The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

Background/Aims: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). Methods: We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. Results: The median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (P=0.215) and 1.698 (1.777–2.448) (P=0.005), respectively. Conclusions SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.

Objective: : Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors. Methods: : Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports. Results: : For the treatment response, a decreased CSF ‘total’ cell count tended to be associated with a ‘controlled’ increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in ‘other’ cell count showed worse OS than ‘no change’ or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of ‘no response’. Conclusion : A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.

Objective: : Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors. Methods: : Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports. Results: : For the treatment response, a decreased CSF ‘total’ cell count tended to be associated with a ‘controlled’ increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in ‘other’ cell count showed worse OS than ‘no change’ or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of ‘no response’. Conclusion : A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.

BACKGROUND: To evaluate the efficacy of modified ventriculolumbar perfusion (VLP) chemotherapy with methotrexate on leptomeningeal carcinomatosis in terms of symptomatic response and side effects. METHODS: Previous infusion rate of 20 mL/h was reduced to 15 mL/h for the purpose of decreasing constitutional side effects of VLP such as nausea/vomiting, insomnia and confusion. The primary outcome was the response rate of increased intracranial pressure (ICP), and the secondary outcome was the occurrence of side effects compared to previous 20 mL/h trial. This interim analysis to validate the reduced infusion rate is not to affect the original effect of VLP chemotherapy. RESULTS: All forty-seven patients were enrolled including 22 patients with increased ICP. Thirteen patients out of these (59%) got normalized ICP after VLP chemotherapy. Moderate to severe (grade 2–3) confusion was observed in 3 patients (6%) and it was significantly reduced compared to those (23%) in the VLP 20 mL/h (p=0.017). Grade 2–3 nausea/vomiting was also reduced from 64% to 45% but failed to reach statistical significance (p=0.08). Median overall survival (OS) was 5.3 months (95% confidence interval, 3.55–7.05) and patients OS, who received maintenance VLP was significantly prolonged compared to patients who underwent induction VLP only (5.8 vs. 3.4 months, p=0.025). CONCLUSION: VLP of reduced perfusion rate (15 mL/h) showed compatible control rate of increased ICP at this interim analysis. Decreased moderate to severe side effects and prolonged OS in patients received maintenance VLP encourage us to evaluate the effectiveness of this trial further.
Drug Therapy ; Humans ; Infusions, Intraventricular ; Intracranial Pressure ; Meningeal Carcinomatosis ; Methotrexate ; Perfusion ; Sleep Initiation and Maintenance Disorders

PURPOSE: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and the Memorial Sloan Kettering Cancer Center (MSKCC) risk models were developed predominantly with clear cell renal cell carcinoma (RCC). Accordingly, whether these two models could be applied to metastatic non-clear cell RCC (mNCCRCC) as well has not been well-known and was investigated herein. MATERIALS AND METHODS: From the Korean metastatic RCC registry, a total of 156 patients (8.1%) with mNCCRCC among the entire cohort of 1,922 patients were analyzed. Both models were applied to predict first-line progression-free survival (PFS), total PFS, and cancer-specific survival (CSS). RESULTS: The median first-line PFS, total PFS, and CSS were 5, 6, and 24 months, respectively. The IMDC risk model reliably discriminated three risk groups to predict survival: the median first-line PFS, total PFS, and CSS for the favorable, intermediate, and poor risk groups were 9, 5, and, 2 months (p=0.001); 14, 7, and 2 months (p < 0.001); and 41, 21, and 8 months (p < 0.001), all respectively. The MSKCC risk model also reliably differentiated three risk groups: 9, 5, and, 2 months (p=0.005); 10, 7, and 3 months (p=0.002); and 50, 21, and 8 months (p < 0.001), also all respectively. The concordance indices were 0.632 with the IMDC model and 0.643 with the MSKCC model for first-line PFS: 0.748 and 0.655 for CSS. CONCLUSION: The current IMDC and MSKCC risk models reliably predict first-line PFS, total PFS, and CSS in mNCCRCC.
Carcinoma, Renal Cell ; Cohort Studies ; Disease-Free Survival ; Humans ; Prognosis ; Retrospective Studies