[Show abstract][Hide abstract] ABSTRACT: Mucosal Th17 cells play an important role in maintaining gut epithelium integrity and thus prevent microbial translocation. Chronic HIV infection is characterized by mucosal Th17 cell depletion, microbial translocation and subsequent immune-activation, which remain elevated despite antiretroviral therapy (ART) correlating with increased mortality. However, when Th17 depletion occurs following HIV infection is unknown. We analyzed mucosal Th17 cells in 42 acute HIV infection (AHI) subjects (Fiebig (F) stage I-V) with a median duration of infection of 16 days and the short-term impact of early initiation of ART. Th17 cells were defined as IL-17+ CD4+ T cells and their function was assessed by the co-expression of IL-22, IL-2 and IFNc. While intact during FI/II, depletion of mucosal Th17 cell numbers and function was observed during FIII correlating with local and systemic markers of immune-activation. ART initiated at FI/II prevented loss of Th17 cell numbers and function, while initiation at FIII restored Th17 cell numbers but not their polyfunctionality. Furthermore, early initiation of ART in FI/II fully reversed the initially observed mucosal and systemic immune-activation. In contrast, patients treated later during AHI maintained elevated mucosal and systemic CD8+ T-cell activation post initiation of ART. These data support a loss of Th17 cells at early stages of acute HIV infection, and highlight that studies of ART initiation during early AHI should be further explored to assess the underlying mechanism of mucosal Th17 function preservation.
[Show abstract][Hide abstract] ABSTRACT: Background: Most acute HIV infection (AHI) patients suffer acute retroviral syndrome (ARS), but information on virologic and immunologic correlates of ARS is limited.
Methods: Subjects were prospectively enrolled during AHI (Fiebig stages I-V) from May 2009 to February 2014 in Bangkok, Thailand. Study physicians completed a standardized checklist for each subject and those with ≥3 qualifying symptoms were considered to have ARS. Colon tissue (n=42) and cerebrospinal fluid (CSF) (n=37) were collected on willing volunteers. HIV burden and biomarkers were compared between those with and without ARS using the Mann-Whitney U test.
Results: Of 97,920 persons screened for HIV infection, 150 were enrolled during AHI at a mean of 18.5 days since history of HIV exposure. Median age was 28 years and 141 (94%) subjects were men. ARS was observed in 114 (76%). The most common symptoms were fever (94%), fatigue (81%), headache (72%), pharyngitis (60%), and myalgia (60%).
In blood, subjects with ARS had higher HIV RNA (median 5.7 vs. 4.6 log10copies/mL, p<0.001); total HIV DNA (134.1 vs. 7.5 copies/106 PBMCs, p=0.02); C-reactive protein (1431 vs. 644 µg/mL, p=0.004); tissue necrosis factor-α (7.41 vs. 4.71 pg/mL, p=0.001); and D-dimer (283 vs. 179 µg/mL, p=0.007).
In colon, subjects with ARS had lower absolute numbers of CD4+ T cells (6.60 vs. 11.8 x 106 cells/gm, p=0.02) and lower colonic HIV RNA (3.13 vs. 1.7 log10 copies/gm, p=0.009), while the frequency of activated CD8+ T cells (HLA-DR+/CD38+) was significantly increased (8.9% vs. 4.4%, p=0.01), as compared to subjects without ARS. In the CSF, ARS was associated with higher HIV RNA (3.7 vs. 1.8 log10 copies/mL, p=0.006) and neopterin (2482 vs. 1101 pg/mL, p=0.001). There were no correlations between these biomarkers and gastrointestinal or central nervous system symptoms.
Conclusion: Subjects with ARS had higher HIV RNA and proviral DNA in blood, colon and CSF. ARS was associated with depletion of CD4+ T cells and increased CD8 T cell activation in the sigmoid colon as well as heightened inflammation in the periphery. Patients with ARS may have poorer outcomes than those without ARS, particularly if they continue to display this unfavorable profile after treatment.
IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
[Show abstract][Hide abstract] ABSTRACT: An overdose of the acetaminophen causes liver injury. This study aims to examine the anti-oxidative, anti-inflammatory effects of Aloe vera in mice with acetaminophen induced hepatitis.
BMC Complementary and Alternative Medicine 07/2014; 14(1):229. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The double balloon enteroscopy (DBE) procedure is long and requires moderate sedation. We aim to determine whether the administration of propofol infusion is safe by comparing it to intravenous midazolam/meperidine in patients undergoing DBE.
[Show abstract][Hide abstract] ABSTRACT: Currently, the strategy for real-time endoscopic diagnosis of duodenal, including ampullary, adenoma is still unclear. In the era of high-definition and magnification endoscopy, using this modality for the detection and diagnosis of these neoplasms is very challenging for endoscopists. Over the past 10 years, many instruments have been developed to improve the detection rate of duodenal and ampullary polyps and to distinguish between adenoma and non-adenoma. The present review will focus on these novel methods and their usefulness in the diagnosis of ampullary and non-ampullary adenoma.
[Show abstract][Hide abstract] ABSTRACT: To evaluate feasibility of the novel forward-viewing radial-array echoendoscope for staging of colon cancer beyond rectum as the first series.
A retrospective study with prospectively entered database. From March 2012 to February 2013, a total of 21 patients (11 men) (mean age 64.2 years) with colon cancer beyond the rectum were recruited. The novel forward-viewing radial-array echoendoscope was used for ultrasonographic staging of colon cancer beyond rectum. Ultrasonographic T and N staging were recorded when surgical pathology was used as a gold standard.
The mean time to reach the lesion and the mean time to complete the procedure were 3.5 and 7.1 min, respectively. The echoendoscope passed through the lesions in 13 patients (61.9%) and reached the cecum in 10 of 13 patients (76.9%). No adverse events were found. The lesions were located in the cecum (n = 2), ascending colon (n = 1), transverse colon (n = 2), descending colon (n = 2), and sigmoid colon (n = 14). The accuracy rate for T1 (n = 3), T2 (n = 4), T3 (n = 13) and T4 (n = 1) were 100%, 60.0%, 84.6% and 100%, respectively. The overall accuracy rates for the T and N staging of colon cancer were 81.0% and 52.4%, respectively. The accuracy rates among traversable lesions (n = 13) and obstructive lesions (n = 8) were 61.5% and 100%, respectively. Endoscopic ultrasound and computed tomography had overall accuracy rates of 81.0% and 68.4%, respectively.
The echoendoscope is a feasible staging tool for colon cancer beyond rectum. However, accuracy of the echoendoscope needs to be verified by larger systematic studies.
World Journal of Gastroenterology 03/2014; 20(10):2681-7. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 55-year-old healthy Thai man presented with incidental finding of a well-circumscribed, 5.8×5.4 cm mass in the right side of the pelvic cavity with heterogeneous density by a CT scan performed for trauma. No other distant lesion was detected. The pathology from pelvic mass showed poorly differentiated neuroendocrine carcinoma (NEC). A submucosal mass of 10 cm from the anal verge was found at colonoscopy, and a biopsy showed the same histopathology as in the pelvic mass. Final diagnosis was poorly differentiated primary rectal NEC with metastasis to the right iliac node (by CT scan). Carboplatin and etoposide were given for six cycles and tumour size was decreased.
[Show abstract][Hide abstract] ABSTRACT: Abstract
Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.
[Show abstract][Hide abstract] ABSTRACT: Management of endoscopic complications is a pertinent aspect of patient care that has received great attention in the past decade due to advancements and increases in complexity of therapeutic endoscopy. Working groups from various institutions such as American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy have devised detailed guidelines and management algorithms. Three main factors that contribute to endoscopic complications are patient, operator, and type of procedure. No one rule suits all;hence endoscopic complication management must be customized to individual patients. Comprehensive knowledge of patient, machine/device, and its interrelationship must be in place to manage endoscopic complications.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS: We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 y, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS: We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 undetermined [IBD-U]). The crude annual overall incidence values, per 100,000 individuals, were 1.37 for IBD in Asia (95% confidence interval [CI], 1.25-1.51) (0.76 for UC, 0.54 for CD, and 0.07 for IBD-U) and 23.67 in Australia (95% CI, 18.46-29.85) (7.33 for UC, 14.00 for CD, and 2.33 for IBD-U). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. The median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15]. Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P =.001), whereas a family history of IBD was less common in Asia (3% vs 17%; P <.001). CONCLUSIONS: We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe, or more severe, in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health-care resources, and offers a unique opportunity to study etiologic factors in developing nations.
[Show abstract][Hide abstract] ABSTRACT: In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear the future for pancreatic cancer is early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging such as computerized tomography (CT) and magnetic resonance imaging (MRI), smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for the detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended to evaluate portal vein confluence, portal vein, celiac axis and SMA origin, and exclude respectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine needle aspiration (FNA) of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.
Journal of Gastroenterology and Hepatology 03/2013; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND AIM: Probe-based confocal laser endomicroscope (pCLE) has been applied for the early detection and confirmation of many GI neoplasms however its use in gastric intestinal metaplasia (GIM) detection has not yet been validated. The objective of this study was to assess the diagnostic yield of magnifying Flexible Spectral Imaging Color Enhancement (ME-FICE) plus pCLE for GIM detection. METHODS: Sixty patients with previous histology confirmed as GIM underwent a surveillance EGD. Standard and 100x ME-FICE were used as a screening mode to depict GIM by light blue crest, large long crest, and villous pattern criteria. Then pCLE was followed to confirm the presence of GIM. In each patient, two biopsies were obtained from one positive area and the other two were taken from the negative area. All specimens were interpreted by a clinically-blinded pathologist. The reading results by ME-FICE and by ME-FICE plus pCLE were assessed for sensitivity, specificity, PPV, NPV, false positive rate, false negative rate, and accuracy. RESULTS: Of the 59 areas suspicious for GIM in 45 patients, 44 areas were confirmed as GIM by histology. The overall criteria from ME-FICE plus pCLE provided the highest sensitivity, specificity, PPV, NPV, and accuracy at 96%, 90%, 86%, 97%, and 92%, respectively. There were 2 false negatives (4%) and 7 false positives (10%). No early gastric cancer was detected in any. CONCLUSION: Combining ME-FICE with pCLE provides high sensitivity and NPV for GIM detection. The prompt histology reading by this technique may avoid unnecessary biopsy. (Clinical trial registration number: NCT01489397).
Journal of Gastroenterology and Hepatology 02/2013; · 3.33 Impact Factor