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Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients:a systematic review and meta-analysis

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Gastroenterology Report 2021年第2期9卷 105-114,I0001页

作者： Pradeep K.Siddappa Fadi Hawa Larry J.Prokop MHassan Murad Barham K.Abu dayyeh Vinay Chandrasekhara mark d.topazian Fateh Bazerbachi division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA department of Internal Medicine St.Joseph Mercy Ann Arbor HospitalYpsilantiMIUSA Library Public Services Mayo ClinicRochesterMNUSA Robert d and Patricia E Kern Center for the Science of Health Care delivery Mayo ClinicRochesterMNUSA division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA division of Gastroenterology Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA

Background Abdominal pain is a debilitating symptom affecting-80%of pancreatic cancer(PC)*** duct(Pd)decompression has been reported to alleviate this pain,although this practice has not been widely *** aimed to evaluate the role,efficacy,and safety of endoscopic Pd decompression for palliation of PC post-prandial obstructive-type *** A systematic review until 7 October 2020 was *** independent reviewers selected studies,extracted data,and assessed the methodological *** We identified 12 publications with a total of 192 patients with PC presenting with abdominal pain,in whom Pd decompression was attempted,and was successful in 167 patients(mean age 62.5 years,58.7%males).The use of plastic stents was reported in 159 patients(95.2%).All included studies reported partial or complete improvement in pain levels after Pd stenting,with an improvement rate of 93%(95%confidence interval,79%-100%).The mean duration of pain improvement was 94616 *** retrograde cholangiopancreatography(ERCP)-related adverse events(AEs)were postsphincterotomy bleeding(1.8%),post-ERCP pancreatitis(0.6%),and hemosuccus pancreaticus(0.6%).AEs were not reported in two patients who underwent endoscopic ultrasound-guided Pd *** the 167 patients with technical success,the stent-migration and stent-occlusion rates were 3.6%and 3.0%,*** AE-related mortality was *** methodological quality assessment showed the majority of the studies having low or unclear *** In this exploratory analysis,endoscopic Pd drainage may be an effective and safe option in selected patients for the management of obstructive-type PC ***,a randomized–controlled trial is needed to delineate the role of this invasive practice.

关键词： cancer-associated pain Endoscopic retrograde cholangiopancreatography palliative therapy pancreas cancer systematic review meta-analysis

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End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients

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World Journal of Gastroenterology 2018年第41期24卷 4691-4697页

作者： Tarek Sawas Fateh Bazerbachi Samir Haffar Won K Cho Michael J Levy John A Martin Bret T Petersen mark d topazian Vinay Chandrasekhara Barham K Abu dayyeh division of Gastroenterology and Hepatology Mayo Clinic department of Gastroenterology Digestive Center for Diagnosis and Treatment division of Gastroenterology and Hepatology Georgetown University Medstar Washington Hospital Center

AIM To determine if end-stage renal disease (ESRd) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). METHOdS We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of diseases 9^(th) Revision (ICd-9-CM). Included patients were divided into three groups: ESRd, chronic kidney disease (CKd), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICd-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression *** There were 492175 discharges that underwent ERCP during the 3 years. The ESRd and CKd groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRd group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95% CI: 1.4-2.1, ~aP d was associated with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, ~aP d had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, ~aP djusted mean difference (aMd) = 5.9 d (95% CI: 5.0-6.7 d, ~aP d higher hospitalization charges aMd = $+82064 (95%CI: $68221-$95906, ~aP d is a risk factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.

关键词： End-stage renal disease Nationwide Inpatient Sample Endoscopic retrograde cholangiopancreatography

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dietary approaches following endoscopic retrograde cholangiopancreatography: A survey of selected endoscopists

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World Journal of Gastrointestinal Endoscopy 2010年第12期2卷 397-403页

作者： Lincoln EVVC Ferreira mark d topazian William S Harmsen Alan R Zinsmeister Todd H Baron department of Medicine Digestive Endoscopy Unit Hospital Universitario da Universidade Federal de Juiz de For a Juiz de Fora department of Medicine Division of Gastroenterology and Hepatology Rochester division of Biomedical Statistics and Informatics Mayo Clinic Rochester

AIM: To describe the dietary recommendations of experienced endoscopists for patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and the factors that influence these recommendations. METHOdS: Selected U.S. endoscopists with ERCP experience were surveyed by e-mail. A questionnaire with three hypothetical ERCP cases of patients at low, medium and high risk for development of post-ERCP pancreatitis (PEP) was shown. For each scenario, respondents were asked to recommend a post-procedure diet and time to first oral intake. Respondents were also asked about the effect of various clinical factors on their recommendations, including risk of ***: 97/187 selected ASGE members (51.9%) responded. When risk of PEP was either low, medium or high, 53%, 88% and 96% recommended a diet of clear liquids/NPO respectively, and 2%, 5% and 18% recommended delaying first oral intake until the following day. About 88% of respondents gave the same type of diet to patients at high as those with moderate-risk of PEP (P = 0.04). However, 37% and 43% of respondents gave different types of diet to patients at low vs moderate-risk and low-risk vs high-risk of PEP respectively (P d regarding the effect of other clinical factors or respondent ***: Most experienced endoscopists limit diet to NPO/clear liquids after ERCP for patients at high or moderate risk of post-ERCP pancreatitis. About half allow a low-fat or regular diet in patients at low risk.

关键词： Cholangiopancreatography Endoscopic retrograde diet Pancreatitis Survey Postoperative care

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Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions

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World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 487-494页

作者： Jad P AbiMansour Barham K Abu dayyeh Michael J Levy Andrew C Storm John A Martin Bret T Petersen Ryan J Law mark d topazian Vinay Chandrasekhara department of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States

BACKGROUNd Endoscopic ultrasound(EUS)-guided main pancreatic duct(Pd)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques *** use of a percutaneous transluminal angioplasty balloon(PTAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)Pd access and to dilate high-grade pancreatic *** To describe the technique,efficacy,and safety of PTABs for EUS-guided Pd *** Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply *** included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch *** primary outcome was technical *** outcomes included incidence of adverse events(AEs)and need for early *** A total of 23 patients were identified(48%female,mean age 55.8 years).Chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).Technical success was achieved in 20(87%)*** AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural *** patients required early *** EUS-guided use of PTABs for Pd access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

关键词： dilating balloon Pancreatic duct intervention Chronic pancreatitis Anastomotic stricture

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EUS FNA of Altered Left Adrenal Gland Morphology Suggests Amending CT and PET-CT Attenuation Threshold Values That Predict Malignancy

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Journal of Cancer Therapy 2012年第6期3卷 1029-1036页

作者： Ferga C. Gleeson Allison J. Clapp Robert C. Murphy Jonathan E. Clain Prasad G. Iyer Elizabeth Rajan mark d. topazian Kenneth K. Wang Michael J. Levy department of Radiology Mayo Clinic College of Medicine Rochester USA division of Gastroenterology and Hepatology Mayo Clinic College of Medicine Rochester USA

Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adrenal gland evaluation include CT, MRI, PET and PET-CT. diagnostic interpretative error can occur as evaluations rarely have complete cytologic or histologic correlation for concordance purposes. Aims: To establish the performance characteristics of non-contrast CT attenuation values (Hounsfield units-HU) and the optimal PET-CT maximum standard uptake value (SUVmax) for predicting adrenal malignancy when correlated with adrenal gland endoscopic ultrasound fine needle aspiration (EUS FNA) cytology results. Methods: A prospectively maintained EUS database was reviewed to identify consecutive patients who underwent a left adrenal gland FNA. Non-contrast CT attenuation values and SUVmax scores were calculated. EUS FNA cytology results were used as the reference standard for determining the presence of benign versus malignant adrenal gland status. Results: Sixty-two patients (69 ± 11 years) underwent adrenal EUS FNA, 34 (54.8%) of whom had a clinically suspected or established extra-adrenal malignancy. Non-invasive imaging was suggestive of abnormal adrenal morphology or altered PET-CT FdG activity in 45 (72.6%) patients. Elevated attenuation values (≥10 HU) by non-enhanced CT had a sensitivity and specificity of 100% and 34.6%, respectively. The SUVmax for malignant altered morphology was significantly higher than that for benign lesions [(8.5 ± 3.1 vs 3.3 ± 0.7;(p = 0.0001)]. ROC curve analysis indicated that an optimum cutoff SUVmax of ≥4.1 (AUC 0.92) yielded the best power distinction for malignancy with a sensitivity and specificity of 89% and 100%. Conclusion: When evaluating altered adrenal morphology by non-invasive methods, the performance characteristics of elevated CT attenuation values are suboptimal. But by adopting a SUVmax cut-off value of ≥4.1

关键词： Altered Adrenal Morphology Endoscopic Ultrasound Fine Needle Aspiration Unenhanced CT Attenuation Value PET Standardized Uptake Value

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design Improvements and Validation of a Novel Fully 3d Printed Analogue Lumbar Spine Motion Segment

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Journal of Bionic Engineering 2024年第3期21卷 1388-1396页

作者： Siril Teja dukkipati mark driscoll Musculoskeletal Biomechanics Research Lab Department of Mechanical EngineeringMcGill University845 Sherbrooke St.W(163)MontréalQCH3A 0C3Canada Orthopaedic Research Lab Montreal General Hospital1650 Cedar Ave(LS1.409)MontréalQCH3G 1A4Canada

Spine biomechanical testing methods in the past few decades have not evolved beyond employing either cadaveric studies or finite element modeling ***,both these approaches may have inherent cost and time *** studies are the present gold standard for spinal implant design and regulatory approval,but they introduce significant variability in measurements across patients,often requiring large sample *** element modeling demands considerable expertise and can be computationally expensive when complex geometry and material nonlinearity are *** analogue spine models could complement these traditional methods as a low-cost and high-fidelity alternative.A fully 3d printable L-S1 analogue spine model with ligaments is developed and validated in this *** stiffness of the model under pure bending loading in flexion-extension,Lateral Bending(LB)and Axial Rotation(AR)is evaluated and compared against historical ex vivo and in silico ***,the effect of interspinous,intertransverse ligaments and the Thoracolumbar Fascia(TLF)on spinal stiffness is evaluated by systematic construction of the *** flexion,model Range of Motion(ROM)was 12.92±0.11°(ex vivo:16.58°,in silico:12.96°)at *** LB,average ROM was 13.67±0.12°at 7.5 Nm(ex vivo:15.21±1.89°,in silico:15.49±0.23°).Similarly,in AR,average ROM was 17.69±2.12°at 7.5Nm(ex vivo:14.12±0.31°,in silico:15.91±0.28°).The addition of interspinous and intertransverse ligaments increased both flexion and LB stiffnesses by approximately 5%.Addition of TLF showed increase in flexion and AR stiffnesses by 29%and 24%,*** novel model can reproduce physiological ROMs with high repeatability and could be a useful open-source tool in spine biomechanics.

关键词： Lumbar spine 3d printing Intervertebral disc Biomechanical testing Spine mechanics

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Analysis of the inflection points of height-diameter models

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Forest Ecosystems 2024年第4期11卷 414-422页

作者： Tzeng Yih Lam mark J.ducey department of Forest Resources Management Faculty of ForestryThe University of British Columbia2045-2424 Main MallVancouverBCV6T 1Z4 Canada department of Natural Resources and the Environment University of New Hampshire114 James HallDurhamNH 03824USA

The inflection point is an important feature of sigmoidal height-diameter(H-d)*** is often cited as one of the properties favoring sigmoidal model ***,there are very few studies analyzing the inflection points of H-d *** goals of this study were to theoretically and empirically examine the behaviors of inflection points of six common H-d models with a regional *** six models were the Wykoff(WYK),Schumacher(SCH),Curtis(CUR),HossfeldⅣ(HOS),von Bertalanffy-Richards(VBR),and Gompertz(GPZ)*** models were first fitted in their base forms with tree species as random effects and were then expanded to include functional traits and spatial *** distributions of the estimated inflection points were similar between the two-parameter models WYK,SCH,and CUR,but were different between the threeparameter models HOS,VBR,and *** produced some of the largest inflection *** and VBR produced concave H-d curves without inflection points for 12.7%and 39.7%of the tree *** species or decreasing shade tolerance resulted in larger inflection *** trends in the estimated inflection points of HOS and VBR were entirely opposite across the ***,HOS could produce concave H-d curves for portions of the *** on the studied behaviors,the choice between two-parameter models may not *** recommend comparing seve ral three-parameter model forms for consistency in estimated inflection points before deciding on *** sigmoidal models to have inflection points does not necessarily mean that they will produce fitted curves with *** study highlights the need to integrate analysis of inflection points into modeling H-d relationships.

关键词： Concavity Forest inventory and analysis Generalized height-diameter models Growth functions Height-diameter functions Mixed-effects modeling Points of inflection Species-specific models

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The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

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Animal Models and Experimental Medicine 2024年第2期7卷 145-155页

作者： Yingfang Fan Jean Yuh Sashank Lekkala Mehmet d.Asik Andrew Thomson Madeline McCanne mark A.Randolph Antonia F.Chen Ebru Oral Harris Orthopaedic Laboratory Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA department of Orthopaedic Surgery Harvard Medical SchoolBostonMassachusettsUSA department of Surgery Harvard Medical SchoolBostonMassachusettsUSA department of Orthopaedic Surgery Brigham and Women's HospitalBostonMassachusettsUSA

Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint *** E is an antioxidant with potential anti-fibroblastic *** aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint ***:We simulated knee replacement in 16 male Sprague–dawley *** immobilized the surgical leg with a suture in full *** control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of *** staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic *** weight bearing(total internal reflection)and range of motion(ROM)were collected for functional ***:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both *** analysis confirmed fibrosis in both lateral and posterior periarticular *** E supplementation showed a moderate anti-inflammatory effect on the local and systemic *** vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control ***:This model is viable for simulating arthrofibrosis after joint *** E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.

关键词： arthrofibrosis range of motion total knee arthroplasty vitamin E

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Biopolymer stabilization of clayey soil

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第7期16卷 2801-2812页

作者： Mahdieh Azimi Amin Soltani Mehdi Mirzababaei mark B.Jaksa Nanjappa Ashwath College of Engineering and Aviation School of Engineering and TechnologyCQUniversityMelbourneVIC 3000Australia Institute of Innovation Science and Sustainabilityand Future Regions Research CenterFederation UniversityChurchillVIC 3842Australia department of Infrastructure Engineering Faculty of Engineering and Information TechnologyThe University of MelbourneParkvilleVIC 3010Australia School of Architecture and Civil Engineering The University of AdelaideAdelaideSA 5005Australia School of Health Medical and Applied SciencesCQUniversityRockhamptonQLD 4701Australia

This study investigates the efficacy of sodium alginate(SA),xanthan gum(XG),guar gum(GG)and chitosan(CS)d each applied at five different solid biopolymer-to-water mass ratios(or dosages)and cured for 7 d and 28 d d on the unconfined compressive strength(UCS)performance of a high plasticity clayey ***,on identifying the optimum biopolymer-treatment scenarios,their performance was compared against conventional stabilization using hydrated *** a given curing time,the UCS for all biopolymers followed a riseefall trend with increasing biopolymer dosage,peaking at an optimum dosage and then subsequently decreasing,such that all biopolymer-stabilized samples mobilized higher UCS values compared to the unamended *** optimum dosage was found to be 1.5%for SA,XG and CS,while a notably lower dosage of 0.5%was deemed optimum for ***,for a given biopolymer type and dosage,increasing the curing time from 7 d to 28 d further enhanced the UCS,with the achieved improvements being generally more pronounced for XG-and CS-treated *** of the investigated biopolymers was able to produce UCS improvements equivalent to those obtained by the 28-d soilelime samples;however,the optimum XG,GG and CS dosages,particularly after 28 d of curing,were easily able to replicate 7-d lime stabilization outcomes achieved with as high as twice the soil’s lime ***,the fundamental principles of clay chemistry,in conjunction with the soil mechanics framework,were employed to identify and discuss the clayebiopolymer stabilization mechanisms.

关键词： Soil stabilization High plasticity clay Biopolymer dosage Hydrated lime Curing time Unconfined compressive strength(UCS)

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A three-dimensional feature extraction-based method for coal cleat characterization using X-ray μCT and its application to a Bowen Basin coal specimen

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第1期16卷 153-166页

作者： Yulai Zhang Matthew Tsang mark Knackstedt Michael Turner Shane Latham Euan Macaulay Rhys Pitchers ARC Training Centre for M3d Innovation Research School of PhysicsAustralian National UniversityCanberraACT2601Australia department of Materials Physics Research School of PhysicsAustralian National UniversityCanberraACT2601Australia Anglo American Steelmaking Coal BrisbaneQLD4000Australia SCT Operations Pty Ltd. WollongongNSW2500Australia

Cleats are the dominant micro-fracture network controlling the macro-mechanical behavior of *** understanding of the spatial characteristics of cleat networks is therefore important to the coal mining *** fracture networks(dFNs)are increasingly used in engineering analyses to spatially model fractures at various *** reliability of coal dFNs largely depends on the confidence in the input cleat *** of these parameters can be made from image-based three-dimensional(3d)characterization of coal cleats using X-ray micro-computed tomography(m CT).One key step in this process,after cleat extraction,is the separation of individual cleats,without which the cleats are a connected network and statistics for different cleat sets cannot be *** this paper,a feature extraction-based image processing method is introduced to identify and separate distinct cleat groups from 3d X-ray m CT ***(filters)representing explicit cleat features of coal are built and cleat separation is successfully achieved by convolutional operations on 3d coal *** new method is applied to a coal specimen with 80 mm in diameter and 100 mm in length acquired from an Anglo American Steelmaking Coal mine in the Bowen Basin,Queensland,*** is demonstrated that the new method produces reliable cleat separation capable of defining individual cleats and preserving 3d topology after ***-parallel fractures are also identified and separated,which has his-torically been challenging to delineate and rarely reported.A variety of cleat/fracture statistics is measured which not only can quantitatively characterize the cleat/fracture system but also can be used for dFN ***,variability and heterogeneity with respect to the core axis are *** heterogeneity is observed and suggests that the representative elementary volume(REV)of the cleat groups for engineering purposes may be a complex problem requ

关键词： Cleat separation Cleat statistics Feature extraction discrete fracture network(dFN)modeling

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