Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase-2 (COX-2) ...expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa-B (NF-κB), specificity protein 1 (Sp1), and c-Jun are known as the transcription factors of the
gene. This exploratory observational study investigated the association of the NF-κB, COX-2, Sp1, and c-Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF-κB (RelA/p65), COX-2, Sp1, and c-Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins' expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11-0.90;
= 0.032) or nuclear NF-κB (aHR = 0.22; 95% CI 0.07-0.66;
= 0.007) was independently associated with a better prognosis in the PDAC patients. COX-2, Sp1, and c-Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF-κB had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought.
Background: Pancreatic cancer is a very rare cancer with age-adjusted rates ranging from about 5 to 10 new cases per 100,000 persons per year. It has one of the worst prognoses of any type of cancer, ...with a 5-year survival rate of only 4.6%. Several risk factors have been identified, including older age, smoking, familial history of pancreatic cancer, obesity, chronic pancreatitis, diabetes mellitus, and alcohol consumption.Method: This was a descriptive study describing the risk factors of patients who were diagnosed with pancreatic cancer in the period between 1 January 2014 – 1 January 2019 at the Cipto Mangunkusumo National Referral Hospital (RSCM) Jakarta. Data were obtained from the medical records and Endoscopic Retrograde Cholangiopancreatography (ERCP) database from the RSCM Gastrointestinal Endoscopy Center.Results: From January 2014 to January 2019 there were 123 patients with newly diagnosed pancreatic cancer in RSCM. The mean age was 52 years old. The incidence of pancreatic cancer is more common in men (53%) than women (47%). The most common risk factor identified is smoking which was found in 29% of patients, followed by obesity at 27.9% and a history of diabetes mellitus at 19.5%. Risk factors with a fairly low prevalence include alcohol consumption at 9.7% and chronic pancreatitis at 2.4%. No family history of pancreatic cancer is identified in any subject.Conclusion: Smoking, obesity, and diabetes mellitus are common risk factors in pancreatic cancer patients. In contrast, chronic pancreatitis, alcohol consumption, and family history of pancreatic cancer are less commonly identified in patients.
Colorectal cancer (CRC) is a significant contributor to cancer-related morbidity and mortality. Biopsy remains the gold standard for CRC diagnosis, but invasive testing may not be preferred as an ...initial diagnostic procedure. Therefore, alternative non-invasive approaches are needed. Circulating tumor cells (CTC) present in the bloodstream have great potential as a non-invasive diagnostic marker for CRC patients. This study aimed to assess the diagnostic potential of CTC in CRC as an adjunctive diagnostic method using a subjective manual identification method and laser capture microdissection at 40x magnification.
A cross-sectional study was conducted on adult patients suspected to have CRC at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, between November 2020 and March 2021. CTC analysis was performed using the negative selection immunomagnetic method with Easysep™ and the CD44 mesenchymal tumor marker. The identification and quantification of CTC were conducted manually and subjectively, with three repetitions of cell counting per field of view at 40x magnification.
Of 80 subjects, 77.5% were diagnosed with CRC, while 7.5% and 15% exhibited adenomatous polyps and inflammatory/hyperplastic polyps, respectively. The diagnostic analysis of CTC for detecting CRC (compared to polyps) using a CTC cutoff point of >1.5 cells/mL suggested sensitivity, specificity, and positive predictive value (PPV) of 50%, 88.89%, and 93.94%. Additionally, the negative predictive value (NPV), as well as the positive and negative likelihood ratio (PLR and NLR) were 34.04%, 4.5, and 0.56, respectively. The subjective manual identification and quantification of CTC were performed at 40x magnification using laser capture microdissection.
This study assessed the diagnostic potential of CTC examination in CRC as an adjunctive diagnostic method using the subjective manual identification method and laser capture microdissection at 40x magnification. Despite the limitations associated with subjective cell counting, the results showed 50% sensitivity and 88.89% specificity in diagnosing CRC. Further studies are needed to optimize the manual identification process and validate the clinical utility of CTC analysis in CRC patients.
To provide consensus statements on the use of per-oral cholangiopancreatoscopy (POCPS).
A workgroup of experts in endoscopic retrograde cholangiopancreatography (ERCP), endosonography, and POCPS ...generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review.
Six consensus statements were generated: (1) POCPS is now an important additional tool during ERCP; (2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis; (3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail; (4) in patients with main duct intraductal papillary mucinous neoplasms (IPMN) POPS may be used to assess extent of tumor to assist surgical resection; (5) in difficult pancreatic ductal stones, POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and (6) additional indications for POCPS include selective guidewire placement, unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents.
POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for pre-operative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusual indications involving selective guidewire placement, assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.
Annona muricata, commonly known as soursop, contains annonacin, acetogenin, and polyphenol which are known to have chemopreventive effects on cancer. In this study, we tend to evaluate the ...apoptosis-inducing effect of soursop (Annona muricata) leaf extract on the colorectal cancer cell line COLO-205 through the activities of caspase-3 which is a marker of cell apoptosis. Cell cultures were incubated with soursop leaf with a concentration of 10 μg/ml and then compared with those of the incubated positive control leucovorin 10 μg/ml and placebo as a negative control. The apoptotic activity of caspase-3 was measured with ELISA. After the administration of each treatment in the colorectal cancer cell line COLO-205, the expression of caspase-3 activity was 1422 ng/ml after incubation with the extract of Annona muricata leaves, 1373 ng/ml after the administration of leucovorin, and 1297 ng/ml in the one with placebo. Annona muricata leaf extract elevated caspase-3 by 1.09 times compared to that of the pure cell line. Annona muricata leaf extract had a higher value of caspase-3 activity than leucovorin and placebo in the COLO-205 colorectal cancer cell line. These results may suggest that Annona muricata leaf extract had anticancer properties by enhancing caspase-3 activity which is a proapoptotic marker.
unresectable malignant distal biliary stricture patients require endoscopic biliary stent placement procedure. The survival rate and its associated factors in Indonesia are unknown.
To identify ...6-month survival of patients with malignant distal biliary stricture following endoscopic biliary stent procedure and its associated factors.
a retrospective cohort study was conducted using medical records of patients with unresectable malignant distal biliary stricture, which involved caput of pancreas, ampulla of Vater or distal cholangiocarcinoma following endoscopic biliary stent procedure between June 2015 and August 2017 at Cipto Mangunkusumo National Central General Hospital. The cumulative survival was defined by using the Kaplan-Meier curve. Bivariate and multivariate analyses were performed using Cox regression of some factors including failure of biliary stent insertion, bleeding, sepsis, comorbidities, malnutrition, and serum albumin levels.
out of total 120 subjects, 85 subjects died within 6 months following the stent procedure with a proportion of 180-day survival of 24% and a median survival of 81 days (CI 95%: 56-106 days). In bivariate analysis, factors of comorbidities, sepsis, malnutrition and albumin levels ≤ 3.0 g/dL had p values of < 0.25; while the subsequent multivariate analysis showed that albumin level of ≤ 3.0 g/dL had HR of 2.73 (CI 95%: 1.48 - 5.05; p = 0.001).
the 6-month survival following endoscopic biliary stent procedure is 24% with a median survival of 81 days. Albumin level of ≤ 3.0 g/dL has a 2.73 times greater risk for 6-month mortality rate.
Aims. To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD). Material and Methods. We conducted a retrospective study among 24 patients with ...malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents. Results. Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma. Conclusions. EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.
Dyspepsia still becomes a major challenge in upper gastrointestinal disease in Indonesia. This disease often correlated with Helicobacter pylori infection. However, the prevalence of this bacterium ...is generally low in Indonesia. Therefore, several considerations should be taken into consideration during the management of dyspepsia and H. pylori infection. "Management of dyspepsia and H. pylori infection in Indonesia: The Indonesian consensus report" comprises information gathered from 22 gastroenterology centers across Indonesia. The experts gathered to evolve a consensus, that consists of the statements, grades of recommendations, evidence levels, and rationales for the dyspepsia and H. pylori infection management for daily clinical practice. The report explains several aspects from the updated epidemiology information to comprehensive management therapy. After the experts worked together on all statements in the recommendations, the results are presented with the final agreement as a consensus to help clinicians in understanding, diagnosing, and treating dyspepsia and H. pylori infection patients in daily clinical practice in Indonesia.
This study investigated the prevalence of malnutrition and its risk factors in hospitalized adult nonsurgery patients at Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. A total of 210 ...patients were hospitalized from June to November 2013. Sociodemographic characteristics were collected at admission. Nutritional status was assessed at admission and discharge using subjective global assessment, anthropometric (body mass index, hand grip, and subcutaneous fat) and body impedance analyses, and albumin level. Only 176 patients completed the study. Prevalence of malnutrition was 65.5% and 70.1% at admission and discharge, respectively, and 65.9% of patients had no improvement in nutritional condition. Female patients or those with anemia or tuberculosis were at risk for nutritional worsening. Male patients or those with dyslipidemia had more improvement than others. The nutritional intake target was met in 89.3% patients, but their nutritional status did not change significantly. Nutritional status did not influence length of hospitalization, but patients with worsening nutritional status had an insignificantly longer hospitalization. It can be concluded that prevalence of hospital malnutrition is high at Dr. Cipto Mangunkusumo National General Hospital. Although the nutritional intake improved, the nutritional status at discharge did not change significantly from that at admission.
The World Health Organization (WHO) has declared COVID-19 as global pandemic since there are tremendous growing numbers of confirmed cases for SARS-C0V-2 infection, the number of affected countries ...and high mortality rate. The global COVID-19 pandemic also will affect various aspects of health care including endoscopic service. The Indonesian Society for Digestive Endoscopy (ISDE), which provides a scope for doctors who perform endoscopic procedures, has developed a clinical and procedural guideline that may serve as a reference for doctors performing gastrointestinal endoscopy in Indonesia.
PDF
