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Differentiation of minimal and grade 1 hepatic encephalopathy using neurophysiological,neuropsychological,magnetic resonance spectroscopic,and systemic inflammatory parameters 认领 引用
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作者 Lalit C Kummetha Shrey Bhatt +10 位作者 Venkatesh Vaithiyam Barjesh C Sharma Siddharth Srivastava Bhawna Mahajan Kalpana Bansal Neera Chaudhry Monica S Tandon Sanjeev Sachdeva Ajay Kumar Ashok Dalal Ujjwal Sonika 《World Journal of Hepatology》 2026年第5期215-233,共19页
BACKGROUND Hepatic encephalopathy(HE)is traditionally classified as overt and minimal HE(MHE).The International Society for HE and Nitrogen Metabolism clubbed MHE and grade 1 HE as“covert”HE.However,these appear to ... BACKGROUND Hepatic encephalopathy(HE)is traditionally classified as overt and minimal HE(MHE).The International Society for HE and Nitrogen Metabolism clubbed MHE and grade 1 HE as“covert”HE.However,these appear to be distinct entities.AIM To compare inflammatory markers,magnetic resonance spectroscopy(MRS),Bispectral index(BIS),spectral electroencephalography(EEG),and natural history of MHE and grade 1 HE.METHODS In this prospective study,150 patients with cirrhosis were categorized into three groups:No HE(n=50),MHE(n=50),and grade 1 HE(n=50).Patients were assessed using the West Haven criteria,the psychometric HE score,critical flicker frequency,MRS,inflammatory markers(cytokines and endotoxins),BIS,and spectral EEG.All patients were followed up for HE progression,complications,hospitalizations,and mortality over 12 months.RESULTS Patients with grade 1 HE showed significantly higher levels of ammonia(164.08±30.12 vs 123.42±19.97,P<0.001),endotoxins(0.60±0.05 vs 0.47±0.04,P<0.001),and cytokines than those with MHE.MRS in grade 1 HE revealed reduced myoinositol(-0.2 vs-0.11,P<0.001)and choline levels(0.38±0.33 vs 0.42±0.18,P<0.001)and elevated glutamine levels(1.01±0.38 vs 0.73±0.23,P<0.001)compared to MHE.BIS values were lower in grade 1 HE compared to MHE(72.9±5.49 vs 81.48±3.9,P<0.001).Spectral EEG metrics effectively distinguished MHE from grade 1 HE with high diagnostic accuracies.Model for end-stage liver disease,interleukin-12,BIS,and spectral EEG changes were independent predictors of survival.CONCLUSION MHE and grade 1 HE exhibit distinct inflammatory,neuropsychological,and neurophysiological profiles,as well as differences in their survival. 展开更多
关键词 Hepatic encephalopathy Neurospectroscopy Bispectral index Systemic inflammation Endotoxins Critical flicker frequency Psychometric hepatic encephalopathy score Serum ammonia
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Predictors of incomplete common bile duct stone clearance at index endoscopic retrograde cholangiopancreatography 认领 引用
2
作者 Shabir A Lone Venkatesh Vaithiyam +7 位作者 Keval Vora Nikhil Sirohi Ujjwal Sonika Ashok Dalal Ajay Kumar Siddharth Srivastava Sanjeev Sachdeva Barjesh C Sharma 《World Journal of Gastrointestinal Endoscopy》 2026年第5期19-28,共10页
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the first-line treatment for common bile duct(CBD)stones.However,a substantial proportion of patients fail to achieve clearance during the index proced... BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the first-line treatment for common bile duct(CBD)stones.However,a substantial proportion of patients fail to achieve clearance during the index procedure.Identifying predictors of incomplete clearance may improve procedural planning and outcomes.AIM To identify the clinical,radiological,and cholangiographic predictors of incomplete CBD stone clearance during the index ERCP.METHODS This single-center retrospective study analyzed consecutive patients who underwent ERCP for clearance of CBD stones at a tertiary care center in New Delhi between January 2023 and October 2023.Univariate and multivariate analyses were performed to identify predictors of incomplete CBD stone clearance.Receiver operating characteristic curve analysis was used to determine the optimal magnetic resonance cholangiopancreatography-and ERCP-based predictors of incomplete CBD stone clearance.RESULTS A total of 245 patients(mean age 46.2±14.8 years;75.5%women)were included in the study.Complete clearance of CBD stones was achieved in 179 patients(73.1%)at the index ERCP.Multivariate analysis revealed that independent predictors of incomplete CBD stone clearance on ERCP included proximal CBD stone location[odds ratio(OR)4.44,P=0.003],stone-to-CBD diameter ratio>1(OR=5.22,P=0.033),presence of a CBD stricture(OR=5.06,P=0.049),and impacted stones(OR=9.33,P=0.003).Receiver operating characteristic curve analysis demonstrated that stone size(area under the curve:0.750)and stone-to-CBD diameter ratio(area under the curve:0.709)on ERCP were the strongest predictors of incomplete CBD stone clearance.CONCLUSION Proximal CBD stones,stone-to-duct size mismatch,CBD strictures,and impacted stones were predictors of incomplete CBD stone clearance,highlighting the need for careful planning and the use of advanced endoscopic techniques or surgery. 展开更多
关键词 Common bile duct stones Endoscopic retrograde cholangiopancreatography Impacted stone Bile duct stricture Stone size
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Predictive factors and outcomes of endoscopic necrosectomy in patients with acute pancreatitis and walled-off necrosis 认领 引用 被引量：1
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作者 Shabir A Lone Ujjwal Sonika +7 位作者 Ravi Teja Reddy Venkatesh Vaithiyam Payila SR Aneesh Sri Harsha Palli Ashok Dalal Ajay Kumar Siddharth Srivastava Sanjeev Sachdeva 《World Journal of Gastrointestinal Endoscopy》 2025年第12期134-145,共12页
BACKGROUND Endoscopic ultrasound-guided drainage using lumen-apposing metal stents(LAMS)has emerged as the first-line approach for managing walled-off necrosis(WON).However,certain patients require escalation to direc... BACKGROUND Endoscopic ultrasound-guided drainage using lumen-apposing metal stents(LAMS)has emerged as the first-line approach for managing walled-off necrosis(WON).However,certain patients require escalation to direct endoscopic necrosectomy,for which the predictive factors have not been completely defined.AIM To determine the predictors of direct endoscopic necrosectomy following LAMS placement in patients with WON and to assess the clinical outcomes and safety.METHODS A retrospective analysis of prospectively collected data from patients with acute pancreatitis who were admitted to the Govind Ballabh Pant Institute of Postgraduate Medical Education in Delhi,India,between January 2020 and October 2023 was conducted.Patients with acute pancreatitis and symptomatic WON who underwent LAMS placement were included in the study.Patients aged30%(OR=14.6,95%CI:1.87-113.86,P=0.001),WON in the pancreatic head(OR=4.246,95%CI:1.80-10.0,P=0.001),and collection size(OR=1.18,95%CI:1.04-1.34,P=0.009)were the predictors of endoscopic necrosectomy.Subsequently,multivariate analysis indicated that the extent of necrosis was an independent predictor of the requirement for necrosectomy(OR=1.085,95%CI:1.026-1.148,P<0.004).Clinical success was higher in the non-necrosectomy group than in the necrosectomy group(88.2%vs 69.4%).CONCLUSION Early identification of these predictive variables can guide treatment planning for WON and facilitate early necrosectomy,thereby improving the clinical outcomes. 展开更多
关键词 Acute pancreatitis Walled-off necrosis Necrosectomy Endoscopy Lumen-apposing metal stent
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PIK3CA基因相关过度生长综合征群的诊治规范:国际专家共识 认领 引用 被引量：3
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作者 周清 李辛 +25 位作者 刘晖 常国营 徐敏 王剑 顾松 王秀敏 Sofia Douzgou Myfanwy Rawson Eulalia Baselga Moise Danielpour Laurence Faivre Alon Kashanian Kim M Keppler-Noreuil Paul Kuentz Grazia M S Mancini Marie-Cecile Maniere Victor Martinez-Glez Victoria E Parker Robert K Semple Siddharth Srivastava Pierre Vabres Marie-Claire Y De Wit John M Graham Jr Jill Clayton-Smith Ghayda M Mirzaa Leslie G Biesecker 《临床儿科杂志》 CAS CSCD 北大核心 2023年第11期875-880,共6页
PIK3CA基因激活突变所导致的一系列发育障碍表型谱被统称为PIK3CA基因相关过度生长综合征群(PIK3CA-related overgrowth spectrum,PROS)。临床表现分型众多,各型分类见表1A。由于基因变异发生在受精卵形成后,临床表型为嵌合体,因此PIK3C... PIK3CA基因激活突变所导致的一系列发育障碍表型谱被统称为PIK3CA基因相关过度生长综合征群(PIK3CA-related overgrowth spectrum,PROS)。临床表现分型众多,各型分类见表1A。由于基因变异发生在受精卵形成后,临床表型为嵌合体,因此PIK3CA基因变异在外周血中的阳性检出率很低,通常需要非血液标本或通过组织活检来发现超低频嵌合体。PIK3CA基因激活变异的作用为促生长,变异导致的表型取决于基因变异发生的时间、组织细胞类型、变异细胞的分布以及变异的激活强度。 展开更多
关键词 组织活检 过度生长 基因变异 诊治规范 临床表型 发育障碍 细胞类型 嵌合体
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Composite pheochromocytoma masquerading as solidpseudopapillary neoplasm of pancreas 认领 引用
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作者 Geetanjali Gupta Ravindra Kumar Saran +3 位作者 Satyajit Godhi Siddharth Srivastava Sundeep Singh Saluja Pramod Kumar Mishra 《World Journal of Clinical Cases》 SCIE 2015年第5期474-478,共5页
Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of... Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation. 展开更多
关键词 Ganglioneuroma Pheochromocytoma Adrenal
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