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Intestinal lymphangiectasia in adults

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World Journal of Gastrointestinal Oncology 2011年第2期3卷 19-23页

作者： hugh James Freeman michael Nimmo Department of Medicine (Gastroen-terology) University of British Columbia Department of Pathology University of British Columbia

Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogamma-globulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial def inition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fe- cal alpha-1-antitrypsin levels, while others may present with iron def iciency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed moreextensive changes along the length of the small intes- tine. A critical diagnostic element in adults with lym- phangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or in? am- matory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following ini

关键词： Intestinal lymphangiectasia Adults Submucosa

Recent advances in celiac disease

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World Journal of Gastroenterology 2011年第18期17卷 2259-2272页

作者： hugh James Freeman Angeli Chopra michael Tom Clandinin Alan BR Thomson Division of Gastroenterology University of British Columbia Division of General Internal Medicine University of Alberta Department of Agricultural Food and Nutritional Science University of Alberta

Celiac disease now affects about one person in a hundred in Europe and North America. In this review, we consider a number of important and exciting recent developments, such as clinical associations, HLA-DQ2 and HLA-DQ8 predispositions, the concept of potential celiac disease, the use of new imaging/endoscopy techniques, and the development of refractory disease. This review will be of use to all internists, pediatricians and gastroenterologists.

关键词：疾病腹腔 HLA 审查内科胃

Recent advances in small bowel diseases:Part Ⅰ

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World Journal of Gastroenterology 2012年第26期18卷 3336-3352页

作者： Alan BR Thomson Angeli Chopra michael Tom Clandinin hugh Freeman Department of Medicine University of Western OntarioLondonON N6A 5A5Canada Division of General Internal Medicine University of AlbertaEdmontonAB T6G 2X8Canada Department of Agricultural Foodand Nutritional ScienceUniversity of AlbertaEdmontonAB T6G 2R1Canada Division of Gastroenterology University of British ColumbiaVancouverBC V6T 2B5Canada

As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal *** 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were *** Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/*** topics were chosen because of their importance to the practicing physician.

关键词：小肠结肠炎疾病感染性腹泻胃肠病学临床应用基础科学肠道发育膜通透性

Nociceptive and Neuropathic Pain Qualities in Men and Women with Acute Coronary Syndromes: A Complex Pain Presentation

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Open Journal of Nursing 2017年第3期7卷 331-344页

作者： Sheila O’Keefe-McCarthy michael mcgillion Charles J. Victor Sheila Rizza Judith McFetridge-Durdle Brock University St. Catharines Ontario Canada Heart and Stroke Foundation/michael G. De Groote Endowed Chair in Cardiovascular Nursing Research School of Nursing Faculty of Health Sciences Hamilton Ontario Canada University of Toronto Toronto Ontario Canada Nurse Practitioner Heart Failure Clinic Trillium Health Partners-Credit Valley Site Mississauga Ontario Canada Florida State University College of Nursing Tallahassee Florida US

Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent ACS episode. Aim: To examine the sensory-discriminative, motivational-affective and cognitive-evaluative dimensions of ACS-related pain. Methods: A descriptive-correlational, repeated-measure design was used to collect data on 121 ACS patients of their cardiac pain intensity. The (numeric rating scale-NRS 0-10 scale) measured chest pain “Now” and “Worst pain in the previous 2 hours over 8 hours” and the McGill Pain Questionnaire Short-Form (MPQ-SF) measured pain at 4 hours. Results: Mean age was 67.6 ± 13, 50% were male, 60% had unstable angina and 40% had Non-ST-elevation myocardial infarction. Cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. MPQ-SF: 66% described pain as distressing and 26% reported pain was horrible or excruciating. Participants described ACS pain quality as acute injury (nociceptive pain: heavy, cramping, stabbing), as nerve damage (neuropathic: gnawing, hot-burning, shooting) and as a mixture of acute and chronic pain qualities (aching, tender and throbbing). Conclusions: Patients reported both nociceptive and neuropathic cardiac pain. It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and neuropathophysiological mechanisms that contribute to complex cardiac pain experiences.

关键词： Acute Coronary Syndromes Nociceptive Pain Neuropathic Pain Pain Descriptors Emergency Department

Influence of Polyalkylmethacrylate VII on Boundary Film Formation,Friction,Wear and Efficiency of Lubricants

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润滑油 2006年第6期21卷 46-54页

作者： michael Müller hugh Spikes Alex Tsay Degussa RohMax Additives GmbH DarmstadtGermany Tribology Section Imperial CollegeLondonUK Degussa(China) ShanghaiChina

Polyalkylmethacrylates(PAMAs) are well-known as viscosity index improvers and dispersant *** paper shows that PAMAs are able to adsorb from oil solution on to metal surfaces,to produce thick,viscous boundary *** films enhance lubricant film formation in slow speed and high temperature conditions and thus produce a significant reduction of friction.A systematic study of this phenomenon has made use of the highly flexible nature of PAMA chemistry.A range of dispersant and non-dispersant polymethacrylates has been *** influence of different functionalities,molecular weights and architectures on both boundary film formation and friction has been explored using optical interferometry and friction-speed *** the results, guidelines have been developed for designing PAMAs having optimal boundary lubricating *** their ability to form boundary films PAMAs can significantly contribute to reduce wear in engine,gear and hydraulic *** a consequence of their viscometric and tribological performance PAMAs can furthermore improve fuel and energy efficiency in different,namely engine and hydraulic *** work is currently conducted in the lubricant industry to develop engine oils with lower sulfur,phosphorus and metal content(low SAPS) and to optimize their frictional properties through the use of friction modifiers or synthetic base *** have investigated the contribution of PAMA viscosity index improvers and boosters to improve fuel economy and to reduce wear *** paper reports our efforts to develop a new range of PAMAs that have been optimized in terms of composition,architecture,molecular weight and functionality and which can be used in low viscosity,low SAPS formulations to help meet the stringent requirements of modern engine oils.

关键词：润滑油添加剂耗油量摩檫力胶卷

One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality:role of the multidisciplinary approach

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Hepatobiliary & Pancreatic Diseases International 2011年第4期10卷 415-421页

作者： Jaswinder S Samra Raul Alvarado Bachmann Julian Choi Anthony Gill michael Neale Vikram Puttaswamy Cameron Bell Ian Norton Sarah Cho Steven Blome Ritchie Maher Sivakumar Gananadha Thomas J hugh Upper Gastrointestinal Surgical Unit University of SydneyRoyal North Shore HospitalSt LeonardsNSW2065SydneyAustralia Department ofAnatomical Pathology University of SydneyRoyal North Shore HospitalSt LeonardsNSW2065SydneyAustralia Department of Vascular Surgery University of SydneyRoyal North Shore HospitalSt LeonardsNSW2065SydneyAustralia Department of Gastroenterology University of SydneyRoyal North Shore HospitalSt LeonardsNSW2065SydneyAustralia Department of Radiology University of SydneyRoyal North Shore HospitalSt LeonardsNSW2065SydneyAustralia

BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary ***,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and *** undertook the study to assess the effect of this approach on diagnosis,resection rates and short-term outcomes such as morbidity and ***:A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was *** cases were discussed at a multidisciplinary meeting comprising surgeons,gastroenterologists,radiologists,oncologists,radiation oncologists,pathologists and nursing staff.A standardized investigation and management algorithm was *** were graded according to the Clavien-Dindo ***:A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%).Sixty-one patients (34%) required either a vascular or an additional organ ***-nine patients experienced complications,of which the commonest was blood transfusion (12%).Thirty-four patients (19%) had major complications,*** 3 or *** was no in-hospital,30-day or 60-day ***:Pancreatoduodenectomy can safely be performed in high-volume centers with very low *** surgeon’s role should be careful patient selection,intensive preoperative investigations,use of a team approach,and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.

关键词： pancreatoduodenectomy multidisciplinary vascular resection

When will it end? Long-lived intracontinental reactivation in central Australia

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Geoscience Frontiers 2019年第1期10卷 149-164页

作者： Raphael Quentin de Gromard Christopher L.Kirkland Heather M.Howard michael T.D.Wingate Fred Jourdan Brent I.A.Mc Innes Martin Danisik Noreen J.Evans Bradley J.McDonald R.hugh Smithies Geological Survey of Western Australia Department of Mines Industry Regulation and Safety School of Earth and Planetary Science/John de Laeter Centre/TIGeR Curtin University

The post-Mesoproterozoic tectonometamorphic history of the Musgrave Province, central Australia, has previously been solely attributed to intracontinental compressional deformation during the 580 -520 Ma Petermann Orogeny. However, our new structurally controlled multi-mineral geochronology results,from two north-trending transects, indicate protracted reactivation of the Australian continental interior over ca. 715 million years. The earliest events are identified in the hinterland of the orogen along the western transect. The first tectonothermal event, at ca. 715 Ma, is indicated by40 Ar/39 Ar muscovite and U e Pb titanite ages. Another previously unrecognised tectonometamorphic event is dated at ca. 630 Ma by Ue Pb analyses of metamorphic zircon rims. This event was followed by continuous cooling and exhumation of the hinterland and core of the orogen along numerous faults, including the Woodroffe Thrust,from ca. 625 Ma to 565 Ma as indicated by muscovite, biotite, and hornblende40 Ar/39 Ar cooling ages. We therefore propose that the Petermann Orogeny commenced as early as ca. 630 Ma. Along the eastern transect,40 Ar/39 Ar muscovite and zircon(Ue Th)/He data indicate exhumation of the foreland fold and thrust system to shallow crustal levels between ca. 550 Ma and 520 Ma, while the core of the orogen was undergoing exhumation to mid-crustal levels and cooling below 600-660℃. Subsequent cooling to 150 -220℃ of the core of the orogen occurred between ca. 480 Ma and 400 Ma(zircon [Ue Th]/He data)during reactivation of the Woodroffe Thrust, coincident with the 450 -300 Ma Alice Springs *** of the footwall of the Woodroffe Thrust to shallow depths occurred at ca. 200 Ma. More recent tectonic activity is also evident as on the 21 May, 2016(Sydney date), a magnitude 6.1 earthquake occurred, and the resolved focal mechanism indicates that compressive stress and exhumation along the Woodroffe Thrust is continuing to the present day. Overall, these results

关键词： Intracontinental deformation Thermochronology Petermann orogen Musgrave Province Plate tectonics Cratonization

迈克尔·契诃夫的表演技术:21世纪演员训练宝典（英文）

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戏剧艺术 2018年第5期 61-77页

作者：休.奥格尔曼美国加州州立大学长滩分校戏剧艺术系

本文指出,迈克尔·契诃夫表演法适用范围广、效果显著,是21世纪演员训练的理想方法。迈克尔·契诃夫不仅是一位天才演员,也是训练演员的天才;不仅开创了未来戏剧,也创立了未来(21世纪)的演员训练法。该方法从直觉出发、十分灵活,可在全... 详细信息

本文指出,迈克尔·契诃夫表演法适用范围广、效果显著,是21世纪演员训练的理想方法。迈克尔·契诃夫不仅是一位天才演员,也是训练演员的天才;不仅开创了未来戏剧,也创立了未来(21世纪)的演员训练法。该方法从直觉出发、十分灵活,可在全世界任何角落训练各种各样的学员,既能用来培养初学表演的大学生,又能帮助专业演员提升表演水平。

关键词：迈克尔·契诃夫康士坦丁·斯坦尼斯拉夫斯基演员演员训练心理姿势身心表演乔安娜·梅林

从腹腔镜到机器人辅助肾部分切除术的过渡:一个资深腹腔镜外科医生的学习曲线

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中国微创外科杂志 2012年第1期12卷 10-11页

作者： hugh J.Lavery Alexander C.Small David B.Samadi michael A.Palese 叶剑飞马潞林 Department of Urology The Mount Sinai Medical CenterNew York 北京大学第三医院泌尿外科北京100191

背景腹腔镜肾部分切除术的高难度和挑战性使许多腹腔镜外科医生采用机器人辅助肾部分切除术治疗肾脏小肿瘤。从腹腔镜肾部分切除术到机器人辅助肾部分切除术的过渡期我们评估一个资深腹腔镜外科医生的学习曲线。方法我们比较同一外科医... 详细信息

背景腹腔镜肾部分切除术的高难度和挑战性使许多腹腔镜外科医生采用机器人辅助肾部分切除术治疗肾脏小肿瘤。从腹腔镜肾部分切除术到机器人辅助肾部分切除术的过渡期我们评估一个资深腹腔镜外科医生的学习曲线。方法我们比较同一外科医生施行的早期20例机器人辅助肾部分切除术和最近18例腹腔镜肾部分切除术的围术期结果。所有手术是在2005年4月～2009年7月间完成的。既往该医生成功施行100余例腹腔镜肾部分切除术和100余例机器人辅助手术。2组手术步骤相同,在镜下充分游离肾动静脉后,完整游离肿瘤表面,利用术中超声来界定肿瘤边界,哈巴狗血管阻断钳控制肾动脉,在热缺血状态下切除肿瘤,2-0可吸收线连续缝合肾实质,如果集合系统切开后也予以缝合。学习曲线的定义指能熟练地在较短的手术时间和热缺血时间内完成机器人辅助肾部分切除术的例数。利用散点图显示机器人辅助肾部分切除术的学习曲线,用以比较2种术式的手术时间和热缺血时间。结果 2组患者术前临床资料和肿瘤病理学结果的比较无统计学差异。2组均无切缘阳性病例。2组手术并发症也无统计学差异。在机器人辅助肾部分切除术的学习曲线(图1)中,手术时间和热缺血时间均呈下降趋势。经过早期5例手术后,机器人辅助肾部分切除术的平均手术时间即可接近最近18例腹腔镜肾部分切除术的平均手术时间。前5例机器人辅助肾部分切除术的平均手术时间是242.8 min,远远长于后15例机器人辅助肾部分切除术平均手术时间171.3 min(P=0.011)。结论一个资深腹腔镜外科医生从腹腔镜到机器人辅助肾部分切除术过渡是一个非常迅速的过程。2组热缺血时间、术中估计出血量和住院时间均无统计学差异。经过前5例机器人辅助肾部分切除术后,一个资深腔镜外科医生行机器人辅助和腹腔镜肾部分切除术的手术时间大致相同。

关键词：肿瘤肾腹腔镜机器人肾部分切除术学习曲线