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Should perioperative immunonutrition for elective surgery be the current standard of care?

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Gastroenterology Report 2016年第2期4卷 87-95,I0001页

作者： Shishira Bharadwaj Brandon Trivax parul tandon Bilal Alkam Ibrahim Hanouneh Ezra Steiger Center for Human Nutrition the Cleveland Clinic FoundationClevelandOHUSA College of Osteopathic Medicine Michigan State UniversityEast LansingMIUSA

Postoperative infectious complications are independently associated with increased hospital length of stay(LOS)and cost and contribute to significant inpatient *** strategies such as avoidance of long periods of preoperative fasting,re-establishment of oral feeding as early as possible after surgery,metabolic control and early mobilization have been used to either prevent or reduce the incidence of postoperative *** these efforts,it remains a big challenge to our current healthcare system to mitigate the cost of postoperative ***,preoperative nutritional status has also been implicated as an independent risk factor for postoperative *** nutritional support using enteral and parenteral routes has been shown to decrease postoperative morbidity,especially in high-risk ***,the role of immunonutrition(IMN)in postoperative infectious complications has been studied *** substrates have been found to positively modulate postsurgical immunosuppression and inflammatory *** have also been shown to be cost-effective by decreasing both tpostoperative infectious complications and hospital *** this review,we discuss the postoperative positive outcomes associated with the use of perioperative IMN,their cost-effectiveness,current guidelines and future clinical implications.

关键词： immunonutrition infections postoperative complications cost-effectiveness guidelines

Distraction osteogenesis for correction of post ankylosis mandibular deformities

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The Journal of Biomedical Research 2015年第4期29卷 332-336页

作者： Ahmed Khan Wamiq Musheer Fareed parul tandon Muhammad Sohail Zafar BabuBanarsi Das College of Dental Sciences College of Dentistry Taibah University

Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progres- sive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteo- genesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia inter- positional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandib-ular deficiencies by optimizing its placement through meticulous planning.

关键词： distraction osteogenesis temporomandibular joint disorders mandibular asymmetry atrophy

Malnutrition:laboratory markers vs nutritional assessment

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Gastroenterology Report 2016年第4期4卷 272-280,I0001页

作者： Shishira Bharadwaj Shaiva Ginoya parul tandon Tushar D.Gohel John Guirguis Hiren Vallabh Andrea Jevenn Ibrahim Hanouneh Department of Gastroenterology/Hepatology McMaster UniversityHamiltonOntarioCanada Department of Gastroenterology/Hepatology Cleveland ClinicClevelandOHUSA

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcarerelated ***,a major dilemma exists due to lack of a unified definition for the ***,there are no standard methods for screening and diagnosing patients with malnutrition,leading to confusion and varying practices among physicians across the *** role of inflammation as a risk factor for malnutrition has also been recently ***,serum proteins such as albumin and prealbumin(PAB)have been widely used by physicians to determine patient nutritional ***,recent focus has been on an appropriate nutrition-focused physical examination(NFPE)for diagnosing *** current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical *** studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively ***,a thorough NFPE has an unprecedented role in diagnosing malnutrition.

关键词： malnutrition physical examination serum markers

Current status of intestinal and multivisceral transplantation

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Gastroenterology Report 2017年第1期5卷 20-28,I0001页

作者： Shishira Bharadwaj parul tandon Tushar D.Gohel Jill Brown Ezra Steiger Donald F.Kirby Ajai Khanna Kareem Abu-Elmagd Center for Gut Rehabilitation and Transplantation the Cleveland Clinic FoundationClevelandOHUSA

Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitation attempts at intestinal adaptation have *** the past two decades,however,outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut *** has become possible through relentless efforts in the standardization of surgical techniques,advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient *** types of intestinal transplants include isolated small bowel transplant,liver-small bowel transplant,multivisceral transplant and modified multivisceral *** guidelines restrict intestinal transplantation to patients who have had significant complications from PN including liver failure and repeated *** an experimental stage to the currently established therapeutic modality for patients with advanced IF,outcome improvements have also been possible due to the introduction of tacrolimus in the early *** have shown that intestinal transplant is cost-effective within 1–3 years of graft survival compared with *** survival and quality of life as well as resumption of an oral diet should enable intestinal transplantation to be an important option for patients with IF in addition to continued *** research should focus on detecting biomarkers of early rejection,enhanced immunosuppression protocols,improved postoperative care and early referral to transplant centers.

关键词： intestinal transplant multivisceral transplant parenteral nutrition intestinal failure gut rehabilitation