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Percutaneous endoscopic gastrostomy:Indications,technique,complications and management

World Journal of Gastroenterology 2014年第24期20卷 7739-7751页

作者： Ata A Rahnemai-Azar Amir A Rahnemaiazar Rozhin Naghshizadian Amparo Kurtz daniel t farkas Department of Surgery Bronx-Lebanon Hospital CenterAlbert Einstein College of MedicineBronxNY 10457United States

Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. these complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and relate

关键词： Gastrostomy tube Percutaneous Enteral feeding Indication Contraindication Complication Management

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Small bowel perforation from a migrated biliary stent: A case report and review of literature

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 543-554页

作者： Konstantinos A Zorbas Shane Ashmeade William Lois daniel t farkas Department of Surgery Bronx Care Health SystemNew YorkNY 10457United States

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome,chronic obstructive pulmonary disease,alcoholic liver cirrhosis,portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local *** further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic *** this case presentation reports on the unusual finding of two migrated biliary stents,with one causing *** addition,we review the relevant literature on migrated stents.

关键词： Biliary stent Biliary stent migration Small bowel perforation Endoscopic retrograde cholangiopancreatography Case report

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Laparoscopic vs open partial colectomy in elderly patients:Insights from the American College of Surgeons- National Surgical Quality Improvement Program database

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World Journal of Gastroenterology 2015年第45期21卷 12843-12850页

作者： Umashankkar Kannan Vemuru Sunil K Reddy Amar N Mukerji Vellore S Parithivel Ajay K Shah Brian F Gilchrist daniel t farkas Department of Surgery Bronx-Lebanon Hospital Center

AIM: to compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons- National Surgical Quality Improvement Program(ACS NSQIP) database. MEtHODS: the ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar preoperative comorbidities. Outcomes including postoperative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ2 and Fisher's exact test were used for discrete variables and Student's t-test for continuous variables. P t and odds ratios with 95%CI were reported when applicable. RESULtS: the total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009(43%) of the cases were done laparoscopically and15595(57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic(LC) and open colectomy(OC) cohorts. the laparoscopic approach had lower post-operative complications(LC 15.2%, OC 23.8%, P ter length of stay(LC 6.61 d, OC 9.62 d, P tality(LC 1.6%, OC 2.9%, P ter propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.

关键词： Colectomy Laparoscopic Outcomes Elderly National S

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A test of the species confidence hypothesis in dusky damselfish

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Current Zoology 2024年第1期70卷 79-86页

作者： Elle Overs Sydney Stump Isabel Severino daniel t.Blumstein Department of Ecology and Evolutionary Biology University of CaliforniaLos AngelesCA 90095-1606USA

Visual cues are important in both interspecific and intraspecific *** species confidence hypothesis proposes that animals are more attracted to conspecific colors and repelled by colors,not on their *** on terrestrial lizards and birds have tested the species confidence hypothesis and shown that conspecific colors elicit reduced antipredator *** date,the species confidence hypothesis has not been tested in the marine environment,specifically on coral reefs where color communication is of vital *** addressed this knowledge gap by measuring flight initiation distance(the distance an individual moves away from an approaching threat)in dusky damselfish(Stegastes nigricans)in response to an approaching disc of 1 of 4 different color treatments:conspecific,blue,yellow,and *** the species confidence hypothesis explained variation in damselfish flight initiation distance,then we expected individuals to tolerate closer approaches when approached by a conspecific *** addition,we calculated the color difference between each stimulus and its corresponding back-ground as a potential alternative explanation for flight *** tolerated the closest approach from the conspecific color stimulus;there were no significant differences between other colors and there was no support for the alternative color difference *** with similar terrestrial studies,these results are relevant to ecotourists'choice of swimsuit and wetsuit colors because color choice may modify naturalantipredatorbehavior.

关键词： antipredator behavior flight initiation distance risk assessment species confidence hypothesis Stegastes nigricans

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Beyond the code:the role of histone methylation in cancer resistance and therapy

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Signal transduction and targeted therapy 2024年第7期9卷 2837-2839页

作者： daniel Noerenberg Frederik Damm Charité–Universitätsmedizin Berlin corporate member of Freie Universität BerlinHumboldt Universität zu Berlinand Berlin Institute of HealthDepartment of HematologyOncologyand Cancer ImmunologyBerlinGermany German Cancer Consortium(Deutsches Konsortium für translationale Krebsforschung DKTK)Partner SiteBerlinGermany

In a recently published paper in Nature,Yamagishi et *** a comprehensive exploration on the mechanistic basis and subsequent emergence of resistance of targeting histone H3 lysine trimethylation(H3K27me3)using the EZH... 详细信息

关键词： EZH2 resistance

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Evaluation of a hepatic biomarker of nutritional imbalance in juvenile red drum(Sciaenops ocellatus) fed 60% soybean meal-based diets using NMR-based metabolomics

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Animal Nutrition 2024年第1期16卷 45-61页

作者： Fabio Casu Aaron M.Watson Justin Yost t.Gibson Gaylord daniel W.Bearden Michael R.Denson Marine Resources Research Institute South Carolina Department of Natural Resources Bozeman Fish technology Center United States Fish and Wildlife Service Marine Biochemical Sciences Group Chemical Sciences Division National Institute of Standards and Technology Hollings Marine Laboratory

A 12-week feeding trial with juvenile red drum(Sciaenops ocellatus) fed high-soybean meal(SBM) diets was conducted to investigate a putative biomarker of nutritional imbalance, N-formimino-L-glutamate(FIGLU). three fishmeal-free, 60% SBM pelleted diets(named B12, Fol, and Met, respectively) were tested to evaluate the effects on growth performance and tissue metabolite profiles of supplementation of vitamin B12(0.012 mg/kg), folate(10 mg/kg), methionine(1 g/kg) respectively, above basal supplementation levels. A fourth SBM-based diet(named B12/Fol/Met) was formulated with a combination of B12, folate, and methionine to attain the above-mentioned target concentrations. A fifth 60% SBM diet(named FWS) with methionine supplementation(1 g/kg above basal supplementation levels), enriched with taurine, lysine and threonine as well as minerals, was also tested. this diet contained formulation targets and additives which have allowed for replacing fishmeal with plant proteins in rainbow trout feeds. Control diets included a fishmeal-based diet(named FM), an unsupplemented basal 60% SBM diet(named SBM60), and a “natural” diet(named N) made up of equal parts of fish(cigar minnows), squid and shrimp as a positive reference for growth performance. Formulated feeds contained approximately 37% total crude protein, approximately 14% total crude lipid and were energetically balanced. Standard growth performance metrics were measured, and tissues(liver, muscle) were collected at week 12 to evaluate diet-induced metabolic changes using nuclear magnetic resonance(NMR)-based *** results show that the FWS diet outperformed all other SBM diets and the FM diet under all performance metrics(Pt detected in fish fed the N diet but was detected in those fed the SBM diets and the FM diet. Fish fed the FWS diet and the Met diet showed lower hepatic levels of FIGLU compared with the other SBM-based diets(Pting that among the different supplementatio

关键词： Aquaculture Metabolomics Nuclear magnetic resonance Red drum Soybean meal N-Formimino-L-glutamate

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In-situ study of the microstructure evolution during tension of a Mg-Y-Zn-Al alloy processed by rapidly solidified ribbon consolidation technique

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Journal of Magnesium and Alloys 2024年第5期12卷 2024-2040页

作者： Jeno Gubicza Kristián Máthis Péter Nagy Péter Jenei Zoltán Hegedus Andrea farkas Jozef Vesely Shin-ichi Inoue Daria Drozdenko Yoshihito Kawamura Department of Materials Physics Faculty of ScienceEotvos Loránd UniversityPázmány P.sétány 1/ABudapest H-1117Hungary Department of Physics of Materials Faculty of Mathematics and PhysicsCharles UniversityKe Karlovu 512116 Praha 2Czech Republic Deutsches Elektronen-Synchrotron DESY Notkestr.85Hamburg 22603Germany Magnesium Research Center Kumamoto University2-39-1 KurokamiChuo-kuKumamoto 860-8555Japan

Mg-Y-Zn-Al alloys processed by rapidly solidified ribbon consolidation(RSRC)technique exhibit an exceptional mechanical performance indicating promising application *** material has a bimodal microstructure consisting of fine recrystallized and coarse non-recrystallized grains with solute-rich stacking faults forming cluster arranged layers(CALs)and nanoplates(CANaPs),or complete long period stacking ordered(LPSO)*** order to reveal the deformation mechanisms,in-situ synchrotron X-ray diffraction line profile analysis was employed for a detailed study of the dislocation arrangement created during tension in Mg-0.9%Zn-2.05%Y-0.15%Al(at%)*** uncovering the effect of the initial microstructure on the mechanical performance,additional samples were obtained by annealing of the as-consolidated specimen at 300 and 400℃ for 2 *** heat treatment at 300℃ had no significant effect on the initial microstructure,its evolution during tension and,thus,the overall deformation behavior under tensile *** the other hand,annealing at 400℃ resulted in a significant increase of the recrystallized grains fraction and a decrease of the dislocation density,leading to only minor degradation of the mechanical *** maximum dislocation density at the failure of the samples corresponding to the plastic strain of 10-25% was estimated to be about 16-20×10^(14)m^(-2).the diffraction profile analysis indicated that most dislocations formed during tension were of non-basal and pyramidal types,what was also in agreement with the Schmid factor values revealed independently from orientation *** was also shown that the dislocation-induced taylor hardening was much lower below the plastic strain of 3% than above this value,which was explained by a model of the interaction between prismatic dislocations and CANaPs/LPSO plates.

关键词： Mg-Zn-Y-Al alloy Long period stacking ordered(LPSO)phase Cluster arranged nanoplates(CANaPs) Annealing tension Dislocation density Hardening

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Gallstone ileus with multiple stones:Where Rigler triad meets Bouveret's syndrome

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World Journal of Gastrointestinal Surgery 2015年第12期7卷 394-397页

作者： Vinaya Gaduputi Hassan tariq Amir A Rahnemai-Azar Anil Dev daniel t farkas Department of Medicine Bronx Lebanon Hospital Center Department of Surgery Bronx Lebanon Hospital Center

A 53-year-old man with multiple medical conditions presented to the emergency department with complaints of vomiting, anorexia and diffuse colicky abdominal pain for 3 d. A computed tomography scan of the abdomen and pelvis showed radiographic findings consistent with Rigler triad seen in small proportion of patients with small bowel obstruction secondary to gallstone impaction. In addition there was a gastric outlet obstruction, consistent with Bouveret's syndrome. the patient underwent an exploratory laparotomy and enterotomy with multiple stones extracted. the patient had an uneventful post-surgical clinical course and was discharged home.

关键词： Rigler triad Gallstone ileus Bouveret'ssyndrome Small bowel obstruction

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Carcinoma in situ in a 7 mm gallbladder polyp: time to change current practice?

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World Journal of Gastrointestinal Endoscopy 2015年第9期7卷 912-915页

作者： David Kasle Amir A Rahnemai-Azar Shahida Bibi Vinaya Gaduputi Brian F Gilchrist daniel t farkas Department of Surgery BronxLebanon Hospital CenterAlbert Einstein College of Medicine Department of Medicine Bronx-Lebanon Hospital CenterAlbert Einstein College of Medicine

Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored. Here, a case of carcinoma-in-situ is presented in a 7 mm gallbladder polyp. A 25-year-old woman, who had undergone a routine cholecystectomy, was found to have an incidental 7 mm polyp containing carcinoma in situ. She had few to no risk factors to alert to her condition. there are few reported cases of cancer transformation in gallbladder polyps smaller than 10 mm reported in the literature. the overwhelming consensus, barring significant risk factors for cancer being present, is that such lesions should be monitored until they become symptomatic or develop signs suspicious for malignancy. In our patient's case this could have led to the possibility of missing a neoplastic lesion, which could then have gone on to develop invasive cancer. As gallbladder carcinoma is an aggressive cancer, this may have led to a tragic outcome.

关键词： Gallbladder Polyp Cholecystectomy Size Carcinoma

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Elevation transition of aquatic insects closely matches a thermal feature in the Yungas of Northwestern Argentina

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Journal of Mountain Science 2024年第2期21卷 433-448页

作者： Alexandra BUItRAGO-GUACANAME Carlos MOLINERI Andrés LIRA-NORIEGA daniel Andrés DOS SANtOS Neotropical Biodiversity Institute(CONICEt-UNt) UNT-DomesHorco Molle S/N4107 TucumánArgentina CONACYt Research Fellow Network of Advanced Molecular StudiesInstitute of Ecology A.COld Road to Coatepec 351El HayaCP 91073XalapaVeracruzMexico Biostatistics Chair Faculty of Natural Sciences and IMLNational University of TucumánSan Miguel de TucumánMiguel Lillo 2054000 TucumánArgentina

temperature is a key factor that shapes the distribution of *** knowledge about how species respond to temperature is relevant to devise strategies for addressing the impacts of climate *** insects are particularly vulnerable to climate change,yet there is still much to learn about their ecology and *** the Yungas ecoregion of Northwestern Argentina,cold-and warm-adapted species of the orders Ephemeroptera,Plecoptera,and trichoptera(EPt)are segregated by *** modeled the ecological niche of South American EPt species in this region using available data and projected their potential distribution in geographic *** were grouped based on their ecogeographic similarity,and we analyzed their replacement pattern along elevation gradients,focusing on the ecotone where opposing thermal preferences *** this interface,we identified critical points where the combined incidence of cold and warm assemblages maximizes,indicating a significant transition *** found that the Montane Cloud Forest holds the interface,with a particularly greater suitability at its lower *** main axis of the interface runs in a N-S direction and falls between 14°C-16°C mean annual *** probability of a particular location within a basin being classified as part of the interface increases as Kira’s warmth index approaches a score around *** the interface is critical for defining the thermal limits of species distribution and designing biomonitoring *** in the location of thermal constants related to mountainous ecotones may cause vertical displacement of aquatic insects and vegetation *** have recognized significant temperature thresholds that serve as indicators of suitability for the *** global warming is anticipated to shift these indicators,we suggest using them to monitor the imprints of climate change on mountain ecosystems.

关键词： Austral Yungas Ecological Niche Model Ephemeroptera Kira’s warmth index Plecoptera trichoptera

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