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1.
Gastroenterol Res Pract ; 2019: 9832482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611916

RESUMO

Background: The association between gallbladder (GB) disease and colorectal precancerous lesions remains elusive. This study sought to explore the association between GB disease and colorectal neoplasms at different locations. Methods: Patients who received general health checkup from January to December 2008 were included and subgrouped into three groups by polyp location: proximal, distal, and whole colon. GB disease and other known risk factors for colon cancer were compared and analyzed. Different types of polyps at different locations were further investigated. Results: Of a total of 3136 patients (1776 men and 1360 women; mean age, 49.3 years) who had colon polyps, 212 (6.8%) had GB stone and 512 (16.3%) had GB polyps. Patients in the proximal colon polyp group had higher rates of GB polyps and stones. GB polyps were independently associated with proximal colon polyps, including both hyperplastic polyps (odds ratio, 1.523; P = 0.034) and adenomatous polyps (odds ratio, 1.351; P = 0.048). No relationship between GB polyps and distal or any colon polyps was observed. Irrespective of the polyp location (i.e., proximal, distal, or any part of the colon), GB stone did not show any association with colon polyp. Conclusions: We suggested that GB polyps are associated with proximal colon polyps. Colonoscopy may be a more effective strategy for screening proximal precancerous lesions among patients with GB polyps. The association between GB disease and colon polyps demands further prospective investigation.

2.
Kaohsiung J Med Sci ; 35(9): 572-577, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31162814

RESUMO

The polyp detection rate (PDR) is an important quality indicator for colonoscopy. Several factors have been shown to be associated with PDR. However, whether the moderate sedation is a factor for polyp detection remains controversial. This study aims to assess factors associated with polyp detection including the moderate sedation factor during colonoscopy. Patients who underwent colonoscopy from June 1, 2014 to May 31, 2015 were enrolled into this retrospective study. Patients with poor colon preparation and failure to reach the cecum were excluded. The clinical factors, including patient's sex, age, midazolam/fentanyl sedation, indications, endoscopist colonoscopy volume, and use of antispasmodic agent were evaluated by multivariate analysis. A total of 3373 patients were included in this study. The mean age was 55.8 years, and 1980 patients (58.7%) were male. Among the 3373 patients, 2513 (74.5%) underwent midazolam/fentanyl-based sedated colonoscopy. The multivariate analysis showed that male sex, age over 50 years old, midazolam/fentanyl sedation and indications of screening and surveillance were significantly associated with polyp detection. Moreover, when stratified by sex and age, the midazolam/fentanyl sedation was associated with polyp detection in male patients and patients over 50 years old. This study has highlighted the role of midazolam/fentanyl sedation administered by colonoscopists as a modifiable factor that may increase polyp detection during colonoscopy.


Assuntos
Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico , Colonoscopia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
3.
Digestion ; : 1-8, 2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30982036

RESUMO

BACKGROUND: The Japan narrow-band imaging Expert Team (JNET) classification of colorectal polyps based on magnifying endoscopy is used in Japan, but not worldwide. The objective of this study was to clarify differences of diagnostic accuracy between JNET users in Japan and non-JNET users in other countries. METHODS: A total of 185 colorectal tumors were assessed. Six endoscopists (3 each from Japan and Taiwan) participated in the study. The Japanese endoscopists normally used the JNET classification and the Taiwanese endoscopists normally used the narrow-band imaging International Colorectal Endoscopic classification for diagnosis of colorectal tumors. After receiving a lecture on the JNET classification, they all observed one blue laser imaging magnified image per lesion and performed diagnosis based on the JNET classification. RESULTS: Diagnostic ability was equivalent for Type 1, Type 2A, and Type 2B. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of Type 3 for deep submucosal invasive carcinoma was, respectively, 44.4, 98.3, 57.1, and 97.2% in Group J and 70.0, 94.7, 40.4, and 98.4% in Group T. The PPV for diagnosis of Type 3 with a high confidence was significantly higher in Group J than in Group T (81.8% [55.4-94.6] vs. 44.4% [33.6-50.9], p < 0.05). CONCLUSIONS: The PPV for Type 3 differed between the 2 groups, suggesting the need to become familiar with differentiation between Type 2B and Type 3.

4.
EMBO J ; 37(20)2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30177570

RESUMO

Expression of mitochondrial proton transporter uncoupling protein 1 (UCP1) in brown adipose tissue (BAT) is essential for mammalian thermogenesis. While human UCP1 mRNA exists in a long form only, alternative polyadenylation creates two different isoforms in mice with 10% of UCP1 mRNA found in the long form (Ucp1L) and ~90% in the short form (Ucp1S). We generated a mouse model expressing only Ucp1S and found that it showed impaired thermogenesis due to a 60% drop in UCP1 protein levels, suggesting that Ucp1L is more efficiently translated than Ucp1S. In addition, we found that ß3 adrenergic receptor signaling promoted the translation of mouse Ucp1L and human Ucp1 in a manner dependent on cytoplasmic polyadenylation element binding protein 2 (CPEB2). CPEB2-knockout mice showed reduced UCP1 levels and impaired thermogenesis in BAT, which was rescued by ectopic expression of CPEB2. Hence, long 3'-UTR Ucp1 mRNA translation activated by CPEB2 is likely conserved and important in humans to produce UCP1 for thermogenesis.


Assuntos
Regiões 3' não Traduzidas/fisiologia , Tecido Adiposo Marrom/metabolismo , Biossíntese de Proteínas/fisiologia , Proteínas de Ligação a RNA/metabolismo , Termogênese/fisiologia , Proteína Desacopladora 1/biossíntese , Animais , Expressão Ectópica do Gene , Feminino , Humanos , Masculino , Camundongos , Camundongos Knockout , Isoformas de Proteínas/biossíntese , Isoformas de Proteínas/genética , Proteínas de Ligação a RNA/genética , Receptores Adrenérgicos beta 3/genética , Receptores Adrenérgicos beta 3/metabolismo , Transdução de Sinais/fisiologia , Proteína Desacopladora 1/genética
5.
Ther Clin Risk Manag ; 14: 1331-1336, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30104879

RESUMO

Background: Subjects with obstructive sleep apnea (OSA) are vulnerable to sedation-related complications during endoscopic procedures. A significant portion of subjects undergoing routine endoscopy is at high risk of OSA, but most are undiagnosed. The purpose of this study was to estimate the prevalence of high risk for OSA among Chinese subjects undergoing deep sedation for screening gastrointestinal endoscopy and to evaluate the hypoxemia risk of these examinees stratified by Berlin Questionnaire (BQ). Patients and methods: We performed a prospective cohort study in subjects undergoing deep sedation with monitored anesthesia care for combined esophagogastroduodenoscopy plus colonoscopy. Subjects who were Chinese were stratified into high- and low-risk groups for OSA by administration of BQ. Deep sedation was achieved via a propofol target-controlled infusion system. Hypoxemia was defined as pulse oximetry reading of less than 90%. The frequency of hypoxemia was compared between high- and low-risk groups for OSA. Results: A total of 615 Chinese subjects were recruited during the study period, and 614 subjects were included for analysis. Two hundred eighteen (35.5%) subjected were classified to be at high risk of OSA, and 396 (64.5%) were stratified to be at low risk of OSA by BQ. Hypoxemia occurred in 83 (13.5%) subjects during endoscopy procedures. The risk of developing hypoxemia in the high-risk group was significantly higher when compared to that of the low-risk group subjects (24.8% vs 7.3%; relative risk, 3.37; 95% CI, 2.22-5.13). Conclusion: About one-third Chinese subjects undergoing deep sedation for screening endoscopy were at high risk of OSA. Subjects at high risk of OSA are associated with an increased risk of hypoxemia in comparison to the low-risk group when undergoing deep sedation for screening gastrointestinal endoscopy.

6.
J Chin Med Assoc ; 81(12): 1033-1037, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29778549

RESUMO

BACKGROUND: Esophagogastroduodenoscopy (EGD) is a standard tool for detection of mucosal and submucosal lesions. However, identification of Helicobacter pylori (H. P) infection using EGD alone is limited in accuracy. Linked color imaging (LCI) is a novel tool to capture real-time image with sufficient contrast to observe mucosal microstructure. METHODS: This study aims to evaluate the applicability of LCI in the identification of H. pylori infection. Consecutive 122 patients scheduled for EGD were included. They were examined with LCI and magnifying endoscopy. The classification of H. pylori was based on pathology results of biopsy and rapid urease test or urea breath test. RESULTS: We compared the results based on LCI or magnifying endoscopy to reference classification. Of 122 patients, 36 had H. pylori infection (29.51%). The level of accuracy of diagnosis of H. pylori infections by LCI, magnifying endoscopy, and both LCI and magnifying endoscopy was 78.38%, 81.98%, and 78.38%, respectively. The sensitivity and specificity of each group were 70.97%, 81.25%, and 80.65% and 82.5%, 83.87%, and 76.25%, respectively. The positive predictive values were 59.46%, 64.10%, and 57.78%, respectively, and the negative predictive values were 87.84%, 91.67%, and 92.42%, respectively. CONCLUSION: LCI could be playing a valuable initial screen tool for real-time diagnosis of H. pylori infections. It has a high accuracy of diagnosis of H. pylori infections. Therefore, in patients suspected to have H. pylori infections using LCI, the infections need to be carefully diagnosed using appropriate methods because, as per the consensus, they should be eradicated as soon as possible before precancerous lesions develop.


Assuntos
Mucosa Gástrica/diagnóstico por imagem , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Adulto , Idoso , Endoscopia Gastrointestinal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Transl Res ; 200: 43-53, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30670154

RESUMO

Implications of plasminogen activator inhibitor-1 (PAI-1) in colonic polyps remain elusive. A prospective study was conducted with 188 consecutive subjects who underwent colonoscopy at a tertiary referral center. Biochemical parameters, serum PAI-1 levels, PAI-1 single-nucleotide polymorphisms (rs-1799889), and colonic polyp profiles were analyzed at baseline and 24 and 48 weeks postpolypectomy. Of 188 patients (mean age: 56.8 years), 78.7% had adenomas; the median polyp number and size were 2 and 1.2cm, respectively. Multivariate analyses revealed the following baseline associations: PAI-1 levels (95% confidence interval [CI] for estimated ß: 0.012-0.223) and polyp pathology (0.294-0.63) with polyp size; polyp size (0.085-0.498) and platelet count (0.013-0.027) with PAI-1 levels. At 24 weeks postpolypectomy, homeostasis model assessment-estimated insulin resistance (HOMA-IR) and platelet count were independently associated with PAI-1 levels. Among patients with colonic adenomas, baseline PAI-1 levels (95% CI odds ratio: 1.06-1.686; cut-off value: >10.65 ng/mL, area under curve: 0.662, P = 0.032) and the PAI-1-rs-17998894G/4G genotype (0.036-0.912) were associated with high-grade dysplasia. Compared with baseline levels, repeated measures analysis of variance showed that PAI-1 levels increased, with concurrent increased HOMA-IR indexes, but decreased alanine transaminase levels and polyp size in follow-up colonoscopies at 24 weeks postpolypectomy. PAI-1 returned to baseline levels, and HOMA-IRs and triglyceride/high-density lipoprotein-cholesterol ratios decreased at 48 weeks postpolypectomy. Taken together, serum PAI-1 levels were positively associated with colonic polyp size and high-grade dysplasia, which was modulated by the PAI-1-rs-17998894G/4G genotype. The beneficial postpolypectomy inflammatory and metabolic alterations might be transiently counter regulated by elevated PAI-1 levels, with a link to HOMA-IR.


Assuntos
Pólipos do Colo/metabolismo , Pólipos do Colo/patologia , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Adenoma/genética , Adenoma/metabolismo , Adenoma/patologia , Adenoma/cirurgia , Idoso , Alanina Transaminase/sangue , HDL-Colesterol/sangue , Pólipos do Colo/genética , Pólipos do Colo/cirurgia , Colonoscopia , Feminino , Genótipo , Homeostase , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/sangue , Contagem de Plaquetas , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Curva ROC , Triglicerídeos/sangue
8.
Ther Clin Risk Manag ; 13: 1317-1321, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29042789

RESUMO

INTRODUCTION: Linked-color imaging (LCI) is a recently developed system used in endoscopy. It creates clear and bright endoscopic images using short-wavelength, narrow-band laser light combined with white laser light. The illuminating light and signal processing emphasize slight color differences in abnormal regions that approximate the normal color of the mucosa. As a result, regions initially appearing red become a deeper shade of red, while regions originally appearing white become brighter, yet with natural tones. This process facilitates recognition of slight differences in the color of the mucosa and clarifies the boundaries of the mucosal pit. AIM: To determine whether LCI of the colon can improve the correlation between endoscopic findings and pathological diagnosis. METHODS: Consecutive patients who underwent colonoscopy requiring polypectomy or removal by biopsy forceps if possible were recruited. Probable polyp histology was assessed by two endoscopists using the Narrow-band imaging International Colorectal Endoscopic (NICE) classification and LCI data. All detected polyps were sent to the pathology department for pathological diagnosis by two pathologists. RESULTS: In total, 94 polyps were found in 43 patients. The sensitivity, specificity, positive predictive value, and negative predictive value for neoplastic lesion prediction (NICE type2/3) were 96.5%, 83.8%, 90.2%, and 93.9%, respectively. CONCLUSION: LCI combined with the NICE classification system is a powerful tool for predicting probable histology of colon polyps.

9.
Nutrients ; 9(6)2017 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-28574439

RESUMO

How hepatatitis C virus (HCV) infection affects the interplay among abundant adipokines in the host remains unclear. A prospective study was conducted with 450 consecutive genotype 1 (G1) and G2 HCV patients who completed a course of anti-HCV therapy and underwent pre-therapy and 24-week post-therapy surveys to assess various profiles and levels of abundant adipokines, including leptin, adiponectin, and plasminogen activator inhibitor-1 (PAI-1). Before anti-HCV therapy, multivariate analyses showed gender to be associated with leptin and adiponectin levels, and BMI with leptin and PAI-1 levels. Among patients with a sustained virological response (SVR, n = 372), associations at 24 weeks post-therapy were as follows: gender and BMI with all adipokine levels; hepatic steatosis and aspartate aminotransferase to platelet ratio index with adiponectin levels; and HOMA-IR and HCV genotype with PAI-1 levels. Paired t-tests revealed increased post-therapeutic PAI-1 levels in G1 SVR patients and decreased adiponectin levels in all SVR patients compared to pre-therapeutic levels. HCV infection may obscure associations between abundant adipokines and metabolic/hepatic profiles. In SVR patients, a higher hierarchical status of PAI-1 versus adiponectin in affecting glucose metabolism was noted at 24 weeks post-therapy. Such genotype-non-specific adiponectin decreases and G1-specific PAI-1 increases warrant careful follow-up of HCV patients after SVR according to viral genotype.


Assuntos
Adipocinas/sangue , Hepatite C/sangue , Hepatite C/tratamento farmacológico , Adulto , Idoso , Alanina Transaminase/sangue , Antivirais/uso terapêutico , Aspartato Aminotransferases/sangue , Índice de Massa Corporal , Colesterol/sangue , Fígado Gorduroso/sangue , Feminino , Seguimentos , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/sangue , Estudos Prospectivos , Triglicerídeos/sangue
10.
Virulence ; 8(7): 1255-1264, 2017 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-28267407

RESUMO

BACKGROUND: The evolution of the relationship between adiponectin and insulin sensitivity in hepatitis C virus (HCV) patients during viral clearance is unclear and warrants investigation. METHODS: A prospective study including 747 consecutive chronic hepatitis C (CHC) patients, of whom 546 had completed a course of anti-HCV therapy and underwent pre-, peri- and post-therapy surveys for anthropomorphic, viral, metabolic and hepatic profiles and adiponectin levels, was conducted in a tertiary care center. RESULTS: Multivariate analyses indicated associations of sex, triglyceride levels and hepatic steatosis with adiponectin levels and of triglyceride levels and interferon λ3 (IFNL3) genotype with homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before anti-HCV therapy. In patients with a sustained virological response (SVR; n = 455), at 24 weeks post-therapy, sex, BMI, aspartate aminotransferase to platelet ratio index (APRI), HOMA-IR and steatosis were associated with adiponectin levels, and IFNL3 genotype was associated with HOMA-IR levels. GEE analysis demonstrated that SVR affected longitudinal trends in adiponectin levels. Compared with pre-therapy levels, adiponectin and APRI levels decreased 24 weeks post-therapy in SVR patients, regardless of baseline insulin resistance (IR). However, HOMA-IR levels decreased in SVR patients with baseline IR but increased in those without baseline IR. Compared with controls, immunohistochemical studies showed that pre-therapy CHC patients had higher hepatic adiponectin expression associated with hepatic fibrosis. CONCLUSIONS: During HCV infection, adiponectin may affect insulin sensitivity through triglycerides. After viral clearance, adiponectin levels were directly associated with insulin sensitivity and decreased upon improved hepatic fibrosis; with a link to the IFNL3 genotype, insulin sensitivity improved only in patients with baseline IR.


Assuntos
Adiponectina/metabolismo , Antivirais/uso terapêutico , Hepacivirus/fisiologia , Hepatite C Crônica/metabolismo , Resistência à Insulina , Insulina/metabolismo , Adiponectina/genética , Adulto , Idoso , Feminino , Genótipo , Hepacivirus/efeitos dos fármacos , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/genética , Hepatite C Crônica/virologia , Humanos , Interferons , Interleucinas/genética , Interleucinas/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Carga Viral/efeitos dos fármacos
11.
Sci Rep ; 6: 30799, 2016 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-27477870

RESUMO

The effect of resistin (RETN) on the response to anti-HCV therapy remains unclear. A prospective cohort study was performed using 655 consecutive HCV patients, of whom 513 had completed a course of interferon-based therapy. Multivariate and GEE analyses revealed four RETN single-nucleotide polymorphisms (SNPs), rs34861192, rs3219175, rs3745367 and rs1423096, to be synergistically associated with resistin levels. After adjusting for co-factors such as interferon λ-3 (IFNL3)-rs12979860, the resistin level and the hyper-resistinemic genotype at the 4 RETN SNPs were positively and negatively associated with a sustained virological response (SVR), respectively. RETN-rs3745367 was in linkage disequilibrium with IFNL3-rs12979860. Compared to non-SVR patients, SVR patients had higher levels of pre-therapy resistin, primarily originating from intrahepatic lymphocytes, stellate cells, Kupffer cells, hepatic progenitor cells and hepatocytes. This difference diminished over the course of therapy, as only SVR patients exhibited a 24-week post-therapy decrease in resistin. Both resistin and IFNL3 mRNAs were upregulated, but only resistin mRNA was upregulated by recombinant resistin in peripheral blood mononuclear cells with and without hyper-resistinemic genotypes of the 4 RETN SNPs, respectively. Fine-tuned by RETN SNPs, intrahepatic, multi-cellular resistin reinforced IFNL3 in eliminating HCV via immunomodulation to counteract pro-inflammation. These results encourage the development of novel resistin-targeted anti-viral agents.


Assuntos
Hepacivirus/imunologia , Hepatite C/genética , Hepatite C/imunologia , Interleucinas , Polimorfismo de Nucleotídeo Único , Resistina , Adulto , Feminino , Hepatite C/terapia , Humanos , Interferons , Interleucinas/genética , Interleucinas/imunologia , Masculino , Resistina/genética , Resistina/imunologia
12.
Medicine (Baltimore) ; 95(14): e3187, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27057845

RESUMO

We aimed to investigate the clinical characteristics of patients with herpes esophagitis (HE) based on endoscopic typing.Herpes simplex virus infection in the gastrointestinal tract primarily affects the esophagus. However, little is known about the presentation, endoscopic findings, and outcomes of HE.From 2003 to 2013, 47 patients with HE were identified histologically from among 1843 patients with esophageal ulcers. Personal data, underlying disease, esophagogastroduodenoscopy indication, endoscopic characteristics, pathological findings, laboratory data, and outcomes were collected. Endoscopic findings were classified into 3 types based on gross appearance and were correlated with clinical presentation.The mean age of patients was 62.04 ±â€Š14.76 years, and most patients were men (39/47, 83%). The most common symptoms were odynophagia/dysphagia (20/47, 42.6%). Whereas 25 patients (53.2%) were diagnosed with malignancy, it was related to human immunodeficiency virus in only 1 patient (2.1%). HE was classified into 3 types based on endoscopic images: type I (n = 19), type II (n = 10), and type III (n = 18). The majority of patients with HE type III had sepsis (72%) and obvious leukocytosis than the other 2 types (P = 0.03). The overall mortality rate was 6.4% (3/47), and most of the patients who died (66.7% [2/3]) belonged to the endoscopic classification type III group. Clinical parameters were analyzed for the risk of poor outcome. Postchemotherapy and/or radiotherapy were associated with 30-day mortality after appearance of HE (P < 0.05).Herpes esophagitis primarily affects men and patients with malignancy or sepsis. However, the disease is usually self-limiting, and HE-related mortality is low. Relationship between severity of endoscopic findings and patients' outcome remains questionable. Further prospective study is needed.


Assuntos
Esofagite/diagnóstico , Esofagite/virologia , Herpes Simples/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taiwan , Adulto Jovem
13.
Brain Res ; 1639: 132-48, 2016 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-26972528

RESUMO

Spinocerebellar ataxia type 17 (SCA17), an autosomal dominant cerebellar ataxia, is a devastating, incurable disease caused by the polyglutamine (polyQ) expansion of transcription factor TATA binding protein (TBP). The polyQ expansion causes misfolding and aggregation of the mutant TBP, further leading to cytotoxicity and cell death. The well-recognized prodromal phase in many forms of neurodegeneration suggests a prolonged period of partial neuronal dysfunction prior to cell loss that may be amenable to therapeutic intervention. The objective of this study was to assess the effects and molecular mechanisms of granulocyte-colony stimulating factor (G-CSF) therapy during the pre-symptomatic stage in SCA17 mice. Treatment with G-CSF at the pre-symptomatic stage improved the motor coordination of SCA17 mice and reduced the cell loss, insoluble mutant TBP protein, and vacuole formation in the Purkinje neurons of these mice. The neuroprotective effects of G-CSF may be produced by increases in Hsp70, Beclin-1, LC3-II and the p-ERK survival pathway. Upregulation of chaperone and autophagy levels further enhances the clearance of mutant protein aggregation, slowing the progression of pathology in SCA17 mice. Therefore, we showed that the early intervention of G-CSF has a neuroprotective effect, delaying the progression of SCA17 in mutant mice via increases in the levels of chaperone expression and autophagy.


Assuntos
Fator Estimulador de Colônias de Granulócitos/farmacologia , Fármacos Neuroprotetores/farmacologia , Sintomas Prodrômicos , Ataxias Espinocerebelares/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Apoptose/fisiologia , Autofagia/efeitos dos fármacos , Autofagia/fisiologia , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Proteínas de Choque Térmico HSP70/metabolismo , Camundongos Transgênicos , Proteínas Associadas aos Microtúbulos/metabolismo , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Células de Purkinje/efeitos dos fármacos , Células de Purkinje/patologia , Células de Purkinje/fisiologia , Ataxias Espinocerebelares/patologia , Ataxias Espinocerebelares/fisiopatologia
14.
Scand J Gastroenterol ; 51(3): 374-7, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26489709

RESUMO

BACKGROUND: Previous research shows that only 10-30% of gastrointestinal stromal tumors (GISTs) are malignant. Nonetheless, some reports suggest that all of them have some degree of potential for malignancy. Endoscopic ultrasonography (EUS) is a useful technique for differentiation of subepithelial lesions in the gastrointestinal tract. We explored EUS characteristics that might predict the malignancy potential of GISTs. METHODS: In this retrospective review of the medical records from 1999 through 2007, patients who had gastric stromal tumors diagnosed prior to surgery using EUS were enrolled. The EUS images, procedure records and tissue histopathology were reviewed. All patients were positive for C-kit. RESULTS: Of the 110 patients enrolled, 57 were males, and 53 were females. Most (67%) of the GISTs were located in the gastric body. The lesion size ranged from 6.3 to 150 mm (mean ± SD: 39.73 ± 22.49 mm). The high-risk GIST group had 19 (17.3%) patients, the intermediate-risk group had 12 (10.9%) patients and the low/very low-risk group had 79 (71.8%) patients. Thirty patients had cystic lesions (27.3%), while six patients had calcification in the lesion (5.5%). Additionally, 27 patients (24.5%) had surface ulceration visible on endoscopy. GISTs at high risk for malignancy were highly associated with lesion size (p < 0.0001), cystic change (p = 0.015) and surface ulceration (p = 0.036) but not with calcification (p = 0.667). We also found that mitosis was associated with lesion size (p < 0.0001) rather than other parameters. Age was not predictive of malignancy potential (p = 0.316). However, tumor size is the only one independent risk factor for malignancy (p ≤ 0.0001). CONCLUSIONS: The preliminary results show that large gastric GISTs with cystic change and surface ulceration may associate with a risk of malignancy, warranting more aggressive management. Nevertheless, the tumor size is more important than other factors.


Assuntos
Calcinose/diagnóstico por imagem , Endossonografia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Transformação Celular Neoplásica , Cistos/diagnóstico por imagem , Feminino , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Índice Mitótico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/cirurgia , Carga Tumoral
15.
Clin Chim Acta ; 450: 273-6, 2015 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-26344337

RESUMO

BACKGROUND: The use of blood-based tumor biomarkers for screening malignancies at early stages has significant advantages, including being convenient, automated, quantitative, objective, and relatively inexpensive compared with histology, endoscopy, and imaging. METHODS: We describe our 12-year experience on the diagnostic usefulness of a biomarker panel consisting of eight molecules (i.e., α-fetoprotein, carcinoembryonic antigen, prostate-specific antigen, CA 19-9, CA125, CA 15-3, squamous cell specific antigen, and cytokeratin 19 fragment) for cancer screening in Taiwanese subjects who underwent a health check-up examination at their own expenses. RESULTS: The sensitivity of the panel for the detection of specific cancers was higher than that of isolated cancer-specific markers. Specifically, the sensitivity of the panel for identifying the four most commonly diagnosed malignancies (i.e., liver cancer, lung cancer, prostate cancer, and colorectal cancer) was 90.9%, 75.0%, 100%, and 76.9%, respectively. The ability of the panel to detect early-stage (stage 1) hepatocellular carcinoma (HCC) or prostate cancer was similar to that observed for advanced malignancies. CONCLUSIONS: The multi-analyte biomarker panel is clinically useful during health check-up examinations for the screening of different tumors (especially for the early detection of HCC and prostate malignancies).


Assuntos
Biomarcadores Tumorais/sangue , Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias/sangue , Neoplasias/diagnóstico , Exame Físico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Gastroenterol Res Pract ; 2015: 564536, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26351451

RESUMO

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

17.
Dig Dis Sci ; 60(8): 2454-62, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25837597

RESUMO

BACKGROUND AND AIM: The purpose of this study was to estimate the sex- and age-specific incidence rates of inflammatory bowel diseases (IBD) in Taiwan. Site-specific cancer occurred in patients with IBD would be reported, too. METHODS: A retrospective study by analyzing the data from the National Health Insurance Research Database of Taiwan. RESULTS: Between 2000 and 2010, the overall incidence rate of Crohn's disease (CD) and ulcerative colitis (UC) was 0.208 and 0.838 per 100,000 person-years. For male, the incidence rate of CD was 0.195 (95 % CI 0.113-0.276) per 100,000 persons in 2000 and increased to 0.318 (95 % CI 0.216-0.421) per 100,000 persons in 2010. For female, the incidence rate of CD was 0.092 (95 % CI 0.035-0.149) per 100,000 persons in 2000 and increased to 0.210 (95 % CI 0.128-0.293) per 100,000 persons in 2010. For male, the incidence rate of UC was 0.690 (95 % CI 0.537-0.843) per 100,000 persons in 2000 and increased to 1.351 (95 % CI, 1.140-1.562) per 100,000 persons in 2010. For female, the incidence rate of UC was 0.386 (95 % CI 0.269-0.503) per 100,000 persons in 2000 and increased to 0.858 (95 % CI 0.691-1.024) per 100,000 persons in 2010. Among the CD patients, 0.19 % had colorectal cancers (1/519). Among the UC patients, 0.24 % had colorectal cancers (5/2098). CONCLUSIONS: This nationwide population-based longitudinal epidemiological study of IBD in Taiwan provides data for future global comparisons.


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Prevalência , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
18.
Biomed J ; 38(1): 65-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25163499

RESUMO

BACKGROUND: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by hepatocellular carcinoma-like histology. As details of this disease remain unknown, the aim of this study was to evaluate the clinicopathological features of GHA. METHODS: From January 2001 to December 2010, 4563 patients were diagnosed with primary gastric cancer at Chang Gung Memorial Hospital, Linkou Medical Center. Ten (0.22%) of these patients were diagnosed with GHA. The clinicopathological characteristics of these patients were collected retrospectively. RESULTS: The median age at diagnosis was 65.5 years, and six patients (60%) were male. Seven patients had lymph node metastasis and five had distant metastasis, with the liver as the most common site (four cases). Serum alpha-fetoprotein (AFP) levels were elevated in seven of eight patients (median: 359.2 ng/ml; range: 4.3-6535.6 ng/ml). Endoscopically, six tumors were classified as Borrmann's type III cancer with the appearance of fungating mass lesion with a purple, berry-like surface. Of the five patients without distant metastasis, all received curative-intent surgery and four received adjuvant chemotherapy. Four patients with distant metastasis received either palliative operation or chemotherapy, and one patient received neither operation nor chemotherapy due to a poor performance status. The median survival time was 7.2 months (range: 0.7-131.8 months), and the 5-year survival rate was 20%. There was survival benefit in the chemotherapy groups. CONCLUSIONS: GHA is a rare subtype of gastric cancer which is prone to lymph node and liver metastasis. Most GHAs appear as Borrmann's type III fungating mass lesion with a purple, berry-like surface. Although the prognosis of advanced stage GHA is poor, chemotherapy might provide some benefit.


Assuntos
Adenocarcinoma/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/terapia , Idoso , Quimioterapia Adjuvante/métodos , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/terapia , alfa-Fetoproteínas/metabolismo
19.
J Gastroenterol Hepatol ; 30(2): 329-36, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25091195

RESUMO

BACKGROUND AND AIM: Alterations of adipocytokine levels and clinical parameters in non-alcoholic fatty liver disease (NAFLD) are crucial for the prognosis and complications of the diseases. However, the key adipocytokines independently associated with NAFLD have not been identified, and we aimed to investigate them. METHODS: This study was conducted on a consecutive series of 210 Taiwanese NAFLD patients and 420 sex- and age-matched controls. Fatty liver was diagnosed by magnetic resonance spectroscopy. The enrolled subjects' body mass indexes, homeostasis model of assessment-insulin resistance, uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, blood pressure, metabolic syndrome (yes/no), alanine aminotransferase, aspartate aminotransferase-to-platelet ratio indexes, leptin, adiponectin, and plasminogen activator inhibitor-1 (PAI-1) levels were analyzed to determine their association with NAFLD. RESULTS: Univariate analysis showed that all of the aforementioned factors were associated with NAFLD, whereas multivariate analysis revealed that only PAI-1 (odds ratio: 1.39, P = 0.039) was independently associated with NAFLD. Subgroup analysis showed that females consistently had higher leptin (P < 0.001) and adiponectin (P < 0.001) levels than males, whereas their PAI-1 levels were similar. Males with NAFLD had higher leptin but lower adiponectin levels than their subgroup counterparts (all P < 0.001). Among the female subgroups, hyperleptinemia and hypoadiponectinemia were only observed in the NAFLD patients ≥ 45 years. CONCLUSIONS: PAI-1 is independently associated with NAFLD after adjusting for other factors, including leptin and adiponectin. Male and female NAFLD patients show distinct patterns of leptin and adiponectin alterations; special attention is required when evaluating these alterations in female NAFLD patients < 45 years.


Assuntos
Adiponectina/metabolismo , Leptina/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Caracteres Sexuais , Análise de Variância , Grupo com Ancestrais do Continente Asiático , Biomarcadores/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Prognóstico , Taiwan
20.
Chem Biol Interact ; 206(2): 319-26, 2013 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-24120544

RESUMO

A clear understanding of physicochemical factors governing nanoparticle toxicity is still in its infancy. We used a systematic approach to delineate physicochemical properties of nanoparticles that govern cytotoxicity. The cytotoxicity of fourth period metal oxide nanoparticles (NPs): TiO2, Cr2O3, Mn2O3, Fe2O3, NiO, CuO, and ZnO increases with the atomic number of the transition metal oxide. This trend was not cell-type specific, as observed in non-transformed human lung cells (BEAS-2B) and human bronchoalveolar carcinoma-derived cells (A549). Addition of NPs to the cell culture medium did not significantly alter pH. Physiochemical properties were assessed to discover the determinants of cytotoxicity: (1) point-of-zero charge (PZC) (i.e., isoelectric point) described the surface charge of NPs in cytosolic and lysosomal compartments; (2) relative number of available binding sites on the NP surface quantified by X-ray photoelectron spectroscopy was used to estimate the probability of biomolecular interactions on the particle surface; (3) band-gap energy measurements to predict electron abstraction from NPs which might lead to oxidative stress and subsequent cell death; and (4) ion dissolution. Our results indicate that cytotoxicity is a function of particle surface charge, the relative number of available surface binding sites, and metal ion dissolution from NPs. These findings provide a physicochemical basis for both risk assessment and the design of safer nanomaterials.


Assuntos
Apoptose/efeitos dos fármacos , Nanopartículas Metálicas/toxicidade , Elementos de Transição/química , Sítios de Ligação , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Humanos , Concentração de Íons de Hidrogênio , Nanopartículas Metálicas/química , Óxidos/química , Propriedades de Superfície
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