AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out....AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver italian Program （CUP） score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS： Ninety-two patients （mean 60.5 ± 22.3 years） were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively （mean F/U 40.2 ± 23.5 mo）. Multivariate analysis identified three predictors of early mortality （〈 6 mo）： bilirubin 〉 3.2 mg/dL （P 〈 0.01）, HCC as first presentation of liver disease （P = 0.035）, and creatinine 〉 1 mg/dL （P = 0.017）. A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.CONCLUSION： HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.展开更多
BACKGROUND Despite its decreased incidence in Japan,gastric cancer continues among the leading causes of cancer-related deaths in both men and women.Accordingly,efforts are still required to lower the mortality rate o...BACKGROUND Despite its decreased incidence in Japan,gastric cancer continues among the leading causes of cancer-related deaths in both men and women.Accordingly,efforts are still required to lower the mortality rate of gastric cancer in Japan.Maebashi City introduced endoscopic gastric cancer screening in 2004,and participants are able to choose between direct radiography and endoscopy.Hence,we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods.AIM To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City,Japan.METHODS Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography(n=11155)or endoscopy(n=10747)were included.Participants were followed until March 31,2012,by cross-referencing their data against the Gunma Prefecture cancer registry data.We compared the detection rate of gastric cancers.Then,we compared the mortality rate between the two groups.The Cox proportional hazards model was used to estimate the hazard ratio(HR)of gastric cancer death.Finally,the reduction in gastric cancer mortality rate associated with each screening method was evaluated.RESULTS Gastric cancer was detected in 22 participants undergoing direct radiography(detection rate,0.20%)and in 52 participants undergoing endoscopy(detection rate,0.48%).However,most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death.We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not.When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis,the HR of gastric cancer death was 1.368(95%CI:0.7308-2.562)in the overall group of participants.The results showed no significant difference between the two screening methods in any of the analysis groups.CONCLUSION Although endoscopic screening detected more gastric cancer than direct radiographic screening,no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.展开更多
BACKGROUND Immune checkpoint inhibitors are one of the modern treatment methods for advanced malignancies.However,this group of medications is also associated with various immune-related adverse events,such as colitis...BACKGROUND Immune checkpoint inhibitors are one of the modern treatment methods for advanced malignancies.However,this group of medications is also associated with various immune-related adverse events,such as colitis or pneumonitis.Immune checkpoint inhibitor-induced gastritis is a less common adverse event.CASE SUMMARY We describe a 64-year-old woman presenting with diarrhea,nausea,and discomfort in the upper abdominal region.The patient had a history of metastatic lung cancer,which was treated with nivolumab.During the first endoscopy,an infiltrating gastric tumour was suspected.Later,based on endoscopic,histological and radiological findings,nivolumab-induced gastritis was diagnosed.The patient was successfully treated with three courses of omeprazole.CONCLUSION As a consequence of the increased use of immune checkpoint inhibitors,a growing number of reported immune-related adverse events could be expected.The diagnosis of immune checkpoint inhibitor-induced gastritis should be considered when assessing a patient treated with nivolumab with upper gastrointestinal distress.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is an autoimmune condition treated with immunosuppressive drugs.However,the need for immune system suppression becomes questionable when infection with the human immunodeficie...BACKGROUND Inflammatory bowel disease(IBD)is an autoimmune condition treated with immunosuppressive drugs.However,the need for immune system suppression becomes questionable when infection with the human immunodeficiency virus(HIV)occurs simultaneously and impacts the course of IBD.Our reported case represents the clinical course,prescribed treatment and its effect,as well as clinical challenges faced by physicians in a combination of such diseases.We also present a comprehensive literature review of similar cases.CASE SUMMARY A 49-year-old woman suffering from a newly diagnosed Crohn’s disease was hospitalized due to exacerbated symptoms(abdominal pain,fever,and weight loss).During her hospital stay,she tested positive for HIV.With conservative treatment,the patient improved and was discharged.In the outpatient clinic,her HIV infection was confirmed as stage C3,and antiretroviral treatment was initiated immediately.That notwithstanding,soon the patient was rehospitalized with pulmonary embolism and developed a series of complications because of the subsequent coexistence of IBD and HIV.After intensive and meticulous treatment,the patient’s condition has improved and she remains in remission.CONCLUSION The paucity of studies and data on the coexistence of HIV and IBD leaves clinicians doubting the optimal treatment options.展开更多
BACKGROUND Pancreatic mucinous cystadenocarcinoma(MCAC)is a rare malignancy with a poor prognosis when it presents metastases at diagnosis.Due to its very low incidence,there are no clear recommendations for the treat...BACKGROUND Pancreatic mucinous cystadenocarcinoma(MCAC)is a rare malignancy with a poor prognosis when it presents metastases at diagnosis.Due to its very low incidence,there are no clear recommendations for the treatment of advanced disease.Olaparib(an oral PARP inhibitor)has been approved for the maintenance treatment of patients with metastatic pancreatic adenocarcinoma harbouring germline BRCA1/2 mutations.Herein,we report the first case of a germline BRCA1 mutated unresectable MCAC which was effectively treated with olaparib.CASE SUMMARY A 41-year-old woman,without personal or family history of cancer,was diagnosed with ovarian and peritoneal metastases of MCAC.She underwent 12 cycles of gemcitabine plus oxaliplatin(GEMOX)obtaining a partial response and allowing radical surgery.One year later,local recurrence was documented,and other 12 cycles of GEMOX were administered obtaining a complete response.Seven years later,another local recurrence,not amenable to surgical resection,was diagnosed.She started FOLFIRINOX(oxaliplatin,irinotecan,leucovorin and fluorouracil),obtaining a partial response after 8 cycles.Given the excellent response to platinum-based chemotherapy,BRCA testing was performed,and a BRCA1 germline mutation was detected.She was switched to maintenance olaparib due to chemotherapy-related toxicities and achieved an almost complete metabolic response,with a reduction in the diameter of the lesion,after three months of therapy.CONCLUSION The current case suggests the beneficial effect of olaparib in BRCA mutated MCAC.However,further studies are required.展开更多
With the purpose to determine the frequency and type of cardiac lesions in naturally exposed dogs to Trypanosoma cruzi, ninety one stray dogs, capture by the Canine and Feline Control Center （dog pound） from the mun...With the purpose to determine the frequency and type of cardiac lesions in naturally exposed dogs to Trypanosoma cruzi, ninety one stray dogs, capture by the Canine and Feline Control Center （dog pound） from the municipality of Merida, were studied. Before euthanasia, blood samples were taken to detect 72 cruzi antigens by indirect immunofluorescence antibody test and Western Blot and to detect the genome of parasite by Polymerase Chain Reaction. Immediately after euthanasia, hearts were macroscopically evaluated and a sample of the middle right atrial wall of each dog was taken for histopathological analyses. DNA was also obtained from paraffin blocks of seropositives animals with microscopic lesions to detect 72 cruzi genome. Of ninety one dogs, thirteen were seropositive. All seropositive dogs showed an association （P 〈 0.05） with lymphocytoplasmatic myocarditis. The presence of the 72 cruzi genome was also detected by PCR in cardiac septum tissue of seropositive dogs and in all the cases with microscopic lesions indicating the high pathogenicity of the local circulating strain. No association with macroscopic lesions was observed in seropositive dogs. Also, the presence of Dirofilaria immitis （D. immitis） was found in 6% of dogs evaluated. This study demonstrates a high tropism to cardiac tissue and virulence of the strains of 72 cruzi circulating in the studied dog population.展开更多
文摘AIM： To study the epidemiology of HCC in Lebanon and prognostic factors predictive of early mortality. METHODS： An observational follow-up cohort study of HCC cases diagnosed over a five-year period was carried out. Multivariate analysis was conducted to identify prognostic factors in comparison to Cancer of the Liver italian Program （CUP） score. Multiple variables including the etiology of underlying liver disease, the demographic characteristics of patients, and the severity of liver disease evaluated by the Child-Pugh score were studied. Tumor parameters included the time of diagnosis of HCC, alpha-fetoprotein level, number and size of nodules, presence of portal vein thrombosis, and treatment modalities. Death or loss of follow-up was considered as an end-point event. RESULTS： Ninety-two patients （mean 60.5 ± 22.3 years） were included. Etiology of underlying disease was hepatitis B, C, and alcohol in 67%, 20%, and 23.5% respectively. Child-Pugh class at diagnosis was A, B, and C in 34.8%, 39.3% and 25.8% respectively. Overall survival was 44.8%, 32.8% and 17.6% at 1, 2 and 3 years respectively （mean F/U 40.2 ± 23.5 mo）. Multivariate analysis identified three predictors of early mortality （〈 6 mo）： bilirubin 〉 3.2 mg/dL （P 〈 0.01）, HCC as first presentation of liver disease （P = 0.035）, and creatinine 〉 1 mg/dL （P = 0.017）. A score based on these variables outperformed the CLIP score by Cox proportional hazard. ROC curve showed both models to be equivalent and moderately accurate.CONCLUSION： HBV is the leading cause of HCC in Lebanon. Independent predictors of early mortality are elevated bilirubin, creatinine and HCC as first manifestation of disease. Prospective validation of a score based on these clinical parameters in predicting short-term survival is needed.
文摘BACKGROUND Despite its decreased incidence in Japan,gastric cancer continues among the leading causes of cancer-related deaths in both men and women.Accordingly,efforts are still required to lower the mortality rate of gastric cancer in Japan.Maebashi City introduced endoscopic gastric cancer screening in 2004,and participants are able to choose between direct radiography and endoscopy.Hence,we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods.AIM To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City,Japan.METHODS Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography(n=11155)or endoscopy(n=10747)were included.Participants were followed until March 31,2012,by cross-referencing their data against the Gunma Prefecture cancer registry data.We compared the detection rate of gastric cancers.Then,we compared the mortality rate between the two groups.The Cox proportional hazards model was used to estimate the hazard ratio(HR)of gastric cancer death.Finally,the reduction in gastric cancer mortality rate associated with each screening method was evaluated.RESULTS Gastric cancer was detected in 22 participants undergoing direct radiography(detection rate,0.20%)and in 52 participants undergoing endoscopy(detection rate,0.48%).However,most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death.We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not.When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis,the HR of gastric cancer death was 1.368(95%CI:0.7308-2.562)in the overall group of participants.The results showed no significant difference between the two screening methods in any of the analysis groups.CONCLUSION Although endoscopic screening detected more gastric cancer than direct radiographic screening,no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.
文摘BACKGROUND Immune checkpoint inhibitors are one of the modern treatment methods for advanced malignancies.However,this group of medications is also associated with various immune-related adverse events,such as colitis or pneumonitis.Immune checkpoint inhibitor-induced gastritis is a less common adverse event.CASE SUMMARY We describe a 64-year-old woman presenting with diarrhea,nausea,and discomfort in the upper abdominal region.The patient had a history of metastatic lung cancer,which was treated with nivolumab.During the first endoscopy,an infiltrating gastric tumour was suspected.Later,based on endoscopic,histological and radiological findings,nivolumab-induced gastritis was diagnosed.The patient was successfully treated with three courses of omeprazole.CONCLUSION As a consequence of the increased use of immune checkpoint inhibitors,a growing number of reported immune-related adverse events could be expected.The diagnosis of immune checkpoint inhibitor-induced gastritis should be considered when assessing a patient treated with nivolumab with upper gastrointestinal distress.
文摘BACKGROUND Inflammatory bowel disease(IBD)is an autoimmune condition treated with immunosuppressive drugs.However,the need for immune system suppression becomes questionable when infection with the human immunodeficiency virus(HIV)occurs simultaneously and impacts the course of IBD.Our reported case represents the clinical course,prescribed treatment and its effect,as well as clinical challenges faced by physicians in a combination of such diseases.We also present a comprehensive literature review of similar cases.CASE SUMMARY A 49-year-old woman suffering from a newly diagnosed Crohn’s disease was hospitalized due to exacerbated symptoms(abdominal pain,fever,and weight loss).During her hospital stay,she tested positive for HIV.With conservative treatment,the patient improved and was discharged.In the outpatient clinic,her HIV infection was confirmed as stage C3,and antiretroviral treatment was initiated immediately.That notwithstanding,soon the patient was rehospitalized with pulmonary embolism and developed a series of complications because of the subsequent coexistence of IBD and HIV.After intensive and meticulous treatment,the patient’s condition has improved and she remains in remission.CONCLUSION The paucity of studies and data on the coexistence of HIV and IBD leaves clinicians doubting the optimal treatment options.
文摘BACKGROUND Pancreatic mucinous cystadenocarcinoma(MCAC)is a rare malignancy with a poor prognosis when it presents metastases at diagnosis.Due to its very low incidence,there are no clear recommendations for the treatment of advanced disease.Olaparib(an oral PARP inhibitor)has been approved for the maintenance treatment of patients with metastatic pancreatic adenocarcinoma harbouring germline BRCA1/2 mutations.Herein,we report the first case of a germline BRCA1 mutated unresectable MCAC which was effectively treated with olaparib.CASE SUMMARY A 41-year-old woman,without personal or family history of cancer,was diagnosed with ovarian and peritoneal metastases of MCAC.She underwent 12 cycles of gemcitabine plus oxaliplatin(GEMOX)obtaining a partial response and allowing radical surgery.One year later,local recurrence was documented,and other 12 cycles of GEMOX were administered obtaining a complete response.Seven years later,another local recurrence,not amenable to surgical resection,was diagnosed.She started FOLFIRINOX(oxaliplatin,irinotecan,leucovorin and fluorouracil),obtaining a partial response after 8 cycles.Given the excellent response to platinum-based chemotherapy,BRCA testing was performed,and a BRCA1 germline mutation was detected.She was switched to maintenance olaparib due to chemotherapy-related toxicities and achieved an almost complete metabolic response,with a reduction in the diameter of the lesion,after three months of therapy.CONCLUSION The current case suggests the beneficial effect of olaparib in BRCA mutated MCAC.However,further studies are required.
文摘With the purpose to determine the frequency and type of cardiac lesions in naturally exposed dogs to Trypanosoma cruzi, ninety one stray dogs, capture by the Canine and Feline Control Center （dog pound） from the municipality of Merida, were studied. Before euthanasia, blood samples were taken to detect 72 cruzi antigens by indirect immunofluorescence antibody test and Western Blot and to detect the genome of parasite by Polymerase Chain Reaction. Immediately after euthanasia, hearts were macroscopically evaluated and a sample of the middle right atrial wall of each dog was taken for histopathological analyses. DNA was also obtained from paraffin blocks of seropositives animals with microscopic lesions to detect 72 cruzi genome. Of ninety one dogs, thirteen were seropositive. All seropositive dogs showed an association （P 〈 0.05） with lymphocytoplasmatic myocarditis. The presence of the 72 cruzi genome was also detected by PCR in cardiac septum tissue of seropositive dogs and in all the cases with microscopic lesions indicating the high pathogenicity of the local circulating strain. No association with macroscopic lesions was observed in seropositive dogs. Also, the presence of Dirofilaria immitis （D. immitis） was found in 6% of dogs evaluated. This study demonstrates a high tropism to cardiac tissue and virulence of the strains of 72 cruzi circulating in the studied dog population.
