Multiplex-PCR-based screening and computational modeling of virulence factors and t-cell mediated immunity in helicobacter pylori infections for accurate clinical diagnosis

The outcome of H. pylori infection is closely related with bacteria's virulence factors and host immune response. The association between T cells and H. pylori infection has been identified, but the effects of the nine major H. pylori specific virulence factors; cagA, vacA, oipA, babA, hpaA, napA, dupA, ureA, ureB on T cell response in H. pylori infected patients have not been fully elucidated. We developed a multiplex- PCR assay to detect nine H. pylori virulence genes with in a three PCR reactions. Also, the expression levels of Th1, Th17 and Treg cell specific cytokines and transcription factors were detected by using qRT-PCR assays. Furthermore, a novel expert derived model is developed to identify set of factors and rules that can distinguish the ulcer patients from gastritis patients. Within all virulence factors that we tested, we identified a correlation between the presence of napA virulence gene and ulcer disease as a first data. Additionally, a positive correlation between the H. pylori dupA virulence factor and IFN-γ, and H. pylori babA virulence factor and IL-17 was detected in gastritis and ulcer patients respectively. By using computer-based models, clinical outcomes of a patients infected with H. pylori can be predicted by screening the patient's H. pylori vacA m1/m2, ureA and cagA status and IFN-γ (Th1), IL-17 (Th17), and FOXP3 (Treg) expression levels. Herein, we report, for the first time, the relationship between H. pylori virulence factors and host immune responses for diagnostic prediction of gastric diseases using computer—based models

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

<p>Abstract</p> <p>Background</p> <p>Ectopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis.</p> <p>Methods</p> <p>Gastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.</p> <p>Results</p> <p>EO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued.</p> <p>Conclusions</p> <p>The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.</p

Inverted Colonic Diverticula Cases

Colonic diverticula are outpouchings of mucosa and submucosa through the large intestine wall. Inverted colonic diverticula can be confused with colonic adenoma. It is important to differentiate them. Here we report two cases of inverted diverticula that seem to like adenomas

Major predictors for difficult common bile duct stone

Giriş ve Amaç: Safra kanalı taşlarının tedavisinde endoskopik retrograd kolanjiopankreatografi standard tedavi haline gelmiş- tir. Bu hastalarda endoskopik retrograd kolanjiopankreatografinin teknik güçlüğünü araştıran küçük hasta grupları ile yapılmış az sayıda çalışma vardır. Bu çalışmada biz bu faktörleri geniş bir hasta grubunda araştırmayı amaçladık. Gereç ve Yöntem: İki yıllık bir süre içerisinde endoskopik retrograd kolanjiopankreatografi yapılan tüm naive hastalar (n=1850) prospektif olarak değer- lendirildi. Taş çıkartmak için birden fazla endoskopik retrograd kolanjiopankreatografi seansı, mekanik litotripsi, ekstra şok dal- ga litotripsi gerektiren yada endoskopik olarak çıkarılamayıp cerrahiye giden hastalar zor taşı olan hastalar olarak kabul edildi. Yaş, cinsiyet, labaratuvar parametreler, endoskopik ve kolanjiografik bulgular kayıt edildi. Zor için prediktif faktörler univariate ve multivariate analizlerle araştırıldı. Bulgular: Çalışma grubu oralama 60±16 yaşında 432 kadın 325 erkek hastadan oluştu. 757 hastanın 654'ünde (%86.4) kolay taş, 103'ünde (%13.6) zor taş var idi. Hastaların %98.1'inde endoskopik taş çıkarma işlemi başarılı idi. Taşın ötesinde darlık olması (OR: 8.248), küçük ortak safra kanalı/taş çapı oranı (OR: 0.348), taş çapı (OR: 1.187), taşın impakte olması (OR: 1.117) ve yüksek bilirubin değerleri (OR: 1.1) zor taş için multivariate analizde bağımsız belir- leyici faktörler olarak tespit edildi. Sonuç: Ortak safra kanalı taşları tedavisinde endoskopik retrograd kolanjiopankreatografi çok etkili bir yöntemdir. Taşın ilerisinde darlık olmasının yanında küçük safra kanalı/taş çapı oranı, taş çapı, impakte taş ve yüksek bilirubin değerleri zor taş için önemli belirteçlerdir.Background/aims: Endoscopic retrograde cholangiopancreatography has become the standard treatment for common bile duct stones worldwide. There are only a few reports with small number of patients concerning the factors that contribute to the techni- cal difficulty of endoscopic retrograde cholangiopancreatography in these patients. In this study, we aimed to investigate these fac- tors in a large group of patients. Materials and Methods: All patients with naive papilla (n=1850) who underwent endoscopic ret- rograde cholangiopancreatography during a study period of 2 years were prospectively evaluated. Among them, 757 patients with common bile duct stones were included in the study. Following successful cannulation, the patients who needed either more than one episode for stone extraction or mechanical lithotripsy, extracorporeal shock wave lithotripsy or in whom stone extraction could not be achieved endoscopically and underwent surgery were regarded as having -difficult stones-. Age, sex, laboratory parameters, endoscopic and cholangiographic findings were recorded in all patients. Predictive factors for difficult stones were investigated in univariate and multivariate analysis. Results: The study group consisted of 432 women and 325 men with a mean age of 60±16 ye- ars . Of the total 757 patients, 654 (86.4%) had easy and 103 (13.6%) had difficult stones. Endoscopic stone extraction was successful in 98.1% of patients. Stricture distal to the stone (OR: 8.248), smaller common bile duct/stone diameter ratio (OR: 0.348), stone diameter (OR: 1.187), stone impaction (OR: 1.117), and higher bilirubin levels (OR: 1.1) were found to be independent predictors of difficult stone in multivariate analysis. Conclusion: Endoscopic retrograde cholangiopancreatography is a very effec- tive method for the treatment of common bile duct stones. Besides strictures distal to the stone, smaller common bile duct/stone di- ameter ratio, stone diameter, impacted stone, and higher bilirubin levels are significant predictors of difficult stone

Zor safra kanalı taşının en Önemli belirteçleri

Giriş ve Amaç: Safra kanalı taşlarının tedavisinde endoskopik retrograd kolanjiopankreatografi standard tedavi haline gelmiş- tir. Bu hastalarda endoskopik retrograd kolanjiopankreatografinin teknik güçlüğünü araştıran küçük hasta grupları ile yapılmış az sayıda çalışma vardır. Bu çalışmada biz bu faktörleri geniş bir hasta grubunda araştırmayı amaçladık. Gereç ve Yöntem: İki yıllık bir süre içerisinde endoskopik retrograd kolanjiopankreatografi yapılan tüm naive hastalar (n=1850) prospektif olarak değer- lendirildi. Taş çıkartmak için birden fazla endoskopik retrograd kolanjiopankreatografi seansı, mekanik litotripsi, ekstra şok dal- ga litotripsi gerektiren ya da endoskopik olarak çıkarılamayıp cerrahiye giden hastalar zor taşı olan hastalar olarak kabul edildi. Yaş, cinsiyet, labaratuvar parametreler, endoskopik ve kolanjiografik bulgular kayıt edildi. Zor için prediktif faktörler univariate ve multivariate analizlerle araştırıldı. Bulgular: Çalışma grubu oralama 60±16 yaşında 431 kadın 325 erkek hastadan oluştu. 757 hastanın 654'ünde (86,4%) kolay taş, 103'ünde (13,6%) zor taş var idi. Hastaların %98,1'inde endoskopik taş çıkarma işlemi başarılı idi. Taşın ötesinde darlık olması (OR: 8,248), küçük ortak safra kanalı/taş çapı oranı (OR: 0,348), taş çapı (OR: 1,187), taşınstone impakte olması (OR: 1,117) ve yüksek bilirubin değerleri (OR: 1,1) zor taş için multivariate analizde bağımsız be- lirleryici faktörler olarak tespit edildi. Sonuç: Ortak safra kanalı taşları tedavisinde endoskopik retrograd kolanjiopankreatogra- fi çok etkili bir yöntemdir. Taşın ilerisinde darlık olmasının yanında küçük safra kanalı/taş çapı oranı, taş çapı, impakte taş ve yüksek bilirubin değerleri zor taş için önemli belirteçlerdirBackground/aims: Endoscopic retrograde cholangiopancreatography has become the standard treatment for common bile duct stones worldwide. However, there are only a few reports with small number of patients concerning the factors that contribute to the technical difficulty of endoscopic retrograde cholangiopancreatography in these patients. In this study we aimed to investigate these factors in a large group of patients. Materials and Methods: All patients with a naıïve papilla (n=1850) who underwent endoscopic retrograde cholangiopancreatography during a study period of 2 years were prospectively evaluated. Of these, 757 patients with com- mon bile duct stones were included in the study. Following successful cannulation, patients who needed either more than one episode for stone extraction or mechanical lithotripsy, extracorporeal shock wave lithotripsy, or patients in whom stone extraction could not be achieved endoscopically and underwent surgery were regarded as having “difficult stones”. Age, sex, laboratory parameters, endo- scopic and cholangiographic findings were recorded in all patients. Predictive factors for difficult stones were investigated using univariate and multivariate analysis. Results: The study group consisted of 432 women and 325 men with a mean age of 60±16 years . Of the total 757 patients, 654 (86.4%) had easy and 103 (13.6%) had difficult stones. Endoscopic stone extrac- tion was successful in 98.1% of patients. A stricture distal to the stone (OR: 8.248), smaller common bile duct/stone diameter ratio (OR: 0,348), stone diameter (OR: 1,187) stone impaction (OR: 1,117) and higher bilirubin levels (OR: 1,1) were found to be inde- pendent predictors of difficult stone extraction on multivariate analysis. Conclusion: Endoscopic retrograde cholangiopancreatog- raphy is a very effective method for the treatment of common bile duct stones. Presence of a stricture distal to the stone, smaller com- mon bile duct/stone diameter ratio, stone diameter, impacted stone, and higher bilirubin levels are significant predictors of diffi- cult ston

Dealing with the gray zones in the management of gastric cancer: The consensus statement of the Istanbul Group

The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes