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Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review

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World Journal of Gastrointestinal Endoscopy 2022年第7期14卷 416-423页

作者： Mohammad Azam Amit Hudgi Pearl Princess Uy Jinal Makhija john erikson l yap Department of Internal Medicine Medical College of Georgia/Augusta UniversityAugustaGA 30912United States Division of Gastroenterology Medical College of Georgia/Augusta UniversityAugustaGA 30912United States Department of Internal Medicine Rush University Medical CenterChicagoIL 60612United States

BACKGROUND Antiangiogenic agents(AAs)are increasingly used to treat malignant tumors and have been associated with gastrointestinal(GI)bleeding and perforation.Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment.Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited.No guidelines are in place to address the concern about withholding these anti-angiogenic drugs.AIM To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution.METHODS This is a single centered retrospective study approved by the institutional review board statement of the institution.Patients that underwent endoscopy within 28 d of antiangiogenic agents’treatment were included in the study.Primary outcome of interest was death,and secondary outcomes included perforation and GI bleeding.Data were analyzed utilizing descriptive statistics.Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk.RESUlTS Among the 59 patients a total of 85 endoscopic procedures were performed with 24(28.2%)categorized as high-risk and 61(71.8%)procedures as low-risk.Of the total number of patients,(50%)were on bevacizumab and the rest were on imatinib(11.7%),lenvatinib(6.7%)and,ramucirumab(5%).The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d.No procedure-related adverse events were noted among our study population.We did observe two deaths with one patient,on lenvatinib for metastatic hepatocellular carcinoma,who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock.Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.CONClUSION As per this single center retrospective study,the rate of endoscopic procedure-related adverse events and death within

关键词： Antiangiogenics Endoscopy Bevacizumab lmatinib lenvatinib Adverse events

Safety of upper endoscopy in patients with active cocaine use

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 510-517页

作者： Anabel liyen Cartelle Alexander Nguyen Parth M Desai Vikram Kotwal Jinal Makhija Jie Yu john erikson l yap Department of Medicine Beth Israel Deaconess HospitalBostonMA 02215United States Division of Gastroenterology and Hepatology John H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States Internal Medicine John H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States Division of Digestive Diseases Rush UniversityChicagoIL 60612United States Division of Infectious Diseases Rush UniversityChicagoIL 60612United States Division of Gastroenterology and Hepatology Augusta UniversityAugustaGA 30912United States

BACKGROUND Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic,but which eventually fell out of favor given its high addiction potential.Its predominantly sympathetic effects raise concern for cardiovascular,respiratory,and central nervous system complications in patients undergoing procedures.Periprocedural cocaine use,often detected via a positive urine toxicology test,has been mostly addressed in the surgical and obstetrical literature.However,there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting,often leading to costly procedure cancellations.Within the field of gastroenterology,there is no current data available regarding safety of performing esophagogastroduodenoscopy(EGD)in patients with recent cocaine use.AIM To compare the prevalence of EGD related complications between active(≤5 d)and remote(>5 d)users of cocaine.METHODS In total,48 patients who underwent an EGD at john H.Stroger,Jr.Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine(23 recent and 25 remote).Descriptive statistics were compiled for patient demographics.Statistical tests used to analyze patient characteristics,procedure details,and preprocedural adverse events included ttest,chi-square,Wilcoxon rank sum,and Fisher exact test.RESUlTS Overall,20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups(12 active vs 8 remote,P=0.09).Pre-and post-procedure hemodynamics demonstrated only a statistically,but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group,as well as drop in diastolic blood pressure and oxygen saturation in the remote group(Pll hemodynamics between both groups.CONClUSION Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients wi

关键词： Gastrointestinal endoscopy Cocaine-related disorders General anesthesia Risk factors local anesthetics Retrospective studies

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0.9%盐水既不正常也不生理（英文）

Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2016年第3期17卷 181-187页

作者： Heng lI Shi-ren SUN john Q.yap Jiang-hua CHEN Qi QIAN Kidney Disease Center the First Affiliated HospitalSchool of MedicineZhejiang University Division of Nephrology Xijing HospitalFourth Military University College of Medicine Department of Physiology and Biomedical Engineering Mayo Clinic College of Medicine Division of Nephrology and Hypertension Department of MedicineMayo Clinic College of Medicine

本文旨在客观评价0.9%氯化钠溶液(盐水)的生物化学和病理生理学特性,并深入探讨静脉输注该盐水对机体酸碱平衡和肾脏血流动力学的影响。研究表明多数临床医生对电解质平衡的认识有限,对静脉输注盐水所引起的血浆电解质变化认识不足。而... 详细信息

本文旨在客观评价0.9%氯化钠溶液(盐水)的生物化学和病理生理学特性,并深入探讨静脉输注该盐水对机体酸碱平衡和肾脏血流动力学的影响。研究表明多数临床医生对电解质平衡的认识有限,对静脉输注盐水所引起的血浆电解质变化认识不足。而错误地应用盐水会增加患者的患病率和死亡率。健康成人大剂量(>2l)输注盐水会导致高氯血症并进而引起代谢性酸中毒、高钾血症和负氮平衡。总之,盐水是一种高度酸化的液体,用于治疗呕吐或上消化道减压引起的低氯性代谢性碱中毒和容量不足较为合适。临床上不加区分地应用盐水对患者特别是对重症患者可能导致不必要的并发症,应注意避免。临床医生对于盐水相关作用和电解质管理的认识亟需增强。

关键词： 0.9%氯化钠溶液(盐水) 高氯血症:酸中毒高钾血症平衡液肾脏血流动力学

Interaction between age and gender on survival outcomes in extramedullary multiple myeloma over the past two decades

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World Journal of Clinical Oncology 2023年第4期14卷 179-189页

作者： Ayrton I Bangolo Pierre Fwelo Chinmay Trivedi Sowmya Sagireddy Hamed Aljanaahi Auda Auda Maryama Mohamed Sonia Onyeka Miriam Fisher Jyoti Thapa Erwin J Tabucanon lyuben Georgiev Annetta Wishart Shilpee Kumari Conrad erikson Mary Bangura Orent Paddy Rashmi Madhukar Eugenio l Gomez Joshua Rathod Mansi Naria Basel Hajal Mohammad Awadhalla David Siegel Harsh Parmar Noa Biran David H Vesole Pooja Phull Simcha Weissman Department of Medicine Palisades Medical CenterNorth BergenNJ 07047United States Department of Epidemiology Human Geneticsand Environmental SciencesUTHealth School of Public HealthHoustonTX 77204United States Division of Myeloma John Theurer Cancer CenterHackensackNJ 07601United States

BACKGROUND Extramedullary multiple myeloma(MM)(EMM)is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course.There is a paucity of data on the clinical characteristics and overall epidemiology of EMM.Furthermore,there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.AIM To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.METHODS A total of 858 patients diagnosed with EMM,between 2000 and 2017,were ultimately enrolled in our study by retrieving the Surveillance,Epidemiology,and End Results database.We analyzed demographics,clinical characteristics,and overall mortality(OM)as well as cancer-specific mortality(CSM)of EMM.Variables with a P valueltivariate Cox model to determine the independent prognostic factors,with a hazard ratio(HR)of greater than 1 representing adverse prognostic factors.RESUlTS From a sample of 858 EMM,the male gender(63.25%),age range 60-79 years(51.05%),and non-Hispanic whites(66.78%)were the most represented.Central Nervous System and the vertebral column was the most affected site(33.10%).Crude analysis revealed higher OM in the age group 80+[HR=6.951,95%confidence interval(95%CI):3.299-14.647,P=0],Non-Hispanic Black population(HR=1.339,95%CI:1.02-1.759,P=0.036),Bones not otherwise specified(NOS)(HR=1.74,95%CI:1.043-2.902,P=0.034),and widowed individuals(HR=2.107,95%CI:1.511-2.938,P=0).Skin involvement(HR=0.241,95%CI:0.06-0.974,P=0.046)and a yearly income of$75000+(HR=0.259,95%CI:0.125-0.538,P=0)had the lowest OM in the crude analysis.Crude analysis revealed higher CSM in the age group 80+,Non-Hispanic Black,Bones NOS,and widowed.Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+(HR=9.792,95%CI:4.403-21.774,P=0)and widowed individuals(HR=1.609,95%CI:1.101-2.3

关键词： Multiple myeloma Age Gender Mortality Plasmacytoma

The molecular conformation of silk fibroin regulates osteogenic cell behavior by modulating the stability of the adsorbed protein-material interface

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Bone Research 2021年第2期9卷 188-199页

作者： Yanlin long Xian Cheng john A.Jansen Sander G.C.leeuwenburgh Jing Mao Fang Yang lili Chen Department of Stomatology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Hubei Province Key laboratory of Oral and Maxillofacial Development and Regeneration Wuhan 430022China Department of Dentistry–Biomaterials Radboud University Medical CenterPhilips van Leydenlaan 256525 EX NijmegenThe Netherlands Center of Stomatology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Silk fibroin(SF)can be used to construct various stiff material interfaces to support bone formation.An essential preparatory step is to partially transform SF molecules from random coils toβ-sheets to render the material water insoluble.However,the influence of the SF conformation on osteogenic cell behavior at the material interface remains unknown.Herein,three stiff SF substrates were prepared by varying theβ-sheet content(high,medium,and low).The substrates had a comparable chemical composition,surface topography,and wettability.When adsorbed fibronectin was used as a model cellular adhesive protein,the stability of the adsorbed protein-material interface,in terms of the surface stability of the SF substrates and the accompanying fibronectin detachment resistance,increased with the increasingβ-sheet content of the SF substrates.Furthermore,(i)larger areas of cytoskeleton-associated focal adhesions,(ii)higher orders of cytoskeletal organization and(iii)more elongated cell spreading were observed for bone marrow-derived mesenchymal stromal cells(BMSCs)cultured on SF substrates with high vs.lowβ-sheet contents,along with enhanced nuclear translocation and activation of yap/TAZ and RUNX2.Consequently,osteogenic differentiation of BMSCs was stimulated on highβ-sheet substrates.These results indicated that theβ-sheet content influences osteogenic differentiation of BMSCs on SF materials in vitro by modulating the stability of the adsorbed protein-material interface,which proceeds via protein-focal adhesion-cytoskeleton links and subsequent intracellular mechanotransduction.Our findings emphasize the role of the stability of the adsorbed protein-material interface in cellular mechanotransduction and the perception of stiff SF substrates with differentβ-sheet contents,which should not be overlooked when engineering stiff biomaterials.

关键词： interface stability adsorbed

yap1对颗粒细胞的重编程可导致具间质谱系和浆液性特征的高级别卵巢癌

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Science Bulletin 2020年第15期65卷 1281-1296,M0004页

作者：吕向民何春波黄聪滑国华陈骍程 Barbara K.Timm Victoria M.Maclin Abigail A.Haggerty Shelly K.Aust Denae M.Golden Bhavana J.Dave Yun-An Tseng 陈利王洪波陈培超 David l.Klinkebiel Adam R.Karpf Jixin Dong Ronny I.Drapkin Bo R.Rueda john S.Davis 王诚 Vincent Center for Reproductive Biology Department of Obstetrics and GynecologyMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114USA Olson Center for Women's Health Department of Obstetrics and GynecologyUniversity of Nebraska Medical CenterOmahaNE 68198USA College of Animal Sciences and Veterinary Medicine Huazhong Agricultural UniversityWuhan 470000China Fred&Pamela Buffett Cancer Center University of Nebraska Medical CenterOmahaNE 68198USA Department of Pathology and Microbiology.University of Nebraska Medical Center OmahaNE 68198USA Heartland Center for Reproductive Medicine OmahaNE 68198USA Munroe-Meyer Institute University of Nebraska Medical CenterOmahaNE 68198USA Key laboratory of Animal Ecology and Conservation Biology Institute of ZoologyChinese Academy of SciencesBeijing 100101China College of life and Environmental Science Wenzhou UniversityWenzhou 325035China Biochemistry and Molecular Biology University of Nebraska Medical CenterOmahaNE 68198USA Department of Obstetrics and Gynecology University of PennsylvaniaPhiladelphiaPA 19104USA

高级别浆液性卵巢癌(HGSC)是临床中最常见、且恶性程度最高的卵巢癌.深入了解高级别浆液性卵巢癌的起源细胞可对该亚型卵巢癌进行有效预防和早期诊断.最近TCGA和AOCS通过分子分型研究发现了一种具有间充质特征的高级别浆液性卵巢癌亚型... 详细信息

高级别浆液性卵巢癌(HGSC)是临床中最常见、且恶性程度最高的卵巢癌.深入了解高级别浆液性卵巢癌的起源细胞可对该亚型卵巢癌进行有效预防和早期诊断.最近TCGA和AOCS通过分子分型研究发现了一种具有间充质特征的高级别浆液性卵巢癌亚型,并且表明该亚型是所有新发现的亚型中预后最差的一种,而且目前大家对于这种卵巢癌新亚型的起源细胞一无所知.在研究Hippo信号通路在卵巢颗粒细胞生理和病理中的作用时,意外地发现Hippo信号传导途径的主要效应分子yap1的高度激活可以诱导具有间质谱系和高可塑性的卵巢颗粒细胞的去分化与重编程,最终导致具有浆液性特征的高级别卵巢癌的发生.本文的研究结果揭示了具间质特征的高级别浆液性卵巢癌的一种潜在起源细胞.

关键词：卵巢颗粒细胞恶性程度重编程信号传导途径卵巢癌浆液性效应分子早期诊断