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Initial Antibiotic Selection of Patients Presenting with Infection after Transrectal Prostate Biopsy Leading to a Quality Improvement Initiative

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Open Journal of Urology 2017年第8期7卷 131-137页

作者： Steven R. Madsen Elizabeth Rourke Stephen Overholser Michael A. Liss Department of Urology University of Texas Health Science Center San Antonio South Texas Veterans Affairs Healthcare San Antonio TX USA

Background: The incidence of infection associated with transrectal prostate biopsy has been increasing largely due to fluoroquinolone resistance (FQR). Purpose: To identify the antibiotic prescribing patterns employed when men seek medical professionals due to infectious complications of prostate biopsy, and employ a quality improvement initiative to improve antibiotic selection. Methods: A retrospective review determined the percentage of patients who presented to the emergency department (ED) after TRUS biopsy, and whether they were given appropriate antibiotic therapy. Prospective quality improvement was initiated by obtaining cultures via rectal swab at the time of transrectal biopsy in order to allow culture results and fluoroquinolone sensitivities to be available in the electronic medical record. The provider to guide antibiotic selection if the patient returned with infection symptoms could utilize the data. Findings: From 10/2009 to 6/2014, 0.5% (9/1724) of patients who underwent TRUS prostate biopsy returned to the ED with infection. Seven patients had complete data and 4 (0.57%) were given appropriate initial antibiotic treatment. To improve antibiotic selection, the 119 men who underwent rectal swab culture prior to biopsy 19.3% (23/119) showed FQR on rectal culture. 4% (5/119) were hospitalized with infection, demonstrating a significant increase in infection incidence from retrospective chart review (0.5% to 4%, p = 0.0013). Of these 5 men, 60% (3/5) had FQR on rectal culture. Conclusions: Rectal culture at the time of biopsy may lead to faster recognition of resistant bacteria when presented with prostate biopsy infection.

关键词： Prostate Biopsy Infection Antibiotic Resistance Fluoroquinolone

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Autoimmune gastritis:Pathologist's viewpoint

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World Journal of Gastroenterology 2015年第42期21卷 12179-12189页

作者： Irene Coati Matteo Fassan Fabio Farinati David Y Graham Robert M Genta Massimo Rugge Department of Medicine (DIMED) Surgical Pathology Unit University of Padua Department of Surgery Oncology and Gastroenterology Gastroenterology Unit University of Padua Department of Medicine Veterans Administration Hospital Baylor College of Medicine Houston Miraca Life Sciences Research Institute Departments of Pathology and Medicine VA North Texas Health Care System and University of Texas Southwestern Medical Center Dallas

Western countries are seeing a constant decline in the incidence of Helicobacter pylori-associated gastritis, coupled with a rising epidemiological and clinical impact of autoimmune gastritis. This latter gastropathy is due to autoimmune aggression targeting parietal cells through a complex interaction of auto-antibodies against the parietal cell proton pump and intrinsic factor, and sensitized T cells. Given the specific target of this aggression, autoimmune gastritis is typically restricted to the gastric corpus-fundus mucosa. In advanced cases, the oxyntic epithelia are replaced by atrophic(and metaplastic) mucosa, creating the phenotypic background in which both gastric neuroendocrine tumors and(intestinal-type) adenocarcinomas may develop. Despite improvements in our understanding of the phenotypic changes or cascades occurring in this autoimmune setting, no reliable biomarkers are available for identifying patients at higher risk of developing a gastric neoplasm. The standardization of autoimmune gastritis histology reports and classifications in diagnostic practice is a prerequisite for implementing definitive secondary prevention strategies based on multidisciplinary diagnostic approaches integratingendoscopy, serology, histology and molecular profiling.

关键词： Autoimmune gastritis Metaplasia Carcinoids Operati

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No significant difference in clinically relevant findings between Pillcam~? SB3 and Pillcam~? SB2 capsules in a United States veteran population

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World Journal of Gastrointestinal Endoscopy 2019年第2期11卷 124-132页

作者： Tyler D Aasen David Wilhoite Aynur Rahman Kalpit Devani Mark Young James Swenson Gastroenterology Section East Tennessee State University Quillen College of Medicine Gastroenterology Section Mountain Home Veterans Affairs Healthcare System

BACKGROUND Capsule endoscopy(CE) allows for a non-invasive small bowel evaluation for a wide range of gastrointestinal(GI) symptoms and diseases. Capsule technology has been rapidly advancing over recent years, often improving image frequency and quality. The Pillcam~? SB3(SB3) capsule is one such technology that offers an adaptive frame rate advantage over the previous versions of the capsule the Pillcam~? SB2(SB2). Some have proposed that this improvement in capsule technology may lead to increased diagnostic yields; however, real world clinical data is currently *** To evaluate the clinically relevant findings of SB3 and SB2 capsules in a population of United States *** A retrospective analysis of 260 consecutive CE studies was performed including130 SB3 and 130 SB2 capsule studies. Recorded variables included: age, gender,type of capsule, body mass index, exam completion, inpatient status, opioid use,diabetes, quality of preparation, gastric transit time, small bowel transit time,indication, finding, and if the exam resulted in a change in clinical *** primary outcome measured was the detection of clinically relevant findings between SB3 and SB2 *** Mean age of the study population was 67.1 ± 10.4 years and 94.2% of patients were male. Of these 28.1% were on opioid users. The most common indications for capsule procedure were occult GI bleeding(74.6%) and overt GI bleeding(14.6%). Rates of incomplete exam were similar between SB3 and SB2 groups(16.9% vs 9.2%, P = 0.066). The overall rate of clinically relevant finding was48.9% in our study. No significant difference was observed in SB3 vs SB2 capsules for clinically relevant findings(46.2% vs 51.5%, P = 0.385) or change in clinical management(40.8% vs 50.0%, P = 0.135).CONCLUSION Our study found no significant difference in clinically relevant findings between SB3 and SB2 capsules.

关键词： Capsule Endoscopy veterans Retrospective studies Capsules Gastrointestinal diseases SB3 SB2

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Esophageal food impaction during cultural holidays and national athletic events

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Gastroenterology Report 2017年第1期5卷 43-46,I0002页

作者： Asim Shuja Diana M.Winston Asad Ur Rahman Roger D.Mitty Bertrand L.Jaber Thormika Keo Department of Medicine St.Elizabeth’s Medical CenterBostonMAUSA Division of Gastroenterology St.Elizabeth’s Medical CenterBostonMAUSA Division of Gastroenterology University of Florida HealthJacksonvilleFLUSA Division of Gastroenterology and Hepatology Tufts Medical CenterBostonMAUSA Division of Gastroenterology Central Texas VA Healthcare SystemTempleTXUSA

Background:Although intrinsic risk factors contributing to esophageal food impaction are well established,whether social behavior affects its occurrence has not yet been ***:We conducted a retrospective review of the gastroenterology endoscopy procedural documentation software for the period of 2001–2012 to identify all patients who presented to our emergency department for esophageal foreign-body removal at the time of national athletic events and holidays associated with dietary ***:We found that adults undergoing emergent esophagogastroduodenoscopy during periods celebrating cultural holidays and national athletic events were more likely to experience esophageal food impaction compared with those undergoing emergent endoscopy during periods not associated with these events(36.8% vs 3.6%;P<0.001):a 10-fold *** a national holiday/athletic event period,the most common impacted food item was turkey(50%)followed by chicken(29%)and beef(21%).Conclusions:Esophageal food impaction is more likely to occur on American holidays and national athletic events and is associated with large *** with intrinsic risk factors should be advised to modify their diet during cultural events associated with tachyphagia and large meals to prevent esophageal food impaction.

关键词： esophagus foreign body food impaction holiday athletic event

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模拟教学理论框架在心力衰竭高仿真模拟课程中的应用效果研究

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International Journal of Nursing Sciences 2023年第4期10卷 549-554,I0004页

作者： Tricia Nwokocha Nancy Cowan Pinio Yan Cao Holly Wei Satish Mahajan Nursing Scholarship and University School of Nursing Affiliations for veterans Affairs Palo Alto healthcare system Palo AltoCAUSA Chabot College CAUSA East Tennessee State University College of Nursing Johnson CityTNUSA Patient Care Service for veterans Affairs Palo Alto healthcare system CAUSA

目的探讨基于美国国家护理联盟(National League for Nursing)杰弗里斯(NLN Jeffries)仿真框架的心力衰竭护理高保真仿真教育对职前护理教育的影响。方法在美国萨克拉门托卡林顿学院进行心力衰竭高仿真模拟教学试点项目。23名学生参加... 详细信息

目的探讨基于美国国家护理联盟(National League for Nursing)杰弗里斯(NLN Jeffries)仿真框架的心力衰竭护理高保真仿真教育对职前护理教育的影响。方法在美国萨克拉门托卡林顿学院进行心力衰竭高仿真模拟教学试点项目。23名学生参加了这项研究。本研究采用类实验设计,在教学前后测量学生的自我效能感、满意度和心力衰竭临床知识。结果结果显示,在高仿真模拟教学实施后,学生的自我效能感平均得分(45.39±7.88比38.91±8.35)、满意度(18.70±3.38比15.57±3.38)及心力衰竭临床知识得分(64.09±10.86比54.48±11.19)均明显提高(P<0.001)。该模拟教学设计中包含护士质量安全教育内容、以患者为中心的护理以及急性心力衰竭患者照护的团队合作,对教学效果产生了积极影响。结论基于NLN Jeffries理论框架的心力衰竭高仿真模拟教学提高了学生的知识、满意度、自我效能感及以患者为中心的护理、安全和团队合作意识。护理教育工作者在进行模拟教学计划时应考虑包含5个特性,即目标、解决问题、为学生提供支持、保真度和总结报告,同时结合安全、以患者为中心和团队合作教育,以保障教学效果。

关键词：高仿真模拟教学护理教育护理专业学生满意度自我效能

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Alginate hydrogel cross-linked by Ca^(2+)to promote spinal cord neural stem/progenitor cell differentiation and functional recovery after a spinal cord injuryhh

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Regenerative Biomaterials 2022年第1期9卷 710-723页

作者： Jun Zhou Yaqi Wu Zhijian Tang Kaipeng Zou Juan Chen Zuowei Lei Xueyan Wan Yanchao Liu Huaqiu Zhang Yu Wang Armin Blesch Ting Lei Shengwen Liu Department of Neurosurgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Anus-intestines Chongqing University Affiliated Jiangjin Hospital(Jiangjin Central Hospital)Chongqing 402260China Department of Orthopedics Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Neurosciences University of California San DiegoLa JollaCA 92093-0626USA veterans Affairs San Diego healthcare system La JollaCA 92093-0626USA

Alginate capillary hydrogels seeded with differentiated cells can fill the lesion cavity and promote axonal regeneration after grafting into the injured spinal *** stem/progenitor cells(NSPCs)can potentially repair the spinal cord;however,effects of alginate hydrogels(AHs)on NSPCs remain *** this study,we fabricated AHs cross-linked by Ca^(2+)and seeded hydrogels with rat embryonic day 14 *** and electron microscopy show that NSPCs survive,proliferate and differentiate into neurons in vitro within the *** transplantation into an acute T8 complete spinal cord transection site in adult rats,approximately one-third(38.3%)of grafted cells survive and differentiate into neurons(40.7%),astrocytes(26.6%)and oligodendrocytes(28.4%)at 8weeks *** promote the growth of host axons within the capillaries in a time-dependent *** axons make synapse-like contacts with NSPC-derived neurons within the hydrogel channels,and graft-derived axons extend into the host white and gray matter making putative *** is paralleled by improved electrophysiological conductivity across the lesion and partial hindlimb locomotor recovery.

关键词： regeneration biomaterial neural stem/progenitor cells neural repair spinal cord injury

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Analytical Image Fusion in the Detection of Intrahepatic Hepatocellular Cancer

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Open Journal of Medical Imaging 2017年第2期7卷 56-61页

作者： Hongyun Zhu Michael L. Goris Department of veterans Affairs Greater Los Angeles Healthcare System Los Angeles CA USA 1455 Ormsby Drive Sunnyvale CA USA

Purpose: Since HCC lesions are generally characterized by lower Hounsfield unit value (HU) values and higher tracer uptake (SUV or Standardized Uptake Values), we intended to determine if normalizing the SUV by the HU, for the lesion and normal liver would improve sensitivity and specificity. Material and Methods: Twenty-three consecutive patients with HCC diagnosed clinically or pathologically underwent C11-Acetate (C11-A) and F18-FDG (FDG) PET/CT imaging before surgery during a 424-day interval. After exclusion of treated or calcified lesions, 44 lesions are included in this study. The original metrics are the maximum SUV (SUVmax) and maximum or average HU (HUmax or HUmean) for lesions and normal liver. For the normal liver, an average SUV (SUVmean) was included. The derived values are the ratios of SUV/HU values. The efficacy is the fraction of outcomes of non-overlapping metrics between lesion and normal liver. Results: For FDG the efficacy is 0.489 for the lesions SUVmax versus normal liver SUVmax. For lesion SUVmax/HUmean versus normal liver SUVmax/HUmax, the efficacy is 1.00. For C11-A the corresponding values are 0.045 and 0.920. Conclusion: Normalizing SUV values for changes in HU values increases the contrast between normal liver and lesions. Analytical fusion can be very effective.

关键词： HCC (Hepatocellular Cancer)

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Distinguishing normal brain aging from the development of Alzheimer＇s disease：inflammation,insulin signaling and cognition

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Neural Regeneration Research 2018年第10期13卷 1719-1730页

作者： Paul Denver Paula L.McClean Greater Los Angeles veterans Affairs healthcare system West Los Angeles Medical Center and Department of NeurologyUniversity of CaliforniaLos AngelesCAUSA Centre for Molecular Biosciences University of UlsterColeraine Northern Ireland UK Northern Ireland Centre for Stratified Medicine ClinicalTranslational and Research Innovation Centre (C-TRIC)University of UlsterDerry/Londonderry Northern Ireland UK

As populations age, prevalence of Alzheimer＇s disease（AD） is rising. Over 100 years of research has provided valuable insights into the pathophysiology of the disease, for which age is the principal risk factor. However, in recent years, a multitude of clinical trial failures has led to pharmaceutical corporations becoming more and more unwilling to support drug development in AD. It is possible that dependence on the amyloid cascade hypothesis as a guide for preclinical research and drug discovery is part of the problem. Accumulating evidence suggests that amyloid plaques and tau tangles are evident in non-demented individuals and that reducing or clearing these lesions does not always result in clinical improvement. Normal aging is associated with pathologies and cognitive decline that are similar to those observed in AD, making differentiation of AD-related cognitive decline and neuropathology challenging. In this mini-review, we discuss the difficulties with discerning normal, age-related cognitive decline with that related to AD. We also discuss some neuropathological features of AD and aging, including amyloid and tau pathology, synapse loss, inflammation and insulin signaling in the brain, with a view to highlighting cognitive or neuropathological markers that distinguish AD from normal aging. It is hoped that this review will help to bolster future preclinical research and support the development of clinical tools and therapeutics for AD.

关键词： Alzheimer's disease aging inflammation cognitive function spatial learning insulin signaling synapses cytokines

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Emerging roles of circular RNAs in retinal diseases

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Neural Regeneration Research 2022年第9期17卷 1875-1880页

作者： Aneliya Hanineva Karen Sophia Park Joshua J.Wang Margaret M.DeAngelis Michael H.Farkas Sarah X.Zhang Department of Ophthalmology and Ross Eye Institute Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloState University of New YorkBuffaloNYUSA Research Service Veterans Administration Western New York Healthcare SystemBuffaloNYUSA Department of Biochemistry Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloState University of New YorkBuffaloNYUSA

Retinal disorders are a group of ocular diseases whose onset is associated with a number of aberrant molecular and cellular processes or physical damages that affect retinal structure and function resulting in neural and vascular degeneration in the *** research has primarily focused on delaying retinal disease with minimal success in preventing or reversing neuronal *** this review,we explore a relatively new field of research involving circular RNAs,whose potential roles as biomarkers and mediators of retinal disease pathogenesis have only just *** knowledge of circular RNAs function is limited given its novelty,current evidence has highlighted their roles as modulators of microRNAs,regulators of gene transcription,and biomarkers of disease development and ***,we summarize how circular RNAs may be implicated in the pathogenesis of common retinal diseases including diabetic retinopathy,glaucoma,proliferative vitreoretinopathy,and age-related macular ***,we explore the potential of circular RNAs as novel biomarkers and therapeutic targets for the diagnosis and treatment of retinal diseases.

关键词： age-related macular degeneration circular RNA diabetic retinopathy glaucoma microRNA proliferative vitreoretinopathy retina

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Brain-derived neurotrophic factor and inflammation in depression:Pathogenic partners in crime?

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World Journal of Psychiatry 2022年第1期12卷 77-97页

作者： Grace A Porter Jason C O’Connor Department of Pharmacology UT Health San AntonioSan AntonioTX 78229United States Department of Pharmacology University of Texas Health San AntonioSan AntonioTX 78229United States Audie L.Murphy VA Hospital South Texas Veterans Health SystemSan AntonioTX 78229United States

Major depressive disorder is a debilitating disorder affecting millions of people each ***-derived neurotrophic factor(BDNF)and inflammation are two prominent biologic risk factors in the pathogenesis of depression that have received considerable *** clinical and animal studies have highlighted associations between low levels of BDNF or high levels of inflammatory markers and the development of behavioral symptoms of ***,less is known about potential interaction between BDNF and inflammation,particularly within the central nervous *** evidence suggests that there is bidirectional regulation between these factors with important implications for the development of depressive symptoms and antidepressant *** levels of inflammatory mediators have been shown to reduce expression of BDNF,and BDNF may play an important negative regulatory role on inflammation within the *** this interaction more fully within the context of neuropsychiatric disease is important for both developing a fuller understanding of biological pathogenesis of depression and for identifying novel therapeutic *** we review these two prominent risk factors for depression with a particular focus on pathogenic implications of their interaction.

关键词： Brain-derived neurotrophic factor Microglia Neuroinflammation Growth factors Depression

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