AIM: To evaluate the efficacy and safety of endoscopicsubmucosal dissection(ESD) for early gastric cancer(EGC) with undifferentiated-type histology.METHODS: A systematic literature review was conducted using the core ...AIM: To evaluate the efficacy and safety of endoscopicsubmucosal dissection(ESD) for early gastric cancer(EGC) with undifferentiated-type histology.METHODS: A systematic literature review was conducted using the core databases. Complete resection,curative resection, en bloc resection, recurrence and adverse event rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated using a funnel plot, the trim and fill method, Egger's test,and a rank correlation test.RESULTS: Fourteen retrospective studies between2009 and 2014 were identified(972 EGC lesions with undifferentiated-type histology). The total en bloc and complete resection rates were estimated as92.1%(95%CI: 87.4%-95.2%) and 77.5%(95%CI:69.3%-84%), respectively. The total curative resection rate was 61.4%(95%CI: 44.5%-75.9%). The overall recurrence rate was 7.6%(95%CI: 3.4%-16%).Limited to histologically diagnosed expanded-criteria lesions, the en bloc and complete resection rates were91.2% and 85.6%, respectively. The curative resection rate was 79.8%.CONCLUSION: In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiatedtype histology. Long-term studies are needed to confirm these therapeutic outcomes.展开更多
AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The ...AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included "alcoholic liver diseases", "osteoporosis", or "bone fractures". The prevalence of any fractures or osteoporosis, and bone mineral density(BMD) were extracted and analyzed using risk ratios and standardized mean difference(SMD). A random effects model was applied. RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944(95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849(95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD(SMD in femur-BMD:-0.172, 95%CI:-0.453-0.110; SMD in spine-BMD:-0.169, 95%CI:-0.476-0.138). Sensitivity analyses showed consistent results. CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.展开更多
AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;fema...AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.展开更多
AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We e...AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We evaluated 5746 patients diagnosed with gastric ulcers(GU),duodenal ulcers(DU),GU + DU,or nonpeptic ulcers associated with an H.pylori infection.We treated them annually with the 2 wk standard first-line triple regimen,proton pump inhibitor(PPI) + amoxicilin + clarithromycin(PAC;PPI,clarithromycin 500 mg,and amoxicillin 1 g,all twice a day).The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H.pylori eradication using the PAC regimen.We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen(PPI b.i.d.,tripotassium dicitrate bismuthate 300 mg q.i.d.,metronidazole 500 mg t.i.d.,and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy.Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS:A total of 5746 patients [2333 males(58.8%),1636 females(41.2%);mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years,P < 0.05,total mean age 51.9 ± 13.3 years(mean ± SD)] were investigated.Among these patients,1674 patients were excluded:35 patients refused treatment;18 patients ceased H.pylori eradication due to side effects;1211 patients had inappropriate indications for H.pylori eradication,having undergone stomach cancer operation or chemotherapy;and 410 patients did not undergo the follow-up.We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above.Finally,we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy.The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows:gastric ulcer in 855(21.5%);duodenal ulcer in 878(22.1%);gastric and duodenal ulcer in 124(3.1%),erosive,atrophic gastritis and functional dyspepsia in 2055(51.8%);and other findings(e.g.,MALToma,patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57(0.5%).The overall eradication rate of the 2 wk standard firstline triple regimen was 86.5%.The annual eradication rates from 2000 to 2010 were 86.7%,85.4%,86.5%,83.3%,89.9%,90.5%,88.4%,84.5%,89.1%,85.8%,and 88.3%,sequentially(P = 0.06).No definite evidence of a significant change in the eradication rate was seen during the past eleven years.The eradication rates of second-line therapy were 88.9%,82.4%,85%,83.9%,77.3%,85.7%,84.4%,87.3%,83.3%,88.9%,and 84%(P = 0.77).The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%.There was no significant difference in the eradication rate according to the H.pylori associated diseases.CONCLUSION:This study showed that there was no trend change in the H.pylori eradication rate over the most recent 11 years in our institution.展开更多
BACKGROUND Ampullary adenoma is a rare premalignant lesion,but its incidence is increasing.Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness,th...BACKGROUND Ampullary adenoma is a rare premalignant lesion,but its incidence is increasing.Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness,thereby replacing surgical resection.However,recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30%of cases.AIM To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.METHODS We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020.We evaluated clinical outcomes and their risk factors.The definitions of outcomes were as follow:(1)curative resection:complete endoscopic resection without recurrence;(2)endoscopic success:treatment of ampullary adenoma with endoscopy without surgical intervention;(3)early recurrence:reconfirmed adenoma at the first endoscopic surveillance;and(4)late recurrence:reconfirmed adenoma after the first endoscopic surveillance.RESULTS A total of 106 patients were included for analysis.Of the included patients,81(76.4%)underwent curative resection,99(93.4%)had endoscopic success,showing that most patients with noncurative resection were successfully managed with endoscopy.Sixteen patients(15.1%)had piecemeal resection,22 patients(20.8%)had shown positive/uncertain resection margin,11 patients(16.1%)had an early recurrence,13 patients(10.4%)had a late recurrence,and 6 patients(5.7%)had a re-recurrence.In multivariate analysis,a positive/uncertain margin[Odds ratio(OR)=4.023,P=0.048]and piecemeal resection(OR=6.610,P=0.005)were significant risk factors for early and late recurrence,respectively.Piecemeal resection was also a significant risk factor for non-curative resection(OR=5.424,P=0.007).Twenty-six patients experienced adverse events(24.5%).CONCLUSION Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas.Careful selection and follow-up of patients is mandatory,particularly in cases with positive/uncertain margin and piecemeal resection.展开更多
AIM: To evaluate the clinical characteristics of patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 and A hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
Pancreatic cancer, a highly lethal cancer, has the lowest 5-year survival rate forseveral reasons, including its tendency for the late diagnosis, a lack of serologicmarkers for screening, aggressive local invasion, it...Pancreatic cancer, a highly lethal cancer, has the lowest 5-year survival rate forseveral reasons, including its tendency for the late diagnosis, a lack of serologicmarkers for screening, aggressive local invasion, its early metastaticdissemination, and its resistance to chemotherapy/radiotherapy. Pancreaticcancer evades immunologic elimination by a variety of mechanisms, includinginduction of an immunosuppressive microenvironment. Cancer-associatedfibroblasts interact with inhibitory immune cells, such as tumor-associatedmacrophages and regulatory T cells, to form an inflammatory shell-like desmoplasticstroma around tumor cells. Immunotherapy has the potential to mobilizethe immune system to eliminate cancer cells. Nevertheless, althoughimmunotherapy has shown brilliant results across a wide range of malignancies,only anti-programmed cell death 1 antibodies have been approved for use inpatients with pancreatic cancer who test positive for microsatellite instability ormismatch repair deficiency. Some patients treated with immunotherapy whoshow progression based on conventional response criteria may prove to have adurable response later. Continuation of immune-based treatment beyond diseaseprogression can be chosen if the patient is clinically stable. Immunotherapeuticapproaches for pancreatic cancer treatment deserve further exploration, given theplethora of combination trials with other immunotherapeutic agents, targetedtherapy, stroma-modulating agents, chemotherapy, and multi-way combinationtherapies.展开更多
Dear Editor,Breast cancer is a leading type of cancer in women,the treatment of basal type,including triple negative breast cancer(TNBC),remains challenging due to its aggressive behaviors and lack of targeted therape...Dear Editor,Breast cancer is a leading type of cancer in women,the treatment of basal type,including triple negative breast cancer(TNBC),remains challenging due to its aggressive behaviors and lack of targeted therapeutic options1.F-box proteins(FBPs)can serve as either oncogenes or tumor suppressors depending on their substrates,and various studies have been conducted on their involvement in different types of cancer and play significant roles in cancer development and progression2.However,the related mechanisms and targets of F-box protein 15(FBX015)are still remain unclear in human breast cancers.展开更多
文摘AIM: To evaluate the efficacy and safety of endoscopicsubmucosal dissection(ESD) for early gastric cancer(EGC) with undifferentiated-type histology.METHODS: A systematic literature review was conducted using the core databases. Complete resection,curative resection, en bloc resection, recurrence and adverse event rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated using a funnel plot, the trim and fill method, Egger's test,and a rank correlation test.RESULTS: Fourteen retrospective studies between2009 and 2014 were identified(972 EGC lesions with undifferentiated-type histology). The total en bloc and complete resection rates were estimated as92.1%(95%CI: 87.4%-95.2%) and 77.5%(95%CI:69.3%-84%), respectively. The total curative resection rate was 61.4%(95%CI: 44.5%-75.9%). The overall recurrence rate was 7.6%(95%CI: 3.4%-16%).Limited to histologically diagnosed expanded-criteria lesions, the en bloc and complete resection rates were91.2% and 85.6%, respectively. The curative resection rate was 79.8%.CONCLUSION: In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiatedtype histology. Long-term studies are needed to confirm these therapeutic outcomes.
文摘AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included "alcoholic liver diseases", "osteoporosis", or "bone fractures". The prevalence of any fractures or osteoporosis, and bone mineral density(BMD) were extracted and analyzed using risk ratios and standardized mean difference(SMD). A random effects model was applied. RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944(95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849(95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD(SMD in femur-BMD:-0.172, 95%CI:-0.453-0.110; SMD in spine-BMD:-0.169, 95%CI:-0.476-0.138). Sensitivity analyses showed consistent results. CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.
基金Supported by The Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology(NRF-2010-0021482)to Suk KT
文摘AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.
文摘AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We evaluated 5746 patients diagnosed with gastric ulcers(GU),duodenal ulcers(DU),GU + DU,or nonpeptic ulcers associated with an H.pylori infection.We treated them annually with the 2 wk standard first-line triple regimen,proton pump inhibitor(PPI) + amoxicilin + clarithromycin(PAC;PPI,clarithromycin 500 mg,and amoxicillin 1 g,all twice a day).The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H.pylori eradication using the PAC regimen.We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen(PPI b.i.d.,tripotassium dicitrate bismuthate 300 mg q.i.d.,metronidazole 500 mg t.i.d.,and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy.Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS:A total of 5746 patients [2333 males(58.8%),1636 females(41.2%);mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years,P < 0.05,total mean age 51.9 ± 13.3 years(mean ± SD)] were investigated.Among these patients,1674 patients were excluded:35 patients refused treatment;18 patients ceased H.pylori eradication due to side effects;1211 patients had inappropriate indications for H.pylori eradication,having undergone stomach cancer operation or chemotherapy;and 410 patients did not undergo the follow-up.We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above.Finally,we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy.The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows:gastric ulcer in 855(21.5%);duodenal ulcer in 878(22.1%);gastric and duodenal ulcer in 124(3.1%),erosive,atrophic gastritis and functional dyspepsia in 2055(51.8%);and other findings(e.g.,MALToma,patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57(0.5%).The overall eradication rate of the 2 wk standard firstline triple regimen was 86.5%.The annual eradication rates from 2000 to 2010 were 86.7%,85.4%,86.5%,83.3%,89.9%,90.5%,88.4%,84.5%,89.1%,85.8%,and 88.3%,sequentially(P = 0.06).No definite evidence of a significant change in the eradication rate was seen during the past eleven years.The eradication rates of second-line therapy were 88.9%,82.4%,85%,83.9%,77.3%,85.7%,84.4%,87.3%,83.3%,88.9%,and 84%(P = 0.77).The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%.There was no significant difference in the eradication rate according to the H.pylori associated diseases.CONCLUSION:This study showed that there was no trend change in the H.pylori eradication rate over the most recent 11 years in our institution.
基金Supported by National Research Foundation of Korea grant funded by the Korean Government,No. NRF-2021M3E5D1A01015177National Research Foundation of Korea grant funded by the Ministry of Education,No. NRF-2018R1D1A1B07048202
文摘BACKGROUND Ampullary adenoma is a rare premalignant lesion,but its incidence is increasing.Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness,thereby replacing surgical resection.However,recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30%of cases.AIM To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.METHODS We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020.We evaluated clinical outcomes and their risk factors.The definitions of outcomes were as follow:(1)curative resection:complete endoscopic resection without recurrence;(2)endoscopic success:treatment of ampullary adenoma with endoscopy without surgical intervention;(3)early recurrence:reconfirmed adenoma at the first endoscopic surveillance;and(4)late recurrence:reconfirmed adenoma after the first endoscopic surveillance.RESULTS A total of 106 patients were included for analysis.Of the included patients,81(76.4%)underwent curative resection,99(93.4%)had endoscopic success,showing that most patients with noncurative resection were successfully managed with endoscopy.Sixteen patients(15.1%)had piecemeal resection,22 patients(20.8%)had shown positive/uncertain resection margin,11 patients(16.1%)had an early recurrence,13 patients(10.4%)had a late recurrence,and 6 patients(5.7%)had a re-recurrence.In multivariate analysis,a positive/uncertain margin[Odds ratio(OR)=4.023,P=0.048]and piecemeal resection(OR=6.610,P=0.005)were significant risk factors for early and late recurrence,respectively.Piecemeal resection was also a significant risk factor for non-curative resection(OR=5.424,P=0.007).Twenty-six patients experienced adverse events(24.5%).CONCLUSION Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas.Careful selection and follow-up of patients is mandatory,particularly in cases with positive/uncertain margin and piecemeal resection.
基金Supported by A Grant from the Korea Healthcare Technology R and D Project,Ministry of Health and Welfare,Republic of Korea No.HI10C2020)The Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education,Science and Technology No.NRF-2010-0021482
文摘AIM: To evaluate the clinical characteristics of patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 and A hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
文摘Pancreatic cancer, a highly lethal cancer, has the lowest 5-year survival rate forseveral reasons, including its tendency for the late diagnosis, a lack of serologicmarkers for screening, aggressive local invasion, its early metastaticdissemination, and its resistance to chemotherapy/radiotherapy. Pancreaticcancer evades immunologic elimination by a variety of mechanisms, includinginduction of an immunosuppressive microenvironment. Cancer-associatedfibroblasts interact with inhibitory immune cells, such as tumor-associatedmacrophages and regulatory T cells, to form an inflammatory shell-like desmoplasticstroma around tumor cells. Immunotherapy has the potential to mobilizethe immune system to eliminate cancer cells. Nevertheless, althoughimmunotherapy has shown brilliant results across a wide range of malignancies,only anti-programmed cell death 1 antibodies have been approved for use inpatients with pancreatic cancer who test positive for microsatellite instability ormismatch repair deficiency. Some patients treated with immunotherapy whoshow progression based on conventional response criteria may prove to have adurable response later. Continuation of immune-based treatment beyond diseaseprogression can be chosen if the patient is clinically stable. Immunotherapeuticapproaches for pancreatic cancer treatment deserve further exploration, given theplethora of combination trials with other immunotherapeutic agents, targetedtherapy, stroma-modulating agents, chemotherapy, and multi-way combinationtherapies.
基金This research was supported by the Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT)(No.2019M3E5D1A01069361)by the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT)(No.2019R1A2C2087551)。
文摘Dear Editor,Breast cancer is a leading type of cancer in women,the treatment of basal type,including triple negative breast cancer(TNBC),remains challenging due to its aggressive behaviors and lack of targeted therapeutic options1.F-box proteins(FBPs)can serve as either oncogenes or tumor suppressors depending on their substrates,and various studies have been conducted on their involvement in different types of cancer and play significant roles in cancer development and progression2.However,the related mechanisms and targets of F-box protein 15(FBX015)are still remain unclear in human breast cancers.
