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直接注射组织纤溶酶原激活剂治疗视网膜下黄斑部出血

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世界核心医学期刊文摘（眼科学分册） 2006年第9期2卷 30-31页

作者： Singh R. p. patel C. Sears J. 王静波(译) 不详 Vitreo-Retinal Service Cole Eye Institute Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195 United States

Background/aims:Recent studies on the treatment of acute subretinal macular haemorrhage have shown that the volume of the clot and the time to evacuation have strong prognostic factors for visual outcome.A novel technique for surgical evacuation of these lesions involves direct injection of tissue plasminogen activator(t-pA)into the haematoma using pars plana *** aim of this study was to evaluate the clinical outcomes of this recently described ***:17 consecutive patients with subretinal macular haemorrhages caused by age related macular degeneration were *** demographics,acuities,and fluorescein angiograms were obtained for all *** patients underwent complete three port pars plana vitrectomy to enable direct cannulation of the subretinal space and injection of 48 μ g of t-pA,partial fluid-air exchange,1 hour face up supine positioning postoperatively,followed by upright positioning ***:88% of patients within the study had stabilisation or improvement of visual *** patients had total clearing of the macular haemorrhage and eight patients had subtotal *** patients had recurrence of the haemorrhage after the procedure and one patient underwent repair for retinal *** lesions demonstrated similar outcomes to classic or predominately classic *** patients required no therapy after the study to treat subfoveal ***:This study represents one of the largest case series to date showing that direct injection of subretinal t-pA with air-fluid exchange only and no intraoperative clot lysis period can have favourable results.

关键词：组织纤溶酶原激活剂黄斑部出血视网膜下直接注射治疗隐匿性病灶老年性黄斑变性荧光素血管造影

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Timing of chemotherapy and survival in patients with resectable gastric adenocarcinoma

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World Journal of Gastrointestinal Surgery 2013年第12期5卷 321-328页

作者： Amanda K Arrington Rebecca Nelson Supriya S patel Carrie Luu Michelle Ko Julio Garcia-Aguilar Joseph Kim Division of Surgical Oncology City of Hope Comprehensive Cancer Center Department of Biostatistics City of Hope Comprehensive Cancer Center Department of Surgery University of Southern California Department of Surgery Harbor-UCLA Medical Center Division of Colorectal Surgery Memorial Sloan-Kettering Cancer Center

AIM: To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups. METHODS: patients with surgically resected gastric adenocarcinoma from 1988 to 2006 were identified from the Los Angeles County Cancer Surveillance program. To evaluate the population most likely to receive and/or benefit from adjunct chemotherapy, inclusion criteria consisted of Stage Ⅱ or Ⅲ gastric cancer patients > 18 years of age who underwent curative-intentsurgical resection. patients were categorized into three groups according to the receipt of chemotherapy:(1) no chemotherapy;(2) preoperative chemotherapy; or(3) postoperative chemotherapy. Clinical and pathologic characteristics were compared across the different treatment ***: Of 1518 patients with surgically resected gastric cancer, 327(21.5%) received perioperative chemotherapy. The majority of these 327 patients were male(68%) with a mean age of 61.5 years; and they were significantly younger than non-chemotherapy patients(mean age, 70.7; p patients had tumors frequently located in the distal stomach(34.5%). preoperative chemotherapy was administered to 11.3% of patients(n = 37) and postoperative therapy to 88.7% of patients(n = 290). An overall survival benefit according to timing of chemotherapy was not observed on univariate or multivariate analysis. Similar results were observed with stagespecific survival analyses(5-year overall survival: Stage Ⅱ, 25% vs 30%, respectively; Stage Ⅲ, 14% vs 11%, respectively). Therefore, our results do not identify a survival advantage for specific timing of chemotherapy in locally advanced gastric cancer. CONCLUSION: This study supports the implementation of a randomized trial comparing the timing of perioperative therapy in patients with locally advanced gastric cancer.

关键词： Chemotherapy Gastric cancer Adjunct therapy postoperative therapy preoperative therapy Timing

The value of neurocognitive testing for acute outcomes after mild traumatic brain injury

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Military Medical Research 2015年第3期3卷 123-132页

作者： Latha Ganti Yasamin Daneshvar Sarah Ayala pratik Shashikant patel Aakash N.Bodhit Keith R.peters Orlando Veterans Affairs Medical Center

Background: Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine whether these tests, when administered acutely, could assist in predicting short-term outcomes after acute traumatic brain injury(TBI).Methods: This is an IRB-approved prospective study of adult patients who came to the emergency department of our Level-1 trauma center with TBI. patients were enrolled prospectively after providing written informed consent and underwent three separate neurocognitive tests: the Galveston Orientation Amnesia Test(GOAT), the Rivermead postConcussion Survey Questionnaire(RpCSQ), and the Mini Mental Status Examination(MMSE).Results: A lower GOAT score was significantly associated with hospitalization(p=0.0212) and the development of post-concussion syndrome(pCS) at late follow-up(p=0.0081). A higher RpCSQ score was significantly associated with hospital admission(p=0.0098), re-admission within 30 days of discharge(p=0.0431) and evidence of pCS at early follow-up(p=0.0004). A higher MMSE score was significantly associated with not being admitted to the hospital(p=0.0002) and not returning to the emergency department(ED) within 72 hours of discharge(p=0.0078). Lower MMSE was also significantly associated with bleeding or a fracture on the brain CT(p=0.0431).Conclusions: While neurocognitive testing is not commonly performed in the ED in the setting of acute head injury, it is both feasible and appears to have value in predicting hospital admission and pCS. These data are especially important in terms of helping patients understand what to expect, thus, aiding in their recovery.

关键词： Neurocognitive testing Mild traumatic brain injury Treatment outcome

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一项前瞻性研究结果:玻璃体切除术对于糖尿病性黄斑水肿治疗结果的预测因素

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世界核心医学期刊文摘(眼科学分册) 2006年第4期 25-26页

作者： Shah S.p. patel M. Thomas D. D.A.H.Laidlaw 桑延智 Dr. Eye Department St. Thomas’s Hospital Lambeth Palace Road London SE1 7EH United Kingdom

Aim: To determine preoperative demographic, clinical, and optical coherence tomography (OCT) factors which might predict the visual and anatomical outcome at 1 year in patients undergoing vitrectomy and inner limiting membrane peel for diabetic macular oedema (DMO). Methods: A prospective, interventional case series of 33 patients who completed 1 year follow up. Measure ments were taken preoperatively and at 1 year. Outcome measures were logMAR visual acuity (VA) and OCT macular thickness. A priori explanatory variables included baseline presence of clinical and/or OCT signs suggesting macular traction, grade of diabetic maculopathy, posterior vitreous detachment, fluorescein leakage and ischaemia on angiography, presence of subretinal fluid, and peroperative indocyanine green (ICG) use. Results: 33 patients completed 1 year follow up. On average VA deteriorated by 0.035 logMAR (p = 0.40). Macular thickness significantly improved by a mean of 139 μm (95%CI; 211 to 67, p patients with evidence of clinical and/or OCT macular traction significantly improved logMAR acuity (logMAR improvement =0.08) compared with patients without traction (log MAR deterioration 0.11,p = 0.01)-. presence of subretinal fluid significantly predicted worse postoperative result (p = 0.01). Conclusion: On average, patients showed a statistically significant improvement in central macular thickness following treatment but a marginal acuity worsening. presence of subretinal fluid on OCT is hypothesised to be exudative rather than fractional in nature. The visual benefit of vitrectomy for DMO in this study was limited to patients who exhibit signs of macular traction either clinically and/or on OCT.

关键词：玻璃体切除术糖尿病性黄斑水肿黄斑厚度

Nationwide retrospective study of hepatitis B virological response and liver stiffness improvement in 465 patients on nucleos(t)ide analogue

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World Journal of Gastroenterology 2022年第31期28卷 4390-4398页

作者： Alnoor Ramji Karen Doucette Curtis Cooper Gerald Yosel Minuk Mang Ma Alexander Wong David Wong Edward Tam Brian Conway David Truong philip Wong Lisa Barrett Hin Hin Ko Sarah Haylock-Jacobs Nishi patel Gilaad G Kaplan Scott Fung Carla S Coffin Department of Medicine University of British ColumbiaVancouver v6t 1z3Canada Department of Medicine University of AlbertaEdmonton t6g 2r7Canada Department of Medicine The Ottawa Hospital Research InstituteUniversity of OttawaOttawa ON K1H 8L6Canada Department of Medicine University of ManitobaWinnipeg r3e 3j7Canada Department of Medicine University of SaskatchewanSaskatoon s7n 5e5Canada Department of Medicine University Health NetworkToronto m5g 2c4Canada pacific Gastroenterology Associates Vancouver v6z 2k5Canada Vancouver Infectious Disease Centre Vancouver v6z 2c7Canada Department of Medicine McGill UniversityMontreal h3a 0g4Canada Department of Microbiology and Immunology Dalhousie UniversityHalifax b3h 4r2Canada Cumming School of Medicine University of CalgaryCalgary t2n 1n4Canada

BACKGROUND Hepatitis B virus(HBV)nucleos(t)ide analog(NA)therapy reduces liver disease but requires prolonged therapy to achieve hepatitis B surface antigen(HBsAg)*** is limited North American real-world data using non-invasive tools for fibrosis assessment and few have compared 1st generation NA or lamivudine(LAM)to tenofovir disoproxil fumarate(TDF).AIM To assess impact of NA on virological response and fibrosis regression using liver stiffness measurement(LSM)(i.e.,FibroScan®).METHODS Retrospective,observational cohort study from the Canadian HBV *** collected included demographics,NA,HBV DNA,alanine aminotransferase(ALT),and *** were HBV monoinfected patients,treatment naïve,and received 1 NA with minimum 1 year *** In 465(median 49 years,37%female,35%hepatitis B e antigen+at baseline,84%Asian,6%White,and 9%Black).percentage of 64(n=299)received TDF and 166 were LAM-treated with similar median duration of 3.9 and 3.7 years,*** mean baseline LSM was 11.2 kpa(TDF)vs 8.3 kpa(LAM)(p=0.003).At 5-year follow-up,the mean LSM was 7.0 kpa in TDF vs 6.7 kpa in LAM(p=0.83).There was a significant difference in fibrosis regression between groups(i.e.,mean-4.2 kpa change in TDF and-1.6 kpa in LAM,ppatients were virologically suppressed(ppproximately 5 years of NA achieves liver fibrosis regression rarely leads to HBsAg loss.

关键词： Nucleos(t)ide analog therapy Functional cure Hepatitis B virus surface antigen loss Fibrosis regression Liver stiffness measurement Transient elastography

Does Anesthesiologist-Directed Sedation Afford Superior Deep Cannulation Rates and procedural Outcomes for ERCp in the Community Setting?

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Open Journal of Gastroenterology 2016年第2期6卷 46-52页

作者： Brad Bowyer Kathy Geissler Robert Barclay Sumeet Tewani James Frakes Nicholas Brown Matthew Houlihan Kunal patel Andrew Spiel Rockford Gastroenterology Associates Rockford IL USA University of Illinois College of Medicine Rockford Rockford IL USA

Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCp). Methods: Nineteen hundred sixteen consecutive patients underwent ERCp from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCp. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCp. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (p = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-b

关键词： ERCp Community-Based Medicine Conscious Sedation Anesthesiologist-Directed Sedation Gastroenterologist-Directed Sedation

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

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World Journal of Gastrointestinal Oncology 2016年第5期8卷 474-480页

作者： Ming Zeng Fernando N Aguila Taral patel Mark Knapp XueQiang Zhu XiLin Chen phillip D price Department of Radiation Oncology Mount Carmel Health System Cancer Center Sichuan Academy of Medical SciencesSichuan Provincial Hospital Central Ohio Surgical Associates Inc. Department of Hematology and Oncology Zangmeister Cancer CenterMount Carmel Health System Department of Oncology 307 Hospital

AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation *** the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical *** was followed by surgical tumor *** analyzed pathological completion response(p CR) rates its relationship with overall survival and ***:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for *** the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac *** Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was *** was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or *** 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),***:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.

关键词： Intensity modulated radiation therapy Esophageal adenocarcinoma Simultaneous integrated boost Neoadjuvant chemoradiation Dose escalation Resection rate

High-temperature thermodynamics of silver:Semi-empirical approach

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Chinese physics B 2017年第11期26卷 400-407页

作者： R H Joshi B Y Thakore p R Vyas A R Jani N K Bhatt Department of physics Sardar Patel University Department of physics School of Sciences Gujarat University Sardar patel Center for Science and Technology Department of physics M.K.Bhavnagar University

We report high-temperature thermodynamics for fcc silver by combining ab initio phonon dynamics to empirical quadratic temperature-dependent term for anharmonic part of Helmholtz free energy. The electronic free energy is added through an interpolation scheme, which connects ambient condition free electron gas model to Thomas-Fermi *** present study shows good agreement with experimental and reported findings for several thermal properties, and the discrepancy observed in some caloric properties is addressed. The decreases in the product of volume thermal expansion coefficient and isothermal bulk modulus and in the constant volume anharmonic lattice specific heat at high temperature are the clear evidences of proper account of anharmonicity. The present study also reveals that T-2-dependent anharmonic free energy is sufficient for correct evaluation of thermal pressure and conventional Grüneisen parameter. We observe that the intrinsic phonon anharmonicity starts dominating above characteristic temperature, which is attributed to higher order anharmonicity and can be related to higher order potential derivatives. We conclude that the uncorrelated and largeamplitude lattice vibrations at high temperature raise dominating intrinsic thermal stress mechanism, which surpasses the phonon-anharmonism and requires future consideration.

关键词： thermodynamics anharmonicity Grüneisen parameter silver

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Antidiabetic and in vitro antioxidant potential of Hybanthus enneaspermus(Linn) *** in streptozotocin—induced diabetic rats

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Asian pacific Journal of Tropical Biomedicine 2011年第4期1卷 316-322页

作者： patel DK Kumar R prasad SK Sairam K Hemalatha S pharmacognosy Research Laboratory Department of PharmaceuticsInstitute of TechnologyBanaras Hindu University

Objective:To evaluate antidiabetic and antioxidant potential of Hybanthus enneaspermus in different ***:The oral glucose tolerance test(OGTT) and normoglycemic effect of alcoholic extract of Hybanthus enneaspermus(AHE) were evaluated at a dose of 125,250 and 500mg/kg *** hypoglycemic activity and effect on body weight were tested at 250 and 500 mg/kg *** day for 21 days in Streptozotocin(STZ) induced diabetic ***,glucose uptake by hemidiaphram was also *** total polyphenolic and flavonoid were determined and their correlation with various antioxidant assays was also ***:The results showed high level of phenolic content in *** also exhibited higher total antioxidant capacity,good reducing power and a significant scavenger of reactive oxygen species like DppH radical,nitric oxide,hydrogen peroxide and *** there was a significant increase in the body weight and decrease in the blood glucose level on treatment with the *** increased glucose uptake on isolated rat hemi-diaphragm compared to control ***:AHE reduce blood glucose level in STZ-induced diabetic *** does not show significant effect in normoglycemic study but showes significant effect in *** has significant antioxidant activity,which may be attributed to high phenolic content.

关键词： Hybanthus enneaspermus Diabetic Antioxidant Total phenol Flavonoid Flavonol Glucose uptake