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Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma:Radiologic-pathologic correlation

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World Journal of Gastroenterology 2009年第22期15卷 2739-2747页

作者： Anjuli A Shah Nisha I Sainani Avinash Kambadakone Ramesh Zarine K Shah vikram Deshpande peter F Hahn Dushyant v Sahani Department of Radiology Division of Abdominal Imaging and Interventional RadiologyWhite Bldg.270Massachusetts General Hospital Department of Pathology Massachusetts General Hospital

AIM： To identify multi-detector computed tomography （MDCT） features most predictive of serous cystadenomas （SCAs）, correlating with histopathology, and to study the impact of cyst size and MDCT technique on reader performance. METHODS： The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs. Accuracy in lesion characterization and reader confidence were correlated with lesion size （≤3 cm or 〉≥3 cm） and scanning protocols （dedicated vs routine）. RESULTS： 28/164 cysts （mean size, 39 mm; range, 8-92 mm） were diagnosed as SCA on pathology. The MDCT features predictive of diagnosis of SCA were microcystic appearance （22/28, 78.6%）, surface Iobulations （25/28, 89.3%） and central scar （9/28, 32.4%）. Stepwise logistic regression analysis showed that only microcystic appearance was significant for CT diagnosis of SCA （P = 0.0001）. The sensitivity, specificity and PPv of central scar and of combined microcystic appearance and Iobulations were 32.4%/100%/100% and 68%/100%/100%, respectively. The reader confidence was higher for lesions 〉 3 cm （P = 0.02） and for MDCT scans performed using thin collimation （1.25-2.5 mm） compared to routine 5 mm collimation exams （P 〉 0.05）. CONCLUSION： Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs. Microcystic morphology is the most significant CT feature in diagnosis of SCA. A combination of microcystic appearance and surface Iobulations offers accuracy comparable to central scar with higher sensitivity.

关键词： Pancreas Serous cystadenoma Multidetector computed tomography Central scar Lobulations Microcystic

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Enhanced expression of interleukin-18 in serum and pancreas of patients with chronic pancreatitis

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World Journal of Gastroenterology 2006年第40期12卷 6507-6514页

作者： Alexander Schneider Stephan L Haas Ralf Hildenbrand Sren Siegmund Iris Reinhard Helmut Nakovics Manfred v Singer peter Feick Department of Medicine II (Gastroenterology Hepatology and Infectious Diseases) Univer-sity Hospital of Heidelberg at Mannheim Mannheim Germany Institute of Pathology University Hospital of Heidelberg at Mannheim Mannheim Germany Central Institute of Mental Health Mannheim Germany

AIM： To investigate interleukin-18 （IL-18） in patients with chronic panreatitis （CP）. METHODS： We studied 29 patients with CP and 30 healthy controls. Peripheral blood mononuclear cells （PBMC） were isolated and incubated with 50 mmol/L ethanol, lipopolysaccharide （LPS）（doses 25 g/L, 250 g/L, 2500 g/L） and both agents for 24 h. Levels of IL-18 in the supernatants, and levels of IL-18, IL-12, interferon （IFN）-T and soluble CD14 in the serum were analysed by EI_ISA technique. Expression of IL-18 in PBMC was investigated by reverse-transcription （RT）-PCR. IL-18 protein levels in CP tissue and in normal pancreas were studied by ELISA technique. IL-18 levels in PBMC and pancreatic tissue were determined by Westernblot. Immunohistochemistry for pancreatic IL-18 expression was performed.RESULTS： In patients, IL-18 serum levels were significantly enhanced by 76% （mean： 289.9 ± 167.7 ng/L） compared with controls （mean： 165.2 ± 43.6 ng/L; P 〈 0.0005）. IL-12 levels were enhanced by 25% in patients （18.3 ± 7.3 ng/L） compared with controls （14.7 ± 6.8 ng/L, P = 0.0576） although not reaching the statistical significance. IFN-γ, and soluble CD14 levels were not increased. In vitro, LPS stimulated significantly and dosedependently IL-18 secretion from PBMC. Incubation with ethanol reduced LPS-stimulated IL-18 secretion by about 50%. The mRNA expression of IL-18 in PBMC and the response of PBMC to ethanol and LPS was similar in CP patients and controls. In PBMC, no significant differences in IL-18 protein levels were detected between patients and controls. IL-18 protein levels were increased in CP tissues compared to normal pancreatic tissues. IL-18 was expressed by pancreatic acinar cells and by infiltrating inflammatory cells within the pancreas. CONCLUSION： IL-18 originates from the chronically inflammed pancreas and appears to be involved in the fibrotic destruction of the organ.

关键词： Chronic pancreatitis Cytokines Interleukin- 18 Pancreatic fibrosis

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Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography

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International Journal of Ophthalmology(English edition) 2020年第1期13卷 120-123页

作者： peter W.MacIntosh S.vijay Kumar v.R.Saravanan virna M.Shah Illinois Eye and Ear Infirmary University of Illinois at ChicagoChicagoIL 60612USA Neuro-Ophthalmology Service Aravind Eye HospitalCoimbatore 641014India

AIM:To elucidate the changes of different ganglion cell layer(GCL)thinning patterns between the optic neuritis(ON)and non-arteritic anterior ischemic optic neuropathy(NAION).METHODS:A prospective,observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence ***:Thinning on optical coherence tomography in the NAION group occurs as early as 11 d after symptomatic onset of vision loss and follows an altitudinal *** mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7μm in the NAION cohort compared to controls of 0.8μm(P=0.032),but not significant in the ON group compared to controls with both groups measuring 1.1μ*** thinning was significant for the ON group compared to controls at 7.2μm(P=0.011)but not the NAION group compared to controls at 1.35μ***:These findings suggest that future treatments for NAION should be given early,and possibly before 11 d in order to prevent GCL and irreversible vision loss.

关键词： optic neuritis non-arteritic ischemic optic neuropathy optical coherence tomography ganglion cell layer

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Lactate reloaded–reevaluation of the importance of lactate monitoring in the management of adult sepsis in the emergency department

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BIOCELL 2021年第3期45卷 445-449页

作者： GABOR XANTUS BALINT KISS GYULA MOLNAR CANDICE MATHESON v.A NNA GYARMATHY peter L.KANIZSAI Cardiff University CardiffCF103ATUK Semmelweis University Budapest1085Hungary Dalhuis University Halifax HalifaxNS B3H 4R2Canada EpiConsult Biomedical Consulting and Medical Communications Agency DoverDE 19901USA Pecs University Clinical CentrePecs7626Hungary

For about a quarter of a century,monitoring lactate levels and/or lactate clearance has been an unquestionable cornerstone in sepsis *** elevated lactate level appeared to be an independent predictor of mortality,and the consequent metabolic acidosis was thought to explain a number of pathophysiological changes seen in septic *** physiological and clinical findings seem to challenge the adverse role of lactic acidosis in *** suggests that lactate levels are not necessarily directly proportional to either tissue or cellular hypoxia,and conversely,despite high lactate levels,increased peripheral tissue oxygen pressure can be measured in adult patients with septic *** to the most recent understanding of in vitro and in vivo evidence,the elevated lactate level in sepsis might be a normal reaction due to adrenergic stress with potential beneficial/protective physiological effects,as *** the one hand,burning lactic may help fuel the body during critical illness,but on the other hand,with a slight drop in pH,the body may counteract certain deleterious changes during the dysregulated host response;reduce the chances of reperfusion myocardial injury,and improve tissue oxygenation by shifting the haemoglobin dissociation curve to the *** the pathophysiological process in sepsis resulting in elevated lactate levels may aid management in an emergency,medicine,and intensive care *** more in-depth physiological knowledge,physicians may inevitably surpass normalisation heuristics and deliver personalized rather than protocolised sepsis resuscitation.

关键词： Reevaluation Lactate Sepsis Resuscitation

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Comorbidity in cirrhosis

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World Journal of Gastroenterology 2014年第23期20卷 7223-7230页

作者： peter Jepsen Department of Hepatology and Gastroenterology Aarhus University HospitalDK-8000 Aarhus CDenmark Department of Clinical Epidemiology Aarhus University HospitalDK-8000 Aarhus CDenmark

Cirrhosis patients’comorbidities are their other diseases than *** are neither causes nor consequences of cirrhosis,but they can increase mortality and are therefore clinically *** are also an important source of confounding in epidemiologic *** scoring systems have been developed as tools to measure the cirrhosis patient’s total burden of comorbidity,and they are useful in the clinic and for epidemiologic *** recently developed CirCom score is the only comorbidity scoring system developed specifically for cirrhosis patients,and it may be preferred over the older,generic,and more complex Charlson comorbidity *** of individual comorbid diseases can provide insight into the interactions between cirrhosis and other diseases and thus into the pathophysiology of *** article reviews the literature on comorbidity in cirrhosis.

关键词： Liver cirrhosis Comorbidity Prognosis Epidemiology

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Cost analysis and outcomes of simple elbow dislocations

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World Journal of Orthopedics 2015年第7期6卷 513-520页

作者： Michalis Panteli Ippokratis Pountos Nikolaos K Kanakaris Theodoros H Tosounidis peter v Giannoudis Academic Department of Trauma and Orthopaedics School of Medicine University of Leeds Leeds Teaching Hospitals University of Leeds

AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow ***: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level Ⅰ trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation(LOI), patients were divided in three groups(Group I, 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100°(from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and ***: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d(median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d(median 57 d; range 10-351 d). Group Ⅲ(prolonged immobilisation) had a statistically significant worse outcome in comparison to Group Ⅰ?and Ⅱ(P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups Ⅰ?and Ⅱ(P = 0.30). No statistically significantdifference in the direct medical costs between the groups was ***: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome.

关键词： Elbow dislocations Simple Management Outcome Cost analysis

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Prediction of disease course in inflammatory bowel diseases

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World Journal of Gastroenterology 2010年第21期16卷 2589-2590页

作者： peter Laszlo Lakatos 1st Department of Medicine Semmelweis UniversityH-1083 BudapestKoranyi S 2AHungary

Clinical presentation at diagnosis and disease course of both Crohn's disease(CD) and ulcerative colitis are heterogeneous and variable over *** most patients have a relapsing course and most CD patients develop complications(*** and/or perforation),much emphasis has been placed in the recent years on the determination of important predictive *** identification of these factors may eventually lead to a more personalized,tailored *** this TOPIC HIGHLIGHT series,we provide an update on the available literature regarding important clinical,endoscopic,fecal,serological/routine laboratory and genetic *** aim is to assist clinicians in the everyday practical decisionmaking when choosing the treatment strategy for their patients suffering from inflammatory bowel diseases.

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Disease course Predictive markers Clinical Serology Genetics

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Effect of age on the standardized ileal amino acid digestibility of soybean meal and canola meal in broilers

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Animal Nutrition 2024年第1期16卷 11-22页

作者： Mukti Barua M.Reza Abdollahi Faegheh Zaefarian Timothy J.Wester Channarayapatna K.Girish peter v.Chrystal velmurugu Ravindran Monogastric Research Center School of Agriculture and EnvironmentMassey UniversityPalmerston North 4442New Zealand Department of Animal Science and Nutrition Faculty of Veterinary MedicineChattogram Veterinary and Animal Sciences UniversityKhulshiChattogram 4225Bangladesh Nutrition and Care Animal NutritionEvonik(SEA)Pte.Ltd609927 Singapore Complete Feed Solutions Howick 2145AucklandNew Zealand

Standardized ileal digestibility coefficients(SIDC)of nitrogen(N)and amino acids(AA)in two protein sources(soybean meal[SBM]and canola meal[CM])were investigated at six broiler ages(d 7,14,21,28,35,and 42).Two assay diets were formulated to contain either SBM(413 g/kg)or CM(553 g/kg)as the sole dietary AA *** dioxide(5 g/kg)was added as an indigestible marker.A total of 696 male broilers at 1 d old were allotted to 12 replicate cages per age *** assay diet was offered to birds for 4 d prior to the ileal digesta collection on d 7(14 birds/cage),14(12 birds/cage),21(10 birds/cage),28(8 birds/cage),35(8 birds/cage)and 42(6 birds/cage),*** apparent digestibility coefficients were standardized using age-specific basal endogenous AA *** the SBM group,though the SIDC of N tended to be influenced(quadratic;P=0.075)by age,no linear or quadratic response of age effect was observed on the average SIDC of indispensable(IAA)and total AA(TAA).An age effect(quadratic;Pved on the average SIDC of dispensable AA(DAA)in SBM with the highest value recorded at d 7,followed by a decrease from d 14 to 28,which increased beyond d *** SIDC of some individual AA(Arg,Thr,Trp,Cys,Pro)were affected(Pverage SIDC of IAA,DAA and TAA were influenced(quadratic;Pverage SIDC of DAA and TAA were higher from d 7 to 14,declined at d 21,and then increased beyond d *** average SIDC of IAA was low between d 7 and 28 and increased *** SIDC of individual AA were affected(linear or quadratic;Pvariable,depending on the protein source and *** results demonstrate that age-specific SIDC AA data might need consideration in broiler feed formulations.

关键词： Age Amino acid Broiler Digestibility Protein source

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Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

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Journal of Geriatric Cardiology 2016年第5期13卷 450-457页

作者： Scott L Hummel John Herald Craig Alpert Kimberlee A Gretebeck Wendy S Champoux Donald R Dengel peter v vaitkevicius Neil B Alexander Department of lnternal Medicine University of Michigan Ann Arbor MI USA vA Ann Arbor Healthcare System Ann Arbor MI USA School of Nursing University of Wisconsin-Madison Madison WI USA William Beaumont School of Medicine Oakland University Royal Oak MI USA School of Kinesiology University of Minnesota Minneapolis MN USA Aspirus Health System Ontanagon ML USA

Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure （HF）. We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, fianctional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction （n = 25, age 75 ：i： 7 years） were compared to 25 healthy ageand gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake （vO2p^ak）, oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go （GUG）, Comfortable Gait Speed （CGS）, Unipedal Stance （US）], and self-reported physical activity （PA）. Results Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, vO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as vO2peak, but weakly associated with PA. Conclusions Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to vO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

关键词： Aging Congestive heart failure Mobility Oxygen uptake The elderly

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Treatment of uncomplicated reflux disease

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World Journal of Gastroenterology 2005年第28期11卷 4291-4299页

作者： Joachim Labenz peter Malfertheiner Department of Medicine Jung-Stilling Hospital Siegen Germany Department of Gastroenterology Hepatology and Infectious Diseases University of MagdeburgGermany

Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always ***-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.

关键词： Erosive reflux disease Non-erosive reflux disease Proton pump inhibitor Uninvestigated reflux disease

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