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Gut as viral reservoir: lessons from gut viromes, HIV and COVID-19
Markus F Neurath, Klaus Überla, Siew C Ng
doi : 10.1136/gutjnl-2021-324622
Gut 2021;70:1605-1608
Vaccines against hepatitis C: a travel into neutralisation space
Jens Bukh
doi : 10.1136/gutjnl-2020-323377
Gut 2021;70:1609-1610
Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update
Andrew M Veitch, Franco Radaelli, Raza Alikhan, Jean Marc Dumonceau, Diane Eaton, Jo Jerrome, Will Lester, David Nylander, Mo Thoufeeq, Geoffroy Vanbiervliet, James R Wilkinson, Jeanin E Van Hooft
doi : 10.1136/gutjnl-2021-325184
Gut 2021;70:1611-1628
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
Endoscopes used in positive and critically ill patients are SARS-CoV-2 negative at virological assessment
Ivo Boškoski, Anna Di Gemma, Maria Valeria Matteo, Fabio Grilli, Paola Cattani, Guido Costamagna
doi : 10.1136/gutjnl-2020-323577
Gut 2021;70:1629-1631
The risk of SARS-CoV-2 transmission in endoscopy is not only between patients and endoscopy staff but is also through inadequately reprocessed endoscopes. There are no studies that could confirm the efficacy of current ways of endoscope reprocessing on the elimination of SARS-CoV-2. The aim of this pilot study was to evaluate the efficacy of high disinfection of endoscopes with peracetic acid on eliminating SARS-CoV-2, but surprisingly we found that the virus cannot be detected on any part of endoscopes used in critically ill patients due to SARS-CoV-2 and this was the same for all types of endoscopies and procedures. If confirmed in larger studies, these findings will probably open a new scenario in the overall understanding of the real impact of the virus.
EGFR amplification and outcome in a randomised phase III trial of chemotherapy alone or chemotherapy plus panitumumab for advanced gastro-oesophageal cancers
Elizabeth C Smyth, Georgios Vlachogiannis, Somaieh Hedayat, Alice Harbery, Sanna Hulkki-Wilson, Massimiliano Salati, Kyriakos Kouvelakis, Javier Fernandez-Mateos, George D Cresswell, Elisa Fontana, Therese Seidlitz, Clare Peckitt, Jens C Hahne, Andrea Lampis, Ruwaida Begum, David Watkins, Sheela Rao, Naureen Starling, Tom Waddell, Alicia Okines, Tom Crosby, Was Mansoor, Jonathan Wadsley, Gary Middleton, Matteo Fassan, Andrew Wotherspoon, Chiara Braconi, Ian Chau, Igor Vivanco, Andrea Sottoriva, Daniel E Stange, David Cunningham, Nicola Valeri
doi : 10.1136/gutjnl-2020-322658
Gut 2021;70:1632-1641
Epidermal growth factor receptor (EGFR) inhibition may be effective in biomarker-selected populations of advanced gastro-oesophageal adenocarcinoma (aGEA) patients. Here, we tested the association between outcome and EGFR copy number (CN) in pretreatment tissue and plasma cell-free DNA (cfDNA) of patients enrolled in a randomised first-line phase III clinical trial of chemotherapy or chemotherapy plus the anti-EGFR monoclonal antibody panitumumab in aGEA (NCT00824785).
Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case–control study
Jonathan Blackwell, Sonia Saxena, Irene Petersen, Matthew Hotopf, Hanna Creese, Alex Bottle, Christopher Alexakis, Richard C Pollok
doi : 10.1136/gutjnl-2020-322308
Gut 2021;70:1642-1648
Depression is a potential risk factor for developing IBD. This association may be related to GI symptoms occurring before diagnosis. We aimed to determine whether depression, adjusted for pre-existing GI symptoms, is associated with subsequent IBD.
Development and initial psychometric validation of a patient-reported outcome measure for Crohn’s perianal fistula: the Crohn’s Anal Fistula Quality of Life (CAF-QoL) scale
Samuel O Adegbola, Lesley Dibley, Kapil Sahnan, Tiffany Wade, Azmina Verjee, Rachel Sawyer, Sameer Mannick, Damian McCluskey, Paul Bassett, Nuha Yassin, Janindra Warusavitarne, Omar Faiz, Robin Phillips, Phil J Tozer, Christine Norton, Ailsa L Hart
doi : 10.1136/gutjnl-2019-320553
Gut 2021;70:1649-1656
Crohn’s perianal fistulas are challenging for patients and clinicians. Many do not respond to available treatments and despite recommendations by a global consensus, there are currently no specific patient-derived quality of life tools to measure response to treatment. We present a new validated patient-reported outcome measure (PROM) for this complicated disease phenotype.
Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System
Nabeel Khan, Nadim Mahmud, Chinmay Trivedi, Walter Reinisch, James D Lewis
doi : 10.1136/gutjnl-2021-324356
Gut 2021;70:1657-1664
Our aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD.
Blue poo: impact of gut transit time on the gut microbiome using a novel marker
Francesco Asnicar, Emily R Leeming, Eirini Dimidi, Mohsen Mazidi, Paul W Franks, Haya Al Khatib, Ana M Valdes, Richard Davies, Elco Bakker, Lucy Francis, Andrew Chan, Rachel Gibson, George Hadjigeorgiou, Jonathan Wolf, Timothy D Spector, Nicola Segata, Sarah E Berry
doi : 10.1136/gutjnl-2020-323877
Gut 2021;70:1665-1674
Gut transit time is a key modulator of host–microbiome interactions, yet this is often overlooked, partly because reliable methods are typically expensive or burdensome. The aim of this single-arm, single-blinded intervention study is to assess (1) the relationship between gut transit time and the human gut microbiome, and (2) the utility of the ‘blue dye’ method as an inexpensive and scalable technique to measure transit time.
FXR in the dorsal vagal complex is sufficient and necessary for upper small intestinal microbiome-mediated changes of TCDCA to alter insulin action in rats
Song-Yang Zhang, Rosa J W Li, Yu-Mi Lim, Battsetseg Batchuluun, Huiying Liu, T M Zaved Waise, Tony K T Lam
doi : 10.1136/gutjnl-2020-321757
Gut 2021;70:1675-1683
Conjugated bile acids are metabolised by upper small intestinal microbiota, and serum levels of taurine-conjugated bile acids are elevated and correlated with insulin resistance in people with type 2 diabetes. However, whether changes in taurine-conjugated bile acids are necessary for small intestinal microbiome to alter insulin action remain unknown.
Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial)
Kesavan Kandiah, Sharmila Subramaniam, Sreedhari Thayalasekaran, Fergus JQ Chedgy, Gaius Longcroft-Wheaton, Carole Fogg, James F Brown, Samuel CL Smith, Marietta Iacucci, Pradeep Bhandari
doi : 10.1136/gutjnl-2020-320980
Gut 2021;70:1684-1690
Longstanding colonic IBD increases the risk of developing colorectal cancer. The utility of chromoendoscopy with standard-definition white light technology has been established. However, the use of high-definition virtual chromoendoscopy (HDV) in colitis surveillance remains undefined.
Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods
W Arnout van Hattem, Neal Shahidi, Sergei Vosko, Imogen Hartley, Kaushali Britto, Mayenaaz Sidhu, Iddo Bar-Yishay, Scott Schoeman, David James Tate, Karen Byth, David G Hewett, María Pellisé, Luke F Hourigan, Alan Moss, Nicholas Tutticci, Michael J Bourke
doi : 10.1136/gutjnl-2020-321753
Gut 2021;70:1691-1697
Large (?20?mm) sessile serrated lesions (L-SSL) are premalignant lesions that require endoscopic removal. Endoscopic mucosal resection (EMR) is the existing standard of care but carries some risk of adverse events including clinically significant post-EMR bleeding and deep mural injury (DMI). The respective risk-effectiveness ratio of piecemeal cold snare polypectomy (p-CSP) in L-SSL management is not fully known.
RNA-binding protein RALY reprogrammes mitochondrial metabolism via mediating miRNA processing in colorectal cancer
Lei Sun, Arabella Wan, Zhuolong Zhou, Dongshi Chen, Heng Liang, Chuwei Liu, Shijia Yan, Yi Niu, Ziyou Lin, Siyue Zhan, Shanfeng Wang, Xianzhang Bu, Weiling He, Xiongbin Lu, Anlong Xu, Guohui Wan
doi : 10.1136/gutjnl-2020-320652
Gut 2021;70:1698-1712
Dysregulated cellular metabolism is a distinct hallmark of human colorectal cancer (CRC). However, metabolic programme rewiring during tumour progression has yet to be fully understood.
Blocking VCAM-1 inhibits pancreatic tumour progression and cancer-associated thrombosis/thromboembolism
Makoto Sano, Ryota Takahashi, Hideaki Ijichi, Kazunaga Ishigaki, Tomoharu Yamada, Koji Miyabayashi, Gen Kimura, Suguru Mizuno, Hiroyuki Kato, Hiroaki Fujiwara, Takuma Nakatsuka, Yasuo Tanaka, Jinsuk Kim, Yohei Masugi, Yasuyuki Morishita, Mariko Tanaka, Tetsuo Ushiku, Yousuke Nakai, Keisuke Tateishi, Yukimoto Ishii, Hiroyuki Isayama, Harold L Moses, Kazuhiko Koike
doi : 10.1136/gutjnl-2020-320608
Gut 2021;70:1713-1723
Pancreatic ductal adenocarcinoma (PDAC) is the deadliest cancer. Cancer-associated thrombosis/thromboembolism (CAT), frequently observed in PDAC, is known as a poor prognostic factor. Here, we investigated the underlying mechanisms between PDAC and CAT, and performed a trial of therapeutic approach for PDAC using a genetically engineered mouse model, PKF (Ptf1acre/+;LSL-KrasG12D/+;Tgfbr2flox/flox ).
Pain patterns in chronic pancreatitis: a nationwide longitudinal cohort study
Marinus A Kempeneers, Yama Issa, Robert C Verdonk, Marco Bruno, P Fockens, Harry van Goor, Eline Alofs, Thomas L Bollen, Stefan Bouwense, Anne S H M van Dalen, Susan van Dieren, Hendrik M van Dullemen, Erwin-Jan van Geenen, Chantal Hoge, Jeanin E van Hooft, Liesbeth M Kager, Yolande Keulemans, Lynn E Nooijen, Jan-Werner Poley, Tom C J Seerden, Adriaan Tan, Willem Thijs, Robin Timmer, Frank Vleggaar, Ben Witteman, Usama Ahmed Ali, Marc G Besselink, Marja A Boermeester, Hjalmar C van Santvoort
doi : 10.1136/gutjnl-2020-322117
Gut 2021;70:1724-1733
1131 patients with chronic pancreatitis (fulfilling M-ANNHEIM criteria) were included between 2011 and 2018 in 30 Dutch hospitals. Patients with continuous or intermittent pain were compared for demographics, pain characteristics, quality of life (Short-Form 36), imaging findings, disease duration and treatment. Alternation of pain pattern and associated variables were longitudinally assessed using a multivariable multinomial logistic regression model.
Hepatitis C reference viruses highlight potent antibody responses and diverse viral functional interactions with neutralising antibodies
Dorothea Bankwitz, Akash Bahai, Maurice Labuhn, Mandy Doepke, Corinne Ginkel, Tanvi Khera, Daniel Todt, Luisa J Ströh, Leona Dold, Florian Klein, Frank Klawonn, Thomas Krey, Patrick Behrendt, Markus Cornberg, Alice C McHardy, Thomas Pietschmann
doi : 10.1136/gutjnl-2020-321190
Gut 2021;70:1734-1745
Neutralising antibodies are key effectors of infection-induced and vaccine-induced immunity. Quantification of antibodies’ breadth and potency is critical for understanding the mechanisms of protection and for prioritisation of vaccines. Here, we used a unique collection of human specimens and HCV strains to develop HCV reference viruses for quantification of neutralising antibodies, and to investigate viral functional diversity.
Cabozantinib-based combination therapy for the treatment of hepatocellular carcinoma
Runze Shang, Xinhua Song, Pan Wang, Yi Zhou, Xinjun Lu, Jingxiao Wang, Meng Xu, Xinyan Chen, Kirsten Utpatel, Li Che, Binyong Liang, Antonio Cigliano, Matthias Evert, Diego F Calvisi, Xin Chen
doi : 10.1136/gutjnl-2020-320716
Gut 2021;70:1746-1757
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer with limited treatment options. Cabozantinib, an orally bioavailable multikinase inhibitor is now approved by Food and Drug Administration (FDA) for HCC patients. We evaluated the therapeutic efficacy of cabozantinib, either alone or in combination, in vitro and in vivo.
Amelioration of systemic inflammation in advanced chronic liver disease upon beta-blocker therapy translates into improved clinical outcomes
Mathias Jachs, Lukas Hartl, Dunja Schaufler, Christopher Desbalmes, Benedikt Simbrunner, Ernst Eigenbauer, David Josef Maria Bauer, Rafael Paternostro, Philipp Schwabl, Bernhard Scheiner, Theresa Bucsics, Albert Friedrich Stättermayer, Matthias Pinter, Michael Trauner, Mattias Mandorfer, Thomas Reiberger
doi : 10.1136/gutjnl-2020-322712
Gut 2021;70:1758-1767
Systemic inflammation promotes the development of clinical events in patients with advanced chronic liver disease (ACLD). We assessed whether (1) non-selective beta blocker (NSBB) treatment initiation impacts biomarkers of systemic inflammation and (2) whether these changes in systemic inflammation predict complications and mortality.
Treatment of advanced gastroenteropancreatic neuroendocrine neoplasia, are we on the way to personalised medicine?
Anja Rinke, Christoph J Auernhammer, Lisa Bodei, Mark Kidd, Sebastian Krug, Rita Lawlor, Ilaria Marinoni, Aurel Perren, Aldo Scarpa, Halfdan Sorbye, Marianne Ellen Pavel, Matthias M Weber, Irvin Modlin, Thomas M Gress
doi : 10.1136/gutjnl-2020-321300
Gut 2021;70:1768-1781
Gastroenteropancreatic neuroendocrine neoplasia (GEPNEN) comprises clinically as well as prognostically diverse tumour entities often diagnosed at late stage. Current classification provides a uniform terminology and a Ki67-based grading system, thereby facilitating management. Advances in the study of genomic and epigenetic landscapes have amplified knowledge of tumour biology and enhanced identification of prognostic and potentially predictive treatment subgroups. Translation of this genomic and mechanistic biology into advanced GEPNEN management is limited. ‘Targeted’ treatments such as somatostatin analogues, peptide receptor radiotherapy, tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors are treatment options but predictive tools are lacking. The inability to identify clonal heterogeneity and define critical oncoregulatory pathways prior to therapy, restrict therapeutic efficacy as does the inability to monitor disease status in real time. Chemotherapy in the poor prognosis NEN G3 group, though associated with acceptable response rates, only leads to short-term tumour control and their molecular biology requires delineation to provide new and more specific treatment options.
Hepatitis D virus in 2021: virology, immunology and new treatment approaches for a difficult-to-treat disease
Stephan Urban, Christoph Neumann-Haefelin, Pietro Lampertico
doi : 10.1136/gutjnl-2020-323888
Gut 2021;70:1782-1794
GI highlights from the literature
Philip J Smith
doi : 10.1136/gutjnl-2021-325649
Gut 2021;70:1795-1796
Combination of CLIF-OF and CCI predicts survival in patients with cirrhosis and COVID-19
Massimo Iavarone, Roberta D'Ambrosio, Pietro Lampertico
doi : 10.1136/gutjnl-2020-322929
Gut 2021;70:1798-1799
Hepatic inflammasome activation as origin of Interleukin-1? and Interleukin-1? in liver cirrhosis
Michael Praktiknjo, Robert Schierwagen, Sofia Monteiro, Cristina Ortiz, Frank Erhard Uschner, Christian Jansen, Joan Claria, Jonel Trebicka
doi : 10.1136/gutjnl-2020-322621
Gut 2021;70:1799-1800
Blurring the picture in leaky gut research: how shortcomings of zonulin as a biomarker mislead the field of intestinal permeability
Lucas Massier, Rima Chakaroun, Peter Kovacs, John T. Heiker
doi : 10.1136/gutjnl-2020-323026
Gut 2021;70:1801-1802
A nationwide cohort study with propensity score matching
Lucien Roulet
doi : 10.1136/gutjnl-2020-323098
Gut 2021;70:1802-1803
Use of water immersion instead of water exchange underlay the unfavourable outcomes in the water-assisted sigmoidoscopy (WAS) study
Chih-Wei Tseng, Yu-Hsi Hsieh
doi : 10.1136/gutjnl-2020-323362
Gut 2021;70:1803-1804
Letter to the editor: prediction of survival in colorectal cancer using artificial intelligence
Ai Guan, Lejia Sun, Meixi Liu, Yilei Mao
doi : 10.1136/gutjnl-2020-323382
Gut 2021;70:1804-1805
Mandatory preprocedure testing for SARS-CoV-2 for all-comers may not be required for resuming endoscopic services amidst the ongoing COVID-19 pandemic
Soumya Jagannath, Ashish Agarwal, Deepak Gunjan, Samir Mohindra, Vishal Sharma, Sudipta Dhar Chowdhury, Sanjeev Sachdeva, Vivek A Saraswat, Rakesh Kochhar, Anoop Saraya
doi : 10.1136/gutjnl-2020-323154
Gut 2021;70:1805-1806
Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis
Guo-Fu Li, Xiao-Xiao An, Yichao Yu, Li-Rong Jiao, Daniele Canarutto, Guo Yu, Guangji Wang, Dan-Na Wu, Yin Xiao
doi : 10.1136/gutjnl-2020-323366
Gut 2021;70:1806-1808
Recurrent food impactions
Florian Hentschel, Andreas Georg Schreyer, Stefan Lüth
doi : 10.1136/gutjnl-2020-321623
Gut 2021;70:1631-1690
Correction: Non-nucleatum Fusobacterium species are dominant in the Southern Chinese population with distinctive correlations to host diseases compared with F. nucleatum
doi : 10.1136/gutjnl-2020-322090corr1
Gut 2021;70:e6
