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Analysis of a ten step protocol to decrease postoperative spinal wound infections

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World Journal of orthopedics 2018年第11期9卷 271-284页

作者： hossein Elgafy Craig J Raberding Megan L Mooney Kyle A andrews Joan M Duggan Department of orthopedics and Infectious Diseases University of Toledo Medical Center

AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current *** In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(hbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was *** Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of hbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting oR traffic and number of personnel in the oR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet *** The ten-step protocol defined herein has significantly helped in decreasing surgical site

关键词： Wound infections Spine Ten step protocol Surgical site infections

Chemical and Mineralogical Characterization of Ghanaian Foundry Slags

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Journal of Minerals and Materials Characterization and Engineering 2012年第2期11卷 183-192页

作者： A. andrews E. Gikunoo L. ofosu-Mensah h. Tofah S. Bansah Department of Geological Engineering Kwame Nkrumah University of Science and Technology Kumasi-Ghana Department of Materials Engineering Kwame Nkrumah University of Science and Technology Kumasi-Ghana

The application of ferrous slags as aggregate, road bed materials, soil fertility conditioner and as clinker materials depend on their chemical and mineralogical characteristics. In order to assess the possibilities of using ferrous slags generated in Ghana, selected slag samples from some foundries have been characterized. A total of six bulk samples were collected from three different foundry shops to determine their chemical and mineralogical composition. The slag samples showed varied chemical and mineralogical characteristics. Differences are as a result of the differences in furnace charge, operation temperatures, grades of refractory furnace lining and melting additives. Calcium oxide (Cao) contents observed in all investigated samples were in combined form (i.e. not free Cao). The low amounts of calcium oxide in the slag samples limit their applications in the area of cement/aggregate production. Even though slags were found to be alkaline, for these slags to effectively neutralize the acidity of soil and improve its fertility, components such as Cao, Sio2, Mgo and Feo in the slag must be improved. however, these slags could be used as road bed materials.

关键词： Cupola slag Induction furnace slag Characterization Recycling

Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis:A global survey of physicians'practice

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World Journal of Gastroenterology 2017年第16期23卷 2995-3002页

作者： Shomron Ben-horin Jane M andrews Konstantinos h Katsanos Florian Rieder Flavio Steinwurz Konstantinos Karmiris Jae hee Cheon Gordon William Moran Monica Cesarini Christian D Stone Doron Schwartz Marijana Protic Xavier Roblin Giulia Roda Min-hu Chen ofir har-Noy Charles N Bernstein Department of Gastroenterology Sheba Medical CenterSackler School of MedicineTel-Aviv UniversityRamat-Gan 52621Israel the First Affiliated hospital of Sun Yat-Sen University Guangzhou 510700Guangdong provinceChina Department of Gastroenterology and hepatology Inflammatory Bowel Disease ServiceRoyal Adelaide HospitalSchool of MedicineUniversity of AdelaideAdelaideSA 5005Australia Division of Gastroenterology School of Health SciencesUniversity of IoanninaIoannina 45500Greece Department of Gastroenterology Hepatology and NutritionDigestive Disease Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOH 44109United States Unit of Inflammatory Bowel Disease Hospital Israelita Albert EinsteinSao PauloSP 05652-900Brazil Department of Gastroenterology Venizeleio General HospitalHeraklion71409 CreteGreece Department of Internal Medicine Yonsei University College of MedicineSeoul 03722South Korea NIhR Nottingham Digestive Diseases Biomedical Research Unit Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG7 2UHUnited Kingdom Dipartimento di Medicina Interna e SpecialitàMediche “Sapienza”University of Rome00185 RomaItaly Comprehensive Digestive Institute of Nevada Las VegasNV 89113United States Department of Gastroenterology and hepatology Soroka University Medical CenterBeer-Sheva 6400111Israel Department of Gastroenterology University Hospital ZvezdaraBelgrade 11000Serbia Department of Gastroenterology University-Hospital of Saint-Etienne42100 Saint EtienneFrance Gastroenterology Unit S.Orsola-Malpighi40138 BolognaItaly IBD Clinical and Research Centre University of ManitobaWinnipegMB R3T2N2Canada

AIM To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates(5ASA) with corticosteroids(CS) versus corticosteroids alone for patients with active ulcerative colitis(UC). METhoDS A cross-sectional questionnaire exploring physicians' attitude toward 5ASA + CS combination therapy vs CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents' agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses. RESULTS Six hundred and sixty-four questionnaires were distributed and 349 received(52.6% response rate). of 340 eligible respondents, 221(65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108(32%) would stop the 5ASA(P ould continue 5ASA in an out-patient starting oral CS. however, only 140/340(41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most(94%) physicians consider the safety profile of 5ASA as very good. only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. on multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS. CoNCLUSIoN Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.

关键词： Inflammatory bowel disease Corticosteroids 5-aminosalicylates Ulcerative colitis

Gastroesophageal reflux disease after diagnostic endoscopy in the clinical setting

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World Journal of Gastroenterology 2013年第16期19卷 2514-2520页

作者： Nora B Zschau Jane M andrews Richard h holloway Mark N Schoeman Kylie Lange William CE Tam Gerald J holtmann Department of Gastroenterology and hepatology Royal Adelaide Hospital Faculty of health Sciences University of AdelaideAdelaide Department of Gastroenterology and hepatology Lyell McEwin Hospital Department of Gastroenterology and hepatology University of Queensland School of Medicine Princess Alexandra Hospital

AIM: To investigate the outcome of patients with symptoms of gastroesophageal reflux disease (GERD) referred for endoscopy at 2 and 6 mo post endoscopy. METhoDS: Consecutive patients referred for upper endoscopy for assessment of GERD symptoms at two large metropolitan hospitals were invited to participate in a 6-mo non-interventional (observational) *** two institutions are situated in geographically and socially disparate areas. Data collection was by selfcompletion of questionnaires including the patient assessment of upper gastrointestinal disorders symptoms severity and from hospital records. Endoscopic finding using the Los-Angeles classification, symptom severity and it's clinically relevant improvement as change of at least 25%, therapy and socio-demographic factors were assessed. RESULTS: Baseline data were available for 266 patients and 2-mo and 6-mo follow-up data for 128 and 108 patients respectively. At baseline, 128 patients had erosive and 138 non-erosive reflux disease. Allmost all patient had proton pump inhibitor (PPI) therapy in the past. overall, patients with non-erosive GERD at the index endoscopy had significantly more severe symptoms as compared to patients with erosive or even complicated GERD while there was no difference with regard to medication. After 2 and 6 mo there was a small, but statistically significant improvement in symptom severity (7.02 ± 5.5 vs 5.9 ± 5.4 and 5.5 ± 5.4 respectively); however, the majority of patients continued to have symptoms (i.e. , after 6 mo 81% with GERD symptoms). Advantaged socioeconomic status as well as being unemployed was associated with greater improvement. CoNCLUSIoN: The majority of GoRD patients receive PPI therapy before being referred for endoscopy even though many have symptoms that do not sufficiently respond to PPI therapy.

关键词： Gastroesophageal reflux disease Epidemiology Proton pump inhibitor Acid suppressive therapy Endoscopy Barrett’s esophagus Functional gastrointestinal disorders

含金绿岩带剖析:以加拿大安大略省红湖地区为例

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华北地质 1988年第2期 1-19页

作者： A. J. andrews h. hugon 卢祥生

红湖绿岩带的岩浆演化伴随约2730和2700Ma间周围岩基的侵位,经历了漫长的火山活动时期(约在2992和2733Ma间)。该区的主要金矿床及与之伴生的强蚀变岩石,在空间上与巨大、多相的剪切系(变形带)有关,它在区域范围横切火山岩系。含金侵入体... 详细信息

红湖绿岩带的岩浆演化伴随约2730和2700Ma间周围岩基的侵位,经历了漫长的火山活动时期(约在2992和2733Ma间)。该区的主要金矿床及与之伴生的强蚀变岩石,在空间上与巨大、多相的剪切系(变形带)有关,它在区域范围横切火山岩系。含金侵入体的U—Pb法年龄测定结果表明,这些大型构造制约了变形的主要阶段以及2720Ma以后的金矿化作用,即值得注意的晚于火山活动期。变形带的形成与周围岩基的底辟侵位有关。在该绿岩带东段和中段所进行的详细研究揭示出,与金矿化伴生的强蚀变作用无论是时间上和空间上均与邻近岩基周围发育的接触变质晕有关。沿变形带,蚀变组合记录了环绕围岩中广泛反映接触热变质梯度的热梯度情况。镁铁质火山岩,通过绿片岩相变质作用蚀变为石英、铁白云石、绢云母、绿泥石、方解石组合;而通过角闪岩相变质作用,则蚀变为石英、黑云母、白云母、柘榴石、红柱石、十字石、堇青石、硬绿泥石组合。根据对坎贝尔矿山和迪肯森(现为A.W.怀特)矿山的研究,认为金矿化与热变质作用高峰期是同时的,但接在大多数碳酸盐蚀变之后的却发生在剪切变形史晚期。综合证据表明,伴有金矿化的接触热变质作用、变形作用和强烈蚀变作用是同时代的产物,并直接与岩基侵位作用有关。

关键词：变形带侵位红湖 Pb 绿岩带变质作用地质作用岩基岩石侵入体黑云母角闪岩相玄武质铁白云石年龄测定绿片岩相长英质火山岩石英脉镁铁质岩石坎贝尔硬绿泥石加拿大北美洲

棉花(Gossypium hirsutum)硬实休眠的发生和解除

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棉花科学 1988年第1期 33-35+43-37页

作者： Patil V.N. andrews C.h 戴日春浙江农业大学

引言Nikolaeva(1979)认为硬实性是物理性外源休眠(Physical exogenous dor-mancy),硬实性普遍存在于豆科植物的许多种中,但在锦葵科和其它科的一些种中也有发生(harrington,1916).Rolston(1978)最近评述了硬实休眠。所谓硬实是指那些在... 详细信息

引言Nikolaeva(1979)认为硬实性是物理性外源休眠(Physical exogenous dor-mancy),硬实性普遍存在于豆科植物的许多种中,但在锦葵科和其它科的一些种中也有发生(harrington,1916).Rolston(1978)最近评述了硬实休眠。所谓硬实是指那些在规定发芽试验周期结束时,由于它们具有不透性种壳而不能种吸收水分、仍然保持坚硬的种子(美国官方种子分析家协会AoSA,1978)。在高湿度贮藏条件下保持棉花(Gos-sypium hirsutum L)的种子质量和在阴雨季节下防止棉花收获前种子变质都与种子

关键词：种子含水量种子含水率发芽率生活力 Gossypium hirsutum 棉铃棉桃收获期棉花种子硬实率种皮种子生活力种子发芽

Antioxidant Effects of Alperujo Extract (Arbequina and Frantoio Varieties) on MIN6 β-Cells Subjected to Stress with Glucose or h2o2

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Food and Nutrition Sciences 2014年第13期5卷 1280-1289页

作者： César González Mónica andrews Elba Leiva Cristina Quispe Miguel Arredondo Faculty of health Sciences University of Talca Interdisciplinary Research Program on Healthy Aging (PIEI-ES) Talca Chile Institute of Chemistry of Natural Resources University of Talca Talca Chile Micronutrient Laboratory Institute of Nutrition and Food Technology (INTA) University of Chile Santiago Chile

Alperujo, an antioxidant-rich by-product of olive oil extraction, could protect β-cells against oxidative damage. our goal was to study the antioxidant effects of an alperujo extract (AE) on MIN6 β-cells challenged with glucose or hydrogen peroxide. MIN6 β-cells were challenged with glucose (100 mM) or h2o2 (0.15 mM), with or without AE (20 μM phenol). Reactive oxygen species, intracellular iron (Fe), insulin, glucose uptake, and mRNA gene expression of Uncoupling Protein-2 (UCP-2), Thioredoxin (TRDX), p47phox, and the ratio Bax/Bcl-2 were measured. RoS increased when the stressors were incubated with AE (p ose presence (100 mM p on improved when cells were pre-incubated with AE (p ose uptake increased when cells were pre-incubated with AE for 3 days and then further treated with glucose (p of AE alone, mRNA relative expression of UCP-2 and TRDX increased (p hox, also increased. The Bax/Bcl-2 ratio tended to decrease in the samples pre-incubated with AE. The Alperujo extract,in vitro, had a pro-oxidant behavior, however pre-incubating MIN6 β-cells with AE tended to protect them against apoptosis, thereby enhancing insulin secretion.

关键词： Alperujo oxidative Stress Apoptosis Glucose β-Cells

腹部X线片对于重症监护病房的胃肠道出血患者无益

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世界核心医学期刊文摘（胃肠病学分册） 2005年第8期1卷 51-52页

作者： andrews A.h Lake J.M Shorr A.F 程欣 Walter Reed Army Medical C enter Department of GastroenterologyBuilding 2 6900 Georgia AvenueWashington DC 20307 United States.Dr

Goals: To determine the utility of plain abdominal radiography in the initial evaluation of acute gastrointestinal (GI) hemorrhage in a medical intensive care unit. Background: Plain abdominal radiographs are frequently used in the routin e evaluation of patients with GI bleeding. The utility of these studies in the i ntensive care unit setting is unclear. Study: The study was a retrospective char t review of 71 adult subjects admitted to a medical intensive care unit with the diagnosis of GI *** were excluded if they presented with peritone al signs,received an abdominal CT scan in the 24 hours prior to admission,or wer e chronically treated with immunosuppressive medication. Subjects were divided i nto two cohorts based on whether or not they underwent plain abdominal radiograp hy during the first hospital day. The primary study endpoints were hospital mort ality, intensive care unit length of stay, and whether or not radiographic findi ngs altered clinical ***: of the 71 patients admitted with a diag nosis of GI bleeding (mean age 65.8 ±14.5 years, 73.2%male), 56(79%) had a plain abdominal radiograph performed. Subjects who had a plain film did not differ significantly from those who did not in age, ge nder, degree of anemia, degree of coagulopathy,or in severity of illness as meas ured by Acute Physiology and Chronic health Evaluation (APAChE II) score. There was no statistically significant difference in hospital mortality or intensive c are unit length of stay between patients who received plain films and those who did not. In no subject (0%; 95%confidence interval, 0%-5.4%) did abdominal radiography reveal an abnormality that altered clinical management. Conclusions: Based on our observations, plain films of the abdomen do not appear to alter cli nical outcomes or management decisions for patients with GI bleeding and normal abdominal examinations who are admitted to the intensive care unit.

关键词：重症监护临床治疗方案腹膜刺激征慢性健康状况常规检查出血早期辅助诊断免疫抑制治疗贫血程度凝血障碍

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Accuracy of a new rapid diagnostic test for urinary antigen detection and assessment of drug treatment in opisthorchiasis

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Infectious Diseases of Poverty 2023年第6期12卷 79-90页

作者： Chanika Worasith Jiraporn Sithithaworn Phattharaphon Wongphutorn Chutima homwong Kanoknan Khongsukwiwat Anchalee Techasen Kulthida Y.Kopolrat Watcharin Loilome Nisana Namwat Bandit Thinkamrop Chaiwat Tawarungruang Attapol Titapun Thewarach Laha Ross h.andrews Simon D.Taylor‑Robinson Paiboon Sithithaworn Department of Adult Nursing Faculty of NursingKhon Kaen UniversityKhon KaenThailand Cholangiocarcinoma Research Institute Khon Kaen UniversityKhon KaenThailand Faculty of Associated Medical Sciences Khon Kaen UniversityKhon KaenThailand Biomedical Science Program Graduate SchoolKhon Kaen UniversityKhon KaenThailand Faculty of Public health Kasetsart University Chalermphrakiat Sakon Nakhon Province CampusSakon NakhonThailand Department of Systems Biosciences and Computational Medicine Faculty of MedicineKhon Kaen UniversityKhon KaenThailand Khon Kaen University Phenome Centre Khon Kaen UniversityKhon KaenThailand Department of Epidemiology and Biostatistics Faculty of Public HealthKhon Kaen UniversityKhon KaenThailand Department of Surgery Faculty of MedicineKhon Kaen UniversityKhon KaenThailand Depart‑ment of Parasitology Faculty of MedicineKhon Kaen UniversityKhon KaenThailand Faculty of Medicine St Mary’s CampusImperial College LondonLondonUK Division of Digestive health Department of Surgery and Can‑cerImperial College LondonLondonUK

Background Screening for opisthorchiasis,a parasitic worm infection affecting many millions of people in Southeast Asia,has traditionally relied on faecal egg examination such as the formalin-ethyl acetate concentration technique(FECT)and Kato-Katz *** the urinary enzyme-linked immunosorbent assay(ELISA)has been used more recently,we developed a urinary antigen-based rapid diagnostic test(RDT)to simplify diagnosis and as a point-of-care testing(PoCT)and field applications for surveillance and control of *** A urinaryopisthorchis viverrini(oV)-RDT was developed using immunochromatographic methodology with a specific monoclonal antibody against *** diagnostic performance of the urinary oV-RDT was compared to that of quantitative faecal FECT and urinary antigen ELISA(n=493).Cross-reactivities of urinary oV-RDT with other helminthiases coexisted *** were determined(n=96).A field trial in the application of urinary oV-RDT was compared with urinary antigen ELISA at baseline screening and assessment of drug treatment outcomes in opisthorchiasis(n=1629).The McNemar chi-square,Kruskal-Wallis and Cohen’s kappa coefficient(κ-value)tests were used for statistical *** Urinary oV-RDT had sensitivity of 94.2%and specificity of 93.2%,compared to faecal *** oV-RDT had high diagnostic agreement(Kappa=0.842-0.874,Porrelation with urinary antigen ELISA(Kruskal-Wallis tests=316.2,Phe positive rates by oV-RDT,ELISA and FECT were 48.9%,52.5%and 49.3%,***-reactions of urinary oV-RDT with other helminthiases were few(2%).Field trials of urinary oV-RDT yielded comparable prevalence *** between urinary oV-RDT(53.2%)and urinary antigen ELISA(54.0%).oV screening showed high diagnostic agreement(kappa>0.8,PoV-RDT and urinary antigen *** cure rates of opisthorchiasis at 1 month post-praziq

关键词： Liver fluke opisthorchis viverrini Urinary antigen detection Urinary opisthorchis viverrini rapid diagnosis test Enzyme-linked immunosorbent assay Quantitative formalin-ethyl acetate concentration technique

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