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Evaluation and management of acute pancreatitis

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World Journal of Clinical Cases 2019年第9期7卷 1006-1020页

作者： Ahmed T Chatila Mohammad Bilal Praveen Guturu Department of Internal Medicine The University of Texas Medical Branch Division of Gastroenterology and Hepatology The University of Texas Medical Branch Division of Gastroenterology and Hepatology the University of Texas Medical Branch

Acute pancreatitis(AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately390000 hospitalizations. The burden of AP is only expected to increase over *** recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria:(1) Abdominal pain consistent with that of AP;(2) Serum amylase and/or lipase greater than three times the upper limit of normal; and(3) Characteristics findings seen in crosssectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain *** retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.

关键词： Acute pancreatitis Necrotizing pancreatitis Resuscitation Gallstone pancreatitis

Operative complications and economic outcomes of cholecystectomy for acute cholecystitis

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World Journal of Gastroenterology 2019年第48期25卷 6916-6927页

作者： Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski School of Medicine University of Texas Medical BranchGalvestonTX 77555United States Department of surgery University of Texas Medical BranchGalvestonTX 77555United States Department of Biostatistics University of Texas Medical BranchGalvestonTX 77555United States

BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost *** adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this *** hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost *** To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute *** Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year *** were identified using the acute care surgery registry and billing *** was retrieved via EMR,operative logs,and Revenue Cycle *** severity of acute cholecystitis was graded according to the Tokyo ***18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,*** were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<*** Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed *** rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs *** with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=

关键词： Acute cholecystitis Tokyo guidelines Cholecystectomy Complications Delayed cholecystectomy

The impact of COVID-19 on clinical outcomes of burn patients

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Burns & Trauma 2023年第1期11卷 792-799页

作者： Elliot T.Walters Alen Palackic Camila Franco-Mesa Nikhil R.Shah Michael J.Erickson Steven E.Wolf Department of surgery University of Texas Medical Branch301 UniversityGalvestonTXUSA Division of Plastic Aesthetic and Reconstructive SurgeryDepartment of SurgeryMedical University of GrazGrazAustria

Background:Multiple studies have shown the SARS-CoV-2 virus(COVID-19)to be associated with deleterious outcomes in a wide range of *** impact of COVID-19 has not been well investigated among burned *** suspect that patients will have worsened respiratory and thrombotic complications,ultimately leading to increased *** objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn ***:This is a retrospective,propensity matched,cohort *** examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020,to 31 July 2021,and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease,tenth revision(ICD-10)*** participants included adults who were treated for a burn injury during the study ***:We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection(total 1472 patients,mean age 36.3±24.3).We found no significant increase in mortality observed for patients with concurrent COVID-19(OR 1.203,95%CI 0.517-2.803;p=0.6675).We did observe significant increase in infections(OR 3.537,95%CI 2.798-4.471;p=0.0001),thrombotic complications(OR 2.342,95%CI 1.351-4.058;p=0.0018),as was the incidence of hypertrophic scarring(OR 3.368,95%CI 2.326-4.877;p=0.0001).Conclusions:We observed that concurrent COVID-19 infection was associated with an increase in infections,thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

关键词： COVID-19 infection mortality burn thrombosis scarring

Machine learning in solid organ transplantation:Charting the evolving landscape

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World Journal of Transplantation 2025年第1期15卷 165-177页

作者： Badi Rawashdeh Haneen Al-abdallat Emre Arpali Beje Thomas Ty B Dunn Matthew Cooper Division of Transplant surgery Medical College of WisconsinMilwaukeeWI 53202United States Department of Medicine Jordan University HospitalAmman 11263Jordan Department of Nephrology Medical College of WisconsinMilwaukeeWI 53226United States

BACKGROUND Machine learning(ML),a major branch of artificial intelligence,has not only demonstrated the potential to significantly improve numerous sectors of healthcare but has also made significant contributions to the field of solid organ *** provides revolutionary opportunities in areas such as donorrecipient matching,post-transplant monitoring,and patient care by automatically analyzing large amounts of data,identifying patterns,and forecasting *** To conduct a comprehensive bibliometric analysis of publications on the use of ML in transplantation to understand current research trends and their *** On July 18,a thorough search strategy was used with the Web of Science *** and transplantation-related keywords were *** the aid of the VOS viewer application,the identified articles were subjected to bibliometric variable analysis in order to determine publication counts,citation counts,contributing countries,and institutions,among other *** Of the 529 articles that were first identified,427 were deemed relevant for bibliometric analysis.A surge in publications was observed over the last four years,especially after 2018,signifying growing interest in this *** 209 publications,the United States emerged as the top ***,the"Journal of Heart and Lung Transplantation"and the"American Journal of Transplantation"emerged as the leading journals,publishing the highest number of relevant *** keyword searches revealed that patient survival,mortality,outcomes,allocation,and risk assessment were significant themes of *** The growing body of pertinent publications highlights ML's growing presence in the field of solid organ *** bibliometric analysis highlights the growing importance of ML in transplant research and highlights its exciting potential to change medical practices and enhance patient *** collaboration between signific

关键词： Machine learning Artificial Intelligence Solid organ transplantation Bibliometric analysis

Effect of Helicobacter pylori on gastric epithelial cells

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World Journal of Gastroenterology 2014年第36期20卷 12767-12780页

作者： Shatha Alzahrani Taslima T Lina Jazmin Gonzalez Irina V Pinchuk Ellen J Beswick Victor E Reyes Department of Microbiology and Immunology University of Texas Medical Branch Galveston TX 77555 United States MSIII School of Medicine University of Texas Medical Branch Galveston TX 77555 United States Department of Internal Medicine University of Texas Medical Branch Galveston TX 77555 United States departments of Molecular Genetics and Microbiology University of New Mexico Health Sciences Center Albuquerque NM 87131 United States departments of Pediatricsand and Microbiology and Immunology University of Texas Medical Branch Galves-ton TX 77555 United States

The gastrointestinal epithelium has cells with features that make them a powerful line of defense in innate mucosal immunity. Features that allow gastrointestinal epithelial cells to contribute in innate defense include cell barrier integrity, cell turnover, autophagy, and innate immune responses. Helicobacter pylori (H. pylori) is a spiral shape gram negative bacterium that selectively colonizes the gastric epithelium of more than half of the world’s population. The infection invariably becomes persistent due to highly specialized mechanisms that facilitate H. pylori’s avoidance of this initial line of host defense as well as adaptive immune mechanisms. The host response is thus unsuccessful in clearing the infection and as a result becomes established as a persistent infection promoting chronic inflammation. In some individuals the associated inflammation contributes to ulcerogenesis or neoplasia. H. pylori has an array of different strategies to interact intimately with epithelial cells and manipulate their cellular processes and functions. Among the multiple aspects that H. pylori affects in gastric epithelial cells are their distribution of epithelial junctions, DNA damage, apoptosis, proliferation, stimulation of cytokine production, and cell transformation. Some of these processes are initiated as a result of the activation of signaling mechanisms activated on binding of H. pylori to cell surface receptors or via soluble virulence factors that gain access to the epithelium. The multiple responses by the epithelium to the infection contribute to pathogenesis associated with H. pylori.

关键词： Helicobacter pylori Apoptosis Gastric epithelial cells Proinflammatory cytokines Chronic inflammation Gastric diseases Gastric cancer

Immune evasion strategies used by Helicobacter pylori

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World Journal of Gastroenterology 2014年第36期20卷 12753-12766页

作者： Taslima T Lina Shatha Alzahrani Jazmin Gonzalez Irina V Pinchuk Ellen J Beswick Victor E Reyes Department of Microbiology and Immunology University of Texas Medical Branch Galveston TX 77555 United States MS-III School of Medicine University of Texas Medical Branch Galveston TX 77555 United States Department of Internal Medicine University of Texas Medical Branch Galveston TX 77555 United States departments of Molecular Genetics and Microbiology University of New Mexico Health Sciences Center Albuquerque NM 87131 United States departments of Pediatrics and Microbiology and Immunology University of Texas Medical Branch Galveston TX 77555 United Statest

Helicobacter pylori(H. pylori) is perhaps the most ubiquitous and successful human pathogen, since it colonizes the stomach of more than half of humankind. Infection with this bacterium is commonly acquired during childhood. Once infected, people carry the bacteria for decades or even for life, if not treated. Persistent infection with this pathogen causes gastritis, peptic ulcer disease and is also strongly associated with the development of gastric cancer. Despite induction of innate and adaptive immune responses in the infected individual, the host is unable to clear the bacteria. One widely accepted hallmark of H. pylori is that it successfully and stealthily evades host defense mechanisms. Though the gastric mucosa is well protected against infection, H. pylori is able to reside under the mucus, attach to gastric epithelial cells and cause persistent infection by evading immune responses mediated by host. In this review, we discuss how H. pylori avoids innate and acquired immune response elements, uses gastric epithelial cells as mediators to manipulate host T cell responses and uses virulence factors to avoid adaptive immune responses by T cells to establish a persistent infection. We also discuss in this review how the genetic diversity of this pathogen helps for its survival.

关键词： Helicobacter pylori Immune response Pattern recognition receptors Phagocytes T cells Antigen presenting cells Gastric epithelial cells Vacuolating cytotoxin T4SS

Advancing spinal cord injury research with optical clearing,light sheet microscopy,and artificial intelligence-based image analysis

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Neural Regeneration Research 2023年第12期18卷 2661-2662页

作者： Qiang Li Alfredo Sandoval Jr Bo Chen Department of Neurobiology University of Texas Medical BranchGalvestonTXUSA

From the days of Ramon y Cajal's first sketches,neuroscientists have recognized the importance of visualizing the complex architecture of the central nervous *** the past century,we have come to appreciate how the rich structural and functional complementarity of axons and cell types in the spinal cord make it uniquely suited for information transfer between the periphery and the brain.

关键词： artificial image sketch

Targeted proteomics for biomarker discovery and validation of hepatocellular carcinoma in hepatitis C infected patients

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World Journal of Hepatology 2015年第10期7卷 1312-1324页

作者： Gul M Mustafa Denner Larry John R Petersen Cornelis J Elferink Department of Pharmacology and Toxicology University of Texas Medical Branch Department of Internal Medicine University of Texas Medical Branch Department of Pathology School of Medicine University of Texas Medical Branch

Hepatocellular carcinoma(HCC)-related mortality is high because early detection modalities are hampered by inaccuracy,expense and inherent procedural *** there is an urgent need for minimally invasive,highly specific and sensitive biomarkers that enable earlydisease detection when therapeutic intervention remains practical. Successful therapeutic intervention is predicated on the ability to detect the cancer early. Similar unmet medical needs abound in most fields of medicine and require novel methodological approaches. Proteomic profiling of body fluids presents a sensitive diagnostic tool for early cancer detection. Here we describe such a strategy of comparative proteomics to identify potential serum-based biomarkers to distinguish high-risk chronic hepatitis C virus infected patients from HCC patients. In order to compensate for the extraordinary dynamic range in serum proteins,enrichment methods that compress the dynamic range without surrendering proteome complexity can help minimize the problems associated with many depletion methods. The enriched serum can be resolved using 2D-difference in-gel electrophoresis and the spots showing statistically significant changes selected for identification by liquid chromatographytandem mass spectrometry. Subsequent quantitative verification and validation of these candidate biomarkers represent an obligatory and rate-limiting process that is greatly enabled by selected reaction monitoring(SRM). SRM is a tandem mass spectrometry method suitable for identification and quantitation of target peptides within complex mixtures independent on peptidespecific antibodies. Ultimately,multiplexed SRM and dynamic multiple reaction monitoring can be utilized for the simultaneous analysis of a biomarker panel derived from support vector machine learning approaches,which allows monitoring a specific disease state such as early HCC. Overall,this approach yields high probability biomarkers for clinical validation in large patient

关键词： Hepatocellular carcinoma Biomarkers Early detection Selected reaction monitoring Targetedproteomics

Inflammasome links traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease

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Neural Regeneration Research 2025年第6期20卷 1644-1664页

作者： Gabriela Seplovich Yazan Bouchi Juan Pablo de Rivero Vaccari Jennifer C.Munoz Pareja Andrew Reisner Laura Blackwell Yehia Mechref Kevin K.Wang J.Adrian Tyndall Binu Tharakan Firas Kobeissy Department of surgery Morehouse School of MedicineAtlantaGAUSA Department of Neurobiology Center for NeurotraumaMultiomics&Biomarkers(CNMB)Neuroscience InstituteMorehouse School of MedicineAtlantaGAUSA Department of Neurological surgery and the Miami Project to Cure Paralysis University of Miami Miller School of MedicineMiamiFLUSA Division of Pediatric Critical Care Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFLUSA Department of Pediatrics Emory UniversityAtlantaGAUSA Department of Neurosurgery Children’s Healthcare of AtlantaAtlantaGAUSA Department of Chemistry and Biochemistry Texas Tech UniversityLubbockTXUSA Morehouse School of Medicine AtlantaGAUSA

Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.

关键词： Alzheimer's disease caspase-1 chronic traumatic encephalopathy inflammasomes neurodegeneration neuroinflammation NLRP1 NLRP3 pyroptosis tauopathy traumatic brain injury