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Angiographic evaluation and management of acute gastrointestinal hemorrhage

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World Journal of Gastroenterology 2012年第11期18卷 1191-1201页

作者： T gregory walker Gloria M Salazar Arthur C Waltman Division of Vascular Imaging and Intervention Massachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States

Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter *** with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to *** angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging *** a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential *** is now wellrecognized as a viable and safe alternative to emergency *** selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal *** must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding *** this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.

关键词： Angiodysplasia Aneurysm Digital subtrac-tion angiography Contrast media Hemorrhage Radio-nuclide angiography Therapeutic embolization

The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion

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Journal of Sport and Health Science 2021年第2期10卷 131-137页

作者： Katie A.Van Deventer Corrine N.Seehusen gregory A.walker Julie C.Wilson David R.Howell University of Colorado School of Medicine AuroraCO 80045USA Sports Medicine Center Children’s Hospital ColoradoAuroraCO 80045USA Department of Orthopedics University of Colorado School of MedicineAuroraCO 80045USA Department of Pediatrics University of Colorado School of MedicineAuroraCO 80045USA

Background:The tandem gait test has gained interest recently for assessment of concussion *** purpose of our study was to determine the prognostic and diagnostic use of the single-and dual-task tandem gait test,alongside other clinical measures,within 10 days of pediatric ***:We assessed 126 patients post-concussion(6.3§2.3 days post-injury,mean§SD)at a pediatric sports medicine clinic and compared them to 58 healthy controls(age:15.6§1.3 years;43%female).We also compared the 31 patients with concussion who developed persistent post-concussion symptoms(PPCS)(age=14.9§2.0 years;48%female)to the 81 patients with concussion who did not develop PPCS following the initial assessment(age:14.1§3.0 years;41%female).All subjects completed a test battery,and concussion patients were monitored until they experienced concussion-symptom *** test battery included tandem gait(single-task,dual-task(performing tandem gait while concurrently completing a cognitive test)conditions),modified Balance Error Scoring System(mBESS),and concussion symptom assessment(Health and Behavior Inventory).We defined PPCS as symptom resolution time>28 days post-concussion for the concussion *** outcomes included tandem gait time(single-and dual-task),dual-task cognitive accuracy,mBESS errors(single/double/tandem stances),and symptom ***:The concussion group completed the single-task(mean difference=9.1 s,95%confidential interval(95%CI):6.1-12.1)and dual-task(mean difference=12.7 s,95%CI:8.716.8)tandem gait test more slowly than the control *** to those who recovered within 28 days of concussion,the PPCS group had slower dual-task tandem gait test times(mean difference=7.9 s,95%CI:2.0-13.9),made more tandem-stance mBESS errors(mean difference=1.3 errors,95%CI:0.2-2.3),and reported more severe symptoms(mean difference=26.6 Health and Behavior Inventory rating,95%CI:21.1-32.6).Conclusion:Worse dual-task tandem gait test time and mB

关键词： Adolescent Balance Mild traumatic brain injury Postural stability Prognosis

Modified rives-stoppa repair for abdominal incisional hernias

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Health 2010年第2期2卷 162-169页

作者： Peter Nau Clancy J. Clark Mason Fisher gregory walker Bradley J. Needleman E. Christopher Ellison Peter Muscarella 不详

Incisional hernias are a prevalent problem in abdominal surgery and occur in 11% of patients who undergo laparotomy. Primary suture clo-sure of incisional hernias results in a 31%-58% chance of recurrence. The addition of a pros-thetic mesh implant decreases recurrence rates to 8%-10%. Popularized in Europe by Rives and Stoppa, the sublay technique has proven to be very effective, with low recurrence rates (0%-23%) and minimal complications. The pur-pose of the study was to evaluate the experi-ence of a single surgeon at a large tertiary care center performing a modified Rives-Stoppa re-pair for abdominal incisional hernias. To do this, the records of all patients undergoing a modi-fied Rives-Stoppa incisional hernia repair be-tween January 2000 and August 2003 were ret-rospectively reviewed. Outpatient clinic notes, discharge summaries, operative reports, and laboratory data were reviewed for patient demographics, surgical data and postoperative complications. Univariate analysis was per-formed in order to identify predictors for recur-rence. During the study period, 83 patients un-derwent a modified Rives-Stoppa incisional hernia repair. Nineteen patients were excluded due to incomplete medical records. No patients required postoperative exploration for an in-tra-abdominal catastrophe. Twenty-five percent (n=16) of patients had a complication as a result of the hernia repair. Only two patients (3.1%) developed recurrent incisional hernias. History of diabetes (p=0.007) and benign prostatic hy-perplasia (p=0.000) were the only significant predictors for recurrence. The results presented here confirm that the modified Rives-Stoppa retromuscular repair is an effective method for the repair of incisional hernias. The complica-tion and recurrence rates compare favorably to results for currently popular alternative tech-niques.

关键词： Incisional Hernia Repair Mesh Rives-Stoppa Repair Abdominal Wall Defects

Transpleural systemic artery to pulmonary vessel fistulas:Imaging characteristics and management of an uncommon entity

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Discussion of Clinical Cases 2020年第3期7卷 7-11页

作者： Thomas J An T.gregory walker Department of Radiology Division of Interventional RadiologyMassachusetts General HospitalBostonMAUSA

Systemic arterial to pulmonary vessel fistulas may develop in the setting of pleural inflammation and/or *** arteries are the most commonly involved vessels,with recruitment often occurring in chronic diseases such as tuberculosis and cystic ***,transpleural systemic arteries that directly communicate with the pulmonary vasculature may develop in the presence of pleural injury or chronic *** clinical presentation and management of three cases of transpleural systemic artery to pulmonary vessel fistulas are *** the atypical imaging appearance of these lesions,there is risk of misdiagnosis of these entities as a pulmonary arteriovenous *** the pathophysiology,complex anatomy,and treatment for these rare vascular malformations is crucial prior to angiographic intervention in order to improve outcomes,avoid misdiagnosis,and prevent inappropriate intervention.

关键词： Pulmonary arteriovenous fistula Transpleural Pulmonary hemorrhage

Angiographic and volumetric effects of mammalian target of rapamycin inhibitors on angiomyolipomas in tuberous sclerosis

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World Journal of Radiology 2016年第3期8卷 308-315页

作者： Rahul A Sheth Adam S Feldman Elahna Paul Elizabeth A Thiele T gregory walker Department of Interventional Radiology MD Anderson Cancer Center Department of Urology Massachusetts General Hospital Department of Pediatric Nephrology Massachusetts General Hospital Department of Neurology Massachusetts General Hospital Division of Interventional Radiology Department of Radiology Massachusetts General Hospital

AIM: To investigate the angiographic and volumetric effects of mammalian target of rapamycin(m TOR) inhibitors on angiomyolipomas(AMLs) in a case series of patients with tuberous sclerosis ***: All patients who underwent catheter angiography prior to and following m TOR inhibitor therapy(n = 3) were evaluated. All cross-sectional imaging studies were analyzed with three-dimensional volumetrics, and tumor volume curves for all three tissue compartments(soft tissue, vascular, and fat) were generated. Segmentation analysis tools were used to automatically create a region of interest(ROI) circumscribing the AML. On magnetic resonance images, the "fat only" map calculated from the in- and opposed-phase gradient recalled echo sequences was used to quantify fat volume within tumors. Tumor vascularity was measured by applying a thresholding toolwithin the ROI on post-contrast subtraction images. On computed tomography images, volume histogram analysis of Hounsfield unit was performed to quantify tumor tissue composition. The angiography procedures were also reviewed, and tumor vascularity based on pre-embolization angiography was characterized in a semi-quantitative manner. RESULTS: Patient 1 presented at the age of 15 with a 6.8 cm right lower pole AML and a 4.0 cm right upper pole AML. Embolization was performed of both tumors, and after a few years of size control, the tumors began to grow, and the patient was initiated on m TOR inhibitor therapy. There was an immediate reduction in the size of both lesions. The patient then underwent repeat embolization and discontinuation of m TOR inhibition, after which point there was a substantial regrowth in both tumors across all tissue compartments. Patient 2 presented at the age of 18 with a right renal AML. Following a brief period of tumor reduction after embolization, she was initiated on m TOR inhibitor therapy, with successful reduction in tumor size across all tissue compartments. As with patient 1, however, th

关键词： Tuberous sclerosis Angiomyolipoma Sirolimus Angiography Transcatheter embolization Interventional radiology Mammalian target of rapamycin inhibition Everolimus Volumetrics

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID- 19 pandemic

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Stroke & Vascular Neurology 2021年第4期6卷 542-552,I0026-I0032页

作者： Thanh N Nguyen Diogo C Haussen Muhammad M Qureshi Hiroshi Yamagami Toshiyuki Fujinaka Ossama Y Mansour Mohamad Abdalkader Michael Frankel Zhongming Qiu Allan Taylor Pedro Lylyk Omer F Eker Laura Mechtouff Michel Piotin Fabricio Oliveira Lima Francisco Mont'Alverne Wazim Izzath Nobuyuki Sakai Mahmoud Mohammaden Alhamza R Al-Bayati Leonardo Renieri Salvatore Mangiafico David Ozretic Vanessa Chalumeau Saima Ahmad Umair Rashid Syed Irteza Hussain Seby John Emma Griffin John Thornton Jose Antonio Fiorot Rodrigo Rivera Nadia Hammami Anna M Cervantes-Arslanian Hormuzdiyar H Dasenbrock Huynh Le Vu Viet Quy Nguyen Steven Hetts Romain Bourcier Romain Guile Melanie walker Malveeka Sharma Don Frei Pascal Jabbour Nabeel Herial Fawaz Al-Mufti Atilla Ozcan Ozdemir Ozlem Aykac Dheeraj Gandhi Chandril Chugh Charles Matouk Pascale Lavoie Randall Edgell Andre Beer-Furlan Michael Chen Monika Killer-Oberpfalzer Vitor Mendes Pereira Patrick Nicholson Vikram Huded Nobuyuki Ohara Daisuke Watanabe Dong Hun Shin Pedro SC Magalhaes Raghid Kikano Santiago Ortega-Gutierrez Mudassir Farooqui Amal Abou-Hamden Tatsuo Amano Ryoo Yamamoto Adrienne Weeks Elena A Cora Rotem Sivan-Hoffmann Roberto Crosa Markus Möhlenbruch Simon Nagel Hosam Al-Jehani Sunil A Sheth Victor S Lopez Rivera James E Siegler Achmad Fidaus Sani Ajit S Puri Anna Luisa Kuhn Gianmarco Bernava Paolo Machi Daniel G Abud Octavio M Pontes-Neto Ajay K Wakhloo Barbara Voetsch Eytan Raz Shadi Yaghi Brijesh P Mehta Naoto Kimura Mamoru Murakami Jin Soo Lee Ji Man Hong Robert Fahed gregory walker Eiji Hagashi Steve M Cordina Hong Gee Roh Ken Wong Juan F Arenillas Mario Martinez-Galdamez Jordi Blasco Alejandro Rodriguez Vasquez Luisa Fonseca M Luis Silva Teddy Y Wu Simon John Alex Brehm Marios Psychogios William J Mack Matthew Tenser Tatemi Todaka Miki Fujimura Roberta Novakovic Jun Deguchi Yuri Sugiura Hiroshi Tokimura Rakesh Khatri Michael Kelly Lissa Peeling Yuichi Murayama Hugh Stephen Winters Johnny Wong Mohamed Teleb Jeremy Payne Hiroki Fukuda Kosuke Miyake Junsuke Shimbo Yusuke Sug Neurology RadiologyBoston Medical CenterBostonMassachusettsUSA Neurology Marcus Stroke&Neuroscience CenterGrady Memorial HospitalEmory University School of MedicineAtlantaGAUSA Radiology Radiation OncologyBoston University School of MedicineBostonMassachusettsUSA Neurology National Hospital Organization Osaka National HospitalOsakaJapan Neurosurgery National Hospital Organization Osaka National HospitalOsakaJapan Neurology Alexandria UniversityAlexandriaEgypt Radiology Boston Medical CenterBostonMassachusettsUSA Department of Neurology Xinqiao HospitalChongqingChina Neurosurgery University of Cape TownRondeboschWestern CapeSouth Africa Neurosurgery Interventional NeuroradiologyClinica La Sagrada FamiliaBuenos AiresArgentina Neuroradiologie Neurologie VasculaireHospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Neurologie Vasculaire Hospices Civils de LyonLyonAuvergne-Rhône AlpesFrance Interventional Neuroradiology Fondation Ophtalmologique Adolphe de RothschildParisÎle-de FranceFrance Neurology Hospital Geral de FortalezaFortalezaBrazil Interventional Neuroradiology Hospital Geral de FortalezaFortalezaBrazil Neuroradiology Nottingham University Hospitals NHS TrustNottinghamUK Department of Neurosurgery Kobe City Medical Center General HospitalKobeHyogoJapan Interventional Neurovascular Unit University Hospital CareggiFirenzeToscanaItaly Neuroradiology University Hospital Centre ZagrebZagrebCroatia Interventional Neuroradiology Hopital BicetreLe Kremlin-BicetreFrance Stroke and Interventional Neuroradiology Lahore General HospitalLahorePakistan Neurological Institute Cleveland Clinic Abu DhabiAbu DhabiUAE Department of Radiology Beaumont HospitalDublinIreland Neurology Stroke UnitHospital-Estadual CentralVitoriaBrazil Neuroradiology Instituto de Neurocirugia Dr AsengoSantiagoChile Interventional Neuroradiology Institut National de NeurologieTunisTunisia Neurology Boston Medical CenterBostonMassachusettsUSA Neurosurgery Boston Medical Center

Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were *** study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar *** We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke *** with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,*** 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May *** prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal *** There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,p<0.0001).Embolisation of ruptured aneurysms declined with 1170-1035 procedures,respectively,representing an 11.5%(95%CI−13.5%to−9.8%,p=0.002)relative *** analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,p<0.0001).A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this *** There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 *** findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.

关键词： diagnosis representing subarachnoid

Superior Conjugative Plasmids Delivered by Bacteria to Diverse Fungi

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BioDesign Research 2022年第1期2022卷 151-165页

作者： Ryan R.Cochrane Arina Shrestha Mariana M.Severo de Almeida Michelle Agyare-Tabbi Stephanie L.Brumwell Samir Hamadache Jordyn S.Meaney Daniel P.Nucifora Henry Heng Say Jehoshua Sharma Maximillian P.M.Soltysiak Cheryl Tong Katherine Van Belois Emma J.L.walker Marc-AndréLachance gregory B.Gloor David R.Edgell Rebecca S.Shapiro Bogumil J.Karas Department of Biochemistry Schulich School of Medicine and DentistryThe University of Western OntarioLondonONCanada N6A 5C1 Department of Molecular and Cellular Biology University of GuelphGuelphONCanada N1G 2W1 Department of Biology The University of Western OntarioLondonOntarioCanada N6A 5B7

Fungi are nature’s recyclers,allowing for ecological nutrient cycling and,in turn,the continuation of life on *** fungi inhabit the human microbiome where they can provide health benefits,while others are opportunistic pathogens that can cause ***,members of the fungal kingdom,have been domesticated by humans for the production of beer,bread,and,recently,medicine and ***,the great untapped potential exists within the diverse fungal ***,many yeasts are intractable,preventing their use in biotechnology or in the development of novel treatments for pathogenic ***,as a first step for the domestication of new fungi,an efficient DNA delivery method needs to be ***,we report the creation of superior conjugative plasmids and demonstrate their transfer via conjugation from bacteria to 7 diverse yeast species including the emerging pathogen Candida *** create our superior plasmids,derivatives of the 57 kb conjugative plasmid pTA-Mob 2.0 were built using designed gene deletions and insertions,as well as some unintentional ***,a cluster mutation in the promoter of the conjugative gene traJ had the most significant effect on improving conjugation to *** addition,we created Golden Gate assembly-compatible plasmid derivatives that allow for the generation of custom plasmids to enable the rapid insertion of designer genetic ***,we demonstrated that designer conjugative plasmids harboring engineered restriction endonucleases can be used as a novel antifungal agent,with important applications for the development of next-generation antifungal therapeutics.

关键词： insertion continuation harbor