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Multiple sclerosis is at a checkpoint: advancing the program

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Neural Regeneration Research 2025年第3期20卷 811-812页

作者： Brandon C.Smith Jessica L.Williams Department of Neurosciences Lerner Research InstituteCleveland ClinicClevelandOHUSA Department of Biological Geologicaland Environmental SciencesCleveland State UniversityClevelandOHUSA

Multiple sclerosis(MS) is a chronic inflammatory and demyelinating disease of the central nervous system(CNS). Patients with MS experience sensory and motor function loss due to myelin and/or axon damage perpetuated b... 详细信息

关键词： Hauser sclerosis damage

Hospital readmission following transjugular intrahepatic portosystemic shunt:a 14-year single-center experience

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Gastroenterology Report 2020年第2期8卷 98-103,I0001页

作者： Catherine F.Vozzo Tavankit Singh Jennifer Bullen Shashank Sarvepalli Arthur McCullough Baljendra Kapoor Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA Department of Inflammation and Immunity Cleveland ClinicClevelandOHUSA Department of Radiology Cleveland ClinicClevelandOHUSA

Background:Placement of a transjugular intrahepatic portosystemic shunt(TIPS)is a relatively common procedure used to treat complications of portal ***,only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital *** therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of ***:We reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients.A series of univariable logistic-regression models were fit to assess potential predictors of 30-day ***:A total of 566 patients were included in the *** 30-day readmission rate after TIPS placement was 36%.The most common causes for readmission were confusion(48%),infection(15%),bleeding(11%),and fluid overload(7%).A higher Model for End-Stage Liver Disease(MELD)score corresponded with a higher rate of readmission(odds ratio associated with each 1-unit increase in MELD score:1.06;95%confidence interval:1.02–1.09;P=0.001).Other potential predictors,including indication for TIPS placement,were not significantly associated with a higher readmission ***:The 30-day readmission rate after TIPS placement with covered stents is high,with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS *** interventions to help reduce the TIPS readmission rate should be prioritized in future research.

关键词： transjugular intrahepatic portosystemic shunt portal hypertension liver cirrhosis hospital readmission

Long-term esophageal and respiratory outcomes in children with esophageal atresia and tracheoesophageal fistula

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Gastroenterology Report 2016年第4期4卷 310-314,I0002页

作者： Richard H.Cartabuke Rocio Lopez Prashanthi N.Thota Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Biostatistics Cleveland ClinicClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA

Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond *** aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF through evaluation of clinical symptoms,diagnostic testing and therapeutic intervention at a tertiary care ***:Patients with congenital EA/TEF evaluated from 2011 to 2014 were *** characteristics,type and mode of repair of EA/TEF,clinical symptoms,radiographic,endoscopic,bronchoscopic and medication use data were ***:A total of 43 patients were *** median age of this predominantly Caucasian population was 8 years(interquartile range:3,20).Twenty(62.5%)had type C(EA with distal TEF)***-one(48.8%)patients had heartburn,19(44.1%)had acid regurgitation,and 31(72.1%)had dysphagia to *** swallow in 26 patients revealed strictures in 17(65.4%),dysmotility in 20(76.9%)and recurrent fistulas in four patients(15.4%).Thirty patients underwent upper endoscopy,of which 21(70.0%)had a stricture,and six(20.0%)had recurrent fistula requiring surgical ***(18.6%)patients underwent *** evaluation showed cough and choking in 31(72.1%)patients and dyspnea and wheezing in 32(53.4%)*** respiratory infections were reported in 19(44.2%).*** findings included tracheomalacia in 86.7% and restrictive lung disease in 54.5%of ***:There is a high burden of residual esophageal and pulmonary pathology in patients with EA/*** follow-up is required to monitor both the clinical symptoms and treatment responses.

关键词： esophageal atresia tracheoesophageal fistula gastroesophageal reflux disease(GERD) esophageal dysmotility aspiration pneumonia

Antibiotic-coated medical devices: with an emphasis on inflatable penile prosthesis

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Asian Journal of Andrology 2004年第3期6卷 249-257页

作者： R.Abouassaly D.K.Montague K.W.Angermeier Glickman Urological Institute Cleveland Clinic FoundationClevelandOH 44195USAGlickman Urological InstituteCleveland Clinic FoundationClevelandOH 44195USAGlickman Urological InstituteCleveland Clinic FoundationClevelandOH 44195USA

One of the most serious complications associated with the use of the inflatable penile prosthesis is infection. This can lead to significant morbidity for the patient, as well as significant health care costs. A number of methods have been used in attempts at minimizing the infection risk, including applying an antibiotic coating to the medical devise. This review aims to evaluate the effectiveness of these products in preventing clinically significant infections.

关键词： penile prosthesis infection erectile dysfunction therapeutic strategy

Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 264-270页

作者： Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo Hepatobiliary and Transplant Surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA Imaging Institute Cleveland Clinic Cleveland OH USA

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.

关键词： mixed hepatocellular carcinoma/ cholangiocarcinoma liver transplantation survival outcomes

Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function

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World Journal of Gastroenterology 2016年第20期22卷 4918-4925页

作者： Madhusudhan R Sanaka Umar Hayat Prashanthi N Thota Ramprasad Jegadeesan Monica Ray Scott L Gabbard Neha Wadhwa Rocio Lopez Mark E Baker Sudish Murthy Siva Raja Department of Gastroenterology Q3 Cleveland Clinic Department of Radiology Cleveland Clinic Department of Cardiothoracic Surgery Cleveland Clinic

AIM: To assess and compare the esophageal function after peroral endoscopic myotomy(POEM) vs other conventional treatments in ***: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy(LHM) or pneumatic dilation(PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow(TBE) and high-resolution esophageal manometry(HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo posttreatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter(LES) pressures and LES-integrated relaxation pressures(IRP). Data are presented as mean ± SD, median [25th, 75 th percentiles] or frequency(percent). Analysis of variance, KruskalWallis test, Pearsons χ~2 test and Fishers Exact tests were used for ***: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older(55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM(29.1 ± 5.9 kg/m^2 vs 26 ± 5.1 kg/m^2, P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group(72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups(P = 0.01 to P < 0.001) except the column height at 1 min in PD group(P = 0.11). At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM(40.5 mm Hg vs 14.5 mm Hg and 24 mm Hg vs 7.1 mm Hg respectively, P < 0.001) and POEM groups(38.7 mm Hg vs 11.4 mm Hg and 23.6 mm Hg vs 6.6 mm Hg res

关键词： Achalasia Dysphagia Heller myotomy Peroral endoscopic myotomy Manometry Pneumatic dilation

Pregnancy in Patients with Shone Complex: A Single-Center Case Series

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Congenital Heart Disease 2022年第2期17卷 147-160页

作者： Rachel Gardner Emily Durbak Rachael Baird Katherine Singh Jeff Chapa David Majdalany Department of Cardiology Cleveland ClinicCleveland44195USA Department of Obstetrics Cleveland ClinicCleveland44195USA Department of Cardiology Mayo ClinicPhoenix85054USA

Background:There is limited literature written on the course and outcomes for pregnant mothers with Shone ***:We describe a case series of five pregnancies in four women with Shone complex within a multidisciplinary cardio-obstetrics clinic from 2016–***:Maternal age ranged from 21–39 *** patients had preserved left ventricular function while one had moderately decreased *** age at presentation ranged from 6–15 *** were three successful pregnancies(mean gestational age=37 weeks,range 35–39 weeks)with one patient accounting for two unsuccessful *** infants were delivered via Cesarean *** infant required a NICU stay,but all other infants delivered were ***:Patients with Shone complex can have successful pregnancies although complications can occur for both the mother and the *** prenatal care,coordinated and consistent management during pregnancy,and tertiary care support can promote positive maternal and fetal outcomes.

关键词： Shone complex pregnancy cardiac disease in pregnancy women’s cardiovascular health

Correlation of the Rutgeerts score and recurrence of Crohn’s disease in patients with end ileostomy

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Gastroenterology Report 2017年第4期5卷 271-276,I0001,I0002页

作者： Vasutakarn Chongthammakun Andre Fialho Andrea Fialho Rocio Lopez Bo Shen Department of Internal Medicine The Cleveland Clinic FoundationClevelandOHUSA Department of Quantitative Health Sciences The Cleveland Clinic FoundationClevelandOHUSA The Center for Inflammatory Bowel Diseases The Cleveland Clinic FoundationClevelandOHUSA

Background:Recurrence of Crohn’s disease(CD)can occur after surgery,including end ileostomy(EI).The Rutgeerts score(RS)was developed to predict postsurgical CD recurrence via ileocolonoscopy in patients having ileocolonic *** role of ileoscopic evaluation via stoma for assessing recurrence of CD has not been *** aim of this study was to evaluate the role of ileoscopy for predicting disease recurrence in CD patients after EI with the use of ***:A total of 73 eligible CD patients with at least two ileoscopies in our institution following EI were *** inflammation of the neo-terminal ileum was graded based on the *** primary outcomes were the need for endoscopic stricture dilation and subsequent surgery due to recurrence of *** secondary outcomes were CDrelated hospitalization and the need to escalate CD-associated ***:The median duration of CD until EI was 9 years(interquartile range:4-13 years),and themedian duration from EI to the first ileoscopy was 28months(interquartile range:11-93 months).The RSs in the neo-terminal ileum close to EI were calculated,and subjects were divided into two groups:the normal RS group with the score being zero(n=25)and the abnormal RS group with the RS score being(n=48).Patients in the abnormal RS group weremore likely to have recurrence of CD(92%vs 27%)and need endoscopic dilation of stricture(40%vs 10%),subsequent bowel surgery(68%vs 15%),disease-related hospitalizations(80%vs 23%)and escalation of CDmedications(64%vs 25%)than those in the normal RS ***-to-event analysis showed that patients in the abnormal RS group were at a higher risk of endoscopic dilation(odds ratio(OR)=1.5;95%CI:1.09–1.9),need of second bowel surgery(OR=1.5;95% CI:1.2–1.8)and disease-related hospitalizations(OR=1.3;95% CI:1.1–1.6)after adjusting for factors such as duration from surgery to sensor,duration of disease and the patient’s sex(all P<0.001).Further multivariable analysis showed

关键词： Crohn’s disease Rutgeerts score ileoscopy ileostomy recurrence

Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

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Gastroenterology Report 2016年第3期4卷 210-215,I0002页

作者： Zubin Arora Xianrui Wu Udayakumar Navaneethan Bo Shen Department of Internal Medicine The Cleveland Clinic FoundationClevelandOHUSA Department of Gastroenterology and Hepatology The Cleveland Clinic FoundationCleveland OHUSA

Objective:Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis(PMVT)and its impact on the outcomes of inflammatory bowel diseases(IBD).Methods:All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record(study group;n=20).Patients were matched for age,sex,and IBD phenotype with control IBD patients who had no PMVT,with a ratio of 1:3(control group;n=60).Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two ***:Of the 20 patients in the Study group,6(30%)had UC,14(70%)had CD and 11(55%)were *** multivariable analysis,inpatient status(odds ratio[OR]6.88;95%confidence interval[CI]1.88-25.12)and baseline corticosteroid use(OR 4.39;95%CI 1.27-15.19)were found to be independent risk factors for the development of *** one-year follow-up,PMVT patients were more likely to have an adverse outcome of IBD,including subsequent emergency room visit(26.3%vs.1.7%;P=0.003),hospitalization for medical management(60.0%vs.20.0%;P=0.001)or IBD-related surgery(65.0%vs.26.7%;P=0.003)than the non-PMVT *** multivariable analysis,PMVT(OR 5.19;95%CI 1.07-25.28)and inpatient status(OR 8.92;95%CI 1.33-59.84)were found to be independent risk factors for poor outcome,whereas baseline immunomodulator use(OR 0.07;95%CI 0.01-0.51)was found to be a protective ***:IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of *** presence of PMVT was associated with poor clinical outcomes in IBD.

关键词： inflammatory bowel diseases portal vein thrombosis outcomes risk factors