المؤلفون: Björn-Ole Stüben, Gabriel A. Plitzko, Julia Sauerbeck, Philipp Busch, Nathaniel Melling, Matthias Reeh, Jakob R. Izbicki, Thomas Rösch, Kai Bachmann, Michael Tachezy

المصدر: Scientific Reports, Vol 13, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract To determine whether a new surgical method using a flexible endoscope (FlexVATS) to perform sparing debridement and apply negative-pressure therapy without extensive decortication may be an alternative treatment option for empyema. Surgical treatment of pleural empyema is associated with considerable postoperative complications and mortality rates, and alternative treatment options are being explored to improve patient outcomes. This was a prospective case series. Seventeen consecutive patients treated with FlexVATS between February 2021 and August 2022 were included in the study. Only patients for whom FlexVATS was the first therapeutic intervention for pleural empyema were included. Treatment success, defined as infection resolution, was the primary endpoint of the study. The secondary endpoints were length of hospital stay, 90-day mortality, and empyema cavity volume reduction. Patients who had previously been treated for pleural empyema by either drainage or surgery were excluded. The trial was performed as a single-centre study at a tertiary medical centre in Germany. In total, 17 patients with pleural empyema were included in the study. The median (IQR) duration of vacuum treatment was 15 days (8–35 days). Twelve of the 17 (71%) patients were successfully treated, and a significant reduction in the empyema cavity volume was observed. 41% of the dressing changes were performed outside the operating room. Compared with a historic cohort of conventionally treated patients (decortication via VATS or thoracotomy), the 90-day mortality rates tended to be lower without reaching statistical significance. Three patients (18%) died in hospital during treatment. No negative pressure-therapy-related complications were observed. FlexVATS therapy is a promising alternative therapy for both healthy and debilitated patients with pleural empyema. Larger randomised trials are required to validate this treatment option.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/3952b185a26040fa90e7b54416bea1edTest

المؤلفون: Marcus Kantowski, Karl Karstens, Pasquale Scognamiglio, Nathaniel Melling, Matthias Reeh, Jakob Izbicki, Thomas Rösch, Michael Tachezy

المصدر: Scientific Reports, Vol 12, Iss 1, Pp 1-9 (2022)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract After gastrointestinal resections, leakages can occur, persist despite conventional therapy and result in enterocutaneous fistulae. We developed a combination method using flexible endoscopic techniques to seal the enteric orifice with an absorbable plug in addition to a percutaneously and fistuloscopically guided open-pore film drainage (Vac-Plug method). We retrospectively searched our endoscopy database to identify patients treated with the outlined technique. The clinical and pathological data were assessed, the method analyzed and characterized and the technical and clinical success determined. We identified 14 patients that were treated with the Vac-Plug method (4 females, 10 males with a mean age of 56 years, range 50–74). The patients were treated over a time period of 23 days (range 4–119) in between one to thirteen interventions (mean n = 5). One patient had to be excluded due to short follow-up after successful closure. Seventy-seven percent (10/13) were successfully treated with a median follow-up of 453 days (range 35–1246) thereafter. No treatment related complications occurred during the therapy. The data of the analysis showed that the Vac-Plug therapy is safe and successful in a relevant proportion of the patients. It is easy to learn and to apply and is well tolerated. In our opinion, it is a promising addition to the armamentarium of interventional methods of these difficult to treat patients. Of course, its usefulness must be further validated in larger prospective studies.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/5389ed4caaf04c74a61fa3cfd39aaeb3Test

المؤلفون: Moritz Schmelzle, Christian Benzing, Lutz Fischer, Uta Herden, Martina Sterneck, Utz Settmacher, Astrid Bauschke, Ulf Neumann, Uwe Pelzer, Tobias Müller, Christian Strassburg, Hauke Lang, Thomas Becker, Alfred Königsrainer, Silvio Nadalin, Markus Quante, Andreas Paul, Helmut Friess, Jürgen Klempnauer, Nicolas Richter, Florian Vondran, Andreas Pascher, Thomas Rösch, Wenzel Schöning, Felix Krenzien, Robert Öllinger, Daniel Seehofer, Peter Neuhaus, Johann Pratschke

المصدر: Frontiers in Oncology, Vol 12 (2022)

مصطلحات موضوعية: perihilar and intrahepatic cholangiocarcinoma, klatskin tumor, adjuvant chemotherapy, gemcitabine, liver transplantation, proximal bile duct cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: BackgroundLiver transplantation (LT) is considered a therapeutic option for unresectable perihilar cholangiocarcinoma (PHC) within defined criteria. It remains uncertain whether patients can safely receive adjuvant chemotherapy after LT.MethodsWe performed a prospective, multi-center, randomized, non-blinded two-arm trial (pro-duct001). Patients after LT for unresectable PHC within defined criteria were randomized to adjuvant gemcitabine (LT-Gem group) and LT alone (LT alone group). The primary objective was to investigate if adjuvant chemotherapy is feasible in ≥ 85% of patients after LT. The primary endpoint was the percentage of patients completing the 24 weeks course of adjuvant chemotherapy. Secondary endpoints included overall survival (OS) and disease-free (DFS), and complication rates.ResultsTwelve patients underwent LT for PHC, of which six (50%) were eligible for randomization (LT-Gem: three patients, LT alone: three patients). Two out of three patients discontinued adjuvant chemotherapy after LT due to intolerance. The study was prematurely terminated due to slow enrollment. One patient with PHC had underlying primary sclerosing cholangitis (PSC). Tumor-free margins could be achieved in all patients. In both the LT-Gem and the LT alone group, the cumulative 1-, 3-, and 5-year OS and DFS rates were 100%, 100%, 67%, and 100%, 67% and 67%, respectively.ConclusionsThis prospective, multi-center study was prematurely terminated due to slow enrollment and a statement on the defined endpoints cannot be made. Nevertheless, long-term survival data are consistent with available retrospective data and confirm defined criteria for LT. Since more evidence of LT per se in unresectable PHC is urgently needed, a prospective, non-randomized follow-up study (pro-duct002) has since been launched.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fonc.2022.910871/fullTest; https://doaj.org/toc/2234-943XTest

الوصول الحر: https://doaj.org/article/dda7e6df87b24095bfb1ff2330e13f29Test

المؤلفون: Michael Tachezy, Seung-Hun Chon, Isabel Rieck, Marcus Kantowski, Hildegard Christ, Karl Karstens, Florian Gebauer, Tobias Goeser, Thomas Rösch, Jakob R. Izbicki, Christiane J. Bruns

المصدر: Trials, Vol 22, Iss 1, Pp 1-10 (2021)

مصطلحات موضوعية: Self-expanding metal stents, Endoscopic vacuum therapy, Anastomotic leaks, Esophagectomy, Esophageal cancer, Interventional endoscopy, Medicine (General), R5-920

الوصف: Abstract Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244 . Registered on May 23, 2019. DRKS-ID DRKS00007941

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1745-6215Test

الوصول الحر: https://doaj.org/article/ee899964c54747bf821bba43e7d3968eTest

المؤلفون: Julia K. Grass, Natalie Küsters, Fabien L. von Döhren, Nathaniel Melling, Tarik Ghadban, Thomas Rösch, Marcel Simon, Jakob R. Izbicki, Alexandra König, Matthias Reeh

المصدر: Cancers, Vol 14, Iss 5, p 1220 (2022)

مصطلحات موضوعية: esophageal cancer, respiratory–digestive tract fistula, tracheoesophageal fistula, tracheobronchial fistula, esophagorespiratory fistula, management strategies, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: Respiratory–digestive tract fistulas are fatal complications that occur in esophageal cancer treatment. Interdisciplinary treatment strategies are still evolving, especially in anatomical treatment stratification. Thus, this study aims to evaluate general therapeutic strategies for this rare condition. Medical records were reviewed for esophageal cancer-associated respiratory–digestive tract fistula patients treated between January 2008 and September 2021. Fistulas were classified according to being surgery- and tumor-associated. Treatment strategies, clinical success, and survival were analyzed. A total of 51 patients were identified: 28 had tumor-associated fistulas and 23 surgery-associated fistulas. Risk factors for fistula development such as radiation (OR = 0.290, p = 0.64) or stent implantation (OR = 1.917, p = 0.84) did not correlate with lack of symptom control for RDF patients. In contrast, advanced lymph node metastasis as another risk factor was associated with persistent symptoms after treatment for RDF patients (OR = 0.611, p = 0.01). Clinical success significantly correlated with bilateral fistula repair in surgery-associated fistulas (p = 0.01), while tumor-associated fistulas benefited the most from non-surgical (p = 0.04) or combined surgical and non-surgical intervention (p = 0.04) and a bilateral fistula repair (p = 0.02) in terms of overall survival. The therapeutic strategy should aim for bilateral fistula closure. A multidisciplinary, stepwise approach might have the best chance for restoration or symptom control with optimized overall survival in selected patients.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2072-6694/14/5/1220Test; https://doaj.org/toc/2072-6694Test

الوصول الحر: https://doaj.org/article/4aec2dae4eb447929dc80f621a56a295Test

المؤلفون: Marcus Hollenbach, Christiane Prettin, Felix Gundling, Wolfgang Schepp, Jochen Seufert, Jürgen Stein, Thomas Rösch, Jens Aberle, Jürgen Feisthammel, David Petroff, Albrecht Hoffmeister

المصدر: BMC Gastroenterology, Vol 18, Iss 1, Pp 1-8 (2018)

مصطلحات موضوعية: Obesity, Endoscopy, Diabetes, Weight loss, Intragastric balloon, Bypass liner, Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Abstract Background Obesity is a global problem leading to reduced life expectancy, cardiovascular diseases, diabetes and many types of cancer. Even people willing to accept treatment only achieve a mean weight loss of about 5 kg using commercial weight loss programs. Surgical interventions, e.g. sleeve gastrectomy or gastric bypass are effective but accompanied by risk of serious complications and side effects. Less invasive endoscopic procedures mainly comprise the intragastric balloon (IB) and the duodenal-jejunal bypass liner (DJBL). To date, a randomized comparison between these devices has not been undertaken or shown to be superior to a sham procedure. Methods We designed a multi-center, randomized, patient and assessor-blinded, controlled trial comparing weight loss in endoscopically implanted IB vs. DJBL vs. a sham procedure. A total of 150 patients with a BMI > 35 kg/m2 or > 30 with obesity-related comorbidities and indication for proton pump inhibitors are randomized to receive either IB, DJBL or a sham gastroscopy (2:2:1 ratio). All participants undergo regular dietary consultation. The IB will be removed after 6 months, whereas the DJBL will be explanted after 12 months. All patients will receive gastroscopies at implantation and explantation of the devices or sedation without gastroscopy to maintain blinding. Main exclusion criteria are malignant diseases, peptic ulcer or previous bariatric intervention. Weight loss 12 months after explantation of the devices, changes in comorbidities, quality of life, complication rates and safety will be evaluated. Discussion This trial could help to identify the most effective and safest endoscopic device, thus determining the new standard procedure for endoscopic bariatric treatment. Trial registration 16th January 2017. DRKS00011036. Funded by the German Research Foundation (DFG).

وصف الملف: electronic resource

العلاقة: http://link.springer.com/article/10.1186/s12876-018-0838-3Test; https://doaj.org/toc/1471-230XTest

الوصول الحر: https://doaj.org/article/c966748d8f3349de8ca5dfdc9ef0d136Test

المؤلفون: Melanie Wittner, Veronika Schlicker, Jana Libera, Jan-Hendrik Bockmann, Thomas Horvatits, Oliver Seiz, Silke Kummer, Carolin F Manthey, Anja Hüfner, Marcus Kantowski, Thomas Rösch, Olaf Degen, Samuel Huber, Johanna M Eberhard, Julian Schulze Zur Wiesch

المصدر: PLoS ONE, Vol 14, Iss 7, p e0220008 (2019)

مصطلحات موضوعية: Medicine, Science

الوصف: Anti-α4β7 therapy with vedolizumab (VDZ) has been suggested as possible immune intervention in HIV. Relatively little is known about the α4β7-integrin (α4β7) expression of different T-cell subsets in different anatomical compartments of healthy individuals, patients with HIV or inflammatory bowel disease (IBD). Surface expression of α4β7 as well as the frequency of activation, homing and exhaustion markers of T cells were assessed by multicolour flow cytometry in healthy volunteers (n = 15) compared to HIV infected patients (n = 52) or patients diagnosed with ulcerative colitis (UC) (n = 14), 6 of whom treated with vedolizumab. In addition, lymph nodal cells (n = 6), gut-derived cells of healthy volunteers (n = 5) and patients with UC (n = 6) were analysed. Additionally, we studied longitudinal PBMC samples of an HIV patient who was treated with vedolizumab for concomitant UC. Overall, only minor variations of the frequency of α4β7 on total CD4+ T cells were detectable regardless of the disease status or (VDZ) treatment status in peripheral blood and the studied tissues. Peripheral α4β7+ CD4+ T cells of healthy individuals and patients with UC showed a higher activation status and were more frequently CCR5+ than their α4β7- counterparts. Also, the frequency of α4β7+ cells was significantly lower in peripheral blood CD4+ effector memory T cells of HIV-infected compared to healthy individuals and this reduced frequency did not recover in HIV patients on ART. Conversely, the frequency of peripheral blood naïve α4β7+ CD4+ T cells was significantly reduced under VDZ treatment. The results of the current study will contribute to the understanding of the dynamics of α4β7 expression pattern on T cells in HIV and UC and will be useful for future studies investigating VDZ as possible HIV cure strategy.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/da46818e3ce244f18c2b1b6134aefd36Test

المؤلفون: Julia Schröder, Vitalia Schüller, Andrea May, Christian Gerges, Mario Anders, Jessica Becker, Timo Hess, Nicole Kreuser, René Thieme, Kerstin U Ludwig, Tania Noder, Marino Venerito, Lothar Veits, Thomas Schmidt, Claudia Fuchs, Jakob R Izbicki, Arnulf H Hölscher, Dani Dakkak, Boris Jansen-Winkeln, Yusef Moulla, Orestis Lyros, Stefan Niebisch, Matthias Mehdorn, Hauke Lang, Dietmar Lorenz, Brigitte Schumacher, Rupert Mayershofer, Yogesh Vashist, Katja Ott, Michael Vieth, Josef Weismüller, Elisabeth Mangold, Markus M Nöthen, Susanne Moebus, Michael Knapp, Horst Neuhaus, Thomas Rösch, Christian Ell, Ines Gockel, Johannes Schumacher, Anne C Böhmer

المصدر: PLoS ONE, Vol 14, Iss 12, p e0227072 (2019)

مصطلحات موضوعية: Medicine, Science

الوصف: Esophageal adenocarcinoma (EA) and its precancerous condition Barrett's esophagus (BE) are multifactorial diseases with rising prevalence rates in Western populations. A recent meta-analysis of genome-wide association studies (GWAS) data identified 14 BE/EA risk loci located in non-coding genomic regions. Knowledge about the impact of non-coding variation on disease pathology is incomplete and needs further investigation. The aim of the present study was (i) to identify candidate genes of functional relevance to BE/EA at known risk loci and (ii) to find novel risk loci among the suggestively associated variants through the integration of expression quantitative trait loci (eQTL) and genetic association data. eQTL data from two BE/EA-relevant tissues (esophageal mucosa and gastroesophageal junction) generated within the context of the GTEx project were cross-referenced with the GWAS meta-analysis data. Variants representing an eQTL in at least one of the two tissues were categorized into genome-wide significant loci (P < 5×10-8) and novel candidate loci (5×10-8 ≤ P ≤ 5×10-5). To follow up these novel candidate loci, a genetic association study was performed in a replication cohort comprising 1,993 cases and 967 controls followed by a combined analysis with the GWAS meta-analysis data. The cross-referencing of eQTL and genetic data yielded 2,180 variants that represented 25 loci. Among the previously reported genome-wide significant loci, 22 eQTLs were identified in esophageal mucosa and/or gastroesophageal junction tissue. The regulated genes, most of which have not been linked to BE/EA etiology so far, included C2orf43/LDAH, ZFP57, and SLC9A3. Among the novel candidate loci, replication was achieved for two variants (rs7754014, Pcombined = 3.16×10-7 and rs1540, Pcombined = 4.16×10-6) which represent eQTLs for CFDP1 and SLC22A3, respectively. In summary, the present approach identified candidate genes whose expression was regulated by risk variants in disease-relevant tissues. These findings may facilitate the elucidation of BE/EA pathophysiology.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/9c36f8077f394aafb298ab13e918fae3Test

المؤلفون: Moritz Peiseler, David Reiners, Hans O Pinnschmidt, Marcial Sebode, Franziska Jung, Johannes Hartl, Roman Zenouzi, Hanno Ehlken, Stefan Groth, Guido Schachschal, Thomas Rösch, Christina Weiler-Normann, Ansgar W Lohse, Christoph Schramm

المصدر: PLoS ONE, Vol 13, Iss 8, p e0202686 (2018)

مصطلحات موضوعية: Medicine, Science

الوصف: BACKGROUND:Endoscopic retrograde cholangiography (ERC) is a mainstay of therapy in patients with primary sclerosing cholangitis (PSC) and obstructive cholestasis. Patients with liver cirrhosis have an increased risk of surgical complications and are more susceptible to infections. Since PSC often progresses to cirrhosis, we aimed to assess whether ERC is associated with increased risk of complications in patients with PSC and cirrhosis. METHODS:Out of 383 patients with PSC, 208 patients received endoscopic treatment between 2009-2017. Seventy patients had cirrhosis when ERC was performed and 138 patients had no signs of cirrhosis. Overall, 663 ERC procedures were analysed, with 250 ERC in patients with cirrhosis and 413 ERC in patients without cirrhosis. Data were analysed retrospectively from a prospectively acquired database using repeated measures logistic regression. RESULTS:Overall, 40 procedure-related complications were documented in 663 ERC interventions (6%). The rate of complications was similar between patients with and without cirrhosis (4.4% vs. 7.0%). First-time ERC was associated with a higher risk of complications (17.5% vs. 4.9%). Biliary sphincterotomy, stent placement and female sex, but not presence of liver cirrhosis, were identified as risk factors for overall complications in multivariate analysis. Patients without cirrhosis showed a significant decline of ALP and bilirubin levels after the first two interventions. In contrast, in patients with cirrhosis, ALP and bilirubin levels did not significantly decline after ERC. CONCLUSIONS:In patients with PSC, cirrhosis was not a risk factor for post-ERC complications. Therefore, cirrhosis should not preclude endoscopic intervention in patients with clear clinical indication.

وصف الملف: electronic resource

العلاقة: http://europepmc.org/articles/PMC6101401?pdf=renderTest; https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/7df9acd499dc452496c11fe30de6b469Test

المؤلفون: Sanja Z Despotović, Novica M Milićević, Dragoslav P Milošević, Nebojša Despotović, Predrag Erceg, Petar Svorcan, Udo Schumacher, Sebastian Ullrich, Gordana Mihajlović, Dragan Kalem, Srđan Marković, Ivana M Lalić, Aleksandar J Krmpot, Mihailo D Rabasović, Dejan V Pantelić, Svetlana Z Jovanić, Thomas Rösch, Živana Milićević

المصدر: Tumor Biology, Vol 39 (2017)

مصطلحات موضوعية: Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: In recent years, it has been demonstrated that malignancy arises and advances through the molecular interplay between tumor cells and non-malignant elements of the tumor stroma, that is, fibroblasts and extracellular matrix. However, in contrast to the mounting evidence about the role of tumor stroma in the genesis and progression of the malignant disease, there are very few data regarding the uninvolved stromal tissue in the remote surrounding of the tumor. Using the objective morphometric approach in patients with adenocarcinoma, we demonstrate the remodeling of extracellular matrix of the lamina propria in the uninvolved rectal mucosa 10 and 20 cm away from the neoplasm. We show that the representation of basic extracellular matrix constituents (reticular and collagen fibers and ground substance) is decreased. Also, the diameter of empty spaces that appear within the extracellular matrix of the lamina propria is increased. These spaces do not represent the blood or lymphatic vessel elements. Very likely, they reflect the development of tissue edema in the remote, uninvolved lamina propria of the mucosa in patients with the malignant tumor of the rectum. We hypothesize that the remodeling of extracellular matrix in lamina propria of the rectal mucosa may increase its stiffness, modulating the mechano-signal transduction, and thus promote the progression of the malignant disease.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1423-0380Test

الوصول الحر: https://doaj.org/article/7ea0a0e1efc34154b74f0399d55f0588Test