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Evaluating the Efficacy of Cervical Tactile Ultrasound Technique as a Predictive Tool for Spontaneous Preterm Birth

Open Journal of Obstetrics and Gynecology 2024年第5期14卷 832-846页

作者： Vladimir Egorov Todd Rosen Jennifer Hill Meena Khandelwal Victors Kurtenoks Brendan Francy Noune Sarvazyan Advanced Tactile Imaging Inc. Ewing New Jersey USA Department of Obstetrics Gynecology and Reproductive Sciences Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA Department of Maternal-Fetal Medicine Cooper Medical School of Rowan University Camden New Jersey USA

Background: Premature cervical softening and shortening may be considered an early mechanical failure that predispose to preterm birth. Purpose: This study aims to explore the applicability of an innovative cervical tactile ultrasound approach for predicting spontaneous preterm birth (sPTB). Materials and Methods: Eligible participants were women with low-risk singleton pregnancies in their second trimester, enrolled in this prospective observational study. A Cervix Monitor (CM) device was designed with a vaginal probe comprising four tactile sensors and a single ultrasound transducer operating at 5 MHz. The probe enabled the application of controllable pressure to the external cervical surface, facilitating the acquisition of stress-strain data from both anterior and posterior cervical sectors. Gestational age at delivery was recorded and compared against cervical elasticity. Results: CM examination data were analyzed for 127 women at 240/7 - 286/7 gestational weeks. sPTB was observed in 6.3% of the cases. The preterm group exhibited a lower average cervical stress-to-strain ratio (elasticity) of 0.70 ± 0.26 kPa/mm compared to the term group’s 1.63 ± 0.65 kPa/mm with a p-value of 1.1 × 10−4. Diagnostic accuracy for predicting spontaneous preterm birth based solely on cervical elasticity data was found to be 95.0% (95% CI, 88.5 - 100.0). Conclusion: These findings suggest that measuring cervical elasticity with the designed tactile ultrasound probe has the potential to predict spontaneous preterm birth in a cost-effective manner.

关键词： Cervical Elasticity Spontaneous Preterm Birth Tactile Ultrasound Probe

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Handheld bedside ultrasound in the diagnosis of myocarditis

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World Journal of Emergency Medicine 2024年第1期15卷 73-74页

作者： Frank Wheeler Robin Lahr James Espinosa Alan Lucerna Henry Schuitema Department of Emergency Medicine Rowan University School of Osteopathic MedicineStratford 08084USA Emergency Medicine Residency Program Jeff erson HealthStratford 08084USA Department of Emergency Medicine and Associate Chief medical Offi cer Stratford 08084USA

Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.

关键词： diagnosis myocarditis Fever

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Sarcopenic obesity in patients awaiting liver transplant: Unique challenges for nutritional recommendations

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World Journal of Transplantation 2024年第2期14卷 40-47页

作者： Darya M Herscovici Katherine M cooper Alessandro Colletta Michelle Rightmyer Alexandra Shingina Lauren D Feld Department of Medicine UMass Chan Medical SchoolWorcesterMA 01655United States Division of Transplant Nutrition UMass Chan Medical SchoolWorcesterMA 01655United States Department of Medicine Vanderbilt University Medical CenterNashvilleTN 37215United States Division of Gastroenterology UMass Chan Medical SchoolWorcesterMA 01655United States

Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period.Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity.While these nutrition guidelines have been established in non-cirrhotic patients,established guidelines for liver transplant candidates with sarcopenic obesity are lacking.In this paper,we review existing literature on sarcopenic obesity in patients with chronic liver disease and address opportunities to improve nutritional counseling in patients awaiting liver transplantation.

关键词： Nutrition Sarcopenia Sarcopenic obesity Liver transplant Cirrhosis Chronic liver disease Body composition Myostatin

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BMPRⅡ^(+)neural precursor cells isolated and characterized from organotypic neurospheres:an in vitro model of human fetal spinal cord development

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Neural Regeneration Research 2024年第2期19卷 447-457页

作者： Michael W.Weible II Michael D.Lovelace Hamish D.Mundell Tsz Wai Rosita Pang Tailoi Chan-Ling Bosch Institute Discipline of Anatomy and Histology(F13)University of SydneySydneyNSWAustralia school of Environment and Science Griffith UniversityNathanQLDAustralia Discipline of Medicine Nepean Clinical SchoolFaculty of Medicine and HealthUniversity of SydneyKingswoodNSWAustralia New South Wales Brain Tissue Resource Centre School of Medical SciencesFaculty of Medicine and HealthUniversity of SydneyCharles Perkins Centre(D17)SydneyNSWAustralia

Roof plate secretion of bone morphogenetic proteins(BMPs)directs the cellular fate of sensory neurons during spinal cord development,including the formation of the ascending sensory columns,though their biology is not well understood.Type-ⅡBMP receptor(BMPRⅡ),the cognate receptor,is expressed by neural precursor cells during embryogenesis;however,an in vitro method of enriching BMPRⅡ^(+)human neural precursor cells(hNPCs)from the fetal spinal cord is absent.Immunofluorescence was undertaken on intact second-trimester human fetal spinal cord using antibodies to BMPRⅡand leukemia inhibitory factor(LIF).Regions of highest BMPRⅡ^(+)immunofluorescence localized to sensory columns.Parenchymal and meningeal-associated BMPRⅡ^(+)vascular cells were identified in both intact fetal spinal cord and cortex by co-positivity with vascular lineage markers,CD34/CD39.LIF immunostaining identified a population of somas concentrated in dorsal and ventral horn interneurons,mirroring the expression of LIF receptor/CD118.A combination of LIF supplementation and high-density culture maintained culture growth beyond 10 passages,while synergistically increasing the proportion of neurospheres with a stratified,cytoarchitecture.These neurospheres were characterized by BMPRⅡ^(+)/MAP2ab^(+/–)/βⅢ-tubulin^(+)/nestin^(–)/vimentin^(–)/GFAP^(–)/NeuN^(–)surface hNPCs surrounding a heterogeneous core ofβⅢ-tubulin^(+)/nestin^(+)/vimentin^(+)/GFAP^(+)/MAP2ab^(–)/NeuN^(–)multipotent precursors.Dissociated cultures from tripotential neurospheres contained neuronal(βⅢ-tubulin^(+)),astrocytic(GFAP+),and oligodendrocytic(O4+)lineage cells.Fluorescence-activated cell sorting-sorted BMPRⅡ^(+)hNPCs were MAP2ab^(+/–)/βⅢ-tubulin^(+)/GFAP^(–)/O4^(–)in culture.This is the first isolation of BMPRⅡ^(+)hNPCs identified and characterized in human fetal spinal cords.Our data show that LIF combines synergistically with high-density reaggregate cultures to support the organotypic reorganization of neurospheres,characterized by surface BMPRⅡ^(+)hNPCs.Our study has provid

关键词： BMPRⅡ bone morphogenetic protein histotypic human spinal cord development leukemia inhibitory factor neurosphere organotypic reaggregate sensory columns

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World Journal of Gastroenterology 2023年第14期29卷 2127-2133页

作者： Sujani Yadlapati Simone A.Jarrett Daniel Baik Adib Chaaya Department of Gastroenterology Cooper University HospitalCooper Medical School of Rowan UniversityCamdenNJ 08103United States Department of Internal Medicine Einstein Medical CenterSidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPA 19140United States

Since its emergence in 2019,it has become apparent that coronavirus 2019(COVID-19)infection can result in multi systemic involvement.In addition to pulmonary symptoms,hepatobiliary involvement has been widely reported.Extent of hepatic involvement ranges from minor elevation in liver function tests(LFTs)to significant hepatocellular or cholestatic injury.In majority of cases,resolution of hepatic injury or improvement in LFTs is noted as patients recover from COVID-19 infection.However,severe biliary tract injury progressing to liver failure has been reported in patients requiring prolonged intensive care unit stay or mechanical ventilation.Due to the timing of its presentation,this form of progressive cholestatic injury has been referred to as COVID-19 cholangiopathy or post-COVID-19 cholangiopathy,and can result in devastating consequences for patients.COVID-19 cholangiopathy is recognized by dramatic elevation in serum alkaline phosphatase and bilirubin and radiologic evidence of bile duct injury.Cholangiopathy in COVID-19 occurs weeks to months after the initial infection and during the recovery phase.Imaging findings and pathology often resemble bile duct injury associated with primary or secondary sclerosing cholangitis.Etiology of COVID-19 cholangiopathy is unclear.Several mechanisms have been proposed,including direct cholangiocyte injury,vascular compromise,and cytokine release syndromes.This review summarizes existing data on COVID-19 cholangiopathy,including reported cases in the literature,proposed pathophysiology,diagnostic testing,and long-term implications.

关键词： COVID-19 cholangiopathy Post COVID-19 cholangiopathy Cholestatic injury Liver transplant

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Customized scaffolds for large bone defects using 3D‑printed modular blocks from 2D‑medical images

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Bio-Design and Manufacturing 2024年第1期7卷 74-87页

作者： Anil AAcar Evangelos Daskalakis Paulo Bartolo Andrew Weightman Glen cooper Gordon Blunn Bahattin Koc Faculty of Engineering and Natural Sciences Sabanci UniversityIstanbul 34956Türkiye D Bioprinting Laboratory Sabanci University Nanotechnology Research and Application CenterIstanbul 34956Türkiye school of Mechanical Aerospace and Civil EngineeringManchester Institute of BiotechnologyUniversity of ManchesterManchester M139PLUK Singapore Centre for 3D Printing School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingapore 639798Singapore school of Pharmacy and Biomedical Sciences University of PortsmouthPortsmouth PO12UPUK

Additive manufacturing(AM)has revolutionized the design and manufacturing of patient-specific,three-dimensional(3D),complex porous structures known as scaffolds for tissue engineering applications.The use of advanced image acquisition techniques,image processing,and computer-aided design methods has enabled the precise design and additive manufacturing of anatomically correct and patient-specific implants and scaffolds.However,these sophisticated techniques can be timeconsuming,labor-intensive,and expensive.Moreover,the necessary imaging and manufacturing equipment may not be readily available when urgent treatment is needed for trauma patients.In this study,a novel design and AM methods are proposed for the development of modular and customizable scaffold blocks that can be adapted to fit the bone defect area of a patient.These modular scaffold blocks can be combined to quickly form any patient-specific scaffold directly from two-dimensional(2D)medical images when the surgeon lacks access to a 3D printer or cannot wait for lengthy 3D imaging,modeling,and 3D printing during surgery.The proposed method begins with developing a bone surface-modeling algorithm that reconstructs a model of the patient’s bone from 2D medical image measurements without the need for expensive 3D medical imaging or segmentation.This algorithm can generate both patient-specific and average bone models.Additionally,a biomimetic continuous path planning method is developed for the additive manufacturing of scaffolds,allowing porous scaffold blocks with the desired biomechanical properties to be manufactured directly from 2D data or images.The algorithms are implemented,and the designed scaffold blocks are 3D printed using an extrusion-based AM process.Guidelines and instructions are also provided to assist surgeons in assembling scaffold blocks for the self-repair of patient-specific large bone defects.

关键词： Additive manufacturing Modular scaffolds Large bone defect Customized scaffold design Patient-specific scaffolds

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Intensity-specific considerations for exercise for patients with inflammatory bowel disease

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Gastroenterology Report 2023年第1期11卷 32-48页

作者： Andrew J.Ordille Sangita Phadtare Department of Biomedical Sciences Cooper Medical School of Rowan UniversityCamdenNJUSA

The rising prevalence of inflammatory bowel disease(IBD)necessitates that patients be given increased access to costeffective interventions to manage the disease.Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of IBD,including disease activity,immune competency,inflammation,quality of life,fatigue,and psychological factors.It is well established that exercise performed at low-to-moderate intensity across different modalities manifests many of these diseased-related benefits while also ensuring patient safety.Much less is known about higher-intensity exercise.The aim of this review is to summarize findings on the relationship between strenuous exercise and IBD-related outcomes.In healthy adults,prolonged strenuous exercise may unfavorably alter a variety of gastrointestinal(GI)parameters including permeability,blood flow,motility,and neuro-endocrine changes.These intensity-and gut-specific changes are hypothesized to worsen IBD-related clinical presentations such as diarrhea,GI bleeding,and colonic inflammation.Despite this,there also exists the evidence that higher-intensity exercise may positively influence microbiome as well as alter the inflammatory and immunomodulatory changes seen with IBD.Our findings recognize that safety for IBD patients doing prolonged strenuous exercise is no more compromised than those doing lower-intensity work.Safety with prolonged,strenuous exercise may be achieved with adjustments including adequate hydration,nutrition,drug avoidance,and careful attention to patient history and symptomatology.Future work is needed to better understand this intensity-dependent relationship so that guidelines can be created for IBD patients wishing to participate in high-intensity exercise or sport.

关键词： IBD strenuous exercise exercise intensity Crohn’s disease ulcerative colitis

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Ayurvedic drug induced liver injury

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World Journal of Hepatology 2017年第31期9卷 1205-1209页

作者： Kunal K Dalal Thomas Holdbrook Steven R Peikin Department of Medicine Cooper Medical School of Rowan UniversityCooper University Hospital Department of Pathology Cooper Medical School of Rowan UniversityCooper University Hospital Division of Gastroenterology and Liver Disease Cooper Medical School of Rowan UniversityCooper University Hospital

Drug induced liver injury is responsible for 50% of acute liver failure in developed countries. Ayurvedic and homeopathic medicine have been linked to liver injury. This case describes the first documented case of Punarnava mandur and Kanchnar guggulu causing drug induced liver injury. Drug induced liver injury may be difficult to diagnosis, but use of multi-modalities tools including the ACG algorithms, causative assessment scales, histological findings, and imaging, is recommended. Advanced imaging, such as magnetic resonance cholangiopancreatography, may possibly have a greater role than previously reported in literature.

关键词： Ayurvedic Punarnava mandur Kanchnar guggulu Drug induced liver injury T2 heterogeneous hyperintensity Roussel Uclaf Causality Assessment Method

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The surviving sepsis campaign： 2013 and beyond

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Chinese medical Journal 2013年第10期126卷 1803-1805页

作者： R. Phillip Dellinger cooper medical school of rowan university Division of Critical Care Medicine Cooper University Hospital Camden N J USA

The 2012 revision of the Surviving Sepsis Campaign.＂ International Guideless for Management of SevereSepsis and Septic Shock was recently published （February 2013） in Critical Care Medicine and Intensive Care Medicine.1,2 The effort to create this document occurred over two years and likely represents the most comprehensive buy-in of any international medical guidelines to date with 30 sponsoring organizations. Included in this list of sponsoring organizations is the Chinese Society of Critical Care Medicine-China medical Association and the Chinese Society of Critical Care Medicine. The evidence based medicine （EBM） grading system continues to evolve under the leadership of the Grades of Recommendation Assessment Development and Evaluation Group （GRADE Group）, based in Canadal Each recommendation is graded based on quality of evidence and strength of recommendation.

关键词： severe sepsis septic shock guideline

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Effects of radiation and chemotherapy on adipose stem cells: Implications for use in fat grafting in cancer patients

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World Journal of Stem Cells 2021年第8期13卷 1084-1093页

作者： Rebecca Platoff Miguel A Villalobos Ashleigh Rapp Hagaman Yuan Liu Martha Matthews Michael E DiSanto Jeffrey P Carpenter Ping Zhang Department of Surgery Cooper University Health CareCamdenNJ 08103United States Department of Surgery Cooper Medical School of Rowan UniversityCamdenNJ 08103United States Department of Biomedical Sciences Cooper Medical School of Rowan UniversityCamdenNJ 08103United States

Autologous fat transplantation is a versatile tool in reconstructive surgery.Adipose-derived stem cells(ASCs)increase survival of fat grafts and thus are increasingly used for breast reconstruction in breast cancer patients.However,radiation and/or chemotherapy have been proposed to inhibit soft tissue regeneration in wound healing thus suggesting alteration in stem cell pathways.Therefore,elucidating effects of radiation and chemotherapy on ASCs is critical if one desires to enhance the survival of fat grafts in patients.This review outlines our work evaluating the function and recoverability of ASCs from radiation or chemotherapy patients,focusing specifically on their availability as a source of autologous stem cells for fat grafting and breast reconstruction in cancer patients.Even though evidence suggests radiation and chemotherapy negatively influence ASCs at the cellular level,the efficiency of the isolation and differentiation capacity did not appear influenced in patients after receiving chemotherapy treatment,although fat from radiated patients exhibited significantly altered ASC differentiation into endothelial-like cells.Further,the in vitro growth rates of patient’s ASCs do not differ significantly before or after treatment.Taken together,these studies suggest ASCs as an important new tool for grafting and reconstruction even when radiation and chemotherapy treatment are involved.

关键词： Fat grafting Breast reconstruction Stem cells Breast cancer Radiation Chemotherapy

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