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Echocardiography in centenarians： characteristics, utility and follow-up

Journal of Geriatric Cardiology 2018年第5期15卷 328-333页

作者： Jorge A Brenes-Salazar Jaime de la Fuente Punnaiah Marella Hari Chaliki Christopher Scott Heidi M Connolly Roger L Click Department of Cardiovascular diseases Mayo Clinic Rochester USA Department of internal Medicine Mayo Clinic Rochester USA Department of Cardiovascular diseases Mayo Clinic Arizona USA Division of Biostatistics Mayo Clinic Rochester USA

Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic ass

关键词： Centenarian Echocardiography Geriatric

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Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes

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Hepatobiliary & Pancreatic diseases International 2016年第4期15卷 434-438页

作者： Padmavathi Mali Department of internal Medicine Marshfield Clinic

BACKGROUND：Acute pancreatitis in pregnancy is a rare and dangerous *** study aimed to examine the etiology,treatment,and outcomes of pancreatitis in ***：A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed ***：The pregnant patients were diagnosed with pancreatitis during a period of 21 ***（60%）of the patients were diagnosed with pancreatitis in the third *** mean age of the patients at presentation was 25.7 years,with a mean gestational age of 24.4 *** pain occurred in most patients and vomiting in one patient was associated hyperemesis *** common cause of the disease was gallstone-related（56%）,followed by alcohol-related（16%）,post-ERCP（4%）,hereditary（4%）and undetermined conditions（20%）.The level of triglycerides was minimally high in three *** and wire-guided sphincterotomy were performed in 6（43%）of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no ***（84%）of the patients underwent a full-term,vaginal *** was no difference in either maternal or fetal outcomes after ***：Acute pancreatitis is rare in pregnancy,occurring most commonly in the third trimester,and gallstones are the most common *** laparoscopic cholecystectomy is not feasible and a common bile duct stone is highly suspected on imaging,endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.

关键词： pancreatitis alcoholic pancreatitis pregnancy complications diagnostic imaging

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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

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Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

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Journal of Geriatric Cardiology 2005年第4期2卷 216-217页

作者： Thomas G.Allison Division of Cardiovascular diseases and internal Medicine Mayo clinic RochesterMNUSA

The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.

关键词： BNP Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

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Outcomes in children with Clostridium difficile infection:results from a nationwide survey

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Gastroenterology Report 2016年第4期4卷 293-298,I0002页

作者： Arjun Gupta Darrell S Pardi Larry M Baddour Sahil Khanna Divisions of Infectious diseases Mayo ClinicRochesterMNUSA Divisions of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Department of internal Medicine University of Texas Southwestern Medical CenterDallasTXUSA

Objective:Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection(CDI)in adults and children;although pediatric CDI outcomes are incompletely *** analysed United States National Hospital Discharge Survey(NHDS)data to study CDI in hospitalized ***:NHDS data for 2005–2009(demographics,diagnoses and discharge status)were obtained;cases and comorbidities were identified using ICD-9 *** univariate and multivariate analyses were performed to ascertain incidence of CDI;associations between CDI and outcomes[length of stay(LOS),colectomy,all-cause in-hospital mortality and discharge to a care facility(DTCF)].Results:Of an estimated 13.8 million pediatric inpatients;46176 had CDI;median age was 3 years;overall incidence was 33.5/10000 *** annual frequency of CDI did not vary from 2005 to 2009(0.24–0.43%;P=0.64).On univariate analyses,children with CDI had a longer median LOS(6 vs 2 days),higher rates of colectomy[odds ratio(OR)2.0;95%confidence interval(CI)1.7–2.4],mortality(OR 2.5;95% CI 2.3–2.7),and DTCF(OR 1.6;95% CI 1.6–1.7)(all P<0.0001).After adjusting for age,sex and comorbidities,CDI was an independent and the strongest predictor of increased LOS(adjusted mean difference,6.4 days;95% CI 5.4–7.4),higher rates of colectomy(OR 2.1;95% CI 1.8–2.5),mortality(OR 2.3;95% CI 2.2–2.5),and DTCF(OR 1.7;95% CI 1.6–1.8)(all P<0.0001).On excluding infants from the analysis,children with CDI had higher rates of mortality,DTCF and longer LOS than children without ***:Despite increased awareness and advancements in management,CDI remains a significant problem and is associated with increased LOS,colectomy,in-hospital mortality and DTCF in hospitalized children.

关键词： Clostridium difficile infection children pediatric outcomes epidemiology

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Efficacy of anagliptin as compared to linagliptin on metabolic parameters over 2 years of drug consumption: A retrospective cohort study

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World Journal of Diabetes 2018年第10期9卷 165-171页

作者： Hidetaka Hamasaki Yasuteru Hamasaki Endocrinology and Metabolism Internal Medicine Hamasaki Clinic Diabetes Hamasaki Clinic

AIM To evaluate the comparative effectiveness of anagliptin and linagliptin on the clinical parameters in patients with type 2 diabetes mellitus(T2 DM). METHODS A 2-year retrospective cohort study was conducted in patients with T2 DM who received anagliptin and linagliptin. We enrolled 234 patients(anagliptin group, 117 patients; linagliptin group, 117 patients). RESULTS The glycemic control considerably improved 3, 6, 12, and 24 mo after the administration of both dipeptidyl peptidase-4(DPP-4) inhibitors. Following the administration of anagliptin, the diastolic blood pressure and serum total cholesterol levels decreased. However, serum high-density lipoprotein cholesterol levels increased and urinary albumin-creatinine ratio decreased following linagliptin administration. Furthermore, the liver function improved after the administration of *** These findings suggest that that the efficacy of DPP-4 inhibitors on the blood pressure, lipid profile, and liver function differs between anagliptin and linagliptin.

关键词： Type 2 diabetes mellitus Dipeptidyl peptidase-4 inhibitor Anagliptin Linagliptin Cholesterol

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Multi-organ IgG4-related disease continues to mislead clinicians: A case report and literature review

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World Journal of clinical Cases 2020年第15期8卷 3267-3279页

作者： Sandra Strainiene Lukas Sarlauskas Ilona Savlan Valentina Liakina Ieva Stundiene Jonas Valantinas clinic of Gastroenterology Nephrourology and SurgeryCentre of HepatologyGastroenterology and DieteticsInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania clinic of internal diseases Family Medicine and OncologyCentre of Internal DiseasesInstitute of Clinical MedicineVilnius UniversityVilnius 01513Lithuania Department of Chemistry and Bioengineering Faculty of Fundamental ScienceVilnius Gediminas Technical UniversityVilnius 10223Lithuania

BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multisystemic mass forming immune-mediated disease that affects almost every organ and is a diagnostic challenge for every *** is a lack of adequate epidemiological data worldwide,and evidence-based treatment recommendations are not yet *** report the first case of IgG4-RD from Lithuania and the Baltic Sea region presented with thyroiditis,orbital myositis,orbitopathy,uveitis,scleritis,sialadenitis,autoimmune pancreatitis and *** SUMMARY A 54-year-old Caucasian male was admitted to our tertiary Centre complaining of severe weight loss,diarrhoea,abdominal pain,salivary gland swelling,sicca symptoms and *** examination,bilateral palpable masses in the projection of major salivary glands,severe protrusion of the left eyeball and cachexia were *** patient was previously diagnosed with autoimmune thyroiditis and endocrine *** magnetic resonance imaging(MRI)of the head revealed enlarged extraocular muscles indicating orbital *** biopsy from the salivary gland mass indicated *** MRI showed signs of autoimmune pancreatitis,and a serological test revealed the elevated serum IgG4 *** patient was then diagnosed with IgG4-RD and successfully treated with *** was a significant clinical,serological and radiological improvement after one month of treatment and no signs of relapse within twenty ***,it took almost 18 years and the efforts of eight different medical specialists to establish the correct *** A comprehensive approach to the patient is essential to improving the recognition of rare immune system conditions,such as IgG4-RD.

关键词： IgG4-related disease Autoimmune pancreatitis Sialadenitis Orbitopathy Autoimmune thyroiditis Case report Literature review

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Vitamin D in esophageal cancer: Is there a role for chemoprevention?

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World Journal of Gastrointestinal Oncology 2018年第1期10卷 23-30页

作者： Carol Rouphael Afrin Kamal Madhusudhan R Sanaka Prashanthi N Thota Department of internal Medicine Cleveland Clinic Department of Gastroenterology and Hepatology Cleveland Clinic

Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B(UVB) radiation. Genetic variations of the vitamin D receptor(VDR) gene and VDR expression in esophageal specimens have also been investigated. Ecological studies evaluating exposure to UVB radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results. In this review article, we present a detailed summary of the current data on the effects of vitamin D on various histological subtypes of esophageal cancer and their precursor lesions. Well-powered prospective studies with accurate measurement of vitamin D status are needed before chemoprevention with vitamin D is recommended, as current evidence does not support a chemopreventive role of vitamin D against esophageal cancer. Future studies looking at the incidence of esophageal cancer in patients with pre-cancerous lesions(Barrett's esophagus and squamous cell dysplasia) receiving vitamin D supplementation are needed.

关键词： vitamin D vitamin D receptor esophageal adenocarcinoma esophageal squamous cell carcinoma genetic polymorphism

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Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas

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World Journal of Gastroenterology 2023年第48期29卷 6179-6197页

作者： Takuya Watanabe Department of internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata 9502002Japan

Follicular lymphoma(FL)is the most common indolent B-cell lymphoma(BCL)***,its incidence has increased in Europe,the United States,and Asia,with the number of gastrointestinal FL cases expected to *** abnormalities related to t(14;18)translocation,BCL2 overexpression,NF-κB pathway-related factors,histone acetylases,and histone methyltransferases cause FL and enhance its ***,microRNAs are commonly used in diagnosing FL and predicting patient *** clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted,resulting in a marked improvement in therapeutic outcomes for *** developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options,FL treatment has become more complex,requiring combinatorial therapeutic ***,optimal treatment combinations have not yet been achieved,highlighting the importance of a complete understanding regarding the pathogenesis of gastrointestinal ***,this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic ***,the results of clinical trials are summarized,with a particular focus on treating nodal and gastrointestinal FLs.

关键词： Gastrointestinal follicular lymphoma Genetic mutation analysis using nextgeneration sequencing MicroRNA Gene targeted therapy Immune therapy

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Cryotherapy in the management of premalignant and malignant conditions of the esophagus

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World Journal of Gastroenterology 2018年第43期24卷 4862-4869页

作者： Pooja Lal Prashanthi N Thota Department of internal Medicine Cleveland Clinic Department of Gastroenterology Digestive Disease Surgery InstituteCleveland Clinic

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen(liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett's esophagus(BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.

关键词： Esophageal cancer Barrett's esophagus Palliative therapy Cryotherapy

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