Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Background: Intestinal fibrosis is a serious complication of inflammatory bowel disease, including Crohnâ��s\ndisease and ulcerative colitis. There is no specific treatment for intestinal fibrosis. Studies have indicated\nthat peroxisome proliferator-activated receptor- �³ (PPAR-�³) agonists have anti-fibrogenic properties in\norgans besides the gut; however, their effects on human intestinal fibrosis are poorly understood.\nThis study investigated the anti-fibrogenic properties and mechanisms of PPAR-�³ agonists on human\nprimary intestinal myofibroblasts (HIFs).\nMethods: HIFs were isolated from normal colonic tissue of patients undergoing resection due to colorectal cancer.\nHIFs were treated with TGF-�²1 and co-incubated with or without one of two synthetic PPAR-�³ agonists, troglitazone\nor rosiglitazone. mRNA and protein expression of procollagen1A1, fibronectin, and �±-smooth muscle actin were\ndetermined by semiquantitative reverse transcription-polymerase chain reaction and Western blot. LY294002 (Akt\ninhibitor) was used to examine whether Akt phosphorylation was a downstream mechanism of TGF-�²1 induced\nexpression of procollagen1A1, fibronectin, and �±-smooth muscle actin in HIFs. The irreversible PPAR-�³ antagonist\nGW9662 was used to investigate whether the effect of PPAR-�³ agonists was PPAR-�³ dependent.\nResults: Both PPAR-�³ agonists reduced the TGF-�²1-induced expression of �±-smooth muscle actin which was\nintegrated into stress fibers in HIFs, as determined by actin microfilaments fluorescent staining and �±-smooth muscle\nactin-specific immunocytochemistry. PPAR-�³ agonists also inhibited TGF-�²1-induced mRNA and protein expressions of\nprocollagen1A1, fibronectin, and �±-smooth muscle actin. TGF-�²1 stimulation increased phosphorylation of downstream\nsignaling molecules Smad2, Akt, and ERK. TGF-�²1 induced synthesis of procollagen1A1, fibronectin, and �±-smooth\nmuscle actin through a phosphatidylinositol 3-kinase/Akt-dependent mechanism. PPAR-�³ agonists down regulated\nfibrogenesis, as shown by inhibition of Akt and Smad2 phosphorylation. This anti-fibrogenic effect was PPAR-�³\nindependent.\nConclusions: Troglitazone and rosiglitazone suppress TGF-�²1-induced synthesis of procollagen1A1, fibronectin, and\n�±-smooth muscle actin in HIFs and may be useful in treating intestinal fibrosis....
Background. Blue laser imaging (BLI) enables the acquisition of more information from tumors� surfaces compared with white light\nimaging. Few reports confirm the validity of magnifying endoscopy (ME) with BLI (ME-BLI) for early gastric cancer (EGC). We\naimed to assess the detailed endoscopic findings from EGCs using ME-BLI. Methods. We enrolled 386 consecutive patients with\n417 EGCs that were diagnosed using ME-BLI and resected by endoscopic submucosal dissection. Using the VS classification\nsystem, three highly experienced endoscopists (HEEs) and three less experienced endoscopists (LEEs) evaluated the demarcation\nline (DL), microsurface pattern (MSP), and microvascular pattern (MVP) within the endoscopic images of EGCs obtained using\nME-BLI, assigning high-confidence (HC) or low-confidence (LC) levels. We investigated the clinicopathological features\nassociated with each confidence level. Results. The HEEs� evaluations determined the presence of DL in 99%, irregular MSP in\n96%, and irregular MVP in 96%, and the LEEs� evaluations determined the presence of DL in 98%, irregular MSP in 95%, and\nirregular MVP in 95% of the EGCs. When DL was present, HC levels in the Helicobacter pylori- (H. pylori-) eradicated group\nand noneradicated group were evident in 65% and 89%, a difference that was significant (p < 0 001). Conclusions. In the\ndiagnosis of EGC with ME-BLI, the VS classification system with ME-NBI can be applied, but identifying the DL after H. pylori\nwas difficult....
Aim. To evaluate different parameters in differentiating intestinal BD from CD. Methods. The medical records of inpatients with\nintestinal BD and CD were retrospectively reviewed. The univariate value of different parameters was analyzed, respectively. A\ndifferentiation model was established by pooling all valuable parameters together. Diagnostic efficacy was evaluated, and a\nreceiver operating curve (ROC) was plotted. Results. Forty-two BD patients and ninety-seven CD patients were reviewed.\nDemographic and clinical parameters that showed significant value included diarrhea, fever, perianal disease, oral ulcers, genital\nulcers, skin lesions, and musculoskeletal lesions. Endoscopic parameters reaching clinical significance included multiple-site\nlesions, lesions confined to the ileocecal region, longitudinal ulcers, round or oval ulcers, punch-out ulcers, ulcers with discrete\nmargin, ulcer size > 2 cm, stricture of bowel, and anorectal involvement. Radiologic parameters aiding the differentiation\nincluded involvement segments � 3, asymmetrical pattern of involvement, intraluminal pseudopolyp formation, target sign,\nstricture with proximal dilation, comb sign, and fistula. The sensitivity, specificity, accuracy, positive predictive value, and\nnegative predictive value of the differentiation model were 90.5%, 93.8%, 92.8%, 86.4%, and 95.8%, respectively. The cutoff value\nwas 0.5 while the area under the ROC curve was 0.981. Conclusion. The differentiation model that integrated the various\nparameters together may yield a high diagnostic efficacy in the differential diagnosis between intestinal BD and CD....
Aims. To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the\nremnant stomach (GEN-RS) after various types of partial gastrectomy. Methods. This study included 29 patients (31 lesions)\nwho underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively\nto assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events.\nResults. The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous\ngastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors\ninvolving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The\nprocedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical\nintervention. During a median follow-up period of 25 months (range, 6ââ?¬â??58 months), there was no recurrence in any case.\nConclusions. ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the\ncomplete resection rate decreases for lesions involving the suture lines....
Background: Obesity is a growing epidemic around the world, and obese patients are generally regarded as high\nrisk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of\nobesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.\nMethods: We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004\nand December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were\ncompared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used\nmethods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more\nsuitable for obese patients.\nResults: A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study\nperiod. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 �± 29.7\nvs. 227.2 �± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 �± 34.1\nvs. 136.9 �± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly\nshorter in the non-obese group than in the obese group (3.3 �± 0.8 vs. 3.6 �± 0.9 days; 4.3 �± 1.0 vs. 4.6 �± 1.0 days; and 9.\n0 �± 2.2 vs. 9.6 �± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as\ncompared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved\nresults for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.\nConclusions: Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic\ngastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese\npatients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early\nsurgical outcomes, for obese patients....
Background. Recent studies have shown a lower risk of surgical site infections (SSI) after laparoscopic distal gastrectomy compared\nto open surgery. This is a phase 2 study aiming to determine the incidence of SSI after laparoscopic distal gastrectomy without using\nantimicrobial prophylaxis (AMP). Methods. cT1N0 gastric cancers that were subject to laparoscopic distal gastrectomy were\nenrolled. Based on the unacceptable SSI incidence of ââ?°Â¥12.5% and the target SSI incidence of ââ?°Â¤5%, 105 patients were enrolled\nwith an Ã?± of 0.05 and a power of 80% (ClinicalTrials.gov, NCT02200315). Results. In intention-to-treat analysis, patients did not\nreach the target SSI rate (12.4%, 95% confidence interval = 6 8%ââ?¬â??19 8%). Of patients, 44 patients had a protocol violation, such\nas extended lymph node dissection (LND) or inappropriate nonpharmacological SSI prevention measures. Per-protocol analysis\nexcluding these patients (n = 61) showed a SSI rate of 4.9%, which was within the target SSI range. Multivariate analysis revealed\nthat extracorporeal anastomosis and extended LND were independent risk factors for SSI. Conclusions. This study failed to\nreach the target SSI rate without using AMP. However, per-protocol analysis suggests that no AMP might be feasible when\nlimited LND and adequate SSI prevention measures were performed....
Background: Gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS)\nare common functional gastrointestinal conditions with a significant impact on daily life. The objectives were to\nanalyse general self-rated health and self-reported functional capacity in adults meeting the criteria for GERD, FD\nand IBS, respectively, and in individuals who meet the criteria for more than one of the conditions.\nMethods: A nationwide study of 100,000 individuals aged 20 years and above, randomly selected in the general\nDanish population. A web-based questionnaire survey formed the basis of this study. Questions regarding FD and\nIBS were extracted from the ROME III adult questionnaire. Questions regarding GERD were developed based on the\nMontreal definition. Self-rated health and functional capacity was measured by single global questions.\nResults: Respondents meeting the criteria for either GERD, FD or IBS have significantly higher odds of reporting\npoor self-rated health and impaired functional capacity compared to individuals not experiencing these functional\ngastrointestinal conditions. Furthermore, respondents with overlapping gastrointestinal (GI) symptom complexes\nhave significantly higher odds of reporting poor self-rated health and impaired functional capacity compared to\nrespondents with symptoms compatible with only one of the symptom complexes.\nConclusions: This study demonstrates that individuals experiencing symptoms of GERD, FD or IBS report poor\nself-rated health as well as impaired functional capacity. The impact on self-rated health and functional capacity is\nhighest among individuals experiencing overlapping symptoms of GERD, FD and IBS....
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