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Digital surgery for gastroenterological diseases

中华医学会第三次全国绝经学术会议暨绝经相关问题学习班

作者： Hans Neubauer Harald Seeger Tanja Fehm Alfred O Mueck michael a cahill University Women’s Hospital TuebingenGermany School of Biomedical Sciences Charles Sturt UniversityWagga WaggaNSWAustralia

Objectives:Evidence is accumulating that progestogens may play a crucial role in the development of breast cancer under contraception and hormone therapy in the *** receptor membrane component 1(PGRMC1) expressed in breast cancer may be important in tumorigenesis and thus may increase breast cancer *** aim of this project was to investigate the influence of progesterone and nine synthetic progestins on MCF-7 breast cancer cells overexpressing ***: MCF-7 cells were stably transfected with PGRMC1 expression plasmid(MCF-7/PGRMC1-3HA).To test the effects of progestogerone(P) and the synthetic progestins chlormadinone acetate(CMA), desogestrel(DSG),dienogest(DNG),drospirenone(DRSP),dydrogesterone(DYD),levonorgestrel (LNG),medroxyprogesterone acetate(MPA),nomegestrol(NOM) and norethisterone(NET) on cell proliferation MCF-7 and MCF-7/PGRMC1-3HA(WT-12) cells were stimulated with different concentrations (10-9 M to 10-7 M).Results:In MCF-7 cells DNG,DSG,DYD,LNG and NET increased the proliferation at 10-7 M,the effect being highest for NET with about 20%.In WT-12 cells the same progestins, but additionally DRSP and MPA showed a significant increase,which was much higher(30- 245%) than in MCF-7 *** again NET showed the highest proliferative *** effect was found for CMA,NOM and ***:Synthetic progestins trigger a proliferative response of PGRMC1 overexpressed MCF-7 cancer *** effect of progestogens on breast cancer tumorigenesis may clearly depend on the specific pharmacology of the various synthetic progestins.

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World Journal of Gastroenterology 2021年第42期27卷 7240-7246页

作者： Niall Philip Hardy Ronan Ambrose cahill UCD Centre for Precision Surgery University College DublinDublin D07 Y9AWIreland

Advances in machine learning,computer vision and artificial intelligence methods,in combination with those in processing and cloud computing capability,portend the advent of true decision support during interventions in real-time and soon perhaps in automated surgical *** capability,deployed alongside technology intraoperatively,is termed digital surgery and can be delivered without the need for high-end capital robotic *** area close to clinical usefulness right now harnesses advances in near infrared endolaparoscopy and fluorescence guidance for tissue characterisation through the use of biophysics-inspired *** represents a potential synergistic methodology for the deep learning methods currently advancing in ophthalmology,radiology,and recently gastroenterology via *** databanks of more general surgical videos are created,greater analytic insights can be derived across the operative spectrum of gastroenterological disease and operations(including instrumentation and operative step sequencing and recognition,followed over time by surgeon and instrument performance assessment)and linked to value-based ***,issues of legality,ethics and even morality need consideration,as do the limiting effects of monopolies,cartels and isolated data ***,the role of the surgeon,surgical societies and healthcare institutions in this evolving field needs active deliberation,as the default risks relegation to bystander or passive *** editorial provides insight into this accelerating field by illuminating the nearfuture and next decade evolutionary steps towards widespread clinical integration for patient and societal benefit.

关键词： Digital surgery Artificial intelligence Gastrointestinal disease Biophysics Deep learning Fluorescence-guided surgery

Inner blood-retina barrier involvement in dry age-related macular degeneration(AMD) pathology

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Neural Regeneration Research 2020年第9期15卷 1656-1657页

作者： Natalie Hudson Mark cahill Matthew Campbell Neurovascular Genetics Unit Smurfit Institute of GeneticsTrinity College DublinDublinIreland Royal Victoria Eye and Ear Hospital Adelaide RoadDublin 2Ireland

Age-relatedmaculardegeneration(AMD)isaprogressiveneurodegenerative disease with a global prevalence of 8.7%in people over the age of 45. It is one of the leading causes of central retinal blindness in the industrialized world leading to loss of an individual’s ability to read, drive and see fine details, such as recognition of faces. By 2040, it is estimated that 288 million individuals worldwide will be diagnosed with AMD due to improved life expectancy(Wong et al., 2014).

关键词： AMD individual degeneration

Single access laparoscopic total colectomy for severe refractory ulcerative colitis

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World Journal of Gastroenterology 2020年第39期26卷 6015-6026页

作者： John Burke Des Toomey Frank Reilly Ronan cahill Department of Colorectal Surgery Beaumont HospitalDublin D09Ireland Department of Surgery Mater Misericordiae University HospitalDublin D07Ireland

BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site *** intuitively appealing,there is sparse evidence for its use beyond *** To examine the usefulness of single access laparoscopy(SAL)in a general series experience of patients sick with ulcerative *** All patients presenting electively,urgently or emergently over a three-year period under a colorectal specialist team were *** was performed via the stoma site on a near-consecutive basis by one surgical team using a“surgical glove port”allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport ***,straight rigid laparoscopic instrumentation were used without additional *** Of 46 consecutive patients requiring surgery,39(85%)had their procedure begun laparoscopically.27(69%)of these were commenced by single port access with an 89%completion rate thereafter(three were concluded by multi-trocar laparoscopy).SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs(>100€case)and postoperative hospital stay(median 5 d vs 7.5 d,P=0.045)without increasing operative *** proved especially efficient in those with preoperative albumin>30 g/dL(n=20).Its comparative advantages were further confirmed in ten pairs case-matched for gender,body mass index and preoperative *** outcomes proved durable in the intermediate term(median follow-up=20 mo).CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory *** regarding duration and cost should not be barriers to its implementation.

关键词： Single incision laparoscopy Minimal access surgery Inflammatory bowel disease Ulcerative colitis Total colectomy and end ileostomy Case match analysis

Small bowel adenocarcinoma and Crohn's disease: Any further ahead than 50 years ago?

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World Journal of Gastroenterology 2014年第33期20卷 11486-11495页

作者： Caitlin cahill Philip H Gordon Andrea Petrucci Marylise Boutros McGill University Department of Surgery Sir Mortimer B. Davis Jewish General Hospital Colorectal Surgery Montreal PQ H3T 1E2 Canada

This review of the literature on small bowel carcinoma associated with Crohn's disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn's disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn's disease.

关键词： Crohn's disease Small bowel adenocarcino-ma Cancer risk Cancer malignancy Incidental carcino-ma Late complications of Crohn's disease Inflammatory bowel disease

What's wrong with sentinel node mapping in colon cancer?

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World Journal of Gastroenterology 2007年第47期13卷 6291-6294页

作者： Ronan A cahill Department of General Surgery Cork University HospitalWiltonCorkIreland

Despite near-universal embrace of the concept and clinical relevance of lymphatic mapping for sentinel node identification and analysis for cancers of the breast and integument,the same technique has struggled to a find a role in gastrointestinal cancers in general and,perhaps,in colon cancer in particular. Despite many studies demonstrating its feasibility in malignancies of the large bowel,concern is continually aroused by the variable and often unacceptably low sensitivity rates. Additionally,many confess uncertainty as to what benefit it could ever confer to patients even if it were proven sufficiently accurate given that standard surgical resection incorporates mesenteric resection anyway. However,the huge impact sentinel node mapping has had on clinical practice in certain cancers means that each of these aspects merit careful reconsideration,from very first principles.

关键词： Sentinel node Lymphatic mapping Colon cancer

Relationship between Endometriosis and Subfertility

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Journal of Reproduction and Contraception 2003年第1期14卷 1-10页

作者： DJ cahill Centre for Reproductive Medicine University of Bristol Division of Obstetrics and Gynaecology St Michael's Hospital Bristol BS2 8EG UK

An association between minor endometriosis and subfertility is shown by prevalence studies but a clear causal relationship has not yet been demonstrated. This review presents the evidence for pituitary-ovarian dysfunction as a cause for subfertility in women with minor endometriosis. Using tubal infertility cases as controls, group comparison has shown effects on the following: follicular growth (impaired) , preovulatory circulating oestradiol levels (reduced) and early luteal phase oestradiol and progesterone (reduced) , and LH surge patterns (disordered), preovulatory follicular fluid LH concentration (reduced) , and granulosa cell steroidogenic capacity (impaired) . However, these findings are not consistent in the literature. Compared with controls, reduced oocyte fertilisation and implantation rates are reported in natural and go-nadotrophin stimulated cycles. An inherent disorder of follicular function is possible as a cause, with LH surge impairment probably a secondary phenomenon. Natural sub-fertility is substantially disordered as a result of oocyte fertilisation impairment. However, as excess numbers of oocytes are available in bitrofertility in vitro fertility (IVF) is still successful.

关键词： endometriosis pituitary-ovarian dysfunction oocyte fertilising ability implantation infertility

Cytokine orchestration in post-operative peritoneal adhesion formation

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World Journal of Gastroenterology 2008年第31期14卷 4861-4866页

作者： Ronan A cahill H Paul Redmond Department of General Surgery Cork University Hospital Wilton Cork Ireland

Peritoneal adhesions are a near inevitable occurrence after laparotomy and a major cause of both patient and physician misery. To date, clinical attempts at their amelioration have concentrated on manipulating the physical factors that affect their development despite a wealth of experimental data elucidating the molecular mechanisms that underlie their initiation, development and maturation. However, the advent of targeted, specific anti-cytokine agents as directed therapy for inflammatory and neoplastic conditions raises the prospect of a new era for anti-adhesion strategies. To harness this potential will require considerable cross-disciplinary collaboration and that surgeon-scientists propel themselves to the forefront of this emerging fi eld.

关键词： Postoperative peritoneal adhesion formation Cytokines Vascular endothelial growth factor

Saphenous graft on transesophageal echocardiogram masquerading as an abnormal vascular communication into the right atrium

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World Journal of Clinical Cases 2013年第1期1卷 28-30页

作者： Long Cao Mohammed Ataullah Farooqui William Wood John cahill Assad Movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart Institute Greenville NC 27858 United States

An unknown aberrant f low in the right atrium observed on doppler with transesophageal echocardiogram(TEE) in a patient with prior coronary bypass. TEE revealed normal size left ventricle with severely dilated left atrium. There was moderate aortic regurgitation and moderate aortic stenosis noted. Patient was incidentally found to have an abnormal vascular communication noted to the right atrium. To further evaluate this f inding, the patient underwent cardiac magnetic resonance angiography which revealed that the tubular structure noted on TEE was actually a graft that was abutting onto the coronary sinus, and the f low anomaly was really the graft coming up and running adjacent to the coronary sinus.

关键词： Vascular Communication Echocardiogram Saphenous vein graft Magnetic resonance imaging

Left ventricular pseudoaneurysm: A case report and review of the literature

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World Journal of Clinical Cases 2014年第4期2卷 90-93页

作者： Lavanya Alapati W Randolph Chitwood John cahill Sanjay Mehra Assad Movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart InstituteGreenville NC 27834 United States

Left ventricular(LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.

关键词： Chest pain Myocardial infarction Transthoracic echocardiogram Left ventricular aneurysm Left ventricular pseudoaneurysm