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Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

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Stroke & Vascular Neurology 2020年第4期5卷 315-322页

作者： Luke Dixon Cillian McNamara Pritika Gaur Dermot Mallon Christopher Coughlan Francesca Tona Wajanat Jan Mark Wilson Brynmor Jones Department of Neuroradiology Imperial College Healthcare NHS TrustLondonUK Department of Cardiac Intensive Care Imperial College Healthcare NHS TrustLondonUK Department of Neurosurgery Imperial College Healthcare NHS TrustLondonUK

Background Cerebral microhaemorrhages are increasingly being recognised as a complication of *** observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and *** comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease,this study aims to propose possible common pathogenic *** A retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on *** distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale,and patients’baseline characteristics and salient test results were also *** Cerebral microhaemorrhages were noted to have a predilection for the corpus callosum,the juxtacortical white matter and *** patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical *** This study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe *** raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.

关键词： Cerebral pattern critical

Surgical interventions for anterior shoulder instability in rugby players: A systematic review

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World Journal of Orthopedics 2015年第4期6卷 400-408页

作者： Sanjeeve Sabharwal Nirav K Patel Anthony MJ Bull Peter Reilly SpR Trauma and Orthopaedics Imperial College NHS Trust St Mary’s Hospital Musculoskeletal Mechanics Imperial College London imperial college London imperial college nhs trust St Mary’s Hospital

AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubM ed, EMBASE and Google Scholar using the following search terms: "rugby" and "shoulder" in combination with "instability" or "dislocation". All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4(poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 ***: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects.

关键词： Shoulder Instability Dislocation Rugby Latarjet

Current perspectives and the future of disease-modifying therapies in type 1 diabetes

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World Journal of Diabetes 2025年第1期16卷 12-21页

作者： Sunetra Mondal Joseph M Pappachan Department of Endocrinology NRS Medical College and HospitalKolkata 700014West BengalIndia Department of Endocrinology and Metabolism Lancashire Teaching Hospitals NHS TrustPreston PR29HTUnited Kingdom Faculty of Science Manchester Metropolitan UniversityManchester M156BHUnited Kingdom Department of Endocrinology Kasturba Medical CollegeManipal 576104India

Use of immunomodulating agents to prevent the progression of autoimmuneβ-cell damage leading to type 1 diabetes mellitus(T1DM)is an interesting area for *** include non-specific anti-inflammatory agents,immunologic vaccination and anti-inflammatory agents targeting specific immune cells or *** is an anti-CD3-molecule that binds to and leads to the disappearance of the CD3/TCR complex and rendering the T cell anergic to its target *** and clinical trials have demonstrated its efficacy in reducing the decline in serum C-peptide levels and the need for insulin therapy if used early in the disease process of *** benefits have been apparent as early as six months to as long as seven years after *** has recently been approved by the Food and Drug Administration to delay the onset of clinical(stage 3)type 1 diabetes in children above 8 years of *** their recent metaanalysis published in the World Journal of Diabetes,Ma et al found that those in the teplizumab treatment group have a greater likelihood of reduction in insulin use,change in C-peptide response,and better glycemic control compared to the control group with a good safety ***,all the included randomized control trials have been conducted in high-income *** cost of therapy and unknown utility of the molecule in stage 3 disease limit its widespread use.

关键词： Teplizumab Type 1 diabetes mellitus Disease modifying therapy β-cell function C-peptide Immunotherapy

Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

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World Journal of Gastroenterology 2009年第4期15卷 502-505页

作者： Kamran Ahmed Amir Darakhshan Eleanor Au Munther A Khamashta Iraklis E Katsoulis Department of Biosurgery and Surgical Technology Imperial College Department of Surgery Guy's and St Thomas'NHS Foundation Trust Lupus Unit Guy's and St Thomas' NHS Foundation Trust

The antiphospholipid syndrome(APS)is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis,fetal loss,thrombocytopenia,leg ulcers,livedo reticularis,chorea,and *** document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean *** laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was *** diagnosis of APS was established during post-operative hospital stay and the patient was commenced on ***,she made a full recovery and had her stoma reversed after 4 *** poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric *** should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.

关键词： Antiphospholipid syndrome Intestinalischemia Acute abdomen Pregnancy

Adult pancreatoblastoma: Current concepts in pathology

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World Journal of Gastroenterology 2021年第26期27卷 4172-4181页

作者： Ayo O Omiyale Department of Cellular Pathology Imperial College Healthcare NHS TrustLondon W68RFUnited Kingdom

Adult pancreatoblastoma is an exceptionally rare malignant tumour of the pancreas that mimics other solid cellular neoplasms of the pancreas,which may pose diagnostic *** of its rarity,little is known about its clinical and pathologic *** article reviews the clinical and pathologic features of pancreatoblastoma in adults including differential diagnosis,treatment,and *** pancreatoblastoma commonly occurs in childhood,there have now been more than 70 adult pancreatoblastomas described in the *** is a slight male *** are no symptoms unique to pancreatoblastomas and adult patients are frequently *** most common presenting symptom is abdominal ***,the tumours are often large and ***,pancreatoblastomas are composed of neoplastic cells with predominantly acinar differentiation and characteristic squamoid *** tumours are positive for trypsin,chymotrypsin,lipase,and *** of heterozygosity on chromosome 11p is the most common molecular alteration in *** pancreatoblastomas are aggressive tumours with frequent local invasion,recurrence,and distant *** consists of surgical *** and radiotherapy may have a role in the treatment of recurrent,residual,unresectable,and metastatic *** is important to distinguish pancreatoblastomas from morphological mimics such as acinar cell carcinomas,solid pseudopapillary neoplasms,and pancreatic neuroendocrine neoplasms.

关键词： Pancreas Adult pancreatoblastoma Pancreatic cancer Solid pancreatic mass Non-ductal pancreatic tumours

COVID-19 pandemic:Building organisational flexibility to scale transplant programs

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World Journal of Transplantation 2020年第10期10卷 277-282页

作者： Jeevan Prakash Gopal Vassilios E Papalois imperial college Renal and Transplant Center Hammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom imperial college Renal and Transplant Center Department of Surgery and CancerHammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom

The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented *** pandemic has had a significant impact on transplantation *** logistics of travel restrictions,stretching of available resources,unclear risk of infection in immunosuppressed transplant recipients,and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant *** must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our *** a culture of honesty and transparency(with patients,families,colleagues,societies,and authorities),keeping the channels of communication open,working in collaboration with others(at local,regional,national,and international levels),and not restarting without rethinking and appraising all elements of our practice,are the main underlying principles to increase the flexibility.

关键词： Organisational flexibility Clinical decision making COVID-19 Organ donation Care delivery Transplantation

Self-replicating digital data storage with synthetic chromosomes

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National Science Review 2021年第7期8卷 66-67页

作者： Xinyu Lu Tom Ellis imperial college Centre for Synthetic Biology Imperial College London Department of Bioengineering Imperial College London Wellcome trust Sanger Institute

With the rapid development of the Internet and computational technologies, the exponential growth of digital data is beginning to overwhelm existing storage device capacities, driving an unprecedented demand for new data storage media. DNA, a natural genetic information storage system, has been proposed as a promising alternative[1]. Compared with traditional siliconbased storage, DNA-based storage hasmany advantages—incredible density,

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Rare presentation of Brunner's gland adenoma:another differentiation in patients with recurrent "idiopathic" pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2012年第1期11卷 107-110页

作者： Soumil Vyas James RA Skipworth Dimitrios Lytras Claire Smyth Anthony Mee Adrian Hatfield Charles Imber George Webster Department of Hepatobiliary & Pancreatic Surgery University College London Hospital NHS Trust Department of Gastroenterology University College London Hospital NHS Trust Department of Gastroenterology Royal Berkshire Hospital NHS Trust

BACKGROUND:Brunner's gland adenoma (BGA) is an unusual benign neoplasm arising from Brunner's glands in the *** symptomatic it presents either with duodenal obstruction or ***,pancreatitis secondary to ampullary obstruction from a BGA is very ***:A 23-year-old female presented with recurrent episodes of 'idiopathic' *** was extensively investigated and was found to have a large polypoid BGA,intermittently obstructing the *** created a ball-valve effect causing secondary intermittent obstruction of the pancreatic duct resulting in *** condition was cured surgically,through transduodenal excision of the *** reviewed the surgical literature pertaining to these unusual and similar causes of obstructive pancreatitis,not related to ***:BGA of the duodenum is a rare cause of *** investigations should be carried out in all cases of unexplained pancreatitis before classifying the condition as 'idiopathic'.Discovery of a lesion of this nature gives an opportunity to provide a permanent surgical ***:BGA adds an unusual etiology for *** patients with pancreatitis should undergo extensive investigations before being termed 'idiopathic'.Surgical excision of the BGA provides a definitive curative treatment for the adenoma and pancreatitis.

关键词： ampullary polyp Brunner's gland adenoma pancreatitis excision

A pilot study of aortic hemodynamics before and after thoracic endovascular repair with a double-branched endograft

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Medicine in Novel Technology and Devices 2019年第4期4卷 7-23页

作者： Yu Zhu Wenbo Zhan Mohamad Hamady Xiao Yun Xu Department of Chemical Engineering Imperial College LondonUK Department of Interventional Radiology St Mary’s HospitalImperial College Healthcare NHS TrustLondonUK

Branched endografts have been developed to treat complex pathology in the aortic arch and ascending *** study aims to evaluate the haemodynamic performance of a double-branched thoracic endograft by detailed comparison of flow patterns and wall shear stress in the aorta and supra-aortic branches before and after stentgraft ***-and post-intervention CT images were acquired from two patients who underwent thoracic endovascular aortic repair(TEVAR)with a double-branched endograft for thoracic aortic *** images were used to reconstruct patient-specific models,which were analysed using computational fluid dynamics employing physiologically realistic boundary *** results showed that there was sufficient blood perfusion through the arch *** presence of inner tunnels caused flow derangement and asymmetric wall shear stress in the ascending aorta,where shear range index was up to 6 times higher than in the preintervention *** shear stress in the aortic arch increased considerably after intervention as a result of accelerated *** maximum flow-induced displacement forces on the branched endografts were around 22 N for both patients,which was below the threshold for device *** from this pilot study demonstrated that aortic flow patterns were significantly altered by the branched endograft which caused increased spatial variation of wall shear stress in the ascending aorta and the *** no obvious adverse hemodynamic features were found immediately after intervention for the cases we analysed,follow-up studies will be needed to assess durability of the device.

关键词： Thoracic endovascular aortic repair(TEVAR) Aortic arch Branched endograft Blood flow Computational fluid dynamics