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World Journal of Gastroenterology 2007年第46期13卷 6281-6283页

作者： Hilary Hurley Ronan A Cahill paul ryan Ashraf I Morcos Henry P Redmond Helen M Kiely Department of Surgery Cork University HospitalCorkIreland Department of Pathology Cork University HospitalCorkIreland Department of Gastroenterology Mercy University HospitalCorkIreland

We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a pa- tient with multiple previous negative investigations. The clinical presentation, radiographic features and patho- logical findings of this case are described, along with the salient lessons learnt. The added value of wireless cap- sule endoscopy （WCE） in such circumstances is debated.

关键词： Non-Meckelean ectopic peptic ulcer Bowel obstruction

Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties

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World Journal of Orthopedics 2021年第12期12卷 1036-1044页

作者： Biju Benjamin paul ryan Yulia Chechelnitskaya Levent Bayam Turab Syed Efstathios Drampalos Department of Trauma and Orthopaedics Forth Valley Royal HospitalLarbert FK54WRScotlandUnited Kingdom Department of Orthopaedic Sakarya UniversitySakarya 54100Turkey

BACKGROUND Arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and *** have been numerous fixation devices described in literature for foot and ankle arthrodesis,each with their own benefits and *** To review the use of intraosseous devices in foot and ankle *** There were 9 papers included in the review(6 clinical and 3 experimental studies)all evaluating arthrodesis in the foot and ankle using the IOFIX device(Extremity Medical™,Parsippany,NJ,United States).Outcome scores,union rates,as well as complications were *** IOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal,and talonavicular joints with early *** comparison to plate/screw constructs there were fewer soft tissue complications and issues of metalwork *** and biomechanical studies on the use of intramedullary fixation for fusion of the tarsometatarsal and ankle joint showed decreased load to failure,cycles to failure and stiffness in comparison to traditional fusion methods using plates and screws,however IOFIX devices produced higher compressive forces at the *** We describe the reasons for which this biomechanical behavior of the intraosseous fixation may be favorable,until prospective and comparative studies with largersample size and longer follow-up confirm the effectiveness and limitations of the method.

关键词： Intra-osseous fixation Foot Ankle Arthrodesis Biomechanical IOFIX

Ultrasound-Guided Greater Occipital Nerve Hydrodissection for Treatment of Cervicogenic Headache: A Case Report

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Pain Studies and Treatment 2023年第1期11卷 1-8页

作者： paul J. ryan Dominic C. Harmon Department of Anaesthesia and Pain Medicine University Hospital Limerick Dooradoyle Limerick Ireland

We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.

关键词： Cervicogenic Headache Neck Pain Occipital Nerve Hydrodissection Ultrasound

Correlation of stress radiographs to injuries associated with lateral ankle instability

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World Journal of Orthopedics 2021年第9期12卷 710-719页

作者： Joshua W Sy Andrew J Lopez Gregory E Lausé J Banks Deal Michael B Lustik paul M ryan Department of Orthopaedic Surgery Tripler Army Medical CenterHonoluluHI 96859United States Department of Statistics Tripler Army Medical CenterHonoluluHI 96859United States

BACKGROUND Stress radiographs have demonstrated superior efficacy in the evaluation of ankle *** To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous *** A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was *** manual radiographic stress views were then correlated with magnetic resonance imaging and operative *** A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology(P=0.008 for tendonitis and P=0.020 for peroneal tendon tears).A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability(P=0.043).CONCLUSION Although valuable in the clinical evaluation of ankle instability,stress radiographs are not an independent predictor of conditions associated with ankle in-stability.

关键词： Ankle stress radiographs Lateral ankle instability Osteochondral defect Arthroscopy Peroneal tendinopathy

Ultrasound-Guided Dorsal Scapular Nerve Blockade in the Diagnosis and Management of Neck Pain

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Pain Studies and Treatment 2023年第2期11卷 9-14页

作者： Alena Boros paul J. ryan Dominic C. Harmon School of Medicine Faculty of Education & Health Services University of Limerick Limerick Ireland Department of Anaesthesia and Pain Medicine University Hospital Limerick Limerick Ireland

Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.

关键词： Technique Ultrasound Neck Pain Middle Scalene Muscle Dorsal Scapular Nerve

Review of Coeliac Plexus Blockade for the Management of Chronic Pancreatitis Pain at Tallaght University Hospital (TUH)

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Pain Studies and Treatment 2022年第3期10卷 21-34页

作者： paul ryan Kevin C. Conlon Philip Hu paul Ridgway Marie Egan Camillus Power Department of Anaesthesia Intensive Care and Pain Medicine Tallaght University Hospital Dublin Ireland Professorial Surgical Unit Department of Surgery Trinity College Dublin and Tallaght University Hospital Dublin Ireland Department of Surgery Trinity College Dublin and Tallaght University Hospital Dublin Ireland Department of Anaesthesia Intensive Care and Pain Medicine Trinity College Dublin and Tallaght University Hospital Dub-lin Ireland

Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction

关键词： Coeliac Plexus Block Chronic Pancreatitis Chronic Pain Opioid Analgesia Opioid Reduction

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平衡时空

缤纷 2009年第Z1期 58-65页

作者： Jan des Bouvrie paul ryan Jay Aspen 刘峰

在法国南部的古镇圣特罗佩(St Tropez),与周围那些布满灰尘的粉红色房子不同,许多名人的住宅都隐藏在高墙后面。在这些房子中间,一栋颇具新意的老式别墅安然矗立,房子的主人兼设计师Jan des Bouvrie在设计中揉合了传统意味与现代手法,... 详细信息

在法国南部的古镇圣特罗佩(St Tropez),与周围那些布满灰尘的粉红色房子不同,许多名人的住宅都隐藏在高墙后面。在这些房子中间,一栋颇具新意的老式别墅安然矗立,房子的主人兼设计师Jan des Bouvrie在设计中揉合了传统意味与现代手法,给这座建筑增加了对称的元素,也为之赋予了活力。

关键词：圣特罗佩设计师

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日本的海洋建筑工程

世界科学 1990年第5期 43-45页

作者： paul R.ryan ,Michael A.Champ ,李廷桓

日本人认为海洋空间是一项大自然资源。因为在将来能够被开发利用的陆地空间有限,所以,日本人正在建筑业中开辟新的领域。年轻的海洋开拓先驱正在努力开发海洋以满足在21世纪中期将面临的严重的空间需求。他们那些雄心勃勃的设想——有... 详细信息

日本人认为海洋空间是一项大自然资源。因为在将来能够被开发利用的陆地空间有限,所以,日本人正在建筑业中开辟新的领域。年轻的海洋开拓先驱正在努力开发海洋以满足在21世纪中期将面临的严重的空间需求。他们那些雄心勃勃的设想——有人称之为幻想——包括浮在海面的,用自身桩脚支承的,和座落在人工岛上的等各种海上城市,以及现代化的沿岸渔村,海上能源工厂和化工厂等,他们甚至设想在印度和东南亚地区的水域建造纺织和其它类型的工厂以发展

关键词：建筑物自升式人工岛海上构筑物海洋空间日本东京湾

Cardiac remodeling as a consequence of atrial fibrillation： An anatomical study of perfusion-fixed human heart specimens

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Journal of Geriatric Cardiology 2011年第3期8卷 141-146页

作者： Christopher D Rolfes Stephen A Howard ryan P Golf paul A Iaizzo Department of Biomedical Engineering University of Minnesota Minneapolis MAr 55455 USA Department of Surgery University of Minnesota Minneapolis MN55455 USA Department of Integrative Biology and Physiology University of Minnesota Minneapolis MN 55455 USA

Background Atrial fibrillation （AF） causes a continuum of atrial anatomical remodeling. Methods Using a library of perfusion-fixed human hearts, specimens with AF were compared to controls. During this preliminary assessment study, direct measurements were taken of atrial volume, pulmonary vein （PV） circumference, and left atrial （LA） wall thicknesses. Results Hearts with AF typically had larger atrial volumes, as well as a much larger variation in volume compared to controls （range of 59.6-227.1 mL in AF hearts compared to 65.1-115.9 mL in controls）. For all hearts, right PVs were larger than left PVs （mean： 171.4 ± 84.6 mm^2 for right and 1182 ± 50.1 mm^2 for left, P 〈 0.005）. LA wall thicknesses ranged from 0.7 mm to 3.1 mm for both AF and control hearts. Conclusions Hearts with AF had a large range of sizes which is consistent with the progression of atrial remodeling during AF. The large range of thicknesses will influence the amount of energy needed to create transmural lesions during ablation procedures.

关键词： left atrial dimensions volumes pulmonary vein ostia atrial fibrillation

Impact of guideline adherence and race on asthma control in children

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World Journal of Pediatrics 2021年第5期17卷 500-507页

作者： Shahid I.Sheikh Nancy A.ryan-Wenger Judy Pitts Rodney Britt Jr Grace paul Lisa Ulrich Department of Pediatrics The Ohio State University College of MedicineColumbus.OH.USA Section of Pulmonary Medicine Nationwide Children's HospitalED 544 Education Building700 Children's DriveColumbusOHUSA Department of Perinatal Research Wexner Research CenterColumbusOH.USA

Background Asthma control in African Americans(AA)is considered more difficult to achieve than in Caucasian Americans(CA).The aim of this study was to compare asthma control over time among AA and CA children w hose asthma is managed per NAEPP(EPR-3)*** This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma *** children received asthma care per NAEPP *** were compared between CA and AA children at baseline and then at three-month intervals for one *** Of the 345 children,ages 2-17 years(mean=6.2±4),220(63.8%)were CA and 125(36.2%)were *** were no significant differences in demographics other than greater pet ownership in CA *** baseline,AA children had significantly more visits to the Emergency Department for acute asthma symptoms(mean=2.3±3)compared to CA(1.4±23,P=0.003).There were no other significant differences in acute care utilization,asthma symptoms(mean days/month),or mean asthma control test(ACT)scores at base *** 3-6 months,in both groups,mean ACT scores,asthma symptoms and acute care utilization significantly improved(P<0.05 for all)and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children(P=002).Conclusion Overall,improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.

关键词： Asthma Asthma control Children Guideline adherence Race