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Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review

World Journal of Gastroenterology 2019年第24期25卷 3079-3090页

作者： Amanda D Deacy Craig A Friesen vincent S Staggs jennifer v schurman Division of Gastroenterology Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States Division of Developmental and Behavioral Sciences Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States Biostatistics and Epidemiology Health Services and Outcomes ResearchChildren’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States

BACKGROUND Pediatric functional gastrointestinal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom ***,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIDs remains *** current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom *** To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical *** Participants were 392 children,ages 8-18[M=13.8;standard deviation(SD)=2.7],seen between August 1,2013 and June 15,2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's *** be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial *** and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational *** regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower *** Nearly 70%of patients followed during the study period achieved resolution on at least one of the employed outcome *** those who achieved resolution during follow up,43%to 49%did so by the first follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of *** specifically,the odds of clinical resolution w

关键词： Pediatric functional gastrointestinal disorders Integrated care Behavioral health consultation Treatment outcomes Abdominal pain clinic

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Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第1期7卷 156-161页

作者： Katherine Zybach Craig A Friesen jennifer v schurman Division of Gastroen- terology Hepatology and Nutrition Children’s Mercy Kansas City Division of Developmental and Beha- vioral Sciences Children’s Mercy Kansas City

AIM: To study the effectiveness of melatonin vs placebo in children with functional dyspepsia(FD).METHODS: The study was conducted as a double blind, randomized, placebo controlled crossover trial. Subjects were aged 8-17 years and diagnosed with FD based on Rome Ⅲ criteria. All subjects had failed to respond to 4 wk of acid suppression. Subjects receive a continuous two weeks of placebo and a continuous two weeks of melatonin in an order blinded to the participant and the study team. A Global Clinical Score was obtained to assess changes in abdominal pain. Pain was self-reported to be worse(grade 1), no change(grade 2), moderate improvement(grade 3), good(grade 4; minimal pain and not interfering with daily activities), or excellent(grade 5; no pain), respectively. A positive clinical response was defined as a grade 3 or greater response. Subjects wore an actigraph to assess sleep during a one week baseline period and during each treatment period. Subjects' sleep latency and total sleep time were recorded throughout the duration of the study. RESULTS: Fourteen subjects were enrolled and 12 completed the study. One withdrew prior to starting both melatonin and placebo and the other before starting melatonin. A positive clinical response(grade 3-5) was achieved in 42% of subjects on melatonin vs 50% of subjects on placebo(NS). Effect size was calculated and revealed a Cohen's D of 0.343 which demonstrates a medium effect favoring placebo. A grade 4 or grade 5 response was seen in 4 patients on melatonin and 5 patients on placebo. Baseline sleep parameters were in the healthy range with the longest sleep latency being just over 20 min(mean 7.46 ± 8.53 min) and the shortest sleep duration just over 7 h(mean 10.09 ± 2.72 h). The mean latency did not differ between periods of treatment with melatonin as compared to placebo(4.48 ± 6.45 min vs 3.58 ± 4.24 min; NS). The mean sleep duration did not differ between periods of treatment with melatonin as compared to placebo(9.9

关键词： Melatonin Abdominal pain Functional dyspepsia Sleep latency Sleep duration Actigraphy

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Present state and future challenges in pediatric abdominal pain therapeutics research: Looking beyond the forest

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 96-104页

作者： Craig A Friesen jennifer v schurman Susan M Abdel-Rahman Division of Gastroenterology Hepatology and Nutrition Children’s Mercy Kansas City Division of Developmental and Behavioral Sciences Children’s Mercy Kansas City Division of Pediatric Pharmacology Medical Toxicology and Therapeutic Innovation Children’s Mercy Kansas City

At the present time, it is nearly impossible to treat pediatric functional gastrointestinal disorders associated with pain in an evidence based fashion. This is due to the overall lack of controlled studies and, even more importantly, the complexity of the contributors to disease phenotype which are not controlled or accounted for in most therapeutic trials. In this manuscript, we review the challenges of defining entry criteria, controlling for the large number of biopsychosocial factors which may effect outcomes, and understanding pharmacokinetic and pharmacodynamic factors when designing therapeutic trials for abdominal pain in children. We also review the current state of pediatric abdominal pain therapeutics and discuss trial design considerations as we move forward.

关键词： Pharmacogenomics Functional dyspepsia Abdominal pa

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Eosinophils and mast cells as therapeutic targets in pediatric functional dyspepsia

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第4期4卷 86-96页

作者： Craig A Friesen jennifer v schurman jennifer M Colombo Susan M Abdel-Rahman Division of Gastroenterology Hepatology and Nutritionthe Children’s Mercy Hospital and Clinics Division of Developmental and Behavioral Sciences the Children’s Mercy Hospital and Clinics Division of Pediatric Pharmacology and Medical Toxicology the Children’s Mercy Hospital and Clinics

There is an increasing appreciation for the importance of inflammation as a pathophysiologic entity that contributes to functional gastrointestinal disorders including functional dyspepsia(FD).Importantly,inflammation may serve as a mediator between psychologic and physiologic *** manuscript reviews the literature implicating two inflammatory cell types,mast cells and eosinophils,in the generation of dyspeptic symptoms and explores their potential as targets for the treatment of *** are a number of inciting events which may initiate an inflammatory response,and the subsequent recruitment and activation of mast cells and *** include internal triggers such as stress and anxiety,as well as external triggers such as microbes and *** studies suggest that there may be efficacy in utilizing medications directed at mast cells and *** exists to suggest that combining "anti-inflammatory" medications with other treatments targeting stress can improve the rate of symptom resolution in pediatric FD.

关键词： Eosinophils Mast cells Functional dyspepsia Abdominal pain Stress

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visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第3期5卷 122-138页

作者： John M Rosen Jose T Cocjin jennifer v schurman jennifer M Colombo Craig A Friesen Division of Gastroenterology Hepatology and Nutrition Children’s Mercy Kansas CityKansas CityMO 64108United States

Functional gastrointestinal disorders(FGID) are common clinical syndromes diagnosed in the absence of biochemical,structural,or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age,geography,and culture. Etiology of abdominal pain associated FGIDs,including functional dyspepsia(FD),remains incompletely understood,but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD,with focus on pediatric data when available,and provides a summary of potential therapeutic targets.

关键词： Motility visceral hypersensitivity Functional dyspepsia

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validation of methods to assess potential biomarkers in pediatric patients with esophageal eosinophilia

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第4期4卷 113-119页

作者： jennifer M Colombo Nancy A Neilan jennifer verrill schurman Craig A Friesen Divisions of Gastroenterology Children’s Mercy Hospital and ClinicsUniversity of Missouri at Kansas City School of Medicine Developmental and Behavioral Sciences Children’s Mercy Hospital and ClinicsUniversity of Missouri at Kansas City School of Medicine

AIM:To validate methods for determining mast cell density,extracellular major basic protein content,and presence of fibrosis in esophageal ***:Twenty specimens with > 20 eosinophils/high-power field(hpf) classified as high eosinophil density(HE) and 20 specimens with valuated by two separate observers and by a single observer on two separate occasions to evaluate reproducibility of the ***:A strong inter-observer correlation was noted for both peak and mean mast cell counts(r = 0.725,P ver correlation also was noted for both peak and mean mast cell counts(r = 0.752,P very strong inter-observer correlation was noted for both peak(τ = 0.867,P very strong intra-observer correlation was noted for both peak(τ = 0.875;P vs *** HE group had significantly higher intraepithelial mast cell peak(29.35 ± 21.61 vs 12.45 ± 8.26,P =0.002) and mean(19.84 ± 15.81 vs 6.35 ± 4.5,P =0.001) densities than the LE *** HE group had significantly higher peak extracellular MBP(2.35 ± 0.67vs 0.45 ± 0.61,P vs 0.20 ± 0.29,P < 0.0001) densities than the LE ***-three percent of patients with HE(11/15) had fibrosis,whereas only 10% of patients with LE(1/10) had fibrosis(P < 0.01).MBP performed the best in pr

关键词： Eosinophilia Immunohistochemical staining Tryptase Major basic protein Subepithelial fibrosis

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Isolation and assessment of gut bacteria from the Formosan subterranean termite, Coptotermes formosanus （Isoptera： Rhinotermitidae）, for paratransgenesis research and application

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Insect Science 2017年第1期24卷 93-102页

作者： Chinmay v. Tikhe Amit Sethi jennifer Delatte Claudia Husseneder Department of Entomology Louisiana State University Agricultural Center Baton Rouge LA 70803 DuPont-Pioneer Johnston IA 50131-0552 USA

Paratransgenesis targeting the gut protozoa is being developed as an alternative method for the control of the Formosan subterranean termite （FST）. This method involves killing the cellulose-digesting gut protozoa using a previously developed antiprotozoal peptide consisting of a target specific ligand coupled to an antimicrobial peptide （Hecate）. In the future, we intend to genetically engineer termite gut bacteria as ＂Trojan Horses＂ to express and spread ligand-Hecate in the termite colony. The aim of this study was to assess the usefulness of bacteria strains isolated from the gut of F ST as ＂Trojan Horses.＂ We isolated 135 bacteria from the guts of workers from 3 termite colonies. Sequencing of the 16S rRNA gene identified 20 species. We tested 5 bacteria species that were previously described as part of the termite gut community for their tolerance against Hecate and ligand- Hecate. Results showed that the minimum concentration required to inhibit bacteria growth was always higher than the concentration required to kill the gut protozoa. Out of the 5 bacteria tested, we engineered Trabulsiella odontotermitis, a termite specific bacterium, to express green fluorescent protein as a proof of concept that the bacteria can be engineered to express foreign proteins. Engineered T. odontotermitis was fed to FST to study if the bacteria are ingested. This feeding experiment confirmed that engineered T. odontotermitis is ingested by termites and can survive in the gut for at least 48 h. Here we report that T. odontotermitis is a suitable delivery and expression system for paratransgenesis in a termite species.

关键词： bacteria gut insect paratransgenesis

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Turbulent burst around experimental spur dike

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International Journal of Sediment Research 2011年第4期26卷 471-486+523页

作者： jennifer DUAN Department of Civil Engineering and Engineering Mechanics University of Arizona

Three-dimensional turbulent flow field was measured around an experimental spur dike by using a micro-acoustic Doppler *** fractions of turbulent burst events including outward interaction,ejection,inward interaction,and sweep were analyzed in each quadrant at the neighbor of the dike before and after the formation of scour *** 80%of burst events near the bed have lower-order of magnitudes for both flat and scoured bed *** and sweeps are prevalent before the local scour was initiated,and then outward interactions are dominant after the scour hole was *** Reynolds stresses and high-order moments of turbulent velocities were analyzed along the *** magnitudes of u’-w’ pair were much larger than those of v’-vv’ pair in the scour *** four burst events,ejections and sweeps are the higher order events contributing to the Reynolds *** sediment entrainment and transport are closely associated with turbulent bursts near bed,the development of scour hole greatly depends on the higher order event near the bed.

关键词： Turbulent burst Spur dike Quadrant analysis High-order momentums

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Endoscopic treatment of Barrett's esophagus:From metaplasia to intramucosal carcinoma

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World Journal of Gastroenterology 2010年第30期16卷 3780-3785页

作者： jennifer Chennat Irving Waxman Center for Endoscopic Research and Therapeutics Section of GastroenterologyDepartment of MedicineUniversity of Chicago Pritzker School of MedicineChicagoIL 60637United States

The annual incidence of adenocarcinoma arising from Barrett’s esophagus (BE) is approximately 0.5%. Through a process of gradual transformation from lowgrade dysplasia to high-grade dysplasia (HGD), adenocarcinoma can develop in the setting of BE. The clinical importance of appropriate identifi cation and treatment of BE in its various stages, from intestinal metaplasia to intramucosal carcinoma (IMC) hinges on the dramatically different prognostic status between early neoplasia and more advanced stages. Once a patient has symptoms of adenocarcinoma, there is usually locally advanced disease with an approximate 5-year survival rate of about 20%. Esophagectomy has been the gold standard treatment for BE with HGD, due to the suspected risk of harboring occult invasive carcinoma, which was traditionally estimated to be as high as 40%. In recent years, the paradigm of BE early neoplasia management has recently evolved, and endoscopic therapies (endoscopic mucosal resection, radiofrequency ablation, and cryotherapy) have entered the clinical forefront as acceptable non-surgical alternatives for HGD and IMC. The goal of endoscopic therapy for HGD or IMC is to ablateall BE epithelium (both dysplastic and non-dysplastic) due to risk of synchronous/metachronous lesion development in the remaining BE segment.

关键词： Barrett’s esophagus High-grade dysplasia Intramucosal carcinoma Esophagectomy Endoscopic mucosal resection Radiofrequency ablation Cryotherapy

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Diverticulitis is a population health problem:Lessons and gaps in strategies to implement and improve contemporary care

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1007-1019页

作者： Stephanie Lee Stovall jennifer A Kaplan Joanna K Law David R Flum vlad v Simianu Department of Surgery Virginia Mason Franciscan HealthSeattleWA 98101United States Department of Gastroenterology Virginia Mason Franciscan HealthSeattleWA 98101United States Department of Surgery University of Washington MedicalSeattleWA 98195United States

The disease burden of diverticulitis is high across inpatient and outpatient settings,and the prevalence of diverticulitis has ***,patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few *** recent studies have challenged the standards of how acute and recurrent diverticulitis are managed,and many clinical practice guidelines(CPGs)have pivoted to recommend outpatient management and individualized decisions about *** the rates of diverticulitis hospitalizations and operations are increasing in the United States,suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular *** this review,we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.

关键词： Diverticulitis Hospitalization Elective Emergent surgery Clinical guidelines Diverticular disease

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