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Subtotal colectomy in ulcerative colitis—long term considerations for the rectal stump

World Journal of Gastrointestinal Surgery 2021年第2期13卷 198-209页

作者： orla hennessy Laurence Egan Myles Joyce Department of Colorectal Surgery Galway University HospitalGalway H91RR2NIreland Department of Gastroenterology Galway University HospitalGalway H91RR2NIreland

BACKGROUND The initial operation of choice in many patients presenting as an emergency with ulcerative colitis is a subtotal colectomy with end ileostomy.A percentage of patients do not proceed to completion proctectomy with ileal pouch anal *** To review the existing literature in relation to the significant long-term complications associated with the rectal stump,to provide an overview of options for the surgical management of remnant rectum and anal canal and to form a consolidated guideline on endoscopic screening recommendations in this *** A systematic review was carried out in accordance with PRISMA guidelines for papers containing recommendations for endoscopy surveillance in rectal remnants in ulcerative colitis.A secondary narrative review was carried out exploring the medical and surgical management options for the retained *** For rectal stump surveillance guidelines,20%recommended an interval of 6 mo to a year,50%recommended yearly surveillance 10%recommended 2 yearly surveillance and the remaining 30%recommended risk stratification of patients and different screening intervals based on *** studies agreed surveillance should be carried out via endoscopy and *** vigilance is needed in endoscopy in these *** review revealed a number of options for surgical management of the remnant *** The retained rectal stump needs to be surveyed endoscopically according to risk *** care must be taken to avoid rectal perforation and pelvic sepsis at time of *** completion proctectomy is indicated the authors favour removal of the anal canal using an intersphincteric dissection technique.

关键词： Stump Ulcerative colitis Surveillance Endoscopy Rectal Screening

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Disability management and rehabilitation for persons with multiple sclerosis

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Neural Regeneration Research 2010年第4期5卷 301-309页

作者： Fary Khan orla Gray Department of Medicine University of MelbourneParkville Department of Rehabilitation Medicine Royal Melbourne HospitalParkville

Multiple sclerosis is the commonest cause of chronic neurological disability in young adults. Patients typically have a normal life span, though with accrued time multiple disabilities with a significant impact on quality of life. This article presents the current literature on symptomatic treatment and rehabilitation for persons with multiple sclerosis. A comprehensive multidisciplinary approach addresses the acute, intermediate and long-term medical, psychological and social issues faced by these individuals. Prevention of medical complications, maintenance and restoration of functional independence, addressing psychosocial factors and issues relating to quality of life are integral to the rehabilitation processes.

关键词： multiple sclerosis disability management rehabilitation multidisciplinary effectiveness literature review neurodegenerative disease neural regeneration

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Oesophageal cancer metastases:An observational study of a more aggressive approach

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 997-1007页

作者： Lianne Pickett Mary Dunne orla Monaghan Liam Grogan Oscar Breathnach Thomas N Walsh Department of Surgery Connolly HospitalBlanchardstownDublin D15 X40DIreland Clinical Trials Resource Unit St Luke's Radiation Oncology NetworkDublin D06 HH36Ireland Department of Radiation Oncology St Luke's Radiation Oncology NetworkDublin D06 HH36Ireland Department of Medical Oncology Beaumont HospitalDublin D09 V2N0Ireland Department of Surgery RCSI BahrainAdliya 15503Bahrain

BACKGROUND The prognosis for oesophageal carcinoma is poor,but once distant metastases emerge the prognosis is considered *** is no consistent protocol for the early identification and aggressive management of *** To examine the outcome of a policy of active postoperative surveillance with aggressive treatment of confirmed *** A prospectively maintained database of 205 patients diagnosed with oesophageal carcinoma between 1998 and 2019 and treated with curative intent was interrogated for patients with metastases,either at diagnosis or on follow-up surveillance and treated for *** cohort was compared with incomplete clinical responders to neoadjuvant chemoradiotherapy(nCRT)who subsequently underwent surgery on their primary *** survival was estimated using the Kaplan-Meier method,and the log-rank test was used to compare survival differences between *** Of 205 patients,11(5.4%)had metastases treated for cure(82%male;median age 60 years;9 adenocarcinoma and 2 squamous cell carcinomas).All had undergone neoadjuvant chemotherapy or chemoradiotherapy,followed by surgery in all but 1 *** the 11 patients,4 had metastatic disease at diagnosis,of whom 3 were successfully downstaged with nCRT before definitive surgery;2 of these 4 also developed oligometastatic recurrence and were treated with curative *** definitive treatment,7 had treatment for metachronous oligometastatic disease;5 of whom underwent metastasectomy(adrenal×2;lung×2;liver×1).The median overall survival was 10.9 years[95%confidence interval(CI):0.7-21.0 years],which was statistically significantly longer than incomplete clinical responders undergoing surgery on the primary tumour without metastatic intervention[n=62;median overall survival=1.9(95%CI:1.1-2.7;P=0.012].The cumulative proportion surviving 1,3,and 5 years was 100%,91%,and 61%,respectively compared to 71%,36%,and 25%for incomplete clinical responders undergoing surge

关键词： Oesophageal metastases Oligometastases Active surveillance Treatment for cure Metastasectomy Survival

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Localization of urea transporter B in the developing bovine rumen

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Animal Nutrition 2022年第3期10卷 216-222页

作者： Chongliang Zhong Tamsin Lyons orla Heussaff Evelyn Doyle Eoin O'Hara Sinead M.Waters David Kenny Gavin S.Stewart School of Biology and Environmental Science University College DublinBelfieldDublin 4Ireland Animal and Bioscience Research Department Animal and Grassland Research and Innovation CentreTeagascGrangeCounty MeathIreland Department of Agriculture Foodand Nutritional SciencesUniversity of AlbertaEdmontonAlbertaCanada

Urea nitrogen secreted from blood to rumen is a crucial factor shaping the symbiotic relationship between host ruminants and their microbial *** of urea across rumen epithelia is facilitated by urea transporter B(UT-B),but the long-term regulation of these proteins remains *** ruminal function develops over a period of months,the developing rumen is an excellent model with which to investigate this *** rumen epithelium samples of calves from birth to 96 d of age,this study performed immunolocalization studies to localize and semi-quantify UT-B protein *** expected,preliminary experiments confirmed that ruminal monocarboxylate transporter 1(MCT1)short chain fatty acid transporter protein abundance increased with age(P<0.01,n=4).Further investigation revealed that ruminal UT-B was present in the first few weeks of life and initially detected in the basolateral membrane of stratum basale *** the next 2 months,UT-B staining spread to other epithelial layers and semi-quantification indicated that UT-B abundance significantly increased with age(P<0.01,n=4 or 6).These changes were in line with the development of rumen function after the advent of solid feed intake and weaning,exhibiting a similar pattern to both MCT1 transporters and papillae *** study therefore confirmed age-dependent changes of in situ ruminal UT-B protein,adding to our understanding of the long-term regulation of ruminal urea transporters.

关键词： UT-B Immunolocalization Rumen Bovine Development

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Achalasia: A review of clinical diagnosis, epidemiology,treatment and outcomes

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World Journal of Gastroenterology 2013年第35期19卷 5806-5812页

作者： orla M O'Neill Brian T Johnston Helen G Coleman Centre for Public Health Queen’s University Belfast Department of Gastroenterology Belfast Health and Social Care Trust

Achalasia is a neurodegenerative motility disorder of the oesophagus resulting in deranged oesophageal peristalsis and loss of lower oesophageal sphincter ***,annual achalasia incidence rates were believed to be low,approximately 0.5-1.2 per *** recent reports suggest that annual incidence rates have risen to 1.6 per 100000 in some *** aetiology of achalasia is still unclear but is likely to be *** causes include environmental or viral exposures resulting in inflammation of the oesophageal myenteric plexus,which elicits an autoimmune *** of achalasia may be elevated in a sub-group of genetically susceptible *** in the diagnosis of achalasia,through the introduction of high resolution manometry with pressure topography plotting,has resulted in the development of a novel classification system for *** classification system can evaluate patient prognosis and predict responsiveness to *** is currently much debate over whether pneumatic dilatation is a superior method compared to the Heller’s myotomy procedure in the treatment of achalasia.A recent com-parative study found equal efficacy,suggesting that patient preference and local expertise should guide the *** achalasia is a relatively rare condition,it carries a risk of complications,including aspiration pneumonia and oesophageal *** risk of both squamous cell carcinoma and adenocarcinoma of the oesophagus is believed to be significantly increased in patients with achalasia,however the absolute excess risk is ***,it is currently unknown whether a surveillance programme in achalasia patients would be effective or cost-effective.

关键词： Epidemiology Achalasia Incidence Treatment Oesophageal cancer risk

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Patterns of Recurrence in Low-Risk Endometrial Cancer

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Open Journal of Obstetrics and Gynecology 2022年第11期12卷 1155-1165页

作者： Taylor Hodge Yael Naaman Thomas Cade Deborah Neesham Antonia Jones orla McNally The Royal Women’s Hospital Melbourne Victoria Australia Department of Obstetrics and Gynaecology University of Melbourne Victoria Australia

Objective: Endometrial cancer is the most common gynaecological cancer in high-income countries and has a good prognosis, particularly when diagnosed early. Early stage, low-grade endometrial cancer has a low risk of recurrence, and is detectable on routine follow up. This study aims to identify rates and patterns of recurrence in low-risk endometrial cancer patients and provide evidence for transitioning to community-based follow-up care. Methods: Retrospective study of patients with early-stage, low-grade endometrioid endometrial adenocarcinoma treated with surgery from January 1981 to December 2018. The rate and patterns of recurrence were identified and analysed. Results: Of 1215 eligible patients, 24 developed recurrent disease (1.98%). The majority of recurrences were pelvic (70%), and confined to the vaginal vault (41.7%). The median duration of follow up was 44.4 months, and time from primary surgery to diagnosis of recurrent disease was 30.5 months. No significant differences were found between the group of patients who recurred and the group of patients who did not. Twelve (50%) patients with recurrences were asymptomatic, but of these, 10 (83%) had obvious findings during routine surveillance physical examination. The remaining 12 patients (50%) presented with symptoms that prompted investigation that led to the recurrence diagnosis. 78% of recurrences were treated with combination therapy (surgical excision, chemotherapy, radiotherapy and hormonal). Ten patients (42%) had salvageable disease. For the non-salvageable cases, there was a mean of 2.1 years from recurrence diagnosis to death. Conclusions: The low recurrence rate of low-risk endometrial cancer following primary surgical management, and the feasibility of detection of recurrent disease, support transitioning surveillance to community-based settings.

关键词： Endometrial Cancer Recurrence Surveillance Survivorship Vaginal Vault

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Curcumin Inhibits Prostate Cancer Bone Metastasis by Up-Regulating Bone Morphogenic Protein-7 <i>in Vivo</i>

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Journal of Cancer Therapy 2014年第4期5卷 369-386页

作者： Thambi Dorai Janane Diouri orla O’Shea Stephen B. Doty Analytical Microscopy Laboratory Hospital for Special Surgery New York USA Department of Urology New York Medical College Valhalla USA

A number of studies have focused on the beneficial properties of Curcumin (diferuloyl methane, used in South Asian cuisine and traditional medicine) such as the chemoprevention of cancer. Recent studies have also indicated that this material has significant benefits for the treatment of cancer and is currently undergoing several clinical trials. We have been interested in the application of this compound as a therapeutic agent for advanced prostate cancer, particularly the skeletal complications in this malignancy. Our earlier work indicated that this compound could inhibit the osteomimetic properties which occur in castration resistant prostate cancer cells, by interfering with the common denominators between these cancer cells and the bone cells in the metastatic tumor microenvironment, namely the osteoblasts and the osteoclast. We predicted that curcumin could break the vicious cycle of reciprocal stimulation that results in uncontrolled osteolysis in the bony matrix. In this work, we have evaluated the potential of this compound in inhibiting the bone metastasis of hormone refractory prostate cancer cells in an established animal model. Our results strongly suggest that curcumin modulates the TGF-βsignaling that occurs due to bone matrix degradation by up-regulating the metastasis inhibitory bone morphogenic protein-7 (BMP-7). This enhancement of BMP-7 in the context of TGF-β in the tumor microenvironment is shown to enhance the mesenchymal-to-epithelial transition. Most importantly, we show that as a result of BMP-7 up-regulation, a novel brown/beige adipogenic differentiation program is also up-regulated which plays a role in the inhibition of bone metastasis. Our results suggest that curcumin may subvert the TGF-β signaling to an alternative adipogenic differentiation program in addition to the previously established interference with the osteomimetic properties, thus inhibiting the bone metastatic processes in a chemopreventive as well as therapeutic setting

关键词： Curcumin Osteomimetic Properties Bone Metastasis Bone Morphogenic Protein-7 TGF-β Prostate Cancer Tumor Microenvironment

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Factors associated with mobile phone ownership and potential use for rabies vaccination campaigns in southern Malawi

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Infectious Diseases of Poverty 2020年第3期9卷 136-137页

作者： orla Marron Gareth Thomas Jordana LBurdon Bailey Dagmar Mayer Paul OGrossman Frederic Lohr Andy DGibson Luke Gamble Patrick Chikungwa Julius Chulu Ian GHandel Barend Mde C Bronsvoort Richard JMellanby Stella Mazeri 不详 The Royal(Dick)School of Veterinary Studies Division of Veterinary Clinical StudiesThe University of EdinburghHospital for Small AnimalsEaster Bush Veterinary CentreRoslinMidlothianUK

Background:Rabies is a fatal but preventable viral disease,which causes an estimated 59000 human deaths globally every *** vast majority of human rabies cases are attributable to bites from infected domestic dogs and consequently control of rabies in the dog population through mass vaccination campaigns is considered the most effective method of eliminating the *** the WHO target of 70%vaccination coverage has proven challenging in low-resource settings such as Sub Saharan Africa,and lack of public awareness about rabies vaccination campaigns is a major barrier to their *** this study we surveyed communities in three districts in Southern Malawi to assess the extent of and socio-economic factors associated with mobile phone ownership and explore the attitudes of communities towards the use of short message service(SMS)to inform them of upcoming rabies vaccination ***:This study was carried out between 1 October–3 December 2018 during the post-vaccination assessment of the annual dog rabies campaign in Blantyre,Zomba and Chiradzulu districts,Malawi.1882 questionnaires were administered to households in 90 vaccination *** surveys gathered data on mobile phone ownership and use,and barriers to mobile phone access.A multivariable regression model was used to understand factors related to mobile phone ***:Most survey respondents owned or had use of a mobile phone,however there was evidence of an inequality of access,with higher education level,living in Blantyre district and being male positively associated with mobile phone *** principal barrier to mobile phone ownership was the cost of the phone *** feature phones were most common and few owned *** was commonly used and the main reason for not using SMS was *** to receiving SMS reminders about future rabies vaccination campaigns were ***:The study showed a majority of those surveyed have the use of

关键词： Rabies Mass vaccination mHealth Short message service

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Retrospective analysis of chronic hepatitis C in untreated patients with nonlinear mixed effects model

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Journal of Biomedical Science and Engineering 2008年第2期1卷 85-90页

作者： Jian Huang Kathleen O’Sullivan John Levis Elizabeth Kenny-Walsh orla Crosbie Liam Fanning Department of Gastroenterology and Hepatology University Hospital Cork Molecular Virology Department of Medicine Hospital Cork University Statistical Consultancy Unit University College Cork Statistical Consultancy Unit University College Cork Ireland

It is well known that viral load of the hepatitis C virus (HCV) is related to the efficacy of interferon therapy. The complex biological parameters that impact on viral load are essentially unknown. The current knowledge of the hepatitis C virus does not provide a mathematical model for viral load dynamics within untreated patients. We car-ried out an empirical modelling to investigate whether different fluctuation patterns exist and how these patterns (if exist) are related to host-specific factors. Data was prospectively col-lected from 147 untreated patients chronically infected with hepatitis C, each contributing be-tween 2 to 10 years of measurements. We pro-pose to use a three parameter logistic model to describe the overall pattern of viral load fluctua-tion based on an exploratory analysis of the data. To incorporate the correlation feature of longitu-dinal data and patient to patient variation, we introduced random effects components into the model. On the basis of this nonlinear mixed ef-fects modelling, we investigated effects of host-specific factors on viral load fluctuation by in-corporating covariates into the model. The pro-posed model provided a good fit for describing fluctuations of viral load measured with varying frequency over different time intervals. The aver-age viral load growth time was significantly dif-ferent between infection sources. There was a large patient to patient variation in viral load as-ymptote.

关键词： Logistic model Viral load Viral genotype Mixed effects modelling

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肯辛顿的贵族生活

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现代装饰（家居） 2012年第12期 96-101页

作者： orla Collins Adam Butler 肖俊英国Purple Design

本案是对一处位于肯辛顿、19世纪40年代的公寓进行彻底翻新和改造。公寓位于一栋已列入英国二级保护建筑名单的古老建筑内。室内亦古典、亦现代的别致风格构成了一个全新的和谐格局。这是一套由三间卧室和两个洗手间组成的公寓,客户是... 详细信息

本案是对一处位于肯辛顿、19世纪40年代的公寓进行彻底翻新和改造。公寓位于一栋已列入英国二级保护建筑名单的古老建筑内。室内亦古典、亦现代的别致风格构成了一个全新的和谐格局。这是一套由三间卧室和两个洗手间组成的公寓,客户是一对年逾40的夫妇及他们的孩子。由于他们在乡间拥有另一套房子,每周他们在这里度过工作目。设计伊始,业主希望能在合理的预算内,打造一套既优雅,又不失奇特笔触、富有个性色彩的空间。由于空间的原有布局极不合理。

关键词：肯辛顿贵族生活个性色彩三间空间的主结构生活空间中式风格目门原有结构

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