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Management of occluded self-expanding biliary metal stents in malignant biliary disease

Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 49-54页

作者： Simon Nennstiel Isolde Tschurtschenthaler Bruno Neu Hana Algül monther bajbouj Roland M. Schmid Stefan von Delius Andreas Weber Klinik und Poliklinik fur Innere Medizin Ⅱ Klinikum rechts der Isar der Technischen Universitar Manchen Ismaninger Straβe 22 Munich 81675 Germany Medizinische Klinik II Krankenhaus Landshut-Achdorf Academic Teaching Hospital Technische Universitar Munchen Achdorferweg 3 Landshut 84036Germany

Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of ***: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case ***: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management

关键词： Self-expanding metal stents Biliary tract neoplasms Endoscopic retrograde cholangiopancreatography Biliary tract diseases Complications

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Positive predictors for gastroesophageal reflux disease and the therapeutic response to proton-pump inhibitors

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World Journal of Gastroenterology 2014年第14期20卷 4017-4024页

作者： Valentin Becker Stefan Grotz Christoph Schlag Simon Nennstiel Analena Beitz Bernhard Haller Roland M Schmid Alexander Meining monther bajbouj Ⅱ. Medizinische Klinik und Poliklinik Technische Universit?t München Institut für Medizinische Statistik und Epidemiologie Technische Universit?t München

AIM: To identify objective and subjective predictors for the reliable diagnosis of gastroesophageal reflux disease (GERD) and the response to proton pump inhibitor (PPI) therapy.

关键词： Gastroesophageal reflux Gastroesophageal reflux disease Non-erosive reflux disease Impedance pH measurement Follow-up Therapy Proton pump inhibitor

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New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal p H metry in extraesophageal gastroesophageal reflux disease

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World Journal of Gastroenterology 2015年第3期21卷 982-987页

作者： Valentin Becker Romina Drabner Simone Graf Christoph Schlag Simon Nennstiel Anna Maria Buchberger Roland M Schmid Dieter Saur monther bajbouj Ⅱ.Medizinische Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany Hals-Nasen Ohren Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany

AIM:To determine the laryngeal H+K+-ATPase and pharyngeal p H in patients with laryngopharyngeal reflux(LPR)-symptoms as well as to assess the symptom scores during PPI ***:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area(immunohistochemistry and PCR analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-*** real-time RT-PCR for each of the H+K+-ATPase subunits was *** p H values were assessed in the aerosolized environment of the oropharynx(Dxp H Catheter) and compared to a subsequently applied combined p H/MII ***:Twenty patients with LPR symptoms were *** only one patient,the laryngeal H+K+-ATPase was verified by immunohistochemical *** another patient,real-time RT-PCR for each H+K+-ATPase subunit was *** out of twenty patients had pathological results in Dxp H,and 6/20 patients had pathological results in p H/*** patients had pathological results in both functional *** out of twenty patients responded to ***:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPR symptoms and is unlikely to cause the LPR *** hypotheses for the pathomechanism are *** role of pharyngeal p H-metry remains unclearand its use can only be recommended for patients in a research study setting.

关键词： Laryngopharyngeal reflux Proton pump inhibitor Gas

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A Reputation-Based AODV Protocol for Blackhole and Malfunction Nodes Detection and Avoidance

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Computers, Materials & Continua 2024年第8期80卷 1867-1888页

作者： Qussai M.Yaseen monther Aldwairi Ahmad Manasrah Artificial Intelligence Research Center(AIRC) College of Engineering and Information TechnologyAjman UniversityAjman346United Arab Emirates Department of Computer Information Systems Faculty of Computer and Information TechnologyJordan University of Science and TechnologyIrbid22110Jordan College of Technological Innovation Zayed UniversityAbu Dhabi144534United Arab Emirates Faculty of Information Technology and Computer Science Yarmouk UniversityIrbid21163Jordan Computer Information Systems Higher Colleges of TechnologySharjah341214United Arab Emirates

Enhancing the security of Wireless Sensor Networks(WSNs)improves the usability of their ***,finding solutions to various attacks,such as the blackhole attack,is crucial for the success of WSN *** paper proposes an enhanced version of the AODV(Ad Hoc On-Demand Distance Vector)protocol capable of detecting blackholes and malfunctioning benign nodes in WSNs,thereby avoiding them when delivering *** proposed version employs a network-based reputation system to select the best and most secure path to a *** achieve this goal,the proposed version utilizes the Watchdogs/Pathrater mechanisms in AODV to gather and broadcast reputations to all network nodes to build the network-based reputation *** minimize the network overhead of the proposed approach,the paper uses reputation aggregator nodes only for forwarding reputation ***,to reduce the overhead of updating reputation tables,the paper proposes three mechanisms,which are the prompt broadcast,the regular broadcast,and the light broadcast *** proposed enhanced version has been designed to perform effectively in dynamic environments such as mobile WSNs where nodes,including blackholes,move continuously,which is considered a challenge for other *** the proposed enhanced protocol,a node evaluates the security of different routes to a destination and can select the most secure routing *** paper provides an algorithm that explains the proposed protocol in detail and demonstrates a case study that shows the operations of calculating and updating reputation values when nodes move across different ***,the paper discusses the proposed approach’s overhead analysis to prove the proposed enhancement’s correctness and applicability.

关键词： AODV blackhole malfunction nodes pathrater reputation system wireless sensor networks(WSNs) watchdogs

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Endoscopic stent therapy in patients with chronic pancreatitis:A 5-year follow-up study

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World Journal of Gastroenterology 2013年第5期19卷 715-720页

作者： Andreas Weber Jochen Schneider Bruno Neu Alexander Meining Peter Born Stefan von Delius monther bajbouj Roland M Schmid Hana Algül Christian Prinz II Medizinische Klinik und Poliklinik Klinikum Rechts der IsarTechnische Universitt München81675 MünchenGermany II Medizinische Klinik Gastroenterologie und HepatologieHelios Klinikum WuppertalUniversitt Witten/Herdecke42283 WuppertalGermany

AIM:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. METHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)with obstructive chronic pancreatitis who were admitted to the 2nd Medical Department of the Technical University of *** patients presented severe chronic pancreatitis(stageⅢ°)according to the Cambridge *** majority of the patients suffered intermittent pain attacks.6 of 19 patients had strictures of the pancreatic duct;13 of 19 patients had strictures and *** first endoscopic retrograde pancreatography(ERP)included an endoscopic sphincterotomy, dilatation of the pancreatic duct,and stent *** first control ERP was performed 4 wk after the initial intervention,and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological *** follow-up was performed annually to document the course of pain and the management of *** course of pain was assessed by a pain scale from 0 to *** date and choice of the therapeutic procedure were documented in case of relapse. RESULTS:Initial endoscopic intervention was successfully completed in 17 of 19 *** 17 patients reported partial or complete pain relief after endoscopic *** therapy failed in 2 patients. Both patients were excluded from further *** failed patient underwent surgery,and the other patient was treated conservatively with pain *** of 19 patients were followed after the successful completion of endoscopic stent *** of 17 patients were lost to *** patient was not avail-able for interviews after the 1st year of *** patients died during the 3rd year of *** both patients chronic pancreatitis was excluded as the cause of *** patient died of myocardial infarction, and one patient succumbed to *** three patient

关键词： Chronic pancreatitis Pain Stent therapy Endoscopic retrograde cholangiopancreatography Pancreaticolithiasis

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Management of Mobile Phone Community in Jordan

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Journal of Software Engineering and Applications 2011年第6期4卷 350-355页

作者： monther Kanan Ziad Al-Asmer 不详

The need of a fast and global communication service has increased the competition among mobile phone companies. Therefore, those companies started adapting new methods to satisfy the needs of their customers. The Information Technology system proposed in this work is believed to provide an effective trading and managing tool for mobile’s community in Jordan.

关键词： System Management SMS Mobile’s Serves Server Replay the SMS

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Acute and Mid-Term Results after Pulmonary Veins Isolation Using a Novel Circular Irrigated Multielectrode Mapping and Ablation Catheter (nMARQ)

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World Journal of Cardiovascular Diseases 2016年第12期6卷 477-488页

作者： Ibrahim Marai Mahmoud Suleiman Jonathan Lessick Miry Blich Sobhi Abadi monther Boulos Division of Pacing and Electrophysiology Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israel Department of Diagnostic Imaging Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israel

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in both paroxysmal and persistent AF. However, this procedure is still challenging and time consuming. Objective: The aim of this study was to present our approach for PVI using a novel circular irrigated multielectrode mapping and ablation catheter (nMARQTM) and to present acute and mid-term results. Methods: The study included 31 consecutive patients with symptomatic AF (4 had persistent and 27 had paroxysmal AF) who underwent PVI using the nMARQTM catheter. Circular ablation was guided by CT image integrated into fast anatomical map and by intra cardiac echo. Isolation of pulmonary veins was identified using the nMARQTM catheter if it was possible to advance it into the veins, otherwise Lasso catheter was used. Patients were followed up to 20 months. Results: PVI was achieved in 119 (98%) out of 121 pulmonary veins identified, and final PVI was obtained in 30 (97%) out of 31 patients. Lasso catheter was needed for PVI confirmation in 16 (52%) patients. Touch up ablation using standard catheter guided by Lasso catheter was needed in 4 (13%) patients. Pericardial tamponade occurred in 1 patient who was treated with pericardiocentesis. No other major complications were detected. During follow-up (mean 15.9 ± 3.6 months, range 9 - 20 months), 4 (13%) patients had recurrence of atrial tachyarrhythmia. Conclusion: PVI using the novel nMARQTM catheter is safe with good acute and mid-term efficacy. Long term follow up trials are needed.

关键词： Atrial Fibrillation Catheter Ablation Image Integration nMARQ Lasso

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Improvement in MR and in the dyssynchrony between the mid segments predict super responders in patients undergoing CRT

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World Journal of Cardiovascular Diseases 2012年第4期2卷 295-301页

作者： Miry Blich Shemy Carasso Mahmoud Suleiman Ibrahim Marai Tawfig Zeidan Shwiri Lior Gepstein monther Boulos Division of Echocardiography Department of Cardiology Rambam Health Care Campus and Rappaport Faculty of Medicine Division of Pacing and Electrophysiology Technion Haifa Israel

Background: Twenty to thirty percent of patients with left heart failure in randomized trials do not respond clinically to cardiac resynchronization therapy (CRT). The objectives of our work were to estimate the effec-tiveness of CRT in our routine practice, and to find predictors of favorable response to CRT. Methods: Retrospective analysis of consecutive patients who underwent CRT from 2003-2007. Results: Fifty six consecutive patients (73.2% men, age 66.3 ± 10.2 years) with left heart failure (LHF) (ischemic cardiomyopathy 60.7%) received CRT and were followed for a mean of 27 months. After the implantation: Mean NYHA improved by one class (p < 0.001), LHF admissions were reduced by 79% (p < 0.0001) and mean ejection fruction improved by 31% (19.5% vs 25.6%, p < 0.002). Significant improvement in severity of mitral regurgitation (MR) was an important predictor of high responsiveness (p = 0.004). Improvement of MR was associated with complete left bundle branch block (CLBBB) (p = 0.04) and lower total mortality (p = 0.005). Improvement in synchronization between the mid lateral and mid septal segments, as was calculated with longitudinal strain using echocardiography (105 ± 38 vs 20 ± 23 msec, p = 0.008) was predictor of super responsiveness and reduction in MR among patients with moderate to severe MR prior to implantation. Worsening the delay between the mid posterior and mid anterior septal segments (21 ± 27 vs 120 ± 0 msec, p = 0.006) was associated with absence of response and lack of improvement in MR. Conclusions: Patients who improve mid segments dyssynchrony in four chamber view, have more chance to improve MR and to become super responders.

关键词： Mitral Regurgitation Cardiac Resynchronization Therapy

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Double diabetes in Saudi Arabia: A new entity or an underestimated condition

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World Journal of Diabetes 2016年第20期7卷 621-626页

作者： Rim Braham Aus Alzaid Asirvatham Alwin Robert Muhammad Mujammami Rania Ahmad Ahmad monther Zitouni Samia Hasan Sobki Mohamed Abdulaziz Al Dawish Department of Endocrinology and Diabetes Prince Sultan Military Medical City Endocrinology and Diabetes Unit Department of MedicineKing Khalid University HospitalKing Saud University Department of Pathology Prince Sultan Military Medical City

AIM To determine the clinical and biological characteristics of double diabetes(DD) among young people in Saudi *** This was a retrospective descriptive chart review study including 312 young newly diagnosed diabetic patients(aged 12-20 years), whom were admitted over a five year period(January 2009 to December 2013). Family history of diabetes mellitus(DM)(first degree), physical body mass index(BMI), acanthosis nigricans, history of auto-immune disease and laboratory information for glycosylated hemoglobin, basal C peptide level and diabetes autoantibody response(anti-GAD, anti-IA2 and anti-ICA) were collected from medical report. A mean follow-up of 3 years for these patients was *** Patients were categorized into 4 groups, based on the autoantibody response(Ab+ or Ab-) and C-peptide secretion(β+ for fasting level 0.4-2.1 ng/mL and β- if < 0.4 ng/mL). Group1(type 1a): Ab+ β-(21%), group 2(type 1b): Ab- β-(9%), group 3(DD): Ab+ β+(31%)and group 4(classic type 2 DM): Ab- β+(39%). The mean age of the DD patients in our study was 15.1 ± 6.4 years. A total of 41% of the study population presented with diabetic ketoacidosis and 61% of the study population presented with positive family history of DM. The mean BMI was 26.8 kg/m2 with 64% of overweight or obese patients. Ninety two percent of the patients were started on insulin at the time of diagnosis. During a mean follow-up of 3 years, only 32% of the patients with DD required insulin and 78% were on metformin alone or with insulin. CONCLUSION Our findings enable us to arrive at the conclusion that almost one-third of the young Saudi diabetic patients reveal atypical forms of DM(double diabetes) expressing features resulting from both T1D and T2D.

关键词： Double diabetes Therapeutic approaches Hybrid diabetes Autoantibody response Saudi Arabia

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Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation

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World Journal of Cardiology 2016年第4期8卷 317-322页

作者： Ibrahim Marai Mahmoud Suleiman Miry Blich Jonathan Lessick Sobhi Abadi monther Boulos the Division of Pacing and Electro- physiology Rambam Health Care Campus and Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of Technology Department of Diagnostic Imaging Rambam Health Care Campus and Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of Technology

AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ***: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs

关键词： Atrial fibrillation Catheter ablation Image integration Contact force

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