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Clinical efficacy of the over-the-scope clip device: A systematic review

World Journal of Gastroenterology 2020年第24期26卷 3495-3516页

作者： Nicholas Bartell Krystle Bittner Vivek Kaul truptesh h kothari Shivangi kothari Division of Gastroenterology and hepatology University of Rochester Medical CenterRochesterNY 14642United States

BACKGROUND The over-the-scope clip(OTSC)system has been increasingly utilized as a nonsurgical option to endoscopically manage refractory gastrointestinal(GI)hemorrhage,perforations/luminal defects and fistulas.Limited data exist evaluating the efficacy and safety of OTSC.AIM To determine the clinical success and adverse event(AE)rates of OTSC across all GI indications.METhODS A PubMed search was conducted for eligible articles describing the application of the OTSC system for any indication in the GI tract.Any article or case series reporting data for less than 5 total patients was excluded.The primary outcome was the rate of clinical success.Secondary outcomes included:Technical success rate,OTSC-related AE rate and requirement for surgical intervention despite-OTSC placement.Pooled rates(per-indication and overall)were calculated as the number of patients with the event of interest divided by the total number of patients.RESULTS A total of 85 articles met our inclusion criteria(n=3025 patients).OTSC was successfully deployed in 94.4%of patients(n=2856/3025).The overall rate of clinical success(all indications)was 78.4%(n=2371/3025).Per-indication clinical success rates were as follows:(1)86.0%(1120/1303)for GI hemorrhage;(2)85.3%(399/468)for perforation;(3)55.8%(347/622)for fistulae;(4)72.6%(284/391)for anastomotic leaks;(5)92.8%(205/221)for defect closure following endoscopic resection(e.g.,following endoscopic mucosal resection or endoscopic submucosal dissection);and(6)80.0%(16/20)for stent fixation.AE’s related to the deployment of OTSC were only reported in 64 of 85 studies(n=1942 patients),with an overall AE rate of 2.1%(n=40/1942).Salvage surgical intervention was required in 4.7%of patients(n=143/3025).CONCLUSION This systematic review demonstrates that the OTSC system is a safe and effective endoscopic therapy to manage GI hemorrhage,perforations,anastomotic leaks,defects created by endoscopic resections and for stent fixation.Clinical success in fistula management appears limited.Further studies,incl

关键词： Over-the-scope clip hemostasis Perforation Fistula closure Endoscopic resection Anastomotic leak Ovesco Endoscopy

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Prospective evaluation of the hemorrhoid energy treatment for the management of bleeding internal hemorrhoids

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World Journal of Gastrointestinal Endoscopy 2021年第8期13卷 329-335页

作者： truptesh h kothari Krystle Bittner Shivangi kothari Vivek Kaul Division of Gastroenterology and hepatology University of Rochester Medical CenterRochesterNY 14642United States

BACKGROUND The hemorrhoid energy treatment(hET)system is a non-surgical bipolar electrotherapy device,which has previously demonstrated efficacy in the management of bleeding Grade I and II internal hemorrhoids;however,data is limited.AIM To prospectively assess the safety and efficacy of the hET device.METhODS This was an IRB-approved prospective study of 73 patients with Grade I or II internal hemorrhoids who underwent hET from March 2016 to June 2019.Patient factors and procedural data were obtained.A post-procedure questionnaire was administered by telephone to all patients at 1-wk and 3-mo following hET to assess for improvement and/or resolution of rectal bleeding and adherence to a stool softener regimen.A chart review was performed to observe recurrent symptoms and durability of response.Statistical analyses were performed using SPSS software(IBM;SPSS Version 25.0).RESULTS Seventy-three patients underwent hET during the study period.Mean post-hET follow-up was 1.89 years.Complete resolution of bleeding was reported in 65%at 1 wk(n=48),with improvement in bleeding in 97.2%(n=71)of patients.At 3-mo,resolution and/or improvement in bleeding was reported in 90%(n=64)of patients.No procedure-related pain or adverse events were reported.CONCLUSION hET is well tolerated,safe and highly effective in the majority of our patients presenting with Grade I and II symptomatic internal hemorrhoids.

关键词： Internal hemorrhoids Bleeding hemorrhoids Painless bleeding Mucus Constipation Straining

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Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 248-252页

作者： Christopher Steevens Maisa Abdalla truptesh h kothari Vivek Kaul Shivangi kothari Division of Gastroenterology and hepatology Center for Advanced Therapeutic Endoscopy University of Rochester Medical Center Developmental Endoscopy Lab at UR Division of Gastroenterology and Hepatology Center for Advanced Therapeutic Endoscopy University of Rochester Medical Center

Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. however, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

关键词： Extrahepatic portal hypertension Duodenal varices

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Indigenous plant medicines for health care:treatment of Diabetes mellitus and hyperlipidemia

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Chinese Journal of Natural Medicines 2014年第5期12卷 335-344页

作者： Nisha h. Parikh Palak K. Parikh Charmy kothari Arihant School of Pharmacy and Bio-Research Institute Institute of Pharmacy Nirma University

Medicinal plants have played an important role in treating and preventing a variety of diseases throughout the world. Metabolic syndrome had become a global epidemic, defined as a cluster of three of five criteria: insulin resistance and glucose intolerance, abdominal obesity, hypertension, low high-density cholesterol, and hypertriglyceridemia. The current review focuses on Indian medicinal plant drugs and plants used in the treatment of diabetes and hyperlipidemia. Though there are various approaches to reduce the ill-effects of diabetes and hyperlipidemia and its secondary complications, plant-based drugs are preferred due to lesser side effects and low cost. The current review focuses on twenty-three medicinal plants used in the treatment of Diabetes mellitus and nine medicinal plants used in the treatment of hyperlipidemia. The wealth of knowledge on medicinal plants points to a great potential for research and the discovery of new drugs to fight diseases, including diabetes and hyperlipidemia.

关键词：药理学天然药物性质实验药理学

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Some New Results on Domination Integrity of Graphs

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Open Journal of Discrete Mathematics 2012年第3期2卷 96-98页

作者： Samir K. Vaidya Nirang J. kothari B. h. Gardi college of Engineering & Technology Rajkot India Saurashtra University Rajkot India

The domination integrity of a connected graph G= (V(G), E(G)) is denoted as DI(G) and defined by DI(G) = min{*S*+ m(G-S) : S is a dominating set } where m(G-S) is the order of a maximum component of G-S . We discuss domination integrity in the context of some graph operations like duplication of an edge by vertex and duplication of vertex by an edge.

关键词： Integrity Dominating Set Domination Integrity

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Master curve generation and modeling of ac conductivity for Mn_(0.7+x)Zn_(0.3)Si_(x)Fe_(2-2x)O_(4) spinel ferrite system

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Journal of Advanced Dielectrics 2017年第3期7卷 54-63页

作者： N.h.Vasoya Prafulla K.Jha K.G.Saija J.A.Bhalodia K.B.Modi Department of Physics Faculty of ScienceM.S.University of Baroda Vadodara 390002India Smt.R.P.Bhalodia Mahila College Upleta 360490India Department of Physics Saurashtra UniversityRajkot 360005India

The compositional dependence of ac conductivity(δac),real(δ′)and imaginary(δ′′)parts of complex electric conductivity(δ*)was investigated as a function of temperature(T)and frequency(f) for Mn_(0.7+x)Zn_(0.3)Si_(x)Fe_(2-2x)O_(4),x=0.0,0.1,0.2 and 0.3 spinel ferrite system.The compositional dependence of lattice constant values suggested that the most of the substituted Si4+-ions reside at grain boundaries and only a few Si-ions are inside grains.The variation ofδ_(ac)(x,f,T)is explained on the basis of segregation and diffusion of Si4+ions at grain boundaries and grains,respectively,and the electrode effect.Thermal variation of ac conductivity at fixed frequency suggested two different mechanisms which could be responsible for conduction in the system.It is found that δ*is not the preferred presentation for dielectric data and the scaling process of real part of conductivity by normalized frequency and the scaled frequency were found unsuccessful.The fitting results of ac conductivity data with path percolation approximation were found suitable in low-frequency regime while in high-frequency regime,effective medium approximation(EMA)was found successful.

关键词： Ferrites ac conductivity scaling modeling.

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