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Clinical implications of the molecular characterization of intraductal papillary mucinous neoplasms of the pancreas

Journal of Cancer Metastasis and Treatment 2021年第1期7卷 430-447页

作者： nicholas V.peters John W.Kunstman Department of Surgery Yale University School of MedicineNew Haven 06510CTUSA.

Intraductal papillary mucinous neoplasm(IPMN)is a pre-malignant,mucin-producing epithelial lesion arising from pancreatic *** reports define IPMN behavior as ranging from indolent,asymptomatic lesions to dysplasia that sometimes degenerate into pancreatic *** goal of IPMN management is risk-reducing surgery for high-risk cysts and observation of the *** high-from low-risk IPMN disease still relies on imaging and clinical cyst ***,we review the accepted classification of IPMN including the most common histological subtypes,their clinical features,and currently-accepted high-risk *** then deeply examine the known molecular landscape of IPMN,which has largely been derived from post-resection *** includes those gene variants unique to IPMN,chiefly GNAS and RNF43,but also examines the overlap between IPMN and conventional pancreatic *** molecular markers in the clinical setting relies on endoscopically-obtained cyst fluid and presumes that it accurately represents the molecular characteristics of the cystic *** synthesize existing data on mutational analysis from IPMN cyst fluid and consider the benefits and proper role of current commercially-available cyst fluid molecular analysis *** conclude that carefully interpreted molecular analysis of resected IPMN tissue reveals insights into its biology and natural history while cyst fluid analysis offers prognostication and data to guide treatment ***,knowledge gaps remain,especially in characterizing IPMN molecular heterogeneity,time to progression,and correlating cyst fluid genotype data with surveillance *** such,substantial additional research is required before the promise of true molecular guidance of IPMN management can be realized.

关键词： Intraductal papillary mucinous neoplasm pancreatic cancer molecular analysis GNAS KRAS RNF43

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Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy:A case report and review of the literature

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World Journal of Orthopedics 2017年第8期8卷 651-655页

作者： Hossein Elgafy Mustafa Khan Jacob Azurdia nicholas peters Department of Orthopedics University of Toledo Medical Center

A 67-year-old female patient developed an esophagocutaneous fistula 4 mo after C4 and C5 partial corpectomy. Plain radiograph and computed tomography(CT) scan of cervical spine showed inferior screws pullout with plate migration that caused the esophageal perforation. Management included removal of anterior hardware, revision C4-5 corpectomy, iliac crest strut autograft and halo orthosis immobilization. The fistula was treated using antibiotics and a 10-french gauge rubber tube for daily irrigation and Penrose drain. At 3 mo, the esophagocutaneous fistula healed and the patient resumed oral feeding. Six months follow-up CT scan showed sound fusion with graft incorporation. At two-year follow-up, patient denied any neck pain or dysphagia. This case report presents a successful outcome of a conservative open wound management without attempted repair. The importance of this case report is to highlight this treatment method that may be considered in such a rare complication particularly if surgical repair failed.

关键词： Wound management Esophagocutaneous fistula

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Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection:A case report and review of the literature

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World Journal of Orthopedics 2016年第7期7卷 452-457页

作者： Hossein Elgafy nicholas peters Justin E Lea Robert M Wetzel Department of Orthopedic Surgery University of Toledo Medical Center

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.

关键词： Lumbar synovial cyst Hemorrhage Antiplatelet therapy Epidural injection

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Critical care of obese patients during and after spine surgery

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World Journal of Critical Care Medicine 2016年第1期5卷 83-88页

作者： Hossein Elgafy Ryan Hamilton nicholas peters Daniel Paull Ali Hassan Departments of Orthopedic University of Toledo Medical Center Departments of Anesthesia University of Toledo Medical Center

Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA articlepublished in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Postoperatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes.

关键词： Obesity Spine sugary Critical care

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Surface hydrolysis-mediated PEGylation of poly(N-isopropyl acrylamide)based nanogels

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Regenerative Biomaterials 2017年第5期4卷 281-287页

作者： Jonathan T.peters Stanley Verghese Deepak Subramanian nicholas A.Peppas McKetta Department of Chemical Engineering The University of Texas at AustinAustinTXUSA Institute for Biomaterials Drug Deliveryand Regenerative MedicineThe University of Texas at AustinAustinTXUSA Department of Biomedical Engineering The University of Texas at AustinAustinTXUSA Department of Pediatrics and Department of Surgery and Perioperative CareDell Medical SchoolThe University of Texas at AustinAustinTXUSA Division of Pharmaceutics College of PharmacyThe University of Texas at AustinAustinTXUSA

In this work,poly(N-isopropyl acrylamide-co-acrylamide)[P(NIPAAm-co-AAm)]nanogels were modified by hydrolysis above the lower critical solution temperature(LCST)to localize carboxylic acid functional groups at the surface(surface hydrolysis).PNIPAAm copolymerized with 15%and 20%nominal AAm in the feed were prepared and compared to equivalent hydrogels with acrylic *** effect and extent of surface hydrolysis was confirmed by potentiometric titration and zeta *** surface modified nanogels were then modified with primary amine functionalized PEG *** hydrolysis-mediated PEGylation had little effect on the swelling response of the nanogels,while also preventing adsorption of model proteins in physiological relevant *** both 15%and 20%AAm gels both decreased protein adsorption,only the 20%AAm gels resulted in fully preventing protein *** results presented here point to surface hydrolysis as a new route to passivate nanogels for use in vivo.

关键词： PNIPMAAm hydrogels PEG passivation

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Advanced biomedical hydrogels:molecular architecture and its impact on medical applications

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Regenerative Biomaterials 2021年第6期8卷 297-317页

作者： Jonathan T.peters Marissa E.Wechsler nicholas A.Peppas McKetta Department of Chemical Engineering The University of Texas at AustinAustin200 E.Dean KeetonAustinTX 78712USA Institute for Biomaterials Drug Deliveryand Regenerative MedicineThe University of Texas at Austin107 W.Dean KeetonAustinTX 78712USA Department of Biomedical Engineering and Chemical Engineering The University of Texas at San AntonioOne UTSA CircleSan AntonioTX78249USA Department of Biomedical Engineering The University of Texas at Austin107 W.Dean KeetonAustinTX 78712USA Division of Molecular Pharmaceutics and Drug Delivery College of PharmacyThe University of Texas at Austin107 W.Dean KeetonAustinTX 78712USA Department of Surgery and Perioperative Care and Department of PediatricsDell Medical SchoolThe University of Texas at Austin1601 Trinity St.Bldg.BAustinTX 78712USA

Hydrogels are cross-linked polymeric networks swollen in water,physiological aqueous solutions or biological *** are synthesized by a wide range of polymerization methods that allow for the introduction of linear and branched units with specific molecular *** addition,they can be tuned to exhibit desirable chemical characteristics including hydrophilicity or *** synthesized hydrogels can be anionic,cationic,or amphiphilic and can contain multifunctional crosslinks,junctions or tie *** these characteristics,hydrogels exhibit compatibility with biological systems,and can be synthesized to render systems that swell or collapse in response to external *** versatility and compatibility have led to better understanding of how the hydrogel’s molecular architecture will affect their physicochemical,mechanical and biological *** present a critical summary of the main methods to synthesize hydrogels,which define their architecture,and advanced structural characteristics for macromolecular/biological applications.

关键词： hydrogels networks mesh size hydrogel reactions biological applications biomedical applications

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The Effects of Externally Paced Exercise on Executive Function and Stress in College-Aged Students

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Journal of Science in Sport and Exercise 2023年第2期5卷 149-155页

作者： Peter C.Douris Joseph Cottone Patricia Cruz nicholas Frosos Christie Marino Leonard Singamenggala Joshua Shapiro Amber Sousa John P.Handrakis Joanne DiFrancisco‑Donoghue Department of Physical Therapy School of Health ProfessionsNew York Institute of TechnologyOld WestburyNY 11758USA College of Osteopathic Medicine New York Institute of Technology(NYIT)Old WestburyNYUSA VA RR&D National Center for the Medical Consequences of Spinal Cord Injury James J.Peters VA Medical CenterBronxNYUSA

Purpose The purpose of the study was to investigate the acute effect of a beginner martial art class and aerobic exercise on executive function(EF)in college-aged young *** is overwhelming evidence that demonstrates acute as well as long-term aerobic exercise improves ***,there is limited research comparing externally paced exercise(EPE)to self-paced exercise(SPE)such as walking on improving *** requires greater cortical demand than SPE to execute a motor *** Eight men and eight women,aged 24.2±2.8 years,participated in a Repeated Measures Crossover ***-and post-testing of EF with the Stroop and Tower of London(ToL)and stress level were measured after each of the two 1-h conditions:the SPE consisted of a walk(aerobic exercise)and the EPE was a beginner martial art *** There were significant main effects for the martial art class for the Stroop’s mean reaction time for congruent trials(P=0.01)with a large-effect *** mean reaction time for incongruent trials was significant(P=0.05)with a medium-effect *** ToL’s mean solution time(P=0.003)and mean execution time(P=0.002)were also significant with large-effect *** levels were not significantly improved following either *** The martial art class significantly improved all the major domains of EF,while aerobic exercise of a similar intensity did not demonstrate any measured significant *** physiological benefits of physical exercise are well documented;however,the cognitive enhancing capability of EPE should also be appreciated given the results of this study.

关键词： Externally paced exercise Self-paced exercise Cognitive performance Executive function

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