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Endoscopic stricturotomy and ileo-colonic resection in patients with primary Crohn’s disease-related distal ileum strictures

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Gastroenterology Report 2020年第4期8卷 312-318,I0002页

作者： Nan lan tracy l.hul. Bo Shen Center for Inflammatory Bowel Disease Digestive Disease and Surgery InstituteCleveland ClinicClevelandOHUSA Present affiliation:Center for Inflammatory Bowel Diseases Columbia University Irving Medical Center-New York Presbyterian HospitalNew YorkNY 10032USA.Fax.***.

Background:Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal *** study aimed to compare the efficacy and safety of patients with primary distal ileum stricture treated with endoscopic stricturotomy(ESt)vs ileo-colonic resection(ICR).Methods:All consecutive patients with primary distal ileum stricture that were treated with ESt and/or ICR were extracted from the interventional inflammatory bowel disease(i-IBD)unit from 2001 to *** patients with a stricture>5cmor those with anastomotic strictures were excluded from the *** primary outcomes were surgery-free survival and post-procedural ***:A total of 13 patients receiving ESt and 32 patients receiving ICR were included in this *** the length of the stricture is comparable between the two groups(2.460.9 vs 3.061.1 cm,P=0.17),patients who received surgery had a more complicated obstruction presented by the high pre-stenosis proximal dilation rate(67.7%vs 9.1%,P=0.001).All patients in both groups achieved immediate technical success after *** follow-up durations were 1.8 and 1.5 years in the ESt and ICR groups,*** subsequent surgery rates were similar between the two groups(15.4%vs 18.8%,P=0.79)and the overall surgery-free survival was also comparable between the two groups(P=0.98).Post-procedural adverse events were seen in 2/29 ESt procedures(6.9%per procedure)and 8/32(25.0%)patients receiving ICR(P=0.05).Conclusions:ESt achieved comparable stricture-related surgery-free survival as ICR,while ESt had a numerically lower post-operative complication rate.

关键词： Crohn’s disease stricture endoscopy stricturotomy resection

Use of signal quality measurements to gain efficiency in the analysis of cDNA microarray data

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Journal of Genetics and Genomics 2010年第4期37卷 265-279页

作者： tracy l Bergemann Division of Biostatistics University of Minnesota

This research provides a new way to measure error in microarray data in order to improve gene expression analysis. Microarray data contains many sources of error. In order to glean information about mRNA expression levels, the true signal must first be segregated from noise. This research focuses on the variation that can be captured at the spot level in cDNA microarray images. Variation at other levels, due to differences at the array, dye, and block levels, can be corrected for by a variety of existing normalization procedures. Two signal quality estimates that capture the reliability of each spot printed on a microarray are described. A parametric estimate of within-spot vari ance, referred to here as σ^2spot, assumes that pixels follow a normal distribution and are spatially correlated. A non-parametric estimate of error, called the mean square prediction error （MSPE）, assumes that spots of high quality possess pixels that are similar to their neighbors. This paper will provide a framework to use either spot quality measure in downstream analysis, specifically as weights in regression models. Using these spot quality estimates as weights can result in greater efficiency, in a statistical sense, when modeling mi- croarray data.

关键词： microarrays signal quality prediction measurement error models

Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome

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World Journal of Gastroenterology 2014年第39期20卷 14172-14184页

作者： Carly E Kelley Ann J Brown Anna Mae Diehl tracy l Setji Department of Medicine Division of Endocrinology Duke University Medical Center Durham NC 27710 United States Department of Medicine Division of Gastroenterology Duke University Medical Center Durham NC 27710 United States

Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance(IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease(NAFlD). NAFlD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis(NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFlD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFlD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFlD. In the interim, clinicians should be aware of this connection and consider screening for NAFlD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.

关键词： Polycystic ovary syndrome Fatty liver Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis

Value of routine stool testing for pathogenic bacteria in the evaluation of symptomatic patients with ileal pouches

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Gastroenterology Report 2018年第2期6卷 93-100,I0001页

作者： Amandeep Singh Jean Ashburn Gursimran Kochhar Rocio lopez tracy l.hul. Bo Shen Department of Gastroenterology&Hepatology Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Colorectal Surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Quantitative Health Sciences Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric *** of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal ***:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the *** with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 *** to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were ***:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool *** spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(plization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed ***:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of *** clinical utility of routine stool culture in those patients warrants further study.

关键词： pouchitis ileal pouch enteric pathogens stool culture

Research Findings Using Mindfulness-Based Interventions for Chronic Pain

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Pain Studies and Treatment 2015年第4期3卷 38-45页

作者： tracy l. Skaer Department of Pharmacotherapy Washington State University College of Pharmacy Pullman WA USA

Chronic pain is a complex condition that is very detrimental to physical and psychological wellbeing. It carries a significant level of disability and economic burden. Pain patients frequently experience comorbid mental illness (e.g. depression, anxiety, PTSD, insomnia) and often require psychotherapeutic interventions in addition to medication management. Mindfulness-based interventions (MBIs) have emerged as a means to treat several chronic conditions (e.g. chronic pain, depression, anxiety, substance abuse, stress, insomnia). The objective of this review is to evaluate the current research on the use of MBIs in chronic pain managment. Although there are several controlled trials on the use of MBIs in chronic pain management, only a few studies were found that demonstrated significant effects on pain intensity, quality of life, as well as physical and psychological functioning. Therefore, the current evidence is mixed and there are insufficient data to definitively confirm the full impact of the use of MBIs in chronic pain conditions such as fibromyalgia, chronic low back pain, rheumatoid arthritis, and chronic musculoskeletal pain. The lack of compelling evidence at this time signals a demand for higher quality investigations in this area. Research examining MBIs and concomitant CBT may be of great value in order to synergize and strengthen patient outcomes.

关键词： Chronic Pain Fibromyalgia Chronic low Back Pain Mindfulness-Based Stress Reduction Acceptance and Commitment Therapy Depression Anxiety Quality of life Psychiatric Comorbidities

Development of gemcitabine-resistant patient-derived xenograft models of pancreatic ductal adenocarcinoma

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Cancer Drug Resistance 2020年第3期3卷 572-585页

作者： Aubrey l.Miller Patrick l.Garcia tracy l.Gamblin Rebecca B.Vance Karina J.Yoon Department of Pharmacology and Toxicology University of Alabama at BirminghamBirminghamAL 35294 USA.

Aim:Gemcitabine is a frontline agent for locally-advanced and metastatic pancreatic ductal adenocarcinoma(PDAC),but neither gemcitabine alone nor in combination produces durable remissions of this tumor *** developed three PDAC patient-derived xenograft(PDX)models with gemcitabine resistance(gemR)acquired in vivo,with which to identify mechanisms of resistance relevant to drug exposure in vivo and to evaluate novel ***:Mice bearing independently-derived PDXs received 100 mg/kg gemcitabine once or twice *** initially responded,but regrew on treatment and were designated *** used immunohistochemistry to compare expression of proteins previously associated with gemcitabine resistance[ribonucleotide reductase subunit M1(RRM1),RRM2,human concentrative nucleoside transporter 1(hCNT1),human equilibrative nucleoside transporter 1(hENT1),cytidine deaminase(CDA),and deoxycytidine kinase(dCK)]in gemR and respective gemcitabine-naïve parental ***:Parental and gemR tumors did not differ in tumor cell morphology,amount of tumor-associated stroma,or expression of stem cell *** consistent pattern of expression of the six gemR marker proteins was observed among the *** in RRM1 and CDA were consistent with in vitro-derived gemR ***,rather than the expected decreases of hCNT1,hENT1,and dCK,gemR tumors expressed no change in or higher levels of these gemR marker proteins than parental ***:These models are the first PDAC PDX models with gemcitabine resistance acquired in *** data indicate that mechanisms identified in models with resistance acquired in vitro are unlikely to be the predominant mechanisms when resistance is acquired in *** work focuses on characterizing unidentified mechanisms of gemR and on identifying agents with anti-tumor efficacy in these gemR models。

关键词： Gemcitabine resistance patient-derived xenograft ribonucleotide reductase subunit M1 ribonucleotide reductase subunit M2 human concentrative nucleoside transporter 1 human equilibrative nucleoside transporter 1 cytidine deaminase deoxycytidine kinase

Contemporary surgical management of rectovaginal fistula in Crohn's disease

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World Journal of Gastrointestinal Pathophysiology 2014年第4期5卷 487-495页

作者： Michael A Valente tracy l.hul. Department of Colorectal Surgery Digestive Disease Institute Cleveland Clinic Cleveland OH 44195 United States

Rectovaginal fistula is a disastrous complication of Crohn's disease(CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.

关键词： Rectovaginal fistula Crohn’s disease Fistula Advancement flap Sleeve advancement Episioproctotomy

Environmental temperatures,physiology and behavior limit the range expansion of invasive Burmese pythons in southeastern USA

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Integrative Zoology 2012年第3期7卷 271-285页

作者： Elliott R.JACOBSON David G.BARKER tracy M.BARKER Richard MAUlDIN Michael l.AVERY Richard ENGEMAN Stephen SECOR College of Veterinary Medicine University of FloridaGainesvilleFlorida Vida Preciosa International(VPI) BoerneTexas US Department of Agriculture Wildlife ServicesNational Wildlife Research CenterFort CollinsColorado US Department of Agriculture Wildlife ServicesNational Wildlife Research CenterGainesvilleFlorida Department of Biological Sciences University of AlabamaTuscaloosaAlabamaUSA

A well-established population of Burmese pythons resides in the Everglades of southern *** in part by a report that identified much of southern USA as suitable habitat for expansion or establishment of the Burmese python,we examined the plausibility of this snake to survive winters at sites north of the *** integrated daily low and high temperatures recorded from October to February from 2005-2011 at Homestead,Orlando and Gainesville,Florida;and Aiken,South Carolina,with minimum temperatures projected for python digestion(16℃),activity(5℃)and survival(0℃).Mean low and high temperatures decreased northward from Homestead to Aiken and the number of days of freezing temperatures increased *** was impaired or inhibited for 2 months in the Everglades and up to at least 5 months in Aiken,and activity was increasingly limited northward during these *** of overwinter survivorship document that a single bout of low and freezing temperatures results in python *** capacity for Burmese pythons to successfully overwinter in more temperate regions of the USA is seemingly prohibited because they lack the behaviors to seek refuge from,and the physiology to tolerate,cold *** tropical Southeast Asia is the source of the Everglades Burmese pythons,we predict it is unlikely that they will be able to successfully expand to or colonize more temperate areas of Florida and adjoining states due to their lack of behavioral and physiological traits to seek refuge from cold temperatures.

关键词： ambient temperature Burmese python invasion snake thermal tolerance

Comparison of hepatitis C virus testing recommendations in high-income countries

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World Journal of Hepatology 2018年第10期10卷 743-751页

作者： Risha Irvin Kathleen Ward tracy Agee Noele P Nelson Claudia Vellozzi David l Thomas Alexander J Millman Division of Infectious Diseases Johns Hopkins University School of Medicine Division of Viral Hepatitis Centers for Disease Control and Prevention

AIM To investigate hepatitis C virus(HCV) testing recommendations from the United States and other high-income *** A comprehensive search for current HCV testing recommendations from the top quartile of United Nations Human Development Index(HDI) countries(very high HDI) was performed using Google and reviewed from May 1-October 30, 2014 and re-reviewed April 1-October 2, 2017. RESUlTS Of the 51 countries identified, 16 had HCV testing recom-mendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel(United States) incorporates recommendations for aone-time test for individuals born during 1945-1965(the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region. CONClUSION This review affirmed the similarities of the HCV Guidance Panel's guidance with those of recommendations from very high HDI countries.

关键词： Hepatitis C Testing Recommendations Mass screening Guidelines