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Comparison of the demographic characteristics of pediatric and adult colorectal cancer patients: a national inpatient sample based analysis

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World Journal of Pediatrics 2019年第1期15卷 37-41页

作者： thomas m.attard Caitlin E.Lawson University of missouri Kansas City Kansas CityMOUSA Pediatric Gastroenterology Children's Mercy Hospital2401Gillham RdKansas CityMO 64108USA Division of Genetics Children's Mercy HospitalKansas CityMOUSA

Background Colorectal cancer in children is rare,but characterized by late presentation,unfavorable histology and poor *** factors for colorectal cancer in children overlap with those for adults with greater influence of hereditary *** epidemiology of colon cancer in children is poorly understood;the aim of this study was to characterize and compare the demographics and relevant clinical characteristics of pediatric and adult colon cancer,using a national inpatient *** The AHRQ online resource HCUPnet/KID database was queried for children,under the age of 18 admitted with ICD 9 Cm diagnoses relating to colorectal cancer,at the time of *** comparison,the corresponding diagnoses in adult patients were queried for each successive *** demographics including residential type and median income by zip-code,tumor localization;if recorded,and mean hospital charges were all accrued and *** Inpatient admissions for pediatric colorectal cancer were more likely male (54%),in the 15-17 years age bracket (57%).They were significantly more likely from Southwestern regions of the Unites States,and were significantly more likely from residential zip-codes identified as at or below the lowest income quartile than adult CRC patients or pediatric patients as a *** charges have more than quadrupled over the time period studied (1997-2012).Conclusions Pediatric colorectal cancer is the most common primary gastrointestinal malignancy in *** understanding associated risk factors including those associated with gender,geographic region and social economic status may contribute to future prevention or early detection strategies.

关键词： Colorectal cancer Colorectal neoplasms Demography International classification of diseases Pediatric risk factors

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mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

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World Journal of Gastroenterology 2017年第9期23卷 1608-1617页

作者： thomas m attard mikaela miller Chaitanya Pant Ashwath Kumar mike Thomson Department of Gastroenterology Children’s Mercy Hospital Clinical Decision Support Children’s Mercy Hospital Department of Gastroenterology The University of Kansas Hospital University of missouri medical School Sheffield Children’s Hospital Western Bank

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their *** interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, *** population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P mortalities were significantly more likely to have multiple complex chronic *** associated mortality in children is highest within 7 d of admission. multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

关键词： Pediatrics Gastrointestinal hemorrhage Endoscopy Proton pump inhibitors mortality Liver disease Hospital Information Systems Octreotide

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Sleep as a window to understand and regulate Alzheimer's disease:emerging roles of thalamic reticular nucleus

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Neural Regeneration Research 2025年第6期20卷 1711-1712页

作者： Haoqi Sun Shiqian Shen Robert J.thomas m.Brandon Westover Can Zhang Department of Neurology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Center for Translational Pain Research Department of AnesthesiaCritical Care and Pain MedicineMassachusetis General HospitalHarvard Medical SchoolBostonMAUSA Division of Pulmonary Critical Care and Sleep MedicineDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Genetics and Aging Research Unit McCance Center for Brain HealthMass General Institute for Neurodegenerative DiseaseDepartment of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA

Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is primarily caused by the deposition of amyloid-β(Aβ), which drives tau phosphorylation, neuroinflammation, and neurodegeneration in the brain. The amyloid hypothesis is strengthened by the significant and moderate benefit of lecanemab, a humanized antibody through an anti-amyloid mechanism,showing slowed clinical decline(van Dyck et al.,2023). The recent positive results of anti-amyloid trials have brought back focus on the amyloid hypothesis through biochemical, genetic, and pharmacological approaches(Zhang, 2023).

关键词： Alzheimer inflammation hypothesis

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Clinical outcome of pediatric collagenous gastritis: Case series and review of literature

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World Journal of Gastroenterology 2013年第9期19卷 1478-1484页

作者： Nadia mazen Hijaz Seth Steven Septer James Degaetano thomas mario attard Section of Pediatric Gastroenterology Children's Mercy Hospital Kansas MO 64108 United States Department of Pathology Mater Dei Hospital Malta Mater Dei Hospital MSD 2090 Msida Malta Department of Pediatrics Mater Dei Hospital Malta Mater Dei Hospital MSD 2090 Msida Malta

Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endohistopathologic data (17 patients) included persistent collagen band and stable mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term

关键词： Collagenous gastritis Pediatric Gastritis Collagenous colitis Lymphocytic gastritis

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microglia:a promising therapeutic target in spinal cord injury

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Neural Regeneration Research 2025年第2期20卷 454-463页

作者： Xiaowei Zha Guoli Zheng thomas Skutella Karl Kiening Andreas Unterberg Alexander Younsi Department of Neurosurgery Heidelberg University HospitalHeidelbergGermany Department of Neuroanatomy Institute for Anatomy and Cell BiologyHeidelberg UniversityHeidelbergGermany

microglia are present throughout the central nervous system and are vital in neural repair,nutrition,phagocytosis,immunological regulation,and maintaining neuronal *** a healthy spinal cord,microglia are accountable for immune surveillance,however,when a spinal cord injury occurs,the microenvironment drastically changes,leading to glial scars and failed axonal *** this context,microglia vary their gene and protein expression during activation,and proliferation in reaction to the injury,influencing injury responses both favorably and unfavorably.A dynamic and multifaceted injury response is mediated by microglia,which interact directly with neurons,astrocytes,oligodendrocytes,and neural stem/progenitor *** a clear understanding of their essential nature and origin,the mechanisms of action and new functions of microglia in spinal cord injury require extensive *** review summarizes current studies on microglial genesis,physiological function,and pathological state,highlights their crucial roles in spinal cord injury,and proposes microglia as a therapeutic target.

关键词： astrocytes cytokines functional recovery immune regulation m1/m2 activation macrophages microglia neuroinflammation spinal cord injury therapy

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Aggressive juvenile polyposis in children with chromosome 10q23 deletion

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World Journal of Gastroenterology 2013年第14期19卷 2286-2292页

作者： Seth Septer Lei Zhang Caitlin E Lawson Jose Cocjin thomas attard Holly H Ardinger Department of Gastroenterology and Hepatology Children's Mercy Hospital and ClinicsKansas CityMO 64108United States Division of Cytogenetics Department of Pathology Children's Mercy Hospital and ClinicsKansas CityMO 64108 United States Division of Clinical Genetics Department of PediatricsChildren's Mercy Hospitals and Clinics and University of MissouriKansas City School of MedicineKansas CityMO 64108United States

Juvenile polyps are relatively common findings in children,while juvenile polyposis syndrome(JPS) is a rare hereditary syndrome entailing an increased risk of colorectal *** in BmPR1A or SmAD4 are found in roughly half of patients diagnosed with *** in PTEN gene are also found in patients with juvenile polyps and in Bannayan-Riley-Ruvalcaba syndrome and Cowden *** previous reports have described microdeletions in chromosome 10q23 encompassing both PTEN and BmPR1A causing aggressive polyposis and malignancy in *** reports have also described extra-intestinal findings in most cases including cardiac anomalies,developmental delay and *** this report we describe a boy with a 5.75 mb deletion of chromosome 10q23 and a 1.03 mb deletion within chromosome band 1p31.3who displayed aggressive juvenile polyposis and multiple extra-intestinal anomalies including macrocephaly,developmental delay,short stature,hypothyroidism,atrial septal defect,ventricular septal defect and *** required colectomy at six years of age,and early colectomy was a common outcome in other children with similar *** to the aggressive polyposis and reports of dysplasia and even malignancy at a young age,we propose aggressive gastrointestinal surveillance in children with 10q23 microdeletions encompassing the BmPR1A and PTEN genes to include both the upper and lower gastrointestinal tracts,and also include a flowchart for an effective genetic testing strategy in children with juvenile polyposis.

关键词： Polyposis Genetics Cancer Endoscopy pediatric

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Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease

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World Journal of Gastroenterology 2019年第28期25卷 3808-3822页

作者： Nadia mazen Hijaz thomas mario attard Jennifer marie Colombo Neil Joseph mardis Craig Alan Friesen Division of Gastroenterology Hepatology and Nutrition University of Missouri Kansas City Children’s Mercy Hospital Kansas City

BACKGROUND magnetic resonance enterography (mRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to mRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIm To prospectively compare the findings of mRE and WCE and their agreement with PCDAI or histology in children with CD or IC. mETHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent mRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (attard Tm and Colombo Jm) blinded to each other's findings and to the findings on mRE (mardis NJ). Agreement between WCE reviewers, WCE and mRE findings and concordance between positive PCDAI and SBI based on mRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good

关键词： Crohn’s disease Wireless capsule endoscopy Inflammatory bowel disease magnetic resonance enterography Small bowel involvement Small bowel disease Indeterminate colitis Pediatric Children

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Burden of celiac disease in the mediterranean area

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World Journal of Gastroenterology 2011年第45期17卷 4971-4978页

作者： Luigi Greco Laura Timpone Abdelhak Abkari mona Abu-Zekry thomas attard Faouzi Bouguerrà Paskal Cullufi Aydan Kansu Dusanka micetic-Turk Zrinjka miak Eleftheria Roma Raanan Shamir Selma Terzic European Laboratory for Food Induced Diseases Federico Ⅱ University of Naples Hopital des Enfant Ibn Rochd de Casablanca Children's Hospital Gastrointestinal Unit Cairo University University of malta Medical School Hopital des Enfants de Tunis Department of Gastroenterology and Hepatology University Hospital Center "Mother Teresa" Department of Pediatric Gastroenterology Ankara University Dikimevi/Mamak University medical Centre Paediatric Department Children's Hospital Zagreb Athens University Aghia Sophia Children's Hospital Schneider Children's medical Center of Israel Tel-Aviv University University Clinical Center Tuzla Children's Hospital

AIm: To estimate the burden of undiagnosed celiac disease (CD) in the mediterranean area in terms of morbidity, mortality and health cost. mETHODS: For statistics regarding the population of each country in the mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available conf idence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic prof iles amongst mediterranean countries. RESULTS: In the next 10 years, the mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550 000 symptomatic adults and about 240 000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600 000 celiac pat

关键词： Pediatric Celiac disease Short stature Anemia Osteopenia Purchasing power parity Standardized mortality rate mediterranean area

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The embryology of persistent cloaca and urogenital sinus malformations

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Asian Journal of Andrology 2020年第2期22卷 124-128页

作者： David F m thomas University of Leeds LeedsWest Yorkshire LS29JTUK

Cloacal malformations are characterized by the confluence of the lower urinary tract,the female reproductive tract,and the rectum to create a common channel with a single opening on the *** presence of a cloaca is a normal phase of early human embryological *** the 4^th and 7^th weeks of gestation,the cloaca undergoes subdivision to form the hindgut and urogenital *** of this process results in the congenital anomaly termed persistent cloaca(PC).The term urorectal septum malformation sequence(URSmS)is also used to describe this *** classic description of this process which is still cited in many standard textbooks dates from the 19th ***,this has been increasingly called into question by the findings of studies using modern scientific *** sinus anomalies are defined by the confluence of the urethra and vagina to form a common channel of varying length with a single perineal *** this condition,the anorectal canal opens separately on the *** presence of a urogenital sinus represents a transient phase of the normal development of the lower genital tract in the female ***,the form of urogenital sinus most commonly encountered in the developed world is a feature of disordered sexual differentiation and does not arise simply from the persistence of the anatomical structure which is a feature of normal fetal development.

关键词： cloaca embryology urogenital sinus

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Theory and practice of runoff space-time distribution

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Science China(Technological Sciences) 2004年第Z1期47卷 90-105页

作者： thomas m. Over Department of Geology/Geography Eastern Illinois University Charleston IL 61920 USA

Based on the domestic and foreign concerning researches, this paper submits the runoff space-time distribution theory which shows evident scientific significances and powerful practical functions. On the basis of digital basin unit cell deriving from the digital elevation model (DEm) and assumption of linear confluence, this theory has been applied successfully to the runoff correlation researches in humid regions. In order to prove the adaptability of the theory in arid and semi-drought regions, this paper is used to the runoff correlation analysis in Wuding River basin——a tributary of Yellow River Basin, and has gained preliminary effective verification.

关键词： runoff space-time distribution, theory, the Wuding River, correlation coefficient, practice.

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