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Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 148-156页

作者： Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Hassam Ali Sahib Singh Yash R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma shyam thakkar Department of Internal Medicine University of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Division of Gastroenterology and Hepatology University of MissouriColumbiaMO 65212United States Department of Rheumatology Medical College of GeorgiaAugusta UniversityNorth AugustaGA 30912United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Interventional Oncology&Surgical Endoscopy GI Oncology Tumor Site TeamParkview Cancer InstituteParkview HealthFort WayneIN 46845United States Section of Gastroenterology&Hepatology West Virginia University School of MedicineMorgantownWV 26505United States

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warranted to in

关键词： Endoscopic retrograde cholangiopancreatography Nonagenarians Frailty Mortality Healthcare burden

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Risk of pancreatic cancer in individuals with celiac disease in the United States:A population-based matched cohort study

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World Journal of Gastrointestinal Oncology 2023年第3期15卷 523-532页

作者： Arunkumar Krishnan Yousaf Bashir Hadi Sarah Shabih Diptasree Mukherjee Ruhee A Patel Rushik Patel Shailendra Singh shyam thakkar Section of Gastroenterology&Hepatology West Virginia University School of MedicineMorgantownWV 26505United States Department of Medicine Apex Institute of Medical ScienceKolkata 700075West BengalIndia

BACKGROUND Celiac disease(CD)has been associated with gastrointestinal malignancies.However,the magnitude of the risk of pancreatic cancer(PC)associated with CD is much less clear,and risks have not been estimated from large populations.AIM To assess the risk of PC in CD patients.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive patients diagnosed with CD using the TriNeTx research network platform.We examined the incidence of PC in patients with CD compared with a matched cohort of patients without CD(non-CD,controls).Each patient in the main group(CD)was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The incidence of PC was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 389980 patients were included in this study.Among them,155877 patients had a diagnosis of CD,and the remaining 234103 individuals without CD were considered a control cohort.The mean duration of follow-up for patients in the CD and control cohorts was 5.8±1.8 and 5.9±1.1 years,respectively.During the follow-up,309 patients with CD developed PC,whereas 240 patients developed PC in the control group(HR=1.29;95%CI:1.09-1.53).In the secondary analyses in the first year after diagnosis of CD,patients with CD were at a significant increase in risk for PC;151 patients with CD had an incidence of PC compared with 96 incidences of PC among the patients in the non-CD control group(HR=1.56;95%CI:1.20-2.01)and sensitivity analysis showed similar magnitude to the one generated in the primary and secondary analysis.CONCLUSION Patients with CD are at increased risk of PC.Risk elevation persists beyond the first year after diagnosis to reference individuals without CD from the general population.

关键词： Celiac disease Cancer Epidemiology Pancreas Pancreatic cancer Malignancy Carcinoma

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Clinical characteristics and outcomes of COVID-19 in patients with autoimmune hepatitis:A population-based matched cohort study

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World Journal of Hepatology 2023年第1期15卷 68-78页

作者： Arunkumar Krishnan Ruhee A Patel Yousaf Bashir Hadi Diptasree Mukherjee Sarah Shabih shyam thakkar Shailendra Singh Tinsay A Woreta Saleh A Alqahtani Section of Gastroenterology and Hepatology West Virginia University School of MedicineMorgantownWV 26505United States Division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMD 21287United States Department of Medicine Apex Institute of Medical ScienceKolkata 700075West BengalIndia Liver Transplant Center King Faisal Specialist Hospital and Research CenterRiyadh 12713Saudi Arabia

BACKGROUND Patients with autoimmune hepatitis(AIH)require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019(COVID-19)outcomes.There is a paucity of large data at the population level to assess whether patients with AIH have an increased risk of severe diseases.AIM To evaluate the impact of pre-existing AIH on the clinical outcomes of patients with COVID-19.METHODS We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive adult patients(≥18 years)diagnosed with COVID-19 using the TriNeTx research network platform.The outcomes of patients with AIH(main group)were compared to a propensity score-matched cohort of patients:(1)Without chronic liver disease(CLD);and(2)Patients with CLD except AIH(non-AIH CLD)control groups.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.The primary outcome was all-cause mortality,and secondary outcomes were hospitalization rate,need for critical care,severe disease,mechanical ventilation,and acute kidney injury(AKI).For each outcome,the risk ratio(RR)and confidence intervals(CI)were calculated to compare the association of AIH with the outcome.RESULTS We identified 375 patients with AIH,1647915 patients with non-CLD,and 15790 patients with non-AIH CLD with COVID-19 infection.Compared to non-CLD patients,the AIH cohort had an increased risk of all-cause mortality(RR=2.22;95%CI:1.07-4.61),hospitalization rate(RR=1.78;95%CI:1.17-2.69),and severe disease(RR=1.98;95%CI:1.19-3.26).The AIH cohort had a lower risk of hospitalization rate(RR=0.72;95%CI:0.56-0.92),critical care(RR=0.50;95%CI:0.32-0.79),and AKI(RR=0.56;95%CI:0.35-0.88)compared to the non-AIH CLD patients.CONCLUSION Patients with AIH are associated with increased hospitalization risk,severe disease,and all-cause mortality compared to patients without pre-existing CLD from the diagnosis of COVID-19.However,patients with AIH were not at risk for worse outc

关键词： Autoimmune hepatitis SARS-CoV-2 COVID-19 Mortality Outcomes Liver disease Severe

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Old vs new: Risk factors predicting early onset colorectal cancer

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World Journal of Gastrointestinal Oncology 2019年第11期11卷 1011-1020页

作者： Aslam R Syed Payal thakkar Zachary D Horne Heitham Abdul-Baki Gursimran Kochhar Katie Farah shyam thakkar Division of Gastroenterology Allegheny Health NetworkPittsburghPA 15212United States Allegheny Singer Research Institute Allegheny Health NetworkPittsburghPA 15212United States Division of Radiation Oncology Allegheny Health Network Cancer InstitutePittsburghPA 15212United States

BACKGROUND Colorectal cancer(CRC)is the second leading cause of all cancer related deaths in the United States and Europe.Although the incidence has been decreasing for individuals’≥50,it has been on the rise for individuals<50.AIM To identify potential risk factors for early-onset CRC.METHODS A population-based cohort analysis using a national database,Explorys,screened all patients with an active electronic medical record from January 2012 to December 2016 with a diagnosis of CRC.Subgroups were stratified based on age(25–49 years vs≥50 years).Demographics,comorbidities,and symptom profiles were recorded and compared between both age groups.Furthermore,the younger group was also compared with a control group consisting of individuals aged 25-49 years within the same timeframe without a diagnosis of CRC.Twentydata points for CRC related factors were analyzed to identify potential risk factors specific to early-onset CRC.RESULTS A total of 68860 patients were identified with CRC,of which 5710(8.3%)were younger than 50 years old,with 4140(73%)between 40-49 years of age.Multivariable analysis was reported using odds ratio(OR)with 95%CI and demonstrated that several factors were associated with an increased risk of CRC in the early-onset group versus the later-onset group.These factors included:African-American race(OR 1.18,95%CI:1.09-1.27,P<0.001),presenting symptoms of abdominal pain(OR 1.82,95%CI:1.72-1.92,P<0.001),rectal pain(OR 1.50,95%CI:1.28-1.77,P<0.001),altered bowel function(OR 1.12,95%CI:1.05-1.19,P=0.0005),having a family history of any cancer(OR 1.78,95%CI:1.67-1.90,P<0.001),gastrointestinal(GI)malignancy(OR 2.36,95%CI:2.18-2.55,P<0.001),polyps(OR 1.41,95%CI:1.08-1.20,P<0.001),and obesity(OR 1.14,95%CI:1.08-1.20,P<0.001).Comparing the early-onset cohort versus the control group,factors that were associated with an increased risk of CRC were:male gender(OR 1.34,95%CI:1.27-1.41),P<0.001),Caucasian(OR 1.48,95%CI:1.40-1.57,P<0.001)and African-American race(OR 1.25,95%CI:1.17-1.35,P<0.001),presenting symptoms

关键词： Colorectal cancer Early-onset colorectal cancer Colorectal cancer screening Epidemiology analysis Colorectal neoplasm Average-risk screening

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Preoperative estimation of humerus intramedullary nail length using clinical landmarks

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中华创伤杂志:英文版 2023年第5期26卷 256-260页

作者： Atmananda S.Hegde Chethan B.Shetty Nitin Joseph Prajwal Mane Samarth thakkar Department of Orthopedics Kasturba Medical College MangaloreManipal Academy of Higher EducationKarnatakaIndia

Purpose:Intramedullary interlocking nailing is one of the accepted methods of treating humerus diaphyseal fractures.Appropriate nail length and diameter are of paramount importance to achieve a stable fracture fixation.Estimating the nail length can be as challenging in certain cases as it is important.This study aims to provide an easy-to-use formula utilizing clinical measurements from contra lateral arm to accurately estimate humeral nail length.Methods:This descriptive cross-sectional study was conducted at 3 tertiary care hospitals in Mangalore,India.Patients above the age of 18 years coming to the outpatient department with elbow,shoulder or arm complaints requiring radiological investigation from July 2021 to July 2022 were included.Patients with fractures or dislocations of upper limbs,malunited or non-united fractures of upper limbs,congenital or developmental deformities and patients with open growth plates were excluded.Patients'variables(like age and gender),radiological humerus length and contralateral arm clinical measurements were recorded.An independent samples t-test was used for univariate analysis,and linear regression analysis was done to estimate the desired nail length using the clinical measurement of the humerus(cm)in both genders separately.The significance level was set at p<0.05.Results:Our study included 204 participants of which 108 were male and 96 were female.The formula for predicting humeral nail length in males is(-2.029)+(0.883×clinical measurement).The formula for females is 1.862+(0.741×clinical measurement).A simplified formula to determine humeral nail length is 0.9 clinical length-2 cm(in males)and 0.7×clinical length+2 cm(in females).Conclusion:To improve the stability of fixation with intramedullary nails it is imperative to select the appropriate nail length.There have been studies that devised reliable methods of determining nail lengths in the tibia and femur using preoperative clinical measurements.A similar clinical method of determining humeral nail length is lackin

关键词： Humerus nailing Nail length Preoperative measurement Intramedullary interlockingnail

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Waste fly ash-ZnO as a novel sunlight-responsive photocatalyst for dye discoloration

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Water Science and Engineering 2023年第1期16卷 76-82页

作者： Leena V.Bora Sonal P.thakkar Kevin S.Vadaliya Nisha V.Bora Nirma University AhmedabadGujarat 382481India Government Engineering College ModasaGujarat 383315India

Treating waste with a waste material using freely available solar energy is the most effective way towards sustainable future.In this study,a novel photocatalyst,partly derived from waste material from the coal industry,was developed.Fly ash hybridized with ZnO(FAeZn)was synthesized as a potential photocatalyst for dye discoloration.The synthesized photocatalyst was characterized by X-ray diffraction,scanning electron microscopy,transmission electron microscopy,and ultravioletevisible/near infra-red spectroscopy.The photocatalytic activity was examined with the discoloration of methylene blue used as synthetic dye wastewater.All the experiments were performed in direct sunlight.The photocatalytic performance of FAeZn was found to be better than that of ZnO and the conventionally popular TiO2.The LangmuireHinshelwood model rate constant values of ZnO,TiO2,and FAeZn were found to be 0.016 min1,0.017 min1,and 0.020 min1,respectively.There were two reasons for this:(1)FAeZn was able to utilize both ultraviolet and visible parts of the solar spectrum,and(2)its BrunauereEmmetteTeller surface area and porosity were significantly enhanced.This led to increased photon absorption and dye adsorption,thus exhibiting an energy-efficient performance.Therefore,FAeZn,partly derived from waste,can serve as a suitable material for environmental remediation and practical solar energy applications.

关键词： Photocatalyst ZnO Fly ash Geopolymer Wastewater treatment Methylene blue

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Pediatric dog bite injuries in the USA: a systematic review

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World Journal of Pediatric Surgery 2022年第2期5卷 46-53页

作者： Kelli Nicole Patterson Kyle Z Horvath Peter C Minneci Rajan thakkar LeeAnn Wurster Dana L Noffsinger Tran Bourgeois Katherine J Deans Center for Surgical Outcomes Research and Department of Surgery Nationwide Children's HospitalColumbusOhioUSA

Introduction Dog bites are one of the leading causes of non-fatal emergency room visits in children.These injuries not only cause physical harm but can lead to long-term psychological stress.This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern.Methods We performed a keyword search of PubMed,Scopus,and OVID Medline databases(January 1980-March 2020)for all published studies focused on dog bite injuries in the pediatric population(≤18 years of age)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Results Out of 1859 abstracts screened,43 studies involving 86880 patients were included.Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes;six were prospective cohort studies;two were cross-sectional studies;and six were experimental studies.Synthesized results demonstrate that children<9 years of age suffer the greatest burden of injuries,with children<6 years of age at higher risk of more severe injuries involving the head,neck,and face.Conclusion Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.

关键词： injuries consequences prevention

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Application of Statistically Based Experimental Designs to Optimize Cellulase Production and Identification of Gene

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Natural Products and Bioprospecting 2014年第6期4卷 341-351页

作者： Aarti thakkar Meenu Saraf Department of Microbiology University School of ScienceGujarat UniversityAhmedabad 380009GujaratIndia

A natural bacterial strain identified as Bacillus amyloliquefaciens MBAA3 using 16S rDNA partial genome sequencing has been studied for optimization of cellulase production.Statistical screening of media components for production of cellulase by B.amyloliquefaciens MBAA3 was carried out by Plackett–Burman design.Plackett–Burman design showed CMC,MgSO4 and pH as significant components influencing the cellulase production from the media components screened by Plackett-Burman fractional factorial design.The optimum concentrations of these significant parameters were determined employing the response surface central composite design,involving three factors and five levels was adopted to acquire the best medium for the production of cellulase enzyme revealed concentration of CMC(1.84 g),MgSO4(0.275 g),and pH(8.5)in media for highest enzyme production.Response surface counter plots revealed that middle level of MgSO4 and middle level of CMC,higher level of CMC and lower level of pH and higher level of MgSO4 with lower level of pH increase the production of cellulase.After optimization cellulase activity increased by 6.81 fold.Presence of cellulase gene in MBAA3 was conformed by the amplification of genomic DNA of MBAA3.A PCR product of cellulase gene of 1500 bp was successfully amplified.The amplified gene was conformed by sequencing the amplified product and sequence was deposited in the gene bank under the accession number KF929416.

关键词： Bacillus amyloliquefaciens Cellulase gene Optimization Plackett-Burman design Response surface methodology

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Complications associated with energy-based devices during thyroidectomy from 2010–2020

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第1期9卷 35-44页

作者： Esther Lee Jane Y.Tong Luke J.Pasick Daniel A.Benito Arjun Joshi Punam G.thakkar Joseph F.Goodman Division of Otolaryngology-Head and Neck Surgery George Washington University School of Medicine&amp Health SciencesWashingtonDCUSA Western University of Health Sciences PomonaCAUSA Department of Otolaryngology-Head and Neck Surgery Drexel University College of MedicinePhiladelphiaPAUSA Department of Otolaryngology-Head and Neck Surgery University of Miami Miller School of MedicineMiamiFLUSA

Objective:Harmonic Focus(Ethicon,Johnson and Johnson,Cincinnati,OH,USA),LigaSure Small Jaw(Medtronic,Covidien Products,Minneapolis,MN,USA),and Thunderbeat Open Fine Jaw(Olympus,Japan)are electrosurgical instruments used widely in head and neck surgery.The study aims to compare device malfunctions,adverse events to patients,operative injuries,and interventions related to Harmonic,LigaSure,and Thunderbeat use during thyroidectomy.Methods:The US Food and Drug Administration's Manufacture and User Facility Device Experience(MAUDE)database was queried for adverse events associated with Harmonic,LigaSure,and Thunderbeat from January 2005 to August 2020.Data were extracted from reports pertaining to thyroidectomy.Results:Of the 620 adverse events extracted,394(63.5%)involved Harmonic,134(21.6%)LigaSure,and 92(14.8%)Thunderbeat.The reported device malfunctions most frequently associated with Harmonic was damage to the blade(110(27.9%)),LigaSure was inappropriate function(47(43.1%)),Thunderbeat was damage to the tissue or Teflon pad(27(30.7%)),respectively.Burn injury and incomplete hemostasis were the most commonly reported adverse events.The operative injury reported most frequently when using Harmonic and LigaSure was burn injury.No operator injuries were reported with Thunderbeat use.Conclusion:The most frequently reported device malfunctions were damage to the blade,inappropriate function,and damage to the tissue or Teflon pad.The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis.Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.

关键词： Adverse events Harmonic LigaSure Manufacture and User Facility Device Experience Patient safety Quality Thunderbeat Thyroidectomy

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Geodetic characterization of active Katrol Hill Fault(KHF)of Central Mainland Kachchh,western India

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Geodesy and Geodynamics 2022年第3期13卷 247-253页

作者： Donupudi Suribabu Rakesh K.Dumka Joydeep Paikray Girish Ch.Kothyari Mahesh thakkar Kandadai V.Swamy Ajay K.Taloor Sandip Prajapati Institute of Seismological Research RaysanGandhinagarGujarat382009India Department of Earth and Environmental Science KSKV UniversityBhujKachchhIndia Adikavi Nannaya University RajahMundaryA.PIndia Department of Remote Sensing and GIS University of JammuJammuIndia

After the M7.7 earthquake in 2001,the Kachchh rift basin became the focus of various geological and geophysical researches on the western Indian plate.As an essential technology,the Global Navigation Satellite System(GNSS)has been utilized to study the deformation pattern in the central mainland Kachchh.We select the east-west striking Katrol Hill Fault(KHF)as the study area and analyze the crustal deformation pattern using the datasets from 2014 to 2019.The geodetic results along the KHF reveal a mean deformation of about 2.1 mm per year,which is higher in the eastern part and lower in the central and western parts.The investigation of deformation and derived strain reveals the segmented behavior of KHF,while the dominance of compressive strain(maximum 22 nanostrain/yr)in the eastern segment makes it the most active segment of the KHF.A higher deformation rate along the eastern KHF can be considered significant in terms of seismic hazard for this part of the Indian plate.

关键词： Geodesy GNSS Deformation Strain Indian plate

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