Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

http://www.klinikcity.ru/wp-content/uploads/2012/03/Guidelines/Gastroenterology/Ulceral_Colitis_ACG_2010.pdf

Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee.

Crohn's disease is a lifelong disease arising from an interaction between genetic and environmental factors, but observed predominantly in developed countries of the world. The precise aetiology is unknown and therefore a causal therapy is not yet available. Within Europe there is a distinct North–South gradient, but the incidence appears to have increased in Southern countries in recent years.1 Many patients live with a considerable symptom burden despite medical treatment in the hope that the aetiology of the disease will shortly be revealed and curative therapies emerge. Since it is uncertain that the precise pathogenesis of Crohn's disease will be revealed anytime soon, clinicians have to advise patients on the basis of information available today rather than an unknown future. Despite a multiplicity of randomised trials there will always be many questions that can only be answered by the exercise of judgement and opinion. This leads to differences in practice between clinicians, which may be brought into sharp relief by differences in emphasis between countries.

The Consensus endeavours to address these differences. The Consensus is not meant to supersede the guidelines of different countries (such as those from the UK,2 Germany,3 or France), which reach broadly the same conclusions since they are, after all, based on the same evidence. Rather, the aim of the Consensus is to promote a European perspective on the management of Crohn's disease and its dilemmas. Since the development of guidelines is an expensive and time-consuming process, it may help to avoid duplication of effort in the future. A Consensus is also considered important because an increasing number of therapeutic trials are based in Europe, especially in eastern European countries where practice guidelines have yet to be published.

This document is based on the European consensus on the diagnosis and management of Crohn's …

https://gut.bmj.com/content/gutjnl/55/suppl_1/i1.full.pdf

The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis

Pain arises from activation of peripheral nociceptors, and strong noxious stimuli may cause an increase in spinal excitability called central sensitization, which is likely involved in many pathological pain states. So far, it has not been achieved to simultaneously visualize in vivo both the temporal and spatial aspects of spinal activity, including central sensitization. Using autofluorescent flavoprotein imaging (AFI), an optical technique suitable for mapping activity in nervous tissue, we demonstrate a close temporal and spatial correlation of electrically evoked nociceptive input with the spinal AFI signal, representing spinal neuronal activity. The AFI signal increases linearly with stimulation intensity. Furthermore, we found that the AFI signal was much larger in intensity and size when the same electrical stimulation was applied after the induction of central sensitization by a subcutaneous capsaicin injection. Finally, innocuous palpation of the hindpaw did not evoke an AFI response in naive animals, but after capsaicin injection a strong response was obtained. This is the first report demonstrating simultaneously the temporal and spatial propagation of spinal nociceptive activity in vivo.

https://www.jneurosci.org/content/jneuro/30/11/4081.full.pdf

Autofluorescent Flavoprotein Imaging of Spinal Nociceptive Activity

Diffuse pulmonary arteriovenous malformations (angiodysplasia) with unusual histologic features: case report and review of the literature.

Objective:The aim of the study was to investigate the association between p53, SOX2, and CD44 protein expression and tumor response, and to validate potential predictive biomarker(s) in an independent cohort.Background:Neoadjuvant chemoradiotherapy (nCRT) followed by surgery has become a standard of

P53 and SOX2 Protein Expression Predicts Esophageal Adenocarcinoma in Response to Neoadjuvant Chemoradiotherapy.

Upper gastrointestinal bleeding (UGIB) is a life-threatening complication and a commonly encountered diagnosis requiring hospitalization. It is defined as bleeding proximal to the ligament of Treitz with the most common cause being peptic ulcer disease. There are multiple causes of UGIB and each of them presents its own unique diagnostic and management challenges. We present a rare case of UGIB due to endometrial adenocarcinoma metastatic to the third part of the duodenum. Most common sites of metastasis from endometrial adenocarcinoma are pelvic and paraaortic lymph nodes, and it is very rare for endometrial cancer to metastasize in gastrointestinal tract and then present as UGIB.

Upper Gastrointestinal Bleeding due to Metastatic Endometrial Adenocarcinoma.

W ith great interest, we read the article by Shapiro et al1 published in the November 2013 edition of Annals of Surgery. The authors meticulously reevaluated the resection specimens of 71 esophageal cancer patients showing pathological noncomplete response to neoadjuvant chemoradiotherapy (nCRT). For each layer of the esophageal wall and for all available lymph nodes, a tumor regression grade was appointed by a pathologist. The conclusion was drawn that after nCRT both the mucosa and the submucosa frequently show residual malignant involvement as opposed to the surrounding stroma. However, the data analysis and interpretation of results raise some questions. In particular, multiple concerns are raised regarding the conclusion of the authors that their findings support a wait-and-see approach in the subgroup of clinical complete responders. First, in the overall population with clinical T3 esophageal tumors, residual disease may involve the surrounding stroma and the mucosa equally frequently. The authors found that in the subgroup of 57 patients with clinical T3 tumors (tumors where the initial cancer also involved the mucosa and surrounding stroma) the presence of residual tumor in the mucosa and surrounding stroma was not significantly different. Therefore, the conclusion that residual cancer is more often present in the mucosa than in the surrounding stroma should be interpreted with caution. The residual tumors in the surrounding stroma will not be detected by endoscopy. Second, even superficial residues tend to be easily missed by endoscopic biopsies and endoscopic ultrasound. In studies investigating the value of endoscopic biopsies in identifying residual cancer after nCRT, consistently poor sensitivities of 31%,2 36%,3 42%,4 and 59%5 were reported. In this study by Shapiro et al,1 the authors suggest that post-nCRT bite-on-bite biopsies or fineneedle aspirations would improve the sensitivity of identifying noncomplete responders. Unfortunately, however, in patients with residual tumor in the submucosa but not in

Joel Shapiro

Papers

Autofluorescent Flavoprotein Imaging of Spinal Nociceptive Activity

Diffuse pulmonary arteriovenous malformations (angiodysplasia) with unusual histologic features: case report and review of the literature.

P53 and SOX2 Protein Expression Predicts Esophageal Adenocarcinoma in Response to Neoadjuvant Chemoradiotherapy.

Upper Gastrointestinal Bleeding due to Metastatic Endometrial Adenocarcinoma.

Reply to Letter: "Residual Esophageal Cancer After Neoadjuvant Chemoradiotherapy Frequently Involves the Mucosa and Submucosa".