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Impact of frailty on approach to colonic resection: laparoscopy vs open surgery

World Journal of Gastroenterology 2016年第43期22卷 9544-9553页

作者： Catalina Mosquera Konstantinos Spaniolas timothy l fitzgerald Department of General Surgery Division of Surgical Oncology East Carolina University Brody School of Medicine Division of Bariatric and Minimally Invasive Surgery East Carolina University Brody School of Medicine

AIM To understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy. METHODS Data were obtained from the National Surgical Quality Improvement Program(2005-2012) for patients undergoing colon resection [open colectomy(OC) and laparoscopic colectomy(lC)]. Patients were classified as non-frail(0 points), low frailty(1 point), moderate frailty(2 points), and severe frailty(≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy(total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery(abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0(SAS Institute Inc., Cary, NC, United States). RESUlTS A total of 94811 patients were identified; the majority underwent OC(58.7%), were white(76.9%), andnon-frail(44.8%). The median age was 61.3 years. Prolonged length of stay(lOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older(61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score(48.3% ASA3 vs 57.7% ASA2 in the lC group)(P l(42.5% OC vs 48% lC, P lications, prolonged lOS, and mortality were significantly more common in patients undergoing OC(P lications compared to lC for all frailty scores(non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P lute mortality with increasing frailty(non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P lUSION lC is associated with improved outcomes. A

关键词： Frailty Outcome Mortality Morbidity Colectomy

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Reconstruction using a pedicled upper arm fillet flap after excision of a malignant peripheral nerve sheath tumor: A case report

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World Journal of Clinical Cases 2014年第12期2卷 899-902页

作者： Parteek Singla Swapnil D Kachare timothy l fitzgerald Richard S Zeri Enamul Haque Brody School of Medicine East Carolina University Greenville NC 27834 United States Department of Surgery The Brody School of Medicine East Carolina University Greenville NC 27834 United States

Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the "spare parts" concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the "spare parts" concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting.

关键词： Reconstruction Flaps Neurofibromatosis Malignant Peripheral Nerve Sheath Tumor Sarcoma

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Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

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Journal of Cancer Therapy 2014年第13期5卷 1223-1233页

作者： timothy l. fitzgerald Cary Suzanne lea Prashanti M. Atluri Jason Brinkley Emmanuel E. Zervos Brody School of Medicine Division of Surgical Oncology East Carolina University Greenville USA School of Public Health East Carolina University Greenville USA Division of Medical Oncology East Carolina University Greenville USA Department of Biostatistics College of Allied Health Sciences East Carolina University Greenville USA

Health care inequalities exist for patients with colon cancer. We hypothesize that factors such as payers and medical comorbidities may explain much of this inequality. Methods: Patients with colon cancer in the NCDB from 2003-2010 were identified in this study. Results: 541,649 patients were identified. Median age and survival were 68.6 years and 62.5 months. A majority of them (80.2%) were non-Hispanic white (NHW). African American (AA) and Hispanic (HS) patients were more likely to have medicaid (MD) or be uninsured (UI) and reside in counties with lower socio-economic status (SES). From univariate analysis, it was found that private insurance (PI) had superior survival (98.7 months) compared to MD (46.0 months), medicare (MC) (50.4 months) and UI (54.4 months). Survival was highest for HS (70.9 months) followed by NHW (63.2 months) and AA (53.0 months). Also, survival was linked to comorbidity index (CI), SES, chemotherapy, gender and surgical resection. On multivariate analysis, it was found that male (RR 1.11), SES, surgery (RR 2.29), chemotherapy (RR 1.96), CI, and stage were associated with survival. Race was a predictor of survival, with a survival advantage for HS (RR 0.87) and others (0.87) compared to NHW (1) and AA (1.2). Insurance status was strongly linked to survival. Compared to PI all other groups had poorer survival: MC RR 1.11;MD RR 1.44;and NI RR ***: Inequality in outcomes for colon cancer patients is strongly associated with race and underinsurance.

关键词： Variability Colorectal Cancer Survival

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In vivo measurement of NADH fluorescence lifetime in skeletal muscle via -ber-coupled time-correlated single photon counting

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Journal of Innovative Optical Health Sciences 2024年第1期17卷 121-134页

作者： Kathryn M.Priest Jacob V.Schluns Nathania Nischal Colton l.Gattis Jeffrey C.Wolchok timothy J.Muldoon Department of Biomedical Engineering University of Arkansas FayettevilleARUSA

Nicotinamide adenine dinucleotide(NADH)is a cofactor that serves to shuttle electrons during metabolic processes such as glycolysis,the tricarboxylic acid cycle,and oxidative phosphorylation(OXPHOS).NADH is autofluorescent,and itsfluorescence lifetime can be used to infer metabolic dynamics in living ***-coupled time-correlated single photon counting(TCSPC)equipped with an implantable needle probe can be used to measure NADH lifetime in vivo,enabling investigation of changing metabolic demand during muscle contraction or tissue *** study illustrates a proof of concept for point-based,minimally-invasive NADHfluorescence lifetime measurement in *** muscle loss(VMl)injuries were created in the left tibialis anterior(TA)muscle of male Sprague Dawley *** lifetime measurements were collected before,during,and after a 30 s tetanic contraction in the injured and uninjured TA muscles,which was subsequently-t to a biexponential decay model to yield a metric of NADH utilization(cytoplasmic vs protein-bound NADH,the A11/A22 ratio).On average,this ratio was higher during and after contraction in uninjured muscle compared to muscle at rest,suggesting higher levels of free NADH in contracting and recovering muscle,indicating increased rates of *** injured muscle,this ratio was higher than uninjured muscle overall but decreased over time,which is consistent with current knowledge of inflammatory response to injury,suggesting tissue regeneration has *** data suggest that-ber-coupled TCSPC has the potential to measure changes in NADH binding in vivo in a minimally invasive manner that requires further investigation.

关键词： Glycolysis oxidative phosphorylation energy metabolism volumetric muscle loss

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Tale of mitochondria and mitochondria-associated ER membrane in patient-derived neuronal models of Wolfram syndrome

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Neural Regeneration Research 2025年第9期20卷 2587-2588页

作者： laetitia Aubry timothy Barrett Sovan Sarkar I-STEM CECSCorbeil-EssonnesFrance UniversitéParis-Saclay Universitéd’EvryINSERMI-STEMUMR861Corbeil-EssonnesFrance Institute of Cancer and Genomic Sciences Institute of Biomedical ResearchCollege of Medical and Dental SciencesUniversity of BirminghamEdgbastonBirminghamUK Department of Endocrinology Birmingham Women’s and Children’s HospitalSteelhouse LaneBirminghamUK

Mitochondria and mitochondria-associated endoplasmic reticulum membrane in neurodegenerative diseases:Mitochondria generate most of the chemical energy needed to power the biochemical reactions of cells,and thus are often referred to as the"powerhouse"of the ***,this organelle is also involved in a pleth,ora of different cellular functions such as calcium(Ca^(2+))homeostasis,apoptosis,oxidative stress,and several metabolic pathways including oxidative phosphorylation,tricarboxylic acid cycle,andβ-oxidation of fatty acids.

关键词： oxidative cycle carboxylic

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Quantitative Applications of Weather Satellite Data for Nowcasting:Progress and Challenges

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Journal of Meteorological Research 2024年第3期38卷 399-413页

作者： Jun lI Jing ZHENG Bo lI Min MIN Yanan lIU Chian-Yi lIU Zhenglong lI WPaul MENZEl timothy J.SCHMIT John l.CINTINEO Scott lINDSTROM Scott BACHMEIER Yunheng XUE Yayu MA Di DI Han lIN Innovation Centre for Fengyun Meteorological Satellite(FYSIC) National Satellite Meteorological CentreChina Meteorological AdministrationBeijing100081China School of Atmospheric Sciences and Guangdong Province Key laboratory for Climate Change and Natural Disaster Studies Sun Yat-sen University and Southern Laboratory of Ocean Science and EngineeringZhuhai519082China Key laboratory of Geographic Information Science(Ministry of Education) East China Normal UniversityShanghai200241China Research Center for Environmental Changes Academia SinicaTaipei11529China Cooperative Institute for Meteorological Satellite Studies University of Wisconsin-MadisonMadisonWI53706USA Sensors and Calibration Branch STAR/NESDISMadisonWI53706USA Wuxi University Wuxi214105China School of Computer Science Chengdu University of Information TechnologyChengdu610225China Collaborative Innovation Center on Forecast and Evaluation of Meteorological Disasters Nanjing University of Information Science&TechnologyNanjing210044China Key laboratory of Spatial Data Mining and Information Sharing of Ministry of Education National and Local Joint Engineering Research Center of Satellite Geospatial Information TechnologyFuzhou UniversityFuzhou350108China

Monitoring and predicting highly localized weather events over a very short-term period,typically ranging from minutes to a few hours,are very important for decision makers and public *** these events usually relies on radar observations through monitoring and *** advanced high-resolution imaging and sounding observations from weather satellites,nowcasting can be enhanced by combining radar,satellite,and other data,while quantitative applications of those data for nowcasting are advanced through using machine learning *** applications include monitoring the location,impact area,intensity,water vapor,atmospheric instability,precipitation,physical properties,and optical properties of the severe storm at different stages(pre-convection,initiation,development,and decaying),identification of storm types(wind,snow,hail,etc.),and predicting the occurrence and evolution of the *** observations can provide information on the environmental characteristics in the preconvection stage and are very useful for situational awareness and storm *** paper provides an overview of recent progress on quantitative applications of satellite data in nowcasting and its challenges,and future perspectives are also addressed and discussed.

关键词： weather satellite quantitative applications nowcasting pre-convection

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Utilization of RNA sequencing to investigate olfactory dysfunction in chronic rhinosinusitis without nasal polyps:A pilot study

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2024年第1期10卷 29-36页

作者： Jorge A.Gutierrez III Jeremy l.Barth Rodney J.Schlosser Thomas S.Edwards timothy l.Smith Zachary M.Soler Department of Otolaryngology-Head and Neck Surgery Medical University of South CarolinaCharlestonSouth CarolinaUSA Department of Regenerative Medicine&Cell Biology Medical University of South CarolinaCharlestonSouth CarolinaUSA Department of Otolaryngology-Head and Neck Surgery Oregon Health&Science UniversityPortlandOregonUSA

Objectives:Prior research on olfactory dysfunction in chronic rhinosinusitis(CRS)has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory *** purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens,comparing normosmic and dysosmic CRS patients without polyps(CRSsNP).Methods:Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus *** subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic(n=7)and normosmic(n=4)***:Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 *** stringent criteria for multiple comparisons,one upregulated gene(Immediate Early Response 3[IER3])had an false discovery rate(FDR)correction adjustedP value considered statistically significant(Pld change 2.69).Reactome functional analysis revealed eight biological pathways significantly different between dysosmic and normosmic patients(Pluding Il-4 and Il-13 signaling,Il-10 signaling,and rhodopsin-like ***:RNA sequencing of the superior turbinates in patients with CRSsNP can provide valuable information regarding biological pathways and genes involved in olfactory *** study supports literature suggesting that Type 2 inflammation may play a role in olfactory dysfunction in at least some patients with *** study also prompts questions regarding the role of Il-10,rhodopsin-like receptors,andIER3 in the pathogenesis of olfactory dysfunction.

关键词： chronic rhinosinusitis without nasal polyps olfactory dysfunction RNA sequencing

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Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular Neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Philip Appleton lisa J Woodhouse Craig S Anderson Sandeep Ankolekar lesley Cala Mark Dixon timothy J England Kailash Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey l Saver Angela Shone Aloysius Niroshan Siriwardena Joanna M Wardlaw Nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science Center BeijingChina Neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service NHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurology and Psychology University of GlasgowGlasgowUK Bob Champion Research and Education Building University of East AngliaNorwichUK Institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and NIHR leicester Biomedical Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurology Oslo University HospitalOsloNorway Research and Development Norwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Health Research Unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is ***,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of *** primary outcome was a shift in scores on the modified Rankin scale(mRS)at day *** outcomes included death;a global analysis(Wei-lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’*** were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%*** 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]***‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe *** In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital *** IS AlREADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those w

关键词： Glasgow nitrate random

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Storylines of family medicine Ⅵ:ways of being—in the office with patients

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Family Medicine and Community Health 2024年第S3期12卷 52-60页

作者： William B Ventres leslie A Stone lisa A laVallee David loxterkamp Jonisha R Brown Dael M Waxman Peter S Dorward Jeanne Cawse-lucas larry B Mauksch Autumn M Kieber-Emmons Benjamin F Crabtree William l Miller Veronica M Brohm timothy P Daaleman Kelly Bossenbroek Fedoriw Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA MAHEC Family Medicine Residency Mountain Area Health Education CenterAshevilleNorth CarolinaUSA Bucksport Regional Health Center BucksportMaineUSA Family Medicine Atrium HealthCharlotteNorth CarolinaUSA Southfield Medical Practice EdinburghUK Family Medicine University of Washington School of MedicineSeattleWashingtonUSA Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA Morsani College of Medicine University of South FloridaTampaFloridaUSA Family Medicine and Community Health Rutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA Cancer Institute of New Jersey New BrunswickNew JerseyUSA Family Medicine UNC School of MedicineChapel HillNorth CarolinaUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅵ:ways of being—in the office with patients’,authors address the following themes:‘Patient-centred care—cultivating deep listening skills’,‘Doctor as witness’,‘Words matter’,‘Understanding others—metaphor and its use in medicine’,‘Communicating with patients—making good use of time’,‘The patient-centred medical home—aspirations for the future’,‘Routine,ceremony or drama?’and‘The life course’.May readers better appreciate the nuances of patient care through these essays.

关键词： centre illustration dimensions

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Motion visualization and estimation for flapping wing systems

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Acta Mechanica Sinica 2017年第2期33卷 327-340页

作者： Tzu-Sheng Shane Hsu timothy fitzgerald Vincent Phuc Nguyen Trisha Patel Balakumar Balachandran Department of Mechanical Engineering University of Maryland College Park MD 20742 USA

Studies of fluid-structure interactions associated with flexible structures such as flapping wings require the capture and quantification of large motions of bodies that may be opaque. As a case study, motion capture of a free flying Manduca sexta, also known as hawkmoth, is considered by using three synchronized high-speed cameras. A solid finite element (FE) representation is used as a reference body and successive snapshots in time of the displacement fields are reconstructed via an optimization procedure. One of the original aspects of this work is the formulation of an objective function and the use of shadow matching and strain-energy regularization. With this objective function, the authors penalize the projection differences between silhouettes of the captured images and the FE representation of the deformed body. The process and procedures undertaken to go from high-speed videography to motion estimation are discussed, and snapshots of representative results are presented. Finally, the captured free-flight motion is also characterized and quantified.

关键词： Insect flight Deformable body High-speed videography Motion estimation

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