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Wedge and needle liver biopsies show discordant histopathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery

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Gastroenterology Report 2013年第1期1卷 51-57页

作者： Sekou R.Rawlins Cynthia M.Mullen Howard M.Simon Taewan Kim Steven K.Landas Marguerite S.Walser robert a.levine Division of Gastroenterology Department of MedicineState University of New York(SUNY)Upstate Medical UniversitySyracuseNYUSA Associates in Gastroenterology RockvilleMDUSA Department of Surgery SUNYUpstate Medical UniversitySyracuseNYUSA Department of Pathology SUNYUpstate Medical UniversitySyracuseNYUSA Section of Gastroenterology Department of MedicineBoston University School of MedicineBostonMAUSA

Background:Controversy exists over whether or not single-needle liver biopsies are sufficient to compare histological parameters in patients with non-alcoholic fatty liver ***:To identify sampling variability,we biopsied four liver specimens per patient,based on biopsy size(needle vs wedge)and location(left vs right lobe),immediately prior to bariatric Roux-en-Y gastric bypass ***:Ten prospectively enrolled,morbidly obese patients underwent 40 laparoscopy-guided biopsies;two needle and two wedge from each of 16 left and 16 right liver *** Kappa coefficient for concordance compared histological parameters from left and right lobe needle-and wedge *** biopsies were considered our‘Gold Standard’.Results:Each patient had two wedge-and two needle liver *** concordance between all needle and wedge biopsies from right and left lobes showed ***-and needle liver biopsies from contralateral lobes had higher concordance with each other,compared to ipsilateral needle/wedge biopsy *** wedge pairs had higher concordance than contralateral needle/needle *** were no biopsy ***:Wedge biopsy pairs had the best Kappa concordance but contralateral needle/needle biopsy pairs had good Kappa *** were no complications from the 40 needle-and wedge liver biopsies,confirming the safety of laporoscopic multi-biopsy in both liver lobes.

关键词： gastric bypass liver biopsy steatosis fibrosis image analysis

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The house of the seven gables

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作者： Nathaniel Hawthorne edited by robert S. levine.

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Primary and secondary prevention of colorectal cancer: An evidence- based review

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Family Medicine and Community Health 2017年第1期5卷 78-84页

作者： Sandra J.Gonzalez Maria C.Mejia de Grubb robert S.levine Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.

关键词： Colorectal cancer adenocarcinoma modifiable risk factors primary prevention secondary prevention primary care

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Smoking,depression,and hospital costs of respiratory cancers:Examining race and sex variation

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Family Medicine and Community Health 2017年第1期5卷 29-42页

作者： Baqar A.Husaini robert S.levine Phillip Lammers Pam Hull Meggan Novotny Majaz Moonis Tennessee State University NashvilleTNUSA Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Meharry Medical College NashvilleTNUSA Division of Epidemiology Vanderbilt UniversityNashvilleTNUSA Counseling Psychology Tennessee State UniversityNashvilleTNUSA Department of Medicine-Neurology University of Massachusetts Medical SchoolWorcesterMAUSA

Objective:To investigate the effect of smoking and depression on hospital costs for lung cancer(LC).Methods:We extracted data on depression,smoking history,demographics,and hospital charges for patients with respiratory cancers(ICD-9 codes 161-163,165)from the 2008 Tennessee Hospital Discharge Data *** sample(n=6665)was mostly white(86%)and male(57%).Age-adjusted rates were developed in accordance with Centers for Disease Control and Prevention methods,and hospital costs were compared for patients with LC with versus without depression and a smoking ***:Three findings(P<0.001)emerged:(1)the LC rate was higher among blacks than among whites,and higher among men than among women;(2)while 66%of LC patients smoked(more men than women without racial variation),24%had depression(more females and whites were depressed);(3)the LC hospital cost was 54%higher than the non-LC hospital cost,and this cost doubled for patients with LC with depression and smoking versus those without such ***:While LC is more prevalent among blacks and men,depression is higher among female and white *** depression with higher costs existed among LC patients,our find-ings point to(1)the possibility of cost savings by diagnosing and treating depression among LC patients,and(2)implementation of proven smoking cessation programs to reduce LC morbidity and hospital costs.

关键词： Smoking depression lung cancer race sex

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Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999-2009

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Family Medicine and Community Health 2017年第1期5卷 3-12页

作者： Maria C.Mejia de Grubb Barbara Kilbourne Katy Kilbourne Michael Langston Lisa Gittner Roger J.Zoorob robert levine Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Sociology Department Tennessee State UniversityNashvilleTNUSA Department of Family and Community Medicine Meharry Medical CollegeNashvilleTNUSA Department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTNUSA Department of Political Science Texas Tech University College of Arts and SciencesLubbockTXUSA

Background:The American Cancer Society estimates that about 25%of all US cancer deaths will be due to lung cancer-more than from cancers of the colon,breast,and prostate ***:We ascertained county-level age-adjusted and age-specific death rates and 95%confidence intervals from the Centers for Disease Control and Prevention Compressed Mortality *** regression analyses were used to estimate the strength and direction of relationships between county poverty,smoking,fine particulate matter(PM2.5)air pollution,and US Census divisions and race-and sex-specific lung cancer ***:Poverty,smoking,and particulate matter air pollution were positively and signifi-cantly related to lung cancer deaths among white men,but of these,only poverty and smoking were significantly associated with lung cancer deaths among white *** in the South Atlantic,East South Central,and West South Central US Census divisions at the time of death was significantly associated with lung cancer deaths for both white men and white *** with white men,poverty and smoking were associated with lung cancer deaths among black men,but of these,only adult smoking had a statistically significant association among black ***:The results support the need for further research,particularly in high-risk areas,to better differentiate factors specific to race and sex and to understand the impact of local risk factors.

关键词： Lung cancer mortality geographic risk factors environmental hot spot

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Depression and race affect hospitalization costs of heart failure patients

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Family Medicine and Community Health 2015年第2期3卷 39-47页

作者： Baqar A.Husaini robert S.levine Meggan L.Novotny Van A.Cain Uchechukwu K.A.Sampson Majaz Moonis Center for Prevention Research Tennessee State UniversityNashvilleTNUSA Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Vanderbilt University Medical Center NashvilleTNUSA Department of Neurology Memorial HospitalWorcesterMAUSA

Objective:Depression and anxiety are frequently observed in heart failure(HF)patients;however,the effect of such factors on hospitalization costs of HF patients,and whether such costs vary by race and gender remain poorly *** analysis delineated the preva-lence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization ***:We examined the 2008 files of the Tennessee Hospital Discharge Data System(HDDS)on patients(≥20 years of age)with a primary diagnosis of HF(ICD-9 codes 402,404,and 428)along with demographic data,depression/anxiety diagnoses,hospital costs,and *** the HF sample(n=16,889)53%were female and 23%were *** and gender differences in hospital costs were evaluated for the following three groups:(1)HF patients with depression/anxiety(HF+D);(2)HF-only patients without depression/anxiety(HFO);and(3)HF patients with other mental diagnoses(HF+M).Results:HF was significantly(p<0.000)higher among blacks compared to whites,and higher among males than *** 25%of HF patients had depression/anxiety(more whites and females were depressed).HF patients averaged more than 3 comorbidities(blacks had a greater number of comorbidities and hospitalization cost for the year).Costs were higher among HF+D patients compared to HFO *** HF+D patients,costs were higher for black males compared with white *** cost patterns prevailed largely because of higher comorbidities that required more re-admissions and longer hospital ***:Race and depression/anxiety are associated with increased hospitalization costs of HF *** higher costs among blacks reflect the higher burden of comorbidities,such as hypertension and diabetes,which calls for widespread dissemination,adoption,and implementation of proven interventions for the control of these comorbidities.

关键词： Hospitalization costs heart failure race gender depression

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Pierre; or, The ambiguities

Pierre; or, The ambiguities

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作者： Herman Melville edited by robert S. levine University of Maryland and Cindy Weinstein California Institute of Technology.

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Rural congestive heart failure mortality among US elderly, 1999-2013: Identifying counties with promising outcomes and opportunities for implementation research

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Family Medicine and Community Health 2015年第2期3卷 27-38页

作者： Maria C.Mejia de Grubb robert S.levine Barbara Kilbourne Baqar A.Husaini Tyler Skelton Lisa Gittner Michael A.Langston George E.Rust Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Department of Sociology Tennessee State UniversityNashvilleTennesseeUSA Center for PreventionResearch Tennessee State University College of AgricultureNashvilleTennesseeUSA Department of Political Science Texas Tech UniversityLubbockTXUSA Department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTennesseeUSA Department of Family Medicine National Center for Primary CareMorehouse School of MedicineAtlantaGeorgiaUSA

Objective:Describe modern trends in congestive heart failure(CHF)among elderly(>65 years of age)in the United States,to identify potentially successful rural *** CHF mortality using multiple-(MCOD)versus underlying-(UCOD)cause of death ***:*** for Disease Control and Prevention mortality files(WONDER internet site).Results:Using MCOD data,overall mortality rates/100,000 population(and 95%confidence intervals)for CHF among persons>65 years of age(1999-2013)were 482.0(481.2-482.8)for large central and large fringe metropolitan(LCLF)counties,549.6(548.6-550.7)in small and medium metropolitan(SM)counties,and 652.6(650.9-654.0)in micropolitan and non-core,non-metropolitan(MNCNM)*** positive deviance NCNM counties(collectively including 198,581 residents>65 years of age)had an overall CHF rate of 300.9(275.0-326.9)in *** was significantly lower than the LCLF rate for 2013(482.0[481.2-482.8]),and rep-resented a reduction of 47%since *** CHF occurrence as estimated with MCOD was 3.4-fold higher than that obtained with ***:These data illustrate underestimation of CHF by UCOD data and the importance of correct death *** CHF mortality rates are higher than urban rates,but some positive deviance counties demonstrate that this is not *** research is needed to understand the relative contribution of research innovation,medical care,and public health to rural-urban disparities and the relative success of positive deviance counties.

关键词： Congestive heart failure elderly mortality rural

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花栗鼠的王国

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商业周刊（中文版） 2012年第8期 112-113页

作者： robert levine

首次跃上票房榜首50多年后，花栗鼠们给这个家族带来几十亿美元。

关键词：商人品牌家族生意经营生意

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How TP53 (almost) became an oncogene

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Journal of Molecular Cell Biology 2019年第7期11卷 531-533页

作者： robert A.Weinberg Whitehead Institute for Biomedical Research Ludwig/MIT Center for Molecular OncologyMIT Department of BiologyCambridgeMA 02142USA

Like the histories of many other genes,the discovery and characterization of p53 are associated with some false leads,dead ends,and major *** chronicle of p53,s early years is no *** is now well known,the protein was ... 详细信息

关键词： histories characterization Old

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