ABSTRACT
Background/Aims@#Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA. @*Methods@#We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology. @*Results@#We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications. @*Conclusions@#EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.
ABSTRACT
Abstract The present work aims to investigate the antiparasitic and the immunomodulating effects of nitazoxanide (NTZ) and ivermectin (IVC) alone or combined together or combined with selenium (Se), on Cryptosporidium infection in diabetic mice. The results revealed that the combined NTZ and IVC therapy achieved the highest reduction of fecal oocysts (92%), whereas single NTZ showed the lowest reduction (63%). Also, adding Se to either NTZ or IVC resulted in elevation of oocyst reduction from 63% to 71% and from 82% to 84% respectively. All treatment regimens, with the exception of NTZ monotherapy, showed a significant improvement in the intestinal histopathology, the highest score was in combined NTZ and IVC therapy. The unique results of immunohistochemistry in this study showed reversal of the normal CD4/CD8 T cell ratio in the infected untreated mice, however, following therapy it reverts back to a normal balanced ratio. The combined (NTZ+ IVC) treatment demonstrated the highest level of CD4 T cell expression. Taken together, NTZ and IVC combined therapy showed remarkable anti-parasitic and immunostimulatory effects, specifically towards the CD4 population that seem to be promising in controlling cryptosporidiosis in diabetic individuals. Further research is required to explore other effective treatment strategies for those comorbid patients.
Resumo O presente trabalho tem como objetivo investigar os efeitos anti-parasitários e imunomodulantes da nitazoxanida (NTZ) e ivermectina (IVC), isoladas ou em associação, e do selênio (SE), associado à NTZ ou à IVC, sobre a infecção por Cryptosporidium em camundongos diabéticos. Os resultados revelaram que a terapia combinada com NTZ e IVC resultou em maior redução de oocistos fecais, enquanto a NTZ isolada mostrou a menor redução de oocistos fecais (63%). Além disso, a associação do SE com a NTZ ou IVC resultou em redução do número de oocistos fecais de 63% para 71% e de 82% para 84%, respectivamente. Todos os tratamentos, com exceção da monoterapia com NTZ, mostraram uma melhora significativa nos índices relacionados à histopatologia intestinal. Os resultados da imuno-histoquímica mostraram reversão da razão celular CD4/CD8 T normal nos camundongos infectados não tratados, no entanto, após a terapia, houve retorno à razão celular CD4/CD8 T normal. O tratamento combinado (NTZ+ IVC) demonstrou o mais alto nível de expressão celular CD4 T. Em conclusão, a terapia combinada com NTZ e IVC mostrou efeitos anti-parasitários e imunoestimuladores notáveis, especificamente para a população CD4, que parecem ser promissores para o controle da criptosporidiose em indivíduos diabéticos.
Subject(s)
Animals , Rabbits , Rodent Diseases , Selenium/therapeutic use , Cryptosporidiosis/drug therapy , Cryptosporidium , Diabetes Mellitus, Experimental/drug therapy , Thiazoles , Ivermectin/therapeutic use , Nitro Compounds , Antiparasitic Agents/therapeutic useABSTRACT
Liver biopsy is the gold standard for assessment of hepatic fibrosis. However, it is invasive with possible complications, costly and prone to sampling errors. Many non-invasive markers of liver fibrosis have been recently proposed and assessed in the clinical setting as surrogates of liver biopsy. Although several non invasive markers of liver fibrosis have been developed in the last decade their implementation in clinical practice has been slow and is still limited. This study aimed to describe the different non invasive markers and methods that have been proposed for the assessment of liver fibrosis, to discuss their advantages and limits and to suggest a rational use in clinical practice. This study included 40 patients with chronic liver disease, 21 of chronic hepatitis C [CHC] as group I, and 19 patients with liver cirrhosis [group 11] as well as 20 healthy subjects with age and sex matched was enrolled as control group. Serum levels of tissue inhibitor of metalloproteinase- 1 [TIMP-I], laminin and cystatin C were measured and correlate with laboratory and histological findings. This study revealed that, significantly elevated serum level of cystatin C in CHC [group I] and cirrhotic patients [group II] than healthy controls [p<0.001] for each. Moreover, cystatin C concentrations were significantly higher in patients with liver cirrhosis [p<0.01] than in patients with CHC. Furthermore, serum cystatin C levels correlated significantly with the stage of liver fibrosis [p<0.01] but revealed no significant difference with the grade of necroinflammation of the disease process [p>0.05]. However, serum TIMP-1 values showed a significant increase in group I and 11 patients than in controls. Serum TIMP-1 levels correlated significantly with both the stage of fibrosis [p<0.05] and the grade of activity [p<0.01]. Serum larninin levels showed significant increase in patients with chronic hepatitis and liver cirrhosis than controls [p<0.001]. While, no significant difference of on comparing chronic hepatitis patients with control group [p>0.05]. Also, serum laminin levels showed a significant correlation with fibrosis stage [p<0.001] but not with inflammatory grade [p>0.05]. Based on available evidence, it can be anticipated that non-invasive markers of liver fibrosis [cystatin C, TIMP-1 and laminin] and their combined use will soon become a most useful tool in the clinical management of many forms of chronic liver disease. However, their implementation is expected to reduce, but not to completely eliminate, the need for liver biopsy