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Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors

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World Journal of Gastroenterology 2015年第8期21卷 2450-2459页

作者： Jonathan R Strosberg george A fisher Al B Benson Lowell B Anthony Bulent Arslan John F Gibbs Edward Greeno Renuka V Iyer Michelle K Kim William J Maples Philip A Philip Edward M Wolin Dasha Cherepanov Michael S Broder Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Medicine Division of Oncology Stanford University Medical Center Stanford Robert H. Lurie Comprehensive Cancer Center of Northwestern University Department of Internal Medicine Division of Medical Oncology University of Kentucky Markey Cancer Center Rush University Medical Center Department of Surgery University at Buffalo - State University of New York Department of Medicine Division of Hematology Oncology and Transplantation University of Minnesota Department of Medical Oncology Roswell Park Cancer Institute Department of Medicine Gastroenterology Mount Sinai School of Medicine Mission Health System Asheville Department of Oncology Karmanos Cancer Institute Partnership for Health Analytic Research LLC

AIM:To evaluate systemic treatment choices in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors(PNETs)and provide consensus treatment ***:Systemic treatment options for pancreatic neuroendocrine tumors have expanded in recent years to include somatostatin analogs,angiogenesis inhibitors,inhibitors of mammalian target of rapamycinand cytotoxic *** this time,there is little data to guide treatment selection and *** therefore assembled a panel of expert physicians to evaluate systemic treatment choices and provide consensus treatment *** appropriateness ratings were collected using the RAND/UCLA modified Delphi *** studying the literature,a multidisciplinary panel of 10 physicians assessed the appropriateness of various medical treatment scenarios on a 1-9 *** were done both before and after an extended discussion of the *** measurements of agreement were made and consensus statements developed from the second round ***:Specialties represented were medical and surgical oncology,interventional radiology,and *** had practiced for a mean of15.5 years(range:6-33).Among 202 rated scenarios,disagreement decreased from 13.2%(26 scenarios)before the face-to-face discussion of evidence to 1%(2)*** the final ratings,46.5%(94 scenarios)were rated inappropriate,21.8%(44)were uncertain,and30.7%(62)were *** statements from the scenarios included:(1)it is appropriate to use somatostatin analogs as first line therapy in patients with hormonally functional tumors and may be appropriate in patients who are asymptomatic;(2)it is appropriate to use everolimus,sunitinib,or cytotoxic chemotherapy therapy as first line therapy in patients with symptomatic or progressive tumors;and(3)beyond first line,these same agents can be *** patients with uncontrolled secretory symptoms,octreotide LAR doses can be titrated u

关键词： Unresectable Neuroendocrine carcinomas Neuroendocr

Delayed gastric emptying following pancreaticoduodenectomy:Incidence,risk factors,and healthcare utilization

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World Journal of Gastrointestinal Surgery 2017年第3期9卷 73-81页

作者： Somala Mohammed george Van Buren II Amy Mc Elhany Eric J Silberfein William E fisher Elkins Pancreas Center Michael E DeBakey Department of SurgeryBaylor College of MedicineHoustonTX 77030United States

AIM To characterize incidence and risk factors for delayed gastric emptying(DGE) following pancreaticoduodenectomy and examine its implications on healthcare utilization. METHODS A prospectively-maintained database was reviewed. DGE was classified using International Study Group of Pancreatic Surgery criteria. Patients who developed DGE and those who did not were compared. RESULTS Two hundred and seventy-six patients underwent pancreaticoduodenectomy(PD)(> 80% pyloruspreserving, antecolic-reconstruction). DGE developed in 49 patients(17.8%): 5.1% grade B, 3.6% grade C. Demographic, clinical, and operative variables were similar between patients with DGE and those without. DGE patients were more likely to present multiplecomplications(32.6% vs 4.4%, ≥ 3 complications, P < 0.001), including postoperative pancreatic fistula(POPF)(42.9% vs 18.9%, P = 0.001) and intra-abdominal abscess(IAA)(16.3% vs 4.0%, P = 0.012). Patients with DGE had longer hospital stay(median, 12 d vs 7 d, P < 0.001) and were more likely to require transitional care upon discharge(24.5% vs 6.6%, P < 0.001). On multivariate analysis, predictors for DGE included POPF [OR = 3.39(1.35-8.52), P = 0.009] and IAA [OR = 1.51(1.03-2.22), P = 0.035].CONCLUSION Although DGE occurred in < 20% of patients after PD, it was associated with increased healthcare utilization. Patients with POPF and IAA were at risk for DGE. Anticipating DGE can help individualize care and allocate resources to high-risk patients.

关键词：推迟了胃的倒空 Pancreaticoduodenectomy 手术后的胰腺的管

Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

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World Journal of Gastroenterology 2017年第6期23卷 1113-1118页

作者： Michael A Mederos Nicole Villafane Sadhna Dhingra Carlos Farinas Amy Mc Elhany William E fisher george Van Buren II Department of General Surgery Baylor College of Medicine Department of Pathology Baylor College of Medicine Department of Radiology Baylor College of Medicine

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16cm×12cm×4cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.

关键词：胰腺的包囊胰腺的子宫内膜的包囊子宫内膜增生胰的 Mucinous 膀胱的瘤远侧的 pancreatectomy

Pancreatic cancer: Advances in treatment

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World Journal of Gastroenterology 2014年第28期20卷 9354-9360页

作者： Somala Mohammed george Van Buren Ⅱ William E fisher The Elkins Pancreas Center Michael E DeBakey Department of Surgeryand Dan L Duncan Cancer CenterBaylor College of Medicine

Pancreatic cancer is a leading cause of cancer mortality and the incidence of this disease is expected to continue *** patients with pancreatic cancer have traditionally faced a dismal prognosis,over the past several years various advances in diagnosis and treatment have begun to positively impact this *** of effective combinations of existing chemotherapeutic agents,such as the FOLFIRINOX and the gemcitabine+nab-paclitaxel regimen,has improved survival for selected patients although concerns regarding their toxicity profiles remain.A better understanding of pancreatic carcinogenesis has identified several pre-malignant precursor lesions,such as pancreatic intraepithelial neoplasias,intraductal papillary mucinous neoplasms,and cystic *** technology has also evolved dramatically so as to allow early detection of these lesions and thereby facilitate earlier *** remains a cornerstone of treatment for patients with resectable pancreatic tumors,and advances in surgical technique have allowed patients to undergo resection with decreasing perioperative morbidity and *** has also become feasible in selected patients with borderline resectable tumors as a result of neoadjuvant ***,pancreatectomy involving vascular reconstruction and pancreatectomy with minimally invasive techniques have demonstrated safety without significantly compromising oncologic ***,a deeper understanding of molecular aberrations contributing to the development of pancreatic cancer shows promise for future development of more targeted and safe therapeutic agents.

关键词： Pancreatic cancer Pancreaticoduodenectomy Treatmen

Emissive displays with transfer-printed assemblies of 8 μm × 15 μm inorganic light-emitting diodes

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Photonics Research 2017年第2期5卷 23-29页

作者： CHRISTOPHER A.BOWER MATTHEW A.MEITL BROOK RAYMOND ERICH RADAUSCHER RONALD COK SALVATORE BONAFEDE DAVID GOMEZ TANYA MOORE CARL PREVATTE BRENT fisher ROBERT ROTZOLL george A.MELNIK ALIN FECIORU ANTóNIO JOSé TRINDADE X-Celeprint Inc. Research Triangle Park X-Celeprint Ltd.

Displays using direct light emission from microscale inorganic light-emitting diodes(μILEDs)have the potential to be very bright and also very power ***-throughput technologies that accurately and cost-effectively assemble microscale devices on display substrates with high yield are key enablers forμILED *** stamp transfer printing is such a candidate assembly technology.A variety ofμILED displays have been designed and fabricated by transfer printing,including passive-matrix and active-matrix displays on glass and plastic substrates.

关键词： Emissive displays with transfer-printed assemblies of 8 m inorganic light-emitting diodes

Attempted Colonic Preservation Strategies Do Not Increase the Risk of In-Hospital Mortality in Patients Presenting with Acute Left-Sided Colonic Emergencies

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Open Journal of Gastroenterology 2017年第12期7卷 316-328页

作者： Mathew A. Kozman Oliver M. fisher Havish Srinath Stephen I. White Department of General Surgery The Tweed Hospital Tweed Heads Australia Department of General Surgery John Flynn Private Hospital Tugun Australia Bond University Robina Australia University of New South Wales Department of Surgery St George Hospital Kogarah Australia St Vincent’s Centre for Applied Medical Research Sydney Australia School of Medicine University of Notre Dame Sydney Australia

Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as laparoscopic lavage and endoscopic stenting have emerged as management options, the safety of which has been debated. We aimed to determine if these alternate colonic preservation techniques result in increased in-hospital mortality. Materials and Methods. Retrospective analysis of prospectively collected data of 210 patients with ALSCE managed from June 2001 to April 2014. Data collected included demographic, pathology type, ASA grading, operative and post-operative progress. Univariable and multivariable logistic regression was performed to determine factors contributing to treatment arm allocation and in-hospital mortality. These were performed on the whole treatment cohort, as well as per pathology subgroup. Results. 210 patients were included. Non-resectional management was attempted in 147 patients (70%), of which 38 (26%) required un-planned colonic resection or died in hospital. Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Female gender was the only independent predictor of increased in-hospital mortality risk. Importantly, the type of procedure performed (colonic preservation vs. resection) did not predict in-hospital mortality risk. Conclusion. Attempted colonic preservation strategies do not increase the risk of in-hospital mortality in patients presenting with ALSCE. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE.

关键词： Colorectal Laparoscopic Stenting Obstruction Perforation

Effects of albumin/glutaraldehyde glue on healing of colonic anastomosis in rats

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World Journal of Gastroenterology 2017年第31期23卷 5680-5691页

作者： Kalliopi Despoudi Ioannis Mantzoros Orestis Ioannidis Aggeliki Cheva Nikolaos Antoniou Dimitrios Konstantaras Savvas Symeonidis Manousos george Pramateftakis Efstathios Kotidis Stamatis Angelopoulos Konstantinos Tsalis Fourth Surgical Department Medical SchoolAristotle University of Thessaloniki Department of Pathology General Hospital“G.Papanikolaou”57010 ThessalonikiGreece

AIM To evaluate the effect of local surgical adhesive glue(albumin/glutaraldehyde-Bioglue) on the healing of colonic anastomoses in *** Forty Albino-Wistar male rats were randomly divided into two groups, with two subgroups of ten animals each. In the control group, an end-to-end colonic anastomosis was performed after segmental resection. In the Bioglue group, the anastomosis was protected with extraluminar application of adhesive glue containing albumin and glutaraldehyde. Half of the rats were sacrificed on the fourth and the rest on the eighth postoperative day. Anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Other parameters of healing, such as hydroxyproline and collagenase concentrations, were evaluated. The experimental data were summarized and computed from the results of a one-way ANOVA. fisher's exact test was applied to compare percentages. RESULTS Bursting pressures, adhesion formation, inflammatory cell infiltration, and collagen deposition were significantly higher on the fourth postoperative day in the albumin/glutaraldehyde group than in the control group. Furthermore, albumin/glutaraldehyde significantly increased adhesion formation, inflammatory cell infiltration, neoangiogenesis, and collagen deposition on the eighth postoperative day. There was no difference in fibroblast activity or hydroxyproline and collagenase concentrations. CONCLUSION Albumin/glutaraldehyde, when applied on colonic anastomoses, promotes their healing in rats. Therefore, the application of protective local agents in colonic anastomoses leads to better outcomes.

关键词：粘附爆炸压力 Bioglue Albumin/glutaraldehyde 骨胶原结肠的吻合

CENTRAL VENOUS CATHETERISATION DURING NEUTROPENIA OR LEUKOCYTOSIS DO NOT INCREASE THE INFECTION RATE OF CENTRAL LINES IN CHILDREN WITH MALIGNANCY

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CENTRAL VENOUS CATHETERISATION DURING NEUTROPENIA OR LEUKOCY...

Mental health and quality of life burden in Buruli ulcer disease patients in Ghana

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作者： george H.Mya Htut Saing Division of Paediatric Surety Department of SurgeryThe University of Hong KongQueen Mary HospitalHong Kong. Division of Paediatric Surgery Department of SurgeryThe University of Hong KongQueen Mary HospitalHong Kong

A total of 24 catheterizations in 16 children with malignancy, admitted into Queen Mary Hospital,Hong Kong,between April 1987 and July 1993,were studied *** cell counts(WCC),taken within the 24 hour period prior to catheterisation,were *** were cate- gorized into four groups:1)neutropenia(WCC? 1.0×10/L),2)subnor- mal(WCC between 1.0 and 3.5×10/L), 3)normal(WCC between 3.5 and 11.0×10/L) and 4)leukocytosis(WCC?11.0×10/L).The mean age of the patients was 4.4 *** total duration of catheterisation was 4801 *** central venous line infection rates for groups 1,2,3 and 4 were 5.3,1.3,1.6 and 2.4 infection per 1000 days of catheter use respec- *** these four groups,we found no difference in the infection rates of central venous catheters(p=0.64,χ-square).When the groups 1, 2 and 4 were compared to group 3(normal),no difference was detected either (p=0.34,1.00 and 0.65 respectively,fisher’s exact test).We conclude that central venous catheterization in children with malignancy under antibiotic cover during neutropenia or leukocytosis is not contraindicated.

关键词： Central venous catheter White cell count Neutropenia

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Infectious Diseases of Poverty 2021年第4期10卷 93-94页

作者： Yaw Ampem Amoako Nancy Ackam John-Paul Omuojine Michael Ntiamoah Oppong Abena Gyawu Owusu-Ansah Harriet Boateng Mohammed Kabiru Abass george Amofa Elizabeth Ofori Portia Boakye Okyere Michael Frimpong Freddie Bailey David Hurst Molyneux Richard Odame Phillips Kumasi Centre for Collaborative Research in Tropical Medicine Kwame Nkrumah University of Science and TechnologyKumasiGhana 不详

Background Buruli ulcer disease(BUD)is a necrotic skin neglected tropical disease(NTD)that has both a mental and physical health impact on affected *** there is increasing evidence suggesting a strong association between neglected tropical diseases(NTDs)and mental illness,there is a relative lack of information on BUD’s impact on the mental health and quality of life(QoL)of affected individuals in *** study is to assess the impact of BUD on mental health and quality of life of patients with active and past BUD infection,and their *** We conducted a case control study in 3 BUD endemic districts in Ghana between August and November ***-to-face structured questionnaire-based interviews were conducted on BUD patients with active and past infection,as well as caregivers of BUD patients using WHO Quality of Life scale,WHO Disability Assessment Schedule,Self-Reporting Questionnaire,Buruli Ulcer Functional Limitation Score and Hospital Anxiety and Depression Scale data *** statistics were used to summarize the characteristics of the study *** groups were compared using student t test and chi-square(χ2)or fisher’s exact *** quality of life scores are reported with their respective 95%confidence *** was analysed using STATA statistical *** Our results show that BUD patients with active and past infection,along with their caregivers,face significant levels of distress and mental health sequelae compared to ***(P=0.003)was more common in participants with active(27%)and past BU infection(17%),compared to controls(0%).Anxiety was found in 42%(11/26)and 20%(6/29)of participants with active and past BUD infection compared to 14%(5/36)of *** of life was also significantly diminished in active BUD infection,compared to *** the physical health domain,mean QoL scores were 54±11.1 and 56±11.0(95%CI:49.5‒58.5 and 52.2‒59.7)respectively for p

关键词： Mental health Depression Anxiety Quality of life Buruli ulcer disease Neglected tropical disease