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Trends in mortality among the geriatric population undergoing Surgical aortic valve replacement (SAVR) and potential racial disparities: a 20-year perspective via the National (Nationwide) Inpatient Sample

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Journal of Geriatric Cardiology 2024年第7期21卷 716-722页

作者： Nomesh Kumar Kamleshun Ramphul FNU Bawna Nitish Behary Paray Mansimran Si-ngh Dulay Jasninder Singh Dhaliwal Shruti Aggarwal Sebastian Mactaggart Suma Sri Chennapragada Shaheen Sombans Renuka Verma Hemamalini Sakthivel Raheel Ahmed Department of internal medicine Detroit Medical Center Sinai Grace-Wayne State UniversityMichiganUSA In-dependent Researcher TrioletMauritius Independent researcher Farmington HillsMichiganUSA Royal Devon University Healthcare NHS Foundation Trust ExeterUnited Kingdom Royal Brompton Hospital part of Guy’s and St.Thomas’NHS Foundation TrustLondonUnited Kingdom Department of internal medicine University of Cali-forniaRiversideUSA Independent Researcher New DelhiIndia Northumbria Hospitals NHS Foundation Trust NewcastleUnited Kingdom Department of internal medicine Louisiana State UniversityShreveportUSA Sha-heen Sombans Independent ResearcherHyderabadIndia Department of internal medicine Kirk Kerkorian School of Medicine at UNLVLas VegasUSA One Brooklyn Health System/Interfaith Medical Ctr Program BrooklynNYUSA

Background Racial disparities in cardiovascular conditions are well *** similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement(SAVR) for aortic stenosis remains *** We abstracted data from the National(Nationwide) Inpatient Sample over a 20-year period from 2001 to 2020 using specific ICD-9 and ICD-10 *** included patients aged ≥ 60 and ≤ 80 years with races recorded as White,African American,or Hispanic at the time of their hospitalization for *** analyzed and reported the baseline characteristics,risk-adjusted inhospital mortality,and complications stratified by *** Of 420,181 patients studied,90.0% identified as White,4.0% as African American and 6.0% as *** a decrease in overall in-hospital mortality rates from 3.8% between 2001-2005 to 1.8% between 2016-2020,African Americans had higher odds of all-cause in-hospital deaths compared to Whites(a OR = 1.390,P < 0.001).Additionally,they were more likely to experience cardiogenic shock(a OR = 1.241,P < 0.001) and acute kidney injury(a OR = 1.314,P < 0.001) as well as more likely to require organ support such as IABP use(a OR = 1.336,P < 0.001) or invasive mechanical ventilation(a OR = 1.342,P < 0.001).Interestingly,African Americans were less likely to report events of acute ischemic stroke compared to Whites(a OR = 0.852,P < 0.001).Conclusions Despite a reassuring reduction in overall in-hospital mortality rates of geriatric patients undergoing SAVR for aortic stenosis,racial disparities in health outcomes remain pervasive with minorities more likely to report higher in-hospital morbidity and mortality.

关键词： mortality likely spite

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Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment

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World Journal of gastroenterology 2017年第40期23卷 7310-7320页

作者： Asad Jehangir Henry P Parkman Department of internal medicine Reading Health System Department of gastro-enterology Temple University Hospital

AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student's t test and χ2 tests where appropriate for data *** Of 223 patients with delayed gastric emptying, 158(70.9%) patients were not taking opioids(Gp NO), 22(9.9%) were taking opioids only as needed, while 43(19.3%) were on chronic(> 1 mo) scheduled opioids(Gp CO), of which 18 were taking opioids forreasons that included gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. Gp CO reported higher severities of many gastrointestinal symptoms compared to Gp NO including nausea(mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching(2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting(2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety(4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness(4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite(3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain(3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort(3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day(2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down(2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day(2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night(2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day(2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth(2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). Gp CO had a longer durati

关键词： Opioid gastroparesis Symptoms Hospitalizations Employment

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Allosteric regulation of Keap1 by 8b-hydroxy-acyclocostunolide for the treatment of acute lung injury

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Acta Pharmaceutica Sinica B 2024年第9期14卷 4174-4178页

作者： Juan Zhang Min Zhang Qi-Meng Zhu Xin-Rong Xu Yan-Li Feng Sheng Lin Feng Qiu Cheng-Peng Sun School of Chinese Materia Medic1 Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese MedicineTianjin University of Traditional Chinese MedicineTianjin 301617China Key Laboratory of Chinese internal medicine of Ministry of Education and Beijing Dongzhimen HospitalBeijing University of Chinese MedicineBeijing 100700China

To the Editor:Acute lung injury(ALI)is a debilitating lung disease characterized by pulmonary edema,diffuse alveolar damage,and uncontrolled neutrophil *** cases of ALI can potentially lead to the development of acute respiratory distress syndrome(ARDS),which can lead to impaired respiratory function,multiorgan dysfunction,and an extremely high mortality *** may be caused by various factors,including aspiration,severe pneumonia,sepsis,trauma,fatty embolism,pancreatitis,and blood *** clinical approaches to treating ALI/ARDS include mechanical ventilation,extracorporeal membrane oxygenation(ECMO),and other supportive therapies5,***,ALI/ARDS is an urgent problem that needs to be addressed in the field of respiratory critical care and innovative mechanisms and therapies6.

关键词： Macrophage overactivation Keap1 8b-Hydroxy-a-cyclocostunolide Nrf2 Acute lung injury

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Mechanism of Qili Qiangxin Capsule for Heart Failure Based on miR133a-Endoplasmic Reticulum Stress

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Chinese Journal of Integrative medicine 2024年第5期30卷 398-407页

作者： JI Xiao-di YANG Ding CUI Xi-yuan LOU Li-xia NIE Bo ZHAO Jiu-li ZHAO Ming-jing WU Ai-ming Dongzhimen Hospital Affiliated to Beijing University of Chinese medicine Key Laboratory of Chinese Internal Medicine of Ministry of Education and BeijingBeijing 100700China Department of Traditional Chinese medicine Fuwai HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100037China

Objective:To investigate the pharmacological mechanism of Qili Qiangxin Capsule(QLQX)improvement of heart failure(HF)based on miR133a-endoplasmic reticulum stress(ERS)***:A left coronary artery ligation-induced HF after myocardial infarction model was used in this *** were randomly assigned to the sham group,the model group,the QLQX group[0.32 g/(kg·d)],and the captopril group[2.25 mg/(kg·d)],15 rats per group,followed by 4 weeks of *** function such as left ventricular ejection fraction(EF),fractional shortening(FS),left ventricular systolic pressure(LVSP),left ventricular end diastolic pressure(LVEDP),the maximal rate of increase of left ventricular pressure(+dp/dt max),and the maximal rate of decrease of left ventricular pressure(–dp/dt max)were monitored by echocardiography and *** and eosin(HE)and Masson stainings were used to visualize pathological changes in myocardial *** m RNA expression of mi R133a,glucose-regulated protein78(GRP78),inositol-requiring enzyme 1(IRE1),activating transcription factor 6(ATF6),X-box binding protein1(XBP1),C/EBP homologous protein(CHOP)and Caspase 12 were detected by *** protein expression of GRP78,p-IRE1/IRE1ratio,cleaved-ATF6,XBP1-s(the spliced form of XBP1),CHOP and Caspase 12 were detected by Western *** T-mediated d UTP nick-end labeling(TUNEL)staining was used to detect the rate of ***:QLQX significantly improved cardiac function as evidenced by increased EF,FS,LVSP,+dp/dt max,-dp/dt max,and decreased LVEDP(P<0.05,P<0.01).HE staining showed that QLQX ameliorated cardiac pathologic damage to some *** staining indicated that QLQX significantly reduced collagen volume fraction in myocardial tissue(P<0.01).Results from RT-PCR and Western blot showed that QLQX significantly increased the expression of mi R133a and inhibited the m RNA expressions of GRP78,IRE1,ATF6 and XBP1,as well as decreased the protein expressions of GRP78,cleave

关键词： heart failure Qili Qiangxin Capsule miR133a endoplasmic reticulum stress apoptosis

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Optimization of colorectal cancer screening strategies: New insights

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World Journal of gastroenterology 2024年第28期30卷 3361-3366页

作者： Magie Tamraz Najib Al Ghossaini Sally Temraz Department of Nutrition and Public Health Holy Spirit University of KaslikJounieh 446Lebanon Department of internal medicine Ain Wazein Medical VillageChouf 1503Lebanon Department of internal medicine Division of Hematology/OncologyAmerican University of Beirut Medical CenterBeirut 11072020Lebanon

In this editorial,we discuss the article by Agatsuma et *** concentrate specifically on the current routinely used screening tests recommended by society guidelines and delve into the significance of early diagnosis of colorectal cancer(CRC)and its substantial impact on both incidence and mortality *** is highly recommended,and an early diagnosis stands out as the most crucial predictor of survival for CRC ***,it is essential to identify and address the barriers hindering adherence to screening measures,as these barriers can vary among different ***,we focus on screening strategy optimization by selecting high-risk *** with comorbidities who regularly visit hospitals have been diagnosed at an early stage,showing no significant difference compared to patients undergoing regular *** finding highlights the importance of extending screening measures to include patients with comorbidities who do not routinely visit the hospital.

关键词： Colorectal neoplasms Early diagnosis Barriers to adherence Cancer screening guidelines Screening tests

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Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia

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World Journal of gastroenterology 2024年第26期30卷 3210-3220页

作者： Lama Ibrahim Maamoun Basheer Tawfik Khoury Wisam Sbeit Department of internal medicine Galilee Medical CenterNahariya 22001Israel Department of gastroenterology Galilee Medical CenterNahariya 22001Israel Azrieli Faculty of medicine Bar-Ilan UniversitySafed 1311502Israel

BACKGROUND Dyspepsia is a very prevalent upper gastrointestinal tract symptoms *** of these symptoms might arise from serious underlying diseases,so the promotion of evidence-based guidelines could potentially better align evaluation and *** To determine the value of alarm features as a predictive factor for significant endoscopic findings(SEFs)among hospitalized patients presenting with *** We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized *** were divided into two groups,with and without SEFs,and compared to elucidate the ability of the different alarm features to predict *** During the study,605 patients fulfilled the inclusion *** the demographics and clinical characteristics of the two groups were compared,tachycardia(Pgastrointestinal bleeding,persistent vomiting,odynophagia[odds ratio(OR)=3.81,P<0.05;OR=1.75,P=0.03;and OR=7.81,P=0.07,respectively]were associated with *** weight loss was strongly associated with malignancy as an endoscopic finding(OR=2.05;P<0.05).In addition,long-term use of anti-aggregate medications other than aspirin(P<0.05)was correlated to *** Novel predictors of SEFs were elucidated in this *** parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

关键词： Dyspepsia Endoscopy Weight loss Anti-aggregate medications Persistent vomiting Odynophagia

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Platelet counts to spleen diameter ratio:A promising noninvasive tool for predicting esophageal varices in cirrhosis patients

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World Journal of Hepatology 2024年第10期16卷 1177-1187页

作者： Getnet Yigzaw Mossie Abdulsemed Mohammed Nur Zekarias Seifu Ayalew Gebeyehu Tessema Azibte Kaleb Assefa Berhane Department of internal medicine Addis Ababa UniversityAddis Ababa 1000Ethiopia Division of gastroenterology and Hepatology Department of Internal MedicineCollege of Health SciencesAddis Ababa UniversityAddis Ababa 1000Ethiopia Department of General medicine Adera Medical and Surgical CenterAddis Ababa 1000Ethiopia

BACKGROUND Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation,wherein the standard hepatic architecture is replaced by regenerative hepatic nodules,which eventually lead to liver *** without any symptoms is referred to as compensated *** such as ascites,variceal bleeding,and hepatic encephalopathy indicate the onset of decompensated *** varices are the hallmark of clini-cally significant portal *** To determine the accuracy of the platelet count-to-spleen diameter(PC/SD)ratio to evaluate esophageal varices(EV)in patients with *** This retrospective observational study was conducted at Tikur Anbessa Specia-lized Hospital and Adera Medical Center from January 1,2019,to December 30,*** were collected via chart review and direct patient interviews using structured *** data were exported to the SPSS software version 26 for analysis and clearance.A receiver operating characteristic curve was plotted for splenic diameter,platelet count,and PC/SD ratio to obtain sensitivity,speci-ficity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood *** Of the 140 participants,67%were *** B(38%)was the most common cause of cirrhosis,followed by cryptogenic cirrhosis(28%)and hepatitis C(16%).Approximately 83.6%of the participants had endoscopic evidence of EV,whereas 51.1%had gastric *** cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63(95%CI:3.16-67.58,P=0.001)and 0.14(95%CI:0.037-0.52,P=0.004),respectively.A PC/SD ratio<1119 had a sensitivity of 86.32%and specificity of 70%with area under the curve of 0.835(95%CI:0.736-0.934,P<0.001).CONCLUSION A PC/SD ratio<1119 predicts EV in patients with *** is a valuable,noninvasive tool for EV risk assess-ment in resource-limited settings.

关键词： Cirrhosis,Esophageal varices,Portal hypertension Platelet count Splenic diameter

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Pylephlebitis-induced acute liver failure: A case report and review of literature

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World Journal of Hepatology 2024年第1期16卷 103-108页

作者： Vera Hapshy Steven Imburgio Harshavardhan Sanekommu Brandon Nightingale Sobaan Taj Mohammad A Hossain Swapnil Patel Department of internal medicine Jersey Shore University Medical CenterNeptuneNJ 07753United States

BACKGROUND Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein,carrying high rates of morbidity and *** SUMMARY We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver *** was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal *** our knowledge,this is the first documented case of acute liver failure as a potential life-threatening complication of *** Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain,especially if there are co-existing risk factors for *** also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.

关键词： Portal vein thrombosis Septic thrombophlebitis Gram negative anaerobic bacteremia Pylephlebitis Acute liver failure Case report

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Case Report: Carnitine Palmitoyl Transferase II (CPT II) Deficiency

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Open Journal of internal medicine 2024年第1期14卷 93-101页

作者： Kathy Po Marius Chivu Edwin Rosas Balpreet Kaur Department of internal medicine Saint James School of Medicine The Quarter Anguilla Department of internal medicine Medicine at University of Chicago Chicago USA Department of internal medicine Medical College of Wisconsin Wisconsin USA

Carnitine Palmitoyl Transferase II (CPTII) is a very important enzyme that helps with the oxidation of long-chain fatty acid to produce energy. Deficiency in CPTII will lead to energy deficiency in the case of fasting and the accumulation of the long chain fatty in the body. There are three types of CPT II deficiency, the myopathic form, the severe infantile hepatocardiomuscular form and the lethal neonatal form. They are all inherited as an autosomal recessive. Diagnosis of the CPTII are 1) tandem mass spectrometry (MS/MS) in adult form and 2) CPTII polymorphism (F352C), which is linked to reducing the activity of CPTII in infantile form [1]. Glucose is the primary management and medium-chain fatty acid is an alternative due to the bypass of the CPTII enzyme in the pathway. For the prevention of CPTII deficiency are to avoid long chain fatty acid (C12-fatty acid), fasting, prolonged exercise, known triggers, and certain medications such as anti-epileptics and general anesthesia. During the rhabdomyolysis and myoglobinuria attack, it is very important to maintain hydration to avoid acute renal failure. If, however, renal failure occurs, dialysis is recommended. We present a case of a 27-year-old African American woman with the significant past medical history of CPT II deficiency leading to recurrent rhabdomyolysis and myoglobinuria. Together with all the research studies from diagnosis to treatment of CPTII deficiency will help in clinical management of patients. And this case report will add to the existing case reports of patients who have CPTII deficiency in terms of how we diagnose, how we treat, and how we prevent symptoms from re-occurring.

关键词： Carnitine Palmitoyl Transferase II (CPTII) Mitochondria Long Chain Fatty Acid Medium Chain Fatty Acid Carnitine Carnitine Palmitoyl Transferase I (CPTI) Acyl-Carnitine Beta-Oxidation Rhabdomyolysis Myoglobinuria Renal Failure Hypoketotic Hypoglycemia

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History of chronic gastritis:How our perceptions have changed

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World Journal of gastroenterology 2024年第13期30卷 1851-1858页

作者： Dmitry Bordin Maria Livzan Department of Pancreatic Biliary and Upper GI Tract DiseasesA.S.Loginov Moscow Clinical Scientific CenterMoscow 111123Russia Department of Propaedeutic of internal Diseases and gastroenterology Russian University of MedicineMoscow 127006Russia Department of Outpatient Therapy and Family medicine Tver State Medical UniversityTver 170100Russia Department of internal medicine and gastroenterology Omsk State Medical UniversityOmsk 644099Russia

Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular *** classification approach with the definition of the stage of gastritis determines the need,activities and frequency of dynamic monitoring of a ***,this attitude to the patient suffering from CG was far from *** present publication is a literature review describing the key milestones in the history of CG research,from the description of the first observations of inflammation of the gastric mucosa,assessment of gastritis as a predominantly functional disease,to the advent of endoscopy of the upper digestive tract and diagnostic gastric biopsy,assessment of the role of Helicobacter pylori infection in progression of inflammatory changes to atrophy,intestinal metaplasia,dysplasia and GC.

关键词： Chronic gastritis Intestinal metaplasia Dysplasia Gastric cancer Helicobacter pylori

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