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Natural history,clinical characteristics,outcomes,and long-term follow-up of pain-free chronic pancreatitis

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Gastroenterology Report 2023年第1期11卷 309-315页

作者： Awais Ahmed Ishani Shah Rachel Bocchino steven D.Freedman Darshan J.Kothari Sunil G.Sheth Department of Medicine Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of Internal MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of GastroenterologyDuke UniversityDurhamNCUSA

Background:Chronic pancreatitis(Cp)is characterized by chronic abdominal pain and functional ***,a small subset of patients with prior acute pancreatitis(Ap)and/or underlying risk factors for developing Cp may be pain-free at diagnosis and may have a different clinical *** aimed to compare the clinical characteristics,outcomes,and healthcare utilization between Cp patients with and without ***:Reviewed patients with established Cp were followed in our pancreas Center between January 2016 and April *** without risk factors for developing Cp and/or without Ap prior to their diagnosis and only with incidental radiologic features of Cp were excluded,so as tominimize confounding factors of pancreatopathy unrelated to *** were divided into painful and pain-free groups to analyze differences in demographics,outcomes,and healthcare ***:Of 368 Cp patients,49(13.3%)were pain-free at diagnosis and had remained so for>9 *** were no significant differences in body mass index,race,sex,or co-morbidities between the two ***-free patients were older at diagnosis(53.9 vs 45.7,p=0.004)and had less recurrent Ap(RAp)(43.8%vs 72.5%,ppancreatic insufficiency(EpI)(34.7%vs 65.7%,ppain-free patients had less disability(2.2%vs 22.0%,p=0.003),mental illness(20.4%vs 61.0%,pp=0.059),and therapeutic interventions(0.0%vs 16.4%,p=0.005)for ***:We described a unique subset of patients with underlying risk factors for Cp and/or prior Ap who were painfree at *** were older at diagnosis,had less EpI and RAp,and overall favorable outcomes with minimal resource utilization.

关键词： chronic pancreatitis pain-free pancreatic insufficiency diabetes

pharmacologic inhibition of mTORC1 mimics dietary protein restriction in a mouse model of lactation

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Journal of Animal Science and Biotechnology 2021年第2期12卷 729-738页

作者： Virginia L.pszczolkowski steven J.Halderson Emma J.Meyer Amy Lin Sebastian I.Arriola Apelo Department of Animal and Dairy Sciences University of Wisconsin-MadisonMadisonWIUSA Endocrinology and Reproductive physiology Graduate Training program University of Wisconsin-MadisonMadisonWIUSA

Background:Understanding the mechanisms of N utilization for lactation can lead to improved requirement estimates and increased efficiency,which modern dairy diets currently fail to *** mechanistic target of rapamycin complex 1(mTORC1)is a central hub of translation regulation,processing extra-and intra-cellular signals of nutrient availability and physiological state,such as amino acids and *** hypothesized that dietary amino acids regulate lactation through mTORC1,such that inhibition of mTORC1 will lead to decreased lactation performance when amino acids are not *** objectives were to assess lactation performance in lactating mice undergoing dietary and pharmacologic interventions designed to alter mTORC1 ***:First lactation mice(N=18;n=6/treatment)were fed an adequate protein diet(18%crude protein),or an isocaloric protein-restricted diet(9%crude protein)from the day after parturition until lactation day 13.A third group of mice was fed an adequate protein diet and treated with the mTORC1 inhibitor rapamycin(4 mg/kg every other day)intraperitoneally,with the first two groups treated with vehicle as *** and pups were weighed daily,and feed intake was recorded every other *** production was measured every other day beginning on lactation day 4 by the weigh-suckle-weigh *** were collected after fasting and ***:Milk production and pup weight were similarly decreased by both protein restriction and rapamycin treatment,with final production at 50%of control(p=0.008)and final pup weight at 85%of control(pphosphorylation of mTORC1’s downstream targets were decreased by protein restriction and rapamycin treatment(ppamycin treated mice,and none by protein ***:Overall,sufficient supply of dietary amino acids was unable to maintain lactation performance status in mice with pharmacologically reduced mam

关键词： Amino acids Lactation Mammary Mouse model mTORC1 Rapamycin

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Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan

第六届材料与热加工物理模拟及数值模拟国际会议

作者： steven Hong p.Y.Shih L.Y.Tseng Yoke Industrial Corporation Department of materials Science and Engineering National Taiwan University

The similar welding of SM490A with flux cored arc welding （FCAW）,including microstructure,the mechanical properties,and corrosion behavior have been *** results show that a multi-pass welding,a thermal treatment,such as tempering or normalization,would happen to the heat affected zone and the under *** unfavorable microstructures,such as Widmanst tten ferrite in the heat affected zone and reheated weld metal,would be eliminated,so the toughness and hardness of the heat affected zone would be *** result of the Charpy-notch impact test shows that,because of the difference in grain refinement,the higher heat input would produce higher impact *** the rise of the heat input,the tensile strength would decrease in the similar ***,the result of the potential-dynamic polarization curve tests reveals that the corrosion current of weld metal is weaker than that of base *** means that the weld metal has a slower corrosion velocity and thus,has a better anti-corrosion *** rise of heat input causes no obvious difference in the corrosion potential of weld metal,but the weld metal would have a better anti-corrosion property if the corrosion current *** is to say that,under higher heat input,it has higher resistance to *** to the anti-pitting corrosion property,the result of the cyclic-polarization curve test indicates that weld metal would be transformed from uniform corrosion into lightly pitting corrosion.

关键词： flux cored arc welding (FCAW) SM490A mechanical property corrosion behavior.

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Military Medical Research 2021年第1期8卷 17-24页

作者： Camaren M.Cuenca Matthew A.Borgman Michael D.April Andrew D.Fisher steven G.Schauer JUS Army Institute of Surgical Research 3698 Chambers PassJBSA Fort Sam HoustonSan AntonioTX 78234-7767USA Brooke Army Medical Center JBSA Fort Sam HoustonSan AntonioTXUSA Uniformed Services University of the Heath Sciences BethesdaMDUSA Texas Army National Guard AustinTXUSA Department of Surgery UNM School of MedicineAlbuquerqueNMUSA 59th Medical Wing JBSA LacklandSan AntonioTXUSA

Background: pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in children. We seek to determine if those previous findings are applicable to the deployed, combat trauma ***: We queried the Department of Defense Trauma Registry(DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. This was a secondary analysis of casualties seeking to validate previously published data using the shock index, pediatric age adjusted. We then used previously published thresholds to determine patients outcome for validation by age grouping, 1–3 years(1.2), 4–6 years(1.2), 7–12 years(1.0), 13–17 years(0.9).Results: From January 2007 through January 2016 there were 3439 pediatric casualties of which 3145 had a documented heart rate and systolic pressure. Of those 502(16.0%) underwent massive transfusion and 226(7.2%) died prior to hospital discharge. Receiver operating characteristic(ROC) thresholds were inconsistent across age groups ranging from 1.0 to 1.9 with generally limited area under the curve(AUC) values for both massive transfusion and death prediction characteristics. Using the previously defined thresholds for validation, we reported sensitivity and specificity for the massive transfusion by age-group: 1–3(0.73, 0.35), 4–6(0.63, 0.60), 7–12(0.80, 0.57), 13–17(0.77, 0.62). For death, 1–3(0.75, 0.34), 4–6(0.66–0.59), 7–12(0.64, 0.52), 13–17(0.70, 0.57). However, negative predictive values(NpV) were generally high with all greater than ***: Within the combat setting, the age-adjusted pediatric shock index had moderate sensitivity and relatively poor specificity for predicting massive transfusion and death. Better scoring systems are needed to p

关键词： pediatric Massive Transfusion Shock Index Age

A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students

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World Journal of Emergency Medicine 2019年第3期10卷 169-176页

作者： Sagar Shah steven Tohmasi Emily Frisch Amanda Anderson Roy Almog Shadi Lahham Roland Bingisser John C. Fox School of Medicine University of California Irvine USA Department of Emergency Medicine University of California Irvine Irvine USA University Hospital Basel Basel Switzerland

BACKGROUND: point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean precourse ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (p>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (p>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3%(pp also showed statistically signifi cant improvement on the physiology exam, improving from 59.3% to 70.0%(pprovement in physiology learning when compared to standard didactic curriculum.

关键词： Ultrasound education pOCUS Switzerland Medical education

Total hip arthroplasty in patients with paget's disease of bone: A systematic review

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World Journal of Orthopedics 2017年第4期8卷 357-363页

作者： Sammy A Hanna Sebastian Dawson-Bowling steven Millington Rej Bhumbra pramod Achan Department of Trauma and Orthopaedic Surgery Royal London HospitalBarts Health NHS Trust

AIM To investigate the clinical and functional outcomes following total hip arthroplasty(THA) in patients with paget's *** We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of THA in patients with paget's disease. Eight studies involving 358 hips were reviewed. The mean age was 70.4 years and follow-up was 8.3 years. There were 247 cemented THAs(69%), 105 uncemented THAs(29%) and 6 hybrid THAs(2%). RESULTS All studies reported significant improvement in hip function following THA. There were 19 cases of aseptic loosening(5%) at a mean of 8.6 years. Three cases occurred in the uncemented cohort(3%) at a mean of 15.3 years and 16 cases developed in the cemented group(6%) at a mean of 7.5 years(p = 0.2052). There were 27 revisions in the 358 cases(8%) occurring at a mean of 7 years. Six revisions occurred in the uncemented cohort(6%) at a mean of 8.6 years and 21 in the cemented cohort(9%) at a mean of 6.5 years(p = 0.5117). CONCLUSION The findings support the use of THA in patients with paget's disease hip arthropathy. The post-operative functional outcome is largely similar to other patients; however, the revision rate is higher with aseptic loosening being the most common reason for revision. Uncemented implants appear to be associated with a lower failure rate, however, there were no modern stem designs fixed using current generation cementing techniques used in the reported studies, and as such, caution is advised when drawing any conclusions.

关键词： Total hip arthroplasty paget’s disease Revision Loosening Heterotopic ossification

Endoscopic retrograde cholangiopancreatography with ampullary biopsy vs ERCp alone:a matched-pairs controlled evaluation of outcomes and complications

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Gastroenterology Report 2017年第4期5卷 277-281,I0002页

作者： Sunil Dacha Saurabh Chawla Jai Eun Lee steven A.Keilin Qiang Cai Field F.Willingham Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGAUSA Department of Medicine Division of GastroenterologyGeorgia Regents UniversityAugustaGAUSA

Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune *** biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCp).Due to the well-established complication rate following ERCp,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled ***:A matched-pairs,case-control analysis was performed for patients undergoing ERCp with or without ampullary *** analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCp compared(via procedural complexity)with a matched control group who underwent ERCp without ampullary ***:Of 159 procedures involving ampullary biopsy,54 ERCps that met the inclusion criteria were performed with ampullary biopsy and included in the analysis *** cohort was compared with 54 patients undergoing ERCp without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural *** were no patients with sphincter of Oddi *** biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous *** major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,p>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,p=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study ***:Ampullary biopsy performed during ERCp had a high diagnostic yield and was not associated with an increased rate of post-procedure complica

关键词： endoscopic retrograde cholangiopancreatography ampullary biopsy complications

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taTME:boom or bust?

Gastroenterology Report 2020年第1期8卷 1-4,I0001页

作者： Liang Kang patricia Sylla Sam Atallah Massaki Ito steven D.Wexner Jian-ping Wang Department of Colorectal Surgery Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Division of Colon and Rectal Surgery Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkNYUSA The College of Medicine Endo-Surgical Center of FloridaDepartment of Colorectal SurgeryFlorida HospitalOrlandoFLUSA Colorectal and pelvic Surgery Division Department of Surgical OncologyNational Cancer Center Hospital EastKashiwaChibaJapan Department of Colorectal Surgery Cleveland Clinic FloridaWestonFLUSA

Since Sylla et al.[1]introduced transanal total mesorectal excision(taTME)in 2010,there has been rapid global uptake of this approach,predicated upon the postulated advantage of improved visualization of and access to the deep pelvic *** approach has been proposed for locally adries have demonstrated the procedural safety and short-and long-term oncologic adequacy of taTME in carefully selected patients,when performed by experienced high-volume taTME surgeons[1–7].

关键词： anatomy carefully experienced

Salivary cytokines and levels in denture stomatitis: An exploratory case-control study

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Open Journal of Stomatology 2012年第4期2卷 326-333页

作者： Silvana p. Barros Sandra Al-Tarawneh Sompop Bencharit Zvi Loewy Linda Gendreau steven Offenbacher Department of periodontology School of Dentistry University of North Carolina Chapel Hill USA Department of pharmaceutical and Biomedical Sciences Touro College of Pharmacy New York USA Department of pharmacology School of Medicine University of North Carolina Chapel Hill USA Department of prosthodontics School of Dentistry University of North Carolina Chapel Hill USA GlaxoSmithKline Consumer Healthcare Parsippany USA

We aimed to evaluate the microbial and inflammatory characteristics associated with Denture Stomatitis (DS) analyzing: l) Levels of salivary cytokines and cultivable C. albicans;2) DNA-DNA checkerboard on biofilm associated with mucosal tissue-bearing denture surfaces, 3) Serum C-reactive protein (CRp) levels. Thirty-two subjects were enrolled in the study with control (n = 17) and DS types II and III (n = 15) subjects. Samples were collected from unstimulated whole saliva, serum and swabs from denture surfaces. Salivary levels of inflammatory mediators and CRp were measured by multiplex. Samples from denture and mucosal surfaces were analyzed by DNA-DNA checkerboard. Saliva from DS subjects showed increase in IL-8 (p = 0.04) and IL-1β (p = 0.04) with trend for increase in IL-1β, TNFα and IL-6 levels. C. albicans higher counts in DS saliva (p = 0.03) showed association with elevated levels of IL-8 (p = 0.03) and IL-1α (p = 0.01). CRp levels were not different among groups (p = 0.74). DNA-DNA checkerboard analyses indicated typical periodontal pathogens below the detection threshold of 104 organisms on both denture and inflamed mucosal surfaces. The data suggest that DS is associated with elevation of salivary IL1 and IL-8 together with increased C. albicans. There was no evidence of systemic inflammation as measured by serum C-reactive protein levels.

关键词： Cytokines Serum C-Reactive protein Denture C. albicans Stomatitis Salivary