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In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study

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World Journal of Gastroenterology 2017年第18期23卷 3338-3348页

作者： Somashekar G Krishna Rohan M Modi Amrit K Kamboj Benjamin J Swanson Phil A Hart Mary E Dillhoff Andrei Manilchuk Carl R Schmidt darwin l conwell Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Department of Internal Medicine The Ohio State University Wexner Medical Center College of Medicine The Ohio State University Wexner Medical Center Department of Pathology The Ohio State University Wexner Medical Center Division of Surgical Oncology The Ohio State University Wexner Medical Center Deparment of General Surgery The Ohio State University Wexner Medical Center

To investigate the reproducibility of the in vivo endoscopic ultrasound (EUS) - guided needle based confocal endomicroscopy (nClE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions (PCls).METHODSIn a prospective study evaluating EUS-nClE for evaluation of PCls, 10 subjects underwent an in vivo nClE (AQ-Flex nClE miniprobe; Cellvizio, MaunaKea, Paris, France) during EUS and ex vivo probe based ClE (pClE) of the PCl (Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo ClE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo ClE imaging *** total of 10 subjects (mean age 53 ± 12 years; 5 female) with a mean PCl size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms (IPMNs), 3 mucinous cystic neoplasms (MCNs), 2 cystic neuroendocrine tumors (cystic-NETs), 1 serous cystadenoma (SCA), and 2 squamous lined PCls. Characteristic in vivo nClE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a “fern pattern” of vascularity for SCA. Identical image patterns were observed during ex vivo pClE imaging of the surgically resected PCls. Both in vivo and ex vivo ClE imaging findings correlated with surgical *** vivo nClE patterns are reproducible in ex vivo pClE for all major neoplastic PCls. These findings add further support the application of EUS-nClE as an imaging biomarker in the diagnosis of PCls.

关键词： Confocal laser endomicroscopy Serous cystadenoma Pancreatic neuroendocrine tumor Intraductal papillary mucinous neoplasm Pancreatic cystic neoplasm

Hospital outcomes and early readmission for the most common gastrointestinal and liver diseases in the United States:Implications for healthcare delivery

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World Journal of Gastrointestinal Surgery 2021年第2期13卷 141-152页

作者： Somashekar G Krishna Brandon K Chu Alecia M Blaszczak Gokulakrishnan Balasubramanian Hisham Hussan Peter P Stanich Khalid Mumtaz Alice Hinton darwin l conwell Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Gastrointestinal(GI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource *** ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial ***-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI *** To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United *** A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI *** 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases,Ninth Revision,Clinical Modification *** outcomes were mortality(index admission,calendar-year),hospitalization costs,and thirty-day readmission and secondary outcomes were predictors of thirty-day *** For the year 2013,the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about$25 *** thirty-day readmission rates were highest for chronic liver disease(25.4%),Clostridium difficile(***)infection(23.6%),functional/motility disorders(18.5%),inflammatory bowel disease(16.3%),and GI bleeding(15.5%).The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease(6.1%and 12.6%),*** infection(2.3%and 6.1%),and GI bleeding(2.2%and 5.0%),***-day readmission correlated with any subsequent admission mortality(r=0.798,P=0.001).Medicare/Medicaid insurances,≥3 Elixhauser comorbidities,and length of stay>3 d were significantly associated with thirty-day readmission for all the thirteen GI *** Preventable and non-chronic GI disease contributed to a significant economic and health

关键词： Gastrointestinal disease Thirty-day readmission Nationwide readmission database Outcomes Mortality Cost

Effect of pancreatic endotherapy on quality of life in chronic pancreatitis patients:A systematic review

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World Journal of Gastrointestinal Endoscopy 2021年第8期13卷 336-344页

作者： Samuel Y Han Georgios I Papachristou Raj J Shah darwin l conwell Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Gastroenterology and Hepatology University of Colorado Anschutz Medical CampusAuroraCO 80045United States

BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones,strictures,and pancreatic fluid *** studies detailing endotherapy,however,have focused on technical success outcomes such as stone clearance or stricture *** To review the effect of pancreatic endotherapy on patient-centered *** Systematic review of studies examining pancreatic *** A total of 13 studies including 3 randomized clinical trials were *** majority of studies found an improvement in quality of life with pancreatic *** While pancreatic endotherapy does appear to improve quality of life,there are clear gaps in knowledge regarding many pancreatic endotherapy ***,qualitative analysis is lacking in these studies and further work is needed to elucidate the patient experience with pancreatic endotherapy.

关键词： Chronic pancreatitis Pancreatic endotherapy Endoscopic retrograde cholangiopancreatography Quality of life

Confocal endomicroscopy and cyst fluid molecular analysis: Comprehensive evaluation of pancreatic cysts

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World Journal of Gastrointestinal Endoscopy 2018年第1期10卷 1-9页

作者： Feng li Ahmad Malli Zobeida Cruz-Monserrate darwin l conwell Somashekar G Krishna Division of Gastroenterology Hepatology and Nutrition Ohio State University Wexner Medical Center

Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCl). Accurate presurgical diagnosis enables appropriate triage of PCls. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCls. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.

关键词： Pancreas Pancreatic cyst Pancreatic adenocarcinoma Confocal endomicroscopy Next generation sequencing Molecular marker

Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States

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World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 371-381页

作者： Mitchell l Ramsey lindsay A Sobotka Somashekar G Krishna Alice Hinton Stephen E Kirkby Susan S li Michael P Meara darwin l conwell Peter P Stanich Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics The Ohio State University College of Public HealthColumbusOH 43210United States Division of Pulmonary and Critical Care Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of General Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of General and Gastrointestinal Surgery The Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Symptomatic biliary and gallbladder disorders are common in adults with cystic fibrosis(CF)and the prevalence may rise with increasing CF transmembrane conductance regulator modulator *** may be considered,but the outcomes of cholecystectomy are not well described among modern patients with *** To determine the risk profile of inpatient cholecystectomy in patients with *** The Nationwide Inpatient Sample was queried from 2002 until 2014 to investigate outcomes of cholecystectomy among hospitalized adults with CF compared to controls without CF.A propensity weighted sample was selected that closely matched patient demographics,patient’s individual comorbidities,and hospital *** propensity weighted sample was used to compare outcomes among patients who underwent laparoscopic *** outcomes of open and laparoscopic cholecystectomy were compared among adults with *** A total of 1239 inpatient cholecystectomies were performed in patients with CF,of which 78.6%were performed *** waslar to those without CF(P=0.719).In the propensity weighted analysis of laparoscopic cholecystectomy,there was no difference in mortality,or pulmonary or surgical complications between patients with CF and *** adjusting for significant covariates among patients with CF,open cholecystectomy was independently associated with a 4.8 d longer length of stay(P=0.018)and an$18449 increase in hospital costs(P=0.005)compared to laparoscopic *** Patients with CF have a very low mortality after cholecystectomy that is similar to the general *** patients with CF,laparoscopic approach reduces resource utilization and minimizes post-operative complications.

关键词： laparoscopic cholecystectomy Nationwide Inpatient Sample Cystic fibrosis Mortality length of stay Symptomatic biliary disorders

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优生学概论

1936年

作者：（英）达尔文（l.darwin）郭大文译

书名原文:What is eugenics?

关键词：优生学

来源：汇雅图书（南通市图书馆... 评论

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采用近空间平台的无源雷达对多目标探测研究

采用近空间平台的无源雷达对多目标探测研究

作者： darwin Ricardo Becerra Quimí 南京航空航天大学

学位级别：硕士

国土安全和军事需求不仅需要借助卫星和飞机的作用，还要借助新型的雷达平台达到反隐形的目的。近年来随着低空技术的进步和发展，使得利用近空间平台实现反隐身成为可能。本论文提出了一种新的收发分置的雷达系统，该雷达系统使用参考... 详细信息

国土安全和军事需求不仅需要借助卫星和飞机的作用，还要借助新型的雷达平台达到反隐形的目的。近年来随着低空技术的进步和发展，使得利用近空间平台实现反隐身成为可能。本论文提出了一种新的收发分置的雷达系统，该雷达系统使用参考发射机作为照射器激发出视频和调频信号，从而照亮潜在的目标，为近空平台提供接收信号。这篇论文主要研究了多接收机探测目标的多普勒频移，用来解决对隐身目标的跟踪问题。理论上采用非线性最小二乘误差（NlSE）近似方法，又称为levenberg-Marquardt（l-M）算法，来检测目标的状态（位置和速度）。当NlSE技术在一个象限内给出一个精确的解，其他三个解将会相应的存在与其他三个象限中。收发分置的基本原理是通过异地接收机的测量(比如DOA)来解决象限歧义问题。论文还进一步考虑了增加多接机来跟踪多个目标的问题.本文中假设目标的数量是固定的，而且所有目标都对每个接收机产生应答。为了给这些目标的关联和追踪算法提供更好的初始目标状态，本论文还研究了栅格辅助的l-M搜索技术。这一改进的初始估计技术能帮助NlSE算法达到更精确的状态估计。仿真结果表明采用多普勒频移作为单独的测量方法进行多目标关联和追踪是可行的。所提出的关联和状态融合估计的方法在大多数蒙特卡洛分析中对优化目标跟踪证明是合理的和准确的。在研究过程中所采用目标相关联与状态估计的方法可以用来初始化实时跟踪算法，如扩展的卡尔曼滤波(EKF)算法，实现稳定跟踪。分置组网雷达在国土安全应用领域有着特殊的价值，这种类型的近空雷达跟踪和信息融合问题通过测量移动的和多目标的多普勒频移可以得到有效解决。

关键词：国土安全近地空间被动雷达遥感与成像双稳态—多基地雷达定位与目标探测levenberg-Marquardt(l-M)算法

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空气过滤系统在猪场的应用

今日养猪业 2010年第2期 29-32页

作者： darwin l.Reicks 温鹏美国明尼苏达州圣彼得市猪兽医中心英国国际猪网

保持蓝耳病阴性对于猪场来说具有重要的经济意义，不论公猪站、母猪场还是断奶-生长-肥育猪场都一样。蓝耳病、猪流感和支原体之类经空气传播的疾病越来越普遍，在这种现实下，任何能够防止这些病原经气雾传播的方式都非常引人注意。我... 详细信息

保持蓝耳病阴性对于猪场来说具有重要的经济意义，不论公猪站、母猪场还是断奶-生长-肥育猪场都一样。蓝耳病、猪流感和支原体之类经空气传播的疾病越来越普遍，在这种现实下，任何能够防止这些病原经气雾传播的方式都非常引人注意。我们在实践中采用了激进的方法，让我们的生产者使用空气过滤系统。2005年有6家猪场安装了过滤系统，2006年又有5家，2007年11家，2008年11家。

关键词：空气过滤系统猪场应用空气传播蓝耳病支原体猪流感生产者

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