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Long-axis rotational volvulus in an ileal J-pouch anal anastomosis: A preventable rare complication

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Case Reports in Clinical Medicine 2014年第1期3卷 28-31页

作者： virgilio v. george Alyssa Fajardo Department of Surgery Indiana University School of Medicine Indianap-olis Indiana

Puropose: This study was designed to report a very rare long-term complication of ileal-Jpouch anal anastomosis: An 180 degree longaxial rotational volvulus causing J pouch obstruction. Methods: An Ovid and Medline search using the following keywords was performed: J pouch ileoanal anastomosis, J-pouch ileoanal anastomosis complications, J-pouch volvulus, J-pouch complications, restorative proctocolectomy complications, and restorative proctocolectomy volvulus. One J-pouch ileoanal anastomosis 180° volvulus report was found [1]. Result: We describe a long-axis 180° rotational volvulus complication of a J-pouch ileoanal anastomosis. The J pouch was performed three years prior after the laparoscopic total proctocolectomy for chronic ulcerative colitis. Pouch excision and new ileoanal J-pouch surgery were then performed along with pexy using alloderm mesh placement with excellent outcomes. Conclusion: Long-axis 180° rotational volvulus is a rare complication of a J-pouch ileoanal anastomosis. Pouch dysfunction after a long-axis rotational volvulus is an uncommon cause of acute abdomen. Lack of adhesions and pouch size are risk factors for the pouch torsion. Prompt diagnosis and treatment are essential for the pouch salvage. Simple abdominal x-ray, barium enema and CT scan represent important tools for diagnosis. Salvage surgery should be performed even if detorsion and decompression of the affected bowel are achieved. Surgery has excellent outcomes if performed after the prompt diagnosis. Pouch pexy should be done to prevent recurrent volvulus.

关键词： Ileal Pouch Ileal Anal Anastomosis Malrotation

Implementation of Clinical video Telemedicine (CvT) within a vA Medical Center Is Cost Effective and Well Received by veterans

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International Journal of Clinical Medicine 2014年第12期5卷 711-716页

作者： John Wennergren Imtiaz Munshi Alyssa D. Fajardo virgilio v. george Department of Surgery Indiana University School of Medicine Indianapolis USA Richard Roudebush vA Medical Center Indianapolis USA

Background: The veterans Administration (vA) has been using telehealth to enhance veteran access to high quality vA care for over a decade. Clinical video telehealth (CvT) is one such telehealth tool that allows veterans the opportunity to be evaluated by specialists at the Indianapolis vA while they actually remain in their community (in their local healthcare setting). Such tools are reported to improve satisfaction by avoiding the need to make the long, stressful, and often costly trips to the Medical Center. Our goal is to describe the results of CvT implementation at the Indianapolis vA. Methods: A retrospective review of the data from 2011-2014 related to the use of CvT at the Indianapolis vA was undertaken. The data collected during this time period included: the number of CvT visits per year by specialty, the number of miles in travel avoided per visit, and patient satisfaction survey data, which are obtained after each CvT visit. Results: A total of 14,708 veterans have enrolled in our CvT telehealth program since 2011. There were 23,267 visits in 2013. 486,170 miles related to travel were avoided (calculating the number of miles avoided in travel from home to a local satellite site as compared to having to travel from home to the Indianapolis vA). At the current Government reimbursement rate of $0.42/mile, this is expressed in a cost avoidance of $209,053. In total, since 2011, the telehealth CvT program has saved the Government $331,132, a total of 770,075 miles saved in travel for our veterans. In addition, the CvT program has been very well received by our veterans with an overall satisfaction score of 96%. Conclusion: Our results indicate that the implementation of CvT is cost effective and is well received by veterans. Telehealth modalities such as CvT are viable options that enhance veteran satisfaction by decreasing the time and the costs related to travel while continuing to offer high quality health care.

关键词： Clinical video Telemedicine

Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve

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Surgical Science 2013年第10期4卷 433-437页

作者： virgilio v. george Michael J. Guzman Joshua A. Waters Andrea L. Jester Don J. Selzer Bruce W. Robb Department of Surgery Indiana University School of Medicine Indianapolis USA

Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.

关键词： Single-Port Laparoscopy Learning Curve Colectomy

Current progress in the treatment of chronic hepatitis C

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World Journal of Gastroenterology 2012年第42期18卷 6060-6069页

作者： Alexandra Alexopoulou george v Papatheodoridis 2nd Department of Internal Medicine Athens University School of MedicineHippokration General Hospital of Athens115 27 AthensGreece

Over the last decade, the standard of care for the treat- ment of chronic hepatitis C has been the combination of pegylated-interferon-alfa （PEG-IFN） and ribavirin （RBv） which results in sustained virological response （SvR） rates of 75%-85% in patients with genotypes 2 or 3 but only of 40%-50% in patients with genotype 1. Cur- rently, there are rapid and continuous developments of numerous new agents against hepatitis C virus （HCv）, which are the focus of this review. Boceprevir and tela- previr, two first-generation NS3/4A HCv protease inhibi- tors, have been recently licensed in several countries around the world to be used in combination with PEG- IFN and RBv for the treatment of genotype 1 patients. Boceprevir or telaprevir based triple regimens, com- pared with the PEG-IFN/RBv combination, improve the SvR rates by 25%-31% in treatment-naTve genotype 1 patients, by 40%-64% in prior relapsers, by 33%-45% in prior partial responders and by 24%-28% in prior null responders. At the same time, the application of response-guided treatment algorithms according to the on-treatment virological response results in shortening of the total therapy duration to only 24 wk in 45%-55% of treatment-na＇ive patients. There are, however, several challenges with the use of the new triple combinations in genotype 1 patients, such as the need for immediate results of HCv RNA testing using sensitive quantitative assays, new and more frequent adverse events （anemia and dysgeusia for boceprevir; pruritus, rash and anemia for telaprevir）, new drug interactions and increasing dif- ficulties in compliance. Moreover, the SvR rates are still poor in very difficult to treat subgroups of genotype 1 patients, such as null responders with cirrhosis, while there is no benefit for patients who cannot tolerate PEG- IFN/RBv or who are infected with non-1 HCv genotype. Many newer anti-HCv agents of different classes and numerous combinations are currently under evaluation with encouraging results. Pre

关键词： Chronic hepatitis C Pegylated interferon Ribavirin Protease inhibitors, Nucleos(t)ide analogueinhibitors Non-nucleos(t)ide analogue inhibitors Hepa-titis C virus polymerase NS5A inhibitors Cyclophilininhibitors

Light concentration using hetero-junctions of anisotropic low permittivity metamaterials

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Light(Science & Applications) 2013年第1期2卷 18-26页

作者： Mohammad Memarian george v Eleftheriades The Edward S.Rogers Sr.Department of Electrical and Computer Engineering University of TorontoTorontoOnt.M5S 2E4Canada

Focusing incident power into an area of high concentration is of significant interest for various *** optics,this has been traditionally achieved with lenses where a higher curvature and lens permittivity typically result in shorter focal distances(low f/D).In this work,we present designs and techniques for collecting,refracting and guiding incident light into an area of high power concentration(a hot spot)at extremely short ***,a flat low-profile focusing mechanism is presented using a hetero-junction of anisotropic metamaterials(MTMs).The hetero-junction is formed from two cleaved finite slabs of low(near zero)permittivity anisotropic MTMs with rotated optical *** MTMs have near zero longitudinal permittivity while matched in the transverse *** MTMs are shown to provide a unique ability to bend the transverse magnetic or p-polarized light away from the normal and along the interface,contrary to conventional dielectrics,and with minimal reflections;hence allowing for a low profile *** in the optical regime are presented using periodic bilayers of metal and *** proposed hetero-junction focusing device concentrates the normally incident plane wave and/or beam into a corresponding focal region similar to a lens via multiple *** hetero-junction is capable of creating a hot spot very close to the device,much closer than dielectric lenses and it significantly outperforms the size requirements of thick high curvature lenses with low f/D *** proposed designs can find applications in various scenarios including solar and thermo photovoltaics,photodetectors,concentrated photovoltaics,non-imaging optics,micro-and nano-Fresnel lenses.

关键词： epsilon near zero focusing light concentration metamaterials non-imaging optics photovoltaics

Review of the pharmacological management of hepatitis B viral infection before and after liver transplantation

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World Journal of Gastroenterology 2013年第48期19卷 9189-9197页

作者： Evangelos Cholongitas george v Papatheodoridis Department of Internal Medicine Medical School of Aristotle University Hippokration General Hospital of Thessaloniki 54642 Thessaloniki Greece george v Papatheodoridis Department of GastroenterologyAthens University Medical School Laiko General Hospital of Athens 11527 Athens Greece

The progress in treatment against hepatitis B virus(HBv)with the development of effective and well tolerated nucleotide analogues(NAs)has improved the outcome of patients with HBv decompensated cirrhosis and has prevented post-transplant HBv *** review summarizes updated issues related to the management of patients with HBv infection before and after liver transplantation(LT).A literature search using the PubMed/Medline databases and consensus documents was ***-transplant therapy has been initially based on lamivudine,but entecavir and tenofovir represent the currently recommended first-line NAs for the treatment of patients with HBv decompensated *** LT,the combination of HBv immunoglobulin(HBIG)and NA is considered as the standard of care for prophylaxis against HBv *** combination of HBIG and lamivudine is related to higher rates of HBv recurrence,compared to the HBIG and entecavir or tenofovir *** HBIG-free prophylactic regimens,entecavir and tenofovir should be the first-line *** choice of treatment for HBv recurrence depends on prior prophylactic therapy,but entecavir and tenofovir seem to be the most attractive ***,liver grafts from hepatitis B core antibody(anti-HBc)positive donors can be safely used in hepatitis B surface antigen negative,preferentially anti-HBc/anti-hepatitis B surface antibody positive recipients.

关键词： Hepatitis B virus Liver transplantation Hepatitis B virus immunoglobulin Antivirals Lamivudine Adefovir Entecavir Tenofovir Telbivudine Resistance

Metasurfaces: physics and applications in wireless communications

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National Science Review 2023年第8期10卷 48-63页

作者： vasileios G. Ataloglou Sajjad Taravati george v. Eleftheriades The Edward S.Rogers Sr.Department of Electrical and Computer Engineering University of Toronto Clarendon Laboratory Department of Physics University of Oxford

The ever increasing number of wireless devices and systems has led to a crowded spectrum and increased the demand for versatile and multi-functional wireless apparatuses. Recently, metasurfaces have been explored as a prominent technological solution to the current paradigm of spectrum scarcity by opportunistically sharing the spectrum with various users. In general, metasurfaces are passive/dynamic,ultra-compact, multi-functional and programmable structures that are capable of both reciprocal and nonreciprocal signal-wave transmissions. The controllability and programmability of such metasurfaces are governed through DC bias and occasionally a radio-frequency modulation applied to the active components of the unit cells of the metasurface, e.g. diodes and transistors. This article overviews some of the recently proposed passive and dynamic metasurfaces and shows that metasurfaces can enhance the performance of wireless communication systems thanks to their unique physical features such as real-time signal coding,nonreciprocal-beam radiation, nonreciprocal beamsteering amplification and advanced pattern-coding multiple access communication.

关键词： metasurface beamsteering beamforming wireless communication time modulation wave engineering

Electric field distributions along helium plasma jets

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High voltage 2020年第6期5卷 650-653页

作者： george v.Naidis Natalia Yu Babaeva Joint Institute for High Temperatures RAS 125412 MoscowRussia

Results of simulations of streamers propagating along the atmospheric-pressure helium plasma jets ejected from a thin tube into ambient air are presented. The computational model includes the equations governing the helium-air mixture composition along and across the jet, as well as the equations, describing streamer propagation in the mixture, for the electric field and the charged species densities. Streamer velocity and spatial-temporal profiles of plasma parameters are obtained for various values of the helium flow rate. It is shown, in agreement with available experimental data, that the electric field values in the heads of streamers increase nearly linearly with the distance from the tube exit and that the slope of this dependence decreases with the growth of the helium flow rate.

关键词： field mixture ambient

Electrochemical manufacturing of nanocarbons from carbon dioxide in molten alkali metal carbonate salts： roles of alkali metal cations

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Advances in Manufacturing 2016年第1期4卷 23-32页

作者： Happiness v. Ijije george Z. Chen Department of Chemical and Environmental Engineering Faculty of Engineering University of NottinghamNottingham NG7 2RD UK Department of Chemical and Environmental Engineering and Centre for Sustainable Energy Technologies Faculty ofScience and Engineering University of Nottingham NingboChina Ningbo 315100 People's Republic of China

One simple and fast way to manufacture a useful product from CO2 is to capture the gas by, and then carry out electrolysis in molten alkali metal carbonates. Carbon electro-deposition in molten Li2CO3-Na2CO3- KaCO3 （molar ratio： 43.5：31.5：25.0） has been widely reported in literature. However, studies in each of the individual alkali metal carbonates either have received less attention or are simply lacking in literature. Electrochem- ical studies of these molten carbonates are important to understand their underlying processes and reactions during the electrolysis. In this work, cyclic voltammograms （Cvs） were recorded in each of the above-mentioned molten alkali carbonate salts using a 0.25 mm diameter Pt wire working electrode. In molten Na2CO3 and K2CO3, the main cathodic reaction was likely the formation of alkali metal, while that in Li2CO3 was carbon deposition. The results also suggest that other competing reactions such as CO and alkali metal carbide formation are possible as well in dif- ferent molten salts. On the Cvs, the anodic current peaks observed are mostly associated with the oxidation of cathodic products. Flake/ring/sheet-like structures and quasi-spherical particles were observed in the produced carbon. The morphology of the carbon contained both amorphous and graphitic structures, which varied with different electrolysis variables.

关键词： Carbon capture and utilisation Electro-deposition Cyclic voltammetry Nanocarbons Moltensalts Alkali metal carbonates