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An Unusual Cause of Obscure Gastrointestinal Bleeding Using an Abdominal CT Scan with Contrast: A Case Report of Small Intestinal GIST at the Duodenojejunal Junction

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Open Journal of Gastroenterology 2023年第11期13卷 351-358页

作者： Vithiarithy Chey Neang Nov Panha Uong Anan Chea keoseyla unn Vitou Leang Syphanna Sou Gastrointestinal Department Khmer Soviet Friendship Hospital Phnom Penh Cambodia University of Health Sciences Phnom Penh Cambodia Loung Mè Hospital Phnom Penh Cambodia

Background/Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. However, they only constitute approximately 1% of all primary GI tumors. GISTs are most commonly found in the stomach (60% - 70%) and small intestine (20% - 30%). Colorectal (5%) and esophageal (Presentation of Clinical Case: A 33-year-old male, presented to the emergency department for melena and dizziness in January 2023. He was hospitalized several times for anemia with multiple blood transfusions since 2017 and never made a final diagnosis. From 2017 to 2019 he underwent esophagogastroduodenoscopy (EGD) and ileocolonoscopy 3 times which always gave a negative result. At this time, laboratory results showed microcytic anemia with hemoglobin 7 g/dl. We performed an EGD and ileocolonoscopy again but still showed negative then we did an abdominal CT scan with contrast with demonstrated a solid exophytic hypervascular mass measuring 62 × 38 × 73 mm that appeared to arise from the duodenojejunal junction. The surgeon decided to proceed with surgical resection of the mass and the histopathologist confirmed the diagnosis of GISTs. The patients were discharged in stable condition after the surgery and followed up every 3 - 6 months with the oncologist. Conclusion: The presentation of chronic GI bleeding with negative results in EGD and ileocolonoscopy, and abdominal CT scan with contrast could provide useful information in order to obtain a diagnosis of bleeding GISTS. Teamwork is the cornerstone in the management of the case. After the resection of the mass by the surgeon, the histopathologist allowed us to establish the definitive diagnosis and the oncologist will follow up with this patient in order to prevent the relapse of symptoms.

关键词： Obscure Gastrointestinal Bleeding Gastrointestinal Stromal Tumors Gastrointestinal Endoscopy Histopathological Study Surgical Resection

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A Case Report on Duodenal Variceal Bleeding Treated with Glue Injection

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Open Journal of Gastroenterology 2022年第11期12卷 324-329页

作者： Nov Neang Chey Vithiarithy Kang Khounthai Khuon Viseth Mon Panha Uong Panha Un Seiha Um Sokchay unn keoseyla Chhit Dimanche Kann Sovannvireak Kaing Kimyi Ny Tharuom SOU Syphanna Khmer Soviet Friendship Hospital Phnom Penh Cambodia University of Health Sciences Phnom Penh Cambodia

Introduction: We present a case of upper gastrointestinal bleeding in a woman aged 56 years with liver cirrhosis who was diagnosed with isolated duodenal variceal bleeding, which was successfully treated with histoacryl injection. Case Presentation: A 57-year female cirrhotic patient presented with melena. She had been diagnosed with duodenal variceal bleeding and treated successfully with 2.4 ml histoacryl using a normal gastroscope. The patient subsequently remained stable and free of any further GI bleeding. She was discharged 48 hours later. Her hemoglobin remained stable at 9 g/L. Conclusion: The histoacryl glue injection provides an effective treatment. Hence, this should ideally be performed by an experienced endoscopist who is aware of and vigilant for the serious complications of this treatment option.

关键词： Upper Gastrointestinal Bleeding Portal Hypertension Duodenal Variceal Bleeding Glue Injection

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Correlation of Platelet Count with Grading of Esophageal Varices in Cirrhotic Patients

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Open Journal of Gastroenterology 2023年第1期13卷 12-27页

作者： Panha Uong Vithiarithy Chey keoseyla unn Neang Nov Khounthai Kang Seiha Un Kimyi Kaing Viseth Khuon Tharuom Ny Panha Mon Sovannvireak Kann Dimanche Chhit Sokchay Um Kimpav Chhay Syphanna Sou Khmer Soviet Friendship Hospital Phnom Penh Cambodia University of Health Sciences Phnom Penh Cambodia

Background/Aims: Cirrhosis represents a late stage of progressive hepatic fibrosis and is generally considered to be irreversible in its advanced stages. Esophageal varix is a complication of liver cirrhosis and is the consequence of portal hypertension. The aim of this study was to determine the correlation between the severity of thrombocytopenia and the presenting of esophageal varices (EVs) in cirrhotic patient. Patients and Methods: This study was a retrospective, descriptive, analytic and monocentric study, which was carried out at Gastroenterology Department, Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia. It was conducted from 1st September 2020 to 31st January 2021. All patients were diagnosed as liver cirrhosis by clinic, biology and ultrasound. Patients’ data were noted in standardized questionnaire with information such as age, sex, address, laboratory result, and the result of endoscopic finding. All data were registered into a data set and then analyzed by SPSS program version 23. Results: 1445 patients were enrolled for gastroscopy. Only 303 patients (21%) were suggested for variceal screening after the exclusions. Male was predominant with sex ratio F/M (1/2.03). Patients’ age varied between 21 and 80 years old, with the mean age of 55 ± 11 years old. 199 patients (66%) were found with EVs, while EVs grade 1 and 2 without red signs were predominated, accounting to 22.8% and 19.5% respectively. The majority of the patients with platelet count between 50 - 99 giga/l had EVs vs platelet count > 150 giga/l had no EVs (p Conclusion: Thrombocytopenia is a non-invasive parameter with high accuracy for the prediction of EVs in cirrhosis. The severity of thrombocytopenia increased as the grading of EVs increased. Thus, it can assist in triaging cirrhotic patients for endoscopy to identify EVs.

关键词： Liver Cirrhosis Portal Hypertension Esophageal Varices Thrombocytopenia Esophagogastroduodenoscopy

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Gastric Variceal Bleeding: The Efficacy and Safety of N-Butyl-2-Cyanoacrylate Glue Injection

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Open Journal of Gastroenterology 2023年第2期13卷 80-90页

作者： Syphanna Sou Roman Meas Vattanak Ek Panha Uong keoseyla unn Neang Nov Seiha Un Kimyi Kaing Viseth Khuon Tharuom Ny Panha Mon Sovannvireak Kann Dimanche Chhit Sokchay Um Vithiarithy Chey Khmer Soviet Friendship Hospital Phnom Penh Cambodia University of Health Sciences Phnom Penh Cambodia

Aims: To assess N-2-butyl cyanoacrylate injection’s effectiveness and safety in the treatment of gastric varix hemorrhage. Methods: Endoscopic treatment with N-Butyl-2-cyanoacrylate injection was performed on 32 patients (21 males and 11 females) with gastric variceal bleeding. The socioeconomic status of the patients, initial hemostasis, rebleeding rate, complications, and mortality rate were all reviewed retrospectively. Patients with liver cirrhosis who presented with hematemesis or melena or whose endoscopy revealed gastric variceal bleeding were included. Therefore, patients with hemodynamic instability were excluded. Results: A total of 32 patients underwent Histoacryl® glue injection to treat bleeding gastric varices. The mean age was 56.09 ± 9.29 (mean ± SD) years old. Viral hepatitis is the leading cause of chronic liver disease, both hepatitis B and C accounted for 11 cases (34.4%). IGV1 was the most commonly seen, according to the Sarin classification, with 15 cases (46.8%), followed by GOV1 with 10 cases (31.3%) and GOV2 with 7 cases (21.9%). With 15 cases (46.9%), the majority of patients had a Child-Pugh (CTP) B score. 12 cases (37.5%) and 11 (34.4%), respectively, of hematemesis and melena, were reported. In all patients, initial hemostasis was achieved, and there was no documented complication rate. Conclusion: Given the higher rate of hemostasis and great results, our study’s findings indicate that the injection of N-butyl-2-cyanoacrylate under endoscopic guidance is safe and effective in the management of GV hemorrhage. After the initial injection, hemostasis was achieved in all of our patients.

关键词： Upper Gastrointestinal Bleeding Portal Hypertension Gastric Varix Initial Hemostasis Cyanoacrylate (Hystoacryl) Injection

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Compulsive Repetition of Rupture： Strategies of Representing Trauma

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Frontiers of Literary Studies in China-Selected Publications from Chinese Universities 2015年第2期9卷 147-159页

作者： Edward M. G_unn Department of Asian Studies Comell University Ithaca NY 14853 USA

This article focuses on the strategies that literature and cultural criticism adopt to represent trauma in comparison to a current medical definition. The contemporary medical definition, trauma as post-traumatic stress disorder （PTSD）, is the most narrow and specific definition to discuss trauma. The discourse of medicine does not necessarily match those of literature and cultural criticism, nor need they conform to each other. PTSD includes a collection of symptoms, any one of which might not have anything to do with traumatic experience, but which together point with increasing intensity to a psychological syndrome caused by traumatic shock. Although this is historically a recently defined syndrome （1980）, its features had long before attracted attention and been recorded under other terms and diagnoses. Although Chinese literature is only occasionally given to psychological realism, we do find occasional descriptions that strongly suggest aspects of the syndrome. Also, the aims and the needs of medicine and literature or cultural criticism are not necessarily the same, but it is important to explore in greater detail the aims and the needs of literature and cultural criticism.

关键词： strategies of representing trauma traumatic memories compulsiverepetition modem and contemporary Chinese literature

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The Relationship among Caregiver Burden, Demographic Variables, and the Clinical Characteristics of Patients with Parkinson’s Disease—A Systematic Review of Studies Using Various Caregiver Burden Instruments

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Open Journal of Nursing 2015年第10期5卷 855-877页

作者： Ingrid Leiknes unn-Tone Lien Elisabeth Severinsson Centre for Movement Disorders Stavanger University Hospital Stavanger Norway Centre for Women’s Family & Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway Research Department Stavanger University Hospital and Centre for Women’s Family & Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway

Caring for a person with Parkinson’s disease (PD) extends far beyond the ordinary exchange of assistance among people in a close relationship. Caregivers must learn to cope with the patient’s increasing disability and loss of independence. The aim of this systematic review was to critically assess and summarize the evidence of the influence of the demographic and clinical characteristics of patients with PD on caregiver burden by means of a caregiver burden instrument. In order to identify articles, electronic databases and reference lists were searched using the search word “Parkinson’s disease” in combination with “caregiver” or “carer” and with “burden” or “distress” or “stress” or “strain”. Thirty one articles were deemed eligible for inclusion. The methodological quality of the studies was evaluated. No studies were excluded due to low quality. The results revealed similar associations among caregiver burden, demographic variables and patient characteristics, across different caregiver burden instruments and various clinical scales. Higher PD stage and functional disability are the non-motor characteristics that contribute the most to caregiver burden. However, when comparing the impact of patient motor and non-motor symptoms, several studies found that mental symptoms had a stronger impact on caregiver burden than motor symptoms. No association was observed between caregiver burden and patient and caregiver demographics with the exception of the sub-scale analysis of caregiver burden in various age groups. Interpreting the results of studies that employ a range of different clinical assessment scales and burden instruments makes it challenging to provide a valid summary of caregiver burden in PD. The most commonly used analysis methods contribute little information about burden variation across caregiver groups or which areas are the most burdensome for caregivers. There is a need for a more uniform use of recommended instruments and for longitudinal studies.

关键词： Caregiver Burden Distress Strain Stress Parkinson’s Disease

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The Impact of Cambodia-ASEAN Free Trade Agreement on Trade Flow: An Application of the Gravity Model

The Impact of Cambodia-ASEAN Free Trade Agreement on Trade F...

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作者： unn BOREY 湖南大学

学位级别：硕士

This paper attempts to focus on the dynamic impact of the ASEAN free trade area(AFTAs) on Cambodia’s trade and prediction of the trade potential of *** is a small country and a member of ASEAN located in the Southeast Asia witha year-by-year economic and trade development since it became a member of theAssociation of Southeast Asian Nations (ASEAN) in1999and WTO (World TradeOrganization) in2004. For Cambodia, economic integration with regional and worldeconomies is seen as one of the national strategies for reconstruction and ***’s accession to ASEAN is considered to be the turning point for Cambodia tointegrate its whole national economics through investment and trade, which have beenmajor driving force for Cambodia’s growth and economic development. This studyreveals and tests how Cambodia’s accession to ASEAN affects its bilateral trade withother countries by using the gravity model of trade specifically adopted for the study ofCambodian trade, and then estimating Cambodia’s trade potential. Panel data for theperiod2000-2010across31countries is employed in the analysis. The coefficient of thegravity model for trade obtained from the model is then used to predict Cambodia’s tradepotential. The results of this empirical study reveal that ASEAN (AFTA) membership hashad a significant effect in increasing Cambodia’s bilateral trade with other ASEANmember countries by3.2percent for the past decade, but doesn’t divert its bilateral tradefrom outside the ASEAN bloc to inside the ASEAN bloc. Likewise, the results also provethat Cambodia’s trade potential is highest with countries in the South East Asian Nationsand East Asia. Specifically, the maximum potential trade exists with Indonesia, Thailandand the Philippines, China, Japan, Sri Lanka, and Pakistan. Moreover, under the scenarioof Cambodia-China FTA in2015, currency appreciation, and the outlook of economicgrowth for China and nine other ASEAN countries for2013-2015, this paper also fou

关键词： ASEAN AFTA gravity model Cambodia Trade potential

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Pain and fatigue in adult patients with rheumatoid arthritis: Association with body awareness, demographic, disease-related, emotional and psychosocial factors

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Open Journal of Nursing 2013年第2期3卷 293-300页

作者： Helena Loof unn-Britt Johansson Elisabet Welin Henriksson Staffan Lindblad Fredrik Saboonchi Sophiahemmet University StockholmSweden Karolinska Institutet Department of Clinical SciencesDanderyd HospitalDivision of MedicineStockholmSweden Karolinska Institutet Division of NursingDepartment of Neurobiology and Rheumatology UnitKarolinska HospitalStockholmSweden Karolinska Institutet Department of Learning InformaticsManagement and EthicsStockholmSweden Karolinska Institutet Department of NeuroscienceDivision of Insurance MedicineStockholmSweden University of Stockholm Stress Research InstituteStockholmSweden Red Cross University College StockholmSweden

Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors. Method: Data were collected from a sample of patients with RA (n = 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 -80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied. Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.

关键词： Pain Fatigue Emotional Psychosocial Rheumatoid Arthritis

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Use of a National Clinical Final Examination in a Bachelor’s Programme in Nursing to Assess Clinical Competence—Students’, Lecturers’ and Nurses’ Perceptions

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Open Journal of Nursing 2014年第7期4卷 501-511页

作者： unn-Britt Johansson Petra Lilja Andersson Maria Larsson Kristina Ziegert Marianne Ahlner-Elmqvist Department of Health Sciences Faculty of Medicine Lund University Lund Sweden Department of Health Sciences Karlstad University Karlstad Sweden School of Social and Health Sciences Halmstad University Halmstad Sweden Sophiahemmet University Stockholm Sweden

Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.

关键词： Assessment Clinical Competence Nurse Education Students

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Beliefs and Experiences of Fear of Hypoglycemia and Use of Uncooked Cornstarch before Bedtime in Persons with Type 1-Diabetes

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Open Journal of Nursing 2018年第11期8卷 795-810页

作者： Therese Anderbro Erik Moberg Ulf Adamson Per-Eric Lins unn-Britt Johansson Stockholm University Department of Psychology Stockholm Sweden Karolinska Institutet Department of Clinical Sciences Danderyd Hospital Stockholm Sweden Karolinska Institutet Department of Medicine Karolinska University Hospital Huddinge Stockholm Sweden Sophiahemmet University Stockholm Sweden Karolinska Institutet Department of Clinical Sciences and Education S&#246 dersjukhuset Stockholm Sweden

Introduction: Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypoglycemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using uncooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia. Methods: Mixed methods with both quantitative and qualitative data were used. Self-reported measures of hypoglycemia and fear of hypoglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach. Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglycemia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hypoglycemia and fear of hypoglycemia.

关键词： Adults Fear of Hypoglycemia Experiences Type 1 Diabetes Uncooked Cornstarch

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