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Considerations for bariatric surgery in patients with cirrhosis

World journal of Gastroenterology 2018年第28期24卷 3112-3119页

作者： George Boon-Bee Goh Philip R Schauer arthur j mccullough Department of Gastroenterology and Hepatology Singapore General HospitalSingapore 169608Singapore Duke-NUS Graduate Medical School Singapore 169608Singapore Bariatric and Metabolic Institute Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Cleveland ClinicClevelandOH 44195United States Department of Pathobiology Cleveland ClinicClevelandOH 44195United States

With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease(NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. Bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis(NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.

关键词： Cirrhosis Portal hypertension Non-alcoholic fatty liver disease Bariatric surgery Complications

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Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease

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journal of Clinical and Translational Hepatology 2017年第3期5卷 261-271页

作者： Mark CC Cheah arthur j mccullough George Boon-Bee Goh Department of Gastroenterology & Hepatology Singapore General Hospital Singapore Department of Gastroenterology Cleveland Clinic Ohio USA Department of Pathobiology Cleveland Clinic Ohio USA Department of Gastroenterology & Hepatology Singapore General Hospital Singapore Duke-NUS Medical School Singapore

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning global health concern.In the subset of NAFLD patients with non-alcoholic steatohepatitis (NASH),the presence of significant fibrosis at index assessment is associated with poor prognosis and increased mortality.Hence,there is a growing need to accurately assess and stage fibrosis.Liver biopsy,the current gold standard,has limitations with sampling error and is invasive,with associated inherent risk.This has led to a host of non-invasive means of assessing fibrosis,which has garnered relevance in a disease that requires serial assessment of fibrosis longitudinally over time.This review discusses,comprehensively,the various tools available to the clinician for the assessment of fibrosis,including the various scoring systems used in liver biopsy,the non-invasive means of serum biomarkers,such as the highly-validated NAFLD fibrosis score,and the imaging-based modalities,such as transient elastography and magnetic resonance elastography.

关键词： NAFLD Fibrosis assessment Modalities

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Impact of transjugular intrahepatic portosystemic shunt on post-colectomy complications in patients with ulcerative colitis and primary sclerosing cholangitis

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Gastroenterology Report 2015年第3期3卷 228-233页

作者： Gursimran Kochhar Udayakumar Navaneethan jose Mari Parungao jason Hartman Ranjan Gupta Rocio Lopez arthur j mccullough Baljiendra Kapoor Bo Shen Department of Gastroenterology and Hepatology The Cleveland ClinicClevelandOHUSA Case Western Reserve University School of Medicine ClevelandOHUSA Department of Vascular and Interventional Radiology The Cleveland ClinicClevelandOHUSA

Objective:Primary sclerosing cholangitis(PSC)occurs in approximately 5%of patients with ulcerative colitis(UC).The risk of colon cancer is higher in patients undergoing colectomy,who have simultaneous PSC&UC.Our aim was to study the impact,in terms of post-colectomy survival and complications,of transjugular intrahepatic portosystemic shunt(TIPS)before colectomy in these patients.Methods:In this retrospective,case-control study,information was obtained on demographics,disease characteristics,TIPS characteristics,and post-colectomy complications.Nine patients with PSC and UC who underwent TIPS prior to colectomy(the Study group)and 37 patients with PSC and UC who underwent only colectomy without TIPS(the Control group)were included.Either an analysis of variance or the non-parametric Kruskal-Wallis test were used for continuous variables and Fisher’s Exact test or Pearson’s chi-squared test was used for categorical factors.Results:There was no difference in themean age between the two groups;however patients in the Study group had lower platelet count(P=0.005)as well as higher Model for End-Stage Liver disease(MELD)scores(Pjusting for disease severity,the Study group hadmore wound infections(P=0.034),more wound dehiscence(P=0.022),and a higher re-admission rate within 30 days(P=0.032);however,the post-operativemortality was not significantly different.Conclusion:Patients with PSC and UC who underwent TIPS prior to colectomy had higher rates of complications;however,this was probably due to the greater severity of cirrhosis and PSC in this population.

关键词： primary sclerosing cholangitis ulcerative colitis transjugular intrahepatic portosystemic shunt(TIPS) colectomy

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Effects of High-Definition Transcranial Direct Current Stimulation on Excitability of Spinal Motoneurons under Ankle Dorsi-Plantarflexion Fatigue Task

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Yiyong Shengwu Lixue/journal of Medical Biomechanics 2024年第2期39卷 293-298页

作者： Yu C. Zhan j. Shen B. Zhou j. Xu L. Fu W. School of Rehabilitation Science Hangzhou Medical College Hangzhou 310000 China Key Laboratory of Exercise and Health Sciences of Ministry of Education Shanghai University of Sport Shanghai 200438 China Harvard Medical School 02115 MA United States Hebrew Senior Life Hinda and arthur Marcus Institute for Aging Research 02131 MA United States

Objective To investigate the effects of high-definition transcranial direct current stimulation (HD-tDCS) on the modulation of the H-reflex and M-wave during ankle dorsiflexion-plantar flexion fatigue tasks to provide direction for the application of HD-tDCS in mitigating neuromuscular fatigue. Methods Twenty healthy young male participants were recruited and randomly assigned to either the real stimulation or sham stimulation group, with 10 participants in each group. The intervention consisted of a 5-day single-blind HD-tDCS application (duration: 20 min; intensity: 2 mA; target: Cz) . Baseline measurements of the H-reflex and M-wave under resting conditions, M-wave during maximal voluntary isometric contraction (MVIC) of the dorsiflexor muscle, and MVIC torque of the dorsiflexor and plantar flexor muscles were obtained. An ankle dorsiflexion fatigue task was performed to determine the time to achieve fatigue for the task. The same fatigue task was repeated and evaluated one day after the intervention. A repeated-measures two-factor (stimulation condition × pre / post fatigue) analysis of variance (ANOVA) was used to analyze the effects of independent variables on the mechanical properties of the muscles and α-motoneuron conduction characteristics. Results After fatigue, voluntary activation (VA), maximal H-reflex (Hmax ), maximal M-wave (Mmax ), and dorsiflexor and plantar flexor MVIC torques in both groups were significantly reduced compared with pre-fatigue levels (P junction under the ankle dorsi-plantarflexion fatigue task. © 2024 Editorial Department of journal of Shanghai Second Medical University. Al

关键词： corticospinal pathway high-definition transcranial direct current stimulation (HD-tDCS) maximal voluntary isometric contraction (MVIC) muscle fatigue neural impulses α-motoneuron activity

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Expediting the transition from replacement medicine to tissue engineering

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Regenerative Biomaterials 2016年第2期3卷 111-113页

作者： arthur j.Coury Department of Chemical Engineering Northeastern UniversityBostonMAUSA

In this article,an expansive interpretation of“Tissue Engineering”is proposed which is in congruence with classical and recent published definitions.I further simplify the definition of tissue engineering as:“Exerting systematic control of the body’s cells,matrices and fluids.”As a consequence,many medical therapies not commonly considered tissue engineering are placed in this category because of their effect on the body’s responses.While the progress of tissue engineering strategies is inexorable and generally positive,it has been subject to setbacks as have many important medical therapies.Medical practice is currently undergoing a transition on several fronts(academics,start-up companies,going concerns)from the era of“replacement medicine”where body parts and functions are replaced by mechanical,electrical or chemical therapies to the era of tissue engineering where health is restored by regeneration generation or limitation of the body’s tissues and functions by exploiting our expanding knowledge of the body’s biological processes to produce natural,healthy outcomes.

关键词： tissue engineering medical devices combination products regenerative medicine

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An implementation assessment of China's Environmental Information Disclosure Decree

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journal of Environmental Sciences 2010年第10期22卷 1649-1656页

作者： Lei Zhang arthur E j Mol Guizhen He Yonglong Lu School of Environment and Natural Resources Renmin University of China Beijing 100872 China Environmental Policy Group Wageningen University Hollandseweg 1 6706 KN Wageningen The Netherlands State Key Laboratory of Urban and Regional Ecology Research Center for Eco-Environmental Sciences Chinese Academy of Sciences Beijing 100085 China

China＇s 2007 Open Government Information Regulations is widely considered as a milestone in the country＇s information policy history and is praised as a ＂sunshine program＂. The Environmental Information Disclosure Decree was the first to operationalize these general regulations into a sectorai information disclosure system on environment. This study assessed the implementation of the environmental information disclosure system about six months after the Decree took effect on May 1, 2008. Through reviewing the websites of all 31 provincial Environmental Protection Bureaus and the Ministry of Environmental Protection, conducting an experiment with actual information disclosure request, and through interviews with all provincial Environmental Protection Bureaus, this article concluded that the implementation of the environmental information disclosure system still fails short. Future improvements should focus on further publicity of the regulations and decree to enhance public participation, the establishment of an independent evaluation and supervision system for information disclosure, the exchange of experiences and best practices among provincial Environmental Protection Bureaus, and on strengthening the legal status of environmental information disclosure.

关键词： environmental information disclosure environmental governance

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Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

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World journal of Gastroenterology 2010年第15期16卷 1885-1889页

作者： Hoi-Poh Tee arthur j Kaffes A W Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital

AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from june 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered during DBE.RESULTS: There were 228 (150 antegrade and 78 retrograde) DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD) of the patients was 62 ± 16 years old. There were 94 females (52.5%). The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6%) had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs); 27 (15.1%) had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions.CONCLUSION: A significant proportion of patients (24.6%) had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

关键词： Bleeding Obscure gastrointestinal bleeding Endoscopy Double-balloon enteroscopy

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Gastrointestinal disease in children with autism spectrum disorders:Etiology or consequence?

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World journal of Psychiatry 2021年第9期11卷 605-618页

作者： arthur Krigsman Stephen j Walker Pediatric Gastroenterology Resources of New York and Texas GeorgetownTX 78628United States Institute for Regenerative Medicine Wake Forest Baptist Medical CenterWinston SalemNC 27157United States

Chronic gastrointestinal(GI)symptoms and disorders are common in children with autism spectrum disorder and have been shown to be significantly correlated with the degree of behavioral and cognitive impairment.In this unique population,GI symptoms often arise very early in development,during infancy or toddlerhood,and may be misdiagnosed-or not diagnosed at all–due in part to the challenges associated with recognition of symptoms in a minimally or noncommunicative child.Evidence demonstrating that the gut-brain-axis can communicate gut dysbiosis and systemic immune dysregulation in a bidirectional manner raises the question as to whether an untreated gastrointestinal disorder can directly impact neurodevelopment or,conversely,whether having a neurodevelopmental disorder predisposes a child to chronic GI issues.From the data presented in this mini review,we conclude that the preponderance of available evidence would suggest the former scenario is more strongly supported.

关键词： Autism spectrum disorder Gastrointestinal disease Immune dysregulation Neurodevelopment

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Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

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World journal of Gastroenterology 2010年第28期16卷 3597-3600页

作者： Hoi-Poh Tee Martin W james arthur j Kaffes Gastroenterology Unit Medical Department Hospital Tengku Ampuan AfzanJalan Tanah Putih25100 KuantanPahangMalaysia Wolfson Digestive Disease Biomedical Re search Unit Nottingham NG7 2UHUnited Kingdom AW Morrow Gastroenterology and Live Centre Royal Prince Alfred HospitalMissenden RoadCamp erdownNSW 2050Australia

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable metal stent(RCSEMS).These 2 patients(both men,aged 44 and 53 years)were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system,8 mm×40 mm stent dimensions)in the common bile duct across the biliary stricture.There was no morbidity associated with stent placement and removal in these 2 cases.Clinical parameters improved after the RCSEMS placement.Longterm biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.

关键词： Anastomosis Biliary stent Biliary stricture Orthotopic liver transplantation Niti-S stent

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Effect of the C:N:P ratio on the denitrifying dephosphatation in a sequencing batch biofilm reactor(SBBR)

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journal of Environmental Sciences 2015年第12期27卷 119-125页

作者： Artur Mielcarek joanna Rodziewicz Wojciech janczukowicz arthur j.Thornton Tomasz józwiak Paula Szymczyk University of Warmia and Mazury in Olsztyn Department of Environment Engineering ul. Warszawska 117a Olsztyn 10-719 Poland. Atkins Woodcote Grove Ashley Road Epsom KT18 United Kingdom

A series of investigations were conducted using sequencing batch biofilm reactor（SBBR） to explore the influence of C：N：P ratio on biological dephosphatation including the denitrifying dephosphatation and the denitrification process.Biomass in the reactor occurred mainly in the form of a biofilm attached to completely submerged disks.Acetic acid was used as the source of organic carbon.C：N：P ratios have had a significant effect on the profiles of phosphate release and phosphate uptake and nitrogen removal.The highest rates of phosphate release and phosphate uptake were recorded at the C：N：P ratio of 140：70：7.The C：N ratio of 2.5：1 ensured complete denitrification.The highest rate of denitrification was achieved at the C：N：P ratio of 140：35：7.The increase of nitrogen load caused an increase in phosphates removal until a ratio C：N：P of 140：140：7.Bacteria of the biofilm exposed to alternate conditions of mixing and aeration exhibited enhanced intracellular accumulation of polyphosphates.Also,the structure of the biofilm encouraged anaerobic-aerobic as well as anoxic-anaerobic and absolutely anaerobic conditions in a SBBR.These heterogeneous conditions in the presence of nitrates may be a significant factor determining the promotion of denitrifying polyphosphate accumulating organism（DNPAO） development.

关键词： Wastewater treatment Sequencing batch biofilm reactor Nitrogen and phosphorus removal Enhanced intracellular polyphosphate accumulation Denitrifying dephosphatation Denitrification and dephosphatation rates

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