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Natural history,clinical characteristics,outcomes,and long-term follow-up of pain-free chronic pancreatitis

Gastroenterology Report 2023年第1期11卷 309-315页

作者： Awais Ahmed Ishani Shah Rachel Bocchino steven d.freedman darshan J.Kothari Sunil G.Sheth department of Medicine Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA department of Medicine Division of Internal MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA department of Medicine Division of GastroenterologyDuke UniversityDurhamNCUSA

Background:Chronic pancreatitis(CP)is characterized by chronic abdominal pain and functional ***,a small subset of patients with prior acute pancreatitis(AP)and/or underlying risk factors for developing CP may be pain-free at diagnosis and may have a different clinical *** aimed to compare the clinical characteristics,outcomes,and healthcare utilization between CP patients with and without ***:Reviewed patients with established CP were followed in our Pancreas Center between January 2016 and April *** without risk factors for developing CP and/or without AP prior to their diagnosis and only with incidental radiologic features of CP were excluded,so as tominimize confounding factors of pancreatopathy unrelated to *** were divided into painful and pain-free groups to analyze differences in demographics,outcomes,and healthcare ***:Of 368 CP patients,49(13.3%)were pain-free at diagnosis and had remained so for>9 *** were no significant differences in body mass index,race,sex,or co-morbidities between the two ***-free patients were older at diagnosis(53.9 vs 45.7,P=0.004)and had less recurrent AP(RAP)(43.8%vs 72.5%,Pd less exocrine pancreatic insufficiency(EPI)(34.7%vs 65.7%,Pd less disability(2.2%vs 22.0%,P=0.003),mental illness(20.4%vs 61.0%,Pd therapeutic interventions(0.0%vs 16.4%,P=0.005)for ***:We described a unique subset of patients with underlying risk factors for CP and/or prior AP who were painfree at *** were older at diagnosis,had less EPI and RAP,and overall favorable outcomes with minimal resource utilization.

关键词： chronic pancreatitis pain-free pancreatic insufficiency diabetes

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Extra-pancreatic complications,especially hemodialysis predict mortality and length of stay,in ICU patients admitted with acute pancreatitis

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Gastroenterology Report 2018年第3期6卷 202-209,I0001页

作者： darshan Kothari Maarten R.Struyvenberg Michael C.Perillo Ghideon Ezaz steven d.freedman Sunil G.Sheth department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School330 Brookline AveBostonMA 02215USA

Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of *** sought to determine the rate of extra-pancreatic complications and its effect on length of stay(LOS)and mortality in ICU patients with ***:We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP.A total of 287 ICU patients had a discharge diagnosis of AP,of which 163 met inclusion *** calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and ***:There were a total of 158 extra-pancreatic complications(0.97 extra-pancreatic complications per patient).Ninetyfive patients had at least one extra-pancreatic complication,whereas 68 patients had no extra-pancreatic *** with extra-pancreatic complications had a significantly longer LOS(14.7 vs 8.8 days,pd a higher rate of mortality(24.0%vs 16.2%,p=0.04).Patients requiring dialysis was an independent predictor for LOS and mortality(incidence risk ratio[IRR]1.73,95%confidence interval[CI]:1.263–2.378 and IRR 1.50,95%CI 1.623–6.843,pdictor for mortality(p=0.05).Other extra-pancreatic complications were not ***:Extra-pancreatic complications occur frequently in ICU patients with AP and impact *** with noninfectious extra-pancreatic complications have a higher mortality *** controlling for local pancreatic complications,patients requiring dialysis remained an independent predictor for LOS and mortality.

关键词： Severe acute pancreatitis extra-pancreatic complications intensive care unit length of stay in-hospital mortality infections

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Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis

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World Journal of Gastroenterology 2022年第16期28卷 1692-1704页

作者： Supisara Tintara Ishani Shah William Yakah Awais Ahmed Cristina S Sorrento Cinthana Kandasamy steven d freedman darshan J Kothari Sunil G Sheth department of Internal Medicine Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States division of Gastroenterology&Hepatology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States division of Gastroenterology Duke University Medical CenterDurhamNC 27710United States division of Gastroenterology Durham VA Medical CenterDurhamNC 27705United States

BACKGROUNd Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having *** To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in *** We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcox

关键词： American Society for Gastrointestinal Endoscopy guidelines Choledocholithiasis Acute gallstone pancreatitis Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

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Burden of bone disease in chronic pancreatitis:A systematic review and meta-analysis

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World Journal of Gastroenterology 2023年第8期29卷 1374-1394页

作者： Ankit Chhoda Maria Jose Hernandez-Woodbine Nana Afua Akkya Addo Syed Alishan Nasir Alyssa Grimshaw Craig Gunderson Awais Ahmed steven d.freedman Sunil G.Sheth department of Gastroenterology Beth Israel Deaconess Medical CenterBostonMA 02215United States department of Medicine Norwalk HospitalYale School of MedicineNorwalkCT 06850United States Cushing/Whitney Medical Library Yale UniversityNew HavenCT 06510United States General Internal Medicine Yale School of MedicineNew HavenCT 06510United States

BACKGROUNd Bone disease is an under-recognized cause of morbidity in chronic pancreatitis(CP).Over the past decade,publications of original studies on bone disease in CP has warranted synthesis of the evidence to ascertain the true burden of the *** To quantify the prevalence of osteopenia,osteoporosis,and fragility fractures in CP patients and investigate the associated clinical features and *** A systematic search identified studies investigating bone disease in CP patients from Cochrane Library,Embase,Google Scholar,Ovid Medline,PubMed,Scopus,and Web of Science,from inception until October *** outcomes included prevalence of osteopenia,osteoporosis,and fragility fractures,which were metaanalyzed using a random-effects model and underwent metaregression to delineate association with baseline clinical *** Twenty-one studies were included for systematic review and 18 studies were included for *** pooled prevalence of osteopenia and osteoporosis in CP patients was 41.2%(95%CI:35.2%-47.3%)and 20.9%(95%CI:14.9%-27.6%),*** pooled prevalence of fragility fractures described among CP was 5.9%(95%CI:3.9%-8.4%).Metaregression revealed significant association of pancreatic enzyme replacement therapy(PERT)use with prevalence of osteoporosis[coefficient:1.7(95%CI:0.6-2.8);Pd no associations with mean age,sex distribution,body mass index,alcohol or smoking exposure,diabetes with prevalence of osteopenia,osteoporosis or fragility *** of data on systemic inflammation,CP severity,and bone mineralization parameters precluded a formal *** This meta-analysis confirms significant bone disease in patients with *** than PERT use,we observed no patient or study-specific factor to be significantly associated with CP-related bone *** studies are needed to identify confounders,at-risk population,and to understand the mechanisms of CP-related bone disease an

关键词： Chronic pancreatitis Fractures Osteoporosis Osteopenia Bone disease

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Einstein’s Concept of Clock Synchronization Conflicts with the Second Relativity Postulate

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Journal of Modern Physics 2024年第7期15卷 985-1000页

作者： steven d. deines donatech Corporation Inc. Fairfield Iowa USA

Einstein defined clock synchronization whenever photon pulses with timetags traverse a fixed distance between two clocks with equal time spans ineither direction. Using the second relativity postulate, he found clocksmounted on a rod uniformly moving parallel with the rod’s length cannot besynchronized, but clocks attached to a stationary rod can. He dismissed thisdiscrepancy by claiming simultaneity and clock synchronization were not commonbetween inertial frames, but this paper proves with both Galilean and Lorentztransformations that simultaneity and clock synchronization are preservedbetween inertial frames. His derivation means moving clocks can never besynchronized in a “resting” inertial frame. Ultraprecise atomic clocks intimekeeping labs daily contradict his results. No algebraic error occurred inEinstein’s derivations. The two cases of clocksattached to a rod reveal three major conflicts with the currentsecond postulate. The net velocity between a photon source and detector plusthe “universal” velocity c is mathematically equivalent toEinstein’s clock synchronization method. As the ultraprecise timekeepingcommunity daily synchronizes atomic clocks on the moving Earth withultraprecise time uncertainty well below Einstein’s lowest limit ofsynchronization, the theoretical resolution of the apparent conflict isaccomplished by expanding the second relativity postulate to incorporate thenet velocity between the photon source and detector with the emitted velocity c as components of the total velocity c. This means the magnitudeof the total photon velocity can exceed the speed limit (299792458 m/s) set by the standard velocity c. .

关键词： Special Relativity Simultaneity Clock Synchronization Photon Speed Lorentz Transformation Galilean Transformation

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Relational and Euclidean Temporal Space

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Journal of Applied Mathematics and Physics 2024年第2期12卷 683-719页

作者： steven d. P. Moore Independent Researcher Milton Canada

In mathematics, space encompasses various structured sets such as Euclidean, metric, or vector space. This article introduces temporal space—a novel concept independent of traditional spatial dimensions and frames of reference, accommodating multiple object-oriented durations in a dynamical system. The novelty of building temporal space using finite geometry is rooted in recent advancements in the theory of relationalism which utilizes Euclidean geometry, set theory, dimensional analysis, and a causal signal system. Multiple independent and co-existing cyclic durations are measurable as a network of finite one-dimensional timelines. The work aligns with Leibniz’s comments on relational measures of duration with the addition of using discrete cyclic relational events that define these finite temporal spaces, applicable to quantum and classical physics. Ancient formulas have symmetry along with divisional and subdivisional orders of operations that create discrete and ordered temporal geometric elements. Elements have cyclically conserved symmetry but unique cyclic dimensional quantities applicable for anchoring temporal equivalence relations in linear time. We present both fixed equivalences and expanded periods of temporal space offering a non-Greek calendar methodology consistent with ancient global timekeeping descriptions. Novel applications of Euclid’s division algorithm and Cantor’s pairing function introduce a novel paired function equation. The mathematical description of finite temporal space within relationalism theory offers an alternative discrete geometric methodology for examining ancient timekeeping with new hypotheses for Egyptian calendars.

关键词： Relationalism Pairing Function Equation discrete Euclidean Timelines Ancient Timekeeping

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Friction and wear performance of polyether ether ketone(PEEK)polymers in three lubrication regimes

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Friction 2024年第4期12卷 670-682页

作者： davide MASSOCCHI Nora LECIS Marco LATTUAdA davide SCAGLIA steven CHATTERTON Paolo PENNACCHI department of Mechanical Engineering Politecnico di MilanoMilan 20156Italy Eni SpA Downstream product R&DLombardia 20097Italy Eurobearings S.R.L. Lombardia 29016Italy

This experimental study investigates the friction and wear of three coatings commonly used in industrial applications,particularly in hydrodynamic *** three materials under investigation were Babbitt,polyether ether ketone(PEEK)reinforced with 15%carbon fibers,and PEEK reinforced with 20%carbon *** first polymer material was extruded,while the other was produced by fused deposition modelling(FdM).The materials were subjected to sliding tests in a pin-on-disc configuration,with a steel ball serving as the counter *** tests were conducted at room temperature,with a load of 10 N and under three different lubrication conditions:dry,grease,and *** linear speed was set at 0.3 m/s for the dry and semi-solid lubrication tests,while for the oil tests,the speed was set at 0.25 m/*** greases used had consistency grades of NGLI 000 and NGLI *** ISO VG 68 circulation oil was used for the oil lubrication ***,thermodynamic analyses were performed under the most severe conditions(i.e.,dry)to investigate the steel-Babbitt and steel-PEEK contact.

关键词： hydrodynamic bearings polyether ether ketone(PEEK)polymers additive manufacturing grease lubrication sliding oil lubrication ball-on-disk tribology

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Exploring unconventional attributes of red blood cells and their potential applications in biomedicine

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Protein & Cell 2024年第5期15卷 315-330页

作者： Alkmini T.Anastasiadi Vasiliki-Zoi Arvaniti Krystalyn E.Hudson Anastasios G.Kriebardis Constantinos Stathopoulos Angelo d’Alessandro steven L.Spitalnik Vassilis L.Tzounakas department of Biochemistry School of MedicineUniversity of Patras26504 PatrasGreece department of Pathology and Cell Biology Columbia University Irving Medical CenterNew York CityNY 10032USA Laboratory of Reliability and Quality Control in Laboratory Hematology(HemQcR) Department of Biomedical SciencesSchool of Health&Caring SciencesUniversity of West Attica(UniWA)12243 EgaleoGreece department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus13001 AuroraCOUSA Present address:Institute for Fundamental Biomedical Research(IFBR) Biomedical Sciences Research Center“Alexander Fleming”Vari11527 AthensGreece

We need to talk about red blood *** cells are defined as cells containing distinct nuclei and other membranous ***,red blood cells(RBCs)lack a nucleus and organelles—perhaps to limit the generation of reactive oxygen species(Zhang et al.,2011)—and are filled with hemoglobin(Hb).This oxygen carrier is limited to the cytosol by the cell membrane and cytoskeleton,which maintain cellular integrity and deformability as RBCs pass through narrow capillaries(Gratzer,1994)to perform their primary function of gas exchange.

关键词： membranous maintain

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Hepatic angiotensin-converting enzyme 2 expression in metabolic dysfunction-associated steatotic liver disease and in patients with fatal COVId-19

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World Journal of Gastroenterology 2024年第31期30卷 3705-3716页

作者： Angus K Jacobs steven d Morley Kay Samuel Katie Morgan Lyndsey Boswell Timothy J Kendall david A dorward Jonathan A Fallowfield Peter C Hayes John N Plevris Hepatology Laboratory University of EdinburghEdinburgh EH164SBUnited Kingdom Scottish National Blood Transfusion Service Jack Copland CentreEdinburgh EH144BEUnited Kingdom Institute for Regeneration and Repair University of EdinburghEdinburgh EH164UUUnited Kingdom Edinburgh Pathology University of EdinburghEdinburgh EH164SBUnited Kingdom

BACKGROUNd Metabolic dysfunction-associated steatotic liver disease(MASLd),characterised by hepatic lipid accumulation,causes inflammation and oxidative stress accompanied by cell damage and *** injury(LI)is also frequently reported in patients hospitalised with coronavirus disease 2019(COVId-19),while preexisting MASLd increases the risk of LI and the development of COVId-19-associated *** of injury at the cellular level remain unclear,but it may be significant that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which causes COVId-19,uses angiotensin-converting expression enzyme 2(ACE2),a key regulator of the‘anti-inflammatory’arm of the renin-angiotensin system,for viral attachment and host cell *** To determine if hepatic ACE2 levels are altered during progression of MASLd and in patients who died with severe *** ACE2 protein levels and localisation,and histological fibrosis and lipid droplet accumulation as markers of MASLd were determined in formalin-fixed liver tissue sections across the MASLd pathological spectrum(isolated hepatocellular steatosis,metabolic dysfunction-associated steatohepatitis(MASH)+/-fibrosis,end-stage cirrhosis)and in post-mortem tissues from patients who had died with severe COVId-19,using ACE2 immunohistochemistry and haematoxylin and eosin and picrosirius red staining of total collagen and lipid droplet areas,followed by quantification using machine learning-based image pixel *** ACE2 staining is primarily intracellular and concentrated in the cytoplasm of centrilobular hepatocytes and apical membranes of bile duct ***,ACE2 protein levels are elevated in non-fibrotic MASH compared to healthy controls but not in the progression to MASH with fibrosis and in ***2 protein levels and histological fibrosis are not associated,but ACE2 and liver lipid droplet content are significantly correlated across the MASLd *** A

关键词： Metabolic dysfunction-associated steatotic liver disease Angiotensin-converting enzyme 2 Immunohistochemistry COVId-19 COVId-19-associated cholangiopathy

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Fetal lung growth predicts the risk for early-life respiratory infections and childhood asthma

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World Journal of Pediatrics 2024年第5期20卷 481-495页

作者： dimitra E.Zazara Olympia Giannou steven Schepanski Mirja Pagenkemper Anastasios d.Giannou Maike Pincus Ioannis Belios Stefan Bonn Ania C.Muntau Kurt Hecher Anke diemert Petra Clara Arck division for Experimental Feto-Maternal Medicine Department of Obstetrics and Fetal MedicineUniversity Medical Center Hamburg-Eppendorf(UKE)Martinistraße 5220251HamburgGermany University Children’s Hospital UKEHamburgGermany Computer Engineering and Informatics department Polytechnic SchoolUniversity of PatrasPatrasGreece Institute of developmental Neurophysiology Center for Molecular Neurobiology Hamburg(ZMNH)UKEHamburgGermany department of Obstetrics and Fetal Medicine UKEHamburgGermany department of General Visceral and Thoracic SurgeryUKEHamburgGermany Section of Molecular Immunology and Gastroenterology Ⅰ.Department of MedicineUKEHamburgGermany Pediatrics and Pediatric Pneumology Practice BerlinGermany Institute of Medical Systems Biology ZMNHUKEHamburgGermany Hamburg Center for Translational Immunology UKEHamburgGermany

Background Early-life respiratory infections and asthma are major health burdens during *** predicting an increased risk for early-life respiratory diseases are ***,we identified the predictive value of ultrasound-monitored fetal lung growth for the risk of early-life respiratory infections and *** Fetal lung size was serially assessed at standardized time points by transabdominal ultrasound in pregnant women participating in a pregnancy *** between fetal lung growth and respiratory infections in infancy or early-onset asthma at five years were ***-learning models relying on extreme gradient boosting regressor or classifier algorithms were developed to predict respiratory infection or asthma risk based on fetal lung *** model development and validation,study participants were randomly divided into a training and a testing group,respectively,by the employed *** Enhanced fetal lung growth throughout pregnancy predicted a lower early-life respiratory infection *** sex was associated with a higher risk for respiratory infections in *** lung growth could also predict the risk of asthma at five years of *** designed three machine-learning models to predict the risk and number of infections in infancy as well as the risk of early-onset *** models’R2 values were 0.92,0.90 and 0.93,respectively,underscoring a high accuracy and agreement between the actual and predicted *** variables included known risk factors and novel predictors,such as ultrasound-monitored fetal lung *** Sonographic monitoring of fetal lung growth allows to predict the risk for early-life respiratory infections and asthma.

关键词： Asthma Child risk Early-life respiratory infections Prenatal lung development Sexual dimorphism

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