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Missed Pancreaticobiliary Malignancy: The Flaw of the Expedited Cholecystectomy

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surgical science 2024年第7期15卷 451-464页

作者： Dylan s. Goto larissa Fujii-Lau Linda L. Wong Department of surgery John A. Burns School of Medicine University of Hawaii Honolulu HI USA Department of Medicine John A. Burns School of Medicine University of Hawaii Honolulu HI USA

Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. We hypothesize that the diagnoses of these malignancies may potentially be delayed as an unintended consequence of expedited cholecystectomies. This study reviews a cohort of patients who underwent pancreaticoduodenectomy (PD) to identify those who underwent a separate cholecystectomy before their PD. Methods: We retrospectively reviewed 162 PDs performed between 2012 and 2022. Data collected included: demographics, disease etiology and the presence of cholelithiasis. We identified patients who had a previous cholecystectomy and the time elapsed before PD as well as procedures done during the interval. We reported detailed case summaries on those patients who had a cholecystectomy within 1 year of PD. Results: In the entire cohort, mean age was 65 years, 54% were males, and 83% had a malignant reason for PD. Thirty-one patients had cholelithiasis with 23 (14%) patients having had previous cholecystectomy. six patients had cholecystectomy within 1 year of PD. They had the following malignancies: ampullary—3, pancreas—1, cholangiocarcinoma—1 and neuroendocrine—1. Four of these patients had expedited cholecystectomy on their index hospital admission and were later found to have a periampullary malignancy with further work up. Conclusions: Pancreaticobiliary malignancies can be difficult to diagnose, and surgeons should not overlook these potential diagnoses when considering expedited cholecystectomy. Future studies in large cohorts are needed to identify high risk candidates who should undergo more detailed testing to exclude malignancy before proceeding with cholecystectomy.

关键词： Cholecystectomy Periampullary Malignancy Pancreas Malignancy Pancreaticoduodenectomy

基于rs-fMRI探讨杨氏絮刺火罐对湿疹瘙痒的影响

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中国针灸 2024年第1期44卷 19-24页

作者：魏翔宇于立新 Taeeun Kim larissa Tao 沈嫱徐慧慧王辉沈卫东上海中医药大学附属曙光医院针灸科上海201203 上海中医药大学附属曙光医院针刺与麻醉研究所上海201203 中国人民解放军联勤保障部队第963医院放射科上海中医药大学国际教育学院上海中医药大学附属曙光医院放射科上海201203

目的:采用静息态功能磁共振成像(rs-f MRI)技术探究杨氏絮刺火罐治疗湿疹瘙痒的临床疗效和中枢机制。方法:50例湿疹瘙痒患者纳入观察组,50名健康受试者纳入对照组。对照组不行任何干预;观察组于大椎及双侧曲池、血海、三阴交行杨氏絮刺... 详细信息

目的:采用静息态功能磁共振成像(rs-f MRI)技术探究杨氏絮刺火罐治疗湿疹瘙痒的临床疗效和中枢机制。方法:50例湿疹瘙痒患者纳入观察组,50名健康受试者纳入对照组。对照组不行任何干预;观察组于大椎及双侧曲池、血海、三阴交行杨氏絮刺火罐治疗,每周1次,共治疗6周。比较观察组治疗前后12项瘙痒严重程度评估量表(12-Pss)、湿疹面积及严重程度(EAsI)、皮肤病生活质量指数(DLQI)、匹兹堡睡眠质量指数(PsQI)和焦虑自评量表(sAs)评分。观察组治疗前后及对照组入组时均接受rs-fMRI扫描并进行局部一致性(ReHo)分析,将差异脑区ReHo值与上述量表评分进行相关性分析。结果:与治疗前比较,观察组治疗后12-Pss、EAsI、DLQI、PsQI、sAs评分均降低(Pss评分呈正相关(r=0.432,P=0.004);右侧眶部额上回ReHo值与PsQI评分呈负相关(r=-0.318, P=0.04)。治疗后,观察组左侧顶上小叶ReHo值与12-Pss评分呈正相关(r=0.384,P=0.012)。结论:湿疹瘙痒患者多个参与刺激反应、情绪调节、行为控制、注意力等功能的脑区存在活动异常。杨氏絮刺火罐能有效改善湿疹患者瘙痒症状和皮肤损害,其作用机制可能和逆转瘙痒所导致的脑区功能活动异常有关。

关键词：湿疹瘙痒絮刺火罐局部一致性静息态功能磁共振成像

Metabolic syndrome and the urinary microbiome of patients undergoing percutaneous nephrolithotomy

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Asian Journal of Urology 2024年第2期11卷 316-323页

作者： Ryan A.Dornbier Chirag P.Doshi shalin C.Desai Petar Bajic Michelle Van Kuiken Mark Khemmani Ahmer V.Farooq larissa Bresler Thomas M.T.Turk Alan J.Wolfe Kristin G.Baldea Loyola University Medical Center Department of UrologyMaywoodILUSA Loyola University Chicago Department of Microbiology and ImmunologyMaywoodILUSA

Objective:To identify possible stone-promoting microbes,we compared the profiles of microbes grown from stones of patients with and without metabolic syndrome(Mets).The association between Mets and urinary stone disease is well established,but the exact pathophysiologic relationship remains *** evidence suggests urinary tract dysbiosis may lead to increased nephrolithiasis ***:At the time of percutaneous nephrolithotomy,bladder urine and stone fragments were collected from patients with and without *** sample types were subjected to expanded quantitative urine culture(EQUC)and 16 s ribosomal RNA gene ***:Fifty-seven patients included 12 controls(21.1%)and 45 Mets patients(78.9%).Both cohorts were similar with respect to demographics and non-Mets *** controls had uric acid stone *** EQUC,bacteria were detected more frequently in Mets stones(42.2%)compared to controls(8.3%)(p=0.041).Bacteria also were more abundant in stones of Mets patients compared to *** validate our EQUC results,we performed 16 s ribosomal RNA gene *** 12/16(75.0%)sequence-positive stones,EQUC reliably isolated at least one species of the sequenced *** were detected in both“infectious”and“non-infectious”stone ***:Bacteria are more common and more abundant in Mets stones than control *** findings support a role for bacteria in urinary stone disease for patients with Mets regardless of stone composition.

关键词： Nephrolithiasis Urolithiasis Metabolic syndrome Urinary microbiome Percutaneous nephrolithotomy

Evaluation of Biodegradation in Aqueous Medium of Poly(Hydroxybutyrate-Co-Hydroxyvalerate)/Carbon Nanotubes Films in Respirometric system

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Journal of Renewable Materials 2019年第2期7卷 117-128页

作者： larissa s.ieven montagna Isabela CÉsAR Oyama Rita de CÁssIA Barbosa Camargo Lamparelli Ana Paula silva THAIs larissa do Amaral Montanheiro Ana Paula Lemes Federal University of são Paulo(UNIFEsP) Institute of Science and TechnologyTechnology Laboratory of Polymers and Biopolymers(TecPBio)Talim330São Josédos CamposSP12231-280BrazilSão Josédos CamposSPBrazil

Biodegradable polymers have been increasingly used for scientific and commercial applications because they are similar to some conventional thermoplastics and exhibit the ability of ***(3-hydroxybutyrate-co-3-hydroxyvalerate)(PHBV)nanocomposites films with 1 and 2 wt% of carbon nanotubes(CNT)were prepared by solution mixing,followed by solvent *** this work,PHBV/CNT nanocomposites were submitted to biodegradation in an aqueous medium for 34 days through a respirometric ***,the PHBV films were analyzed by the CO2 production and mineralization as a response of a microbial attack,which was monitored by back titration during all the *** films were also characterized by measuring the weight loss;crystallinity was evaluated by differential scanning calorimetry(DsC)and the surface morphology by scanning electron microscopy(sEM).By analyzing the weight loss of the films,it was observed that adding CNT increases the resistance to biodegradation *** obtained values of CO2 production and mineralization of the samples,as well as the values of weight loss,showed that the biodegradation of PHBV/CNT nanocomposites was minor in comparison to neat *** addition of CNT in PHBV matrix influences the surface morphology,causing the presence of cavities and an increase of roughness.

关键词： Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) carbon nanotube nanocomposites biodegradation in aqueous medium

Progress Toward Implementing the sendai Framework, the Paris Agreement, and the sustainable Development Goals: Policy from Aotearoa New Zealand

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International Journal of Disaster Risk science 2020年第2期11卷 190-205页

作者： Wendy s.A.saunders scott Kelly suzanne Paisley larissa B.Clarke GNs science Lower Hutt 5010New Zealand

In 2015, Aotearoa New Zealand became a signatory to the sendai Framework for Disaster Risk Reduction 2015–2030(sendai Framework), the Paris Climate Change Agreement(Paris Agreement), and the sustainable Development Goals(sDGs). since 2017 Aotearoa New Zealand has been undergoing governance reform to realign priorities and to improve the management of natural hazards and climate change. The aim of this article is to provide a review of how Aotearoa New Zealand is taking steps to improve consistency of planning across the legislative environment, thereby implementing its commitments to the sendai Framework, the sDGs, and the Paris Agreement. It provides an overview of the national governance arrangements, with a focus on the key legislative tools;identifies how key terms are defined nationally;and provides an overview of the governance arrangements that contribute to the country’s international obligations. The discussion describes how obligations are applied, and considers two"disruptive and proactive" action examples. Four recommended actions are provided to further implement these international aspirations:(1) take into account these international agreements during the development and implementation of all legislation;(2) build awareness, capability,and capacity within central, regional, and local governments to support implementation;(3) actively evaluate the progress of implementing initiatives designed to reduce vulnerability and strengthen resilience;and(4) ensure that more weight and value are given to indigenous planning documents.

关键词： Disaster risk resilience Living standards framework Natural hazard vulnerability New Zealand sustainable development goals National wellbeing

Predicting utility of a model for end stage liver disease in alcoholic liver disease

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World Journal of Gastroenterology 2006年第25期12卷 4020-4025页

作者： Aspasia s soultati spyridon P Dourakis Alexandra Alexopoulou Melanie Deutsch larissa Vasilieva Athanasios J Archimandritis 2nd Department of Internal Medicine University of Athens Medical school Hippokration General Hospital114 Vas Sofias AvenuesAthens 11527Greece

AIM： To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-stage Liver Disease as predictors of short term （30 d and 90 d） mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODs： Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. REsULTs： 30- and 90-d mortality rates were reported at 5.9% （2/34） and 14.7% （5/34）, respectively. significant correlation was demonstrated for the Model for End- stage Liver Disease （P30 = 0.094, P90 = 0.046） and the Maddrey Discriminant Function score （P30 = 0.033, P90 = 0.038） with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans- ferase （P = 0.057）, fibrin degradation products （P = 0.048） and C-reactive protein （P = 0.067） with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 （95%CI： 0.902-1.036, P = 0.028） for the Model for End-stage Liver Disease score and 0.984 （95%CI： 0.942-1.027, P = 0.023） for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 （sensitivity 1, specificity 0.937） and 108.68 （sensitivity 1, specificity 0.969）, respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 （95%CI： 0.559-0.965, P = 0.065） for the Model for End-stage Liver Disease score and 0.752 （95%CI： 0.465-1.038, P = 0.076） for the Maddrey Discriminant Function score with the optimal cut off point of 19 （sensitivity 0.6, specificity 0.6） and 92 （sensitivity 0.6, specificity 0.946）, respectively. The observed Kaplan Meier survival rates for different score-categories were compared with logrank tests and higher score values were correlated with a lower survival. CONCLUsION： Equivale

关键词： Alcoholic liver disease Alcoholic hepatitis Maddrey discriminant function score Model for end-stage liver disease score

Zoology, Celibacy, and the Heterosexual Imperative： Notes on Teaching Lu Xun＇s ＂Loner＂ as a Queer Text

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Frontiers of Literary studies in China-selected Publications from Chinese Universities 2013年第3期7卷 441-458页

作者： Ari larissa Heinrich Department of Literature University of California San Diego CA 92093 USA

This essay reflects on the reception of Lu Xun＇s short story ＂The Loner＂（Gudu zhe, alternately translated as ＂The Lone Wolf, The Misanthrope,＂ and ＂The Isolate＂） in American classrooms, where students have sometimes wondered whether that character might be read as ＂queer.＂ It suggests that the title character＇s unusual and self-imposed celibacy is probably best explained by his belief, in a very general sense, in the foundational values of zoology as practiced in Japan and China in the late nineteenth and early twentieth centuries, and thus that the story may be a better gateway to understanding the ways in which Lu Xun envisioned the mixed impact of new political economies on private life than a source text for queer studies. At the same time, however, this essay emphasizes that in ＂The Loner,＂ as elsewhere, accounting for the ＂heterosexual imperative＂ of early zoology （e.g., with its emphases on animal husbandry, propagation, reproduction） can have meaningful consequences for ＂queering＂ interpretations of received texts from literature, history of science, and beyond.

关键词： queer Lu Xun zoology celibacy modem Chinese literature "TheLoner," pedagogy

Opportunities for agent based modeling of retinal stem cell transplantation

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Neural Regeneration Research 2022年第9期17卷 1978-1980页

作者： larissa M.DePamphilis Troy shinbrot Maribel Vazquez Department of Biomedical Engineering RutgersThe State University of New JerseyPiscatawayNJUSA

Late stage blindness and visual impairment(BVI)affects over 400 mi l l ion adul ts *** disabilities severely impact the ability of adults to function independently,reduce their quality of life,and worsen socio-economic burdens on health care ***,the World Health Organization projects worldwide BVI from degenerated retina to more than double by the year 2050(Bourne et al.,2021).To understand the clinical problem,consider Figure 1A depicting the retina’s seven neuronal cell types that interconnect across three nuclear *** photoreceptors of the outer nuclear layer(ONL)are light sensitive neurons that absorb and convert photons into bioelectrical signals.

关键词： Figure outer convert

Resilience, the 6th Vital sign: Conceptualizing, Contextualizing, and Operationalizing All six Vital signs

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Health 2024年第7期16卷 657-673页

作者： Rose E. Constantino Betty J. Braxter Chi Ching Vivian Hui larissa C. Allen Lillian J. Wolfe Katherine H. Endres Jezyl Cempron Cutamora Laurence L. Garcia Daisy R. Palompon Kathleen Thimsen Brayden N. Kameg Margarete L. Zalon Department of Health and Community systems School of Nursing University of Pittsburgh Pittsburgh PA USA Undergraduate Affairs School of Nursing University of Pittsburgh Pittsburgh PA USA The Hong Kong Polytechnic University Hong Kong China school of Nursing Adjunct Faculty at the University of Pittsburgh Pittsburgh PA USA school of Nursing University of Pittsburgh Pittsburgh PA USA Department of Health Promotion and Development School of Nursing University of Pittsburgh Pittsburgh PA USA College of Nursing Cebu Normal University Cebu City Philippines school of Nursing University of Nevada Las Vegas USA Department of Health and Community systems University of Pittsburgh PA USA Department of Nursing University of Scranton Scranton PA USA

There are five vital signs that healthcare providers assess: temperature, pulse, respiration, blood pressure, and pain. Normal levels for the five vital signs are published by the American Heart Association, and other specialty organizations, however, the sixth vital sign (resilience) which adopts the measure of immune resilience is suggested in this paper. Resilience is the ability of the immune system to respond to attacks and defend effectively against infections and inflammatory stressors, and psychological resilience is the capacity to resist, adapt, recover, thrive, and grow from a challenge or a stressor. Individuals with better optimal immune resilience had better health outcomes than those with minimal immune resilience. The purpose of this paper is to conceptualize, contextualize, and operationalize all six vital signs. We suggest measuring resilience subjectively and objectively. subjectively, use a 5-item guided interview revised from the Connor-Davidson Resilience scale (CDRC), a scale of 10 items. The revised CDRC scale is a 5-item scale. The scale is rated on a 5-point Likert scale from 0 (not true) to 4 (true all the time). The total score ranges from 0 to 20, with higher total scores indicating greater resilience. The scale demonstrated good construct validity and internal consistency (α = 0.85) during the development of the scale. The CD-RIsC had a good Cronbach’s alpha level of 0.85. The Revised CD-RIsC can be completed in 2 - 4 minutes. To measure resilience objectively, we suggest using Immune Resilience (IR) levels, the level of resilience to preserve and/or rapidly restore immune resilience functions that promote disease resistance and control inflammation and other inflammatory stress. IR levels are gauged with two peripheral blood metrics that quantify the balance between CD8 and CD4 T-cell levels and gene expression signatures tracking longevity-associated immunocompetence and mortality- or entropy-associated inflammation. IR deregulation i

关键词： Conceptualization Contextualization Operationalization Body Temperature Pulse Respiration Blood Pressure Pain Resilience