| 1. |
- Ciuti, Gastone, et al.
(författare)
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Frontiers of robotic colonoscopy : A comprehensive review of robotic colonoscopes and technologies
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 9:6
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Forskningsöversikt (refereegranskat)abstract
- Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.
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| 2. |
- Jeppsson, Bengt, et al.
(författare)
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Use of Probiotics as Prophylaxis for Postoperative Infections
- 2011
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 3:5, s. 604-612
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Forskningsöversikt (refereegranskat)abstract
- Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut microbiota and influence on clinical management. The use of probiotics must be better delineated in relation to type of bacteria, dose and length of administration.
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| 3. |
- Khan, Umama, et al.
(författare)
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Neutrophil extracellular traps in colorectal cancer progression and metastasis
- 2021
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Ingår i: International Journal of Molecular Sciences. - : MDPI AG. - 1661-6596 .- 1422-0067. ; 22:14
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Forskningsöversikt (refereegranskat)abstract
- Neutrophils form sticky web-like structures known as neutrophil extracellular traps (NETs) as part of innate immune response. NETs are decondensed extracellular chromatin filaments comprising nuclear and cytoplasmic proteins. NETs have been implicated in many gastrointestinal diseases including colorectal cancer (CRC). However, the regulatory mechanisms of NET formation and potential pharmacological inhibitors in the context of CRC have not been thoroughly discussed. In this review, we intend to highlight roles of NETs in CRC progression and metastasis as well as the potential of targeting NETs during colon cancer therapy.
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| 4. |
- Schramm, R, et al.
(författare)
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Neutrophil recruitment in mast cell-dependent inflammation: inhibitory mechanisms of glucocorticoids
- 2004
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Ingår i: Inflammation Research. - : Springer Science and Business Media LLC. - 1420-908X .- 1023-3830. ; 53:12, s. 644-652
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Forskningsöversikt (refereegranskat)abstract
- Mast cells are strategically localized along the microvasculature in tissues in close contact with the external environment, such as the skin, lung and intestines. By releasing a multi-faceted spectrum of proinflammatory mediators, such as cytokines and chemokines, mast cells have the capacity to coordinate trafficking of leukocytes. Mast cells play a pathophysiological role in numerous inflammatory diseases as diverse as hypersensitivity reactions, ischemia/reperfusion injury and rheumatoid arthritis. On the other hand, mast cells act also as tissue sentinels and are critically involved in the host defensive response against microbial infection by stimulating neutrophil recruitment. Glucocorticoids are powerful agents frequently used in mast cell-dependent diseases, although the anti-inflammatory mechanisms of these compounds are not completely understood at present. In order to circumvent steroid-associated side-effects and develop more specific therapeutics, numerous studies have examined the mechanisms underlying glucocorticoid inhibition of mast cell-dependent neutrophil recruitment. Based on recent findings, it may be suggested that glucocorticoids selectively inhibit the expression and function of certain adhesion molecules and chemokines. This review summarizes current insights into the underlying mechanisms of mast cell-regulated tissue accumulation of neutrophils and the inhibitory effects of glucocorticoids.
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| 5. |
- Thorlacius, Henrik, et al.
(författare)
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Anti-infective effects o Lactobacilli in the gastrointestinal tract
- 2003
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Ingår i: Current Medicinal Chemistry - Anti-Infective Agents. - 1568-0126. ; 2:4, s. 263-267
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Forskningsöversikt (refereegranskat)abstract
- Antibiotics constitute the dominant treatment of gastrointestinal infections. However, several serious side-effects are associated with extensive use of antibiotics, including spread of bacterial resistance and allergic reactions as well as potential overgrowth of pathogenic bacteria and viruses. On the other hand, there is a growing body of evidence suggesting that certain bacteria, referred to as probiotics, have anti-bacterial properties and may counteract the development of infections. Probiotics are defined as viable non-pathogenic microorganisms, which, upon ingestion exert a positive impact in the host. This review will focus on the antiinfective mechanisms and effects of lactobacilli and suggests that administration of lactobacilli may be an effective approach to prevent and treat a vast spectrum of infections of enteric origin.
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| 6. |
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| 7. |
- Thorlacius, Henrik, et al.
(författare)
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European experience of colorectal endoscopic submucosal dissection : a systematic review of clinical efficacy and safety
- 2019
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Ingår i: Acta Oncologica. - 0284-186X. ; 58:sup1, s. 10-14
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Forskningsöversikt (refereegranskat)abstract
- Background: Endoscopic submucosal dissection (ESD) is an advanced method allowing en bloc resection of large and complex lesions in colon and rectum. Herein, the European experience of colorectal ESD was systematically reviewed in the medical literature to determine the clinical efficacy and safety of colorectal ESD in Europe. Material and methods: A systematic search of PubMed for full-text studies including more than 20 cases of colorectal ESD emanating from European centres was performed. Data were independently extracted by two authors using predefined data fields, including efficacy and safety. Results: We included 15 studies containing a total of 1404 colorectal ESD cases (41% in the colon) performed between 2007 and 2018. Lesion size was 40 mm (range 24–59 mm) and procedure time was 102 min (range 48–176 min). En bloc resection rate was 83% (range 67–93%) and R0 resection rate was 70% (range 35–91%). Perforation rate was 7% (range 0–19%) and bleeding rate was 5% (range 0–12%). The percentage of ESD cases undergoing emergency surgery was 2% (range 0–6%). Additional elective surgery was performed in 3% of all cases due to histopathological findings showing deep submucosal invasion or more advanced cancer. The recurrence rate was 4% (range 0–12%) after a median follow-up time of 12 months (range 3–24 months). Conclusions: This review shows that ESD is effective and safe for treating large and complex colorectal lesions in Europe although there is room for improvement. Thus, it is important to develop standardized and high-quality educational programs in colorectal ESD in Europe.
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| 8. |
- Thorlacius, Henrik, et al.
(författare)
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Role of chromoendoscopy in colon cancer surveillance in inflammatory bowel disease.
- 2007
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1536-4844 .- 1078-0998. ; 13:7, s. 911-917
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Forskningsöversikt (refereegranskat)abstract
- Inflammation in the intestine is a well-known risk factor for neoplastic changes in the mucosa. In fact, it has been shown that long-standing ulcerative colitis and colonic Crohn's disease have a significantly increased risk for developing colorectal cancer, although the estimates vary widely between studies. Conventional colonoscopy is effective in detecting polypoid changes in the mucosa. However, it is now generally accepted that neoplastic changes in colitis are frequently flat and depressed, which are easily missed by use of routine colonoscopy. The introduction of chromoendoscopy, especially in combination with magnifying endoscopy, has greatly advanced our means to detect and differentiate neoplastic lesions in the colorectum. Accumulating evidence-based data indicate that implementation of chromoendoscopy into colon cancer surveillance protocols for patients with inflammatory bowel disease is effective. However, the introduction of chromoendoscopy into surveillance programs requires meticulous training and further studies to compare the value of chromoendoscopy to newer endoscopic devices and techniques, such as narrow band imaging.
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| 9. |
- Thorlacius, Henrik, et al.
(författare)
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Serrated polyps–a concealed but prevalent precursor of colorectal cancer
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 52:6-7, s. 654-661
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Forskningsöversikt (refereegranskat)abstract
- Serrated polyps have long been considered to lack malignant potential but accumulating data suggest that these lesions may cause up to one-third of all sporadic colorectal cancer. Serrated polyps are classified into three subtypes, including sessile serrated adenomas/polyps (SSA/Ps), traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). SSA/P and TSA harbour malignant potential but TSA represents only 1–2%, wheras SSA/P constitute up to 20% of all serrated lesions. HPs are most common (80%) of all serrated polyps but are considered to have a low potential of developing colorectal cancer. Due to their subtle appearence, detection and removal of serrated polyps pose a major challenge to endoscopists. Considering that precancerous serrated polyps are predominately located in the right colon could explain why interval cancers most frequently appear in the proximal colon and why colonoscopy is less protective against colon cancer in the proximal compared to the distal colon. Despite the significant impact on colorectal cancer incidence, the aetiology, incidence, prevalence, and natural history of serrated polyps is incompletely known. To effectively detect, remove, and follow-up serrated polyps, endoscopists and pathologists should be well-informed about serrated polyps. This review highlights colorectal serrated polyps in terms of biology, types, diagnosis, therapy, and follow-up.
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