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Conf irmation of endotracheal tube placement using disposable f iberoptic bronchoscopy in the emergent setting

World Journal of Emergency Medicine 2019年第4期10卷 210-214页

作者： Avir Mitra Asaf Gave kelsey coolahan Thomas Nguyen Department of Emergency Medicine Mount Sinai Beth IsraelIcahn School of MedicineNew Jersey 08043USA Department of Surgery Critical Care Mount Sinai Beth IsraelIcahn School of MedicineNew York 10009USA

BACKGROUND:Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED).Direct and adjunct strategies exist,but each has limitations and there is no definitive gold standard.The utility of bronchoscopy in ED intubation has been studied,but scant literature exists on its use for ET tube confirmation.This study aims to assess effectiveness,ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy.METHODS:Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable,flexible Ambu aScope interfaced with a monitor.With residents blinded,the researcher randomly placed the ET tube in the trachea,esophagus or right mainstem.Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy.Each resident underwent 4 trials.Accuracy,speed and perceptions of difficulty were measured.RESULTS:Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%).The median time-to-guess was 7.0 seconds,IQR (5.0-10.0).Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult).No tubes were damaged or dislodged.CONCLUSION:While simulation cannot completely replicate the live experience,fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation.Further studies directly comparing this novel approach to established practices on actual patients are warranted.

关键词： Airway Simulation Bronchoscopy Tube confi rmation

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Glutamine-released ammonia acts as an unprecedented signaling molecule activating lipid production

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Genes & Diseases 2023年第2期10卷 307-309页

作者： Chunming Cheng Scott kelsey Deliang Guo Department of Radiation Oncology Ohio State Comprehensive Cancer CenterArthur G. James Cancer Hospital and Richard J. Solove Research Instituteand College of Medicine at The Ohio State UniversityColumbusOH 43210USA Center for Cancer Metabolism James Comprehensive Cancer Center at The Ohio State UniversityColumbusOH 43210USA

In healthy humans, ammonia circulates in the bloodstream at a concentration around 11–32 μmol/L. Whether ammonia plays any physiological role has been unknown until a recent report published in Nature Metabolism.1 Ammonia, long thought to be a toxic waste product of amino acid metabolism, needs to be excreted from the human body as urea. Intriguingly, in this paper, Cheng et al1 for the first time reported that ammonia is not a waste product;rather, it is an unprecedented signaling molecule tying glucose and glutamine to lipid production in human cells. This study revealed that ammonia released from glutamine triggers a cascade of cellular processes leading to the activation of lipogenesis machinery for lipid production (Fig. 1). This discovery has major implications for developing treatments for human diseases such as cancers and metabolic syndromes, as dysregulated metabolism is a hallmark of these diseases.

关键词： ammonia metabolism Ammonia

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Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection

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World Journal of Gastroenterology 2022年第30期28卷 4019-4043页

作者： Francesco Crafa Serafino Vanella Onofrio A Catalano kelsey L Pomykala Mario Baiamonte Division of General and Surgical Oncology St.Giuseppe Moscati HospitalCenter of National Excellence and High SpecialtyAvellino 83100Italy Department of Radiology Athinoula A.Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States Department of Nuclear Medicine Department of Radiological SciencesDavid Geffen School of Medicine at University of CaliforniaLos AngelesUniversity Hospital EssenUniversity of Duisburg-EssenEssen 45141Germany

Current histopathological staging procedures in colorectal cancer(CRC)depend on midline division of the lymph nodes(LNs)with one section of hematoxylin and eosin staining.Cancer cells outside this transection line may be missed,which could lead to understaging of Union for International Cancer Control Stage II high-risk patients.The one-step nucleic acid amplification(OSNA)assay has emerged as a rapid molecular diagnostic tool for LN metastases detection.It is a molecular technique that can analyze the entire LN tissue using a reversetranscriptase loop-mediated isothermal amplification reaction to detect tumorspecific cytokeratin 19 mRNA.Our findings suggest that the OSNA assay has a high diagnostic accuracy in detecting metastatic LNs in CRC and a high negative predictive value.OSNA is a standardized,observer-independent technique,which may lead to more accurate staging.It has been suggested that in stage II CRC,the upstaging can reach 25%and these patients can access postoperative adjuvant chemotherapy.Moreover,intraoperative OSNA sentinel node evaluation may allow early CRC to be treated with organ-preserving surgery,while in more advanced-stage disease,a tailored lymphadenectomy can be performed considering the presence of aberrant lymphatic drainage and skip metastases.

关键词： Colorectal malignancies One-step nucleic acid amplification Diagnostic accuracy Negative predictive value Upstaging Organ-sparing surgery Tailored lymphadenectomy

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Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students

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Journal of Sport and Health Science 2022年第2期11卷 164-171,I0002页

作者： Caio Victor Sousa Jungyun Hwang Romina Cabrera-Perez Austin Fernandez Aika Misawa kelsey Newhook Amy Shirong Lu Health Technology Lab College of ArtsMedia and DesignBouvé College of Health SciencesNortheastern UniversityBostonMA 02115USA Department of Aging and Geriatric Research University of FloridaGainesvilleFL 32603USA

Background:Active video games are a new method for increasing physical activity(PA).Fully immersive virtual reality(VR)is a hardware device on which an active video game can run.Active(video games in)VR(AVR),might increase immersion,game engagement,and moderate-to-vigorous PA(MVPA),thereby yielding greater exercise-related benefits,e.g.,cognitive performance.Methods:We examined the induction of MVPA via an AVR and a sedentary VR(SVR)as well as the effects of VR play on cognitive performance,which was monitored using 2 different methods.Each of 29 sedentary college students attended three 20-min laboratory sessions(AVR,SVR,or control)in a randomized order;during the control session,they sat quietly doing nothing.A fully immersive headset was used for the 2 video game sessions.We monitored and computed participants’PA using hip-wom accelerometers(wGT3 x-bt;ActiGraph,Pensacola,FL,USA)and a heart rate band(Polar H7;Polar,Kempele,Finland).After each session,the participants completed a mnemonic similarity test(MST)to measure recognition memory.They also filled out a motion sickness questionnaire and an abbreviated game experience questionnaire.Results:The AVR session induced a significantly greater heart rate and more time spent in MVPA than did either of the other 2 sessions regardless of the PA monitoring method.AVR elicited greater game experience questionnaire-assessed sensory and imaginative immersion,challenge,and positive affect than did SVR.The mnemonic similarity test recognition score was marginally higher post-AVR session than it was post-SVR session.Conclusion:AVR elicited MVPA without a significant increase in motion sickness and induced a better game experience and better borderline cognitive performance than did SVR.

关键词： Active video game Cognitive performance Mnemonic similarity test MVPA Virtual reality

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Sclerostin antibody improves alveolar bone quality in the Hyp mouse model of X-linked hypophosphatemia

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International Journal of Oral Science 2023年第4期15卷 640-648页

作者： kelsey A.Carpenter Delia O.Alkhatib Bryan A.Dulion Elizabeth Guirado Shreya Patel Yinghua Chen Anne George Ryan D.Ross Department of Anatomy&Cell Biology Rush University Medical CenterChicagoILUSA Department of Oral Biology The University of Illinois at ChicagoChicagoILUSA Department of Orthopedic Surgery Rush University Medical CenterChicagoILUSA Department of Microbial Pathogens and Immunity Rush University Medical CenterChicagoILUSA

X-linked hypophosphatemia (XLH) is a rare disease of elevated fibroblast growth factor 23 (FGF23) production that leads tohypophosphatemia and impaired mineralization of bone and teeth. The clinical manifestations of XLH include a high prevalence ofdental abscesses and periodontal disease, likely driven by poorly formed structures of the dentoalveolar complex, including thealveolar bone, cementum, dentin, and periodontal ligament. Our previous studies have demonstrated that sclerostin antibody (SclAb) treatment improves phosphate homeostasis, and increases long bone mass, strength, and mineralization in the Hyp mousemodel of XLH. In the current study, we investigated whether Scl-Ab impacts the dentoalveolar structures of Hyp mice. Male andfemale wild-type and Hyp littermates were injected with 25 mg·kg−1 of vehicle or Scl-Ab twice weekly beginning at 12 weeks of ageand euthanized at 20 weeks of age. Scl-Ab increased alveolar bone mass in both male and female mice and alveolar tissue mineraldensity in the male mice. The positive effects of Scl-Ab were consistent with an increase in the fraction of active(nonphosphorylated) β-catenin, dentin matrix protein 1 (DMP1) and osteopontin stained alveolar osteocytes. Scl-Ab had no effecton the mass and mineralization of dentin, enamel, acellular or cellular cementum. There was a nonsignificant trend towardincreased periodontal ligament (PDL) attachment fraction within the Hyp mice. Additional PDL fiber structural parameters were notaffected by Scl-Ab. The current study demonstrates that Scl-Ab can improve alveolar bone in adult Hyp mice.

关键词： alveolar impaired elevated

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Unexpected cancellation on a catatonic patient’s electroconvulsive therapy due to the coronavirus pandemic

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General Psychiatry 2020年第6期33卷 442-444页

作者： kelsey Casano Erin Capone Department of Psychiatry LSU Health Sciences Center New OrleansNew OrleansLouisianaUSA Psychiatry LSU Health Sciences Center New OrleansNew OrleansLouisianaUSA

We report a case of a 39-year-old woman with a psychiatric history of schizoaffective disorder with catatonia,dependent personality disorder and substance use disorder whose symptoms have been very difficult to control.During her most recent inpatient admission,she w as treated with electroconvulsive therapy(ECT)for catatonia.Our treatment team was hopeful that ECT was making a difference for this patient.However,she w as only able to receive two sessions of treatment due to new hospital protocols related to the coronavirus pandemic.Although the patient was not suspected to have the coronavirus,she could no longer undergo ventilation with a bag and mask during the procedure.Bag-m ask ventilation is known to aerosolise the coronavirus and other diseases and potentially put healthcare workers at risk.Although orotracheal intubation also aerosolises the coronavirus,this was the only means of airway management still allowed by anaesthesia providers at this time.Our psychiatry team estimated that the risks of intubation outweighed the benefits of treatment,and ECT was cancelled.Without additional ECT treatments,the patient again decompensated for several weeks before being stabilised on clozapine,haloperidol and lorazepam.Although she eventually had a positive treatment outcome,her hospital course w as likely prolonged due to unforeseen events related to the novel coronavirus.We feel that the current medical climate is unprecedented and is interfering with necessary psychiatric treatment In an unanticipated way.Anaesthesiologists will need to be flexible while working with psychiatrists and identify safe ways to provide this necessary psychiatric treatment for patients.

关键词： patient treatment aerosol

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神经重症监护中的预后预测与共同决策

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英国医学杂志中文版 2022年第12期25卷 712-720页

作者： kelsey Goostrey Susanne Muehlschlegel 莫云凌(译) Department of neurology University of Massachusetts Chan Medical SchoolWorcesterMAUSA Department of anesthesiology/critical care University of Massachusetts Chan Medical SchoolWorcesterMAUSA Department of surgery University of Massachusetts Chan Medical SchoolWorcesterMAUSA 航空医学研究所附属医院

神经重症监护病房(NICU)中的预后预测至关重要。急性重症脑损伤(SABI)患者由于损伤自身表现或者镇静的需要无法做出自己的决定。代理决策者通常是患者的家属,必须代表患者做出决定。然而,由于SABI的突发性和意外性,很多人对自己作为代... 详细信息

神经重症监护病房(NICU)中的预后预测至关重要。急性重症脑损伤(SABI)患者由于损伤自身表现或者镇静的需要无法做出自己的决定。代理决策者通常是患者的家属,必须代表患者做出决定。然而,由于SABI的突发性和意外性,很多人对自己作为代理人的角色毫无准备。这些代理人往往需要依赖NICU的临床医生为其提供疾病的转归(预后),据此做出替代判断,并代表患者决定治疗强度和监护目标。因此,怎样得出预后评估并与家属进行沟通显得极为重要。NICU的预后预测在不同的临床医生和机构之间差异很大,目前缺乏相应的循证指南。共同决策(SDM)是指代理人和临床医生根据患者的价值观、偏好一起做出个性化的决策,它被认为是改善临床医生和患者家属沟通情况的一个机会,能够确保患者得到他们自己愿意选择的治疗决定。本综述根据相关研究和专家意见,概述了NICU中预后预测的重要性及其当前面临的挑战,简要说明了预后预测和SDM是如何相互交叉相互影响的。

关键词：临床医生预后预测神经重症监护病房循证指南重症脑损伤共同决策 NICU 治疗强度

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Conceptus elongation in ruminants: roles of progesterone, prostaglandin, interferon tau and cortisol

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Journal of Animal Science and Biotechnology 2015年第2期6卷 151-162页

作者： kelsey Brooks Greg Burns Thomas E Spencer Department of Animal Science and Center for Reproductive Biology Washington State University

The majority of pregnancy loss in ruminants occurs during the first three weeks after conception, particularly during the period of conceptus elongation that occurs prior to pregnancy recognition and implantation. This review integrates established and new information on the biological role of ovarian progesterone （P4）, prostaglandins （PGs）, interferon tau （IFNT） and cortisol in endometrial function and conceptus elongation. Progesterone is secreted by the ovarian corpus luteum （CL） and is the unequivocal hormone of pregnancy. Prostaglandins （PGs） and cortisol are produced by both the epithelial cells of the endometrium and the trophectoderm of the elongating conceptus. In contrast, IFNT is produced solely by the conceptus trophectoderm and is the maternal recognition of pregnancy signa that inhibits production of luteolytic pulses of PGF2α by the endometrium to maintain the CL and thus production of P4. Available results in sheep support the idea that the individual, interactive, and coordinated actions of P4, PGs, IFNT and cortisol regulate conceptus elongation and implantation by controlling expression of genes in the endometrium and/or trophectoderm. An increased knowledge of conceptus-endometrial interactions during early pregnancy in ruminants is necessary to understand and elucidate the causes of infertility and recurrent early pregnancy loss and provide new strategies to improve fertility and thus reproductive efficiency.

关键词： Conceptus Cortisol Endometrium Interferon Prostaqlandin Ruminant

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Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors:Personal experience and literature review

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World Journal of Gastroenterology 2023年第24期29卷 3883-3898页

作者： Francesco Crafa Serafino Vanella Aristide Morante Onofrio A Catalano kelsey L Pomykala Mario Baiamonte Maria Godas Alexandra Antunes Joaquim Costa Pereira Valentina Giaccaglia Division of General and Surgical Oncology St.Giuseppe Moscati HospitalCenter of National Excellence and High SpecialtyAvellino 83100Italy Division of Gastorenterology and Endoscopy St.Giuseppe Moscati HospitalCenter of National Excellence and High SpecialtyAvellino 83100Italy Department of Radiology Athinoula A Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States Department of Nuclear Medicine Department of Radiological SciencesUniversity Hospital EssenUniversity of Duisburg-EssenEssen 45141Germany Department of General Surgery Braga HospitalBraga 4710-243Portugal Department of Surgery Medclinic City HospitalDubai 505004United Arab Emirates

BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe,organ-sparing surgery that achieves full-thickness resection with adequate margins.Recent studies have demonstrated the safety and efficacy of these procedures.However,these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity,which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity.Non-exposed endoscopic wallinversion surgery(NEWS)is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity.Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection.One-step nucleic acid amplification(OSNA)can provide a rapid method of evaluating nodal tissue,whilst nearinfrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node(LN)assessment with OSNA.METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St.Giuseppe Moscati Hospital(Avellino,Italy).Patients with early-stage gastric or colon cancer(diagnosed via endoscopy,endoscopic ultrasound,and computed tomography)were included.All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022.LNs were examined intraoperatively with OSNA and postoperatively with conventional histology.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.Data were collected prospectively and analyzed retrospectively.RESULTS A total of 10 patients(5 males and 5 females)with an average age of 70.4±4.5 years(range:62-78 years)were enrolled in this study.Five patie

关键词： Laparoscopic and endoscopic cooperative surgery Non-exposed endoscopic wall inversion surgery Early gastric cancer Early colorectal cancer Sentinel lymph node One-step nucleic acid amplification Endoscopic full-thickness resection

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The Effects of 5 Weeks of Leg-Drive Training on Bench Press Performance in Recreationally-Trained,College-Age Men

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Journal of Science in Sport and Exercise 2022年第3期4卷 231-236页

作者： Jacob K.Gardner Justin T.Chia Brent M.Peterson kelsey L.Miller Department of Kinesiology and Health Science Biola University13800 Biola AveLa MiradaCA 90639USA Department of Health and Human Development Western Washington University516 High StreetBellinghamWA 98225USA

Introduction The bench press is commonly used to measure upper-body strength.While much emphasis has been placed on the upper-body,little is known about how the lower-body can play a role in bench press performance.Leg-drive is a technique that includes flexing the knee so the feet line up posterior to the knee joint,while simultaneously contracting the knee extensors isometrically during the lift.The purpose of this study was to compare strength characteristics of lifters in a standard bench press versus a leg-drive bench press over the course of 5-weeks of training.Methods Twenty-three recreationally active males(age:22.4±2.1 years,height:175.0±5.9 cm,mass:78.4±9.5 kg)were randomized into a standard bench or leg-drive bench press group.Participants performed four sets to failure,two times per week for five weeks.Variables of interests were training volume and 1-repetition maximum(1RM)strength.For training volume,a 2×5(group×week)repeated measures analysis of variance(RMANOVA)was used.For the 1RM’s,a 2×2×2(group×press type×time)RMANOVA was used.A priori alpha levels were set to 0.05.Results Over time,both groups showed an approximate 6%increase in 1RM strength.Training volume for week 4 was 5.6%less than week 5,but was not different from weeks 1 through 3.No between-group differences were observed for 1RM strength or training volume.Conclusion This results of this work indicates that 5 weeks of leg-drive training is effective in increasing 1RM strength,but was not more effective than standard bench press training.Practically,lifters should choose either lifting style based on personal preference.

关键词： Chest press Lower-body Weight lifting Isometric contraction

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