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Organization of future training in bariatric gastroenterology

World journal of Gastroenterology 2017年第35期23卷 6371-6378页

作者： Timothy R Koch Timothy R Shope christopher j gostout Center for Advanced Laparoscopic General and Bariatric Surgery Med Star Washington Hospital Center and Georgetown University School of Medicine Division of Gastroenterology and Hepatology Mayo Clinic

A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the longterm impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a longterm approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees' prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and

关键词： Obesity Bariatrics Bariatric surgery Intragastric balloon Endoscopic sleeve gastroplasty Nutrition Endoscopy Training

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Development of minimally invasive techniques for management of medically-complicated obesity

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World journal of Gastroenterology 2014年第37期20卷 13424-13445页

作者： Farzin Rashti Ekta Gupta Suzan Ebrahimi Timothy R Shope Timothy R Koch christopher j gostout Section of Gastroenterology and Hepatology MedStar-Washington Hospital Center and Georgetown University Schoolof Medicine Department of Surgery MedStar-Washington Hospital CenterCenter for Advanced Laparoscopic and Bariatric Surgery Division of Gastroenterology and Hepatology Mayo Medical School

The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal inter-ventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss.

关键词： Obesity Bariatrics Bariatric surgery Weight loss Endoscopy

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Advanced endoscopic imaging of indeterminate biliary strictures

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World journal of Gastrointestinal Endoscopy 2015年第18期7卷 1268-1278页

作者： james H Tabibian Kavel H Visrodia Michael j Levy christopher j gostout Division of Gastroenterology and Hepatology Mayo Clinic Division of Gastroenterology Wilmott Center for Endoscopic Innovation Research and Training University of Pennsylvania Department of Internal Medicine Mayo Clinic

Endoscopic evaluation of indeterminate biliary stric-tures(IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography(ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition(i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demon-strated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

关键词： Cholangiocarcinoma Bile duct diseases Cholangiopat

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Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease:A prospective study

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World journal of Gastrointestinal Endoscopy 2019年第2期11卷 145-154页

作者： james H Tabibian jean F Perrault joseph A Murray Konstantinos A Papadakis Felicity T Enders christopher j gostout Division of Gastroenterology and Hepatology Mayo Clinic Division of Gastroenterology Olive View-UCLA Medical Center Division of Biomedical Statistics and Informatics Mayo Clinic

BACKGROUND Duodenal biopsies are commonly obtained during esophagogastroduodenoscopy(EGD) but are very often histopathologically normal. Therefore, a more strategic method for evaluating the duodenal mucosa and avoiding unnecessary biopsies is *** To examine the clinical utility of narrow band imaging(NBI) for evaluating duodenal villous *** We performed a prospective cohort study of adult patients at Mayo Clinic Rochester from 2013-2014 who were referred for EGD with duodenal biopsies. A staff endoscopist scored, in real-time, the NBI-based appearance of duodenal villi into one of three categories(normal, partial villous atrophy, or complete villous atrophy), captured ≥ 2 representative duodenal NBI images, and obtained mucosal biopsies therein. Images were then scored by an advanced endoscopist and gastroenterology fellow, and biopsies(gold standard) by a pathologist, in a masked fashion using the same three-category classification. Performing endoscopist, advanced endoscopist, and fellow NBI scores were compared to histopathology to calculate performance characteristics [sensitivity, specificity,positive and negative, negative predictive value(NPV), and accuracy]. Inter-rater agreement was assessed with Cohen's ***112 patients were included. The most common referring indications were dyspepsia(47%), nausea(23%), and suspected celiac disease(14%). Duodenal histopathology scores were: 84% normal, 11% partial atrophy, and 5% complete atrophy. Performing endoscopist NBI scores were 79% normal, 14% partial atrophy, and 6% complete atrophy compared to 91%, 5%, and 4% and 70%, 24%,and 6% for advanced endoscopist and fellow, respectively. NBI performed favorably for all raters, with a notably high(92%-100%) NPV. NBI score agreement was best between performing endoscopist and fellow(κ = 0.65).CONCLUSION NBI facilitates accurate, non-invasive evaluation of duodenal villi. Its high NPV renders it especially useful for foregoing biopsies of hi

关键词： Endoscopy Digestive tract Mucosa Celiac disease Minimally-invasive imaging Esophagogastroduodenoscopy

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Apples to oranges:environmentally derived,dynamic regulation of serotonin neuron subpopulations in adulthood?

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Neural Regeneration Research 2025年第9期20卷 2596-2597页

作者： christopher j.O’Connell Matthew j.Robson Department of Genetics College of MedicineHarvard UniversityBostonMAUSA james L.Winkle College of Pharmacy Division of Pharmaceutical SciencesUniversity of CincinnatiCincinnatiOHUSA Neuroscience Graduate Program College of MedicineUniversity of CincinnatiCincinnatiOHUSA

Traumatic brain injury(TBI)is a public health problem with an undue economic burden that impacts nearly every age,ethnic,and gender group across the globe(Capizzi et al.,2020).TBIs are often sustained during a dynamic range of exposures to energetic environmental forces and as such outcomes are typically heterogeneous regarding severity and pathology(Capizzi et al.,2020).

关键词： sustained orange dynamic

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Studying turbulence structure near the wall in hydrodynamic flows:An approach based on the Schur decomposition of the velocity gradient tensor

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journal of Hydrodynamics 2022年第5期34卷 806-825页

作者： christopher j.Keylock School of Architecture Building and Civil EngineeringLoughborough UniversityLeicestershireUK

The Schur decomposition of the velocity gradient tensor(VGT)is an alternative to the classical Cauchy-Stokes decomposition into rotation rate and strain rate ***,there have been several strands of work that have employed this decomposition to examine the physics of turbulence dynamics,including approaches that combine the Schur and Cauchy-Stokes *** are briefly reviewed before the latter approach is set *** partitions the rotation rate and strain rate tensors into normal/local and non-normal/non-local *** then study the relation between the VGT dynamics and ejection-sweep events in a channel flow *** show that the sweeps in particular exhibit novel behaviour compared with either the other quadrants,or the flow in general,with a much-reduced contribution to the dynamics from the non-normal terms above the viscous *** particular,the reduction in the production term that is the interaction between the non-normality and the normal straining reduces in the log-layer as a consequence of an absence of alignment between the non-normal vorticity and the strain rate *** have been early forays into using the Schur transform approach for subgrid-scale modelling in large-eddy simulation(LES)and this would appear to be an exciting way forward.

关键词： Turbulence channel flow velocity gradient tensor Schur decomposition

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Development process for a higher capacity Propsetter~ system

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International journal of Mining Science and Technology 2018年第1期28卷 121-126页

作者： christopher j.Brown Product Development-Strata Worldwide LLC

As longwall tailgate support technologies continue to be developed and improved, strata worldwide has worked to design and manufacture a revised Propsetter to provide additional support capacity and enable applications at greater mine *** support is targeted for tailgate applications, however, it can also be utilized for roof support in various types of mining *** paper describes the design changes for enhancing the support capacity of the Propsetter to more closely align its performance with other support technologies currently being employed in longwall *** changes to each design aspect of the Propsetter was key to successfully improving the roof support's load capacity while maintaining controlled *** the load capacity would allow a mine to improve support efficiency with a smaller, less intrusive support compared to support alternatives and reduce the cost per foot of supported *** target support capacity was 711–890 k N at 50 mm of deformation to more closely match the performance of competing tailgate supports such as the 610 mm-diameter CAN~.To achieve this goal, changes were made to all design aspects of the Propsetter: diameter, wedge cut depth and angle, pod size, and confinement *** results from the NIOSH Mine Roof Simulator verified that these design changes were successful in increasing the capacity of the Propsetter to the 711–890 k N range at fifty mms of deformation.

关键词： Propsetter Can Longwall mining Tailgate roof support Controlled deformation

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Plasma-catalysis: Is it just a question of scale?

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Frontiers of Chemical Science and Engineering 2019年第2期13卷 264-273页

作者： j.christopher Whitehead School of Chemistry The University of ManchesterManchester M13 9PLUK

The issues of describing and understanding the changes in performance that result when a catalyst is placed into plasma are discussed. The different chemical and physical interactions that result and how their combination might produce beneficial results for the plasma-catalytic processing of different gas streams are outlined with particular emphasis being placed on the different range of spatial and temporal scales that must be considered both in experiment and modelling. The focus is on non-thermal plasma where the lack of thermal equilibrium creates a range of temperature scales that must be considered. This contributes in part to a wide range of inhomogeneity in different properties such as species concentrations and electric fields that must be determined experimentally by in situ methods and be incorporated into modelling. It is concluded that plasmacatalysis is best regarded as conventional catalysis perturbed by the presence of a discharge, which modifies its operating conditions, properties and outcomes often in a very localised way. The sometimes used description "plasma-activated catalysis" is an apt one.

关键词： plasma catalysis plasma-activated catalysis non-thermal plasma CO2 conversion

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Endocasts-the direct evidence and recent advances in the study of human brain evolution

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Progress in Natural Science:Materials International 2007年第9期17卷 993-1002页

作者： christopher j.Norton 86011-4099 AZ Beijing 100044 China Flagstaff Institute of Vertebrate Paleontology and Paleoanthropology Chinese Academy of Sciences Laboratory of Quaternary Paleontology Northern Arizona University USA

Brain evolution is one of the most important aspects of human evolution,usually studied through *** of fossil hominid endocasts allows inferences on functional anatomy,physiology,and *** this paper,we describe the general features of endocast studies and review some of the major topics in *** are:absolute and relative brain size evolution;brain shape variation;brain asymmetry and lateralization;middle meningeal vessels and venous sinuses;application of computed tomography and virtual imaging;the history of Chinese brain endocast *** particular,this review emphasizes endocast studies on Chinese hominin fossils.

关键词： endocast human fossil brain evolution cranial capacity human evolution

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Structural subgrid-scale modeling for large-eddy simulation: A review

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Acta Mechanica Sinica 2016年第4期32卷 567-578页

作者： Hao Lu christopher j.Rutland School of Energy and Power Engineering Huazhong University of Science and Technology Engine Research Center Mechanical EngineeringUniversity of Wisconsin-Madison

Accurately modeling nonlinear interactions in turbulence is one of the key challenges for large-eddy simulation（LES） of turbulence. In this article, we review recent studies on structural subgrid scale modeling, focusing on evaluating how well these models predict the effects of small scales. The article discusses a priori and a posteriori test results. Other nonlinear models are briefly discussed, and future prospects are noted.

关键词： turbulence turbulent viscosity priori dissipation posteriori scalar A review scales Reynolds

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