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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 complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS 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 30,2023.Stan-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 complications.RESULTS 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 facility.Major 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 complication.Four(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 PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We 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 protocols.

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

Examination of care processes and treatment optimization for head and neck cancer patients in a community setting"hub and hub"model

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World journal of Otorhinolaryngology-Head and Neck Surgery 2022年第2期8卷 152-157页

作者： Harleen K.Sethi elijah Walker Travis Weinsheim Matthew j.Brennan Christopher E.Fundakowski Department of Otolaryngology-Head and Neck Surgery Sidney Kimmel Cancer Center at Abington—Jefferson HealthWillow GrovePennsylvaniaUSA Department of Otolaryngology-Head and Neck Surgery Philadelphia College of Osteopathic MedicinePhiladelphiaPennsylvaniaUSA College of Applied Health Science University of Illinois at Urbana-ChampaignUrbanaIllinoisUSA Department of Otolaryngology-Head and Neck Surgery Thomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA

Objective:To examine referral pattern,the timing of diagnostic/staging processes,and treatment initiation for new head and neck cancer patients in a community setting.Methods:Patients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020.Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation.Results:One hundred and five patients were included in the study.The primary referral sources were external general otolaryngology(56.3%).Oral surgery and dermatology obtained tissue biopsy approximately 80%of the time before referral.The average time from the ordering of initial staging positron emission tomography/computed tomography to finalized results was 14 days(range:10-25 days).Patients referred from dermatology and oral surgery were more likely to require single modality care,namely definitive surgical management.Time to treatment initiation average was 37 days(range:29-41 days).Patients with longer treatment times noted significantly higher times to both radiation and medical oncology consults(48.42 vs.18.13 days;P<0.001).Conclusions:No notable differences in treatment initiation times were identified based on referral source or extent of workup performed before head/neck surgery consult.It appears the largest opportunities for improvement in terms of reducing overall treatment length exist in the optimization of radiation initiation time.

关键词： head and neck cancer package time referral source time to treatment initiation total treatment length

Advent of torsional optomechanics from Beth’s legacy

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Advanced Photonics 2023年第4期5卷 3-4页

作者： jaehyuck jang jungho mun junsuk Rho Pohang University of Science and Technology(POSTECH) Department of Chemical EngineeringPohangRepublic of Korea Pohang University of Science and Technology(POSTECH) Department of Mechanical EngineeringPohangRepublic of Korea POSCO-POSTECH-RIST Convergence Research Center for Flat Optics and Metaphotonics PohangRepublic of Korea

Torsional optomechanics,which involves the transfer of angular mo-mentum from light to matter,has been a vibrant research area since Beth’s pioneering contribution in 1935.Beth proposed a method to measure the transfer of spin angular momentum using a torsional pen-dulum,1 laying the foundation for classical and quantum optomechanics related to particle levitation,trapping,and cooling in modern optics.

关键词： angular optics momentum

Production systems and important antimicrobial resistant-pathogenic bacteria in poultry:a review

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journal of Animal Science and Biotechnology 2023年第2期14卷 481-500页

作者： Philip H.W.Mak Muhammad Attiq Rehman elijah G.Kiarie Edward Topp Moussa S.Diarra Guelph Research and Development Centre Agriculture and Agri-Food Canada(AAFC)GuelphONCanada Department of Animal Biosciences University of GuelphGuelphONCanada London Research and Development Center AAFCLondonONCanada.

Economic losses and market constraints caused by bacterial diseases such as colibacillosis due to avian pathogenic Escherichia coli and necrotic enteritis due to Clostridium perfringens remain major problems for poultry producers,despite substantial efforts in prevention and control.Antibiotics have been used not only for the treatment and prevention of such diseases,but also for growth promotion.Consequently,these practices have been linked to the selection and spread of antimicrobial resistant bacteria which constitute a significant global threat to humans,ani-mals,and the environment.To break down the antimicrobial resistance(AMR),poultry producers are restricting the antimicrobial use(AMU)while adopting the antibiotic-free(ABF)and organic production practices to satisfy consum-ers’demands.However,it is not well understood how ABF and organic poultry production practices influence AMR profiles in the poultry gut microbiome.Various Gram-negative(Salmonella enterica serovars,Campylobacter jejuni/coli,E.coli)and Gram-positive(Enterococcus spp.,Staphylococcus spp.and C.perfringens)bacteria harboring multiple AMR determinants have been reported in poultry including organically-and ABF-raised chickens.In this review,we discussed major poultry production systems(conventional,ABF and organic)and their impacts on AMR in some potential pathogenic Gram-negative and Gram-positive bacteria which could allow identifying issues and opportuni-ties to develop efficient and safe production practices in controlling pathogens.

关键词： Antibiotic-free Antimicrobial resistance Conventional feeding Organic Poultry

Symplectic feedback using Hamiltonian Lie algebra and its applications to an inverted pendulum

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控制理论与应用（英文版） 2013年第2期11卷 275-281页

作者： j. Lorca ESPIRO C. munoz POBLETE Departamento de Ciencias Fisicas Facultad de Ingenieria Ciencias y Administracion Universidad de La FronteraAvenida Francisco Salazar 01145 Casilla 54-D Temuco Chile Departamento de Ingenieria Electrica Facultad de Ingenieria Ciencias y Administracion Universidad de La FronteraAvenida Francisco Salazar 01145 Casilla 54-D Temuco Chile

From the symplectic representation of an autonomous nonlinear dynamical system with holonomic con- straints, i.e., those that can be represented through a symplectic form derived from a Hamiltonian, we present a new proof on the realization of the symplectic feedback action, which has several theoretical advantages in demonstrating the uniqueness and existence of this type of solution. Also, we propose a technique based on the interpretation, construction and character- ization of the pull-back differential on the symplectic manifold as a member of a one-parameter Lie group. This allows one to synthesize the control law that governs a certain system to achieve a desired behavior; and the method developed from this is applied to a classical system such as the inverted pendulum.

关键词： Hamiltonian systems Symplectic structures Lie algebra Nonlinear dynamical systems Geometric con-trol

A method to evaluate REE-HFSE mineralised provinces by value creation potential, and an example of application: Gardar REE-HFSE province, Greenland

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Geoscience Frontiers 2020年第6期11卷 2141-2156页

作者： Graham j.Banks Símun D.Olsen Antonio Gusak Geological Survey of Denmark and Greenland Øster Voldgade 10DK-1350CopenhagenDenmark Permanent Address:Route to Reserves Ulriksdalvej 13Valby2500CopenhagenDenmark University of Copenhagen Øster Voldgade 10DK-1350CopenhagenDenmark

The rare earth elements and high-field-strength elements(REE-HFSE)exploration sector conducts most evaluations at deposit and smaller scales.It is not evident how the sector performs a preceding exploration stage—rating and prioritising REE-HFSE mineralised provinces—to determine which provinces are prospective enough to warrant investment.Here we present an objective,repeatable,low-cost method to screen any REE-HFSE province,as a foundation for district-scale investigations or asset evaluations.It is original for REE-HFSE screening,and adapted from regional scale copper,cobalt and petroleum exploration,and CO2 storage,screening methods.It is centred upon a mineralised province’s favourability for potential value creation,and to identify:(a)its main information gaps;(b)its weakest links;(c)its exploration maturity and remaining potential category;(d)how it compares against other REE-HFSE provinces;and(e)if further investigation is justified.This method incorporates geoscience,strategy,economic and socio-environmental factors in a way that is understandable and directly usable across stakeholder groups.The workflow is systematic,yet flexible enough to accommodate organisationspecific criteria,and usable for other commodities.It provides the platform to build a global REE-HFSE province map and database consistently across national boundaries and organisations.Categories for the extent of province exploration maturity and remaining mineral potential are proposed.We illustrate the applicability of these methods using the Gardar REE-HFSE Province(GRHP)of south Greenland.We conclude that it is a moderate size,frontier province that is currently of questionable favourability for value creation.To move GRHP into a positive favourability class,its current weak links need strengthening by research,government policy and industry stakeholders:evaluate the mineral system;integrate all information geospatially and place it in the public domain;help the region improve some community health and safety issues;convert some mineral

关键词： REE HFSE Province Screening Favourability Value

Impact of xylanases on gut microbiota of growing pigs fed corn-or wheat-based diets

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Animal Nutrition 2018年第4期4卷 339-350页

作者： Zhengxiao Zhang Hein M.Tun Ru Li Beatriz j.M.Gonzalez Hannah C.Keenes Charles M.Nyachoti elijah Kiarie Ehsan Khafipour Department of Animal Science University of Manitoba Department of Medical Microbiology and Infectious Diseases University of Manitoba Department of Animal Bioscience University of Guelph

This study investigated the effects of xylanase supplementations with cereal-based diets on nutrient digestibility and gut microbiota of growing pigs. A total of 96 individually penned pigs(initial BW = 22.7 ± 0.65 kg) were allotted to 12 treatments and subjected to a completely randomized block design experiment. Pigs in each treatment were fed an isocaloric wheat-based or corn-based diet with or without 1 of 5 types of xylanase supplements(XA, XB, XC, XD, XE). On d 42, all piglets were euthanized to obtain ileal and cecal digesta for microbial analysis, which involved high-throughput sequencing of the V1 - V3 regions of 16 S rRNA gene. Corn-and wheat-based diets differed(P munity. Among xylanases, only XC within the wheat-based diet altered(P jority of which belonged to the Firmicutes phylum. To

关键词： Piglets Microbiota Xylanase Arabinoxylans Digestibility

Right trisegmentectomy with thoracoabdominal approach after transarterial embolization for giant hepatic hemangioma

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World journal of Gastroenterology 2009年第27期15卷 3437-3439页

作者： Hyung-Il Seo Hong jae jo mun Sup Sim Suk Kim Department of Surgery Postgraduate School of Medicine and Medical Research Institute Pusan National UniversityBusan 602-739 South Korea Department of Radiology Postgraduate School of Medicine Pusan National UniversityBusan 602-739 South Korea

Hepatic hemangiomas need to be treated surgically in cases where they are accompanied with symptoms, have a risk of rupture, or are hardly distinguishable from malignancy. The present authors conducted embolization of the right hepatic artery one day before an operation for a huge hemangioma accompanied with symptoms and confirmed a decrease in its size. The authors performed a right trisegmentectomy through a j-shape incision, using a thoracoabdominal approach, and safely removed a giant hemangioma of 32.0 cm × 26.5 cm × 8.0 cm in size and 2300 g in weight. Even for inexperienced surgeons, a j-shape incision with a thoracoabdominal approach is considered a safe and useful method when right-side hepatectomy is required for a large mass in the right liver.

关键词：手术治疗血管肝脏栓塞恶性肿瘤中国气象局三叶形执行权

Effects of palbociclib on oral squamous cell carcinoma and the role of PIK3CA in conferring resistance

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Cancer Biology & Medicine 2019年第2期16卷 264-275页

作者： Nur Syafinaz Zainal Bernard Kok Bang Lee Zheng Wei Wong Iuan Sheau Chin Pei San Yee Chai Phei Gan Kein Seong mun Zainal Ariff Abdul Rahman j. Silvio Gutkind Vyomesh Patel Sok Ching Cheong Head and Neck Team Cancer Research Malaysia Selangor 47500 Malaysia Department of Oral & Maxillofacial Clinical Sciences Faculty of Dentistry University of Malaya Kuala Lumpur 50603 Malaysia Department of Pathology Faculty of Medicine University of Malaya Kuala Lumpur 50603 Malaysia Oral Cancer Research and Co-ordinating Centre (OCRCC) Faculty of Dentistry University of Malaya Kuala Lumpur 50603 Malaysia Department of Pharmacology University of California San Diego 92093-5004 CA USA

Objective: Lack of effective therapies remains a problem in the treatment of oral squamous cell carcinoma(OSCC), especially in patients with advanced tumors. OSCC development is driven by multiple aberrancies within the cell cycle pathway, including amplification of cyclin D1 and loss of p16. Hence, cell cycle inhibitors of the CDK4/6-cyclin D axis are appealing targets for OSCC treatment. Here, we determined the potency of palbociclib and identified genetic features that are associated with the response of palbociclib in OSCC.Methods: The effect of palbociclib was evaluated in a panel of well-characterized OSCC cell lines by cell proliferation assays and further confirmed by in vivo evaluation in xenograft models. PIK3CA-mutant isogenic cell lines were used to investigate the effect of PIK3CA mutation towards palbociclib response.Results: We demonstrated that 80% of OSCC cell lines are sensitive to palbociclib at sub-micromolar concentrations.Consistently, palbociclib was effective in controlling tumor growth in mice. We identified that palbociclib-resistant cells harbored mutations in PIK3CA. Using isogenic cell lines, we showed that PIK3CA mutant cells are less responsive to palbociclib as compared to wild-type cells with concurrent upregulation of CDK2 and cyclin E1 protein levels. We further demonstrated that the combination of a PI3 K/mTOR inhibitor(PF-04691502) and palbociclib completely controlled tumor growth in mice.Conclusions: This study demonstrated the potency of palbociclib in OSCC models and provides a rationale for the inclusion of PIK3CA testing in the clinical evaluation of CDK4/6 inhibitors and suggests combination approaches for further clinical studies.

关键词： OSCC palbociclib CDK4/6 inhibitors PIK3CA