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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael Calleja Angus Hann george clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of Liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

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Why Doesn＇t Adversity Make Everyone Stronger？ Mediators of the Relationship Between Trait Emotion and Resilience

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Psychology Research 2013年第5期3卷 290-301页

作者： george K. clarke J University of York York United Kingdom

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Functional lumen imaging probe use in a high-volume practice:Practical and technical implications

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 396-405页

作者： Yan Jiang Raul Vazquez-Reyes Afrin Kamal Thomas Zikos george Triadafilopoulos John O clarke Division of Gastroenterology and Hepatology Stanford University School of MedicineRedwoodCA 94063United States

BACKGROUND The functional lumen imaging probe(FLIP)is a Food and Drug Administration approved tool to aid the diagnosis and management of esophageal disorders.However,widespread adoption of FLIP remains limited and its utility in highvolume practices remains unclear.AIM To analyze large sample data on clinical use of FLIP and provide insight on several technical aspects when performing FLIP.METHODS We conducted a retrospective comparative and descriptive analysis of FLIP procedures performed by a single provider at an academic medical center.There was a total of 398 FLIP procedures identified.Patient medical records were reviewed and data regarding demographics and procedural details were collected.Statistical tests,including chi-squared,t-test,and multivariable logistic and linear regression,were performed.RESULTS There was an increase in FLIP cases with each successive time period of 13 months(n=68,146,184,respectively)with notable rises specifically for indications of dysphagia and gastroesophageal reflux disease.There was a shift toward use of the longer FLIP balloon catheter for diagnostic purposes(overall 70.4%vs 29.6%,P<0.01).Many cases(42.8%)were performed in conjunction with other diagnostics/interventions,such as dilation and wireless pH probe placement.Procedures were nearly equally performed with anesthesia vs moderate sedation(51.4%anesthesia),with no major complications.Patients who had anesthesia were less likely to have recurrent antegrade contractions[odds ratio(OR)=0.4,95%CI:0.3-0.8]and were also more likely to have absent contractility(OR=2.4,95%CI:1.3-CONCLUSION FLIP cases have increased in our practice with expanding indications for its use.Given limited normative data,providers should be aware of several potential technical issues,including the possible impact of sedation choice when assessing esophageal motility patterns.

关键词： Gastroenterology Endoscopy Functional lumen imaging probe Esophagus Motility

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Gastric per-oral endoscopic myotomy: Current status and future directions

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World Journal of Gastroenterology 2019年第21期25卷 2581-2590页

作者： Alexander Podboy Joo Ha Hwang Linda A Nguyen Patricia Garcia Thomas A Zikos Afrin Kamal george Triadafilopoulos John O clarke Division of Gastroenterology and Hepatology Stanford University School of Medicine

Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.

关键词： Gastroparesis Gastric per-oral endoscopic myotomy Per-oral endoscopic pyloromyotomy Myotomy Endoscopic myotomy Peroral endoscopic myotomy Gastric emptying

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Isolated free intra-abdominal fluid on CT in blunt trauma： The continued diagnostic dilemma

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Chinese Journal of Traumatology 2015年第6期18卷 357-359页

作者： Victor Y. Kong Damon Jeetoo Leah C. Naidoo george V. Oosthuizen Damian L. clarke Pietermaritzburg Metropolitan Trauma Service Department of Surgery Nelson R Mandela School of Medicine University of KwaZulu Natal Durban South Africa

Purpose： The clinical significance of isolated flee fluid （FF） without solid organ injury on computed to- mography （CT） continues to pose significant dilemma in the management of patients with blunt abdominal trauma （BAT）. Methods： We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service, Results： Of the 121 CTs, FF was identified in 36 patients （30%）. Seven patients （6%） had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% （25/ 29） of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were： spleen, 12; liver, 8; kidney, 5; pancreas, 2; small bowel, 4; duodenum, 1. Six （21%） patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 （43%） were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in I case, and a negative laparotomy in 1 case. Four （5？%） patients were successfully managed without surgical interventions. Conclusions： Isolated FF is uncommon and the clinical significance remains unclear. Provided that reli- able serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

关键词： Blunt Trauma Computed Tomography Non Operative Management Abdominal Injury

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Evaluation of conflict-resolution policies on controller taskload

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Chinese Journal of Aeronautics 2021年第5期34卷 315-330页

作者： Adan Ernesto VELA William SINGHOSE Karen FEIGH John-Paul clarke Eric FERON Department of Industrial Engineering and Management System University of Central FloridaOrlandoFL 32816USA george W.Woodruff School of Mechanical Engineering Georgia Institute of TechnologyAtlantaGA 30332USA Daniel Guggenheim School of Aerospace Engineering Georgia Institute of TechnologyAtlantaGA 30332USA

In an effort to maintain safety while satisfying growing air traffic demand,air navigation service providers are considering the inclusion of advisory systems to identify potential conflicts and propose resolution commands for the air traffic controller to verify and issue to aircraft.To understand the potential workload implications of introducing advisory conflict-detection and resolution tools,this paper examines a metric of controller taskload:how many resolution commands an air traffic controller issues under the guidance of an advisory system.Through a simulation study,the research presented here evaluates how the underlying protocol of a conflict-resolution tool affects the controller taskload(system demands)associated with the conflict-resolution process,and implicitly the controller workload(physical and psychological demands).Ultimately,evidence indicates that there is significant flexibility in the design of conflict-resolution algorithms supporting an advisory system.

关键词： Air traffic control Air traffic management Conflict detection and resolution Decision-support tools Simulation analysis

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World Journal of Gastroenterology 2007年第38期13卷 5151-5153页

作者： GL Gupte S Mahadevan JR clarke H Alton SV Beath Liver Unit Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Department of Respiratory Medicine Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Department of Radiology Birmingham Children's Hospital Steelhouse Lane B4 6NH United Kingdom Liver Unit Birmingham Children’s Hospital Steelhouse Lane B4 6NH United Kingdom

Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.

关键词：肺结核肺疾病哮喘小肠移植

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Spatiotemporal event detection: a review

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International Journal of Digital Earth 2020年第12期13卷 1339-1365页

作者： Manzhu Yu Myra Bambacus Guido Cervone Keith clarke Daniel Duffy Qunying Huang Jing Li Wenwen Li Zhenlong Li Qian Liu Bernd Resch Jingchao Yang Chaowei Yang Department of Geography Pennsylvania State UniversityUniversity ParkPAUSA NASA Goddard Space Flight Center NASA Goddard Space Flight CenterGreenbeltMDUSA Department of Geography University of California-Santa BarbaraSanta BarbaraCAUSA Department of Geography University of Wisconsin-MadisonMadisonWIUSA Department of Geography and the Environment University of DenverDenverCOUSA School of Geographical Sciences and Urban Planning Arizona State UniversityTempeAZUSA Department of Geography University of South CarolinaColumbiaSCUSA NSF Spatiotemporal Innovation Center&Dept.of Geography and GeoInformation Science George Mason UniversityFairfaxVAUSA Department of Geoinformatics University of SalzburgKapitelgasseSalzburgAustria Center for Geographic Analysis Harvard UniversityBostonMAUSA

The advancements of sensing technologies,including remote sensing,in situ sensing,social sensing,and health sensing,have tremendously improved our capability to observe and record natural and social phenomena,such as natural disasters,presidential elections,and infectious diseases.The observations have provided an unprecedented opportunity to better understand and respond to the spatiotemporal dynamics of the environment,urban settings,health and disease propagation,business decisions,and crisis and crime.Spatiotemporal event detection serves as a gateway to enable a better understanding by detecting events that represent the abnormal status of relevant phenomena.This paper reviews the literature for different sensing capabilities,spatiotemporal event extraction methods,and categories of applications for the detected events.The novelty of this review is to revisit the definition and requirements of event detection and to layout the overall workflow(from sensing and event extraction methods to the operations and decision-supporting processes based on the extracted events)as an agenda for future event detection research.Guidance is presented on the current challenges to this research agenda,and future directions are discussed for conducting spatiotemporal event detection in the era of big data,advanced sensing,and artificial intelligence.

关键词： GeoAI geography and geoscience human dynamics digital earth computational challenges cloud computing internet of things

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Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 183-188页

作者： Vinay Chandrasekhara Joyce Koh Lakshmi Lattimer Kerry B Dunbar William J Ravich John O clarke Division of Gastroenterology and Hepatology Department of Internal Medicinethe Johns Hopkins Medical Institutions Gastroenterology Division Department of Internal MedicineUniversity of Pennsylvania Health System Perelman Center for Advanced Medicine South Pavilion Gastroenterology and Liver Diseases Depart-ment of Internal Medicinethe George Washington University Division of Gastroenterology and Hepatology Department of MedicineUniversity of Texas Southwestern Medical SchoolDallas VA Medical Center

AIM To evaluate the safety and efficacy of upper esophageal sphincter(UES) dilatation for cricopharyngeal(CP) dysfunction. To determine if:(1) indication for dilatation; or(2) technique of dilatation correlated with symptom improvement.METHODS All balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static(stationary balloon distention) and retrograde(brusque pull-back of a fully distended balloon across the UES).RESULTS Four hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years(range 27-81)and 55% of patients were male. Indications included dysphagia(28 patients), globus sensation with evidence of UES dysfunction(2 patients) and obstruction to echocardiography probe with cricopharyngeal(CP)bar(1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients(52%) and a small Zenker's diverticula(≤ 2 cm) in 7 patients(23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone.Follow-up was available for 24 patients for a median of 2.5 mo(interquartile range 1-10 mo), of whom 19 reported symptomatic improvement(79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement(80%).Nineteen patients underwent retrograde dilatation(84%response) while 5 patients had static dilatation(60%response); however, there was no significant difference in symptom improvement between the techniques(P = 0.5).Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunction,Zenker's diverticulum, age or gender(P > 0.05). The only complicat

关键词： Cricopharygeal 机能障碍 Cricopharyngeal 酒吧咽下困难食道的膨胀内视镜的汽球膨胀

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遵循英国国家常规初级医疗实践指南使用肠促胰素治疗的临床和成本效用以及患者偏好评价

遵循英国国家常规初级医疗实践指南使用肠促胰素治疗的临床和成本...

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中华医学会第十一次全国内分泌学学术会议

作者： MARC EVANS PHIL MCEWAN RICHARD O' SHEA ALISON clarke LINDSAY george Llandough Hospital PenarthCardiffUK Swansea University SwanseaUK University of Wales College of Medicine Cardiff Heath ParkUK

目的:根据现行英国治疗指南,本研究对在常规初级医疗中使用利拉鲁肽、艾塞那肽、DPP-4抑制剂的临床疗效和患者偏好进行了评价。方法:从全科医生处收集包括HbA

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