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Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

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Liver Research 2019年第2期3卷 106-117页

作者： Brian M.Fung james h.tabibian University of California Los Angeles-Olive View Internal Medicine Residency Program SylmarCAUSA Division of Gastroenterology Department of MedicineOlive View-University of California Los Angeles Medical CenterSylmarCAUSA

Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile *** can affect individuals of all age groups and gender,has no established pharmacotherapy,and is associated with a variety of neoplastic(***)and non-neoplastic(*** strictures)hepatobiliary *** these considerations,endoscopy plays a major role in the care of patients with *** this review,we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of *** evidence is limited,we suggest pragmatic approaches based on currently available data and expert opinion.

关键词： Primary sclerosing cholangitis(PSC) Biliary tract disease Balloon dilation Cholangioscopy Dominant stricture Cholangiocarcinoma(CCA) Endoscopic retrograde cholangiopancreatography(ERCP)

hemobilia: Etiology, diagnosis, and treatment

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Liver Research 2018年第4期2卷 200-208页

作者： Rani Berry james han Ani A.Kardashian Nicholas F.LaRusso james h.tabibian Department of Internal Medicine UCLA Ronald Reagan Medical CenterLos AngelesCAUSA Department of Internal Medicine University of California IrvineIrvineCAUSA UCLA Gastroenterology Fellowship Training Program Vatche and Tamar ManoukianDivision of Digestive DiseasesLos AngelesCAUSA Division of Gastroenterology and hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA

hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal *** of hemobilia date back to the 1600s,but due to its relative rarity and challenges in diagnosis,only in recent decades has hemobilia been more critically *** majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver,pancreas,bile ducts and/or the hepatopancreatobiliary vasculature,with trauma and malignancy rep-resenting the two other leading causes.A classic triad of right upper quadrant pain,jaundice,and overt upper gastrointestinal bleeding has been described(***'s triad),but this is present in only 25%e30%of patients with ***,prompt diagnosis depends critically on having a high index of suspicion,which may be based on a patient's clinical presentation and having recently undergone(peri-)biliary instrumentation or other predisposing *** treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic,interventional radiologic,or surgical *** we provide a clinical overview and update regarding the eti-ology,diagnosis,and treatment of hemobilia geared for specialists and subspecialists alike.

关键词： hemobilia Upper gastrointestinal hemmorhage Etiology Diagnosis Imaging hepatopancreatobiliary interventions

Preventative care in cholestatic liver disease: Pearls for the specialist and subspecialist

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Liver Research 2019年第2期3卷 118-127页

作者： Adnan Malik Ani A.Kardashian Kais Zakharia Christopher L.Bowlus james h.tabibian Department of Public health and Business Administration The University of Alabama at BirminghamBirminghamALUSA Department of Internal Medicine Beaumont HospitalDearbornMIUSA University of California Los Angeles Gastroenterology Fellowship Training Program Vatche and Tamar Manoukian Division of Digestive DiseasesLos AngelesCAUSA Division of Gastroenterology and hepatology University of IowaIowaIAUSA Division of Gastroenterology and hepatology University of California DavisSacramentoCAUSA Division of Gastroenterology Department of MedicineOlive View-University of California Los Angeles Medical CenterSylmarCAUSA

Cholestatic liver diseases(CLDs)encompass a variety of disorders of abnormal bile formation and/or *** often lead to progressive hepatic insult and injury and following the development of cirrhosis and associated *** such complications are clinically silent until they manifest with severe sequelae,including but not limited to life-altering symptoms,metabolic disturbances,cirrhosis,and hepatobiliary diseases as well as other *** sclerosing cholangitis(PSC)and primary biliary cholangitis(PBC)are the most common CLDs,and both relate to mutual as well as unique *** review provides an overview of PSC and PBC,with a focus on preventive measures aimed to reduce the incidence and severity of disease-related complications.

关键词： Biliary tract diseases Primary sclerosing cholangitis(PSC) Primary biliary cholangitis(PBC) Cirrhosis Inflammatory bowel disease(IBD) Metabolic bone disease Pruritus Prophylaxis

Incidence, mortality, and risk factors of immunotherapy-associated hepatotoxicity: A nationwide hospitalization analysis

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Liver Research 2021年第1期5卷 28-32页

作者： Simcha Weissman Saad Saleem Sachit Sharma Menashe Krupka Faisal Inayat Muhammad Aziz james h.tabibian Department of Medicine Hackensack Meridian Health Palisades Medical CenterNorth BergenNJUSA Department of Medicine Sunrise Hospital and Medical CenterLas VegasNVUSA Department of Medicine University of Toledo Medical CenterToledoOHUSA Department of Medicine Westchester Medical CenterValhallaNYUSA Department of Medicine Allama Iqbal Medical CollegeLahorePakistan Division of Gastroenterology and hepatology University of Toledo Medical CenterToledoOHUSA Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA David Geffen School of Medicine at UCLA Los AngelesCAUSA

Background and aims Anti-neoplastic immunotherapy has revolutionized cancer management;however,its safety profile with respect to liver-related injury remains largely ***,we analyzed a United States national database to determine the incidence,mortality,and predictors of hepatotoxicity in the setting of anti-neoplastic *** This was a nationwide retrospective study of hospital encounters from 2011 to 2014 using the National Inpatient Sample(NIS)*** utilized the International Classification of Diseases,Ninth Revision(ICD-9)coding system to identify all adult patients who underwent anti-neoplastic immunotherapy during *** primary outcome was the incidence of hepatotoxicity during the same *** outcomes included in-hospital mortality as well as socioeconomic and ethno-racial predictors of *** were performed using IBM SPSS Statistics *** The sample included 3002 patients who underwent inpatient anti-neoplastic *** incidence of hepatotoxicity was 10.1%,which was significantly higher as compared to a matched inpatient population(adjusted odds ratio(aOR)4.93,95%confidence interval(CI):3.80–6.40,P=0.001).No significant mortality difference was seen in those that developed hepatotoxicity compared to those who did not(aOR 0.47,95%CI:0.03–8.03,P=0.612).Age under 60(aOR 1.56,95%CI:1.23–1.78,P=0.050)and white race(aOR 1.85,95%CI:1.35–2.04,Pherapy-associated *** In this large,nationwide database analysis,we found that anti-neoplastic immunotherapy was associated with a nearly five-fold risk of in-hospital hepatotoxicity as compared to a matched inpatient population,though without an associated mortality ***,younger age and white race were identified as predictors of immunotherapy-associated *** vigilance and prospective investigation of the

关键词： hepatotoxicity Tumor immunotherapy Liver enzymes Outcomes Risk factors Mortality

Machine learning models compared to existing criteria for noninvasive prediction of endoscopic retrograde cholangiopancreatography-confirmed choledocholithiasis

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Liver Research 2021年第4期5卷 224-231页

作者： Camellia Dalai John M Azizian harry Trieu Anand Rajan Formosa C Chen Tien Dong Simon W Beaven james h.tabibian UCLA-Olive View Internal Medicine Residency Program Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA Keck School of Medicine University of Southern CaliforniaLos AngelesCAUSA Department of Surgery David Geffen School of Medicine at UCLALos AngelesCAUSA Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLALos AngelesCAUSA Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA

Background and aims:Noninvasive predictors of choledocholithiasis have generally exhibited marginal performance *** aimed to identify noninvasive independent predictors of endoscopic retrograde cholangiopancreatography(ERCP)-confirmed choledocholithiasis and accordingly developed predictive machine learning models(MLMs).Methods:Clinical data of consecutive patients undergoing first-ever ERCP for suspected chol-edocholithiasis from 2015 to 2019 were abstracted from a prospectively-maintained *** logistic regression was used to identify predictors of ERCP-confirmed *** were then trained to predict ERCP-confirmed choledocholithiasis using pre-ERCP ultrasound(US)imaging only as well as using all available noninvasive imaging(US,computed tomography,and/or magnetic reso-nance cholangiopancreatography).The diagnostic performance of American Society for Gastrointestinal Endoscopy(ASGE)“high-likelihood”criteria was compared to ***:We identified 270 patients(mean age 46 years,62.2%female,73.7%hispanic/Latino,59%with noninvasive imaging positive for choledocholithiasis)with native papilla who underwent ERCP for suspected choledocholithiasis,of whom 230(85.2%)were found to have ERCP-confirmed *** regression identified choledocholithiasis on noninvasive imaging(odds ratio(OR)¼3.045,P¼0.004)and common bile duct(CBD)diameter on noninvasive imaging(OR¼1.157,P¼0.011)as predictors of ERCP-confirmed *** the various MLMs trained,the random forest-based MLM performed best;sensitivity was 61.4%and 77.3%and specificity was 100%and 75.0%,using US-only and using all available imaging,*** high-likelihood criteria demonstrated sensitivity of 90.9%and specificity of 25.0%;using cut-points achieving this specificity,MLMs achieved sensitivity up to 97.7%.Conclusions:MLMs using age,sex,race/ethnicity,presence of diabetes,fever,body mass index(BMI),total bilirubin,maximum CBD di

关键词： Machine learning models(MLMs) Endoscopic retrograde cholangiopancreatography(ERCP) Noninvasive imaging Bile duct disorders Common bile duct stones Gallstones

Analysis of the Oscillatory Flows of Multiple Shock Waves in a Constant Area Duct

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Journal of Thermal Science 2024年第3期33卷 794-806页

作者： K james Jintu KIM heuy Dong Department of Mechanical Engineering Andong National UniversityAndong36729Republic of Korea CAD-IT Korea Co. Ltd.Seoul08591Republic of Korea

The oscillatory response of multiple shock waves to downstream perturbations in a supersonic flow is studied numerically in a rectangular *** shock waves are formed inside the duct at a shock Mach number of *** duct has an exit height of h,and the effect of duct resonance on multiple shock oscillations is investigated by attaching exit ducts of lengths 0h,50h,and *** downstream disturbance frequency varied from 10 hz to 200 hz to explore the oscillation characteristics of the multiple shock *** oscillatory response of shock waves under self-excited and forced oscillation conditions are analyzed in terms of wall static pressure,shock train leading-edge location,shock train length,and the size of the separation *** extent of the initial shock location increases with an increase in exit duct length for the self-excited oscillation *** analysis of the shock train leading edge and the spectral analysis of wall static pressure variations are *** variation in the shock train length is analyzed using the pressure ratio method for self-excited as well as forced *** RMS amplitude of the normalized shock train length(ζ_(ST))increases with an increase in the exit duct length for the self-excited oscillation *** the downstream perturbation frequency is increased,ζ_(ST)is decreased for exit duct *** all exit duct designs and downstream forcing frequencies,the size of the separation bubble grows and shrinks during the shock oscillations,demonstrating the dependence on duct resonance and forced oscillations.

关键词： shock train downstream disturbance supersonic flow shock wave boundary layer interaction duct resonance flow separation

Cancer risk in primary sclerosing cholangitis: Epidemiology,prevention, and surveillance strategies

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World Journal of Gastroenterology 2019年第6期25卷 659-671页

作者： Brian M Fung Keith D Lindor james h.tabibian UCLA-Olive View Internal Medicine Residency Program Olive View-UCLA Medical Center Office of the University Provost Arizona State University Division of Gastroenterology Department of MedicineOlive View-UCLA Medical Center

Primary sclerosing cholangitis(PSC) is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intra-and/or extrahepatic biliary ducts. While its features and disease course can be variable,most patients with PSC have concurrent inflammatory bowel disease and will eventually develop liver cirrhosis and end-stage liver disease, with liver transplantation representing the only potentially curative option. Importantly,PSC is associated with a significantly increased risk of malignancy compared to the general population, mainly cholangiocarcinoma, gallbladder carcinoma,hepatocellular carcinoma, and colorectal cancer, with nearly 50% of deaths in patients with PSC being due to cancer. Therefore, robust surveillance strategies are needed, though uncertainty remains regarding how to best do so. In this review, we discuss the epidemiology, prevention, and surveillance of cancers in patients with PSC. Where evidence is limited, we present pragmatic approaches based on currently available data and expert opinion.

关键词： Bile duct diseases Cholangiocarcinoma Gallbladder carcinoma hepatocellular carcinoma Colorectal cancer Chemoprotection Inflammatory bowel disease

New Opportunities for Neutrons in Environmental and Biological Sciences

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Frontiers of Environmental Science & Engineering 2024年第7期18卷 179-186页

作者： Alexander Johs Shuo Qian Leighton Coates Brian h.Davison james G.Elkins Xin Gu Jennifer Morrell-Falvey hugh O'Neill Jeffrey M.Warren Eric M.Pierce Kenneth herwig Oak Ridge National Laboratory Oak RidgeTN37831USA

The use of neutron methods in environmental and biological sciences is rapidly emerging and accelerating with the development of new instruments at neutron user *** article,based on a workshop held at Oak Ridge National Laboratory(ORNL),offers insights into the application of neutron techniques in environmental and biological *** highlight recent advances and identify key challenges and potential future research *** include soil and rhizosphere processes,root water dynamics,plant-microbe interactions,structure and dynamics of biological systems,applications in synthetic biology and enzyme engineering,next-generation bioproducts,biomaterials and bioenergy,nanoscale structure,and fluid dynamics of porous materials in *** provide an outlook on emerging opportunities with an emphasis on new capabilities that will be enabled at the Spallation Neutron Source Second Target Station currently under design at *** mission of scientific neutron user facilities worldwide is to enable science using state-of-the-art neutron *** aim to encourage researchers in the environmental and biological research community to explore the unique capability afforded by neutrons at these facilities.

关键词： Neutrons Environment Biology Neutron imaging Neutron scattering Second Target Station(STS)

Synthesis of carbon nitride in potassium hydroxide molten salt for efficient uranium extraction from radioactive wastewater

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Frontiers of Environmental Science & Engineering 2024年第8期18卷 89-99页

作者： Shuang Liu Junhan Luo Daniel-james Maguire Liyuan Zheng Zhe Wang Yuexiang Lu Institute of Nuclear and New Energy Technology Tsinghua UniversityBeijing 100084China Nuclear Research Institute for Future Technology and Policy Seoul National UniversitySeoul 08826Republic of Korea Department of Earth Sciences University of CambridgeCambridge CB23EQUK The MOE Key Laboratory of Resources and Environmental System Optimization College of Environmental Science and EngineeringNorth China Electric Power UniversityBeijing 102206China

Photocatalysis-assisted removal of uranium has been proven as an effective method for the elimination of radioactive pollution from *** this work,carbon nitride materials were synthesized in potassium hydroxide(KOh)molten salt and applied to photocatalytic uranyl *** materials were confirmed to possess the triazine-s-heptazine structure by NMR,XPS and UV-Vis characterization,and exhibited a wider visible light absorption than graphitic carbon nitride(g-C_(3)N_(4)).The photocatalytic activity of the carbon nitride materials was tailored by varying the precursor mass *** carbon nitride obtained at 80%melamine as precursor(K-CN-80)exhibited the highest photocatalytic extraction ability and its photocatalytic reaction rate is 6.6 times faster than that of g-C_(3)N_(4).The influence of sacrificial agents was studied and the results showed that triethanolamine inhibited U(Ⅵ)photoreduction,but methanol can accelerate U(Ⅵ)photoreduction by consuming photogenerated *** unary KOh molten salt synthesis method has exceptional potential applications in the preparation of carbon nitrides,and the obtained products showed potential in extracting U(Ⅵ)from aqueous solutions for use in nuclear fuel industry and for U(Ⅵ)environmental pollution cleanup.

关键词： Uranium Carbon nitride Molten salt Photocatalysis Radioactive wastewater