46% , P= 0.01 and 14% vs46% , P= 0.03, respectively）. Time from initial virologic response to virologic breakthrough （VBR） was greater among initial responders receiving combination treatment compared to those receiving lamivudine （22.9 mo vs 15.9 mo, respectively; P = 0.005）.CONCLUSION： Our results demonstrate that IFN-α plus lamivudine combination therapy does not increase the sustained response, compared to lamivudine. However, combination therapy reduces the likelihood of VBR due to YMDD mutants and prolongs the time period until the breakthrough development.展开更多
Pancreatic cancer is one of the highest and in fact,unchanged mortality-associated tumor,with an exceptionally low survival rate due to its challenging diagnostic approach.So far,its treatment is based on a combinatio...Pancreatic cancer is one of the highest and in fact,unchanged mortality-associated tumor,with an exceptionally low survival rate due to its challenging diagnostic approach.So far,its treatment is based on a combination of approaches(such as surgical resection with or rarely without chemotherapeutic agents),but with finite limits.Thus,looking for additional space to improve pancreatic tumorigenesis therapeutic approach,research has focused on gene therapy with unexpectedly growing horizons not only for the treatment of inoperable pancreatic disease,but also for its early stages.In vivo gene delivery viral vectors,despite few disadvantages(possible immunogenicity,toxicity,mutagenicity,or high cost),could be one of the most efficient cancer gene therapeutic strategies for clinical application due to their superiority compared with other systems(ex vivo delivery strategies).Their dominance consists of simple preparation,easy operation and a wide range of functions.Adenoviruses are one of the most common used vectors,inducing strong immune as well as inflammatory reactions.Oncolytic virotherapy,using the above mentioned in vivo viral vectors,is one of the most promising nonpathogenic,highly-selective cytotoxic anti-cancer therapy using anti-cancer agents with high anti-tumor potency and strong oncolytic effect.There have been a variety of targeted therapeutic and pre-clinical strategies tested for gene therapy in pancreatic cancer such as gene-editing systems(e.g.,clustered regularly interspaced palindromic repeats-Cas9),RNA interference technology(e.g.,microRNAs,short hairpin RNA or small interfering RNA),adoptive immunotherapy and vaccination(e.g.,chimeric antigen receptor T-cell therapy)with encouraging results.展开更多
文摘Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.
文摘Ectropion is an outward turning of the eyelid margin, as a result the conjunctiva is permanently irritated, thickened and dry. Since the lacrimal puncta are moved away from the eyeball, the tear elimination is difficult, tears are always present. Materials and Methods: This study includes patients suffering from senile ectropion, who were treated surgically at Polyclinic “SHOSHI” in Prishtina. Our study includes 19 patients suffering from senile ectropion, out of which, 17 were older than 75 years old and in those patients the ectropion was preset on both lower eyelids, while 2 patients were under 75 years old and the ectropion was present only on one side lower eyelid. Prior to surgery, patients have undergone laboratory examinations. The surgery was performed under local anesthesia. The suturing was done in three layers using 6.0 vicryl sutures. No operative or post-operative complications were encountered. Purpose: The purpose of this case report study is to show the success of the surgical treatment of ectropion, a procedure that is mainly performed so the tear elimination is enabled, and there are no tears present constantly. Conclusion: In old patients where the eyelid is turned outwards its margin, conjunctiva is constantly irritated, thickened and dry, the best method of treatment is the surgical treatment, making it possible for the tears to drain properly.
文摘Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p Conclusion: Mortality is high in patients with AKI during COVID-19 infection.
文摘Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated three-dimensional(3D)models have been proposed as a valuable tool to enhance this understanding.However,a systematic comparison of different display modalities across professional groups has not yet been performed.Methods:In this prospective,monocentric randomized trial,we compared high-resolution twodimensional(2D)CT images of liver malignancies with their corresponding standardized,non-colored 3D virtual and printed models in facilitating anatomical and spatial understanding as well as surgical decision-making.A total of 91 participants,including 40 surgeons,10 radiologists,and 41 students,evaluated six clinical cases(three centrally and three peripherally located liver malignancies).Each participant assessed one central and one peripheral case per display modality,presented in a random order.Results:Compared to 2D CT images,both 3D virtual and printed models significantly improved the identification of tumor location(P<0.001),enhanced the comprehension of spatial relationships with adjacent liver and portal veins(P<0.001 and P=0.019,respectively),and facilitated clinical decisionmaking(P<0.001).No significant difference was observed between virtual and printed models in terms of effectiveness.Within the different groups,surgeons and students,but not radiologists,more accurately identified tumor location and spatial relationships with adjacent liver and portal veins using 3D models.Subjectively,most surgeons and students preferred 3D printed models over virtual models and 2D CT images.Conclusions:This study demonstrated that standardized,non-colored 3D virtual and printed models equally help preoperative anatomical understanding and decision-making,particularly for surgeons and students.By isolating the influence of display modality,our findings clarify prior inconsistent results and support the integration of cost-effective 3D visualization by applying virtual models into surgical planning and education.Preference for printed models despite comparable efficacy highlights the importance of user-centered implementation strategies.
文摘Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective,but unsafe,drugs as well as invasive surgical treatments.This aim can be achieved by detecting its first signal represented by the gastric emptying(GE)delay,by using,among the tests to measure GE,the simple,safe,reliable,and easily available one,that is realtime ultrasonography,possibly done annually.Once the GE delay has been identified,it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm,which should be treated by means of non-surgical endoscopic therapies.If,instead,it depends on initial gastropathy,detected by electrogastrograhic body surface gastric mapping,it should be treated with the safest prokinetic drugs and with the newly emerging treatments,thus distancing heavy medical and surgical treatments,while waiting for future solutions.
文摘As prepubertal boys do not yet produce spermatozoa,they cannot rely on sperm cryopreservation for fertility preservation before gonadotoxic therapy,such as high-dose alkylating agents or radiotherapy in the case of childhood cancers.According to the current guidelines,cryopreservation of testicular biopsies containing spermatogonial stem cells(SSCs)may be proposed to high-risk patients for potential later therapeutic use to fulfill the patients’wish for a biological child.One promising technique for human in vitro spermatogenesis and in vitro propagation of human SSCs is microfluidic(MF)culture,in which cells or tissues are subjected to a continuous flow of medium.This provides exact control over such parameters as nutrient content and gradients,as well as the removal of waste metabolites.While MF has been shown to maintain tissues and cell populations of organs for longer than conventional in vitro culture techniques,it has not been widely used for testicular in vitro culture.MF could advance human testicular in vitro culture and is also applicable to reprotoxicity studies.This review summarizes the findings and achievements of testis-on-chip(ToC)setups to date and discusses the benefits and limitations of these for spermatogenesis in vitro and toxicity assessment.
基金the Global WACh Rising Star Seed Award by the Department of Global Health,University of Washington,Seattle,USA(Grant No:UW/GWACh/RSA/2023-01)。
文摘Background Globally,suicide is the third leading cause of death among girls aged 15-19 years.However,there is a growing concern that suicide research has paid lttle attention to pregnant adolescent girls,particularly in lowincome and middle-income countries,including Ghana,where nearly one in seven adolescents experiences(unwanted)pregnancy.Aims To assess the prevalence and correlates of suicidal ideation and suicide attempt and the self-reported reasons for attempted suicide among pregnant adolescent girls in Ghana.Methods We collected cross-sectional data(between August 2022 and December 2023)using structured anonymous questionnaires from a sample of 449 pregnant adolescent girls(aged 14-19 years)drawn from the three geographical zones of Ghana.We applied bivariable and multivariable analysis techniques to the data.Results Overall,28.51%(95%confidence interval(Cl)24.37%to 32.93%)reported suicidal ideation,and 18.04%(95%Cl 14.59%to 21.91%)reported suicide attempt during the current pregnancy.Participants who reported attempted suicide endorsed more interpersonal reasons(eg,to communicate distress,to seek help or to influence others)than intrapersonal reasons for their attempted suicide.In the final adjusted logistic regression models,food insecurity(adjusted odds ratio(aOR)=2.69;95%Cl 1.34 to 5.41;p=0.005)was uniquely associated with increased odds of suicidal ideation.Adverse childhood experiences(a0R=3.04;95%CI 1.33 to 6.97;p=0.008),history of attempted suicide before current pregnancy(a0R=3.47;95%CI 1.27 to 9.47;p=0.015)and depression(measured by the 5-item World Health Organization Well-Being Index;aOR=0.31;95%CI 0.12 to 0.77;p=0.012)were uniquely associated with increased odds of suicide attempt.Five variables were commonly associated with increased odds of both suicidal ideation and suicide attempt:conflict with parents,alcohol use,pregnancy-related anxiety,history of attempted suicide and intimate partner violence.While being in junior high school was uniquely associated with reduced odds of suicidal ideation,intimate partner's acceptance of paternity was commonly associated with reduced odds of both suicidal ideation and suicide attempt.Conclusions Although the prevalence estimates of suicidal ideation and suicide attempt in this study are comparable with known rates among non-pregnant adolescent girls in Ghana,additional research is needed to nuance our understanding of the correlates identified in this study.The evidence aiso highlights a need for both routine antepartum primary care mental health screening for suicidality and related risks and targeted prevention and intervention programmes.
文摘BACKGROUND Patients with inflammatory bowel diseases(IBD)often miss the scheduled vaccines and have a higher risk of infection susceptibility,including vaccineprevented diseases.AIM To evaluate the vaccine coverage and levels of the post-vaccine antibodies against measles,mumps,rubella,and hepatitis B in children with IBD.METHODS Total 98 patients:46 females(47.2%)and 52 males(52.8%)with IBD(Crohn’s disease-75%and ulcerative colitis-25%)with disease onset age-11.0(6.0;14.0)years whom clinical data,vaccination status and levels of the postvaccination antibodies(IgG)for measles,rubella,mumps,hepatitis B,measured with ELISA were prospectively evaluated.The control group consisted of 88 healthy peers from the biobank data.RESULTS Patients with IBD had lower levels of measles,rubella,and hepatitis B,except mumps,compared to controls.Incomplete vaccination/non-protective titer of the antibodies against measles,mumps rubella,and hepatitis B had 33(33.7%)/52.3%,21(21.4%)/50.4%,26(25.8)/25.6%and 26(25.8%)/55.2%,respectively.Patients with incomplete vaccination had a lower age at the diagnosis for all vaccines.The age of the IBD diagnosis≤6 years was the predictor of incomplete vaccination for measles[odds ratio(OR)=4.6,P=0.001],mumps(OR=5.0,P=0.001),rubella(OR=5.4,P=0.0005)and hepatitis B(OR=5.4,P=0.0005)and corticosteroid treatment for measles(OR=2.2,P=0.074)and mumps(OR=3.0,P=0.047)vaccines.Incomplete vaccination was the predictor of nonprotective titer of antibodies against rubella(OR=6.8,95%CI:2.3-19.9,P=0.0002)/mumps(OR=7.0,95%CI:2.4-20.8;P=0.0002).CONCLUSION Patients with IBD had low vaccine coverage and lower levels of anti-vaccine antibodies against measles,rubella,and hepatitis B.Nearly half of the IBD patients require revaccination.
文摘BACKGROUND Children with juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)face an elevated risk of severe infection owing to their diseases and the immunosuppressive treatment for disease control.AIM To compare scheduled vaccination coverage and the levels of post-vaccine antibodies against measles,mumps,rubella(MMR)and hepatitis B in pediatric patients with IBD and JIA.METHODS A comparative cohort study included 97 patients with IBD and 170 patients with JIA.Vaccination history was obtained from medical records,while post-vaccination immunity was assessed prospectively by measuring specific IgG antibody titers using enzyme-linked immunosorbent assays(Vector-Best JSC,Russia;IBL International,Germany)during routine visits between January 2022 and April 2023.RESULTS A complete two-dose MMR course had been administered to 66.3%of IBD patients and 55.9%of JIA patients(P=0.121).By contrast,the three-dose hepatitis B schedule was completed in 74.2%of IBD and 100%of JIA patients(P<0.001).Protective level of anti-vaccine antibodies against measles(47.7%vs 57.7%;P=0.168);mumps(75.3%vs 80.0%;P=0.366);rubella(74.4%vs 98.2%;P<0.0001);and hepatitis B(44.8%vs 50.0%;P=0.514)were detected in IBD and JIA patients,respectively.CONCLUSION Patients with IBD and JIA demonstrated different vaccination coverage patterns and levels of anti-vaccine antibodies.Routine baseline serology and timely booster vaccination should be implemented for all pediatric patients receiving chronic immunosuppression.
基金Supported by the IBD-ONCO 25-27 Project,No.R&D 125030703327-1.
文摘BACKGROUND The gut microbiota displays pronounced compositional differences between pediatric and adult populations,both under normal conditions and during the development of inflammatory bowel disease(IBD).These structural variations are accompanied by substantial changes in microbial metabolic activity.AIM To identify novel early diagnostic biomarkers of IBD,we performed an integrated multi-omics analysis that included assessing microbial community structure and profiling microbial metabolic activity in pediatric and adult cohorts with ulcerative colitis(UC)and Crohn’s disease(CD).METHODS The study cohort consisted of two distinct age groups with confirmed IBD diagnoses:Adult patients(aged 45 to 70)and pediatric patients(aged 5 to 15),each diagnosed with either CD or UC.16S rRNA gene sequencing was performed using the MinION^(TM)Mk1B platform,with data acquisition carried out via Min-KNOW software version 22.12.7(Oxford Nanopore Technologies).Stool samples were analyzed using a Shimadzu QP2010 Ultra GC/MS system equipped with a Shimadzu HS-20 headspace extractor.RESULTS Comparative analysis revealed significant age-related differences in the abundance of Bacteroidota,with pediatric IBD patients showing a lower prevalence compared to adults.Microbial profiling identified Streptococcus salivarius and Escherichia coli as potential biomarkers for assessing IBD risk in children.Furthermore,metagenomic analysis uncovered five microbial signatures with diagnostic potential for CD:Ralstonia insidiosa,Stenotrophomonas maltophilia,Erysipelatoclostridium ramosum,Blautia spp.,and Coprococcus comes.Using comprehensive metabolomic profiling,we developed and validated novel risk prediction algorithms for pediatric IBD.The CD risk stratification model identifies high-risk patients based on two key biomarkers:An elevated IBD risk coefficient score and reduced levels of 1H-indole-3-methyl.The UC risk prediction model incorporates three metabolic biomarkers indicative of increased disease risk:An elevated risk coefficient score,increased acetate levels,decreased pentanoic acid,and altered excretion of p-cresol(4-methylphenol).CONCLUSION Functional metabolomics holds transformative potential for IBD diagnostics across all age groups,with especially significant implications for pediatric patients.The distinct metabolic and metagenetic profiles observed in the pediatric cohort may represent primary alterations in IBD,providing valuable insights for exploring novel mechanisms underlying disease pathogenesis.
文摘BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with the possibility of extending the induction period to 16 weeks.The maintenance dose of tofacitinib is either 5 mg or 10 mg bid.AIM To assess predictors for clinical remission and drug persistence in patients with UC receiving the extended induction tofacitinib protocol.METHODS This was a real-world multicenter retrospective study in patients with moderateto-severe UC.Patients received physician-directed extended induction tofacitinib treatment.We collected clinical and demographic data at baseline and data regarding clinical,laboratory,and endoscopic evaluations,therapeutic modifications,and adverse events at the 52-week follow-up.Possible predictors for clinical remission at week 52 was the primary endpoint.Differences between patients receiving 5 mg bid vs 10 mg bid at week 52 and identification of predictors for treatment persistence were secondary endpoints.RESULTS Thirty-seven consecutive patients from 11 medical centers were included[51.4%males with median age 39(17-64)years].Twenty-eight patients continued treatment until week 52(75.7%)with 67.9%receiving 10 mg tofacitinib;all had prior history of biologic use.We observed that 57.1%of patients achieved clinical remission(66.7%in the 5 mg tofacitinib group and 52.6%in the 10 mg tofacitinib group,P=0.483).De-escalation to 5 mg tofacitinib was attempted in 17 patients with a success rate of 52.9%.Prior biologic use was significantly more frequent in patients treated with 10 mg tofacitinib.Active smoking was significantly associated with treatment discontinuation at week 52.We identified eight adverse events,and only one led to treatment discontinuation.CONCLUSION Our results supported the extended induction strategy with tofacitinib in selected patients with UC.Patients with prior failure of advanced therapies particularly benefitted,highlighting the importance of personalized maintenance regimens.
文摘The liver has a central role in regulating inflammation by its capacity to secrete a number of proteins that control both local and systemic inflammatory responses. Chronic inflammation or an exaggerated inflammatory response can produce detrimental effects on target organs. Chronic hepatitis C virus(HCV) infection causes liver inflammation by complex and not yet well-understood molecular pathways, including direct viral effects and indirect mechanisms involving cytokine pathways,oxidative stress and steatosis induction. An increasing body of evidence recognizes the inflammatory response in chronic hepatitis C as pathogenically linked to the development of both liver-limited injury(fibrosis, cirrhosis and hepatocellular carcinoma) and extrahepatic HCV-related diseases(lymphoproliferative disease,atherosclerosis, cardiovascular and brain disease). Defining the complex mechanisms of HCV-induced inflammation could be crucial to determine the global impact of infection, to estimate progression of the disease, and to explore novel therapeutic approaches to avert HCVrelated diseases. This review focuses on HCV-related clinical conditions as a result of chronic liver and systemic inflammatory states.
文摘AIM： To investigate the results of radiofrequency ablation （RFA） in obtaining the necrosis of hepatocellular carcinoma （HCC） in cirrhotic patients and to assess the results of RFA in relation to recurrence of HCC and survival of the treated patients.METHODS： Fifty-six consecutive cirrhotic patients with 63 HCCs were treated with RFA between May 2000 and May 2004. The diameter of the HCCs ranged from 1 cm to 5 cm （mean 2.8 cm）. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable needle electrode （LeVeen needle）. Treatment efficacy and recurrence were evaluated with dual-phase spiral computed tomography （CT）.RESULTS： Complete necrosis after single or multiple treatment was achieved in 96.8% （61/63） tumors. We observed recurrence after complete necrosis in 23 patients （41%） during a mean follow-up of 32.3 months. The recurrences were local in 2 patients （8.6%） and in different segments in 21 （91.4%）. Major complications occurred in 3 patients （4%）. During follow-up period, 32 （57.1%） patients died; 15 due to progression of HCC, 11 from liver failure, 3 from esophageal varices bleeding and 3 from the causes not related to liver disease.CONCLUSION： RFA with LeVeen needle is an effective and safe treatment for HCC 〈 5cm in cirrhotic patients. It has yet to be established how far this treatment influences the survival rate of patients. It becomes important to establish treatments to prevent recurrences in different segments, such as interferon therapy.
基金funded by grants to JK by the Else-Kr?ner-Fresenius-Stiftung (EKFS 2017_A22)by grants to JK from the Berlin Institute of Health
文摘Osteoporosis is a systemic bone disease that affects more than 200 million people worldwide and is caused by the disruption of the equilibrium between osteoclastic bone resorption and osteoblastic bone formation. Sphingosine-1-phosphate(S1 P) is a natural,bioactive sphingolipid that has been shown to play a major role in cardiovascular and immunological pathologies by regulating biological and cellular processes, including migration, differentiation, proliferation and survival. Recent studies also suggest a central role for S1 P in bone diseases, including osteoporosis;however, the effects of S1 P, particularly in bone metabolism, remain to be further elucidated. In this review, we summarize the available literature on the role of S1 P in bone metabolism with a focus on osteoporosis. On the cellular level, S1 P acts as an osteoclast-osteoblast coupling factor to promote osteoblast proliferation and bone formation. Moreover, the recruitment of osteoclast precursors to resorption sites is regulated by the interplay of S1 P gradients and S1 P receptor expression. From a clinical perspective, increasing evidence suggests that systemically elevated S1 P blood levels may serve as an independent risk factor for osteoporosis-related fractures. Taken together, S1 P signaling is a potential therapeutic target and may serve as a novel biomarker in patients with systemic bone disease.
文摘The pandemic of coronavirus disease 2019(COVID-19),caused by a newly identifiedβ-coronavirus(SARS-CoV-2)has emerged as a dire health problem,causing a massive crisis for global health.Primary method of transmission was firstly thought to be animal to human transmission.However,it has been observed that the virus is transmitted from human to human via respiratory droplets.Interestingly,SARS-CoV-2 ribonucleic acid(RNA)has been isolated from patient stools,suggesting a possible gastrointestinal(GI)involvement.Most commonly reported clinical manifestations are fever,fatigue and dry cough.Interestingly,a small percentage of patients experience GI symptoms with the most common being anorexia,diarrhea,nausea and vomiting.The presence of viral RNA in stools is also common and fecal tests can be positive even after negative respiratory samples.The exact incidence of digestive symptoms is a matter of debate.The distribution of Angiotensin converting enzyme type 2 receptors in multiple organs in the body provides a possible explanation for the digestive symptoms’mechanism.Cases with solely GI symptoms have been reported in both adults and children.Viral RNA has also been detected in stool and blood samples,indicating the possibility of liver damage,which has been reported in COVID-19 patients.The presence of chronic liver disease appears to be a risk factor for severe complications and a poorer prognosis,however data from these cases is lacking.The aim of this review is firstly,to briefly update what is known about the origin and the transmission of SARS-CoV-2,but mainly to focus on the manifestations of the GI tract and their pathophysiological background,so that physicians on the one hand,not to underestimate or disregard digestive symptoms due to the small number of patients exhibiting exclusively this symptomatology and on the other,to have SARS-CoV-2 on their mind when the“gastroenteritis”type symptoms predominate.
基金Supported by(in part)the Kaohsiung Veterans General Hospital,No.VGHKS100-032
文摘Epidemiological studies have found that low 25-hydroxyvitamin D levels may be associated with coronary risk factors and adverse cardiovascular outcomes.Additionally,vitamin D deficiency causes an increase in parathyroid hormone,which increases insulin resistance and is associated with diabetes,hypertension,inflammation,and increased cardiovascular risk.In this review,we analyze the association between vitamin D supplementation and the reduction in cardiovascular disease.The role of vitamin D deficiency in cardiovascular morbidity and mortality is still controversial,and larger scale,randomized placebo controlled trials are needed to investigate whether oral vitamin D supplementation can reduce cardiovascular risk.Given the low cost,safety,and demonstrated benefit of higher 25-hydroxyvitamin D levels,vitamin D supplementation should become a public health priority for combating common and costly chronic cardiovascular diseases.
文摘AIM:To profile protein expression in mucosal biopsies from patients with chronic refractory pouchitis following antibiotic or probiotic treatment,using a comparative proteomic approach. METHODS:Two-dimensional polyacrylamide gel electrophoresis and matrix-assisted laser desorption/ ionization-time of flight mass spectrometry were used to characterize the changes related to antibiotic therapy in the protein expression profiles of biopsy samples from patients with chronic refractory pouchitis.The same proteomic approach was applied to identify differentially expressed proteins in the non-inflamed pouch before and after probiotic administration. RESULTS:In the first set of 2D gels,26 different proteins with at least 2-fold changes in their expression levels between the pouchitis condition and antibiotic-induced remission were identified.In the second set of analysis,the comparison between mucosal biopsy proteomes in the normal and probiotic-treated pouch resulted in 17 significantly differently expressed proteins.Of these,8 exhibited the same pattern of deregulation as in the pouchitis/pouch remission group. CONCLUSION:For the first time,2D protein maps of mucosal biopsies from patients with ileal pouch-anal anastomosis were provided,and differentially expressed proteins following antibiotic/probiotic treatment were identified.
文摘We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia,which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropathy. The patient presented with a grand mal seizure caused by malabsorption-derived electrolytes and a protein disorder. Signs of the disease, including chronic diarrhea and peripheral edema, manifested10 years ago, but a diagnosis was never made. The diagnosis was suspected because of the clinical manifestations, laboratory tests, imaging and endoscopic findings. Hyperemic and edematous mucosa of the small intestine corresponded to scattered white spots with dilated intestinal lymphatics and whitish villi in the histological specimen of the biopsied jejunal mucosa.Although numerous therapeutic strategies are available,only octreotide therapy proved to be an effective means of therapeutic resolution in this patient. Although the patient had a partial remission following the use of a slow release formula of octreotide, his prognosis, clinical course, and future treatment challenges are yet to be determined.
文摘AIM： To investigate the efficacy of combination treatment of IFN-α and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAgnegative hepatitis B patients. METHODS： Fifty consecutive patients were randomly assigned to receive IFN-α-2b （5 MU thrice per week, n = 24） plus lamivudine （100 mg daily） or lamivudine only （n = 26） for 24 mo. Patients were followed up for further 6 mo. The primary outcome was the proportion with sustained virological response （undetectable serum HBV DNA concentrations） and or sustained biochemical response （transaminase levels within normal range） at 30 mo （6 mo after the end of therapy）. Secondary end-points were timed from initial virological （biochemical） response to VBR （BBR, respectively） and the emergence of YMDD mutants across the two arms. RESULTS： Five of twenty-four （21%） patients in the combination arm vs 3/26 （12%） in the lamivudine arm had sustained response （i.e., normal serum transaminase levels and undetectable HBV DNA by PCR assay） 6 mo after treatment discontinuation. A reduction in the emergence of YMDD mutants and in the development of virological breakthroughs was observed in patients receMng combination treatment （10% vs46% , P= 0.01 and 14% vs46% , P= 0.03, respectively）. Time from initial virologic response to virologic breakthrough （VBR） was greater among initial responders receiving combination treatment compared to those receiving lamivudine （22.9 mo vs 15.9 mo, respectively; P = 0.005）.CONCLUSION： Our results demonstrate that IFN-α plus lamivudine combination therapy does not increase the sustained response, compared to lamivudine. However, combination therapy reduces the likelihood of VBR due to YMDD mutants and prolongs the time period until the breakthrough development.
文摘Pancreatic cancer is one of the highest and in fact,unchanged mortality-associated tumor,with an exceptionally low survival rate due to its challenging diagnostic approach.So far,its treatment is based on a combination of approaches(such as surgical resection with or rarely without chemotherapeutic agents),but with finite limits.Thus,looking for additional space to improve pancreatic tumorigenesis therapeutic approach,research has focused on gene therapy with unexpectedly growing horizons not only for the treatment of inoperable pancreatic disease,but also for its early stages.In vivo gene delivery viral vectors,despite few disadvantages(possible immunogenicity,toxicity,mutagenicity,or high cost),could be one of the most efficient cancer gene therapeutic strategies for clinical application due to their superiority compared with other systems(ex vivo delivery strategies).Their dominance consists of simple preparation,easy operation and a wide range of functions.Adenoviruses are one of the most common used vectors,inducing strong immune as well as inflammatory reactions.Oncolytic virotherapy,using the above mentioned in vivo viral vectors,is one of the most promising nonpathogenic,highly-selective cytotoxic anti-cancer therapy using anti-cancer agents with high anti-tumor potency and strong oncolytic effect.There have been a variety of targeted therapeutic and pre-clinical strategies tested for gene therapy in pancreatic cancer such as gene-editing systems(e.g.,clustered regularly interspaced palindromic repeats-Cas9),RNA interference technology(e.g.,microRNAs,short hairpin RNA or small interfering RNA),adoptive immunotherapy and vaccination(e.g.,chimeric antigen receptor T-cell therapy)with encouraging results.
