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Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

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World Journal of Transplantation 2024年第2期14卷 62-75页

作者： Faisal Inayat pratik patel Hassam Ali Arslan Afzal Hamza Tahir Ahtshamullah Chaudhry Rizwan Ishtiaq Attiq Ur Rehman Kishan Darji Muhammad Sohaib Afzal Gul Nawaz Alexa Giammarino Sanjaya K Satapathy Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Division of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Saint Francis Hospital and Medical CenterHartfordCT 06105United States Division of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine Campbell University and Cape Fear Valley Medical CenterFayettevilleNC 28301United States Department of Internal Medicine North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States Division of Hepatology North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern *** with comorbid conditions are at risk of adverse outcomes following *** organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 *** could lead to higher rates of inpatient complications and mortality in this patient ***,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent *** To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United *** We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample *** with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding *** primary outcomes included trends in LT hospitalizations before and during the COVID-19 *** outcomes included comparative trends in inpatient mortality and transplant rejection in LT *** A total of 15720 hospitalized LT recipients were *** 0.8% of patients had a secondary diagnosis of COVID-19 *** both cohorts,the median admission age was 57 *** linear trends for LT hospitalizations did not differ significantly before and during the pandemic(P=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December *** to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95% confidence interval(CI):1.55-1.84),P<0.001].The frequency of transplant rejections among hospitalized LT recipients increased from 0.2%to 3.6% between January 2019 and December *** hospitalizations during the COVID-19 pandemic had a higher associ

关键词： Liver transplant recipients Solid organ transplantation COVID-19 Hospitalization Transplant rejection Mortality

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Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations:A propensity-matched analysis of the United States

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World Journal of Virology 2024年第1期13卷 51-60页

作者： Abdullah Sohail Hassam Ali pratik patel Subanandhini Subramanium Dushyant Singh Dahiya Amir H Sohail Manesh Kumar Gangwani Sanjaya K Satapathy Department of Internal Medicine University of Iowa Roy J and Lucille A Carver College of MedicineIowaIA 52242United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY11777United States Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Section on Gastroenterology and Hepatology North Shore University Hospital and Long Island Jewish Medical CenterManhassetNY 11030United States

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United *** with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and ***,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the *** We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and *** primary outcomes included inpatient mortality,length of stay,and hospitalization *** outcomes included the prevalence of systemic *** A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity ***,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD ***,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD *** The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 *** data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been *** will be interesting to see if these trends are

关键词： COVID-19 Metabolic dysfunction-associated steatotic liver disease Prevalence Hospital charges Inpatient resource utilization

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Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

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World Journal of Experimental Medicine 2024年第2期14卷 75-88页

作者： Hassam Ali Faisal Inayat Waqas Rasheed Arslan Afzal Ahtshamullah Chaudhry pratik patel Attiq Ur Rehman Muhammad Sajeel Anwar Gul Nawaz Muhammad Sohaib Afzal Amir H Sohail Subanandhini Subramanium Dushyant Singh Dahiya Deepa Budh Babu P Mohan Douglas G Adler Department of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Texas Tech University Health Sciences CenterLubbockTX 79430United States Department of Internal Medicine St.Dominic’s HospitalJacksonMS 39216United States Department of Gastroenterology Mather Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States Department of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 64108United States Department of Internal Medicine St.Barnabas Hospital and Albert Einstein College of MedicineBronxNY 10457United States Department of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCentura HealthDenverCO 80210United States

BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare *** peripancreatic fluid collection(APFC)may negatively impact the clinical course of *** could worsen symptoms and potentially lead to additional ***,clinical evidence regarding the specific association between APFC and early readmission in AP remains *** the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare *** To evaluate the association between APFC and 30-day readmission in patients with *** This retrospective cohort study is based on the Nationwide Readmission Database for *** with a primary diagnosis of AP were *** were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was *** primary outcome was early readmission *** outcomes included the incidence of inpatient complications and healthcare *** analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission *** A total of 673059 patients with the principal diagnosis of AP were *** these,5.1%had APFC on initial *** propensity score matching,each cohort consisted of 33914 *** with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APF

关键词： Acute pancreatitis Acute peripancreatic fluid collections Readmission predictors Inpatient complications Healthcare utilization and costs

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Global trends in hepatitis C-related hepatocellular carcinoma mortality:A public database analysis(1999-2019)

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World Journal of Virology 2024年第1期13卷 69-83页

作者： Hassam Ali Fnu Vikash Vishali Moond Fatima Khalid Abdur Rehman Jamil Dushyant Singh Dahiya Amir Humza Sohail Manesh Kumar Gangwani pratik patel Sanjaya K Satapathy Department of Internal Medicine/Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States Department of Internal Medicine Saint Peter's University Hospital/Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine Quaid-e-Azam Medical CollegeBahawalpur 63100PunjabPakistan Department of Internal Medicine Samaritan Medical CentreWatertownMA 13601United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery New York University Winthrop HospitalNew YorkMineloaNY 11501United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY 11777United States Division of Hepatology Department of MedicineNorth Shore University HospitalManhassetNY 11030United States

BACKGROUND Hepatitis C is the leading cause of chronic liver disease worldwide and it significantly contributes to the burden of hepatocellular carcinoma(HCC).However,there are marked variations in the incidence and mortality rates of HCC across different geographical *** the advent of new widely available treatment modalities,such as direct-acting antivirals,it is becoming increasingly imperative to understand the temporal and geographical trends in HCC mortality associated with Hepatitis ***,gender disparities in HCC mortality related to Hepatitis C are a crucial,yet underexplored aspect that adds to the disease's global *** some studies shed light on gender-specific trends,there is a lack of comprehensive data on global and regional mortality rates,particularly those highlighting gender *** gap in knowledge hinders the development of targeted interventions and resource allocation *** The results of our study show an overall decline in the mortality rates of patients with hepatitis C-related HCC over the last two ***,females exhibited a remarkable decrease in mortality compared to ***,East Asia and the Pacific displayed a significant decline in mortality,while Europe and Central Asia witnessed an upward *** America and the Caribbean also experienced an increase in mortality ***,no significant difference was observed in the Middle East and North *** America exhibited a notable upward *** Asia and Sub-Saharan Africa significantly declined throughout the study *** raises the hope of identifying areas for implementing more targeted *** some progress,multiple challenges remain in meeting the WHO 2030 goal of eliminating viral hepatitis[24].

关键词： Carcinoma Hepatocellular Antiviral agents Global Burden of Disease Quality indicators Health care Liver neoplasms Hepatitis C Chronic hepatitis C

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Early versus delayed necrosectomy in pancreatic necrosis:A population-based cohort study on readmission,healthcare utilization,and in-hospital mortality

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World Journal of Methodology 2024年第3期14卷 55-67页

作者： Hassam Ali Faisal Inayat Vinay Jahagirdar Fouad Jaber Arslan Afzal pratik patel Hamza Tahir Muhammad Sajeel Anwar Attiq Ur Rehman Muhammad Sarfraz Ahtshamullah Chaudhry Gul Nawaz Dushyant Singh Dahiya Amir H Sohail Muhammad Aziz Division of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Division of Gastroenterology and Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening *** poses a considerable challenge for clinicians due to its complex nature and the high risk of *** minimally invasive and open necrosectomy procedures have been *** advancements in treatment modalities,the optimal timing to perform necrosectomy lacks *** To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United *** A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions *** with non-elective admissions for pancreatic necrosis were *** participants were divided into two groups based on the necrosectomy timing:The early group received intervention within 48 hours,whereas the delayed group underwent the procedure after 48 *** various intervention techniques included endoscopic,percutaneous,or surgical *** major outcomes of interest were 30-day readmission rates,healthcare utilization,and inpatient *** A total of 1309 patients with pancreatic necrosis were *** propensity score matching,349 cases treated with early necrosectomy were matched to 375 controls who received delayed *** early cohort had a 30-day readmission rate of 8.6% compared to 4.8%in the delayed cohort(P=0.040).Early necrosectomy had lower rates of mechanical ventilation(2.9%vs 10.9%,P<0.001),septic shock(8%vs 19.5%,P<0.001),and in-hospital mortality(1.1%vs 4.3%,P=0.01).Patients in the early intervention group incurred lower healthcare costs,with median total charges of $52202 compared to$147418 in the delayed *** in the early cohort also had a relatively shorter median length of stay(6 vs 16 days,P<0.001).The timing of necrosectomy did not significantly influence the risk of 30-day readmission,with a hazard ratio of 0.56(95%confidence interval:0.31-1.02,P=0.06).CONCLUSION Our findings show that

关键词： Acute necrotizing pancreatitis Pancreatic necrosis Early necrosectomy Delayed necrosectomy Readmission,Healthcare costs Mortality

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Racial and gender-based disparities and trends in common psychiatric conditions in liver cirrhosis hospitalizations:A ten-year United States study

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World Journal of Hepatology 2023年第2期15卷 289-302页

作者： pratik patel Hassam Ali Faisal Inayat Rahul Pamarthy Alexa Giammarino Fariha Ilyas Lucia Angela Smith-Martinez Sanjaya K Satapathy Department of Gastroenterology Mather Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahore 54550PunjabPakistan Department of Internal Medicine North Shore University Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States Department of Psychiatry East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Hepatology North Shore University Hospital and Hofstra University Zucker School of MedicineManhassetNY 11030United States

BACKGROUND Chronic liver disease is associated with various neuropsychiatric *** are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of *** To examine the trends of hospitalizations among psychiatric conditions in *** We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver *** outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these ***-square for categorical variables and the Wilcoxon rank test for continuous variables were *** The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in *** related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other ***-and NAFLD-associated cirrhosis had a stronger link to psychiatric *** had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to ***,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD wh

关键词： Liver cirrhosis hospitalizations Psychiatric conditions Racial and gender disparities

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Association between alcohol-associated cirrhosis and inpatient complications among COVID-19 patients:A propensity-matched analysis from the United

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World Journal of Virology 2023年第4期12卷 221-232页

作者： Faisal Inayat Hassam Ali pratik patel Rubaid Dhillon Arslan Afzal Attiq Ur Rehman Muhammad Sohaib Afzal Laraib Zulfiqar Gul Nawaz Muhammad Hassan Naeem Goraya Subanandhini Subramanium Saurabh Agrawal Sanjaya K Satapathy Department of Internal Medicine Allama Iqbal Medical CollegeLahore 54550PunjabPakistan Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Gastroenterology Cleveland Clinic FoundationClevelandOH 44195United States Department of Hepatology Mercy Medical CenterBaltimoreMD 21202United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Internal Medicine Quaid-e-Azam Medical CollegeBahawalpur 63100PunjabPakistan Department of Hepatology Tampa General Medical Group and University of South FloridaTampaFL 33606United States Department of Hepatology North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States

BACKGROUND Alcohol-associated cirrhosis(AC)contributes to significant liver-related mortality in the United *** is known to cause immune dysfunction and coagulation *** with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019(COVID-19).The specific association between AC and COVID-19 mortality remains inconclusive,given the lack of robust clinical evi-dence from prior *** To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United *** We conducted a retrospective cohort study using the National Inpatient Sample(NIS)database *** were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC.A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser *** outcomes included median length of stay,median inpatient charges,and in-hospital *** outcomes included a prevalence of systemic *** A total of 1325 COVID-19 patients with AC were matched to 1135 patients without *** was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC(P>0.05).There was an increased prevalence of septic shock(5.7%vs 4.1%),ventricular fibrillation/ventricular flutter(0.4%vs 0%),atrial fibrillation(13.2%vs 8.8%),atrial flutter(8.7%vs 4.4%),first-degree atrioventricular nodal block(0.8%vs 0%),upper extremity venous thromboembolism(1.5%vs 0%),and variceal bleeding(3.8%vs 0%)in the AC cohort compared to the non-AC cohort(P<0.05).There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC,with an odds ratio of 0.97(95%confidence interval:0.78-1.22,P=0.85).Predictors of mortality included advanced age,cardiac arrhythmias,coagulopathy,protein-calorie malnutrition,flui

关键词： Alcoholic cirrhosis COVID-19 Chronic liver disease Mortality predictors Inpatient complications

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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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Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection

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World Journal of Gastrointestinal Surgery 2022年第12期14卷 1397-1410页

作者： pratik Bhattacharya Ishaan patel Noureen Fazili Shahab Hajibandeh Shahin Hajibandeh Department of Surgery Sandwell and West Birmingham Hospitals NHS TrustBirmingham B714HJUnited Kingdom Department of Surgery Queen Elizabeth Hospital BirminghamBirmingham B152GWUnited Kingdom Department of Surgery University Hospital of WalesCardiff CF144XWUnited Kingdom Department of Surgery Royal Stoke University HospitalStoke-on-Trent ST46QGUnited Kingdom

BACKGROUND Achieving a clear resection margins for low rectal cancer is technically *** approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal ***,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer *** To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal *** A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome *** We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal *** was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with ***,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to *** randomised controll

关键词： Total mesorectal excision Laparoscopic Transanal Rectal cancer

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Number of medications is associated with outcomes in the elderly patient with metabolic syndrome

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Journal of Geriatric Cardiology 2012年第3期9卷 213-219页

作者： Akshar Y. patel pratik Shah Joseph H. Flaherty School of Medicine Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA College of Arts and Sciences Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA Division of Geriatrics Department of Internal Medicine Saint Louis University 1402 South Grand St. Louis Missouri 63104 USA

新陈代谢的症候群的 BackgroundThe 诊断显示一聚类简言之作为一个主要预言者被认出了的新陈代谢的不平衡心血管并且所有原因死亡。这研究的目的是在一个第三级的医学中心与新陈代谢的 *** 图表评论在老病人估计在药店下面和poly药店和... 详细信息

新陈代谢的症候群的 BackgroundThe 诊断显示一聚类简言之作为一个主要预言者被认出了的新陈代谢的不平衡心血管并且所有原因死亡。这研究的目的是在一个第三级的医学中心与新陈代谢的 *** 图表评论在老病人估计在药店下面和poly药店和它的预示的影响的水平，为新陈代谢的症候群诊断满足了国际糖尿病基础标准的比 65 岁伟大的 324 个病人[身体集体索引( BMI ) > ；类型 2 糖尿病，高血压，和 dyslipidemia 的 30 kg/m 2, 诊断].ResultsThere 是 60 (18.5%) 病人在低(≤；5 ) 药负担组， 159 (49.1%) 在媒介(>；5 并且 ≤；10 ) 药负担组，并且 105 (32.4%) 在高度(>；10 ) 药负担组。在基线，这些组仅仅由收缩血压不同。在二年后续，中等的组在高密度脂蛋白有显著地更好的改进胆固醇(高级数据链路控制)，低密度脂蛋白胆固醇( LDL-C )， HbA1c ，和与低药相比的收缩血压在 triglycerides 麻烦组和显著地更好的改进，血色素 A1c ( HbA1c )和与高药组相比的收缩血压。在高级数据链路控制的减少是与击联系的唯一的变量。高药负担预言了住院负担。数字反高血压，在高级数据链路控制的烟草使用，低、高的药负担和减少的历史都与 *** poly药店被联系，在药店下面以象心肌的梗塞那样的重要实验室大小以及临床的结果与新陈代谢的症候群在病人之中与一个减少的治疗学的好处被联系，住院，和死亡。

关键词：代谢综合征药物治疗患者老年高密度脂蛋白胆固醇低密度脂蛋白胆固醇糖化血红蛋白抗高血压药物

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