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Medical therapy vs early revascularization in diabetics with chronic total occlusions:A meta-analysis and syst.matic review

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World Journal of Cardiology 2020年第11期12卷 559-570页

作者： Muhammad Shayan Khan Farhad Sami Hemindermeet Singh Waqas Ullah Ma'en Al-Dabbas Khalid Hamid Changal Tanveer Mir Zain Ali Ameer Kabour Internal Medicine Mercy Saint Vincent Medical CentreToledoOH 43608United States Internal Medicine University of Kansas School of MedicineKansas CityKansas66202United States Department of Cardiovascular Fellowship Mercy St Vincent Medical Center and HospitalToledoOH 43608United States Internal Medicine Abington Jefferson HealthAbingtonAbington TownshipMontgomery CountyPA 19001United States Department of Cardiovascular Medicine University of ToledoToledoOH 43606United States Internal Medicine Detroit Medical CenterDetroitMI 48201United States Internal Medicine Abington Jefferson HealthPhiladelphiaPA 19001United States

BACKGROUND Management of chronic total occlusions(CTO)in diabetics is challenging,with a recent trend towards early revascularization[ER:Percutaneous coronary intervention(PCI)and bypass grafting]inst.ad of optimal medical therapy(OMT).We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to *** To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with *** Potentially relevant published clinical trials were identified in Medline,Embase,chemical abst.acts and Biosis(from st.rt of the databases till date)and pooled hazard ratios(HR)computed using a random effects model,with significant P valuest.was all-cause *** outcomes included cardiac death,prompt revascularization(ER)or repeat myocardial infarction(MI).Due to scarcity of data,both Randomized control trials and observational st.dies were included.4 eligible articles,containing 2248 patients were identified(1252 in OMT and 1196 in ER).Mean follow-up was 45-60 *** OMT was associated with a higher all-cause mortality[HR:1.70,95%confidence interval(CI):0.80-3.26,P=0.11]and cardiac mortality(HR:1.68,95%CI:0.96-2.96,P=0.07).Results were close to *** risk of repeat MI was almost.the same in both groups(HR:0.97,95%CI:0.61-1.54,P=0.90).Similarly,patients assigned to OMT had a higher risk of repeat revascularization(HR:1.62,95%CI:1.36-1.94,Pst.ated higher all-cause(HR:1.98,95%CI:1.36-2.87,P=0.0003)and cardiac mortality(HR:1.87,95%CI:0.96-3.62,P=0.06)in the OMT *** risk of repeat MI was low in the OMT group vs PCI(HR:0.53,95%CI:0.31-0.91,P=0.02).Data on repeat revascularization revealed no difference between the two(HR:1.00,95%CI:0.52-1.93,P=1.00).CONCLUSION In diabetic patients with CTO,there was a trend for improved outcomes with ER regarding all-cause and cardiac death as

关键词： Coronary angiography Diabetes mellitus Percutaneous coronary Intervention Coronary bypass grafts Chronic total occlusions Mortality

Thalidomide effect in endothelial cell of acute radiation proctitis

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World Journal of Gast.oenterology 2008年第30期14卷 4779-4783页

作者： Ki-Tae Kim Hiun-Suk Chae Jin-Soo Kim Hyung-Keun Kim Young-Seok Cho Whang Choi Kyu-Yong Choi Sang-Young Rho Suk-Jin Kang Department of Radiology College of Medicine The Catholic University of Korea Uijeongbu St. Mary’s Hospital Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary's Hospital Department of Internal Medicine College of Medicine The Catholic University of Korea Our Lady of Mercy Hospital Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary’s Hospital Department of Pathology College of Medicine The Catholic University of Korea St. Vincent Hospital

AIM: To determine whether thalidomide prevents microvascular injury in acute radiation proctitis in white rats. METHODS: Fourteen female Wist.r rats were used: six in the radiation group, six in the thalidomide group, and two in normal controls. The radiation and thalidomide groups were irradiated at the pelvic area using a single 30 Gy exposure. The thalidomide (150 mg/kg) was injected into the peritoneum for 7 d from the day of irradiation. All animals were sacrificed and the rectums were removed on day 8 after irradiation. The microvessels of resected specimens were immunohist.chemically st.ined with thrombomodulin (TM), von Willebrand Factor (vWF), and vascular endothelial growth factor (VEGF). RESULTS: The microscopic scores did not differ significantly between the radiation and thalidomide groups, but both were higher than in the control group. Expression of TM was significantly lower inthe endothelial cells (EC) of the radiation group than in the control and thalidomide groups (P < 0.001). The number of capillaries expressing vWF in the EC was higher in the radiation group (15.3 ± 6.8) than in the control group (3.7 ± 1.7), and the number of capillaries expressing vWF was attenuated by thalidomide (10.8 ± 3.5, P < 0.001). The intensity of VEGF expression in capillaries was greater in the radiation group than in the control group and was also attenuated by thalidomide (P = 0.003). CONCLUSION: The mechanisms of acute radiation- induced proctitis in the rats are related to endothelial cell injury of microvessel, which may be attenuated with thalidomide.

关键词： Radiation proctitis Von Willebrand factor Thrombomodulin Vascular endothelial growth factor Thalidomide

Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review

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World Journal of Gast.oenterology 2019年第24期25卷 3079-3090页

作者： Amanda D Deacy Craig A Friesen vincent S st.ggs Jennifer V Schurman Division of Gast.oenterology Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States Division of Developmental and Behavioral Sciences Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States Biost.tist.cs and Epidemiology Health Services and Outcomes ResearchChildren’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States

BACKGROUND Pediatric functional gast.ointest.nal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom ***,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIDs remains *** current st.dy hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonst.ate clinical resolution of symptoms during the st.dy period and that specific psychosocial variables would be significantly predictive of GI symptom *** To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characterist.cs that predicted clinical *** Participants were 392 children,ages 8-18[M=13.8;st.ndard deviation(SD)=2.7],seen between August.1,2013 and June 15,2016 in an interdisciplinary APC housed within the Division of Gast.oenterology in a medium-sized Midwest.rn children's *** be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial *** and psychosocial data collected as part of st.ndard of care were retrospectively reviewed and analyzed in the context of the observational *** regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower *** Nearly 70%of patients followed during the st.dy period achieved resolution on at least.one of the employed outcome *** those who achieved resolution during follow up,43%to 49%did so by the first.follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of *** specifically,the odds of clinical resolution w

关键词： Pediatric functional gast.ointest.nal disorders Integrated care Behavioral health consultation Treatment outcomes Abdominal pain clinic

Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic st.te

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World Journal of Clinical Cases 2022年第32期10卷 11702-11711页

作者： Esraa Mamdouh Hassan Hisham Mushtaq Esraa Elaraby Mahmoud Sherley Chhibber Shoaib Saleem Ahmed Issa Jain Nitesh Abbas B Jama Anwar Khedr Sydney Boike Mikael Mir Noura Attallah Salim Surani Syed A Khan Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States Medicine St.Vincent's Medical CenterBridgeportCT 06606United States Medicine College of MedicineUniversity of SharjahSharjah 27272United Arab Emirates Medicine Mercy Catholic Medical CenterDarbyPA 19025United States Medicine Mayo HospitalLahore 54000PunjabPakistan Medicine Medical University of the AmericasNevisWest Indies Medicine BronxCare Health SystemBronxNY 10457United States Medicine University of Minnesota Medical SchoolMinneapolisMN 55455United States Medicine&Pharmacology Texas A&M University Health Science CenterCollege StationTX 77843United States Anest.esiolgy Mayo ClinicRochesterMN 55905United States

Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia st.te(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and *** major advances,reaching a uniform consensus regarding the diagnost.c criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional *** has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom ***,there is a lack of large-scale st.dies that help define how hyperglycemic crises should be *** article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.

关键词： Diabetic ketoacidosis Hyperosmolar Coma Diabetes Metabolic acidosis Hypernatremia Hyperosmolar hyperglycemia st.te

Burden of atrial fibrillation in patients with rheumatic diseases

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World Journal of Clinical Cases 2021年第14期9卷 3252-3264页

作者： Muhammad Zubair Khan Kirtenkumar Patel Krunalkumar A Patel Rajkumar Doshi Vraj Shah Devina Adalja Zainulabedin Waqar Sona Franklin Neelesh Gupta Muhammad Hamdan Gul Shruti Jesani st.ven Kutalek vincent Figueredo Department of Internal Medicine St.Mary Medical CenterLanghornePA 19047United States Division of Cardiology North Shore University HospitalManhassetNY 11030United States Department of Internal Medicine University of Nevada Reno School of MedicineRenoNV 89502United States Division of Cardiology Medical College of BarodaBaroda 390001India Department of Internal Medicine GMERS Gotri Medical CollegeVadodara 390021India Department of Internal Medicine Mercy St.Vincent Medical CenterToledoOH 43608United States Department of Internal Medicine Nazareth HospitalPhiladelphiaPA 19115United States Department of Internal Medicine Saint Joseph HospitalChicagoIL 60657United States Department of Internal Medicine Trinitas Regional Medical CenterElizabethNJ 07202United States Department of Cardiology St.Mary Medical CenterLanghornePA 19047United States

BACKGROUND st.dies have suggest.d that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to *** morbidity and mortality associated with AF in hospitalized patients with *** The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different *** The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest.in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjust.ng for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast.enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of *** mortality,length of st.y,and hospitalization cost. were higher in patients with RD having AF vs without *** the RD subgroup,the highest.mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest.association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other *** was two-fold higher in patients with RD with AF.

关键词： Atrial fibrillation Rheumatic diseases Lupus Gout Scleroderma Vasculitis

Safety of endovascular therapy for symptomatic intracranial artery st.nosis:a national prospective regist.y

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st.oke & Vascular Neurology 2022年第2期7卷 166-171页

作者： Yabing Wang Tao Wang Adam Andrew Dmytriw Kun Yang Liqun Jiao Huaizhang Shi Jie Lu Tianxiao Li Yujie Huang Zhenwei Zhao Wei Wu Jieqing Wan Qinjian Sun Bo Hong Yongli Li Liyong Zhang Jianfeng Chu Qiong Cheng Yiling Cai Pengfei Wang Qi Luo Hua Yang Baijing Dong Yang Zhang Jun Zhao Zuoquan Chen Wei Li Xiaoxin Bai Weiwen He Xueli Cai Maimai Ti Osama O Zaidat Department of Neurosurgery Xuanwu HospitalBeijingChina Neuroendovascular Program Massachusetts General HospitalBostonMassachusettsUSA Department of Evidence-Based Medicine Xuanwu HospitalBeijingChina Department of Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Radiology Xuanwu HospitalBeijingChina Center of Neurointerventional Therapy Henan Provincial People's HospitalZhengzhouChina Department of Neurology Nanjing Drum Tower HospitalNanjingJiangsuChina Department of Neurosurgery Tangdu Hospital Fourth Military Medical UniversityXi'anShaanxiChina Department of Neurology Shandong University Qilu HospitalJinanShandongChina Department of Neurosurgery Shanghai Jiao Tong University School of Medicine Affiliated Renji HospitalShanghaiShanghaiChina Department of Neurology Shandong Provincial HospitalJinanShandongChina Neusurgery Changhai HospitalShanghaiChina Department of Neurosurgery Second Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Liaocheng People's HospitalLiaocheng CityShandongChina Department of Neurosurgery Jining First People's HospitalJiningShandongChina Department of Neurology Fujian Provincial HospitalFuzhouFujianChina Department of Neurology 306 Hospital of People's Liberation ArmyBeijingChina Department of Neurosurgery Tianjin Huanhu HospitalTianjinTianjinChina Department of Neurosurgery Jilin University First HospitalChangchunJilinChina Department of Neurology Affiliated Hospital of Guiyang Medical CollegeGuiyangGuizhouChina Department of Neurosurgery Fourth Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Peking University First HospitalBeijingBeijingChina Department of Neurology Liaocheng Second People's HospitalLiaochengChina Department of Neurology Shanghai Tenth People's HospitalShanghaiChina Department of Neurosurgery Tianjin Medical University General HospitalTianjinTianjin

Introduction The safety outcomes of endovascular therapy for intracranial artery st.nosis in a real-world st.tting are largely *** Clinical Regist.ation Trial of Intracranial st.nting for Patients with Symptomatic Intracranial Artery st.nosis(CRTICAS)was a prospective,multicentre,real-world regist.y designed to assess these outcomes and the impact of centre *** 1140 severe,symptomatic intracranial arterial st.nosis(ICAS)patients treated with endovascular therapy were included from 26 centres,further divided into three groups according to the annual centre volume of intracranial angioplast. and st.nt placement procedures over 2 years:(1)high volume for≥25 cases/year;(2)moderate volume for 10–25 cases/year and(3)low volume forst.oke,transient ischaemic attack or death was 9.7%(111),with 5.4%,21.1%and 9.7%in high-volume,moderate-volume and low-volume centres,respectively(pst.c regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres(OR=0.187,95%CI:0.056 to 0.627;p≤0.0001),while moderate-volume and low-volume centres showed no significant difference(p=0.8456).Conclusion Compared with the preceding randomised controlled trials,this real-world,prospective,multicentre regist.y shows a lower complication rate of endovascular treatment for symptomatic ***-uniform utilisation in endovascular technology,inst.tutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

关键词： intracranial prospective st.nosis