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Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

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Open Journal of Organ Transplant Surgery 2011年第1期1卷 1-7页

作者： Brintha K. Enestvedt C. Kristian Enestvedt brian diggs Susan L. Orloff 不详

Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2);268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.

关键词： Portal Vein Thrombosis Orthotopic Liver Transplantation Hypercoagulability Thromboses

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INTERIM ANALYSIS OF ACUPUNCTURE PROVES BLINDING IN A RANDOMIZED CONTROLLED TRIAL IS FEASIBLE IN THE INTENSIVE CARE UNIT

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Journal of Integrative Medicine 2014年第3期 300-301页

作者： Alexis Moren Jennifer Watters brian diggs Kate Watson Erika Simeon David Shapiro Robert Kaneko Miko Enomoto David Hampton Oregon Health & Science University University of Connecticut School of Medicine

Objective: The use of alternative therapies in the intensive care unit(ICU) is infrequent in the United *** has been proven to reduce pain, swelling, nausea, and sedative use for *** hypothesized that acupuncture would reduce sedative and analgesic requirements during mechanical ventilation(MV) with fewer side effects, and decrease length of MV and length of ICU ***, we hypothesized that acupuncture can be effectively blinded in the ***: A randomized controlled trial was conducted randomly assigning patients in the ICU to verum or sham *** were compared between the two groups using descriptive *** analysis using Mann-Whitney-U tests was used on all continuous ***: Fourteen enrolled patients were included in the interim analysis, 8 males(57%) and 6 females(43%).Verum and sham groups had similar vital signs when compared over all sessions: heart rate(97.2 vs.93.8; P=0.78), systolic blood pressure(110.2 vs.116.4; P=0.47), respiratory rate(16.8 vs.14.2; P=0.36) and RASS score(-1.3 vs.-2.7; P=0.52).No significance was found when assessing age(51 vs.50; P=0.79), APACHE score(15 vs.10.5; P=0.1), number of completed sessions(3 vs.2.5; P=0.37), or time to first acupuncture session(20 h vs.18.2 h; P=0.89).Although without statistically significant(P=0.69), large variation was demonstrated in time to extubation(65.3 h vs.138.3 h).Blinding proved successful as there was no significant difference between groups(P=0.77).Conclusion: Blinding in a randomized controlled trial of acupuncture in the ICU is feasible.

关键词： ICU INTERIM ANALYSIS OF ACUPUNCTURE PROVES BLINDING IN A RANDOMIZED CONTROLLED TRIAL IS FEASIBLE IN THE INTENSIVE CARE UNIT

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Impact of Ventricular Assist Device Implantation on Clinical and Economic Outcomes of Heart Transplantation in the United States from 2003-2007

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World Journal of Cardiovascular Surgery 2013年第5期3卷 154-159页

作者： Julie W. Doberne brian diggs Frederick Tibayan Matthew Slater Christopher V. Chien Jill Gelow James Mudd Howard K. Song Divisions of Cardiothoracic Surgery and Cardiovascular Medicine Oregon Health & Science University Portland USA

The use of ventricular assist devices (VADs) as a bridge to transplantation (BTT) has evolved considerably as clinical experience has grown and newer generation devices have become available. This study investigated the impact of VAD implantation on the clinical and economic outcomes of patients undergoing heart transplantation in the United States(US) from 2003-2007. A retrospective study was carried out using the Nationwide Inpatient Sample, to track the characteristics and outcomes of an estimated 7859 patients undergoing heart transplantation in the United States from 2003-2007. Patients were divided based on whether they were bridged to transplant with a VAD and whether they were outpatient (VAD Outpt) or inpatient (VAD Inpt). Multivariate analysis was performed to identify risk factors for inhospital mortality following heart transplantation. Hospital costs were also measured. A VAD was used as a BTT in 20.8% of patients undergoing heart transplantation during the study period. Early in the series the frequency of VAD Outpts and Inpts was similar but in later years patients were more commonly bridged as outpatients. Hospital mortality for the entire population was 6.2%. Multivariate analysis identified several risk factors for mortality, including advanced age, history of congenital heart disease, and VAD Inpt status. VAD Inpt status was the strongest predictor of mortality. The hospital cost of patients bridged as inpatients was more than double the cost of outpatients. Median hospital cost declined by 11% over the study period, from $115,868 to $103,578. Much of this cost reduction was related to the shift in VAD status from Inpt to Outpt. Heart transplant recipients are increasingly bridged to transplantation with VADs as outpatients. Those bridged as inpatients have substantially higher hospital mortality and cost. These findings have important clinical implications and should inform policy development, resource utilization and donor allocation.

关键词： Ventricular Assist Device Heart Transplantation Cost Effectiveness

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地震反射数据中的直接烃指标（DHI）在油气检测中的应用——该方法是在俄亥俄州的一个应用实例，说明在古老地层中也能用DHI来检测油气

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世界石油工业 2016年第3期23卷 58-61页

作者： Dominique M.Haneberg—diggs 俄亥俄州自然资源局地质调查部

地震剖面上的直接烃类显示是由于油气聚集产生的地震反射特征，通常被认为仅仅是气具有的特征，但由于地层中的原油中可能也含有大量溶解气，所以含油岩层也可能产生诸如亮点和平同相轴的直接烃类显示。俄亥俄州东部的克林顿地层单元长... 详细信息

地震剖面上的直接烃类显示是由于油气聚集产生的地震反射特征，通常被认为仅仅是气具有的特征，但由于地层中的原油中可能也含有大量溶解气，所以含油岩层也可能产生诸如亮点和平同相轴的直接烃类显示。俄亥俄州东部的克林顿地层单元长久以来采用岩心分析法和测井法进行油气勘探，很少认为地震反射可以运用到该区域，但是本研究结合地震反射、地震属性分析及初始油气产量图证实了地震反射法在本研究区域的适用性。这一研究结果的应用可能会影响当前能源工业的多个方面。对这项研究的进展还是应谨慎预期．进一步的研究也很有必要。

关键词：地震反射法直接烃类显示俄亥俄州克林顿地层油气检测

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磷酸腺苷激活的蛋白激酶在慢性应激诱发小鼠非酒精性脂肪肝中的作用

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第二军医大学学报 2017年第12期38卷 1521-1525页

作者：杨政华寇兴瑞杜格致黄俊龙张友磊第二军医大学东方肝胆外科医院肝外五科上海200438 第二军医大学学员旅学员3队上海200433 第二军医大学国际交流学院上海200433

目的探讨磷酸腺苷激活的蛋白激酶(AMPK)及其激动剂5-氨基咪唑-4-甲酰胺核苷酸(AICAR)在慢性应激诱发小鼠非酒精性脂肪肝(NAFLD)中的作用。方法建立小鼠慢性应激模型,设对照组、应激组、应激加AICAR给药组和AICAR给药组,每组6只。采用EL... 详细信息

目的探讨磷酸腺苷激活的蛋白激酶(AMPK)及其激动剂5-氨基咪唑-4-甲酰胺核苷酸(AICAR)在慢性应激诱发小鼠非酒精性脂肪肝(NAFLD)中的作用。方法建立小鼠慢性应激模型,设对照组、应激组、应激加AICAR给药组和AICAR给药组,每组6只。采用ELISA法检测小鼠血浆促炎性细胞因子(肿瘤坏死因子α,γ干扰素)浓度,采用自动生化分析仪检测小鼠血浆丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇、三酰甘油、游离脂肪酸的水平,采用苏木精-伊红染色和油红O染色检测肝细胞脂肪变性,采用蛋白质印迹法检测肝组织AMPK蛋白表达;然后用AICAR处理慢性应激小鼠并检测上述指标的变化。结果慢性应激导致小鼠肝细胞脂肪变性,肝功能损害(ALT、AST水平升高,P<0.01),血浆促炎性细胞因子浓度升高(P<0.05),血浆游离脂肪酸水平升高(P<0.01)以及肝组织AMPK蛋白表达降低(P<0.01)。AICAR改善了肝细胞脂肪变性,并缓解了上述指标的变化。结论慢性应激可能通过AMPK信号通路诱发NAFLD,AMPK激动剂AICAR可缓解慢性应激导致的NAFLD。

关键词：非酒精性脂肪肝应激腺苷-磷酸活化的蛋白激酶

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