Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Rece...Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Recently,emerging evidence has suggested that UC presents complications in esophageal,stomachic,and duodenal mucosal injuries.However,UC-related UGI tract manifestations are varied and frequently silenced or concealed.Moreover,the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific.Therefore,UGI involvement may be ignored by many clinicians.In addition,no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy.Furthermore,specific treatment recommendations may be needed for patients with UC-associated UGI lesions.Herein,we review the esophageal,gastric,and duodenal mucosal lesions of the UC-associated UGI tract,as well as the potential pathogenesis and therapy.展开更多
Beh?et's disease(BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in cou...Beh?et's disease(BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in countries along the ancient silk road from the Mediterranean basin to East Asia. By comparison, the prevalence in North American and Northern European countries is low. Gastrointestinal manifestations of Beh?et's disease are of particular importance as they are associated with significant morbidity and mortality. Although ileocecal involvement is most commonly described, BD may involve any segment of the intestinal tract as well as the various organs within the gastrointestinal system. Diagnosis is based on clinical criteria- there are no pathognomonic laboratory tests. Methods for monitoring disease activity on therapy are available but imperfect. Evidence-based treatment strategies are lacking. Different classes of medications have been successfully used for the treatment of intestinal BD which include 5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody therapy. Like inflammatory bowel disease, surgery is reserved for those who are resistant to medical therapy. A subset of patients have a poor disease course. Accurate methods to detect these patients and the optimal strategy for their treatment are not known at this time.展开更多
Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at...Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.展开更多
Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore th...Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy(RNU),a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center(West China Hospital,Chengdu,China)were included in this study.Kaplan-Meier method and Cox regressi on an a lyses were performed to assess the relationship betwee n Cys-C and survival outcomes using SPSS versi on 22.0.The cutoff value of Cys-C was set as 1.4 mg I1 using the receiver operating characteristic(ROC)curves and Youden index.The mean age of patients included was 66.1±11.1 years,and the media n follow-up durati on was 38(interquartile ran ge:19-56)mon ths.Overall,162(30.1%)patients had elevated Cys-C,and they were much older and had worse renal function than those with Cys-C<1.4 mg I^-1(both P<0.001).Meanwhile,Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival(CSS,P=0.001),disease recurrence-free survival(RFS,P=0.003),and overall survival(OS,P<0.001).Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS(hazard ratio[HR]:1.997,95%confidential interval[CI]:1.331-2.996),RFS(HR:1.429,95%CI:1.009-2.023),and OS(HR:1.989,95%CI:1.366-2.896).In conclusion,our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.展开更多
Introduction: Urogenital fistula is the existence of an abnormal pathway between a urinary organ and a genital organ. It is a public health problem because of its frequency and social aspect. The aim of this study was...Introduction: Urogenital fistula is the existence of an abnormal pathway between a urinary organ and a genital organ. It is a public health problem because of its frequency and social aspect. The aim of this study was to analyse the management of urogenital fistulas by the upper route at the National Fistula Treatment Centre in N’Djamena. Material and Methods: This was a 10-year retrospective descriptive and analytical study from May 2011 to April 2021. The records of all patients who had received fistula treatment during this period were identified and analysed. Results: During the study period 2369 patients were managed for cure of urogenital fistula including 84 by the upper route, i.e. 3.5%. The mean age was 28.5 ± 8.13 years. Loss of urine was the most common reason for consultation (71.4%). Primigravida were represented in 50% (n = 42). The average gestational age was 3.2 ± 2.8 with extremes of 0 to 9 pregnancies. Obstetric aetiology was the most common (92.8%). Ureterovaginal fistulas were the most common anatomoclinical type (36.9%). Uretero-vesical reimplantation was the main surgical procedure (41.7%). Late postoperative follow-up was successful in 85.7% of cases. Conclusion: Urogenital fistulas are common in our practice. The only way to combat this scourge is through prevention through information, education and communication.展开更多
OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the ...OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the guidance of evidence-based medicine concept,in strict accordance with the rules of international s development,as well as on the basis of evidence of clinical research of TCM,the s solicited opinions from clinical experts and methodologists in TCM and Western Medicine.GRADE standard was applied to form experts' consensus.RESULTS:The s standardized classification of TCM patterns and TCM treatments in children with AURI,including prescription,Chinese patent medicine,non-drug treatment and prevention.CONCLUSION:Follows the principle of "evidence based,consensus supplemented,and experience referred",these s were formulated,but the quality of evidence of included studies were relatively low.Further refinement of the s should be needed as deeper clinical studies as available in future.展开更多
AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypot...AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases,pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. RESULTS:Of the 59 cases,esophageal MPC (EMPC) was seen in 24,esophageal and gastric MPC (EGMPC) in 27 and gastric MPC (GMPC) in 8. Of the 49 lesions found in 24 EMPC,hyperplastic type was seen in 23,medullary type in 9. The lesions were located at the upper (n = 17),middle (n = 19) or lower (n = 13) segment of the esophagus. In 27 EGMPC,the esophageal lesions were located at the middle (n = 16) or lower (n = 11) segment of the esophagus,while the gastric le-sions were located at the gastric cardia (n = 16),fundus (n = 1),body (n = 3) and antrum (n = 7). The esophageal lesions were mainly of the hyperplastic type (n = 12) or medullary type (n = 7),while the gastric lesions were mainly of the hyperplastic type (n = 18). A total of 119 lesions in the 59 patients with synchronous multiple carcinoma were proved by surgery or endoscopy biopsy,and preoperative upper radiographic examination detected 100 of them (84.03% sensitivity). Eighteen (52.94%) of the T1 lesions were found during preoperative diagnosis by radiographic examination. Moreover,only 3 (3.53%) of the T2-4 lesions were misdiagnosed. CONCLUSION:Hypotonic double-contrast upper gastrointestinal examination,providing accurate information about lesion morphology,location and size,can serve as a sensitive technique for the preoperative diagnosis of MPC.展开更多
Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen,avoiding perforation and reducing gastrointestinal f...Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen,avoiding perforation and reducing gastrointestinal fistulae.They are becoming more widely used in clinical practice,but,they may also present a variety of complications.Gas-related complications are one of the most common,which can be left untreated if the symptoms are mild,but in severe cases,they can lead to rapid changes in the respiratory and circulatory systems in a short period,which can be life-threatening.Therefore,it is important to predict the occurrence of gas-related complications early and take preventive measures actively.Based on the authors'results in the prepublication of the article“Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions,”and in conjunction with our evaluation and additions to the relevant content,radiographs may help screen patients at high risk for gas-related complications.Controlling blood glucose levels,shortening the duration of surgery,and choosing the most appropriate surgical resection may positively impact the prognosis of patients at high risk for gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions.展开更多
BACKGROUND Upper tract urothelial carcinoma(UTUC)representing only a small fraction of all urothelial tumors.It predominantly affects the renal pelvis in men,often coexisting with bladder carcinoma.UTUC displays a mor...BACKGROUND Upper tract urothelial carcinoma(UTUC)representing only a small fraction of all urothelial tumors.It predominantly affects the renal pelvis in men,often coexisting with bladder carcinoma.UTUC displays a more aggressive genetic profile compared to bladder neoplasms,with the majority of patients presenting with advanced disease.Histologically,about a quarter of UTUC cases exhibit high-grade subtypes,associated with a worse prognosis.Tobacco use and past exposure to aromatic amines are significant risk factors for UTUC.Imaging modalities such as Uro-computed tomography and magnetic resonance imaging play crucial roles in diagnosis.Ureterorenoscopy is vital for direct visualization and biopsy sampling,but its limited sampling capacity presents challenges in determining tumor depth and staging.Traditionally,nephroureterectomy with bladder cuff excision has been the gold-standard treatment for UTUC.Endoscopic conservative treatment has recently emerged as a viable option for selected patients,offering comparable oncological outcomes to radical surgery.Percutaneous access is also feasible for larger intrarenal tumors.CASE SUMMARY We present a case of an 84-year-old woman who underwent percutaneous endoscopic excision of a renal pelvis neoplasm using the Tullio laser.Despite successful tumor removal,the patient experienced a postoperative complication with abdominal fluid leakage.Conservative management effectively resolved the complication.Given the patient's age and refusal for radical surgery,the conservative approach proved to be a valid therapeutic choice.CONCLUSION Overall,UTUC remains a diagnostic and therapeutic challenge due to its rarity.However,advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients,warranting further exploration in this evolving field.展开更多
Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of H...Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of HAdV-7-infected patients with pneumonia or upper respiratory tract infection(URTI)were explored.Methods In total,35 patients were enrolled in the study following an outbreak of HAdV-7 in the army,of whom 14 had pneumonia and 21 had URTI.Blood samples were collected at the acute stage and at the recovery stage and were analyzed by untargeted metabolomics.Results Over 90% of the differential metabolites identified between the pneumonia patients and URTI patients were lipids and lipid-like molecules,including glycerophospholipids,fatty acyls,and sphingolipids.The metabolic pathways that were significantly enriched were primarily the lipid metabolism pathways,including sphingolipid metabolism,glycerophospholipid metabolism,and linoleic acid metabolism.The sphingolipid metabolism was identified as a significantly differential pathway between the pneumonia patients and URTI patients and between the acute and recovery stages for the pneumonia patients,but not between the acute and recovery stages for the URTI patients.Ceramide and lactosylceramide,involved in sphingolipid metabolism,were significantly higher in the pneumonia patients than in the URTI patients with good discrimination abilities[area under curve(AUC)0.742 and 0.716,respectively;combination AUC 0.801].Conclusion Our results suggested that HAdV modulated lipid metabolism for both the patients with URTI and pneumonia,especially the sphingolipid metabolism involving ceramide and lactosylceramide,which might thus be a potential intervention target in the treatment of HAdV infection.展开更多
Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for t...Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.展开更多
The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation reve...The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation revealed an eccentric,soft esophageal lesionlocated 25-35 cm from the incisors,which appeared asa protrusion of the esophagus wall,with active bleeding. Biopsies were acquired. Tissue evaluation wascompatible with a melanoma. After excluding other sites of primary neoplasm,the definitive diagnosis of Primary Malignant Melanoma of the Esophagus(PMME) was made. The patient developed a hospital-acquired respiratory infection and died before tumor-directed treatment could begin. Primary malignant melanoma represents only 0.1% to 0.2% of all esophageal ma-lignant tumors. Risk factors for PMME are not defined.A higher incidence of PMME has been described in Japan. Dysphagia,predominantly for solids,is the most frequent symptom at presentation. Retrosternal orepigastric discom fort or pain,melena or hemate mesishave also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion,with variablesize,usually pigmented. The neoplasm occurs in thelower two-thirds of the esophagus in 86% of cases.PMME metastasizes via hematogenic and lymphatic pathways. At diagnosis,50% of the patients present with distant metastases to the liver,the mediastinum,the lungs and the brain. When possible,surgery(curative or palliative) ,is the preferential method of treatment. There are some reports in the literature where chemotherapy,chemohormon otherapy,radiotherapy and immunotherapy,with or without surgery,wereused with variable efficacy. The prognosis is poor;themean survival after surgery is less than 15 mo.展开更多
Helicobacter pylori(H. pylori) is a major cause of chronic gastritis and gastric ulcers and considerable evidence supports the notion that infection with this bacterium is also associated with gastric malignancy in ad...Helicobacter pylori(H. pylori) is a major cause of chronic gastritis and gastric ulcers and considerable evidence supports the notion that infection with this bacterium is also associated with gastric malignancy in addition to various other conditions including pulmonary, vascular and autoimmune disorders. Gastric juice infected with H. pylori might play an important role in upper respiratory tract infection. Although direct and/or indirect mechanisms might be involved in the association between H. pylori and upper respiratory tract diseases, the etiological role of H. pylori in upper respiratory tract disorders has not yet been fully elucidated. Although various studies over the past two decades have suggested a relationship between H. pylori and upper respiratory tract diseases, the findings are inconsistent. The present overview describes the outcomes of recent investigations into the impact of H. pylori on upper respiratory tract and adjacent lesions.展开更多
Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma(UTUC).Current guidelines and expert opinions propose some exceptions to this approach based on patient c...Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma(UTUC).Current guidelines and expert opinions propose some exceptions to this approach based on patient characteristics,disease status,and function of the contralateral kidney.We present a rare case of a patient with horseshoe kidney,bilateral large nephrolithiasis,high-grade UTUC in one moiety,and relative parenchymal thinning of the contralateral side.The patient was treated with a percutaneous,minimally invasive,nephron sparing approach.The patient also had intracollecting system instillations of gemcitabine and docetaxel.Minimally invasive percutaneous resection of high-grade UTUC is a safe procedure in select cases.Current guidelines may not apply to all patients;unique scenarios with UTUC may require personalized decision-making and treatment at specialized centers.展开更多
Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression rate.The standardmanagement for this disease is nephroureterectomy.Nephron sparing nonradical surgery is an alternative...Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression rate.The standardmanagement for this disease is nephroureterectomy.Nephron sparing nonradical surgery is an alternative therapeutic approach.In men with limited life expectancy,the potential harm of UTUC progression must be weighed against surgical morbidity and mortality,and thus,more conservative approaches may be selected.This study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized UTUC.Materials and methods A search was conducted in the Surveillance,Epidemiology,and End Results database for patients older than 80 years who were diagnosed with localized(T1–2N0M0)cancer in the renal pelvis or ureter as the only malignancy from 2004 to 2015.Patients were divided into 3 therapeutic groups:no surgery,local intervention(ie,local tumor excision or segmented ureterectomy),and radical surgery(nephroureterectomy).Demographic and cancer-related parameter data were collected.Logistic regression analysis was conducted to investigate predictors for surgical treatment.Kaplan-Meier curves and Cox regression were used to analyze survival outcomes.Results Data from 774 patients were analyzed,including 205 in the no-surgery group,181 in the local intervention group,and 388 in the radical surgery group.Older,African American patients with T1 stage disease were less likely to receive surgical treatment.Among surgically treated patients,renal pelvic tumors,and high-grade and T2 stage disease were associated with radical resection.Surgically treated patients had a longer median overall survival(OS)than in those treated nonsurgically(13,35,and 47 months in no-surgery,local intervention,and radical surgery groups,respectively;p<0.001).Although surgically treated patients demonstrated higher 5-year OS(8.8%[no surgery],23.2%[local intervention],and 23.5%[radical surgery],p<0.001)and 5-year disease-specific survival(DSS)(41.0%[no surgery],69.1%[local展开更多
Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper...Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper urinary tract-LELC cases which provided insight into this disease;however,the current evidence does not provide clinicians with clear guidelines due to its rarity.Therefore,the aim was to report a new case of renal pelvis LELC presented in our hospital.In this instance,we were able to report treatment experience and longterm follow-up results.This patient presented with hypertension and haemturia which initiated further investigation.While ultrasound identified an hypechoic mass,no malignant cells were detected using cytological testing.Abdominal magnetic resonance imaging identified a slightly enhanced mass in the left renal pelvis with no evidence of lymph node metastasis.Ureteroscopic tumor biopsy suggested the existence of urothelial carcinoma,hence,laparoscopic radical left nephroureterectomy with bladder cuff excision was performed.Through patientpractitioner consultations,we decided to adopt a"watch and wait"approach after radical nephroureterectomy rather than administering chemotherapy.Although,we would encourage clinicians to record and publish cases to garner insight into this type of malignant disease.展开更多
文摘Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Recently,emerging evidence has suggested that UC presents complications in esophageal,stomachic,and duodenal mucosal injuries.However,UC-related UGI tract manifestations are varied and frequently silenced or concealed.Moreover,the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific.Therefore,UGI involvement may be ignored by many clinicians.In addition,no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy.Furthermore,specific treatment recommendations may be needed for patients with UC-associated UGI lesions.Herein,we review the esophageal,gastric,and duodenal mucosal lesions of the UC-associated UGI tract,as well as the potential pathogenesis and therapy.
文摘Beh?et's disease(BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in countries along the ancient silk road from the Mediterranean basin to East Asia. By comparison, the prevalence in North American and Northern European countries is low. Gastrointestinal manifestations of Beh?et's disease are of particular importance as they are associated with significant morbidity and mortality. Although ileocecal involvement is most commonly described, BD may involve any segment of the intestinal tract as well as the various organs within the gastrointestinal system. Diagnosis is based on clinical criteria- there are no pathognomonic laboratory tests. Methods for monitoring disease activity on therapy are available but imperfect. Evidence-based treatment strategies are lacking. Different classes of medications have been successfully used for the treatment of intestinal BD which include 5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody therapy. Like inflammatory bowel disease, surgery is reserved for those who are resistant to medical therapy. A subset of patients have a poor disease course. Accurate methods to detect these patients and the optimal strategy for their treatment are not known at this time.
文摘Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
基金the National Key Research and Development Program of China(Grant No.SQ2017YFSF090096)the Prostate Cancer Foundation Young Investigator Award 2013,the National Natural Science Foundation of China(Grant No.81300627,81370855,81702536,and 81770756)+1 种基金the Science and Technology Department of Sichuan Province(Grant No.2014JY0219 and 2017HH0063)Young Investigator Award of Sichuan University 2017.The funders had no role in patient selection,data extraction,statistical analysis or interpretation,writing of this article,or the decision to publish.
文摘Cystatin-C(Cys-C)has been reported as a valuable prognostic biomarker in various malignancies.However,its effect on upper tract urothelial carci noma(UTUC)patie nts has not bee n investigated before.Thus,to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy(RNU),a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center(West China Hospital,Chengdu,China)were included in this study.Kaplan-Meier method and Cox regressi on an a lyses were performed to assess the relationship betwee n Cys-C and survival outcomes using SPSS versi on 22.0.The cutoff value of Cys-C was set as 1.4 mg I1 using the receiver operating characteristic(ROC)curves and Youden index.The mean age of patients included was 66.1±11.1 years,and the media n follow-up durati on was 38(interquartile ran ge:19-56)mon ths.Overall,162(30.1%)patients had elevated Cys-C,and they were much older and had worse renal function than those with Cys-C<1.4 mg I^-1(both P<0.001).Meanwhile,Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival(CSS,P=0.001),disease recurrence-free survival(RFS,P=0.003),and overall survival(OS,P<0.001).Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS(hazard ratio[HR]:1.997,95%confidential interval[CI]:1.331-2.996),RFS(HR:1.429,95%CI:1.009-2.023),and OS(HR:1.989,95%CI:1.366-2.896).In conclusion,our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.
文摘Introduction: Urogenital fistula is the existence of an abnormal pathway between a urinary organ and a genital organ. It is a public health problem because of its frequency and social aspect. The aim of this study was to analyse the management of urogenital fistulas by the upper route at the National Fistula Treatment Centre in N’Djamena. Material and Methods: This was a 10-year retrospective descriptive and analytical study from May 2011 to April 2021. The records of all patients who had received fistula treatment during this period were identified and analysed. Results: During the study period 2369 patients were managed for cure of urogenital fistula including 84 by the upper route, i.e. 3.5%. The mean age was 28.5 ± 8.13 years. Loss of urine was the most common reason for consultation (71.4%). Primigravida were represented in 50% (n = 42). The average gestational age was 3.2 ± 2.8 with extremes of 0 to 9 pregnancies. Obstetric aetiology was the most common (92.8%). Ureterovaginal fistulas were the most common anatomoclinical type (36.9%). Uretero-vesical reimplantation was the main surgical procedure (41.7%). Late postoperative follow-up was successful in 85.7% of cases. Conclusion: Urogenital fistulas are common in our practice. The only way to combat this scourge is through prevention through information, education and communication.
文摘OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the guidance of evidence-based medicine concept,in strict accordance with the rules of international s development,as well as on the basis of evidence of clinical research of TCM,the s solicited opinions from clinical experts and methodologists in TCM and Western Medicine.GRADE standard was applied to form experts' consensus.RESULTS:The s standardized classification of TCM patterns and TCM treatments in children with AURI,including prescription,Chinese patent medicine,non-drug treatment and prevention.CONCLUSION:Follows the principle of "evidence based,consensus supplemented,and experience referred",these s were formulated,but the quality of evidence of included studies were relatively low.Further refinement of the s should be needed as deeper clinical studies as available in future.
基金Supported by Henan Province Outstanding Youth Program funded projects, No. 084100510020
文摘AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases,pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. RESULTS:Of the 59 cases,esophageal MPC (EMPC) was seen in 24,esophageal and gastric MPC (EGMPC) in 27 and gastric MPC (GMPC) in 8. Of the 49 lesions found in 24 EMPC,hyperplastic type was seen in 23,medullary type in 9. The lesions were located at the upper (n = 17),middle (n = 19) or lower (n = 13) segment of the esophagus. In 27 EGMPC,the esophageal lesions were located at the middle (n = 16) or lower (n = 11) segment of the esophagus,while the gastric le-sions were located at the gastric cardia (n = 16),fundus (n = 1),body (n = 3) and antrum (n = 7). The esophageal lesions were mainly of the hyperplastic type (n = 12) or medullary type (n = 7),while the gastric lesions were mainly of the hyperplastic type (n = 18). A total of 119 lesions in the 59 patients with synchronous multiple carcinoma were proved by surgery or endoscopy biopsy,and preoperative upper radiographic examination detected 100 of them (84.03% sensitivity). Eighteen (52.94%) of the T1 lesions were found during preoperative diagnosis by radiographic examination. Moreover,only 3 (3.53%) of the T2-4 lesions were misdiagnosed. CONCLUSION:Hypotonic double-contrast upper gastrointestinal examination,providing accurate information about lesion morphology,location and size,can serve as a sensitive technique for the preoperative diagnosis of MPC.
文摘Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen,avoiding perforation and reducing gastrointestinal fistulae.They are becoming more widely used in clinical practice,but,they may also present a variety of complications.Gas-related complications are one of the most common,which can be left untreated if the symptoms are mild,but in severe cases,they can lead to rapid changes in the respiratory and circulatory systems in a short period,which can be life-threatening.Therefore,it is important to predict the occurrence of gas-related complications early and take preventive measures actively.Based on the authors'results in the prepublication of the article“Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions,”and in conjunction with our evaluation and additions to the relevant content,radiographs may help screen patients at high risk for gas-related complications.Controlling blood glucose levels,shortening the duration of surgery,and choosing the most appropriate surgical resection may positively impact the prognosis of patients at high risk for gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions.
文摘BACKGROUND Upper tract urothelial carcinoma(UTUC)representing only a small fraction of all urothelial tumors.It predominantly affects the renal pelvis in men,often coexisting with bladder carcinoma.UTUC displays a more aggressive genetic profile compared to bladder neoplasms,with the majority of patients presenting with advanced disease.Histologically,about a quarter of UTUC cases exhibit high-grade subtypes,associated with a worse prognosis.Tobacco use and past exposure to aromatic amines are significant risk factors for UTUC.Imaging modalities such as Uro-computed tomography and magnetic resonance imaging play crucial roles in diagnosis.Ureterorenoscopy is vital for direct visualization and biopsy sampling,but its limited sampling capacity presents challenges in determining tumor depth and staging.Traditionally,nephroureterectomy with bladder cuff excision has been the gold-standard treatment for UTUC.Endoscopic conservative treatment has recently emerged as a viable option for selected patients,offering comparable oncological outcomes to radical surgery.Percutaneous access is also feasible for larger intrarenal tumors.CASE SUMMARY We present a case of an 84-year-old woman who underwent percutaneous endoscopic excision of a renal pelvis neoplasm using the Tullio laser.Despite successful tumor removal,the patient experienced a postoperative complication with abdominal fluid leakage.Conservative management effectively resolved the complication.Given the patient's age and refusal for radical surgery,the conservative approach proved to be a valid therapeutic choice.CONCLUSION Overall,UTUC remains a diagnostic and therapeutic challenge due to its rarity.However,advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients,warranting further exploration in this evolving field.
基金supported by the National Natural Science Foundation of China(No.82073617)Joint Research Fund for Beijing Natural Science Foundation and Haidian Original Innovation(No.L202007)+1 种基金Fundamental Research Funds for the Central Universities and Peking University Health Science Center(No.BMU2021YJ041)Peking University Medicine Fund of Fostering Young Scholars'Scientific&Technological Innovation(No.BMU2021PY005).
文摘Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of HAdV-7-infected patients with pneumonia or upper respiratory tract infection(URTI)were explored.Methods In total,35 patients were enrolled in the study following an outbreak of HAdV-7 in the army,of whom 14 had pneumonia and 21 had URTI.Blood samples were collected at the acute stage and at the recovery stage and were analyzed by untargeted metabolomics.Results Over 90% of the differential metabolites identified between the pneumonia patients and URTI patients were lipids and lipid-like molecules,including glycerophospholipids,fatty acyls,and sphingolipids.The metabolic pathways that were significantly enriched were primarily the lipid metabolism pathways,including sphingolipid metabolism,glycerophospholipid metabolism,and linoleic acid metabolism.The sphingolipid metabolism was identified as a significantly differential pathway between the pneumonia patients and URTI patients and between the acute and recovery stages for the pneumonia patients,but not between the acute and recovery stages for the URTI patients.Ceramide and lactosylceramide,involved in sphingolipid metabolism,were significantly higher in the pneumonia patients than in the URTI patients with good discrimination abilities[area under curve(AUC)0.742 and 0.716,respectively;combination AUC 0.801].Conclusion Our results suggested that HAdV modulated lipid metabolism for both the patients with URTI and pneumonia,especially the sphingolipid metabolism involving ceramide and lactosylceramide,which might thus be a potential intervention target in the treatment of HAdV infection.
文摘Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.
文摘The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation revealed an eccentric,soft esophageal lesionlocated 25-35 cm from the incisors,which appeared asa protrusion of the esophagus wall,with active bleeding. Biopsies were acquired. Tissue evaluation wascompatible with a melanoma. After excluding other sites of primary neoplasm,the definitive diagnosis of Primary Malignant Melanoma of the Esophagus(PMME) was made. The patient developed a hospital-acquired respiratory infection and died before tumor-directed treatment could begin. Primary malignant melanoma represents only 0.1% to 0.2% of all esophageal ma-lignant tumors. Risk factors for PMME are not defined.A higher incidence of PMME has been described in Japan. Dysphagia,predominantly for solids,is the most frequent symptom at presentation. Retrosternal orepigastric discom fort or pain,melena or hemate mesishave also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion,with variablesize,usually pigmented. The neoplasm occurs in thelower two-thirds of the esophagus in 86% of cases.PMME metastasizes via hematogenic and lymphatic pathways. At diagnosis,50% of the patients present with distant metastases to the liver,the mediastinum,the lungs and the brain. When possible,surgery(curative or palliative) ,is the preferential method of treatment. There are some reports in the literature where chemotherapy,chemohormon otherapy,radiotherapy and immunotherapy,with or without surgery,wereused with variable efficacy. The prognosis is poor;themean survival after surgery is less than 15 mo.
基金Supported by JSPS KAKENHI(Grants-in-Aid for Scientific Research),No.23791900 and No.25462642
文摘Helicobacter pylori(H. pylori) is a major cause of chronic gastritis and gastric ulcers and considerable evidence supports the notion that infection with this bacterium is also associated with gastric malignancy in addition to various other conditions including pulmonary, vascular and autoimmune disorders. Gastric juice infected with H. pylori might play an important role in upper respiratory tract infection. Although direct and/or indirect mechanisms might be involved in the association between H. pylori and upper respiratory tract diseases, the etiological role of H. pylori in upper respiratory tract disorders has not yet been fully elucidated. Although various studies over the past two decades have suggested a relationship between H. pylori and upper respiratory tract diseases, the findings are inconsistent. The present overview describes the outcomes of recent investigations into the impact of H. pylori on upper respiratory tract and adjacent lesions.
文摘Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma(UTUC).Current guidelines and expert opinions propose some exceptions to this approach based on patient characteristics,disease status,and function of the contralateral kidney.We present a rare case of a patient with horseshoe kidney,bilateral large nephrolithiasis,high-grade UTUC in one moiety,and relative parenchymal thinning of the contralateral side.The patient was treated with a percutaneous,minimally invasive,nephron sparing approach.The patient also had intracollecting system instillations of gemcitabine and docetaxel.Minimally invasive percutaneous resection of high-grade UTUC is a safe procedure in select cases.Current guidelines may not apply to all patients;unique scenarios with UTUC may require personalized decision-making and treatment at specialized centers.
文摘Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression rate.The standardmanagement for this disease is nephroureterectomy.Nephron sparing nonradical surgery is an alternative therapeutic approach.In men with limited life expectancy,the potential harm of UTUC progression must be weighed against surgical morbidity and mortality,and thus,more conservative approaches may be selected.This study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized UTUC.Materials and methods A search was conducted in the Surveillance,Epidemiology,and End Results database for patients older than 80 years who were diagnosed with localized(T1–2N0M0)cancer in the renal pelvis or ureter as the only malignancy from 2004 to 2015.Patients were divided into 3 therapeutic groups:no surgery,local intervention(ie,local tumor excision or segmented ureterectomy),and radical surgery(nephroureterectomy).Demographic and cancer-related parameter data were collected.Logistic regression analysis was conducted to investigate predictors for surgical treatment.Kaplan-Meier curves and Cox regression were used to analyze survival outcomes.Results Data from 774 patients were analyzed,including 205 in the no-surgery group,181 in the local intervention group,and 388 in the radical surgery group.Older,African American patients with T1 stage disease were less likely to receive surgical treatment.Among surgically treated patients,renal pelvic tumors,and high-grade and T2 stage disease were associated with radical resection.Surgically treated patients had a longer median overall survival(OS)than in those treated nonsurgically(13,35,and 47 months in no-surgery,local intervention,and radical surgery groups,respectively;p<0.001).Although surgically treated patients demonstrated higher 5-year OS(8.8%[no surgery],23.2%[local intervention],and 23.5%[radical surgery],p<0.001)and 5-year disease-specific survival(DSS)(41.0%[no surgery],69.1%[local
基金Supported by the Capital Clinical Characteristics Applications Research Program,No.Z171100001017201the Beijing Hospital Clinical Research 121Project,No. BJ-2018-090.
文摘Lymphoepithelioma-like carcinoma(LELC)is a rare,malignant epithelial tumour which can arise within the upper urinary tract.This letter adds to a previous systematic review and cumulative analysis of 28 published upper urinary tract-LELC cases which provided insight into this disease;however,the current evidence does not provide clinicians with clear guidelines due to its rarity.Therefore,the aim was to report a new case of renal pelvis LELC presented in our hospital.In this instance,we were able to report treatment experience and longterm follow-up results.This patient presented with hypertension and haemturia which initiated further investigation.While ultrasound identified an hypechoic mass,no malignant cells were detected using cytological testing.Abdominal magnetic resonance imaging identified a slightly enhanced mass in the left renal pelvis with no evidence of lymph node metastasis.Ureteroscopic tumor biopsy suggested the existence of urothelial carcinoma,hence,laparoscopic radical left nephroureterectomy with bladder cuff excision was performed.Through patientpractitioner consultations,we decided to adopt a"watch and wait"approach after radical nephroureterectomy rather than administering chemotherapy.Although,we would encourage clinicians to record and publish cases to garner insight into this type of malignant disease.
