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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

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Primary sclerosing cholangitis and cholangiocarcinoma:the 2023 practice guidance and future perspectives

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Hepatobiliary Surgery and Nutrition 2024年第1期13卷 172-175页

作者： Francesca Saffioti Vasileios K.Mavroeidis Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxfordUK UCL Institute for Liver and Digestive Health University College LondonLondonUK Department of HPB Surgery University Hospitals Bristol&Weston NHS Foundation TrustBristol Royal InfirmaryBristolUK Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristolUK

The 2023 practice guidance on primary sclerosing cholangitis(PSC)and cholangiocarcinoma(CCA)of the American Association for the Study of Liver Diseases(AASLD)came as a needful update to the previous 2010 guidelines on PSC,with a first-time inclusion of dedicated guidance on the diagnosis and management of CCA(1,2).This data-supported approach developed by consensus of an expert panel,provides guidance statements based on analytical review of the relevant literature.

关键词： American Association for the Study of Liver Diseases(AASLD) guidelines primary sclerosing cholangitis(PSC) liver cancer biliary cancer

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Using clinical cases to guide healthcare

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World Journal of Clinical Cases 2024年第9期12卷 1555-1559页

作者： Michael Colwill Samantha Baillie Richard Pollok Andrew Poullis Department of Gastroenterology St George's University Hospital NHS Foundation TrustLondon SW170QTUnited Kingdom

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their *** well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support ***-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare *** series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming *** are also vital in generating and disseminating early signals and encouraging further *** these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

关键词： Evidence based medicine Hierarchy of evidence Case reports Case series

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Design and optimisation of soft robotic actuators for augmented lung-ventilation

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Biomimetic Intelligence & Robotics 2024年第3期4卷 66-73页

作者： Christopher Michael Hofmair Kunal Bhakhri Manish Chauhan School of Physics Engineering and TechnologyUniversity of YorkYork YO105DDUK Department of Thoracic Surgery University College London HospitalsNHS Foundation TrustLondonUK

Pulmonary rehabilitation through invasive ventilation involves the insertion of an endotracheal tube into the trachea of a sedated patient to control breathing via a ventilating *** ventilation offers benefits such as greater control over oxygen supply,higher efficiency in supporting patient respiration,and the ability to manage airway ***,this method also poses treatment challenges like ventilator-induced pneumonia,airway injury,long recovery times,and ventilator ***,we explore an alternative invasive ventilation technique using soft robotic actuators to mimic the biological function of the diaphragm for augmenting and assisting *** investigated two actuator geometries,each at two locations superior to the *** actuators were tested on a bespoke ex vivo testbed that accurately simulated key diaphragmatic characteristics throughout the respiratory *** this,we have been able to drive intrathoracic pressures greater than the 5 cmH_(2)O required for ventilation in a human ***,by optimising the placement and geometry of these soft robotic actuators we have been able to generate maximum intrathoracic pressures of(6.81±0.39)cmH_(2)O.

关键词： Lung rehabilitation Soft robotic actuation Diaphragm augmentation Invasive ventilation

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Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

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Stroke & Vascular Neurology 2024年第3期9卷 279-288,I0247页

作者： Adam Ingleton Marko Raseta Rui-En Chung Kevin Jun Hui Kow Jake Weddell Sanjeev Nayak Changez Jadun Zafar Hashim Noman Qayyum Phillip Ferdinand Indira Natarajan Christine Roffe Neurosciences University Hospitals of North Midlands NHS TrustStoke-on TrentUK Statistics and Mathematical Modelling Department of Molecular GeneticsErasmus Medical CenterRotterdamZuid-HollandThe Netherlands Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK School of Medicine Keele UniversityKeeleUK Interventional Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK Stroke Research Keele UniversityKeeleUK

Background Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy(MT).Most patients undergoing MT are also given *** agents are contraindicated within 24 hours of *** evaluated outcomes and complications of patients stented with and without intravenous aspirin during *** All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital,UK between 2010 and 2020,were *** were thrombolysed before MT,unless *** 500 mg intravenously was given intraoperatively at the discretion of the *** intracranial haemorrhage(sICH)and the National Institutes for Health Stroke Scale score(NIHSS)were recorded at 7 days,and mortality and functional recovery(modified Rankin Scale:mRS≤2)at 90 *** Out of 565 patients treated by MT 102 patients(median age 67 IQR 57–72 years,baseline median NIHSS 18 IQR 13–23,76(75%)thrombolysed)had a stent *** these 49(48%)were given aspirin and 53(52%)were *** treated with aspirin had greater NIHSS improvement(median 8 IQR 1–16 vs median 3 IQR-9–8 points,p=0.003),but there were no significant differences in sICH(2/49(4%)vs 9/53(17%)),mRS≤2(25/49(51%)vs 19/53(36%))and mortality(10/49(20%)vs 12/53(23%))with and without *** improvement(median 12 IQR 4–18 vs median 7 IQR-7–10,p=0.01)was greater,and mortality was lower(4/33(12%)vs 6/15(40%),p=0.05)when aspirin was combined with thrombolysis,than for aspirin alone,with no increase in *** Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes,even when combined with intravenous thrombolysis.

关键词： patients aspirin intravenous

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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

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Prostate cancer genotyping for risk stratification and precision treatment

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Current Urology 2024年第2期18卷 87-97页

作者： Ashish A.Kumar Department of Urology York&Scarborough Teaching Hospitals NHS Foundation TrustYorkUK

Prostate cancer(PC)is the most frequently diagnosed cancer and second leading cause of cancer-related deaths in *** is heterogeneous,as is evident from the wide spectrum of therapeutic *** patients with PC are initially responsive to androgen deprivation therapy;however,themajority of cases are either hormone-sensitive PC or castration-resistant *** therapeutic protocols follow the evolution of PC,a continuously progressive process involving a combination of widespread genomic *** genomic alterations are either hereditary germline mutations,such as mutations in BRCA2,or specific only to tumor cells(somatic).Tumor-specific genomic spectra include genomic structural rearrangements,canonical androgen response genes,andmany other specific genes such as TMPRSS2-ERG fusion,SPOP/FOXA1,TP53/RB1/PTEN,*** evidence indicates the involvement of signaling pathways including PI3K,WNT/β-catenin,SRC,and IL-6/STAT,which have been shown to promote epithelial-mesenchymal transition cancer stem cell–like features/stemness,and neuroendocrine differentiation in *** the last decade,our understanding of the genotype-phenotype relationships has been enhanced *** genetic background of PC related to canonical genetic alterations and signaling pathway activation genes has shed more insight into the molecular subtype and disease landscape,resulting in a more flexible role of individual therapies targeting diverse genotypes and phenotypes.

关键词： Prostate cancer Prostate cancer treatment Prostate cancer genomics Hereditary prostate cancer Androgen deprivation therapy Hormone sensitive prostate cancer Kinase signaling

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Navigating reflux disease after achalasia treatments:Balancing risks and benefits

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World Journal of Gastroenterology 2024年第21期30卷 2740-2743页

作者： Ewen A Griffiths Enoch Wong Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWWest MidlandsUnited Kingdom Department of Immunology and Immunotherapy University of BirminghamBirmingham B152TTWest MidlandsUnited Kingdom

The peroral endoscopic myotomy(POEM)procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally invasive endoscopic solution to their dysphagia caused by *** its success in alleviating dysphagia,concerns regarding postoperative gastroesophageal reflux disease have emerged as a pertinent issue which are not fully *** this study,Nabi et al have comprehensively reviewed the topic of the prediction,prevention and management of gastroesophageal reflux after *** is a purely endoscopic procedure which is usually performed without any anti-reflux *** patients may be better served by a laparoscopic Heller’s myotomy and fundoplication and it is important that gastroenterologists and surgeons provide comprehensive risks and benefits of each achalasia treatment option so that patients can decide what treatment is best for *** article by Nabi et al provides a comprehensive review of the current status of this issue to allow these discussions to occur.

关键词： Achalasia Gastro-esophageal reflux disease Laparoscopic heller’s myotomy Peroral endoscopic myotomy Fundoplication

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Development of an experimental method for well-controlled blast induced traumatic limb fracture in rats

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Defence Technology（防务技术） 2024年第4期34卷 168-176页

作者： Luyang Xu Xiancheng Yu Clement DFavier Ibidumo Igah Thuy-Tien Nguyen Warren Macdonald Anthony MJ.Bull Centre for Blast Injury Studies Imperial College LondonLondonUnited Kingdom Department of Bioengineering Imperial College LondonLondonUnited Kingdom Dyson School of Design Engineering Imperial College LondonLondonUnited Kingdom Department of Trauma and Orthopaedics Royal Free London National Health Service Foundation TrustLondonUnited Kingdom

Heterotopic ossification(HO)is a consequence of traumatic bone and tissue damage,which occurs in 65%of military casualties with blast-associated ***,the mechanisms behind blast-induced HO remain *** models are used to study blast-induced HO,but developing such models is challenging,particularly in how to use a pure blast wave(primary blast)to induce limb fracture that then requires an *** studies,including our recent study,have developed platforms to induce limb fractures in rats with blast loading or a mixture of blast and impact ***,these models are limited by the survivability of the animal and repeatability of the *** this study,we developed an improved platform,aiming to improve the animal's survivability and injury repeatability as well as focusing on primary blast *** platform exposed only one limb of the rat to a blast wave while providing proper protection to the rest of the rat's *** obtained very consistent fracture outcome in the tibia(location and pattern)in cadaveric rats with a large range of size and ***,the rats did not obviously move during the test,where movement is a potential cause of uncontrolled *** further conducted parametric studies by varying the features of the design of the *** factors,such as how the limb is fixed and how the cavity through which the limb is placed is sealed,significantly affect the resulting *** platform and test setups enable well-controlled limb fracture induced directly by pure blast wave,which is the fundamental step towards a complete in vivo animal model for blast-induced HO induced by primary blast alone,excluding secondary and tertiary blast *** addition,the platform design and the findings presented here,particularly regarding the proper protection of the animal,have implications for future studies investigating localized blast injuries,such as blast induced brain and lung injuries.

关键词： Blast injury Biomechanics Heterotopic ossification Limb fracture Blast wave Animal model

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Sex Sent Me to the ER: Case Series on Postcoital Laceration

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Case Reports in Clinical Medicine 2024年第8期13卷 269-274页

作者： Zubaida Abubakar-Aliyu Peter Thabet Eziaha Ogbuagu Department of Obstetrics and Gynaecology Homerton Healthcare NHS Foundation Trust London England

Background: Sexual intercourse may be associated with serious complications and morbidities which may not be commonly experienced in clinical practice. One such complication is severe vaginal bleeding. Aim: To report a case series of postcoital vaginal lacerations in three women of various age groups with no prior surgical history who complained of acute onset, severe vaginal pain and bleeding after consensual intercourse. Case presentation: This case series describes the clinical features and management of women who required an examination under anaesthesia and surgical repair of vaginal injuries following consensual intercourse. The Post-operative recovery period was uneventful. Conclusion: A postcoital laceration is a rare emergency that may be complicated by excessive blood loss, which is increased if there is a delay in seeking care and or diagnosis. Prompt treatment should be instituted in such cases to minimise complications.

关键词： Coitus Vaginal Laceration Haemorrhage

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