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High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

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World Journal of Gastroenterology 2016年第47期22卷 10398-10405页

作者： Roman Schumann Nikola S Natov Klifford A Rocuts-martinez matthew D Finkelman Tom V Phan Sanjay R Hegde robert m knapp Department of Anesthesiology and Perioperative medicine Tufts Medical CenterBoston MA 02111United States The Gastroenterology/Hepatology Division Tufts Medical CenterBoston MA 02111United States Critical Care medicine Dartmouth-Hitchcock Medical CenterLebanon NH 03756 United States Tufts University School of Dental medicine Boston MA 02111United States Tufts University School of medicine Boston MA 02111United States

AIm To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated *** In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases *** During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P me within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

关键词： Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography Endoscopy Sedation Anesthesia Oxygenation High flow nasal oxygen

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Sleep as a window to understand and regulate Alzheimer's disease:emerging roles of thalamic reticular nucleus

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Neural Regeneration Research 2025年第6期20卷 1711-1712页

作者： Haoqi Sun Shiqian Shen robert J.Thomas m.Brandon Westover Can Zhang Department of Neurology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Center for Translational Pain Research Department of AnesthesiaCritical Care and Pain MedicineMassachusetis General HospitalHarvard Medical SchoolBostonMAUSA Division of Pulmonary Critical Care and Sleep MedicineDepartment of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Genetics and Aging Research Unit McCance Center for Brain HealthMass General Institute for Neurodegenerative DiseaseDepartment of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA

Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is primarily caused by the deposition of amyloid-β(Aβ), which drives tau phosphorylation, neuroinflammation, and neurodegeneration in the brain. The amyloid hypothesis is strengthened by the significant and moderate benefit of lecanemab, a humanized antibody through an anti-amyloid mechanism,showing slowed clinical decline(van Dyck et al.,2023). The recent positive results of anti-amyloid trials have brought back focus on the amyloid hypothesis through biochemical, genetic, and pharmacological approaches(Zhang, 2023).

关键词： Alzheimer inflammation hypothesis

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Abdominal wall procedures: the beneifts of prehabilitation

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Plastic and Aesthetic Research 2020年第2期7卷 37-50页

作者： Nathan knapp Breanna Jedrzejewski robert martindale Division of Gastrointestinal and General Surgery Department of Surgery Oregon Health and Science UniversityPortlandOR 97239USA Division of Plastic and Reconstructive Surgery Department of SurgeryOregon Health and Science UniversityPortlandOR 97239USA

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical *** includes interventions that optimize nutrition,glycemic control,functional status,and utilization of the patient's microbiome pre-,intra-,and *** a multidisciplinary and anticipatory approach to patients'existing co-morbidities,the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective *** increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay,it is incumbent on the surgeon to employ these practices in elective abdominal wall *** research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.

关键词： Prehabilitation perioperative optimization abdominal wall reconstruction minimize co-morbidities

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On-line non-intrusive particle size measurement of pulverised fuel through digital imaging

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仪器仪表学报 2007年第11期28卷 1942-1946页

作者： Carter robert m Department of Electronics University of Kent

This paper presents the basic principles of particle size measurement and latest industrial results recorded using an innovative optical instrumentation system designed to measure the size distribution of particles in a pneumatic *** system is non-intrusive and cost-effective.A low-cost CCD camera is used to capture images of the particulate flow field,which is illuminated by a low-cost pulsed laser sheet *** particle size distribution is then determined by processing the particle images through the use of novel processing *** results obtained in the past on a small scale particle flow test rig have demonstrated that the system is capable of measuring the size distribution of pneumatically conveyed particles with an accuracy of a few *** the present paper results obtained when testing the system at a 4 mW industrial test facility are *** are made with both off-line reference data achieved through sieving and on-line laser diffraction data recorded using an intrusive,extractive,malvern Instruments *** general there is good agreement between results when considering the characteristics and limitations of the individual *** novel imaging system shows itself to be rugged,practical and useful under genuine industrial conditions.

关键词：粒子测量方法数字成像数码

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Role of Hox genes in stem cell differentiation

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World Journal of Stem Cells 2015年第3期7卷 583-595页

作者： Anne Seifert David F Werheid Silvana m knapp Edda Tobiasch Department of Applied Sciences Bonn-Rhine-Sieg University of Applied Sciences

Hox genes are an evolutionary highly conserved gene family. They determine the anterior-posterior body axis in bilateral organisms and influence the developmental fate of cells. Embryonic stem cells are usually devoidof any Hox gene expression, but these transcription factors are activated in varying spatial and temporal patterns defining the development of various body regions. In the adult body, Hox genes are among others responsible for driving the differentiation of tissue stem cells towards their respective lineages in order to repair and maintain the correct function of tissues and organs. Due to their involvement in the embryonic and adult body, they have been suggested to be useable for improving stem cell differentiations in vitro and in vivo. In many studies Hox genes have been found as driving factors in stem cell differentiation towards adipogenesis, in lineages involved in bone and joint formation, mainly chondrogenesis and osteogenesis, in cardiovascular lineages including endothelial and smooth muscle cell differentiations, and in neurogenesis. As life expectancy is rising, the demand for tissue reconstruction continues to increase. Stem cells have become an increasingly popular choice for creating therapies in regenerative medicine due to their self-renewal and differentiation potential. Especially mesenchymal stem cells are used more and more frequently due to their easy handling and accessibility, combined with a low tumorgenicity and little ethical concerns. This review therefore intends to summarize to date known correlations between natural Hox gene expression patterns in body tissues and during the differentiation of various stem cells towards their respective lineages with a major focus on mesenchymal stem cell differentiations. This overview shall help to understand the complex interactions of Hox genes and differentiation processes all over the body as well as in vitro for further improvement of stem cell treatments in future regenerative me

关键词： Genes Homeobox Stem cells Asymmetriccell division mesenchymal stromal cells Growth Development Regeneration Patterning Cell lineage

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Universal correlations in percolation

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Frontiers of physics 2020年第4期15卷 1-3页

作者： robert m.Zif Center for the Study of Compler Systems and Department of Chemical Engineering University of MichiganAnn ArborMI 48109-2800USA

Percolation is the process where connections from link to link in random systems leads to clustering and long-range connectivity.A standard model of percolation is a reg-ular lattice,with the links being nearest-neighbor bonds that are randomly occupied(bond percolation),or all links exist and random sites(vertices)are occupied(site per-colation).At a critical occupancy fraction Pe of sites or bonds,the mean cluster size in an infinite system first becomes infinite,and many properties become universal for a given *** characteristics of the uni-versal behavior has been the focus of much research for decades[1-5].

关键词： bonds percolation infinite

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Thiolsulfonate functionalized polystyrene resin:Preparation and application in the isolation and identification of electrophilic mutagens

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Journal of Environmental Sciences 2007年第12期19卷 1520-1527页

作者： Wu El robert m. Carlson Research Center for Eco-Environmental Sciences Chinese Academy of Sciences Beijing 100085 China Department of Chemistry University of Minnesota-Duluth Duluth MN 55812 USA

A new approach for isolation and identification of elecrtophilic mutagens from complex matrix was developed. Thiosulforfic anion was immobilized onto polystyrene beads and used as separation media. Potassium polystyryl-thiosulfonate, prepared from polystyryl- sulfonyl chloride and KHS, was observed to selectively react with model electrophilic mutagens such as alkyl halides, ct-chloroketones and α-chloroesters to produce polystyryl-thiosulfonlc esters. After separation from other nonreactive organic compounds, the beads then reacted with ethanethiol to produce unsymmetrical ethyl disulfides which are easily detected by GC/mS. For one mutagenic compound, only one unsymmetrical disulfide was found to contain its structure part. Thus, the structure of the parent mutagens could be deduced from that of the unsymmetrical disulfides. The degree of functionalization of the potassium polystyryl-thiosulfonate resin was 1.11 mmol/g. Its reactivity was discussed and its recycling method was reported here.

关键词： functionalized polystyrene potassium polystyryl-thiosulfonate unsymmetrical ethyl disulfides electrophilic mutagens

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Advances in local ablation of malignant liver lesions

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World Journal of Gastroenterology 2016年第15期22卷 3885-3891页

作者： robert m Eisele Department of General Visceral Vascular and Pediatric Surgery Medical Faculty of the University of Saarland

Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.

关键词： Local ablation Liver microwave ablation Hepatocellular carcinoma Colorectal liver metastases Navigation

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Junction Point Elimination based Tamil Handwritten Character Recognition:An Experimental Analysis

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Journal of Systems Science and Systems Engineering 2020年第1期29卷 100-123页

作者： m.Antony robert Raj S.Abirami Department of Information Science and Technology Anna UniversityChennai 600025

Optical Character Recognition is the mechanical or electronic conversion of images of typed,handwritten or printed text into machine-encoded text for online reading and *** this OCR technique,Tamil handwritten character recognition is one of the most needed and challengeable subjects of *** encounter between selection and extraction of proper features eliminates the issues faced by the Tamil handwritten *** character and the writers complexities are the major difficulties and challenges faced by this recognition ***,the character complexity can be overcome by any pre-extraction or selection process,wherein,structured or statistical pre-extraction algorithm can be designed,discovering the essential features,in the case of writer *** challenges of Tamil handwritten characters are structure over looping;unnecessary character portion;structure discontinuations and so *** character portions in this research are chosen by implementing a new algorithm called the Junction Point Elimination(JPE)after conscientious analysis done on the existing algorithms like Zoning,Zoning and Junction Point(ZJP)and the Junction Point (JP) based feature pre-extraction *** novelty behind this work is introducing an algorithm in order to truncate the problem in the existing feature selection and preextraction *** feature extraction and classification algorithm are chosen and applied on the features extracted by JPE to test whether the same can be reached in successful *** final analysis and experiments shows that the JPE is better than the others.

关键词： Junction point elimination chain code zoning prism tree quad tree support vector machine

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Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

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Asian Journal of Andrology 2016年第3期18卷 373-380,I0007页

作者： J Abram mcBride robert m Coward Department of Urology University of North Carolina School of Medicine Chapel Hill NC 27599-7235 USA.

The use of testosterone replacement therapy （TRT） for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids （AAS） within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal （HPG） axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use.

关键词： anabolic steroids hypogonadism infertility spermatogenesis testosterone testosterone replacement therapy vasectomy reversal

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