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Dilemma of first line regimens in metastatic pancreatic adenocarcinoma

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World Journal of Gastroenterology 2016年第46期22卷 10124-10130页

作者： Marwan Ghosn Tony Ibrahim Tarek Assi elie el rassy Hampig Raphael Kourie Joseph Kattan Department of Oncology Faculty of Medicine Saint Joseph University

Pancreatic cancer is one of the deadliest cancers,ranking fourth among cancer-related deaths. Despite all the major molecular advances and treatment breakthroughs, mainly targeted therapies, the cornerstone treatment of metastatic pancreatic cancer(m PC) remains cytotoxic chemotherapy. In 2016, more than 40 years after the introduction of gemcitabine in the management of m PC, the best choice for first-line treatment has not yet been fully elucidated. Two main strategies have been adopted to enhance treatment efficacy. The first strategy is based on combining non-cross resistant drugs, while the second option includes the development of newer generations of chemotherapy. More recently, two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel(GNP), have both been shown to improve overall survival in comparison with gemcitabine alone, at the cost of increased toxicity. Therefore, the best choice for first line therapy is a matter of debate. For some authors, FOLFIRINOX should be the first choice in patients with an Eastern Cooperative Oncology Group score(0-1) given its lower hazard ratio. However, others do not share this opinion. In this paper, we review the main comparison points between FOLFIRINOX and GNP. We analyze the two pivotal trials to determine the similarities and differences in study design. In addition, we compare the toxicity profile of the two regimens as well as the impact on quality of life. Finally, we present studies revealing real life experiences and review the advantages and disadvantages of possible second-line therapies including their cost effectiveness.

关键词： Review Metastatic pancreatic cancer FOLFIRINOX Gemcitabine/nab-paclitaxel Pivotal trials

Where does chemotherapy stands in the treatment of ampullary carcinoma? A review of literature

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World Journal of Gastrointestinal Oncology 2016年第10期8卷 745-750页

作者： Marwan Ghosn Hampig Raphael Kourie elie el rassy Fady Ghassan Haddad Colette Hanna Fadi el Karak Dolly Nasr Department of Oncology Faculty of MedicineSaint Joseph University Department of Oncology Jules Bordet InstituteFree University of Brussels (ULB) Department of Radiation Oncology Faculty of MedicineSaint Joseph University

Ampullary carcinoma(AC) is a rare gastrointestinal tumor without clear treatment *** management of this tumor is usually extrapolated from the treatment of pancreatic,biliary duct and intestinal *** papers have studied the AC as an independent entity and yet succombs to several *** studies were retrospective single institutional experiences with limited sample sizes recruited over a long period of *** metastatic ACs where chemotherapy is the only recommended option,localized AC once excised may be approached by either chemotherapy alone or concomitant chemoradiation *** this review,we report the overall survival and recurrence factors of more than 1000 patients from all the studies treating exclusively *** also review the medical treatment of this tumor and conclude to the necessity of multi-institutional randomized controlled studies for AC exclusively.

关键词： Ampullary cancer Prognostic factors Treatment Review Novel therapies

Optimum chemotherapy for the management of advanced biliary tract cancer

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World Journal of Gastroenterology 2015年第14期21卷 4121-4125页

作者： Marwan Ghosn Hampig Raphael Kourie elie el rassy Ralph Chebib Fadi el Karak Colette Hanna Dolly Nasr Department of Oncology Faculty of MedicineSaint Joseph University

Biliary tract cancers(BTCs) are highly fatal malignancies, which are often diagnosed at an advanced stage and have relatively poor *** treatment of patients with advanced BTC is systemic, based on chemotherapy or best supportive care, depending on their performance *** clinical trials studyingmany chemotherapeutic regimens and targeted therapies for the treatment of BTC, the standard of care for advanced BTC remains the combination of gemcitabine with *** new molecules targeting proliferation and survival pathways, the immune response and angiogenesis are currently undergoing phase Ⅰ and Ⅱ trials for the treatment of advanced BTC with promising results.

关键词： Biliary tract cancer Chemotherapy Updates Treatmen

Understanding myofibroblast origin in the fibrotic lung

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Chinese Medical Journal Pulmonary and Critical Care Medicine 2024年第3期2卷 142-150页

作者： Mahsa Zabihi Mahtab Shahriari Felordi Arun Lingampally Saverio Bellusci Xuran Chu elie el Agha Department of Medicine V Internal MedicineInfectious Diseases and Infection ControlUniversities of Giessen and Marburg Lung Center(UGMLC)German Center for Lung Research(DZL)Justus-Liebig University GiessenGiessen 35392Germany Cardio-Pulmonary Institute(CPI) Giessen 35392Germany Institute for Lung Health(ILH) Giessen 35392Germany Department of Medicine II Internal MedicinePulmonary and Critical CareUniversities of Giessen and Marburg Lung Center(UGMLC)German Center for Lung Research(DZL)Justus-Liebig University GiessenGiessen 35392Germany Oujiang Laboratory(Zhejiang Lab for Regenerative Medicine Vision and Brain Health)School of Pharmaceutical ScienceWenzhou Medical UniversityWenzhouZhejiang 325035China

Idiopathic pulmonary fibrosis(IPF)is characterized by accumulation of myofibroblasts(MYFs)and extracellular matrix components,which leads to severe distortion and scarring of the gas exchange units of the lung,the alveoli,and ultimately respiratory ***-associated MYFs are therefore widely regarded as the culprits that compromise the architectural makeup of the lung in fibrotic *** the past decade,the cellular source of MYFs has been intensely *** rationale for such studies is that identifying the origin of these cells might help identify novel therapeutic targets and candidates to treat IPF *** advances in basic and translational research employing lineage tracing and multi-omics approaches have helped address the identity of MYF precursors,highlight the underlying heterogeneity,and to a less extent investigate MYF fate during fibrosis *** this review,we discuss the current understanding of such important aspects of MYF biology as well as recent developments in the treatment of IPF.

关键词： Idiopathic pulmonary fibrosis Myofibroblasts Fibrotic disease Myofibroblast heterogeneity Lineage tracing

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

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World Journal of Clinical Cases 2024年第17期12卷 2966-2975页

作者： Georges Khattar Samer Asmar Laurence Aoun Fares Saliba Shaza Almardini Saif Abu Baker Catherine Hong Carolla el Chamieh Fadi Haddadin Toni Habib Omar Mourad Zeina Morcos Fatema Arafa Jonathan Mina Khalil el Gharib Mohammad Aldalahmeh Salman Khan elie Bou Sanayeh Department of Medicine Holy Spirit University of KaslikJounieh 00000Lebanon Department of Internal Medicine Staten Island University HospitalStaten IslandNY 10305United States Public Heath and Biostatistics Independent ResearchBeirut 0000Lebanon Department of Medicine Lebanese UniversityBeirut 00000Lebanon Department of Medicine University of BalamandBeirut 00000Lebanon Department of Medicine Lebanese American UniversityBeirut 00000Lebanon Department of Medicine Northwell Health Staten Island University HospitalNew YorkNY 10305United States

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ***,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at *** evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS *** We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample *** patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)*** applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical *** Following 1:1 propensity score matching,the analysis included 274 patients in each ***,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon *** Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

关键词： Acute respiratory distress syndrome Type 2 diabetes mellitus Insulin Length of stay Mortality Endotracheal intubation Acute kidney injury Coronavirus disease 2019

Surgical management of gallstone ileus after one anastomosis gastric bypass: A case report

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 2083-2088页

作者： elie el Feghali Rhea Akel Bilal Chamaa Daniel Kazan Ghassan Chakhtoura Department of General Surgery Saint Joseph UniversityBeirut 1107Lebanon Department of Radiology Saint Joseph UniversityBeirut 1107Lebanon

BACKGROUND Gallstone ileus following one anastomosis gastric bypass(OAGB)is an exceptionally rare *** presented case report aims to highlight the unique occurrence of this condition and its surgical *** the clinical presentation,diagnostic challenges and successful surgical inter-vention in such cases is crucial for healthcare professionals involved in bariatric *** SUMMARY We present a case report of gallstone ileus following OAGB and discuss its diagnosis and surgical management.A 66-year-old female with a history of OAGB presented to the emergency room with symptoms of small bowel *** tomography scan revealed a gallstone impacted in the distal ileum,causing *** patient underwent a laparoscopically assisted enterolithotomy,during which the gallstone was extracted and the enterotomy was *** patient had an uneventful recovery and was dis-charged on postoperative day *** Gallstone ileus should be considered as a possible complication after OAGB,and prompt surgical intervention is usually required for its *** case report contributes to the limited existing literature,providing insights into the management of this uncommon complication.

关键词： Gallstone ileus One anastomosis gastric bypass Bariatric surgery Intestinal occlusion Bilio-digestive fistula Enterolithotomy Case report

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

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World Journal of Gastroenterology 2009年第29期15卷 3636-3642页

作者： Heitham Abdul-Baki Ihab I el Hajj Lara elZahabi Cecilio Azar elie Aoun Assaad Skoury Hani Chaar Ala I Sharara Department of Internal Medicine Division of Gastroenterology American University of Beirut Medical Center Riad El Solh 110 72020 Beirut Lebanon

AIM: To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS: A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk was performed. Doubling the dose was allowed once at week 2 in case of an unsatisfactory early response. Primary efficacy variables were subjective global symptom relief and quality of life (QoL) using SF-36 at week 12. RESULTS: One hundred and seven patients were enrolled by advertisement or referral by general practitioners and 56 (31 imipramine: 25 placebo) completed the 16-wk study. Baseline characteristics were comparable. A high overall dropout rate was noted in the imipramine and placebo arms (47.5% vs 47.9%, P > 0.05), a mean of 25.0 and 37.4 d from enrollment, respectively (P elief with imipramine over placebo (per-protocol: 80.6% vs48.0%, P = 0.01) and a trend on intent-to-treat (ITT) analysis (42.4% vs 25.0%, P = 0.06). This improvement was evident early and persisted to week 16 (P = 0.024 and 0.053 by per-protocol and ITT analyses, respectively). Mean cumulative and componentspecific SF-36 scores improved in the imipramine group only (per-protocol, P elated adverse events leading to patient dropout were more common in the imipramine group (25.4% vs 12.5%, P > 0.05). CONCLUSION: Imipramine may be effective in the treatment of IBS patients and is associated with improved QoL. Careful patient selection, initiation of a low dose with gradual escalation and monitoring for side effects may result in an improved therapeutic response.

关键词： Tricyclic antidepressants Quality of life Functional gastrointestinal disorders Irritable bowelsyndrome Pain

A Methodological Approach to Study Almond Oil Stability in Relation to <i>α</i>-Tocopherol Supplementation

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Food and Nutrition Sciences 2012年第12期3卷 1710-1715页

作者： Lizette Auezova Chawki Saliba elie Hajj-Moussa Leina el Hosry Said Yammine Ramez Chahine Department of Chemistry Faculty of Sciences II Lebanese University Fanar Jdaidet el Matn Lebanon Faculty of Agriculture and Veterinary Sciences Lebanese University Dekwaneh Beirut Lebanon Faculty of Medical Sciences Lebanese University Hadath Campus Beirut Lebanon Faculty of Pharmacy Lebanese University Hadath Campus Beirut Lebanon

The objectives of the present study were to identify a suitable parameter to assess the oil oxidation and to study the possibilities of delaying the oxidation of moderately oxidized unrefined almond oil by adding supplementary amounts of α-tocopherol. Three oil samples, with initial peroxide values of 13.3, 19.5 (moderately oxidized oils), and 28.9 (oxidized oil), were supplemented with 100, 250 and 500 ppm of α-tocopherol and subjected to the oxidation at 50°C for 9 days. The level of oxidation was determined by measuring peroxide value (PV), conjugated dienes (CD) and thiobarbituric acid reactive substances (TBARS). Chemometric analysis indicated that, under the conditions of the present study, PV was the most suitable indicator of oil oxidation. The results have shown that the α-tocopherol could have an anti- oxidant or pro-oxidant effects, depending on its concentration and initial level of oil oxidation. Results also show that α-tocopherol addition at all the concentrations tested resulted in pro-oxidation of the moderately oxidized oils;hence additional supplementation with α-tocopherol could not be recommended to delay oxidation of unrefined almond oil.

关键词： Almond Oil Oxidative Stability α-Tocopherol PV CD TBARS Chemometrics

Etiologies and Outcome of Children with Purulent Meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (Cameroon)

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Open Journal of Pediatrics 2014年第4期4卷 269-275页

作者： Seraphin Nguefack Andreas Chiabi Jacob Enoh el Hadji Djouberou Evelyn Mah Karen Kengne Kamga Sandra Tatah elie Mbonda Departement of Pediatric Neurology Yaounde Gynaeco-Obstetric and Pediatric HospitalYaoundeCameroon Faculty of Medicine and Biomedical Sciences University of Yaounde IYaoundeCameroon Departement of Pediatric University of Cocody-AbidjanAbidjanCote d’Ivoire

Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess

关键词： Bacterial Meningitis Etiologies Outcome Children Cameroon