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Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma:a national survey

Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 624-630页

作者： Khalid mumtaz Nishi Patel rohan m modi Vihang Patel Alice Hinton James Hanje Sylvester m Black Somashaker Krishna Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Columbus OHUSA Department of Internal medicine The Ohio State University Wexner Medical Center Columbus OHUSA Department of Surgery The Ohio State University Wexner Medical Center Columbus OHUSA Division of Biostatistics College of Public Health The Ohio State University Columbus OH USA

BACKGROUND:Transarterial chemoembolization(TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma(HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last ***:We utilized the National Inpatient Sample(2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients(age >18 years). multivariate analyses for the outcomes of in-hospital "procedure-related complications"(PRCs) and "post-procedure complications"(PPCs) were performed. We also compared early(2002 to 2006) and late(2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and ***:Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE(Pmortality [adjusted Odds ratio(a OR):0.58; 95% CI:0.41, 0.82], reduced length of hospital stay(-1.87 days; 95% CI:-2.77,-0.97) and increased hospital charges($19232; 95% CI:11013, 27451) in the late era. Additionally, there was increased mortality(a OR:4.07; 95% CI:2.96, 5.59), PRCs(a OR:3.21; 95% CI:2.56, 4.02), and PPCs(a OR:2.70; 95% CI:2.11, 3.46) among patients with ***:There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.

关键词： transarterial chemoembolization hepatocellular carcinoma procedural complications mortality

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Outcomes of liver transplantation in patients with hepatorenal syndrome

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World Journal of Hepatology 2016年第24期8卷 999-1011页

作者： rohan m modi Nishi Patel Sherif N metwally Khalid mumtaz Department of Internal medicine the Ohio State University Wexner Medical Center Department of Internal medicine Division of Gastroenterology Hepatology and Nutrition the Ohio State University Medical Center

Hepatorenal syndrome(HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation(LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant(SLKT) in transplant candidates. many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS. Unfortunately, even after aggressive measures such as terlipressin use, the rate of recovery is less than 50% of patients. moreover, current SLKT guidelines include:(1) estimation of glomerular filtration rate of 30 m L/min or less for 4-8 wk;(2) proteinuria > 2 g/d; or(3) biopsy proven interstitial fibrosis or glomerulosclerosis. Even with these updated criteria there is a lack of consistency regarding longterm benefits for SLKT vs LT alone. Finally, in regards to kidney dysfunction in the post-transplant setting, an estimation of glomerular filtration rate mL /min per 1.73 m2 may be associated with an increased risk of patients having long-term end stage renal disease. HRS is common in patients with cirrhosis and those on liver transplant waitlist. Prompt identification and therapy initiation in transplant candidates with HRS may improve post-transplantation outcomes. Future studies identifying optimal vasoconstrictor regimens, alternative therapies, and factors predictive of response to therapy are needed. The appropriate use of SLKT in patients with HRS remains controversial and requires further evidence by the transplant community.

关键词： Liver transplantation Simultaneous liver kidney transplantation Vasopressors Dialysis Posttransplant outcomes Hepatorenal syndrome

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mechanical Behavior and microstructure Evolution during Tensile Deformation of Twinning Induced Plasticity Steel Processed by Warm Forgings

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Journal of Wuhan University of Technology(materials Science) 2024年第2期39卷 417-424页

作者：王文 ZHAO modi WANG Xingfu 汪聃韩福生 School of Aerospace and mechanical Engineering Flight College Changzhou Institute of TechnologyChangzhou 213032China Key Laboratory of materials Physics Institute of Solid State PhysicsChinese Academy of SciencesHefei 230031China School of Physics and Electronic Information Yan’an UniversityYan’an 716000China

The mechanical behavior and microstructural evolution of an Fe-30mn-3Al-3Si twinninginduced plasticity(TWIP)steel processed using warm forging was *** is found that steel processed via warm forging improves comprehensive mechanical properties compared to the TWIP steel processed via cold rolling,with a high tensile strength(R_(m))of 793 mPa,a yield strength(R_(P))of 682 mPa,an extremely large R_(P)/R_(m)ratio as high as 0.86 as well as an excellent elongation rate of 46.8%.The microstructure observation demonstrates that steel processed by warm forging consists of large and elongated grains together with fine,equiaxed *** micro-defect configurations were also observed within the steel,including dense dislocation networks and a few coarse deformation *** the plastic deformation proceeds,the densities of dislocations and deformation twins significantly ***,a great number of slip lines could be observed in the elongated *** findings reveal that a much more dramatic interaction between microstructural defect and dislocations glide takes place in the forging sample,wherein the fine and equiaxed grains propagated dislocations more rapidly,together with initial defect configurations,are responsible for enhanced strength ***,larger,elongated grains with more prevalently activated deformation twins result in high plasticity.

关键词： TWIP steel twinning mechanical property deformation mechanism microstructure

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In vivo and ex vivo confocal endomicroscopy of pancreatic cystic lesions: A prospective study

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World Journal of Gastroenterology 2017年第18期23卷 3338-3348页

作者： Somashekar G Krishna rohan m modi Amrit K Kamboj Benjamin J Swanson Phil A Hart mary E Dillhoff Andrei manilchuk Carl R Schmidt Darwin L Conwell Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Department of Internal medicine The Ohio State University Wexner Medical Center College of medicine The Ohio State University Wexner Medical Center Department of Pathology The Ohio State University Wexner Medical Center Division of Surgical Oncology The Ohio State University Wexner Medical Center Deparment of General Surgery The Ohio State University Wexner Medical Center

AIm To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions(PCLs). mETHODS In a prospective study evaluating EUS-nC LE for evaluation of PCLs, 10 subjects underwent an in vivo nC LE(AQFlex nC LE miniprobe; Cellvizio, maunaK ea, Paris, France) during EUS and ex vivo probe based CLE(pC LE) of the PCL(Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects(mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms(IPmNs), 3 mucinous cystic neoplasms(mCNs), 2 cystic neuroendocrine tumors(cystic-NETs), 1 serous cystadenoma(SCA), and 2 squamous lined PCLs. Characteristic in vivo nC LE image patterns included papillary projections for IPmNs, horizon-type epithelial bands for mCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pC LE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical *** In vivo n CLE patterns are reproducible in ex vivo p CLE for all major neoplastic PCLs. These findings add further support the application of EUS-nC LE as an imaging biomarker in the diagnosis of PCLs.

关键词：共焦的激光 endomicroscopy 浆液的 cystadenoma 胰腺的 neuroendocrine 肿瘤 Intraductal 乳突的 mucinous 瘤胰腺的膀胱的瘤

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Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

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World Journal of Hepatology 2018年第6期10卷 425-432页

作者： Lindsay A Sobotka rohan m modi Akshay Vijayaraman A James Hanje Anthony J michaels Lanla F Conteh Alice Hinton Ashraf El-Hinnawi Khalid mumtaz Department of Internal medicine the Ohio State University Wexner Medical Center Division of Gastroenterology Hepatology and Nutrition the Ohio State Wexner Medical Center Division of Biostatistics College of Public Health the Ohio State University Department of Surgery the Ohio State Wexner Medical Center

AIm To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and *** A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. multivariate analysis was performed to assess predictors of 30-d readmission and cost of *** Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age medicaid(OR: 1.21; CI: 1.04-1.41) and medicare coverage(OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: mission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

关键词： Cirrhosis Readmission rates Paracentesis Ascites

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Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database

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World Journal of Hepatology 2017年第2期9卷 99-105页

作者： Khalid mumtaz Sherif metwally rohan m modi Nishi Patel Dmitry Tumin Anthony J michaels James Hanje Ashraf El-Hinnawi Don Hayes Jr Sylvester m Black Wexner medical Center Gastroenterology Hepatology and Nutrition Division the Ohio State University Department of Internal medicine the Ohio State University Department of Pediatrics the Ohio State University Department of Surgery the Ohio State University Section of Pulmonary medicine the Ohio State University

AIm To determine the impact of transjugular intrahepatic porto-systemic shunt(TIPS) on post liver transplantation(LT) *** Utilizing the United Network for Organ Sharing(UNOS) database, we compared patients who underwent LT from 2002 to 2013 who had underwent TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay(LOS), and need for re-LT were studied. For evaluation of mean differences between baseline characteristics for patients with and without TIPS, we used unpaired t-tests for continuous measures and χ~2 tests for categorical measures. We estimated the impact of TIPS on each of the outcome measures. multivariate analyses were conducted on the study population to explore the effect of TIPS on 30-d mortality post-LT, need for re-LT and LOS. All covariates were included in logistic regression *** We included adult patients(age ≥ 18 years) who underwent LT from may 2002 to September 2013. Only those undergoing TIPS after listing and before liver transplant were included in the TIPS group. We excluded patients with variceal bleeding within two weeks of listing for LT and those listed for acute liver failure or hepatocellular carcinoma. Of 114770 LT in the UNOS database, 32783(28.5%) met inclusion criteria. Of these 1366(4.2%) had TIPS between the time of listing and LT. We found that TIPS increased the days on waitlist(408 ± 553 d) as compared to those without TIPS(183 ± 330 d), P multivariate analysis showed that TIPS had no effect on 30-d post LT mortality(OR = 1.26; 95%CI: 0.91-1.76) and re-LT(OR = 0.61; 95%CI: 0.36-1.05). Pre-transplant hepatic encephalopathy added 3.46 d(95%CI: 2.37-4.55, P me on waitlist for LT. more importantly, TIPS was not associated with 30-d mortality and re-LT, but it did lengthen hospital LOS after transplantation.

关键词： Transjugular intrahepatic porto 全身的分流分流肝移植腹水为结束阶段肝疾病当模特儿死亡 Transjugular

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Effect of transplant center volume on post-transplant survival in patients listed for simultaneous liver and kidney transplantation

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World Journal of Hepatology 2018年第1期10卷 134-141页

作者： rohan m modi Dmitry Tumin Andrew J Kruger Eliza W Beal Don Hayes Jr James Hanje Anthony J michaels Kenneth Washburn Lanla F Conteh Sylvester m Black Khalid mumtaz Department of Internal medicine Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Anesthesiology and Pain medicine Nationwide Children’s HospitalColumbusOH 43205United States Department of General Surgery Division of TransplantationOhio State University Wexner Medical CenterColumbusOH 43210United States Comprehensive Transplant Center Ohio State University Wexner Medical CenterColumbusOH 43210United States Section of Pulmonary medicine Nationwide Children’s HospitalColumbusOH 43205United States Department of Internal medicine Division of GastroenterologyHepatology and NutritionOhio State University Wexner Medical CenterColumbusOH 43210United States

AIm To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT) and liver transplantation alone(LTA) in SLKT-listed *** The United Network of Organ Sharing database was queried for patients ≥ 18 years of age listed for SLKT between February 2002 and December 2015. Posttransplant survival was evaluated using stratified Cox regression with interaction between transplant type(LTA vs SLKT) and center *** During the study period, 393 of 4580 patients(9%) listed for SLKT underwent a LTA. Overall mortality was higher among LTA recipients(180/393, 46%) than SLKT recipients(1107/4187, 26%). The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT [hazard ratio, hazard ratio(HR) = 2.85; 95%CI: 2.21, 3.66; P ming 30 SLKT over the study period. This disadvantage was modestly attenuated as center SLKT volume increased, with a 3% reduction(HR = 0.97; 95%CI: 0.95, 0.99; P = 0.010) for every 10 SLKs *** In conclusion, LTA is associated with increased mortality among patients listed for SLKT. This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes.

关键词： Kidney transplantation Center volume mortality Liver transplantation United network for organ sharing

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Whole-eye transplantation: Current challenges and future perspectives

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World Journal of Transplantation 2024年第2期14卷 28-39页

作者： Anna Scarabosio Pier Luigi Surico Vlad Tereshenko rohan Bir Singh Carlo Salati Leopoldo Spadea Glenda Caputo Pier Camillo Parodi Caterina Gagliano Jonathan m Winograd marco Zeppieri Department of Plastic Surgery University Hospital of UdineUdine 33100Italy Department of Plastic Surgery Massachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States Schepens Eye Research Institute of mass Eye and Ear Harvard Medical SchoolBostonMA 02114United States Department of Ophthalmology University Hospital of UdineUdine 33100Italy Eye Clinic Policlinico Umberto I"Sapienza"University of RomeRome 00142Italy Department of medicine and Surgery University of Enna"Kore"Enna 94100Italy Eye Clinic Catania University San marco Hospital Viale Carlo Azeglio Ciampi 95121 CataniaItaly

Whole-eye transplantation emerges as a frontier in ophthalmology,promising a transformative approach to irreversible *** advancements,formidable challenges *** of donor eye viability post-enucleation necessitates meticulous surgical techniques to optimize retinal integrity and ganglion cell *** the inhibitory milieu of the central nervous system for successful optic nerve regeneration remains elusive,prompting the exploration of neurotrophic support and immunomodulatory *** tolerance,paramount for graft acceptance,confronts the distinc-tive immunogenicity of ocular tissues,driving research into targeted immunosup-pression *** and legal considerations underscore the necessity for stringent standards and ethical *** collaboration and ongoing research endeavors are imperative to navigate these ***,stem cell therapies,and precision immunomodulation represent promising avenues in this ***,the aim of this review is to critically assess the current landscape of whole-eye transplantation,elucidating the challenges and advancements while delineating future directions for research and clinical *** concerted efforts,whole-eye transplantation stands to revolu-tionize ophthalmic care,offering hope for restored vision and enhanced quality of life for those afflicted with blindness.

关键词： Eye Transplantation Optic nerve Nerve regeneration Immunological tolerance

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Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

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World Journal of Cardiology 2024年第1期16卷 40-48页

作者： Farah Yasmin Abdul moeed rohan Kumar Ochani Hamna Raheel malik Ali Ehtsham Awan Ayesha Liaquat Arisha Saleem muhammad Aamir Nael Hawwa Salim Surani Department of Internal medicine Yale University School of MedicineNew HavenCT 06511United States Department of medicine Dow University of Health ScienceKarachi 74200SindhPakistan Department of medicine SUNNY Upstate Medical UniversitySyracuseNY 13210United States Department of Cardiovascular medicine Lehigh Valley Heart and Vascular InstituteAllentownPA 18105United States Department of medicine Cleveland ClinicClevelandOH 44195United States Department of medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIm To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of *** Systematic review and meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology *** In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with *** A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT ***,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

关键词： Left bundle branch pacing Biventricular pacing QRS duration Left ventricular ejection fraction Heart failure

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Integration of evacuated solar collectors with an adsorptive ice maker for hot climate region

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Energy and Built Environment 2022年第2期3卷 181-189页

作者： Nishant modi Bhargav Pandya College of Sciences and Engineering University of TasmaniaTasmaniaAustralia School of Chemical Engineering University of BirminghamBirminghamUnited Kingdom

This research study compares the steady-state and dynamic behaviour of a solar-powered activated carbon-35(AC35)/methanol-based vapour adsorption refrigeration system for production of ice at hot climate ***-modynamic comparisons are made with the coefficient of performance(COP),system COP(SCOP),specific refrig-eration capacity(SRC)and critical parameters such as cycle time and ice production rate are ***,the sustainability of the proposed ice maker has proven by integrating economic and environmental *** minimum solar flux required to ensure continuous ice production was found 800 W/m^(2).moreover,the max-imum ice production rate and COP were decreased by 32.36%and 37.63%respectively when the system was operated under real ambient *** proposed solar adsorptive ice maker achieved maximum SRC of 61.6 g m^(−2)during April month and reduced the CO_(2)emissions by 12.82 ton annually.

关键词： Solar cooling system Adsorption refrigeration cycle Ice production rate Activated carbon-35(AC35)/methanol GHG emissions Simple payback period

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