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Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

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International Journal of Ophthalmology(English edition) 2024年第5期17卷 845-851页

作者： Behnam Rabiee Muhamad Festok Michael Gaspari Abid Haseeb Aaila chaudhry Layla Kamoun Imtiaz chaudhry Iftikhar chaudhry Department of Ophthalmology Trinity Health Mid-AtlanticNazareth HospitalPhiladelphiaPA 19020USA IC Laser Eye Care BensalemPA 19020USA

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOp) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, p=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (p=0.10). The incidence of severe IOp spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (p=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (p=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (p=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant p-values;larger studies couldanalyze better considering low incidence).

关键词： cataract endophthalmitis cystoid macular edema postoperative complications transzonular injection

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Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

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World Journal of Gastroenterology 2018年第8期24卷 905-916页

作者： Mohamad A Mouchli Lidia Ouk Marianne R Scheitel alisha p chaudhry Donna Felmlee-Devine Diane E Grill Shahrooz Rashtak panwen Wang Junwen Wang Rajeev chaudhry Thomas C Smyrk Ann L Oberg Brooke R Druliner Lisa A Boardman Division of Gastroenterology and Hepatology Mayo Clinic Knowledge and Delivery Center Mayo Clinic Biostatistics and Bioinformatics Health Sciences Research Mayo Clinic Division of Biomedical Statistics and Informatics Health Sciences Research Mayo Clinic Biostatistics and Bioinformatics Health Science Research Center for Individualized Medicine Mayo Clinic Department of Biomedical Informatics Arizona State University primary Care Internal Medicine Mayo Clinic Center for Innovation Mayo Clinic Department of Laboratory Medicine and pathology Mayo Clinic

AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

关键词： Colon cancer Rectal Cancer Advanced adenoma Sessile serrated adenoma High risk polyps post-polypectomy colorectal cancer

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Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

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World Journal of Experimental Medicine 2024年第2期14卷 75-88页

作者： Hassam Ali Faisal Inayat Waqas Rasheed Arslan Afzal Ahtshamullah chaudhry pratik patel Attiq Ur Rehman Muhammad Sajeel Anwar Gul Nawaz Muhammad Sohaib Afzal Amir H Sohail Subanandhini Subramanium Dushyant Singh Dahiya Deepa Budh Babu p Mohan Douglas G Adler Department of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Texas Tech University Health Sciences CenterLubbockTX 79430United States Department of Internal Medicine St.Dominic’s HospitalJacksonMS 39216United States Department of Gastroenterology Mather Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States Department of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 64108United States Department of Internal Medicine St.Barnabas Hospital and Albert Einstein College of MedicineBronxNY 10457United States Department of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCentura HealthDenverCO 80210United States

BACKGROUND patients with acute pancreatitis(Ap)frequently experience hospital readmissions,posing a significant burden to healthcare *** peripancreatic fluid collection(ApFC)may negatively impact the clinical course of *** could worsen symptoms and potentially lead to additional ***,clinical evidence regarding the specific association between ApFC and early readmission in Ap remains *** the link between ApFC and readmission may help improve clinical care for Ap patients and reduce healthcare *** To evaluate the association between ApFC and 30-day readmission in patients with *** This retrospective cohort study is based on the Nationwide Readmission Database for *** with a primary diagnosis of Ap were *** were categorized into those with and without ApFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was *** primary outcome was early readmission *** outcomes included the incidence of inpatient complications and healthcare *** analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission *** A total of 673059 patients with the principal diagnosis of Ap were *** these,5.1%had ApFC on initial *** propensity score matching,each cohort consisted of 33914 *** with ApFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,pportal venous thrombosis(4.4%vs 0.8%,pppFC patients[4(3-7)vs 3(2-5)days,ppital charges($29451 vs$24418,ppFC patients had a higher rate(15.7%vs 6.5%,pppF

关键词： Acute pancreatitis Acute peripancreatic fluid collections Readmission predictors Inpatient complications Healthcare utilization and costs

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predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1097-1108页

作者： Hassam Ali Faisal Inayat Vishali Moond Ahtshamullah chaudhry Arslan Afzal Zauraiz Anjum Hamza Tahir Muhammad Sajeel Anwar Dushyant Singh Dahiya Muhammad Sohaib Afzal Gul Nawaz Amir H Sohail Muhammad Aziz Department of Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Saint Peter's University Hospital and Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnsonNY 13790United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansasKS 66160United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III *** aids in significant weight loss and improves obesity-related medical *** its effectiveness,postoperative care still has *** evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after ***,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB *** To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing *** Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of *** resultant risk scores were derived from the coefficients of statistically significant *** performance of the model was evaluated using receiver operating curves through 5-fold *** Of the 26 initial variables,six predictors were *** included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(ppprior deep venous thrombosis(Coef 1.61,p7%(Coef 1.19,pppreoperative anticoagulation use(Coef 1.24,ppredicting 30-d VTE risk *** risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of *** training,the same model performed satisfactorily

关键词： Roux-en-Y gastric bypass Venous thromboembolism Machine learning Bariatric surgery predictive modeling

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Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

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World Journal of Transplantation 2024年第2期14卷 62-75页

作者： Faisal Inayat pratik patel Hassam Ali Arslan Afzal Hamza Tahir Ahtshamullah chaudhry Rizwan Ishtiaq Attiq Ur Rehman Kishan Darji Muhammad Sohaib Afzal Gul Nawaz Alexa Giammarino Sanjaya K Satapathy Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Division of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Saint Francis Hospital and Medical CenterHartfordCT 06105United States Division of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine Campbell University and Cape Fear Valley Medical CenterFayettevilleNC 28301United States Department of Internal Medicine North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States Division of Hepatology North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern *** with comorbid conditions are at risk of adverse outcomes following *** organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 *** could lead to higher rates of inpatient complications and mortality in this patient ***,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent *** To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United *** We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample *** with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding *** primary outcomes included trends in LT hospitalizations before and during the COVID-19 *** outcomes included comparative trends in inpatient mortality and transplant rejection in LT *** A total of 15720 hospitalized LT recipients were *** 0.8% of patients had a secondary diagnosis of COVID-19 *** both cohorts,the median admission age was 57 *** linear trends for LT hospitalizations did not differ significantly before and during the pandemic(p=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December *** to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95% confidence interval(CI):1.55-1.84),pplant rejections among hospitalized LT recipients increased from 0.2%to 3.6% between January 2019 and December *** hospitalizations during the COVID-19 pandemic had a higher associ

关键词： Liver transplant recipients Solid organ transplantation COVID-19 Hospitalization Transplant rejection Mortality

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Early versus delayed necrosectomy in pancreatic necrosis:A population-based cohort study on readmission,healthcare utilization,and in-hospital mortality

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World Journal of Methodology 2024年第3期14卷 55-67页

作者： Hassam Ali Faisal Inayat Vinay Jahagirdar Fouad Jaber Arslan Afzal pratik patel Hamza Tahir Muhammad Sajeel Anwar Attiq Ur Rehman Muhammad Sarfraz Ahtshamullah chaudhry Gul Nawaz Dushyant Singh Dahiya Amir H Sohail Muhammad Aziz Division of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Division of Gastroenterology and Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening *** poses a considerable challenge for clinicians due to its complex nature and the high risk of *** minimally invasive and open necrosectomy procedures have been *** advancements in treatment modalities,the optimal timing to perform necrosectomy lacks *** To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United *** A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions *** with non-elective admissions for pancreatic necrosis were *** participants were divided into two groups based on the necrosectomy timing:The early group received intervention within 48 hours,whereas the delayed group underwent the procedure after 48 *** various intervention techniques included endoscopic,percutaneous,or surgical *** major outcomes of interest were 30-day readmission rates,healthcare utilization,and inpatient *** A total of 1309 patients with pancreatic necrosis were *** propensity score matching,349 cases treated with early necrosectomy were matched to 375 controls who received delayed *** early cohort had a 30-day readmission rate of 8.6% compared to 4.8%in the delayed cohort(p=0.040).Early necrosectomy had lower rates of mechanical ventilation(2.9%vs 10.9%,pptic shock(8%vs 19.5%,ppital mortality(1.1%vs 4.3%,p=0.01).patients in the early intervention group incurred lower healthcare costs,with median total charges of $52202 compared to$147418 in the delayed *** in the early cohort also had a relatively shorter median length of stay(6 vs 16 days,pp=0.06).CONCLUSION Our findings show that

关键词： Acute necrotizing pancreatitis pancreatic necrosis Early necrosectomy Delayed necrosectomy Readmission,Healthcare costs Mortality

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Optimizing Service Stipulation Uncertainty with Deep Reinforcement Learning for Internet Vehicle Systems

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Computers, Materials & Continua 2023年第3期74卷 5705-5721页

作者： Zulqar Nain B.Shahana Shehzad Ashraf chaudhry p.Viswanathan M.S.Mekala Sung Won Kim Department of Information and Communication Engineering Yeungnam UniversityGyeongsan-siKorea Department of Computer Science and Engineering KLEFIndia Department of Computer Engineering Faculty of Engineering and ArchitectureIstanbul Gelisim UniversityIstanbul34310Turkey School of Computer Science and Engineering VIT UniversityVelloreIndia

Fog computing brings computational services near the network edge to meet the latency constraints of cyber-physical System(CpS)*** devices enable limited computational capacity and energy availability that hamper end user *** designed a novel performance measurement index to gauge a device’s resource *** examination addresses the offloading mechanism issues,where the end user(EU)offloads a part of its workload to a nearby edge server(ES).Sometimes,the ES further offloads the workload to another ES or cloud server to achieve reliable performance because of limited resources(such as storage and computation).The manuscript aims to reduce the service offloading rate by selecting a potential device or server to accomplish a low average latency and service completion time to meet the deadline constraints of sub-divided *** this regard,an adaptive online status predictive model design is significant for prognosticating the asset requirement of arrived services to make float ***,the development of a reinforcement learning-based flexible x-scheduling(RFXS)approach resolves the service offloading issues,where x=service/resource for producing the low latency and high performance of the *** approach to the theoretical bound and computational complexity is derived by formulating the system efficiency.A quadratic restraint mechanism is employed to formulate the service optimization issue according to a set ofmeasurements,as well as the behavioural association rate and adulation *** system managed an average 0.89%of the service offloading rate,with 39 ms of delay over complex scenarios(using three servers with a 50%service arrival rate).The simulation outcomes confirm that the proposed scheme attained a low offloading uncertainty,and is suitable for simulating heterogeneous CpS frameworks.

关键词： Fog computing task allocation measurement models feasible node selection methods performance metrics

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MCMV-based vaccine vectors expressing full-length viral proteins provide long-term humoral immune protection upon a single-shot vaccination

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Cellular & Molecular Immunology 2022年第2期19卷 234-244页

作者： Yeonsu Kim Xiaoyan Zheng Kathrin Eschke M.Zeeshan chaudhry Federico Bertoglio Adriana Tomić Astrid Krmpotić Markus Hoffmann Yotam Bar-On Julia Boehme Dunja Bruder Thomas Ebensen Linda Brunotte Stephan Ludwig Martin Messerle Carlos Guzman Ofer Mandelboim Michael Hust Stefan pöhlmann Stipan Jonjić LukaČičin-Šain Department of Viral Immunology Helmholtz Centre for Infection Research(HZI)BraunschweigGermany Department of Biotechnology Institut für BiochemieBiotechnologie und BioinformatikTechnischen Universität BraunschweigBraunschweigGermany Oxford Vaccine Group University of OxfordOxfordUK Center for proteomics University of RijekaFaculty of MedicineRijekaCroatia Infection Biology Unit German Primate CenterGöttingenGermany Faculty of Biology and psychology Georg-August-University GöttingenGöttingenGermany Department of Immunology Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael Infection Immunology Institute for Medical Microbiology and Hospital HygieneHealth Campus ImmunologyInfectiology and InflammationOtto-von-Guericke-University MagdeburgMagdeburgGermanyImmune RegulationHelmholtz Centre for Infection ResearchBraunschweigGermany Department of Vaccinology and Applied Microbiology Helmholtz Centre for Infection ResearchBraunschweigGermany Institute of Virology Medical University MünsterMünsterGermany Institute of Virology Hannover Medical School(MHH)HannoverGermany German Centre for Infection Research(DZIF) Hannover-Braunschweig SiteHannoverGermany Centre for Individualized Infection medicine(CiiM) a joint venture of HZI and MHHHannoverGermany

Global pandemics caused by influenza or coronaviruses cause severe disruptions to public health and lead to high morbidity and *** remains a medical need for vaccines against these ***(cytomegalovirus)is aβ-herpesvirus that induces uniquely robust immune responses in which remarkably large populations of antigen-specific CD8+T cells are maintained for a ***,CMV has been proposed and investigated as a novel vaccine vector for expressing antigenic peptides or proteins to elicit protective cellular immune responses against numerous *** generated two recombinant murine CMV(MCMV)vaccine vectors expressing hemagglutinin(HA)of influenza A virus(MCMV^(HA))or the spike protein of severe acute respiratory syndrome coronavirus 2(MCMV^(S)).A single injection of MCMVs expressing either viral protein induced potent neutralizing antibody responses,which strengthened over ***,MCMV^(HA)-vaccinated mice were protected from illness following challenge with the influenza virus,and we excluded that this protection was due to the effects of memory T ***,we show here that MCMV vectors induce not only long-term cellular immunity but also humoral responses that provide long-term immune protection against clinically relevant respiratory pathogens.

关键词： Vaccine vector SARS-CoV-2 Influenza Cytomegalovirus humoral imunity

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A Diagnostic Study of Record Heavy Rain in Twin Cities Islāmābad-Rāwalpindi

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Advances in Atmospheric Sciences 2004年第6期21卷 976-988页

作者： Ghulam RASUL Qamar-uz-Zaman chaudhry 赵思雄曾庆存 Meteorological Service of pakistan P. O. Box 1214 Islāamāabad-Pakistan Institute of Atmospheric physics Chinese Academy of Sciences Beijing 100029 Graduate School Chinese Academy of Sciences Beijing 100039

Using surface and NCEp reanalysis data along with radar and satellite images, diagnosis has been carried out to probe the reasons for the very heavy rainfall that occurred in Islāmābad-Rāwalpindi on 23 July 2001. It has been revealed that the sudden evolution of this meso-scale severe weather system was the direct result of strong surface convection in moist and unstable lower layers of the atmosphere. The subsequent rapid development was the combined effect of the presence of the mid latitude westerly’s trough in the north and moisture feeding through monsoon flow along the Himalayas and also the direct south-westerly current from the Arabian Sea. After the westward shifting of the Sub-Tropical High (STH) from the north of India, the strong divergence zone on its eastern edge contributed positively to the development of upward motion. Initially the convective systems moved towards the south and then southeastward following the steering current in the middle troposphere. Based on these analyses, the physical model of the sudden record heavy rainfall has been proposed and a comparison between the heavy rainfall in this case and one in China has been conducted.

关键词： monsoon circulation mesoscale systems heavy rainfall

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Transmitted cardiovascular pulsations on high resolution esophageal impedance manometry, and their significance in dysphagia

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World Journal of Gastroenterology 2017年第44期23卷 7840-7848页

作者： Naueen A chaudhry Kamran Zahid Sara Keihanian Yunfeng Dai Qing Zhang Depart-ment of Medicine Division of GastroenterologyUniversity of Florida Department of Medicine Division of Hospital MedicineUniversity of Florida Department of Biostatistics University of Florida

AIM To investigate the behavior of pulsatile pressure zones(ppZ's) as noted on high resolution esophageal impedance manometry(HREIM), and determine their association with *** Retrospective, single center case control design scr-eening HREIM studies for cases(dysphagia) and controls(no dysphagia). Thoracic radiology studies were reviewed further in cases for(thoracic cardiovascular) thoracic cardiovascular(TCV) structures in esophageal proximity to compare with HREIM findings. Manometric data was collected for number, location, axial length, ppZ pressure and esophageal clearance function(impedance). RESULTS Among 317 screened patients, 56% cases and 64% controls had ppZ's. Fifty cases had an available thoracic radiology comparison. The distribution of ppZ's in these 50 cases and 59 controls was similar(average 1.4 ppZ/patient). Controls(mean 31.2 ± SD 12 years) were a significantly younger population than cases(mean 67.3 ± SD 14.9 years) with p pright posture ppZ pressure was higher in controls(15.7 ± 10.0 mm Hg) than cases(10.8 ± 9.7 mm Hg). Although statistically significant(p = 0.005), it was a weak predictor using logistic regression and ROC model(AUC = 0.65). Three dysphagia patients had partial compression from external TCV on radiology(1 aberrant subclavian artery, 2 dilated left atrium). The posture(supine vs upright) with more prominent ppZ's impaired bolus clearance in 9 additional cases by > 20%. CONCLUSION Transmitted TCV pulsations observed in HREIM bear no significant impact on swallowing. However, in older adults with dysphagia, evidence of impaired bolus clearance on impedance should be evaluated for external TCV compression. These associations have never been explored previously in literature, and are novel.

关键词：高分辨率食道的 manometry 咽下困难咽下困难 lusoria 咽下困难贲门食道的活动性胸的心血管的结构食道的混乱

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