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Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich elijah dixon Parul j Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta johnson johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between january 1,2013 and june 30,***-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD *** Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this *** complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their ***(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protoc

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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肾小球样血管瘤提示POeMS综合征的诊断

世界核心医学期刊文摘（皮肤病学分册） 2006年第9期2卷 59-60页

作者： Phillips j.A. dixon j.e. Richardson j.B 潘敏

POeMS is an acronym for polyneuropathy, organomegaly, endocrinopathy,monoclonal protein, and skin changes. It is a poorly understood paraneoplastic syndrome that stems from an underlying plasma cell dyscrasia. Of the skin changes, the glomeruloid hemangioma is considered to be a specific marker of POeMS syndrome. We describe a 68-year-old man who presented to his dermatologist with multiple hemangiomas, whose biopsy diagnosis of glomeruloid hemangioma resulted in further revaluation and an eventual diagnosis of POeMS.

关键词： POeMS综合征多发性血管瘤肾小球样诊断 POeMS综合症多发性神经病变皮肤改变内分泌病变

Insm1:orchestrating cellular mimicry in the thymus medulla

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Cellular & Molecular Immunology 2024年第4期21卷 414-416页

作者： K.D.james j.e.Cowan UCL Institute of Immunity and Transplantation The Pears BuildingRowland Hill StreetLondonNW32PPUK

The thymus is the primary production site for a functional and self-tolerant T-cell *** establishment of immune tolerance is mediated by the generation and presentation of tissue-restricted self-antigens(TRAs)by medullary thymic epithelial cells(mTeCs),which screen T-cell receptors for self-reactivity to eliminate autoreactive T *** studies have extended our understanding of mTeC heterogeneity by examining the mechanisms by which mTeCs mimic the peripheral self[1].

关键词： medullary eliminate restricted

miniSCIDOM: a scintillator-based tomograph for volumetric dose reconstruction of single laser-driven proton bunches

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High Power Laser Science and engineering 2024年第2期12卷 41-50页

作者： A.Corvino M.Reimold e.Beyreuther F.-e.Brack F.Kroll j.Pawelke j.D.Schilz M.Schneider U.Schramm M.e.P.Umlandt K.Zeil T.Ziegler j.Metzkes-Ng Helmholtz-Zentrum Dresden–Rossendorf DresdenGermany Technische Universität Dresden DresdenGermany OncoRay–National Center for Radiation Research in Oncology Faculty of Medicine and University Hospital Carl Gustav CarusTUD Dresden University of TechnologyHelmholtz-Zentrum Dresden–RossendorfDresdenGermany Current affiliation:Institut Curie UniversitéPSLCNRS UMR3347OrsayFrance Current affiliation:Universitätsklinikum Freiburg FreiburgGermany

Laser plasma accelerators(LPAs)enable the generation of intense and short proton bunches on a micrometre scale,thus offering new experimental capabilities to research fields such as ultra-high dose rate radiobiology or material *** spectrally broadband,laser-accelerated proton bunches allow for tailored volumetric dose deposition in a sample via single bunches to excite or probe specific sample *** rising number of such experiments indicates a need for diagnostics providing spatially resolved characterization of dose distributions with volumes of approximately 1 cm^(3) for single proton bunches to allow for fast online *** we present the scintillator-based miniSCIDOM detector for online single-bunch tomographic reconstruction of dose distributions in volumes of up to approximately 1 cm^(3).The detector achieves a spatial resolution below 500μm and a sensitivity of 100 *** detector performance is tested at a proton therapy cyclotron and an LPA proton *** experiments’primary focus is the characterization of the scintillator’s ionization quenching behaviour.

关键词： beam monitoring detectors laser-driven proton beams scintillator-based diagnostics ultra-high dose rate

Impact of device resistances in the performance of graphene‑based terahertz photodetectors

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Frontiers of Optoelectronics 2024年第2期17卷 87-97页

作者： O.Castelló Sofía M.López Baptista K.Watanabe T.Taniguchi e.Diez j.e.Velázquez-Pérez Y.M.Meziani j.M.Caridad j.A.Delgado-Notario Department of Applied Physics University of Salamanca37008 SalamancaSpain Unidad de excelencia en Luz y Materia estructurada(LUMeS) University of Salamanca37008 SalamancaSpain Research Center for electronic and Optical Materials National Institute for Materials Science1-1 NamikiTsukuba 305-0044Japan Research Center for Materials Nanoarchitectonics National Institute for Materials Science1-1 NamikiTsukuba 305-0044Japan Nanotechnology Group USAL-NanolabUniversity of Salamanca37008 SalamancaSpain

In recent years,graphene field-effect-transistors(GFeTs)have demonstrated an outstanding potential for terahertz(THz)photodetection due to their fast response and *** features are essential to enable emerging THz applications,including 6G wireless communications,quantum information,bioimaging and ***,the overall performance of these photodetectors may be utterly compromised by the impact of internal resistances presented in the device,so-called access or parasitic *** this work,we provide a detailed study of the influence of internal device resistances in the photoresponse of high-mobility dual-gate GFeT *** dual-gate architectures allow us to fine tune(decrease)the internal resistance of the device by an order of magnitude and consequently demonstrate an improved responsivity and noise-equivalent-power values of the photodetector,*** results can be well understood by a series resistance model,as shown by the excellent agreement found between the experimental data and theoretical *** findings are therefore relevant to understand and improve the overall performance of existing high-mobility graphene photodetectors.

关键词： Graphene THz Photodetector Field-effect transistor Plasmonic

沙利度胺治疗骨髓增生异常综合征相关的人顽固性Sweet综合征

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世界核心医学期刊文摘（皮肤病学分册） 2005年第11期1卷 58-59页

作者： Browning C.e. dixon j.e. Malone j.C. Callen j.P. 罗素菊 Dr.310 east Broadway Louisville KY 40202 United States

Sweet’s syndrome is a neutrophilic dermatosis characterized by tender, erythematous, pseudovesicular plaques that can be associated with hematologic malignancy. We report a patient with recalcitrant Sweet’s syndrome that preceded the development of myelodysplastic syndrome by 30 months. The delay between the onset of Sweet’s syndrome and the subsequent diagnosis of myelodysplasia highlights the need for thorough and repeated evaluation for underlying malignancy in patients with such a course. Although corticosteroids are the initial treatment of choice, this patient’s eruption was only partially responsive to high-dose prednisone andwas refractory tometronidazole, dapsone, and methotrexate. Treatmentwith thalidomide resulted in complete resolution of the cutaneous lesions within one month of therapy.

关键词： Sweet综合征沙利度胺中性粒细胞增多疼痛性氨苯砜甲氨蝶呤皮质激素

Comparisons of oxbow lake fish assemblages in relation to bigheaded carp establishment in the lower White River, Arkansas

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ecological Processes 2024年第1期13卷 188-205页

作者： Michael A.eggleton Cody j.Salzmann joseph e.Kaiser Shannon C.F.Smith Department of Aquaculture and Fisheries University of Arkansas at Pine Bluff Arkansas Game and Fish Commission Virginia Institute of Marine Science

Background Since the late 1990s, bigheaded carps(largely silver carp [Hypophthalmichthys molitrix] but also bighead carp [H. nobilis]) have established throughout the lower Mississippi River basin. Using previously studied oxbow lakes in the lower White River basin, Arkansas, we compared current(2017, “post-carp” establishment) fish assemblages to historical(2002, “pre-carp” establishment) fish assemblages. Fish assemblages were comprehensively assessed using multiple gears, including boat electrofishing, mini-fyke nets, and experimental small-mesh gill *** T-tests suggested that fish assemblage indices of richness, diversity, evenness, and dominance were often greater(P e post-carp period as reflected by boat electrofishing and experimental gill nets. However, all indices were generally similar(P > 0.05) between the pre-carp and post-carp period with fish assemblages depicted using mini-fyke nets. Nonmetric multidimensional scaling analyses indicated that fish assemblages differed structurally between pre-carp and post-carp periods. Assemblage differences were linked to both small and large abundance changes for more than 20 species. Abundances of gizzard shad(Dorosoma cepedianum), emerald shiner(Notropis atherinoides), pugnose minnow(Opsopoeodus emiliae), crappies(Pomoxis spp.), bluegill(Lepomis macrochirus), orangespotted sunfish(L. humilis), and yellow bass(Morone mississippiensis) declined between the pre-carp and postcarp periods. Conversely, abundances of weed shiner(N. texanus), pallid shiner(Hybopsis amnis), longear sunfish(L. megalotis), buffalofishes(Ictiobus spp.), and gars(Lepisosteus spp.) generally increased during the same *** Although not possible to conclude assemblage shifts were entirely related to bigheaded carps due to the absence of an appropriate reference system where carps did not establish, the wide establishment of these carps is one of the most pervasive changes to have occurred in the lower White

关键词： Bigheaded carp Silver carp Aquatic nuisance species Fish assemblage Oxbow lake Large river

exploring the effects of anthropogenic disturbance on predator inspection activity in Trinidadian guppies

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Current Zoology 2024年第1期70卷 109-111页

作者： Alix j.P Brusseau Laurence e.A.Feyten Adam L.Crane Grant e.Brown Department of Biology Concordia UniversityMontrealQCH4B 1R6Canada Department of Biomedical Sciences WCVMUniversity of SaskatchewanSaskatoonSKCanada

Prey animals are often faced with uncertainty due to having imperfect information regarding current local conditions,including predation risks and the availability of reliable foraging opportunities(Dall 2010).As this uncertainty increases,the probability of making costly behavioral errors also increases,leading to more risk averse behavioral tactics(Feyten et al.2019).For example,Trinidadian guppies Poecilia reticulata are far more risk averse when faced with multiple unknown sources of risk assessment information than when faced with a mix of known and unknown cues(Feyten et al.2019).Prey can reduce uncertainty by gathering and integrating private and social information regarding current risk levels within microhabitats(Dall 2010;Munoz and Blumstein 2012).

关键词： human disturbance information availability information reliability predator-prey interactions risk assessment uncertainty

Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular Neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： jason Philip Appleton Lisa j Woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark dixon Timothy j.e.gland Kailash Krishnan Grant Mair Keith W Muir john Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe else C Sandset jeffrey L Saver Angela Shone Aloysius Niroshan Siriwardena joanna M Wardlaw Nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science Center BeijingChina Neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia east Midlands Ambulance Service NHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurology and Psychology University of GlasgowGlasgowUK Bob Champion Research and education Building University of East AngliaNorwichUK Institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurology Oslo University HospitalOsloNorway Research and Development Norwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Health Research Unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is ***,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of *** primary outcome was a shift in scores on the modified Rankin scale(mRS)at day *** outcomes included death;a global analysis(Wei-Lachin test)containing Barthel Index,euroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’*** were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%*** 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]***‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe *** In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital *** IS ALReADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those w

关键词： Glasgow nitrate random