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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 rative 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 re more likely to require transitional care upon discharge(24.5% vs 6.6%, P riate 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 r 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： Delayed gastric emptying Pancreaticoduodenectomy Post-operative pancreatic fistula

When will it end? Long-lived intracontinental reactivation in central Australia

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Geoscience Frontiers 2019年第1期10卷 149-164页

作者： raphael Quentin de Gromard Christopher L.Kirkland Heather M.Howard Michael T.D.Wingate Fred jourdan Brent I.A.mc Innes Martin Danisik Noreen j.Evans Bradley j.mcDonald r.Hugh Smithies Geological Survey of Western Australia Department of Mines Industry Regulation and Safety School of Earth and Planetary Science/john de Laeter Centre/TIGer Curtin University

The post-Mesoproterozoic tectonometamorphic history of the Musgrave Province, central Australia, has previously been solely attributed to intracontinental compressional deformation during the 580 -520 Ma Petermann Orogeny. However, our new structurally controlled multi-mineral geochronology results,from two north-trending transects, indicate protracted reactivation of the Australian continental interior over ca. 715 million years. The earliest events are identified in the hinterland of the orogen along the western transect. The first tectonothermal event, at ca. 715 Ma, is indicated by40 Ar/39 Ar muscovite and U e Pb titanite ages. Another previously unrecognised tectonometamorphic event is dated at ca. 630 Ma by Ue Pb analyses of metamorphic zircon rims. This event was followed by continuous cooling and exhumation of the hinterland and core of the orogen along numerous faults, including the Woodroffe Thrust,from ca. 625 Ma to 565 Ma as indicated by muscovite, biotite, and hornblende40 Ar/39 Ar cooling ages. We therefore propose that the Petermann Orogeny commenced as early as ca. 630 Ma. Along the eastern transect,40 Ar/39 Ar muscovite and zircon(Ue Th)/He data indicate exhumation of the foreland fold and thrust system to shallow crustal levels between ca. 550 Ma and 520 Ma, while the core of the orogen was undergoing exhumation to mid-crustal levels and cooling below 600-660℃. Subsequent cooling to 150 -220℃ of the core of the orogen occurred between ca. 480 Ma and 400 Ma(zircon [Ue Th]/He data)during reactivation of the Woodroffe Thrust, coincident with the 450 -300 Ma Alice Springs *** of the footwall of the Woodroffe Thrust to shallow depths occurred at ca. 200 Ma. More recent tectonic activity is also evident as on the 21 May, 2016(Sydney date), a magnitude 6.1 earthquake occurred, and the resolved focal mechanism indicates that compressive stress and exhumation along the Woodroffe Thrust is continuing to the present day. Overall, these results

关键词： Intracontinental deformation Thermochronology Petermann orogen Musgrave Province Plate tectonics Cratonization

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Clinical outcomes following salvage Gamma Knife radiosurgery for recurrent glioblastoma

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World journal of Clinical Oncology 2014年第2期5卷 142-148页

作者： Erik W Larson Halloran E Peterson Wayne T Lamoreaux Alexander r MacKay robert K Fairbanks jason A call jonathan D Carlson Benjamin C Ling john j Demakas Barton S Cooke Christopher M Lee Gamma Knife of Spokane Spokane WA 99204 United States Cancer Care Northwest Spokane WA 99204 United States University of Washington School of Medicine Seattle WA 98195 United States MacK ay and Meyer MDs Spokane WA 99202 United States Inland Neurosurgery and Spine Associates Spokane WA 99204 United States Spokane Brain and Spine Spokane WA 99204 United States

Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKrS) salvage therapy. Following a Pub Med search for studies usingGKrS as salvage therapy for malignant gliomas, nine articles from 2005 to july 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKrS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKrS for rG BM before the possibility of selection bias can be dismissed.

关键词： Gamma Knife radiosurgery Malignant glioma Glioblastoma Salvage therapy Stereotactic radiosurgery Multimodal treatment

Combinatorial therapies for spinal cord injury repair

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Neural regeneration research 2025年第5期20卷 1293-1308页

作者： Carla S.Sousa Andreia Monteiro António j.Salgado Nuno A.Silva Life and Health Sciences research Institute(ICVS) School of MedicineUniversity of MinhoCampus de Gualtar-gualtarBragaPortugal ICVS/3B’s Associate Lab PT Government Associated LabCampus de Gualtar-gualtarBragaPortugal

Spinal cord injuries have profound detrimental effects on individuals, regardless of whether they are caused by trauma or non-traumatic events. The compromised regeneration of the spinal cord is primarily attributed to damaged neurons, inhibitory molecules, dysfunctional immune response, and glial scarring. Unfortunately, currently, there are no effective treatments available that can fully repair the spinal cord and improve functional outcomes. Nevertheless, numerous pre-clinical approaches have been studied for spinal cord injury recovery, including using biomaterials, cells, drugs, or technological-based strategies. Combinatorial treatments, which target various aspects of spinal cord injury pathophysiology, have been extensively tested in the last decade. These approaches aim to synergistically enhance repair processes by addressing various obstacles faced during spinal cord regeneration. Thus, this review intends to provide scientists and clinicians with an overview of pre-clinical combinatorial approaches that have been developed toward the solution of spinal cord regeneration as well as update the current knowledge about spinal cord injury pathophysiology with an emphasis on the current clinical management.

关键词： electric stimulation neural tissue regeneration neuroprotection polytherapy spinal cord injury

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Is there an acute exercise-induced physiological/biochemical threshold which triggers increased speed of cognitive functioning? A meta-analytic investigation

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journal of Sport and Health Science 2015年第1期4卷 4-13页

作者： Terry mc Morris Beverley j.Hale Department of Sport and Exercise Science University of ChichesterCollege Lane

Purpose： The purpose of this study was to examine, using meta-analytic measures, the evidence regarding the optimal exercise intensity at which improvements in speed of cognitive function are triggered. Specifically, it was hypothesized that the catecholamine, lactate, and ventilatory thresholds is the point at which significant improvements in speed of cognitive function are observed. Methods： We compared mean effect sizes for threshold studies and for those studies where exercise intensity was classed as moderate （40%-- 79% VO2 or equivalent） but in which the thresholds were not measured. results： random effects meta-analysis showed significant, moderate, mean effect sizes for studies at the threshold （g = 0.58, Z = 2.98, p 〈 0.003） and for those during moderate intensity exercise but in which the threshold was not measured （ g = 0.54, Z = 5.0l, p 〈 0.001）. There was no significant difference between mean effect sizes, which suggests that the thresholds are unlikely to represent a trigger point. Conclusion： Moderate intensity exercise, even below the thresholds, can induce improved speed of cognition, possibly due to a combination of increased peripheral catecholamine concentrations inducing vagal/nucleus tractus solitarii pathway activation and central increases due to perceptions of stress.

关键词： Catecholamine threshold Lactate threshold Stress Vagus nerve Ventilatory threshold

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Factors associated with increased incidence of severe toxicities following yttrium-90 resin microspheres in the treatment of hepatic malignancies

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World journal of Gastroenterology 2016年第10期22卷 3006-3014页

作者： john D roberson II Andrew M mc Donald Craig j Baden Chee Paul Lin rojymon jacob Omer L Burnett III School of Medicine University of Alabama at Birmingham Birmingham AL 35294-3412 United States Department of radiation Oncology University of Alabama at Birmingham Birmingham AL 35233 United States Center for Clinical and Translational Science University of Alabama at Birmingham Birmingham AL 35205 United States

AIM: To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 (90Y) ***: Fifty-eight patients undergoing 79 treatments were retrospectively assessed for development of clinical and laboratory toxicity incidence following 90Y administration. Severe toxicity events were defined using Common Terminology Criteria for Adverse Events version 4.03 and defined as grade ≥ 3. Univariate logistic regression analyses were used to evaluate the effect of different factors on the incidence of severe toxicity events. Multicollinearity was assessed for all factors with P rson correlation matrices. All factors not excluded due to multicollinearity were included in a multivariate logistic regression model for each measurement of severe ***: Severe (grade ≥ 3) toxicities occurred following 21.5% of the 79 treatments included in our analysis. The most common severe laboratory toxicities were severe alkaline phosphatase (17.7%), albumin (12.7%), and total bilirubin (10.1%) toxicities. Decreased pre-treatment albumin (Or = 26.2, P = 0.010) and increased pre-treatment international normalized ratio (INr) (Or = 17.7, P = 0.048) were associated with development of severe hepatic toxicity. Increased pre-treatment aspartate aminotransferase (AST; Or = 7.4, P = 0.025) and decreased pre-treatment hemoglobin (Or = 12.5, P = 0.025) were associated with severe albumin toxicity. Increasing pre-treatment model for end-stage liver disease (MELD) score (Or = 1.8, P = 0.033) was associated with severe total bilirubin toxicity. Colorectal adenocarcinoma histology was associated with severe alkaline phosphatase toxicity (Or = 5.4, P = 0.043).CONCLUSION: Clinicians should carefully consider pre-treatment albumin, INr, AST, hemoglobin, MELD, and colorectal histology when choosing appropriate candidates for 90Y microsphere therapy.

关键词： Yttrium-90 microspheres Liver metastases Multivariate analysis Toxicity incidence Colorectal adenocarcinoma

Potential availability of non-woody biomass feedstock for pellet production within the republic of Ireland

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International journal of Agricultural and Biological Engineering 2010年第1期3卷 63-73页

作者： Anthony Nolan Kevin mc Donnell Ger j.Devlin john P.Carroll john Finnan Biosystems Engineering UCD School of AgricultureFood Science and Veterinary MedicineUniversity College DublinBelfieldDublin 4Ireland Teagasc Crops research Centre Oak ParkCarlowIreland

The threat of increasing fuel prices and climate change necessitates the need for clean,renewable and independent energy sources.A GIS(Geographical Information Systems)model was developed using ArcGIS 9.2 to analyze the availability of non-woody biomass(wheat,oat,barley and rape straw,willow and miscanthus)for pellet production in *** within the heating and electricity sector would displace currently used fossil fuels with cleaner,carbon neutral non-woody *** aim of the analysis was to determine the total hectares of biomass within Ireland and compute the potential non-woody biomass *** greatest potential source of biomass for pelleting is cereal *** the republic of Ireland the South-East,South-West and Mid-East of Ireland have the greatest biomass yield for pellet production and likely to be most economically ***-woody biomass has a realistic potential to displace fossil fuels within the heating and electricity sector resulting in CO2 mitigation.

关键词： biomass pellet production non-woody biomass GIS analysis renewable energy source CO2 mitigation

Soy-based renoprotection

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World journal of Nephrology 2016年第3期5卷 233-257页

作者： Nancy j mc Graw Elaine S Krul Elizabeth Grunz-Borgmann Alan r Parrish Global Nutrition Du Pont Nutrition and Health Department of Medical Pharmacology and Physiology School of Medicine University of Missouri

Chronic kidney disease （CKD） is a significant public health problem as risk factors such as advanced age, obesity, hypertension and diabetes rise in the global po-pulation. Currently there are no effective pharmacologic treatments for this disease. The role of diet is important for slowing the progression of CKD and managing symptoms in later stages of renal insuffciency. While low protein diets are generally recommended, maintaining adequate levels of intake is critical for health. There is an increasing appreciation that the source of protein may also be important. Soybean protein has been the most extensively studied plant-based protein in subjects with kidney disease and has demonstrated renal protective properties in a number of clinical studies. Soy protein consumption has been shown to slow the decline in estimated glomerular filtration rate and significantly improve proteinuria in diabetic and non-diabetic patients with nephropathy. Soy’s beneficial effects on renal function may also result from its impact on certain phy-siological risk factors for CKD such as dyslipidemia, hypertension and hyperglycemia. Soy intake is also associated with improvements in antioxidant status and systemic infammation in early and late stage CKD pati-ents. Studies conducted in animal models have helped to identify the underlying molecular mechanisms that may play a role in the positive effects of soy protein on renal parameters in polycystic kidney disease, metabolically-induced kidney dysfunction and age-associated prog-ressive nephropathy. Despite the established relationship between soy and renoprotection, further studies are needed for a clear understanding of the role of the cellular and molecular target（s） of soy protein in main-taining renal function.

关键词： Chronic kidney disease Diet Proteinuria Protein Soy

Socio-economic status and lifestyle factors are associated with achalasia risk: A population-based case-control study

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World journal of Gastroenterology 2016年第15期22卷 4002-4008页

作者： Helen G Coleman ronan T Gray Kar W Lau Conall mc Caughey Peter V Coyle Liam j Murray Brian T johnston Cancer Epidemiology and Health Services research Group Centre for Public Health Queen’s University Belfast regional Virus Laboratory Royal Victoria Hospital Belfast Department of Gastroenterology Royal Victoria HospitalBelfast

AIM: To evaluate the association between various lifestyle factors and achalasia ***: A population-based case-control study was conducted in Northern Ireland, including n = 151 achalasia cases and n = 117 age- and sexmatched controls. Lifestyle factors were assessed via a face-to-face structured interview. The association between achalasia and lifestyle factors was assessed by unconditional logistic regression, to produce odds ratios(Or) and 95% confidence interval(CI).rESULTS: Individuals who had low-class occupations were at the highest risk of achalasia(Or = 1.88, 95%CI: 1.02-3.45), inferring that high-class occupation holders have a reduced risk of achalasia. A history of foreign travel, a lifestyle factor linked to upper socioeconomic class, was also associated with a reduced risk of achalasia(Or = 0.59, 95%CI: 0.35-0.99). Smoking and alcohol consumption carried significantly reduced risks of achalasia, even after adjustment for socio-economic status. The presence of pets in the house was associated with a two-fold increased risk of achalasia(Or = 2.00, 95%CI: 1.17-3.42). Nochildhood household factors were associated with achalasia ***: Achalasia is a disease of inequality, and individuals from low socio-economic backgrounds are at highest risk. This does not appear to be due to corresponding alcohol and smoking behaviours. An observed positive association between pet ownership and achalasia risk suggests an interaction between endotoxin and viral infection exposure in achalasia aetiology.

关键词： Achalasia risk factors Epidemiology Lifestyle Socio-economic status