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Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

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Asian Journal of Urology 2024年第1期11卷 72-79页

作者： Vanessa A.Lukas Rahul Dutta Ashok K.Hemal Matvey Tsivian Timothy E.Craven nicholas A.Deebel David D.Thiel Ram Anil Pathak Brigham and Women's Hospital Division of UrologyDepartment of Surgery75 Francis StreetBostonMAUSA Atrium Health Wake Forest Baptist Medical Center Department of Urology1 Medical Center BlvdWinston-SalemNCUSA Mayo Clinic Florida Department of Urology4500 San Pablo RoadJacksonvilleFLUSA

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 ***:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were *** analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical ***:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were *** and multivariable analysis exhibited similar *** LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant *** hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant ***:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program *** the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

关键词： Minimally-invasive partial nephrectomy The American College of Surgeons National Surgical Quality Improvement Program Lengthof stay Hospital readmission

Hidden risks associated with conventional short intermittent hemodialysis:A call for action to mitigate cardiovascular risk and morbidity

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World Journal of Nephrology 2022年第2期11卷 39-57页

作者： Bernard Canaud Jeroen P Kooman nicholas M Selby Maarten Taal Andreas Maierhofer Pascal Kopperschmidt Susan francis Allan Collins Peter Kotanko Global Medical Office Fresenius Medical CareBad Homburg 61352Germany Department of Nephrology Montpellier UniversityMontpellier 34000France Department of Internal Medicine Maastricht UniversityMaastricht 6229 HXNetherlands Centre for Kidney Research and Innovation Academic Unit for Translational Medical SciencesSchool of MedicineUniversity of NottinghamDerby DE223DTUnited Kingdom Global Research Development Fresenius Medical CareSchweinfurt 97424Germany University of Nottingham Nottingham NG72RDUnited Kingdom Renal Research Institute Icahn School of Medicine at Mount SinaiNew YorkNY 10065United States

The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many ***,intermittent renal replacement therapy is also a source of recurrent stress for *** thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease *** cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular *** unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.

关键词： End stage kidney disease Cardiovascular mortality Dialytic morbidity Circulatory stress Biologic storm Dialysis sickness Personalized medicine

Combined risk modelling approach to identify the optimal carotid revascularisation approach

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Stroke & Vascular Neurology 2021年第3期6卷 476-482,I0080-I0084页

作者： James francis Burke Lewis B Morgenstern nicholas H Osborne Rodney A Hayward Neurology University of Michigan Michigan MedicineAnn ArborMichiganUSA Vascular Surgery Univerity of Michigan MedicineAnn ArborMichiganUSA Internal Medicine University of Michigan Michigan MedicineAnn ArborMichiganUSA

Background Carotid endarterectomy(CEA)results in fewer perioperative strokes,but more myocardial infarctions(MI)than carotid artery stenting(CAS).We explored a combined modelling approach that stratifies patients by baseline stroke and *** Baseline registry-based risk models for perioperative stroke and MI were identified via literature *** then selected treatment risk models in the Carotid Revascularisation Stenting versus Endarterectomy(CREST)trial by serially adding covariates(baseline risk,treatment(CEA vs CAS),treatment-risk interaction and age-treatment interaction terms).Treatment risk models were externally validated using data from the Society for Vascular Surgery(SVS)Vascular Quality Initiative(VQI)CEA and carotid stenting registries and treatment models were recalibrated to the SVS-VQI *** net benefit was estimated by summing the predicted stroke and MI risk differences with CEA versus *** Perioperative treatment models had moderate predictiveness(c-statistic 0.69 for stroke and 0.68 for MI)and reasonable calibration across the risk spectrum for both stroke and MI within *** external validation in SVS-VQI,predictiveness was substantially reduced(c-statistic 0.61 for stroke and 0.54 for MI)and models substantially overpredicted *** patients(86.7%)were predicted to have net benefit from CEA in CREST(97.0%of symptomatic patients vs 75%of asymptomatic patients).Discussion A combined modelling approach that separates risk elements has potential to inform optimal ***,our current approach is not ready for clinical *** data support guidelines that suggest that CEA should be the preferred revascularisation modality in most patients with symptomatic carotid stenosis.

关键词： carotid Surgery optimal

Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units:A systematic review and meta-analysis

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World Journal of Meta-Analysis 2024年第1期12卷 1-10页

作者： Donatien Serge Mbaga Sebastien Kenmoe Seraphine Nkie Esemu Arnol Bowo-Ngandji Nene Kaah Keneh Jane-francis Tatah Kihla Akoachere Hortense Kamga Gonsu Roland Ndip Ndip Jean Thierry Ebogo-Belobo Cyprien Kengne-Ndé nicholas Tendongfor Jean Paul Assam Assam Lucy Mande Ndip Jacky Njiki Bikoï Sara Honorine Riwom Essama Department of Microbiology The University of Yaounde IYaounde 00237Cameroon Department of Microbiology and Parasitology University of BueaBuea 00237Cameroon Faculty of Medicine and Biomedical Sciences The University of Yaounde IYaounde 00237Cameroon Center for Research in Health and Priority Pathologies Institute of Medical Research and Medicinal Plants StudiesYaounde 00237Cameroon Epidemiological Surveillance Evaluation and Research UnitNational AIDS Control CommitteeDouala 00237Cameroon

BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all *** infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune *** To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted *** We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index *** were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB *** excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary *** study selection and quality assessment were conducted independently by two *** extraction involved collecting comprehensive details about each *** statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional *** assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication *** We analyzed 737 records from f

关键词： Colonization Carbapenem-resistant Acinetobacter baumannii Neonatal intensive-care unit

Bile acid signaling and biliary functions

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Acta Pharmaceutica Sinica B 2015年第2期5卷 123-128页

作者： Hannah Jones Gianfranco Alpini Heather francis Baylor Scott & White Digestive Disease Research Center Division Research Central Texas Veterans Health Care System Department of Medicine Texas A&M University

This review focuses on various components of bile acid signaling in relation to cholangiocytes. Their roles as targets for potential therapies for cholangiopathies are also explored. While many factors are involved in these complex signaling pathways, this review emphasizes the roles of transmembrane G protein coupled receptor(TGR5), farnesoid X receptor(FXR), ursodeoxycholic acid(UDCA) and the bicarbonate umbrella. Following a general background on cholangiocytes and bile acids,we will expand the review and include sections that are most recently known(within 5–7 years) regarding the field of bile acid signaling and cholangiocyte function. These findings all demonstrate that bile acids influence biliary functions which can, in turn, regulate the cholangiocyte response during pathological events.

关键词： Bile acids Cholangiocytes Receptors Signaling

Perigeniculate arachnoid cysts and CSF fistulae of the fallopian canal:Histopathologic correlates of a rare clinical entity

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2021年第2期7卷 71-81页

作者： Emerson E.Lee nicholas S.Andresen Bryan McKenzie Jeffrey D.Sharon Howard W.francis Daniel Q.Sun Department of Otolaryngology-Head and Neck Surgery Johns Hopkins UniversityUSA Inova Fairfax Hospital USA Deportment of Otolaryngology-Head and Neck Surgery University of California Son FranciscoUSA Department of Head and Neck Surgery and Communication Sciences Duke UniversityUSA

Cerebrospinal fluid(CSF)fistulae originating from the fallopian canal of the facial nerve is hypothesized to arise due to atypical patterns of subarachnoid space extension into the geniculate ganglion or more distal regions along the intratemporal course of the facial nerve,but its pathogenesis remains poorly *** a rare etiology of CSF fistulae of the temporal bone,there are significant clinical ramifications due to the risk of recurrent meningitis,difficulty in identifying the anatomic location of the CSF leak,and technical challenges associated with surgical *** present three clinical cases of arachnoid cysts within the geniculate fossa with or without CSF fistulization and provide histopathologic correlates of this rare clinical phenomenon from a human temporal bone *** pediatric and adult patients presented suggest differential pathophysiologic mechanisms associated with CSF *** bone histology reveals atypical patterns of subarachnoid space extension in the fallopian canal that may underlie arachnoid cyst formation and overt CSF leak from the geniculate region.

关键词： Geniculate ganglion Arachnoid cyst Fallopian canal Facial nerve Cerebrospinal fluid otorrhea Cerebrospinal fluid leak Subarachnoid space

趣味与古物(四)古典雕塑的魅力:1500—1900

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新美术 2023年第4期44卷 4-36页

作者： [英]弗朗西斯·哈斯克尔 [英]尼古拉斯·彭尼孔令伟(译) 杨思梁(校) 不详中国美术学院

第九章十八世纪罗马的博物馆1728年12月10日,罗马的法兰西学院院长,尼古拉·伍勒格斯[Nicolas Vleughels]给国王的建筑总监——巴黎的安廷公爵[Duc d’Antin]写了一封信:“波兰国王派人到罗马,买下了基吉王子[Chigi]所有的古代雕像,还... 详细信息

第九章十八世纪罗马的博物馆1728年12月10日,罗马的法兰西学院院长,尼古拉·伍勒格斯[Nicolas Vleughels]给国王的建筑总监——巴黎的安廷公爵[Duc d’Antin]写了一封信:“波兰国王派人到罗马,买下了基吉王子[Chigi]所有的古代雕像,还有红衣主教亚历山德罗·阿尔巴尼[Cardinal Alessandro Albani]收罗的很多藏品。前段时间,西班牙国王也搬走了唐·利维奥·奥代斯卡尔基[Don Livio Odescalchi]的藏品。数量可不少。看起来,这个不幸的国家正在一点点被洗劫。”

关键词：法兰西学院西班牙国王尼古拉阿尔巴尼一封信卡尔基

Males as Partners in Family Planning Service Uptake in Ghana: A Descriptive Cross-Sectional Survey

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Health 2019年第8期11卷 1043-1054页

作者： Seth Christopher Yaw Appiah francis Adjei Osei nicholas Karikari Mensah Patrick Lebene Adonoo Abdul Ganiu Tanko Phans Oduro Sarpong Department of Sociology and Social Work Kwame Nkrumah University of Science Technology Kumasi Ghana Ludwig-Maximilians Universitate LMU-Centre for International Health-University of Munich Munchen Germany Public Health Unit Komfo Anokye Teaching Hospital Kumasi Ghana School of Government Sun Yat-Sen University of Guangzhou Guangzhou China Department of Planning Kwame Nkrumah University Science Technology Kumasi Ghana Research and Development Unit Komfo Anokye Teaching Hospital Kumasi Ghana

Background: Family planning is an efficient and effective intervention that results in quick benefits for the whole family socio-economically. Differences exist in the rate of contraceptive use between male and female and male involvement of service uptake in Ghana. The objective of this study was to explore male direct involvement and or support to their partners in family planning service uptake. Methods: The study used a descriptive cross-sectional survey to sample 384 men of reproductive age (18 - 45 year) using cluster sampling to enlist participants from within the Suame Magazine light Industrial area in the Ashanti Region of Ghana. Data was analyzed descriptively using SPSS version 16. Results: Men showed very high knowledge (90%) about what constitutes Family Planning, with moderate level of involvement both active and passive involvement (56%) though only a few (38.9%) were presently adopting or using modern contraceptive. The study rather found only 14% (55) males were willing to be solely responsible and actively involved in Family Planning service. Family Planning services did not adequately meet the needs of men with the services centers remaining unavailable in the study area. Conclusion: The extent of male involvement in family planning programmes is marginally above average. Males showed appreciable knowledge of family planning options though misconceptions continued to exist. A more couple-oriented approach to family planning is needed including recruiting males as family planning providers, offering more family planning counseling for couples, and promoting female-oriented methods with men and vice versa.

关键词： Family Planning Information Sharing Attitude Knowledge Contraceptives Utilization Ghana

Cellular crosstalk during cholestatic liver injury

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Liver Research 2017年第1期1卷 26-33页

作者： Joanne Thomson Laura Hargrove Lindsey Kennedy Jennifer Demieville Heather francis Research Central Texas Veterans Healthcare SystemTXUSA Digestive Disease Research Center Baylor Scott&White HealthTXUSA Medicine Texas A&M Health Science CenterTempleTXUSA

The functions of the liver are very *** detoxifying blood to storing glucose in the form of glycogen and producing bile to facilitate fat digestion,the liver is a very active and important *** liver is comprised of many varied cell types whose functions are equally *** line the biliary tree and aid in transporting and adjusting the composition of bile as it travels to the *** stellate cells and portal fibroblasts are located in different areas within the liver architecture,but both contribute to the development of fibrosis upon activation after liver *** cells,including those that constitute the peribiliary vascular plexus,are involved in functions other than blood delivery to and from the liver,such as supporting the growth of the biliary tree during *** cells are normally found in healthy livers but in very low ***,after injury,mast cell numbers greatly increase as they infiltrate and release factors that exacerbate the fibrotic *** not an all-inclusive list,these cells have individual roles within the liver,but they are also able to communicate with each other by cellular *** this review,we examine some of these pathways that can lead to an increase in the homeostatic dysfunction seen in liver injury.

关键词： Mast cells Paracrine Cholangiocytes Hepatic stellate cells Crosstalk