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Complications of chronic pancreatitis prior to and following surgical treatment:A proposal for classification

World Journal of Clinical Cases 2022年第22期10卷 7808-7824页

作者： marko murruste Ülle Kirsimägi Karri Kase Tatjana Veršinina Peep Talving Urmas Lepner Department of Surgery Tartu University HospitalTartu 50406Estonia Department of Surgery BoardNorth Estonia Medical CentreTallinn 13419Estonia

BACKGROUND Chronic pancreatitis(CP)is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological *** The aims of this study were to:Propose a pathophysiological classification of the complications of CP;evaluate their prevalence in a surgical cohort prior to,and following surgical management;and assess the impact of the surgical treatment on the occurrence of new complications of CP during *** hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications,with the exclusion of pancreatic *** primary outcomes were prevalence of complications of CP at baseline(prior to surgical treatment)and occurrence of new complications during *** After institutional review board approval,a prospective observational cohort study with long-term follow-up(up to 20.4 years)was *** consecutive single-center adult patients(≥18 years of age)with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021,were *** prevalence of CP complications evaluated,according to the proposed classification,in a surgical cohort of 166 *** of the pathophysiological classification was based on a literature review on the clinical presentation,course,and complications of CP,as well a review of previous classification systems of *** We distinguished four groups of complications:Pancreatic duct complications peripancreatic complications,pancreatic hemorrhages,and pancreatic insufficiency(exocrine and endocrine).Their baseline prevalence was 20.5%,23.5%,10.2%,31.3%,and 27.1%,*** treatment was highly effective in avoiding new complications in the first and third *** the group of peripancreatic complications,the 15-year Kaplan-Meier prevalence of new complications was 12.1%.The prevalence of pancreatic exocrine and en

关键词： Chronic pancreatitis Complications Classification Pathophysiology Surgical treatment

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‘Short’pancreaticojejunostomy might be a valid option for treatment of chronic pancreatitis in many cases

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1673-1684页

作者： marko murruste Ülle Kirsimägi Karri Kase Tatjana Veršinina Peep Talving Urmas Lepner Department of Surgery Tartu University HospitalTartu 50406Estonia Faculty of Medicine University of TartuTartu 50411Estonia Division of Acute Care Surgery Department of SurgeryNorth-Estonia Medical CentreTallinn 13419Estonia

BACKGROUND The Partington-Rochelle pancreaticojejunostomy(PJ)is an essential management option for patients with chronic pancreatitis(CP)associated with intractable pain and a dilated pancreatic duct(PD).Wide ductotomy and long PJ(L-PJ)have been advocated as the standard of care to ensure full PD ***,the role of short PJ(S-PJ)in a uniformly dilated PD has not yet been *** To evaluate the possible advantages and disadvantages of S-PJ and L-PJ and to interpret the perspective of S-PJ in the treatment of *** A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side *** length of the PJ was adapted to anatomical alterations in PD.A comparison was made of S-PJ(<50 mm)for uniformly dilated PD and L-PJ(50-100 mm)in the setting of multiple PD strictures,calcifications and *** hypothesized that S-PJ and L-PJ ensure comparable clinical *** primary outcomes were pain relief and quality of life(QOL);the secondary outcomes were perioperative characteristics,body weight,patients’satisfaction with treatment,and readmission rate due to *** Overall,91 patients underwent side-to-side PJ for CP,including S-PJ in 46 patients and L-PJ in 45 patients.S-PJ resulted in better perioperative outcomes:Significantly shorter operative time(107.5 min vs 134 min),lower need for intraoperative(0%vs 15.6%)and total(2.2%vs 31.1%)blood transfusions,and lower rate of perioperative complications(6.5%vs 17.8%).We noted no significant difference in pain relief,improvement in QOL,body weight gain,patients’satisfaction with surgical treatment,or readmission rate due to *** Based on our data,in the setting of a uniformly dilated PD,S-PJ provides adequate decompression of the *** the clinical outcomes following S-PJ are not inferior to those of L-PJ,S-PJ should be preferred as a surgical option in the case of a uniformly dilated PD.

关键词： Chronic pancreatitis Surgical treatment Pancreaticojejunostomy Partington-Rochelle Length of anastomosis

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Torsion of Meckel's diverticulum as a cause of small bowel obstruction: A case report

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World Journal of Gastrointestinal Surgery 2014年第10期6卷 204-207页

作者： marko murruste Geidi Rajaste Karri Kase Department of General and Plastic Surgery Surgery Clinic Tartu University Hospital Tartu 51014 Estonia Surgery Clinic Tartu University Hospital Tartu 51014 Estonia

Axial torsion and necrosis of Meckel's diverticulum causing simultaneous mechanical small bowel obstruc-tion are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel's diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and re-tention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography(CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral con-trast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proxi-mal to the obstruction, and a large(12 cm × 14 cm) Meckel's diverticulum at the site of obstruction. Meckel's diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel's diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postopera-tive day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel's diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; de-lay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.

关键词： Meckel’s diverticulum Axial torsion Gangrene Bowel obstruction Emergency surgery

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Discontinuation of therapy in inflammatory bowel disease: Current views

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World Journal of Clinical Cases 2024年第10期12卷 1718-1727页

作者： Antonio Meštrović marko Kumric Josko Bozic Department of Gastroenterology University Hospital of SplitSplit 21000Croatia Department of Pathophysiology University of Split School of MedicineSplit 21000Croatia

The timely introduction and adjustment of the appropriate drug in accordance with previously well-defined treatment goals is the foundation of the approach in the treatment of inflammatory bowel disease(IBD).The therapeutic approach is still evolving in terms of the mechanism of action but also in terms of the possibility of maintaining *** patients with achieved long-term remission,the question of de-escalation or discontinuation of therapy arises,considering the possible side effects and economic burden of long-term *** each of the drugs used in IBD(5-aminosalycaltes,immunomodulators,biological drugs,small molecules)there is a risk of ***,studies show that more than 50%of patients who discontinue therapy will *** on the findings of large studies and meta-analysis,relapse of disease can be expected in about half of the patients after therapy withdrawal,in case of monotherapy with aminosalicylates,immunomodulators or biological ***,longer relapse-free periods are recorded with withdrawal of medication in patients who had previously been on combination therapies immunomodulators and anti-tumor necrosis *** needs to be stressed that randomised clinical trials regarding withdrawal from medications are still *** making a decision on discontinuation of therapy,it is important to distinguish potential candidates and predictive factors for the possibility of disease *** calprotectin level has currently been identified as the strongest predictive factor for *** other predictive factors have also been identified,such as:High Crohn's disease activity index or Harvey Bradshaw index,younger age(40 years),smoking,young age of disease onset,steroid use 6-12 months before *** important factor in the decision to withdraw medication is the success of re-treatment with the same or other *** decision to discontinue therapy must be based on in

关键词： Inflammatory bowel disease Therapy discontinuation Therapy de-escalation Ulcerative colitis Crohn’s disease

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Design and initial testing of a maize cob collection system

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International Journal of Agricultural and Biological Engineering 2024年第3期17卷 108-114页

作者： Bojan Dolšak Anita Breznik Klemen Kaučič Nataša Imenšek marko Marčec Peter Gselman Jani Humar Mitja Krajnc University of Maribor Faculty of Mechanical EngineeringSmetanova ulica 172000 MariborSlovenia ŽIPO Lenart Ltd. Šetarova 212230 LenartSlovenia KGS Krajnc Ltd Vinička vas 42230 LenartSlovenia Interkorn Ltd. Gančani 949231 BeltinciSlovenia

Maize cobs are valuable plant residues that can be used for many different purposes,including as a renewable energy *** their value,maize cobs are still underutilized,mainly because people are not aware of their potential and harvesting techniques for their collection are still being ***,this research focused on finding the most suitable energy-and time-efficient method for mechanical collection of maize *** the combine harvester with an additional hopper proved to be the most promising solution,as it allows harvesting and storage of maize grain and maize cobs in one pass,while the harvesting time remains almost the same and the maize cobs are of good quality,as they do not fall on the field.A prototype with enlarged openings in the straw walkers,an additional grab container for maize cobs,a transport auger,a transport cleaning fan with built-in knives,a transport tube and some other assemblies was fabricated and used in *** first test results are very encouraging(94.4%-96.0%purity of maize cobs)and the system has been patented as a promising solution,especially in times when the environmental sustainability of the planet and energy independence are becoming increasingly important.

关键词： maize cobs utilization mechanical harvesting combine harvester upgrade

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Twenty-nine million intrinsic Q-factor monolithic microresonators on thin-film lithium niobate

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Photonics Research 2024年第8期12卷 I0001-I0006页

作者： XINRUI ZHU YAOWEN HU SHENGYUAN LU HANA KWARNER XUDONG LI YUNXIANG SONG LETÍCIA MAGALHÃES AMIRHASSAN SHAMS-ANSARI ANDREA CORDARO NEIL SINCLAIR marko LONČAR John A.Paulson School for Engineering and Applied Sciences Harvard UniversityCambridgeMassachusetts 02138USA State Key Laboratory for Mesoscopic Physics and Frontiers Science Center for Nano-optoelectronics School of PhysicsPeking UniversityBeijing 100871China DRS Daylight Solutions San DiegoCalifornia 92127USA

The recent emergence of thin-film lithium niobate(TFLN)has extended the landscape of integrated *** has been enabled by the commercialization of TFLN wafers and advanced nanofabrication of TFLN such as high-quality dry ***,fabrication imperfections still limit the propagation loss to a few dB/m,restricting the impact of this ***,we demonstrate TFLN microresonators with a record-high intrinsic quality(Q)factor of twenty-nine million,corresponding to an ultra-low propagation loss of 1.3 dB/*** present spectral analysis and the statistical distribution of Q factors across different resonator *** work pushes the fabrication limits of TFLN photonics to achieve a Q factor within 1 order of magnitude of the material limit.

关键词： resonator lithium film

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Growth differentiation factor-15 serum concentrations reflect disease severity and anemia in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2024年第13期30卷 1899-1910页

作者： Ante Tonkic marko Kumric Ivna Akrapovic Olic Doris Rusic Piero Marin Zivkovic Daniela Supe Domic Zeljko Sundov Ivan Males Josko Bozic Biology of Neoplasms University of Split School of MedicineSplit 21000Croatia Department of Pathophysiology University of Split School of MedicineSplit 21000Croatia Department of Gastroenterology University Hospital of SplitSplit 21000Croatia Department of Pharmacy University of Split School of MedicineSplit 21000Croatia Department of Medical Laboratory Diagnostics University Hospital of SplitSplit 21000Croatia Department of Health Studies University of SplitSplit 21000Croatia Department of Internal Medicine University of Split School of MedicineSplit 21000Croatia Department of Surgery University Hospital of SplitSplit 21000Croatia

BACKGROUND Population of patients with inflammatory bowel disease(IBD)is burdened by various extraintestinal manifestations which substantially contribute to greater morbidity and ***-differentiation factor-15(GDF-15)is often overexpressed under stress conditions,such as inflammation,malignancies,heart failure,myocardial ischemia,and many *** To explore the association between GDF-15 and IBD as serum concentrations of GDF-15 were shown to be an independent predictor of poor outcomes in multiple *** additional aim was to determine possible associations between GDF-15 and multiple clinical,anthropometric and laboratory parameters in patients with *** This cross-sectional study included 90 adult patients diagnosed with IBD,encompassing both Crohn’s disease(CD)and ulcerative colitis(UC),and 67 healthy age-and sex-matched *** patients underwent an extensive workup,including colonoscopy with subsequent histopathological *** activity was assessed by two independent gastroenterology consultants specialized in IBD,employing well-established clinical and endoscopic scoring ***-15 serum concentrations were determined following an overnight fasting,using electrochemiluminescence *** In patients with IBD,serum GDF-15 concentrations were significantly higher in comparison to the healthy controls[800(512-1154)pg/mL vs 412(407-424)pg/mL,P<0.001],whereas no difference in GDF-15 was found between patients with CD and UC[807(554-1451)pg/mL vs 790(509-956)pg/mL,P=0.324].Moreover,multiple linear regression analysis showed that GDF-15 levels predict CD and UC severity independent of age,sex,and C-reactive protein levels(P=0.016 and P=0.049,respectively).Finally,an association between GDF-15 and indices of anemia was ***,negative correlations were found between GDF-15 and serum iron levels(r=-0.248,P=0.021),as well as GDF-15 and hemoglobin(r=-0.351,P=0.021).Accordingly,in comparison to I

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Growth-differentiation factor-15 Anemia Extraintestinal manifestations

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Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

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Oncology Research 2024年第5期32卷 807-815页

作者： marko SKELIN BRUNA PERKOV-STIPIČIN SANJA VUŠKOVIĆ MARINAŠANDRK PLEHAČEK ANE BAŠIĆ DAVIDŠARČEVIĆ MAJA ILIĆ IVAN KREČAK Pharmacy Department General Hospital ofŠibenik-Knin CountyŠibenikCroatia Faculty of Medicine University of RijekaRijekaCroatia Undergraduate Study in Nursing University of Applied SciencesŠibenikCroatia Department of Oncology University Hospital Center ZagrebZagrebCroatia Pharmacies Joukhadar Sveta NedeljaCroatia Pharmacies Prima Pharme ZagrebCroatia Pharmacy Department General Hospital ZadarZadarCroatia Pharmacy Department General Hospital PulaPulaCroatia Department of Internal Medicine General Hospital ofŠibenik-Knin CountyŠibenikCroatia

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)***,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically *** study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer ***:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each *** examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer ***:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR ***,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous *** proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current *** the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)*** variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer ***:One-third of the current ESMO CPG recommendations are supported by the highest level of *** well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

关键词： ESMO guidelines Clinical practice guidelines Level of evidence Grade of recommendation

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Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

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Stroke & Vascular Neurology 2024年第3期9卷 279-288,I0247页

作者： Adam Ingleton marko Raseta Rui-En Chung Kevin Jun Hui Kow Jake Weddell Sanjeev Nayak Changez Jadun Zafar Hashim Noman Qayyum Phillip Ferdinand Indira Natarajan Christine Roffe Neurosciences University Hospitals of North Midlands NHS TrustStoke-on TrentUK Statistics and Mathematical Modelling Department of Molecular GeneticsErasmus Medical CenterRotterdamZuid-HollandThe Netherlands Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK School of Medicine Keele UniversityKeeleUK Interventional Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK Stroke Research Keele UniversityKeeleUK

Background Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy(MT).Most patients undergoing MT are also given *** agents are contraindicated within 24 hours of *** evaluated outcomes and complications of patients stented with and without intravenous aspirin during *** All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital,UK between 2010 and 2020,were *** were thrombolysed before MT,unless *** 500 mg intravenously was given intraoperatively at the discretion of the *** intracranial haemorrhage(sICH)and the National Institutes for Health Stroke Scale score(NIHSS)were recorded at 7 days,and mortality and functional recovery(modified Rankin Scale:mRS≤2)at 90 *** Out of 565 patients treated by MT 102 patients(median age 67 IQR 57–72 years,baseline median NIHSS 18 IQR 13–23,76(75%)thrombolysed)had a stent *** these 49(48%)were given aspirin and 53(52%)were *** treated with aspirin had greater NIHSS improvement(median 8 IQR 1–16 vs median 3 IQR-9–8 points,p=0.003),but there were no significant differences in sICH(2/49(4%)vs 9/53(17%)),mRS≤2(25/49(51%)vs 19/53(36%))and mortality(10/49(20%)vs 12/53(23%))with and without *** improvement(median 12 IQR 4–18 vs median 7 IQR-7–10,p=0.01)was greater,and mortality was lower(4/33(12%)vs 6/15(40%),p=0.05)when aspirin was combined with thrombolysis,than for aspirin alone,with no increase in *** Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes,even when combined with intravenous thrombolysis.

关键词： patients aspirin intravenous

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Outcomes of long-acting injectable antipsychotics use in pregnancy:A literature review

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World Journal of Psychiatry 2024年第4期14卷 582-599页

作者： Ana V Pejčić Srdjan M Stefanović MilošN Milosavljević Vladimir S Janjić marko M Folić Nevena D Folić Jovana Z Milosavljević Department of Pharmacology and Toxicology Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of Pharmacy Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of Clinical Pharmacology University Clinical Center KragujevacKragujevac 34000Serbia Department of Psychiatry Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Clinic for Psychiatry University Clinical Center KragujevacKragujevac 34000Serbia Center for Pharmaceutical and Pharmacological Research Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Department of Pediatrics Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia Pediatric Clinic University Clinical Center KragujevacKragujevac 34000Serbia Department of Anatomy Faculty of Medical SciencesUniversity of KragujevacKragujevac 34000Serbia

BACKGROUND Women with a history of serious psychotic disorders are at increased risk of disease relapse during ***-acting injectable(LAI)antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders,but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during *** To summarize relevant data on maternal,pregnancy,neonatal,and developmental outcomes from published cases of LAI antipsychotic use in *** A literature search was performed through November 11,2023,using three online databases:PubMed/MEDLINE,Scopus,and Web of *** reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy,with available full texts,were *** statistics,narrative summation,and tabulation of the extracted data were *** A total of 19 publications satisfied the inclusion criteria:3 case series,15 case reports,and 1 conference *** reported the outcomes of LAI antipsychotic use in 74 women and 77 *** use of secondgeneration LAI antipsychotics was reported in the majority(n=47;61.0%)of ***-generation LAI antipsychotics were administered during 30 pregnancies(39.0%).Most of the women(approximately 64%)had either satisfactory control of symptoms or no information about relapse,while approximately 12%of them had developed gestational diabetes mellitus.A minority of cases reported adverse outcomes such as stillbirth,spontaneous abortion,preterm birth,low birth weight,congenital anomalies,and neurological manifestations in ***,there were no reports of negative long-term developmental *** Currently available data seem reassuring,but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

关键词： Antipsychotic agents Long-acting injectable Pregnancy Outcome Review

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