Main Recommendations
Patients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk ...stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent
Helicobacter pylori
gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up with a high quality endoscopy every 3 years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high quality endoscopic reassessment with CE is recommended. Patients with an endoscopically visible lesion harboring low or high grade dysplasia or carcinoma should undergo staging and treatment.
H. pylori
eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions, and it is recommended.
H. pylori
eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high risk regions, identification and surveillance of patients with precancerous gastric conditions is cost-effective.
Background
Gastric dysplasia is classified as adenomatous/type I (intestinal phenotype) and foveolar or pyloric/type II (gastric phenotype) according to morphological (architectural and cytological) ...features. The immunophenotypic classification of dysplasia, based on the expression of the mucins, CD10 and CDX2, recognizes the following immunophenotypes: intestinal (MUC2, CD10, and CDX2); gastric (MUC5AC and/or MUC6, absence of CD10, and absent or low expression of CDX2); hybrid (gastric and intestinal markers); and null.
Methods
Sixty-six cases of nonpolypoid epithelial dysplasia of the stomach were classified according to morphological features (histotype and grade) and immunophenotype. Immunohistochemical staining was performed with antibodies against MUC2, MUC5AC, MUC6, CD10, CDX2, chromogranin, synaptophysin, Ki-67, and TP53. HER2 alterations were analyzed by immunohistochemistry and silver-enhanced in situ hybridization.
Results
By conventional histology, dysplasia was classified as adenomatous/intestinal (
n
= 42; 64 %) and foveolar or pyloric/gastric (
n
= 24; 36 %) and graded as low grade (
n
= 37; 56 %) or high grade (
n
= 29; 44 %). Immunophenotypic classification showed intestinal (
n
= 22; 33.3 %), gastric (
n
= 25; 37.9 %), hybrid (
n
= 17; 25.8 %), or null (
n
= 2; 3.0 %) phenotypes. In 20 cases a coexistent intramucosal carcinoma was identified. The intestinal immunophenotype was shown to be significantly associated with low-grade dysplasia (
p
= 0.001), high expression of CDX2 (
p
= 0.015), TP53 (
p
= 0.034), synaptophysin (
p
= 0.003), and chromogranin (
p
< 0.0001); the gastric immunophenotype was significantly associated with high-grade dysplasia (
p
= 0.001), high Ki-67 proliferative index (
p
= 0.05), and coexistence of intramucosal carcinoma (
p
= 0.013).
HER2
amplification was observed in 3 cases, typed as gastric or hybrid.
Conclusions
Epithelial nonpolypoid dysplasia of the stomach with gastric immunophenotype shows features of biological aggressiveness and may represent the putative precursor lesion in a pathway of gastric carcinogenesis originated de novo from the native gastric mucosa, leading to gastric-type adenocarcinoma.
In this paper, we study inverse limits with one upper semi-continuous function which is the union of mappings. Using the concept of Dom(F), we give sufficient conditions so that, the inverse limit is ...either a continuum or a Cantor set.
Objective
To analyze the influence of the resting interval after removal of a double‐balloon for cervical ripening and oxytocin administration on the time to onset of active labor in singleton ...pregnancies.
Methods
A retrospective cohort study of women who required a cervical ripening with double‐balloon was conducted between January 2019 and December 2022. We collected data for cervical ripening balloon insertion and removal, oxytocin administration, suspicious or pathological cardiotocographic trace, mode of delivery, maternal and neonatal complications, neonatal outcomes. Proportional hazards model comparing resting interval between double‐balloon cervical ripening removal and oxytocin administration.
Results
A total of 403 singleton pregnancies were recruited and 213 pregnant women experienced a rest of 12 h between cervical balloon removal and oxytocin administration (resting group). Oxytocin was administered immediately after balloon removal in 190 women (non‐resting group). Median insertion‐to‐active labor interval and insertion‐to‐delivery interval were significantly shorter in the non‐resting group: 18.5 versus 24.0 h, HR 2.59 (CI 95%: 1.97–3.41) and 24.0 versus 29.0 h, HR 2.38 (CI 95%: 1.85–3.05) respectively. Bishop score change and mode of delivery between were similar in both groups. No differences in maternal nor neonatal complications between both groups were found.
Conclusions
Oxytocin administration immediately after removal of a double‐balloon for cervical ripening compared with 12 h delayed interval resulted in a shortened time from insertion to active labor onset and to delivery interval without increasing maternal or neonatal adverse outcomes.
Synopsis
In a retrospective study of 403 singleton pregnancies, administering oxytocin immediately after double‐balloon removal reduced labor onset time without increasing complications.
Irritable Bowel Syndrome: News from an Old Disorder Ferreira, Ana Isabel; Garrido, Mónica; Castro-Poças, Fernando
GE Portuguese journal of gastroenterology,
07/2020, Letnik:
27, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder, which can affect all members of a society, regardless of age, sex, race or socioeconomic status. Because of its high ...prevalence and chronic nature, it represents a significant economic burden. In fact, these patients have a relevant impairment of their quality of life, which limits their work productivity and daily social activities, especially when it is associated with other disorders, such as anxiety and depression. The diagnosis of IBS relies on symptom-based diagnostic criteria with normal results on a limited number of complementary tests that rule out other possible diagnoses. The aetiology of this condition is incompletely established. However, evidence suggests that it is a multifactorial disorder with several different mechanisms that have been implicated as responsible for the symptoms. Since the treatment strategy is usually based on predominant symptoms and their severity, it is important to recognise the underlying mechanisms in order to successfully relief the visceral pain and altered bowel habits. The aim of this non-systematic review of the literature was to explore the pathophysiology and treatment options of IBS, highlighting the most recent evidence, from the new Rome IV criteria to the new drug armamentarium.
•Bait controls the pest C. longicaudatum in libraries, archives, and museums.•Cost-efficiency is demonstrated by the low amount of bait and few work hours.•The small amounts of bait used to achieve ...control pose a low risk to human health.•Bait can easily be incorporated in existing conservation efforts and IPM approaches.
The problem of bristletail Ctenolepisma longicaudatum (Zygentoma: Lepismatidae) in libraries, archives, and museums is increasing. It can cause damage to valuable and irreplaceable objects. We describe the effect of the use of insecticidal gel bait (active ingredient: indoxacarb) against C. longicaudatum populations in three libraries, seven archives, and seven museums in Norway and Austria. Pest activity was monitored with sticky traps to evaluate the effect of bait application. Significant declines in pest populations were observed at all locations when small bait droplets were applied either systematically throughout the buildings or strategically close to suspected aggregations. In addition, bait was successfully used to prevent infestation in a new museum building. The cost of treatment, measured by the amount of bait and work hours spent, was low, and bait application was conducted by either the professional pest control technicians or the local integrated pest management (IPM) manager. The use of insecticidal gel bait and its secondary effects is a cost-efficient alternative for population decimation; moreover, the method has a low probability of negative health issues for employees at the treated localities or damage to the objects. The application of bait is discussed in relation to its alignment with other IPM methods in libraries, archives, and museums.
Abstract
Colitis-associated cancer is a major complication of inflammatory bowel disease remaining an important clinical challenge in terms of diagnosis, screening, and prognosis. Inflammation is a ...driving factor both in inflammatory bowel disease and cancer, but the mechanism underlying the transition from colon inflammation to cancer remains to be defined. Dysregulation of mucosal glycosylation has been described as a key regulatory mechanism associated both with colon inflammation and colorectal cancer development. In this review, we discuss the major molecular mechanisms of colitis-associated cancer pathogenesis, highlighting the role of glycans expressed at gut epithelial cells, at lamina propria T cells, and in serum proteins in the regulation of intestinal inflammation and its progression to colon cancer, further discussing its potential clinical and therapeutic applications.
Lay Summary
Colitis-associated cancer (CAC) is a major complication of inflammatory bowel disease and the molecular mechanisms underlying CAC progression are still elusive. Protein glycosylation holds a great promise for improving the understanding of CAC immunopathogenesis, opening new avenues for clinical and therapeutic interventions.
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