AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein(AFP) and prothrombin induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ) in chronic hepatitis B(CHB).METHODS: A total of 1255 patients ...AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein(AFP) and prothrombin induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ) in chronic hepatitis B(CHB).METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma(HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic(AUROC) curves of PIVKA-Ⅱ, AFP and their combination were calculated and compared.RESULTS: The optimal cutoff values for PIVKA-Ⅱ and AFP were 40 m AU/m L and 10 ng/m L, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-Ⅱ and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-Ⅱ and AFP were not significantly different(0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-Ⅱ was significantly better than that of AFP in patients with cirrhosis(0.870 vs 0.812, P = 0.042). When PIVKA-Ⅱ and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-Ⅱ alone for the differentiation of HCC from nonmalignant CHB(P < 0.05), especially when cirrhosis was present(P < 0.05).CONCLUSION: Serum PIVKA-Ⅱ might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.展开更多
Reactive oxygen species （ROS） attack guanine bases in DNA easily and form 8-hydroxydeoxyguanosine （8-OHdG）, which can bind to thymidine rather than cytosine, based on which, the level of 8-OHdG is gen- erally rega...Reactive oxygen species （ROS） attack guanine bases in DNA easily and form 8-hydroxydeoxyguanosine （8-OHdG）, which can bind to thymidine rather than cytosine, based on which, the level of 8-OHdG is gen- erally regarded as a biomarker of mutagenesis conse- quent to oxidative stress. For example, higher levels of 8-OHdG are noted in Helicobacter pylori-associated chronic atrophic gastritis as well as gastric cancer. However, we have found that exogenous 8-OHdG can paradoxically reduce ROS production, attenuate the nuclear factor-KB signaling pathway, and ameliorate the expression of proinflammatory mediators such as interleukin （IL）-I, IL-6, cyclo-oxygenase-2, and induc- ible nitric oxide synthase in addition to expression of nicotinamide adenine dinucleotide phosphate oxidase （NOX）-I, NOX organizer-1 and NOX activator-1 in vari- ous conditions of inflammation-based gastrointestinal （GI） diseases including gastritis, inflammatory bowel disease, pancreatitis, and even colitis-associated carci- nogenesis. Our recent finding that exogenous 8-OHdG was very effective in either inflammation-based or oxidative-stress-associated diseases of stress-related mucosal damage has inspired the hope that synthetic 8-OHdG can be a potential candidate for the treatment of inflammation-based GI diseases, as well as the pre- vention of inflammation-associated GI cancer. In this editorial review, the novel fact that exogenous 8-OHdG can be a functional molecule regulating oxidative- stress-induced gastritis through either antagonizing Rac-guanosine triphosphate binding or blocking the signals responsible for gastric inflammatory cascade is introduced.展开更多
AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were a...AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.展开更多
AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric a...AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria(Hb < 12 g/dL in women and < 13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 g/dL.Vitamin B12 deficiency was defined as serum vitamin B 12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B 12 deficiency was defined as megaloblastic anemia(mean cell volume > 100 fL) with vitamin B 12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12(40.0% vs 22.0%,P = 0.033),24(45.0% vs 25.0%,P = 0.023),36(55.0% vs 28.0%,P = 0.004),and 48 mo(52.0% vs 31.0%,P = 0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery(60.7% vs 31.3%,P = 0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6(35.4% vs 13.3%,P = 0.002),12(45.8% vs 16.8%,P < 0.001),18(52.1% vs 22.3%,P < 0.001),24(60.4% v展开更多
The Ni-rich Li[Ni0.6Co0.2Mn0.2]O2 surface has been modified with H3PO4. After coating at 80 ℃, the products were heated further at a moderate temperature of 500 ℃ in air, when the added H3PO4 transformed to Li3PO4 a...The Ni-rich Li[Ni0.6Co0.2Mn0.2]O2 surface has been modified with H3PO4. After coating at 80 ℃, the products were heated further at a moderate temperature of 500 ℃ in air, when the added H3PO4 transformed to Li3PO4 after reacting with residual LiOH and Li2CO3 on the surface. A thin and uniform smooth nanolayer （〈 10 nm） was observed on the surface of Li[Ni0.6Co0.2Mn0.2]O2 as confirmed by transmission electron microscopy （TEM）. Time-of-flight secondary ion mass spectroscopic （ToF-SIMS） data exhibit the presence of LIP＋, LiPO-, and Li2PO2＋ fragments, indicating the formation of the Li3PO4 coating layer on the surface of the Li[Ni0.6Co0.2Mn0.2]O2. As a result, the amounts of residual lithium compounds, such as LiOH and Li2CO3, are significantly reduced. As a consequence, the LigPO4-coated Li[Ni0.6Co0.2Mn0.2]O2 exhibits noticeable improvement in capacity retention and rate capability due to the reduction of residual LiOH and Li2CO3. Further investigation of the extensively cycled electrodes by X-ray diffraction （XRD）, TEM, and ToF-SIMS demonstrated that the LiBPO4 coating layers have multi-functions： Absorption of water in the electrolyte that lowers the HF level, HF scavenging, and protection of the active materials from deleterious side reactions with the electrolyte during extensive cycling, enabling high capacity retention over 1,000 cycles.展开更多
Endoscopic submucosal dissection(ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea.However,ESD has technical difficulties and a longer procedure time than c...Endoscopic submucosal dissection(ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea.However,ESD has technical difficulties and a longer procedure time than conventional endoscopic resection.So it may have a higher risk of complications than conventional endoscopic resection techniques.We,the ESD study group of Korean Society of Gastrointestinal Endoscopy,have experienced many complications,mostly treated by endoscopic or conservative management.Here,we introduce and share our experiences for managementof post ESD complications and review published papers on the topic.展开更多
BACKGROUND Despite advancements in operative technique and improvements in postoperative managements,postoperative pancreatic fistula(POPF)is a life-threatening complication following pancreatoduodenectomy(PD).There a...BACKGROUND Despite advancements in operative technique and improvements in postoperative managements,postoperative pancreatic fistula(POPF)is a life-threatening complication following pancreatoduodenectomy(PD).There are some reports to predict POPF preoperatively or intraoperatively,but the accuracy of those is questionable.Artificial intelligence(AI)technology is being actively used in the medical field,but few studies have reported applying it to outcomes after PD.AIM To develop a risk prediction platform for POPF using an AI model.METHODS Medical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016.A total of 38 variables were inserted into AI-driven algorithms.The algorithms tested to make the risk prediction platform were random forest(RF)and a neural network(NN)with or without recursive feature elimination(RFE).The median imputation method was used for missing values.The area under the curve(AUC)was calculated to examine the discriminative power of algorithm for POPF prediction.RESULTS The number of POPFs was 221(12.5%)according to the International Study Group of Pancreatic Fistula definition 2016.After median imputation,AUCs using 38 variables were 0.68±0.02 with RF and 0.71±0.02 with NN.The maximal AUC using NN with RFE was 0.74.Sixteen risk factors for POPF were identified by AI algorithm:Pancreatic duct diameter,body mass index,preoperative serum albumin,lipase level,amount of intraoperative fluid infusion,age,platelet count,extrapancreatic location of tumor,combined venous resection,co-existing pancreatitis,neoadjuvant radiotherapy,American Society of Anesthesiologists’score,sex,soft texture of the pancreas,underlying heart disease,and preoperative endoscopic biliary decompression.We developed a web-based POPF prediction platform,and this application is freely available at http://popfrisk.smchbp.org.CONCLUSION This study is the first to predict POPF with multiple risk factors using AI.This platform is reliable(AUC 0.74),so it could be used to select展开更多
AIM: To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea. METHODS: AIP was diagnosed by t...AIM: To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea. METHODS: AIP was diagnosed by the international consensus diagnostic criteria. The medical records and pathology were retrospectively reviewed and IgG4-positive cells were counted in a high power field (HPF). Type I AIP was defined as a high serum level of IgG4or histological finding. SIN type 1 AIP was defined as a histological evidence of type 1 AIP and a normal serum IgG4 level. The clinical and pathological findings were compared between the two groups. The analysis was performed using Student's t test, Fischer's exact test and Mann-Whitney's U test. A P value of < 0.05 was considered statistically significant. As repeated com- parison was made, P values of less than 5% (P < 0.05) were considered significant. RESULTS: Twenty five patients with definite type 1 AIP (19 histologically and six serologically diagnosed cases) were enrolled. The mean tissue IgG4 concentrations were significantly higher in SIP than SIN group (40 cells per HPF vs 18 cells per HPF, P = 0.02). Among eight SIN patients, the tissue IgG4 concentrations were less than 15 cells per HPF in most of cases, except one. The sensitivity of serum IgG4 was 68% (17 SIP and eight SIN AIP). Other organ involvement was more frequent- ly associated with SIP than SIN AIP (59% vs 26%, P = 0.016). However, the relapse rate and diffuse swelling of the pancreas were not associated with serum IgG4 level. The concentrations of IgG4-positive cells per HPF were higher in SIP than SIN AIP (40 vs 18, P = 0.02). CONCLUSION: The sensitivity of serum IgG4 was 68% in type 1 AIP. High serum IgG4 level was associated with other organ involvement and tissue IgG4 concentration but did not affect the relapse rate in type 1 AIP.展开更多
AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathoge...AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease （GERD） makes it interesting to examine the effect of itopride on esophageal acid exposure.METHODS： The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time （pH〈4） of more than 5% and mild esophagitis （SavaryMiller grades I, II） proven by endoscopy. Ambulatory 24hpH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day （t.i.d.） for 30 d in random order, using an open label method.For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment.RESULTS： Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300 mg was significantly effective than 150 mg on decreasing the total per cent time with pH〈4, total time with pH〈4 and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups.CONCLUSION： Itopride 100 mg t.i.d, is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.展开更多
AIM:To investigate the role and clinicopathological significance of aberrant expression of Notch receptors and Delta-like ligand-4 (DLL4) in extrahepatic cholangiocarcinoma and gallbladder carcinoma.METHODS:One hundre...AIM:To investigate the role and clinicopathological significance of aberrant expression of Notch receptors and Delta-like ligand-4 (DLL4) in extrahepatic cholangiocarcinoma and gallbladder carcinoma.METHODS:One hundred and ten patients had surgically resected extrahepatic cholangiocarcinoma (CC) and gallbladder carcinoma specimens examined by immunohistochemistry of available paraffin blocks.Immunohistochemistry was performed using anti-Notch receptors 1-4 and anti-DLL4 antibodies.We scored the immunopositivity of Notch receptors and DLL4 expression by percentage of positive tumor cells with cytoplasmic expression and intensity of immunostaining.Coexistent nuclear localization was evaluated.Clinicopatho-logical parameters and survival data were compared with the expression of Notch receptors 1-4 and DLL4.RESULTS:Notch receptor proteins showed in the cytoplasm with or without nuclear expression in cancer cells,as well as showing weak cytoplasmic expression in non-neoplastic cells.By semiquantitative evaluation,positive immunostaining of Notch receptor 1 was detected in 96 cases (87.3%),Notch receptor 2 in 97 (88.2%),Notch receptor 3 in 97 (88.2%),Notch receptor 4 in 103 (93.6),and DLL4 in 84 (76.4%).In addition,coex- istent nuclear localization was noted [Notch receptor 1;18 cases (18.8%),Notch receptor 2;40 (41.2%),Notch receptor 3;32 (33.0%),Notch receptor 4;99 (96.1%),DLL4;48 (57.1%)].Notch receptor 1 expression was correlated with advanced tumor,node,metastasis (TNM) stage (P=0.043),Notch receptor 3 with advanced T stage (P=0.017),tendency to express in cases with nodal metastasis (P=0.065) and advanced TNM stage (P=0.052).DLL4 expression tended to be related to less histological differentiation (P=0.095).Coexistent nuclear localization of Notch receptor 3 was related to no nodal metastasis (P=0.027) and Notch receptor 4 with less histological differentiation (P=0.036),while DLL4 tended to be related inversely with T stage (P=0.053).Coexistent nuclear localization of DLL4 was related to poor survival (P=0.002)展开更多
AIM:To evaluate the noninvasive parameters and hepatic fibrosis scores in obese children with nonalcoholic fatty liver disease(NAFLD).METHODS:A total of 77 children diagnosed with NAFLD via liver biopsy were included ...AIM:To evaluate the noninvasive parameters and hepatic fibrosis scores in obese children with nonalcoholic fatty liver disease(NAFLD).METHODS:A total of 77 children diagnosed with NAFLD via liver biopsy were included and divided into 2 subgroups according to the histopathologic staging of hepatic fibrosis:mild(stage 0-1)vs significant fibrosis(stage 2-4).Clinical and laboratory parameters were evaluated in each patient.The aspartate aminotransferase(AST)/alanine aminotransferase(ALT)ratio,AST/platelet ratio index(APRI),PGA index,Forns index,FIB-4,NAFLD fibrosis score,and pediatric NAFLD fibrosis index(PNFI)were calculated.RESULTS:No clinical or biochemical parameter exhibited a significant difference between patients with mild and significant fibrosis.Among noninvasive hepatic fibrosis scores,only APRI and FIB4 revealed a significant difference between patients with mild and significant fibrosis(APRI:0.67±0.54 vs 0.78±0.38,P=0.032 and FIB4:0.24±0.12 vs 0.31±0.21,P=0.010).The area under the receiving operating characteristic curve of FIB4 was 0.81,followed by Forns index(0.73),APRI(0.70),NAFLD fibrosis score(0.58),AST/ALT ratio(0.53),PGA score(0.45),and PNFI(0.41).CONCLUSION:APRI and FIB4 might be useful noninvasive hepatic fibrosis scores for predicting hepatic fibrosis in children with NAFLD.展开更多
East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithro...East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.展开更多
Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and s...Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.展开更多
AIM: To evaluate the feasibility of a preoperative colonoscopy through a self-expendable metallic stent (SEMS) and to identify the factors that affect complete colonoscopy.
Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods...Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P<0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.展开更多
AIM:To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer. METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and ...AIM:To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer. METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postop-erative clinical course and follow-up data were retro-spectively collected and analyzed for this study. RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival. CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.展开更多
背景尽管肺药物敏感结核(DS-TB)和耐多药结核(MDR-TB)的诊断需要微生物检查证实,但胸部影像学早期识别可疑MDR-TB可以对诊断过程提供指引。本文对文献资料中与MDR-TB相关的放射学征象进行分析。方法于2018年1月29日搜索PubMed数据库,搜...背景尽管肺药物敏感结核(DS-TB)和耐多药结核(MDR-TB)的诊断需要微生物检查证实,但胸部影像学早期识别可疑MDR-TB可以对诊断过程提供指引。本文对文献资料中与MDR-TB相关的放射学征象进行分析。方法于2018年1月29日搜索PubMed数据库,搜索关键字组合为"((extensive drug resistant tuberculosis)OR(multidrug-resistant tuberculosis))AND(CT or radiograph or imaging or X-ray or computed tomography)",并分析了报道DS-TB和MDR-TB放射学征象的英文文献。结果我们发现和分析了与分析目的有充分相关性的17篇文章。我们将报告的肺MDR-TB病例分为四个类别:(1)之前治疗过(继发或获得性)的HIV阴性成人MDRTB;(2)新发(或原发)HIV阴性成人MDR-TB;(3)HIV阳性成人MDR-TB;(4)儿童MDR-TB。肺MDR-TB的常见放射学表现包括:小叶中央小结节、分枝状线征和结节影(树芽征)、斑块或叶实变、空洞和支气管扩张。虽然总体上MDR-TB病例倾向病变更广泛、更容易双侧发病、胸膜受累、支气管扩张,及肺体积缩小;但仅依据这些征象难以作出MDR-TB的鉴别诊断。迄今的文献提示,肺MDR-TB特异性较高的放射学征象是厚壁多发空洞病变(特别是空洞≥3个时),虽然可能其敏感性不高。对于成人HIV阴性患者,与继发MDR-TB一致,新发MDR-TB也往往有较高的空洞病变发生率,估计在70%左右。结论厚壁多发空洞病变是提示MDR-TB诊断最有意义的放射学征象。未来的研究应该细致地量化空洞病变形态特征。展开更多
文摘AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein(AFP) and prothrombin induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ) in chronic hepatitis B(CHB).METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma(HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic(AUROC) curves of PIVKA-Ⅱ, AFP and their combination were calculated and compared.RESULTS: The optimal cutoff values for PIVKA-Ⅱ and AFP were 40 m AU/m L and 10 ng/m L, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-Ⅱ and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-Ⅱ and AFP were not significantly different(0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-Ⅱ was significantly better than that of AFP in patients with cirrhosis(0.870 vs 0.812, P = 0.042). When PIVKA-Ⅱ and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-Ⅱ alone for the differentiation of HCC from nonmalignant CHB(P < 0.05), especially when cirrhosis was present(P < 0.05).CONCLUSION: Serum PIVKA-Ⅱ might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.
基金Supported by A grant from the Ministry of Education and Science Technology,South Korea,No.2010-0002052
文摘Reactive oxygen species （ROS） attack guanine bases in DNA easily and form 8-hydroxydeoxyguanosine （8-OHdG）, which can bind to thymidine rather than cytosine, based on which, the level of 8-OHdG is gen- erally regarded as a biomarker of mutagenesis conse- quent to oxidative stress. For example, higher levels of 8-OHdG are noted in Helicobacter pylori-associated chronic atrophic gastritis as well as gastric cancer. However, we have found that exogenous 8-OHdG can paradoxically reduce ROS production, attenuate the nuclear factor-KB signaling pathway, and ameliorate the expression of proinflammatory mediators such as interleukin （IL）-I, IL-6, cyclo-oxygenase-2, and induc- ible nitric oxide synthase in addition to expression of nicotinamide adenine dinucleotide phosphate oxidase （NOX）-I, NOX organizer-1 and NOX activator-1 in vari- ous conditions of inflammation-based gastrointestinal （GI） diseases including gastritis, inflammatory bowel disease, pancreatitis, and even colitis-associated carci- nogenesis. Our recent finding that exogenous 8-OHdG was very effective in either inflammation-based or oxidative-stress-associated diseases of stress-related mucosal damage has inspired the hope that synthetic 8-OHdG can be a potential candidate for the treatment of inflammation-based GI diseases, as well as the pre- vention of inflammation-associated GI cancer. In this editorial review, the novel fact that exogenous 8-OHdG can be a functional molecule regulating oxidative- stress-induced gastritis through either antagonizing Rac-guanosine triphosphate binding or blocking the signals responsible for gastric inflammatory cascade is introduced.
基金Supported by Research grant from Pharmbio Korea,Co.Ltd.,Seoul,South Korea
文摘AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.
文摘AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria(Hb < 12 g/dL in women and < 13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 g/dL.Vitamin B12 deficiency was defined as serum vitamin B 12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B 12 deficiency was defined as megaloblastic anemia(mean cell volume > 100 fL) with vitamin B 12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12(40.0% vs 22.0%,P = 0.033),24(45.0% vs 25.0%,P = 0.023),36(55.0% vs 28.0%,P = 0.004),and 48 mo(52.0% vs 31.0%,P = 0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery(60.7% vs 31.3%,P = 0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6(35.4% vs 13.3%,P = 0.002),12(45.8% vs 16.8%,P < 0.001),18(52.1% vs 22.3%,P < 0.001),24(60.4% v
文摘The Ni-rich Li[Ni0.6Co0.2Mn0.2]O2 surface has been modified with H3PO4. After coating at 80 ℃, the products were heated further at a moderate temperature of 500 ℃ in air, when the added H3PO4 transformed to Li3PO4 after reacting with residual LiOH and Li2CO3 on the surface. A thin and uniform smooth nanolayer （〈 10 nm） was observed on the surface of Li[Ni0.6Co0.2Mn0.2]O2 as confirmed by transmission electron microscopy （TEM）. Time-of-flight secondary ion mass spectroscopic （ToF-SIMS） data exhibit the presence of LIP＋, LiPO-, and Li2PO2＋ fragments, indicating the formation of the Li3PO4 coating layer on the surface of the Li[Ni0.6Co0.2Mn0.2]O2. As a result, the amounts of residual lithium compounds, such as LiOH and Li2CO3, are significantly reduced. As a consequence, the LigPO4-coated Li[Ni0.6Co0.2Mn0.2]O2 exhibits noticeable improvement in capacity retention and rate capability due to the reduction of residual LiOH and Li2CO3. Further investigation of the extensively cycled electrodes by X-ray diffraction （XRD）, TEM, and ToF-SIMS demonstrated that the LiBPO4 coating layers have multi-functions： Absorption of water in the electrolyte that lowers the HF level, HF scavenging, and protection of the active materials from deleterious side reactions with the electrolyte during extensive cycling, enabling high capacity retention over 1,000 cycles.
文摘Endoscopic submucosal dissection(ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea.However,ESD has technical difficulties and a longer procedure time than conventional endoscopic resection.So it may have a higher risk of complications than conventional endoscopic resection techniques.We,the ESD study group of Korean Society of Gastrointestinal Endoscopy,have experienced many complications,mostly treated by endoscopic or conservative management.Here,we introduce and share our experiences for managementof post ESD complications and review published papers on the topic.
基金Supported by the National Research Foundation of Korea grant funded by the Korea government(Ministry of Science and ICT),No.NRF-2019R1F1A1042156and the Bio&Medical Technology Development Program,No.NRF-2017M3A9E1064784.
文摘BACKGROUND Despite advancements in operative technique and improvements in postoperative managements,postoperative pancreatic fistula(POPF)is a life-threatening complication following pancreatoduodenectomy(PD).There are some reports to predict POPF preoperatively or intraoperatively,but the accuracy of those is questionable.Artificial intelligence(AI)technology is being actively used in the medical field,but few studies have reported applying it to outcomes after PD.AIM To develop a risk prediction platform for POPF using an AI model.METHODS Medical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016.A total of 38 variables were inserted into AI-driven algorithms.The algorithms tested to make the risk prediction platform were random forest(RF)and a neural network(NN)with or without recursive feature elimination(RFE).The median imputation method was used for missing values.The area under the curve(AUC)was calculated to examine the discriminative power of algorithm for POPF prediction.RESULTS The number of POPFs was 221(12.5%)according to the International Study Group of Pancreatic Fistula definition 2016.After median imputation,AUCs using 38 variables were 0.68±0.02 with RF and 0.71±0.02 with NN.The maximal AUC using NN with RFE was 0.74.Sixteen risk factors for POPF were identified by AI algorithm:Pancreatic duct diameter,body mass index,preoperative serum albumin,lipase level,amount of intraoperative fluid infusion,age,platelet count,extrapancreatic location of tumor,combined venous resection,co-existing pancreatitis,neoadjuvant radiotherapy,American Society of Anesthesiologists’score,sex,soft texture of the pancreas,underlying heart disease,and preoperative endoscopic biliary decompression.We developed a web-based POPF prediction platform,and this application is freely available at http://popfrisk.smchbp.org.CONCLUSION This study is the first to predict POPF with multiple risk factors using AI.This platform is reliable(AUC 0.74),so it could be used to select
文摘AIM: To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea. METHODS: AIP was diagnosed by the international consensus diagnostic criteria. The medical records and pathology were retrospectively reviewed and IgG4-positive cells were counted in a high power field (HPF). Type I AIP was defined as a high serum level of IgG4or histological finding. SIN type 1 AIP was defined as a histological evidence of type 1 AIP and a normal serum IgG4 level. The clinical and pathological findings were compared between the two groups. The analysis was performed using Student's t test, Fischer's exact test and Mann-Whitney's U test. A P value of < 0.05 was considered statistically significant. As repeated com- parison was made, P values of less than 5% (P < 0.05) were considered significant. RESULTS: Twenty five patients with definite type 1 AIP (19 histologically and six serologically diagnosed cases) were enrolled. The mean tissue IgG4 concentrations were significantly higher in SIP than SIN group (40 cells per HPF vs 18 cells per HPF, P = 0.02). Among eight SIN patients, the tissue IgG4 concentrations were less than 15 cells per HPF in most of cases, except one. The sensitivity of serum IgG4 was 68% (17 SIP and eight SIN AIP). Other organ involvement was more frequent- ly associated with SIP than SIN AIP (59% vs 26%, P = 0.016). However, the relapse rate and diffuse swelling of the pancreas were not associated with serum IgG4 level. The concentrations of IgG4-positive cells per HPF were higher in SIP than SIN AIP (40 vs 18, P = 0.02). CONCLUSION: The sensitivity of serum IgG4 was 68% in type 1 AIP. High serum IgG4 level was associated with other organ involvement and tissue IgG4 concentration but did not affect the relapse rate in type 1 AIP.
基金Supported by the 2004 Research Fund of Wonkwang University
文摘AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease （GERD） makes it interesting to examine the effect of itopride on esophageal acid exposure.METHODS： The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time （pH〈4） of more than 5% and mild esophagitis （SavaryMiller grades I, II） proven by endoscopy. Ambulatory 24hpH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day （t.i.d.） for 30 d in random order, using an open label method.For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment.RESULTS： Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300 mg was significantly effective than 150 mg on decreasing the total per cent time with pH〈4, total time with pH〈4 and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups.CONCLUSION： Itopride 100 mg t.i.d, is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.
文摘AIM:To investigate the role and clinicopathological significance of aberrant expression of Notch receptors and Delta-like ligand-4 (DLL4) in extrahepatic cholangiocarcinoma and gallbladder carcinoma.METHODS:One hundred and ten patients had surgically resected extrahepatic cholangiocarcinoma (CC) and gallbladder carcinoma specimens examined by immunohistochemistry of available paraffin blocks.Immunohistochemistry was performed using anti-Notch receptors 1-4 and anti-DLL4 antibodies.We scored the immunopositivity of Notch receptors and DLL4 expression by percentage of positive tumor cells with cytoplasmic expression and intensity of immunostaining.Coexistent nuclear localization was evaluated.Clinicopatho-logical parameters and survival data were compared with the expression of Notch receptors 1-4 and DLL4.RESULTS:Notch receptor proteins showed in the cytoplasm with or without nuclear expression in cancer cells,as well as showing weak cytoplasmic expression in non-neoplastic cells.By semiquantitative evaluation,positive immunostaining of Notch receptor 1 was detected in 96 cases (87.3%),Notch receptor 2 in 97 (88.2%),Notch receptor 3 in 97 (88.2%),Notch receptor 4 in 103 (93.6),and DLL4 in 84 (76.4%).In addition,coex- istent nuclear localization was noted [Notch receptor 1;18 cases (18.8%),Notch receptor 2;40 (41.2%),Notch receptor 3;32 (33.0%),Notch receptor 4;99 (96.1%),DLL4;48 (57.1%)].Notch receptor 1 expression was correlated with advanced tumor,node,metastasis (TNM) stage (P=0.043),Notch receptor 3 with advanced T stage (P=0.017),tendency to express in cases with nodal metastasis (P=0.065) and advanced TNM stage (P=0.052).DLL4 expression tended to be related to less histological differentiation (P=0.095).Coexistent nuclear localization of Notch receptor 3 was related to no nodal metastasis (P=0.027) and Notch receptor 4 with less histological differentiation (P=0.036),while DLL4 tended to be related inversely with T stage (P=0.053).Coexistent nuclear localization of DLL4 was related to poor survival (P=0.002)
文摘AIM:To evaluate the noninvasive parameters and hepatic fibrosis scores in obese children with nonalcoholic fatty liver disease(NAFLD).METHODS:A total of 77 children diagnosed with NAFLD via liver biopsy were included and divided into 2 subgroups according to the histopathologic staging of hepatic fibrosis:mild(stage 0-1)vs significant fibrosis(stage 2-4).Clinical and laboratory parameters were evaluated in each patient.The aspartate aminotransferase(AST)/alanine aminotransferase(ALT)ratio,AST/platelet ratio index(APRI),PGA index,Forns index,FIB-4,NAFLD fibrosis score,and pediatric NAFLD fibrosis index(PNFI)were calculated.RESULTS:No clinical or biochemical parameter exhibited a significant difference between patients with mild and significant fibrosis.Among noninvasive hepatic fibrosis scores,only APRI and FIB4 revealed a significant difference between patients with mild and significant fibrosis(APRI:0.67±0.54 vs 0.78±0.38,P=0.032 and FIB4:0.24±0.12 vs 0.31±0.21,P=0.010).The area under the receiving operating characteristic curve of FIB4 was 0.81,followed by Forns index(0.73),APRI(0.70),NAFLD fibrosis score(0.58),AST/ALT ratio(0.53),PGA score(0.45),and PNFI(0.41).CONCLUSION:APRI and FIB4 might be useful noninvasive hepatic fibrosis scores for predicting hepatic fibrosis in children with NAFLD.
基金partly supported by the National Research Foundation (NRF) Republic of Korea (NRF-2015R1A5A2008833)
文摘East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.
文摘Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.
基金Supported by Catholic Research Coordinating Center of the Korea Health 21 RD Project,Ministry of Health and Welfare,South Korea,No.A070001
文摘AIM: To evaluate the feasibility of a preoperative colonoscopy through a self-expendable metallic stent (SEMS) and to identify the factors that affect complete colonoscopy.
文摘Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P<0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.
文摘AIM:To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer. METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postop-erative clinical course and follow-up data were retro-spectively collected and analyzed for this study. RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival. CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.
基金美国National Institute of Allergy and Infectious Diseases,National Institutes of Healt支持中国TB门户网Gran援助计划/FOCUS(OISE-17-63315-1)深圳市海外高层次人才创新创业专项基金资助(KQTD2017033110081833)
文摘背景尽管肺药物敏感结核(DS-TB)和耐多药结核(MDR-TB)的诊断需要微生物检查证实,但胸部影像学早期识别可疑MDR-TB可以对诊断过程提供指引。本文对文献资料中与MDR-TB相关的放射学征象进行分析。方法于2018年1月29日搜索PubMed数据库,搜索关键字组合为"((extensive drug resistant tuberculosis)OR(multidrug-resistant tuberculosis))AND(CT or radiograph or imaging or X-ray or computed tomography)",并分析了报道DS-TB和MDR-TB放射学征象的英文文献。结果我们发现和分析了与分析目的有充分相关性的17篇文章。我们将报告的肺MDR-TB病例分为四个类别:(1)之前治疗过(继发或获得性)的HIV阴性成人MDRTB;(2)新发(或原发)HIV阴性成人MDR-TB;(3)HIV阳性成人MDR-TB;(4)儿童MDR-TB。肺MDR-TB的常见放射学表现包括:小叶中央小结节、分枝状线征和结节影(树芽征)、斑块或叶实变、空洞和支气管扩张。虽然总体上MDR-TB病例倾向病变更广泛、更容易双侧发病、胸膜受累、支气管扩张,及肺体积缩小;但仅依据这些征象难以作出MDR-TB的鉴别诊断。迄今的文献提示,肺MDR-TB特异性较高的放射学征象是厚壁多发空洞病变(特别是空洞≥3个时),虽然可能其敏感性不高。对于成人HIV阴性患者,与继发MDR-TB一致,新发MDR-TB也往往有较高的空洞病变发生率,估计在70%左右。结论厚壁多发空洞病变是提示MDR-TB诊断最有意义的放射学征象。未来的研究应该细致地量化空洞病变形态特征。
