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Post-endoscopic retrograde cholangiopancreatography pancreatitis

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Gastroenterology Report 2015年第1期3卷 32-40页

作者： Adarsh m.Thaker Jeffrey D.mosko tyler m.berzin Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA

Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography(ERCP).It is reported to occur in 2–10%of unselected patient samples and up to 40%of high-risk *** purpose of this article is to review the evidence behind the known risk factors for post-ERCP pancreatitis,as well as the technical and medical approaches developed to prevent *** have been many advances in identifying the causes of this *** on this knowledge,a variety of preventive strategies have been developed and *** approach to prevention begins with careful patient selection and performing ERCP for specific indications,while considering alternative diagnostic modalities when *** should also be classified by high-risk factors such as young age,female sex,suspected sphincter of Oddi dysfunction,a history of post-ERCP pancreatitis,and normal serum bilirubin,all of which have been identified in numerous research *** pathways of injury that are believed to cause post-ERCP pancreatitis eventually lead to the common endpoint of inflammation,and these individual steps can be targeted for preventive therapies through procedural techniques and medical *** includes the use of a guide wire for cannulation,minimizing the number of cannulation attempts,avoiding contrast injections or trauma to the pancreatic duct,and placement of a temporary pancreatic duct stent in high-risk *** of rectal non-steroidal anti-inflammatory agents(NSAIDs)in high-risk patients is the proven pharmacological measure for prevention of post-ERCP *** evidence for or against numerous other attempted therapies is still unclear,and ongoing investigation is required.

关键词： endoscopic retrograde cholangiopancreatography pancreatitis prevention complications

Endometriosis mimicking colonic stromal tumor

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Gastroenterology Report 2016年第3期4卷 257-259,I0003页

作者： Vaibhav Wadhwa Eoin Slattery Sagar Garud Saurabh Sethi Helen Wang Vitaliy YPoylin tyler m.berzin Department of Internal medicine Fairview HospitalCleveland ClinicClevelandOHUSA Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Department of Pathology Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Department of Surgery Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA

Endometriosis is defined as the presence of endometrial glands and stroma at extra-uterine sites;it is a common disease affecting women of reproductive *** tissue can implant itself to various organs,including the gastrointestinal tract,and can cause significant gastrointestinal *** ectopic endometrial tissue implants are usually located in the pelvis but can be present almost anywhere in the *** seems to be the most frequent cause of chronic pelvic pain in women of reproductive age and may cause prolonged suffering and disability that negatively affect health-related quality of *** report a case in a generally healthy young female patient who presented for evaluation of diarrhea.

关键词： endometriosis gastrointestinal stromal tumor pathology

Central endoscopy reads in inflammatory bowel disease clinical trials:The role of the imaging core lab

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Gastroenterology Report 2014年第3期2卷 201-206页

作者： Harris Ahmad tyler m.berzin Hui Jing Yu Christopher S.Huang Daniel S.mishkin medical Affairs BioClinica Inc.NewtownPennsylvaniaUSA Division of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBoston MAUSA Section of Gastroenterology Boston Medical CenterBoston University School of MedicineBostonMAUSA Division of Gastroenterology Granite Medical GroupBoston Medical CenterBostonMAUSA

Clinical trials in inflammatory bowel disease(IBD)are evolving at a rapid pace by employing central reading for endoscopic mucosal assessment in a field that was,historically,largely based on assessments by local *** transition from local to central reading carries with it numerous technical,operational,and scientific challenges,many of which can be resolved by imaging core laboratories(ICLs),a concept that has a longer history in clinical trials in a number of diseases outside the realm of *** IBD trials,ICLs have the dual goals of providing objective,consistent assessments of endoscopic findings using central-reading paradigms whilst providing important expertise with regard to operational issues and regulatory *** review focuses on current approaches to using ICLs for central endoscopic reading in IBD trials.

关键词： inflammatory bowel disease clinical trials imaging core laboratorie

Clinical controversies in endoscopic ultrasound

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Gastroenterology Report 2013年第1期1卷 33-41页

作者： Arvind J.Trindade tyler m.berzin Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA.USA

The field of diagnostic and therapeutic endoscopic ultrasound(EUS)is growing *** EUS has enhanced our ability to diagnose and treat a wide variety of GI conditions,there are many controversial issues regarding the appropriate application of EUS *** this review we discuss five controversial topics in EUS:the utility of EUS in staging of esophageal and gastric cancer;selection of appropriate needle gauge for fine needle aspiration(FNA);use of the stylet in FNA;and the emerging role of contrast agents in endoscopic ultrasound.

关键词： Endoscopic ultrasound controversies gastric cancer esophageal cancer contrast enhanced fine needle aspiration

Ameta-analysis on efficacy and safety:single-balloon ***-balloon enteroscopy

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Gastroenterology Report 2015年第2期3卷 148-155页

作者： Vaibhav Wadhwa Saurabh Sethi Sumeet Tewani Sushil Kumar Garg Douglas K.Pleskow Ram Chuttani tyler m.berzin Nidhi Sethi mandeep S.Sawhney Department of Internal medicine Fairview HospitalCleveland ClinicClevelandOHUSA Division of Gastroenterology Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Division of Basic and Translational Research Department of SurgeryUniversity of MinnesotaMinneapolisMNUSA

Background and aim:Double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)are new techniques capable of providing deep *** of individual studies comparing these techniques have not been able to identify a superior *** aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small ***:Databases were searched,including Pubmed,Embase,and the Cochrane Central Register of Controlled *** main outcome measures were complete small-bowel visualization,diagnostic yield,therapeutic yield,and complication *** analysis was performed using Review manager(Revman version 5.2).meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant *** used the v2 and I2 test to assess heterogeneity between *** were expressed as risk ratios(RR)or mean differences with 95%confidence intervals(CI).Results:Four prospective,randomized,controlled trials with a total of 375 patients were *** was superior to SBE for visualization of the entire small bowel[pooled RR=0.37(95%CI:0.19–0.73;P=0.004)].DBE and SBE were similar in ability to provide diagnosis[pooled RR=0.95(95%CI:0.77–1.17;P=0.62)].There was no significant difference between DBE and SBE in therapeutic yield[pooled RR=0.78(95%CI:0.59–1.04;P=0.09)]and complication rate[pooled RR=1.08(95%CI:0.28–4.22);P=0.91].Conclusions:DBE was superior to SBE with regard to complete small bowel *** was similar to SBE with regard to diagnostic yield,ability to provide treatment and complication rate,but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low tomoderate,due to the small sample size.

关键词： small bowel enteroscopy single-balloon enteroscopy double-balloon enteroscopy meta-analysis outcomes

Lumen apposing metal stents for pancreatic fluid collections:Recognition and management of complications

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World Journal of Gastrointestinal Endoscopy 2017年第9期9卷 456-463页

作者： michael L DeSimone Akwi W Asombang tyler m.berzin Department of medicine Beth Israel Deaconess Medical CenterHarvard Medical Schoo Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical School

For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,whether,and how the collection should be *** PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary *** approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement),and the placement of percutaneous *** drainage techniques have emerged in the last several years as the preferred approach for most patients,when local expertise is ***-apposing metal stents(LAmS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections,and less commonly,for other indications,such as gallbladder *** considering LAmS placement must be aware of the complications most commonly associated with LAmS including bleeding,migration,buried stent,stent occlusion,and *** of the patient complexity associated with severe pancreatitis,management of pancreatic fluid collections can be a complex and multidisciplinary *** and safe use of LAmS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAmS techniques,including how to recognize and manage expected complications.

关键词： Pancreatic fluid collection Lumen apposing metal stent Endoscopic necrosectomy Cystgastrostomy

Artificial intelligence in gastrointestinal endoscopy:The future is almost here

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World Journal of Gastrointestinal Endoscopy 2018年第10期10卷 239-249页

作者： muthuraman Alagappan Jeremy R Glissen Brown Yuichi mori tyler m.berzin Center for Advanced Endoscopy Beth Israel Deaconess Medical Center Harvard Medical Digestive Disease Center Showa University Northern Yokohama Hospital

Artificial intelligence(AI) enables machines to provide unparalleled value in a myriad of industries and applications. In recent years, researchers have harnessed artificial intelligence to analyze large-volume, unstructured medical data and perform clinical tasks, such as the identification of diabetic retinopathy or the diagnosis of cutaneous malignancies. Applications of artificial intelligence techniques, specifically machine learning and more recently deep learning, are beginning to emerge in gastrointestinal endoscopy. The most promising of these efforts have been in computeraided detection and computer-aided diagnosis of colorectal polyps, with recent systems demonstrating high sensitivity and accuracy even when compared to expert human endoscopists. AI has also been utilized to identify gastrointestinal bleeding, to detect areas of inflammation, and even to diagnose certain gastrointestinal infections. Future work in the field should concentrate on creating seamless integration of AI systems with current endoscopy platforms and electronic medical records, developing training modules to teach clinicians how to use AI tools, and determining the best means for regulation and approval of new AI technology.

关键词： Artificial intelligence machine learning Gastrointestinal endoscopy Computer-assisted decision making Computer-aided detection Colonic polyps Colonoscopy Computer-aided diagnosis Colorectal adenocarcinoma

Application of lung microphysiological systems to COVID-19 modeling and drug discovery:a review

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Bio-Design and manufacturing 2021年第4期4卷 757-775页

作者： Argus m.Sun tyler Hoffman Bao Q.Luu Nureddin Ashammakhi Song Li Department of Bioengineering Samueli School of EngineeringUniversity of California-Los Angeles420 Westwood Plaza 5121 Engineering V University of CaliforniaLos AngelesCA 90095-1600USA UC San Diego Healthcare UCSDLa JollaCA 92037USA Pulmonary Diseases and Critical Care Scripps Green HospitalScripps HealthLa JollaCA 92037USA Department of Biomedical Engineering College of EngineeringMichigan State UniversityEast LansingMI 48824USA Department of medicine David Geffen School of MedicineUCLALos AngelesCA 90095USA

There is a pressing need for effective therapeutics for coronavirus disease 2019(COVID-19),the respiratory disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)*** process of drug development is a costly and meticulously paced process,where progress is often hindered by the failure of initially promising *** aid this chal-lenge,in vitro human microphysiological systems need to be refined and adapted for mechanistic studies and drug screening,thereby saving valuable time and resources during a pandemic *** SARS-CoV-2 virus attacks the lung,an organ where the unique three-dimensional(3D)structure of its functional units is critical for proper respiratory *** in vitro lung models essentially recapitulate the distinct tissue structure and the dynamic mechanical and biological interactions between different cell *** model systems include Transwell,organoid and organ-on-a-chip or microphysiological systems(mPSs).We review models that have direct relevance toward modeling the pathology of COVID-19,including the processes of inflammation,edema,coagulation,as well as lung immune *** also consider the practical issues that may influence the design and fabrication of *** role of lung mPS is addressed in the context of multi-organ models,and it is discussed how high-throughput screening and artificial intelligence can be integrated with lung mPS to accelerate drug development for COVID-19 and other infectious diseases.

关键词： Bioengineering microfluidics COVID-19 Organ-on-a-chip Lung microvascular networks Drug development

Decision making for managing Community Flood Risks:Perspectives of United States Floodplain managers

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International Journal of Disaster Risk Science 2021年第5期12卷 649-660页

作者： Jenna tyler Abdul-Akeem Sadiq Douglas S.Noonan Rebecca m.Entress School of Public Administration University of Central FloridaOrlandoFL 32801USA O'Neill School of Public and Environmental Affairs Indiana University–Purdue University IndianapolisIN 46202USA

To reduce flood losses,floodplain managers make decisions on how to effectively manage their community’s flood *** there is a growing body of research that examines how individuals and households make decisions to manage their flood risks,far less attention has been directed at understanding the decision-making processes for flood management at the community *** study aimed to narrow this research gap by examining floodplain managers’perceptions of the quality of their community’s flood management decision-making *** gathered from interviews with 200 floodplain managers in the United States indicate that most floodplain managers perceive their community’s flood management decision-making processes to be *** results also indicate that communities participating in the Federal Emergency management Agency’s Community Rating System,as well as communities with a higher level of concern for flooding and a lower poverty rate,are significantly more likely to report better flood management decision-making processes.

关键词： Community flood risk management Decision making Floodplain managers United States