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Controversies in the treatment of gastroesophageal reflux and achalasia

World Journal of Gastroenterology 2006年第20期12卷 3155-3161页

作者： kurt e roberts Andrew J Duffy Robert L Bell Department of Surgery Yale University School of Medicine 40 Temple St. Suite 3 ANew HavenCT 06510United States

The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease （GeRD） and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GeRD evolves around laparoscopic antireflux surgery （LAP, S） as the preferred treatmerit for Barrett＇s esophagus and the procedure＇s potential to reduce the risk of adenocarcinoma of the esophagus. GeRD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GeRD. A new and promising alternative in the treatment of GeRD is endoluminal therapy. Three types of this new treatment option will be discussed： radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter. Laparoscopic surgery is discussed not only as a very effective treatment for GeRD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia： medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LAPS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective nonsurgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concer

关键词： Gastroesophageal reflux disease Nissen Toupet Fundoplication Achalasia Heller myotomy

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evolution of surgical skills training

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World Journal of Gastroenterology 2006年第20期12卷 3219-3224页

作者： kurt e roberts Robert L Bell Andrew J Duffy Department of Surgery Yale University School of Medicine 40 Temple StreetSuite 3ANew HavenCT 06510United Staets

Surgical training is changing： one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated ＂tissue＂ in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical education＇s （ACGMe） has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

关键词： Surgery Training Certification Skills Simulation Curriculum

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Fetal lung growth predicts the risk for early-life respiratory infections and childhood asthma

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World Journal of Pediatrics 2024年第5期20卷 481-495页

作者： Dimitra e.Zazara Olympia Giannou Steven Schepanski Mirja Pagenkemper Anastasios D.Giannou Maike Pincus Ioannis Belios Stefan Bonn Ania C.Muntau kurt Hecher Anke Diemert Petra Clara Arck Division for experimental Feto-Maternal Medicine Department of Obstetrics and Fetal MedicineUniversity Medical Center Hamburg-Eppendorf(UKE)Martinistraße 5220251HamburgGermany University Children’s Hospital UKEHamburgGermany Computer engineering and Informatics Department Polytechnic SchoolUniversity of PatrasPatrasGreece Institute of Developmental Neurophysiology Center for Molecular Neurobiology Hamburg(ZMNH)UKEHamburgGermany Department of Obstetrics and Fetal Medicine UKEHamburgGermany Department of General Visceral and Thoracic SurgeryUKEHamburgGermany Section of Molecular Immunology and Gastroenterology Ⅰ.Department of MedicineUKEHamburgGermany Pediatrics and Pediatric Pneumology Practice BerlinGermany Institute of Medical Systems Biology ZMNHUKEHamburgGermany Hamburg Center for Translational Immunology UKEHamburgGermany

Background early-life respiratory infections and asthma are major health burdens during *** predicting an increased risk for early-life respiratory diseases are ***,we identified the predictive value of ultrasound-monitored fetal lung growth for the risk of early-life respiratory infections and *** Fetal lung size was serially assessed at standardized time points by transabdominal ultrasound in pregnant women participating in a pregnancy *** between fetal lung growth and respiratory infections in infancy or early-onset asthma at five years were ***-learning models relying on extreme gradient boosting regressor or classifier algorithms were developed to predict respiratory infection or asthma risk based on fetal lung *** model development and validation,study participants were randomly divided into a training and a testing group,respectively,by the employed *** enhanced fetal lung growth throughout pregnancy predicted a lower early-life respiratory infection *** sex was associated with a higher risk for respiratory infections in *** lung growth could also predict the risk of asthma at five years of *** designed three machine-learning models to predict the risk and number of infections in infancy as well as the risk of early-onset *** models’R2 values were 0.92,0.90 and 0.93,respectively,underscoring a high accuracy and agreement between the actual and predicted *** variables included known risk factors and novel predictors,such as ultrasound-monitored fetal lung *** Sonographic monitoring of fetal lung growth allows to predict the risk for early-life respiratory infections and asthma.

关键词： Asthma Child risk early-life respiratory infections Prenatal lung development Sexual dimorphism

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Storylines of family medicine Ⅻ:family medicine and the healthcare system

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Family Medicine and Community Health 2024年第S3期12卷 109-118页

作者： William B Ventres Leslie A Stone Jeannette e South-Paul Kendall M Campbell Aerial R Petty Hima ekanadham kurt C Stange Rebecca S etz William L Miller Robert L Ferrer Marianna Kong Thomas Bodenheimer Roger Strasser Sharon C M Reece Joshua Freeman John M Westfall Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Meharry Medical College NashvilleTennesseeUSA Family Medicine University of Texas Medical Branch at Galveston School of MedicineGalvestonTexasUSA Family Medicine Residency Program New York-Presbyterian Columbia University Medical CenterNew YorkNew YorkUSA Center for Family and Community Medicine Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA Center for Community Health Integration Case Western Reserve University School of MedicineClevelandOhioUSA Family Medicine and Population Health Virginia Commonwealth University School of MedicineRichmondVirginiaUSA Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA University of South Florida Morsani College of Medicine TampaFloridaUSA Family and Community Medicine UT Health San Antonio Long School of MedicineSan AntonioTexasUSA Family and Community Medicine University of California San Francisco School of MedicineSan FranciscoCaliforniaUSA Northern Ontario School of Medicine University SudburyOntarioCanada Family Medicine Baylor Scott and White HealthTempleTexasUSA Family Medicine University of Kansas School of MedicineKansas CityKansasUSA DARTNet Insitute AuroraColoradoUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅻ:Family medicine and the future of the healthcare system’,authors address the following themes:‘Leadership in family medicine’,‘Becoming an academic family physician’,‘Advocare—our call to act’,‘The paradox of primary care and three simple rules’,‘The quadruple aim—melding the patient and the health system’,‘Fit-for-purpose medical workforce’,‘Universal healthcare—coverage for all’,‘The futures of family medicine’and‘The 100th essay.’May readers of these essays feel empowered to be part of family medicine’s exciting future.

关键词： system illustration family

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Petrology and Geochemistry of Post-Collisional early Miocene Volcanism in the Karacadag Area(Central Anatolia,Turkey)

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Acta Geologica Sinica(english edition) 2011年第5期85卷 1100-1117页

作者： Krsad ASAN Hseyin kurt Department of Geological engineering Selcuk University

early Miocene（ca.21-18 Ma） volcanism in the Karacadag area comprises three groups of volcanic rocks:（1） calcalkaline suite（andesitic to rhyolitic lavas and their pyroclastics）,（2） mildly-alkaline suite（alkali basalt,hawaiite,mugearite,benmoreite and trachydacite）,and（3） a single trachyandesitic flow *** observations,40Ar/39Ar ages and geochemical data show that there was a progressive temporal transition from group 1 to 3 in a post-collisional tectonic *** calcalkaline suite rocks with medium-K in composition resemble those of subduction-related lavas, whereas the mildly-alkaline suite rocks having a sodic tendency（Na2O/K2O=l.5-3.2） resemble those of within-plate *** element and Sr-Nd isotopic characteristics of the suites suggest that the lithospheric mantle beneath the Karacadag area was heterogeneously enriched by two processes before collision:（1） enrichment by subduction-related processes,which is important in the genesis of the calcalkaline volcanism,（2） enrichment by small degree melts from the astenosphere,which dominates the mildly alkaline *** of the enriched lithosphere by either delamination following collision and uplift or removal of the subducted slab following subduction and collision（i.e.,slab breakoff） is the likely mechanism for the initiation of the post-collision volcanism.

关键词： post-collision calcalkaline Sr-Nd isotopes Karacadag Central Anatolia

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Wide-Band Multi-spectral Space for Color Representation

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Geo-Spatial Information Science 2003年第2期6卷 69-74页

作者： kurt Muenger School of Journalism and Communication Wuhan University Wuhan China

This paper develops a wide-band multi-spectral space for color representationwith Aitken PCA algorithm. This novel mathematical space using the broad-band spectra matchingmethod aims at improving the accuracy of color representation as well as reducing costs forprocessing and storing multi-spectral images. The results show that the space can present ourexperimental original spectral spaces (i. e. Munsell color matt and DIN-6164 color chips) with highefficiency, and that the spanning space with three eigenvectors can present the original space atmore than 98% CSCR, and when 5 eigenvectors are used it can cover almost the whole o-riginal spaces.

关键词： color representation metamerism wide-band multispectral space PCA(principal component analysis)

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Mssbauer and electron microscopy study of martensitic transformations in an Fe-Mn-Mo alloy

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International Journal of Minerals,Metallurgy and Materials 2010年第4期17卷 448-452页

作者： T.Kirindi U.Sari M.kurt Department of Computer education and Instructional Technology Kirkkale University Kirkkale 71450Turkey Institute of Sciences Kirkkale University Yahsihan CampusKirkkale 71450Turkey

The kinetic,morphological,crystallographic,and magnetic characteristics of thermally induced martensites in Fe-13.4wt% Mn-5.2wt%Mo alloy were investigated by scanning electron microscopy（SeM）,transmission electron microscopy（TeM）,and M（o｜¨）ssbauer *** experimental results reveal that two types of thermal-induced martensites,e（hcp） andα＇（bcc） martensites,are formed in the as-quenched condition,and these transformations have athermal *** addition to the Fe-Mn alloy does not change the coexistence ofεandα＇ martensites with the Mn content between 10wt%and 15wt%.Besides,M（o｜¨）ssbauer spectra reveal a paramagnetic character with a singlet for theγ（fcc） austenite andεmartensite phases and a ferromagnetic character with a broad sextet for theα＇ martensite phase. The volume fraction ofα＇ martensite forming in the quenched alloy is much more than that of theεmartensite.

关键词： Fe-Mn alloy molybdenum martensitic transformation scanning electron microscopy(SeM) transmission electron microscopy(TeM) Mossbauer spectroscopy

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Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

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Asian Journal of Andrology 2009年第4期11卷 461-477页

作者： Vittorio Magri Florian M. e. Wagenlehner emanuele Montanari emanuela Marras Viviana Orlandi Antonella Restelli erminio Torresani kurt G. Naber Gianpaolo Perletti Urology and Sonography Primary Care Clinic Hospital：＂Istituti Clinici di Perfezionamento＂ Milano 20100 Italy Department of Urology and Pediatric Urology Justus-Liebig-University Giessen 35390 Germany Third Urological Clinic San Paolo Hospital University of Milan Milan 20142 Italy Laboratory of Toxicology and Pharmacology Department of Structural and Functional Biology University of Insubria Busto A. 21052 Italy Laboratory of Molecular and environmental Microbiology Department of Structural and Functional Biology University of lnsubria Varese 21100 Italy Microbiology Unit Hospital：＂Osp. Maggiore Policlinico Mangiagalli Regina Elena＂ Milano 20122 Italy Technical University Munich Munich 80333 Germany

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （enterobacteriaceae, enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is u

关键词： alfuzosin azithromycin chronic bacterial prostatitis chronic pelvic pain syndrome ciprofloxacin Meares and Stamey test National Institutes of Health Chronic Prostatitis Symptom Index prostatitis semen analysis seminal fluid Serenoa repens

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Pyrolyzed biomass-derived nanoparticles:a review of surface chemistry,contaminant mobility,and future research avenues to fill the gaps

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Biochar 2022年第1期4卷 635-651页

作者： Logan Swaren Salman Safari kurt O.Konhauser Daniel S.Alessi Department of earth and Atmospheric Sciences University of Alberta3-16 Earth Sciences BuildingEdmontonAB T6G 2E3Canada

Nanoparticles are abundant in the subsurface,soil,streams,and water bodies,and are often a critical control on elemental speciation,transport and cycling in the natural *** review provides an overview of pyrolyzed biomass-derived nanoparticles(PBNPs),their surface properties and reactivity towards aqueous *** focus specifically on biochar-derived nanoparticles and activated carbon-derived nanoparticles which fall under our classification of *** carbon-iron(nano)composites are included in some instances where there are significant gaps in literature because of their environmental *** use of activated carbon,along with a resurgence in the manufacture and application of biochar for water treatment and soil amendment,has generated significant concerns about the mobility and toxicity of PBNPs derived from the bulk material in environmental *** examples are discussed to highlight current progress in understanding the influence of PBNPs on contaminant transport,followed by a critical discussion of gaps and future research directions.

关键词： Nanoparticles Surface chemistry Activated carbon Biochar

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Wrongly Prescribed Half Tablets in a Swiss University Hospital

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International Journal of Clinical Medicine 2012年第7期3卷 637-643页

作者： Isabelle Arnet Maya von Moos kurt e. Hersberger Pharmaceutical Care Research Group Pharmaceutical Sciences University of Basel Basel Switzerland.

Background: Prescription of 1/2 tablets is a widespread practice, mainly to achieve dose flexibility and to facilitate swallowing. However, tablet splitting includes several disadvantages, like destruction of galenic formulation, stability problems, and unequal amount of active ingredient that may reduce effectiveness or result in a greater risk of toxicity. Objective: To assess the rate of wrongly prescribed 1/2 tablets in discharge prescriptions at the University Hospital in Basel (UHBS, 600 beds) and to evaluate its consequences for community pharmacists. Setting: Discharge prescriptions written between January 1st and December 31st 2011 and containing the term “1/2” were extracted from the electronic patients’ data management system of the UHBS. Presence of a score line and suitability for splitting were retrieved from two official sources of drug information. Main Outcome Measure: Wrong prescription was assigned for tablets with no score line or not suitable for dose splitting. Results: Of the 36,751 discharge prescriptions that were recorded in 2011 at the UHBS, 3724 (10.1%) contained at least one prescription item with the term “1/2”. The recipient patients were on average 72.9 ± 14.8 years old (median 76 years), 50.9% were women. Of the 4517 analysed items, 49% had a corresponding lower dosage strength available on the market, making splitting unnecessary. Rate of wrongly prescribed 1/2 tablets reached 16.4% (2.8% of all prescriptions) and concerned predominantly unscored tablets. When the lack of information on splitting suitability (5.6%) and on score lines (0.5%) was taken into account, the rate reached 22.4%. Half of all wrong prescriptions could be assigned to 14 different products that were prescribed with an overall rate between 3.1 and 0.2%. Quetiapine (Seroquel?) at all strengths was the most often wrongly prescribed tablet to split (3.1%;no score line), followed by atorvastatin (Sortis?) at all strengths (1.3%;no score line) and oxazepam (Seresta?)

关键词： Tablet Splitting Scored Tablets Score Lines Subdivision of Tablets Prescription error Medication error

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