Role of hepatitis A virus in diabetes mellitus

BACKGROUND Although much information is available regarding hepatitis C virus infection and diabetes,less is known about the relationship between hepatitis A virus(HAV)infection and diabetes.AIM To examine the roles of HAV in diabetes risk.METHODS This cross-sectional study population included data from the National Health and Nutrition Examination Survey collected between 2005-2012.Adult subjects(≥20 years old)with available body mass index measurements,defined diabetes status,history of HAV vaccination,and HAV serology were included.HAV vaccination was based on self-reported history.Successful HAV immunization was defined as the presence of both vaccination and anti-HAV antibody.HAV infection was defined by the absence of vaccination but presence of anti-hepatitis A antibody.The odds ratio(OR)for diabetes with 95%confidence intervals(95%CI)was calculated for each HAV status and then adjusted for covariates.Sensitivity tests,based on different definitions of diabetes,were performed to verify the results.RESULTS Among 19942 subjects,4229 subjects(21.21%)received HAV vaccination and HAV antibody was present in 9224 subjects(46.25%).Although HAV infection was associated with an increased risk of diabetes(OR:1.13;95%CI:1.08-1.18),HAV vaccination was not associated with diabetes(OR:1.06;95%CI:0.95-1.18),and successful HAV immunization had no impact on the risk of diabetes(OR:1.11;95%CI:0.97-1.27).Thus,HAV infection was an unlikely cause of diabetes.Alternatively,in non-vaccinated subjects,diabetes increased the risk of HAV infection by 40%(OR:1.40,95%CI:1.27-1.54).CONCLUSION An association between HAV infection and diabetes is observed which is best explained by an increased risk of HAV infection in diabetic patients.Diabetic subjects are more susceptible to HAV.Thus,HAV vaccination is highly recommended in diabetic patients.

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

BACKGROUND Acute gastrointestinal(GI)graft-vs-host disease(aGVHD)is the most complication of hematopoietic stem cell transplant(HSCT)in patients with hematologic malignancy.Limited data exists on endoscopic evaluation of GVHD in post-HSCT patients with differing GI symptoms.Further,the diagnostic value of gross endoscopic findings as well as the safety of endoscopy in this commonly thrombocytopenic and neutropenic patient population remains unclear.AIM To understand the diagnostic value of symptoms and gross endoscopic findings as well as safety of endoscopy in aGVHD patients.METHODS We analyzed 195 endoscopies performed at City of Hope in patients who underwent allogeneic HSCT less than 100 d prior for hematologic malignancy and were subsequently evaluated for aGVHD via endoscopy.The yield,sensitivity,and specificity of diagnosing aGVHD were calculated for upper and lower endoscopy,various GI tract locations,and presenting symptoms.RESULTS Combined esophagogastroduodenoscopy(EGD)and flexible sigmoidoscopy(FS)demonstrated a greater diagnostic yield for aGVHD(83.1%)compared to EGD(66.7%)or FS(77.2%)alone with any presenting symptom.The upper and lower GI tract demonstrated similar yields regardless of whether patients presented with diarrhea(95.7%vs 99.1%)or nausea/vomiting(97.5%vs 96.8%).Normalappearing mucosa was generally as specific(91.3%)as abnormal mucosa(58.7%-97.8%)for the presence of aGVHD.Adverse events such as bleeding(1.0%),infection(1.0%),and perforation(0.5%)only occurred in a small proportion of patients,with no significant differences in those with underlying thrombocytopenia(P=1.000)and neutropenia(P=0.425).CONCLUSION Combined EGD and FS with biopsies of normal and inflamed mucosa demonstrated the greatest diagnostic yield regardless of presenting symptom and appears to be safe in this population of patients.

政府政策海报设计

屏东的台湾地区设计博览会创建了世界上最大的设计超市“超级南方”。“超级政策”是展览的一部分,旨在促进屏东县政府的九项主要政策。“超级政策”创意的灵感来自于超市里无处不在的传单,它们巧妙地把枯燥的政府文件变成了丰富多彩的广告,吸引人们阅读的兴趣。海报上所有的排版都是手写的,就像传统市场的招牌那样。

Organ and function preservation in gastrointestinal cancer: Current and future perspectives on endoscopic ablation

The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches.Current treatment costs amount to billions of dollars annually,combined with the risks and comorbidities associated with invasive surgery.This highlights the importance of less invasive alternatives with organ preservation being a central aspect of the treatment paradigm.The current standard of care typically involves neoadjuvant systemic therapy followed by surgical resection.There is a growing interest in organ preservation approaches by way of minimizing extensive surgical resections.Endoscopic ablation has proven to be useful in precursor lesions,as well as in palliative cases of unrese-ctable disease.More recently,there has been an increase in reports on the utility of adjunct endoscopic ablative techniques for downstaging disease as well as contributing to non-surgical complete clinical response.This expansive field within endoscopic oncology holds great potential for advancing patient care.By addressing challenges,fostering collaboration,and embracing technological advancements,the gastrointestinal cancer treatment paradigm can shift towards a more sustainable and patient-centric future emphasizing organ and function preservation.This editorial examines the evolving landscape of endoscopic ablation strategies,emphasizing their potential to improve patient outcomes.We briefly review current applications of endoscopic ablation in the esophagus,stomach,duodenum,pancreas,bile ducts,and colon.

Verification of an independent dose calculation method for portal-specific QA of proton and carbon ion beams

Objective:To verify the accuracy of an independent dose calculation method,as incorporated into an in-house developed treatment planning system(TPS),for performing quality assurance of dose distributions delivered to a water phantom planned by a clinical TPS.Methods:A Monte Carlo based track repeating algorithm was incorporated into an in-house treatment planning system for proton and carbon ion beams.Calculations were performed in a flat water phantom for both a traditional pencil beam algorithm and a new Monte Carlo algorithm,and then compared to measurements made at multiple depths with a 2D ionization array for 44 patient portals.The comparisons utilized a Gamma analysis.Results:A total of 124 measurements were performed for proton and carbon ion patient portals.Using a small Gamma criteria of 2%/2 mm,an average of 93%and 97%of measurement points passed for each portal for pencil beam and Monte Carlo calculations,respectively.The passing rate was substantially higher for Monte Carlo calculations than for pencil beam calculations for portals that used a range shifter.Conclusions:The implemented independent method has been verified against measurements.The high passing rate with small tolerances leads to the possibility of reducing the number of required quality assurance measurements.

Implementation of Monte Carlo based PET verification of ion beam delivery into a TPS

Objective:To develop and implement an ion beam teletherapy verification system based upon simulations of induced radioactivity and comparison with patient positron emission tomography(PET)scans.Methods:A Monte Carlo algorithm was integrated into an in-house built treatment,information,management,and planning system(TIMPS■)to calculate distributions of positron emitters induced by ion beams.These distribu-tions are processed to simulate PET images taking into account positron diffusion,radioactive decay,biological washout,and detector blurring.Additional tools were developed to register simulated PET images with planning CT images and perform comparisons of measured and simulated PET images.Results:Production cross-sections were generated for various isotopes and materials.Treatment plans for several different body sites were used to verify the functioning and utility of the new tools for both proton and carbon ion beams.Conclusions:Several tools have been developed to simulate PET scans of patients irradiated with ion beams and compare the simulated images to measurements.After commissioning and implementation into the clinic,the appropriate sizes for margins that account for uncertainties may be investigated.

Optimization oftheplanningprocesswithan in-house treatment information,management,andplanningsystem

Objective:To describe the major categories of components of an in-house treatment information,management,and planning system(TIMPS■)that were designed and built to optimize the planning process.Methods:The system was designed,from the beginning,to manage the multi-user complex process of planning and delivering external beam treatments with the eventual goal of providing one-day planning,multiple radiation modality optimization,robust optimization,4D planning,daily adaptive treatments,and treatment verification and reconstruction.A Monte Carlo based track repeating algorithm was chosen for dose simulations.The user interface was based on web applications.Results:The first set of released tools included task queuing,followed by resource scheduling calendars and planning aims.Later releases included tools for image registration,manipulating motion profiles and 4D images,segmentation,PET simulation,and portal QA.Currently under testing are plan optimization and biophysical models.Conclusions:The in-house TIMPS first entered clinical service in April of 2017 with new tools added every few months.Since implementation,the time for planning has decreased simultaneously with a reduction of errors.