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Strategies for overcoming anti-tumor necrosis factor drug antibodies in inflammatory bowel disease:Case series and review of literature

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第3期8卷 155-161页

作者： Mansi M Kothari douglas l nguyen Nimisha K Parekh Department of Medicine(Gastroenterology) University of California-IrvineCA 92868United States

Anti-tumor necrosis factor(TNF) biologics are currentlyamongst the most widely used and efficacious therapies for inflammatory bowel disease(IBD). The development of therapeutic drug monitoring for infliximab and ada-limumab has allowed for measurement of drug levels and antidrug antibodies. This information can allow for manipulation of drug therapy and prediction of response. It has been shown that therapeutic anti-TNF drug levels are associated with maintenance of remission, and development of antidrug antibodies is predictive of loss of response. Studies suggest that a low level of drug antibodies, however, can at times be overcome by dose escalation of anti-TNF therapy or addition of an immunomodulator. We describe a retrospective case series of twelve IBD patients treated at the University of California-Irvine, who were on infliximab or adalimumab therapy and were found to have detectable but low-level antidrug antibodies. These patients underwent dose escalation of the drug or addition of an immunomodulator, with subsequent follow-up drug levels obtained. Eight of the twelve patients(75%) demonstrated resolution of antidrug antibodies, and were noted to have improvement in disease activity. Though data regarding overcoming low-level anti-TNF drug antibodies remains somewhat limited, cases described in the literature as well as our own experience suggest that this may be a viable strategy for preserving the use of an anti-TNF drug. low-level anti-TNF drug antibodies may be overcome by dose escalation and/or addition of an immunomodulator, and can allow for clinical improvement in disease status. Therapeutic drug monitoring is an important tool to guide this strategy.

关键词： Inflammatory bowel disease Adalimumab Anti-tumor necrosis factor Infliximab Therapeutic drug monitoring Drug antibody Antidrug antibodies Dose escalation

Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第2期7卷 306-319页

作者： Dominik D Alexander lauren C Bylsma laura Elkayam douglas l nguyen Epid Stat Institute Exponent Inc. Health Sciences Department of Medicine Irvine School of Medicine University of California

AIM:To critically review and summarize the literature on nutritional and health outcomes of semi-elemental formulations on various nutritionally vulnerable patient populations who are unable to achieve adequate nutrition from standard oral ***:We conducted a comprehensive literature search of Pubmed and Embase *** manually screened articles that examined nutritional and health outcomes(e.g.,growth,disease activity,gastrointestinal impairment,mortality,and economic impact)among various patient groups receiving semi-elemental *** review focused on full-text articles of randomized controlled clinical trials and other intervention studies,but pertinent abstracts and case studies were also *** pertaining primarily to tolerance,digestion,and absorption were summarized for each patient population in this systematic ***:Results pertaining primarily to tolerance,digestion,and absorption were summarized for each patient *** efficacy of semi-elemental whey hydrolyzed protein(WHP)diet have been reported in various nutritionally high risk patient populations including-Crohn’s disease,short bowel syndrome,acute and chronic pancreatitis,cerebral palsy,cystic fibrosis,cerebrovascular accidents,human immunodeficiency virus,critically ill,and ***,the evidence from the medical literature indicates that feeding with a semi-elemental diet performs as well or better than parenteral or amino acid based diets in terms of toler-ance,digestion,and nutrient assimilation measures across various disease ***:Based on this comprehensive review of the literature,patient populations who have difficulty digesting or absorbing standard diets may be able to achieve improved health and nutritional outcomes through the use of semi-elemental WHP diets.

关键词： Semi-elemental diet Malnutrition 100% hydrolyzed whey protein Nutrition Malabsorption

Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review

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World Journal of Gastrointestinal Endoscopy 2014年第11期6卷 549-554页

作者： Imran Ashraf Sohail Ashraf Sameer Siddique douglas l nguyen Abhishek Choudhary Matthew l Bechtold Department of Medicine University of Mis-souri Columbia MO 65212 United States Department of Gastroenterology and Hepatology Central Manchester University Hospitals M139WL Manchester United Kingdom Department of Medicine University of California Irvine CA 92868 United States

AIM: To assess the role of hyoscine for polyp detectionduring ***: Studies(randomized controlled trials orRCTs) that compared the use of hyoscine vs no hyo-scine or placebo for polyp detection during colonoscopywere included in our analysis. A search on multiple da-tabases was performed in September 2013 with searchterms being "hyoscine and colonoscopy", "hyoscineand polyp", "hyoscine and adenoma", "antispasmoticand colonoscopy", "antispasmotic and adenoma", and"antispasmotic and polyp". Jadad scoring was used toassess the quality of studies. The efficacy of hyoscinewas analyzed using Mantel-Haenszel model for polypand adenoma detection with odds ratio(OR). The I2measure of inconsistency was used to assess hetero-geneity(P 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication ***: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an ab-stract(n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality(Jadad score ≥ 2). Eight RCTs as-sessed the polyp detection rate(PDR)(n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR(OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate(ADR)(n = 2015). The use of hyoscine demonstrated no statisti-cally significant difference as compared to no hyoscine or placebo for ADR(OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine admin-istration(given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the ***: Hyoscine use in pa

关键词： Hyoscine Antispasmodic Polyp detection Colonoscopy

Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy

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World Journal of Gastrointestinal Endoscopy 2016年第16期8卷 553-557页

作者： Umair Sohail Chela Harleen Amin O Mahdi Murtaza Arif douglas l nguyen Matthew l Bechtold Division of Gastroenterology and Hepatology Department of Medicine University of Missouri Department of Medicine University of California

AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy(PEG) with or without *** After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG(1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the *** Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirtythree patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesiswithin 48 h of percutaneous endoscopic gastrostomy(PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dl(2 vs 5 patients; P = 0.16), blood transfusions(2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding(no patients in either group). CONClUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.

关键词： Percutaneous endoscopic gastrostomy Clopidogrel Bleeding Complications Antiplatelets

Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis

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World Journal of Meta-Analysis 2015年第1期3卷 4-10页

作者： Ashraf A Almashhrawi Rubayat Rahman Samuel T Jersak Akwi W Asombang Alisha M Hinds Hazem T Hammad douglas l nguyen Matthew l Bechtold Division of Gastroenterology and Hepa-tology University of Missouri Columbia MO 65212 United States Division of Gastroenterology and Hepa-tology University of California Irvine CA 92697 United States

AIM： To evaluate usefulness of prophylactically intu-bating upper gastrointestinal bleeding （UGIB） patients. METHODS： UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHl, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States （2004-2014）. Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and laird models with results presented as odds ratio for aspiration, pneumonia （within 48 h）, and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments. RESUlTS： Initial search identi？ed 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors （Almashhrawi AA and Bechtold Ml）. Of these studies, eight were excluded： Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies （N = 367） were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia （within 48 h） was identified in 20 of 134 （14.9%） patients as compared to 5 of 95 （5.3%） patients that were not intubated prophylactically （P = 0.02）. Despite observed trends, no significant differences were found for mortality （P = 0.18） or aspiration （ P = 0.11）.CONClUSION： Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation p

关键词： Prophylactic endotracheal intubation Upper gastrointestinal bleeding Endoscopy Complication Pneumonia Aspiration

Use of music during colonoscopy:An updated meta-analysis of randomized controlled trials

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World Journal of Meta-Analysis 2019年第9期7卷 428-435页

作者： Ryan D Heath Nasim Parsa Michelle l Matteson-Kome Victoria Buescher Sami Samiullah douglas l nguyen Veysel Tahan Yezaz A Ghouri Srinivas R Puli Matthew l Bechtold Division of Gastroenterology University of Missouri School of MedicineColumbiaMO 65212United States Division of Gastroenterology Heart of the Rockies Regional Medical CenterColorado SpringsCO 80907United States Division of Gastroenterology University of Illinois–PeoriaPeoriaIL 61604United States

BACKGROUND Music seems to be beneficial in multiple clinical *** is a stressful event for patients,especially with conscious *** during colonoscopy has been evaluated in multiple randomized controlled trials(RCTs)with varied *** meta-analyses on the subject over the years have yielded inconsistent ***,we conducted an up-to-date meta-analysis regarding music during *** To assess the effects of music played during colonoscopy on patients’perspectives and sedation *** Multiple large databases were aggressively searched(November 2018).RCTs comparing music to without music during colonoscopy on adult patients were *** estimates were calculated for sedative medication doses,total procedure time,and patients’experience,willingness to repeat procedure,and pain scores using odds ratio(OR)and mean difference(MD)with random effects *** Eleven studies(n=988)were *** during colonoscopy showed a statistically significant reduction in procedure times(MD:-2.3 min;95%CI:-4.13 to-0.47;P=0.01)and patients’pain(MD:-1.26;95%CI:-2.28 to-0.24;P=0.02)while improving patients’experience(MD:-1.11;95%CI:-1.7 to-0.53;Plly significant differences were observed between music and no music during colonoscopy for midazolam(MD:-0.4 mg;95%CI:-0.9 to 0.09;P=0.11),meperidine(MD:-3.06 mg;95%CI:-10.79 to 4.67;P=0.44),or patients’willingness to repeat the colonoscopy(OR:3.89;95%CI:0.76 to 19.97;P=0.1).CONClUSION Music appears to improve overall patient experience while reducing procedure times and patient ***,music,being a non-invasive intervention,should be strongly considered during colonoscopy.

关键词： Colonoscopy Music Relaxation Meta-analysis

Split-dose vs same-day bowel preparation for afternoon colonoscopies:A meta-analysis of randomized controlled trials

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World Journal of Meta-Analysis 2020年第6期8卷 461-470页

作者： Nasim Parsa Eric A Grisham Courtney J Cockerell Michelle l Matteson-Kome Ramakrishna V Bysani SamiSamiullah douglas l nguyen Veysel Tahan Yezaz A Ghouri Srinivas R Puli Matthew l Bechtold Division of Gastroenterology and Hepatology Department of MedicineUniversity of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Heart of the Rockies Regional Medical CenterColorado SpringsCO 80907United States Division of Gastroenterology University of Illinois-PeoriaPeoriaIL 61604United States

BACKGROUND Quality of bowel preparation in afternoon colonoscopies has been a ***,a choice of same-day preparation(SaD)or split-dose preparation(SpD)exists;however,randomized controlled trials’results have *** To examine the outcomes of SaD and SpD for afternoon *** An extensive literature search was conducted using multiple *** randomized controlled trials(RCTs)in adults that compared SaD to SpD with Ottawa bowel preparation score(OBPS)were *** ratio(OR)or mean difference was used to analyze *** Eleven RCTs were included(n=1846).No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD(OR 0.77;95%CI:-0.57-1.03;P=0.07;I2=5%).Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula(polyethylene glycol)(OR 0.83;95%CI:0.51-1.35;P=0.46;I2=39%)as well as receiving same formula and volume(4 l polyethylene glycol)(OR 1.14;95%CI:0.65-2.01;P=0.64;I2=0%).CONClUSION In patients undergoing afternoon colonoscopies,SaD is comparable with SpD in terms of satisfactory bowel *** studies are needed to validate these results and determine the optimal formula and dosages.

关键词： Afternoon Colonoscopy Preparation Split-dose Same-day Meta-analysis

A stable CS-FEM for the static and seismic stability of a single square tunnel in the soil where the shear strength increases linearly with depth

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Journal of Rock Mechanics and Geotechnical Engineering 2022年第4期14卷 1253-1265页

作者： H.C.nguyen l.nguyen-Son Department of Civil and Environmental Engineering Imperial College LondonLondonUK Department of Civil Engineering and Industrial Design University of LiverpoolLiverpoolUK Faculty of Civil Engineering Ho Chi Minh City University of Technology(HUTECH)Ho Chi Minh CityViet Nam

A numerical procedure using a stable cell-based smoothed finite element method(CS-FEM)is presented for estimation of stability of a square tunnel in the soil where the shear strength increases linearly with *** kinematically admissible displacement fields are approximated by uniform quadrilateral elements in conjunction with the strain smoothing technique,eliminating volumetric locking issues and the singularity associated with the MohreCoulomb ***,a rich set of simulations was performed to compute the static stability of a square tunnel with different geometries and soil *** presented results are in excellent agreement with the upper and lower bound solutions using the standard finite element method(FEM).The stability charts and tables are given for practical use in the tunnel design,along with a newly proposed formulation for predicting the undrained stability of a single square ***,the seismic stability number was computed using the present numerical *** results reveal that the seismic stability number reduces with an increasing value of the horizontal seismic acceleration(a_(h)),for both cases of the weightless soil and the soil with unit ***,the link between the static and seismic stability numbers is described using corrective factors that represent reductions in the tunnel stability due to seismic *** is shown from the numerical results that the corrective factor becomes larger as the unit weight of soil mass increases;however,the degree of the reduction in seismic stability number tends to reduce for the case of the homogeneous ***,this advanced numerical procedure is straightforward to extend to three-dimensional(3D)limit analysis and is readily applicable for the calculation of the stability of tunnels in highly anisotropic and heterogeneous soils which are often encountered in practice.

关键词： Tunnels Stability limit analysis Cell-based smoothed finite element method (CS-FEM) Second-order cone programming(SOCP)

Adaptive data fusion framework for modeling of non-uniform aerodynamic data

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Chinese Journal of Aeronautics 2023年第7期36卷 316-336页

作者： Vinh PHAM Maxim TYAN Tuan Anh nguyen Chi-Ho lEE l.V.Thang nguyen Jae-Woo lEE Department of Aerospace Information Engineering Konkuk UniversitySeoul 05029Republic of Korea Konkuk Aerospace Design-Airworthiness Institute Konkuk UniversitySeoul 05029Republic of Korea

Multi-fidelity Data Fusion(MDF)frameworks have emerged as a prominent approach to producing economical but accurate surrogate models for aerodynamic data modeling by integrating data with different fidelity ***,most existing MDF frameworks assume a uniform data structure between sampling data sources;thus,producing an accurate solution at the required level,for cases of non-uniform data structures is *** address this challenge,an Adaptive Multi-fidelity Data Fusion(AMDF)framework is proposed to produce a composite surrogate model which can efficiently model multi-fidelity data featuring non-uniform ***,the design space of the input data with non-uniform data structures is decomposed into subdomains containing simplified ***,different MDF frameworks and a rule-based selection process are adopted to construct multiple local models for the subdomain *** the other hand,the Enhanced local Fidelity Modeling(ElFM)method is proposed to combine the generated local models into a unique and continuous global ***,the resulting model inherits the features of local models and approximates a complete database for the whole design *** validation of the proposed framework is performed to demonstrate its approximation capabilities in(A)four multi-dimensional analytical problems and(B)a practical engineering case study of constructing an F16C fighter aircraft’s aerodynamic *** comparisons of the generated models using the proposed AMDF framework and conventional MDF approaches using a single global modeling algorithm are performed to reveal the adaptability of the proposed approach for fusing multi-fidelity data featuring non-uniform ***,the results indicated that the proposed framework outperforms the state-of-the-art MDF approach in the cases of non-uniform data.

关键词： Aerodynamic modeling Data fusion Diverse data structure Multi-fidelity data Multi-fidelity surrogate modeling