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Clinical and Translational... May 2024Circulating tissue transglutaminase immunoglobulin A concentration is a sensitive and specific indicator of celiac disease, but discrepancies between serologic and...
INTRODUCTION
Circulating tissue transglutaminase immunoglobulin A concentration is a sensitive and specific indicator of celiac disease, but discrepancies between serologic and histologic findings occur. We hypothesized that fecal markers of inflammation and protein loss would be greater in patients with untreated celiac disease than in healthy controls. Our study aims to evaluate multiple fecal and plasma markers in celiac disease and correlate these findings with serologic and histologic findings as noninvasive means of evaluating disease activity.
METHODS
Participants with positive celiac serologies and controls with negative celiac serologies were prospectively enrolled before upper endoscopy. Blood, stool, and duodenal biopsies were collected. Concentrations of fecal lipocalin-2, calprotectin, and alpha-1-antitrypsin and plasma lipocalin-2 were determined. Biopsies underwent modified Marsh scoring. Significance was tested between cases and controls, modified Marsh score and tissue transglutaminase immunoglobulin A concentration.
RESULTS
Lipocalin-2 was significantly elevated in the stool ( P = 0.006) but not the plasma of participants with positive celiac serologies. There was no significant difference in fecal calprotectin or alpha-1 antitrypsin between participants with positive celiac serologies and controls. Fecal alpha-1 antitrypsin >100 mg/dL was specific, but not sensitive for biopsy-proven celiac disease.
DISCUSSION
Lipocalin-2 is elevated in the stool but not the plasma of patients with celiac disease suggesting a role of local inflammatory response. Calprotectin was not a useful marker in the diagnosis of celiac disease. While random fecal alpha-1 antitrypsin was not significantly elevated in cases compared with controls, an elevation of greater than 100 mg/dL was 90% specific for biopsy-proven celiac disease.
Topics: Humans; Celiac Disease; Female; Biomarkers; Male; Child; alpha 1-Antitrypsin; Leukocyte L1 Antigen Complex; Feces; Lipocalin-2; Transglutaminases; Prospective Studies; Child, Preschool; Immunoglobulin A; Protein Glutamine gamma Glutamyltransferase 2; GTP-Binding Proteins; Adolescent; Duodenum; Biopsy; Case-Control Studies; Lipocalins; Acute-Phase Proteins; Inflammation
PubMed: 38483287
DOI: 10.14309/ctg.0000000000000695 -
Acute Medicine & Surgery 2024Cardiopulmonary resuscitation is essential for cardiopulmonary arrest, but complications from chest compressions warrant monitoring. Although rib and sternal fractures...
BACKGROUND
Cardiopulmonary resuscitation is essential for cardiopulmonary arrest, but complications from chest compressions warrant monitoring. Although rib and sternal fractures are common, abdominal injuries are rare, and splenic injuries are much rarer.
CASE PRESENTATION
A 74-year-old man was admitted to the emergency room with a hemorrhagic duodenal ulcer. During hospitalization, the patient went into cardiopulmonary arrest due to hemorrhagic shock. Spontaneous circulation returned after 7 min of cardiopulmonary resuscitation. He underwent transcatheter arterial embolization to stop the bleeding from the duodenal ulcer. The next day, a close examination of the patient's progressive anemia revealed splenic injury; transcatheter arterial embolization was performed to save his life.
CONCLUSION
It is important to consider the complication of splenic injury in patients with cardiopulmonary arrest who have undergone appropriate cardiopulmonary resuscitation. A possible mechanism-especially in patients with a full stomach-is the squeezing of the spleen by the diaphragm, abdominal wall, and stomach.
PubMed: 38481627
DOI: 10.1002/ams2.940 -
Case Reports in Gastroenterology 2024Solid organ malignancies rarely metastasize to the duodenal papilla. We describe a case of primary lung cancer with duodenal papillary metastasis in a patient who...
INTRODUCTION
Solid organ malignancies rarely metastasize to the duodenal papilla. We describe a case of primary lung cancer with duodenal papillary metastasis in a patient who presented with melena. To the best of our knowledge, this is only the second report of duodenal papillary metastasis from lung cancer.
CASE PRESENTATION
A 65-year-old woman presented with complaints of anorexia, weight loss, and black stool. Imaging studies led to a clinical diagnosis of stage IVB lung cancer, and anticoagulants were initiated to treat pulmonary artery thrombosis. However, endoscopic hemostasis was challenging because of bleeding from a duodenal papillary tumor. Fortunately, the patient was positive for the plasma epidermal growth factor receptor (EGFR) gene mutation, and osimertinib, an EGFR tyrosine kinase inhibitor, was administered, successfully achieving hemostasis. Subsequently, endoscopic ultrasonography-guided transbronchial needle aspiration of an enlarged mediastinal lymph node and duodenal papillary tumor biopsy confirmed duodenal papillary metastasis of the primary lung adenocarcinoma.
CONCLUSION
Although duodenal papillary metastasis is extremely rare, a good clinical outcome was achieved in this case by considering duodenal papillary metastasis from lung cancer as the differential diagnosis and administering systemic osimertinib therapy.
PubMed: 38476646
DOI: 10.1159/000537778 -
Nutrients Mar 2024The diagnosis of celiac disease (CD) is complex and requires a multi-step procedure (symptoms, serology, duodenal biopsy, effect of a gluten-free diet, and optional...
The diagnosis of celiac disease (CD) is complex and requires a multi-step procedure (symptoms, serology, duodenal biopsy, effect of a gluten-free diet, and optional genetic). The aim of the study was to contribute to the improvement of CD diagnosis by preparing a water-soluble gluten peptide fraction (called Solgluten) and by selecting gluten-specific enzyme-linked immunosorbent assays (ELISA) for the detection of gluten immunogenic gluten peptides (GIPs) in urine and blood serum spiked with Solgluten. Food-grade Solgluten was prepared by the extraction of a peptic digest of vital gluten with water, centrifugation, and freeze-drying. The process was relatively easy, repeatable, and cheap. The content of gliadin-derived GIPs was 491 mg/g. Solgluten was used as antigenic material to compare two competitive ELISA kits (R7021 and K3012) and two sandwich ELISA kits (M2114 and R7041) in their quality regarding the quantitation of GIPs in urine and blood serum. The quality parameters were the reactivity, sensitivity, coefficients of variation and determination, and curve shape. The evaluation of the kits showed a number of discrepancies in individual quality parameters measured in urine and serum. Due to the lowest limit of quantitation and the highest coefficient of determination, M2114 may be the first choice, while R7021 appeared to be less suitable because of the high coefficients of variation and unfavorable curve progression. The results set the stage for improving CD diagnosis by supplementing conventional blood tests with oral provocation with Solgluten and subsequent ELISA measurement of GIPs that could support the no-biopsy approach and by better assessing the effect of a gluten-free diet by monitoring adherence to the diet by measuring GIPs in urine and blood.
Topics: Humans; Glutens; Celiac Disease; Diet, Gluten-Free; Enzyme-Linked Immunosorbent Assay; Peptides; Gliadin
PubMed: 38474870
DOI: 10.3390/nu16050742 -
Animals : An Open Access Journal From... Mar 2024This study aimed to investigate the interactions between corn particle size (PS) and conditioning temperature (CT) on the performance, carcass traits, intestinal...
This study aimed to investigate the interactions between corn particle size (PS) and conditioning temperature (CT) on the performance, carcass traits, intestinal morphology, and immune responses in broilers fed a corn-soybean meal-based diet. A total of 360 one-day-old male broiler chicks (Ross 308) were randomly allocated into six dietary treatments in a 2 × 3 factorial arrangement, consisting of two corn PS (finely ground with geometric mean diameter (GMD) of 357 µm (PS) vs. coarsely ground corn with GMD of 737 µm (PS), and three CT [unconditioned (CT), conditioned at 75 °C (CT) and 90 °C (CT)]. Birds were accommodated in 30 pens with five replicates and 12 chicks per each pen. There was no interaction between corn PS and CT on the growth performance and immune response of broilers at any growth phases. However, during the starter (0-10 days) period, the average daily weight gain (ADWG) and feed conversion ratio (FCR) of PS-fed birds were significantly improved compared to those fed PS ( < 0.05). During the starter (0-10 days) and grower (11-24 days) periods, increasing the conditioning temperature of corn increased the ADWG, while in the starter phase only the CT caused a lower FCR ( < 0.05). Broilers fed PS corn showed the lowest FCR during the finisher (25-42 days) period compared to those fed PS ( < 0.05). Conditioning corn at 75 °C reduced FCR during the finisher (25-42 days) period compared to the birds fed CT and CT corn ( < 0.05). In whole experimental periods (1-42 days), PS and CT treatment increased the ADWG compared to the PS and CT ( < 0.05). The CT treatment improved primary total anti-sheep red blood cell (SRBCs) titer (IgT) and IgM and secondary IgT and IgG responses compared to the other experimental groups (CT and CT) ( < 0.05). No significant PS × CT interaction was found on the Newcastle disease (ND) antibody titer of broiler chickens ( > 0.05). Feeding CT corn reduced duodenum and jejunum relative lengths compared to the birds fed diets containing CT corn. Significant PS × CT interactions ( < 0.05) were observed for villus height, villus height to crypt depth, crypt depth, muscle thickness, and absorption surface area of the jejunum. The highest carcass yield was observed in the PS-CT group ( < 0.05). In conclusion, the use of finely ground corn (PSF) conditioned at 75 °C (CT75) was beneficial to growth performance, development of the digestive tract, jejunum histomorphometry and the immune responses of broilers.
PubMed: 38473202
DOI: 10.3390/ani14050818 -
ACG Case Reports Journal Mar 2024Gastric extranodal NK/T-cell lymphoma (ENKTL) is a rare presentation of a rare disease. We report a 33-year-old woman presenting with epigastric pain, nausea, and...
Gastric extranodal NK/T-cell lymphoma (ENKTL) is a rare presentation of a rare disease. We report a 33-year-old woman presenting with epigastric pain, nausea, and vomiting. Endoscopic examination revealed gastric and duodenal ulceration. Biopsy of the ulcers revealed ENKTL. The patient began treatment, but developed hemorrhagic shock from her ulcers and died. Gastric ENKTL is a rare disease that presents with gastric ulceration. It has a high rate of mortality, and treatment is challenging because of its aggressive nature and lack of high-quality data to guide therapy.
PubMed: 38425941
DOI: 10.14309/crj.0000000000001280 -
Experimental and Therapeutic Medicine Apr 2024The primary objective of the present study was to investigate the efficacy and safety of endoscopic therapy for acute obstructive suppurative cholangitis (AOSC) in...
The primary objective of the present study was to investigate the efficacy and safety of endoscopic therapy for acute obstructive suppurative cholangitis (AOSC) in patients with different underlying conditions. The present study comprised 47 patients diagnosed with AOSC, with a mean age of 70±14 years. Minimally invasive endoscopic treatments, including endoscopic duodenal papillary sphincterotomy, endoscopic duodenal nasobiliary drainage and/or placement of an endobiliary duct stent drainage tube, were performed. Variations in the levels of the white blood cell count, liver function, procalcitonin (PCT) and carbohydrate antigen-199 (CA199) were examined, compared and evaluated both prior to and following endoscopic retrograde cholangiopancreatography (ERCP). Among the 47 patients, 45 had a high fever, although their body temperature returned to normal after 7 days of ERCP treatment. The infection was difficult to control completely in two cases, including one case of biliary anastomosis secondary tumor with stenosis and AOSC and another case of an elderly patient with multiple choledocholithiasis complicated with sepsis. Within 7 days following treatment, the abdominal pain was resolved in 27 patients and jaundice subsided in 29 patients. On the 7th day after endoscopic treatment, the blood leukocyte, liver function, PCT and CA-199 parameters of all patients were significantly improved compared with those at admission. A total of 35 bile cultures yielded positive results, with accounting for 11 cases (31.4%), accounting for 7 cases (20%), accounting for 5 cases (14.3%), accounting for 4 cases (11.4%) and other strains making up the remaining 17 cases. No serious complications were encountered with these patients, such as perforation, bleeding, severe pancreatitis or mortality, following ERCP. In conclusion, ERCP has been shown to be a safe and effective minimally invasive treatment method for elderly patients with AOSC, yielding a high rate of success.
PubMed: 38414791
DOI: 10.3892/etm.2024.12416 -
Korean Journal of Radiology Mar 2024We aimed to investigate whether 2-[F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[F]FDG PET/CT) can aid in evaluating the risk of...
OBJECTIVE
We aimed to investigate whether 2-[F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy.
MATERIALS AND METHODS
This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test.
RESULTS
The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in early-phase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy.
CONCLUSION
Adding 2-[F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.
Topics: Humans; Male; Female; Middle Aged; Aged; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Radiopharmaceuticals; Retrospective Studies; Ampulla of Vater; Tomography, X-Ray Computed; Common Bile Duct Neoplasms; Positron-Emission Tomography; Endoscopy
PubMed: 38413109
DOI: 10.3348/kjr.2023.0295 -
Biomedicines Feb 2024Systemic inflammation in chronic kidney disease (CKD) is associated (as a cause or effect) with intestinal barrier dysfunction and increased gut permeability, with...
BACKGROUND
Systemic inflammation in chronic kidney disease (CKD) is associated (as a cause or effect) with intestinal barrier dysfunction and increased gut permeability, with mechanisms not yet fully understood. This study investigated different parameters of the intestinal barrier in CKD patients, especially tight junction (TJ) proteins and their possible association with systemic endotoxemia and inflammation.
METHODS
Thirty-three patients with stage I-IV CKD (n = 17) or end-stage kidney disease (ESKD) (n = 16) and 11 healthy controls underwent duodenal biopsy. Samples were examined histologically, the presence of CD3+ T-lymphocytes and the expression of occludin and claudin-1 in the intestinal epithelium was evaluated by means of immunohistochemistry, circulating endotoxin concentrations were determined by means of ELISA and the concentrations of the cytokines IL-1β, IL-6, IL-8, IL-10 and TNF-α in serum were measured using flow cytometry.
RESULTS
Patients with stage I-IV CKD or ESKD had significantly higher serum endotoxin, IL-6, IL-8 and IL-10 levels compared to controls. Intestinal occludin and claudin-1 were significantly decreased, and their expression was inversely correlated with systemic endotoxemia. Regarding occludin, a specific expression pattern was observed, with a gradually increasing loss of its expression from the crypt to the tip of the villi.
CONCLUSION
The expression of occludin and claudin-1 in enterocytes is significantly reduced in patients with CKD, contributing to systemic endotoxemia and inflammatory responses in these patients.
PubMed: 38397970
DOI: 10.3390/biomedicines12020368 -
Langenbeck's Archives of Surgery Feb 2024Anomalies of the right hepatic artery (RHA) may represent an additional challenge in pancreatoduodenectomy (PD). The aim of this study is to assess the potential impact...
Anomalies of the right hepatic artery in periampullary cancer treatment: are pathological and clinical outcomes different? A single tertiary referral center retrospective analysis.
PURPOSE
Anomalies of the right hepatic artery (RHA) may represent an additional challenge in pancreatoduodenectomy (PD). The aim of this study is to assess the potential impact of variations in hepatic arterial anatomy on perioperative outcomes.
METHODS
PDs performed for periampullary malignancies between 2017 and 2022 were retrospectively enrolled and subdivided in two groups: modal pattern of vascularization (MPV) and anomalous pattern of vascularization (APV). A propensity score matching (PSM) analysis was conducted to homogenize the two study populations. The two groups were then compared in terms of perioperative outcomes and pathological findings.
RESULTS
Thirty-eight patients (16.3%) out of 232 presented a vascular anomaly: an accessory RHA in 7 cases (3%), a replaced RHA in 26 cases (11.2%), and a replaced HA in 5 cases (2.1%). After PSM, 76 MPV patients were compared to the 38 APV patients. The incidence rate of postoperative complications was comparable between the two study populations (p=0.2). Similarly, no difference was detected in terms of histopathological data, including margin status. No difference was noted in terms of intraoperative hemorrhage and vascular resection.
CONCLUSION
When PDs are performed in high-volume centers, the presence of an APV of the RHA does not relate to a significant impact on perioperative complications. Moreover, no influence was noted on histopathological findings.
Topics: Humans; Hepatic Artery; Retrospective Studies; Tertiary Care Centers; Pancreaticoduodenectomy; Duodenal Neoplasms
PubMed: 38393349
DOI: 10.1007/s00423-024-03263-6