检索结果-南通市图书馆

Eight-week ledipasvir/sofosbuvir in non-cirrhotic, treatment-na?ve hepatitis C genotype-1 patients with hepatitis C virus-RNA < 6 million: Single center, real world effectiveness and safety

引用

World Journal of Gastroenterology 2017年第26期23卷 4759-4766页

作者： Nyan L Latt Beshoy T Yanny Derenik Gharibian Rita Gevorkyan Amandeep K Sahota division of Gastroenterology and Hepatology Mayo Clinic College of Medicine division of Gastro-enterology and Hepatology Kaiser Permanente Los Angeles Medical Center Pharmacy Operations Office Kaiser Permanente Los Angeles Medical Center Department of Clinical Operations Kaiser Permanente Southern California

AIM To evaluate sustained viral response(SVR) of 8-wk ledipasvir/sofosbuvir therapy among non-cirrhotic, genotype-1 hepatitis C virus(HCV) patients with RNA < 6 million IU/m *** We performed a retrospective cohort study to examine SVR rates, predictors of treatment failure and safety analysis of 8-wk ledipasvir/sofosbuvir(LDV/SOF) therapy among non-cirrhotic, genotype 1 HCV patients with viral load < 6 million IU/m L. Primary outcome was an achievement of SVR at 12 wk after treatment. Secondary outcomes were identifying predictors of treatment failure and adverse events during *** Total 736 patients: 55% males, 51% Caucasians and 65% were genotype 1a. Non-cirrhotic state of 53% was determined by clinical judgment(imaging, AST, platelet count) and 47% had documented liver fibrosis testing(biopsy, vibration-controlled transient elastography, serum biomarkers). Overall SVR12 was 96%. No difference in SVR12 was seen between patients whose non-cirrhotic state was determined by clinical judgment and patients who had fibrosis testing. Age groups, gender, ethnicity and genotype 1 subtype did not predict SVR. Non-cirrhotic state determined by clinical judgment based on simple, non-invasive tests were not associated with lower SVR [OR = 1.02, 95%CI: 0.48-2.17, P = 0.962]. The AUROC for hepatitis C RNA viral load was 0.734(P < 0.001, 95%CI: 0.66-0.82). HCV RNA 2.2 million IU/m L was identified as the cutoff value with sensitivity 73% and specificity 64%. HCV RNA < 2.2 million IU/m L was associated with significantly higher SVR 98% with OR = 0.22(95%CI: 0.1-0.49, P < 0.001) compared to SVR 92% in HCV RNA ≥ 2.2 million IU/m L. No death or morbidities were *** Our outcomes validate safety and effectiveness of 8-wk LDV/SOF therapy in non-cirrhotic, untreated HCV genotype 1 patients with HCV RNA < 6 million IU/m L.

关键词： Hepatitis C Sustained viral response Ledipasvir Cirrhosis Sofosbuvir

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system

引用

World Journal of Clinical Cases 2018年第13期6卷 624-631页

作者： Andrew Khoi Nguyen Agathon Girgis Timnit Tekeste Karen Chang Mopelola Adeyemo Armen Eskandari Emilio Alonso Priyanka Yaramada Charles Chaya Albert Ko Edmund Burke Isaiah Roggow Rebecca Butler Aniket Kawatkar Brian S Lim School of Medicine University of California Department of Gastroenterology Kaiser Permanente Riverside Medical Center Department of Surgery Kaiser Permanente Riverside Medical Center Department of research and Evaluation Southern California Permanente Medical Group

AIM To examine the practice pattern in kaiser permanente Southern California(KPSC), i.e., gastroenterology(GI)/surgery referrals and endoscopic ultrasound(EUS), for pancreatic cystic neoplasms(PCNs) after the regionwide dissemination of the PCN management *** Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015(18 mo before and after the publication of the algorithm) in KPSC(integrated health system with 15 hospitals and 202 medical offices in Southern California) were ***2558(1157 pre-and 1401 post-algorithm) received a new diagnosis of PCN in the study period. There was no difference in the mean cyst size(pre-19.1 mm vs post-18.5 mm, P = 0.119). A smaller percentage of PCNs resulted in EUS after the implementation of the algorithm(pre-45.5% vs post-34.8%, P < 0.001). A smaller proportion of patients were referred for GI(pre-65.2% vs post-53.3%, P < 0.001) and surgery consultations(pre-24.8% vs post-16%, P < 0.001) for PCN after the implementation. There was no significant change in operations for PCNs. Cost of diagnostic care was reduced after the implementation by 24%, 18%, and 36% for EUS, GI, and surgery consultations, respectively, with total cost saving of 24%.CONCLUSION In the current healthcare climate, there is increased need to optimize resource utilization. Dissemination of an algorithm for PCN management in an integrated health system resulted in fewer EUS and GI/surgery referrals, likely by aiding the physicians ordering imaging studies in the decision making for the management of PCNs. This translated to cost saving of 24%, 18%, and 36% for EUS, GI, and surgical consultations, respectively, with total diagnostic cost saving of 24%.

关键词： Pancreatic cyst Algorithm incorporation Pancreas Optimization of resource utilization Fukuoka criteria Sendai criteria Pancreatic cancer Intraductal papillary mucinous neoplasm Practice management Algorithm

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis

引用

Journal of Clinical and Translational Hepatology 2016年第2期4卷 83-89页

作者： Eric M.Nyberg Michael Batech T.Craig Cheetham Jose R.Pio Susan L.Caparosa Mary Alice Chocas Anshuman Singh Department of Orthopaedics Kaiser PermanenteSan DiegoUSA Department of research & Evaluation Kaiser PermanentePasadenaUSA Department of Orthopaedics Kaiser PermanenteSan DiegoUSA Department of Orthopaedics University of California at San DiegoSan DiegoUSA

Background and Aims:Previous studies have shown increased hepatic decompensation in patients with cirrhosis undergoing ***,there are little data available in cirrhotics undergoing orthopedic surgery compared to cirrhotics who did not undergo *** aim of this study was to examine the demographics,comorbid conditions,and clinical factors associated with hepatic decompensation within 90 days in cirrhotics who underwent orthopedic ***:This is a retrospective matched cohort *** criteria were cirrhosis diagnosis,age > 18 years,≥ 6 months continuous health plan membership,and a procedure code for orthopedic *** to five cirrhotic controls without orthopedic surgery were matched on age,gender,and cirrhosis diagnosis *** abstraction was performed for demographics,socioeconomics,clinical,and decompensation *** review was performed for *** analysis estimated relative risk of ***:Eight hundred fifty-three orthopedic surgery cases in cirrhotics were matched with 4,263 cirrhotic *** the cases and matched controls,the mean age was 60.5 years,and 52.2% were *** 90 days after surgery,cases had more decompensation compared to matched controls (12.8% vs 4.9%).Using multivariable analysis,orthopedic surgery,a 0.5 g/dL decrease in serum albumin,and a 1-unit increase in Charlson Comorbidity Index were associated with a significantincrease in decompensation within 90 days of ***,chronic obstructive pulmonary disease,and chronic kidney disease were seen with increased frequency in cases *** ***:Cirrhotics who underwent orthopedic surgery had a significant increase in hepatic decompensation within 90 days of surgery compared to matched *** incremental decrease in serum albumin and an incremental increase in the Charlson Comorbidity Index were significantly associated with hepatic decompensation after surgery.

关键词： Cirrhosis Orthopedic surgery

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Entangled chimeras in nonlocally coupled bicomponent phase oscillators:From synchronous to asynchronous chimeras

引用

Frontiers of physics 2020年第6期15卷 115-123页

作者： Qiong-Lin Dai Xiao-Xuan Liu Kai Yang Hong-Yan Cheng Hai-Hong Li Fagen Xie Jun-Zhong Yang School of Science Beiing University of Posts and TelecommunicationsBeijing 100876China Department of research and Eoaluation Kaiser Permanente Southern CaliforniaPasadenaCA 91101USA

Chimera states,a symmetry-breaking spatiotemporal pattern in nonlocally coupled identical dynamical units,have been identified in various systems and generalized to coupled nonidentical *** has been shown that strong heterogeneity in the frequencies of nonidentical oscillators might be harmful to chimera *** this work,we consider a ring of nonlocally coupled bicomponent phase oscillators in which two types of oscillators are randomly distributed along the ring:some oscillators with *** w1 and others with *** this model,the heterogeneity in frequency is measured by frequency mismatch|w1-w2|between the oscillators in these two *** report that the nonlocally coupled bicomponent phase oscillators allow for chimera states no matter how large the frequency mismatch *** bicomponent oscillators are composed of two chimera states,one supported by oscillators with natural frequency wI and the other by oscillators with natural frequency *** two chimera states in two subpopulations are synchronized at weak frequency mismatch,in which the coberent oscillators in thern share similar mean phase velocity,and are desynchronized at large frequency mismatch,in which the coherent oscillators in different subpopulations have distinct mean phase *** synchronization-desynchronization transition between chimera states in these two subpopulations is observed with the increase in the frequency *** observed phenomena are theoretically analyzed by passing to the continuum limit and using the Ott-Antonsen approach.

关键词： chimera states bicomponent phase oscillators nonlocal coupling desynchronization transition

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

To scan or not to scan:Use of transient elastography in an integrated health system

引用

World Journal of Hepatology 2023年第3期15卷 419-430页

作者： Libby Stein Rasham Mittal Hubert Song Joanie Chung Amandeep Sahota Department of Internal Medicine Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States Department of Transplant Hepatology Kaiser Permanente Los Angeles Medical CenterLos AngelesCA 90027United States research and Evaluation Kaiser Permanente Southern CaliforniaLos AngelesCA 91101United States

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for *** To analyze how this CDST impacted health care utilization and patient *** We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and *** We identified 958 patients who had FibroScan,115 before and 843 after the CDST was *** percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was *** there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more *** few patients were hospitalized or *** This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

关键词： Non-alcoholic fatty liver disease Transient elastography FibroScan Clinical decision support tool Health care utilization Primary care

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study

引用

The Journal of Biomedical research 2019年第3期33卷 208-216页

作者： Kee D.Kim Huy Duong Aditya Muzumdar Mir Hussain Mark Moldavsky Bandon Bucklen Department of Neurological Surgery University of California Davis Department of Neurosurgery kaiser permanente Medical Group Musculoskeletal Education and research Center(MERC) Globus Medical Inc

In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(Presearch concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.

关键词： lumbosacral fixation sacropelvic fixation sacroiliac screw computer-assisted surgery image-guided surgery

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study

引用

Journal of Geriatric Cardiology 2020年第11期17卷 653-658页

作者： Wei-Jia WANG Darleen Lessard Jane Saczynski Robert J Goldberg Alan S.Go Tenes Paul Ely Gracia David D McManus Department of Medicine University of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA division of research Kaiser Permanente Northern CaliforniaOaklandCAUSA

Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's < 0.01). In multivariable adjusted regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration.

关键词： Atrial fibrillation Cognitive impairment Heart failure Frailty

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Anti-carcinogenic properties of curcumin on colorectal cancer

引用

World Journal of Gastrointestinal Oncology 2010年第4期2卷 169-176页

作者： Jung Park Chris N Conteas Department of Internal Medicine Kaiser Permanente Los Angeles Medical Center1526 Edgemont AveLos AngelesCA 90027United States Department of Gastroenterology Kaiser Permanente Los Angeles Medical Center1526 Edgemont AveLos AngelesCA 90027United States

Curcumin has been used in traditional Indian medicine for many centuries for its anti-inflammatory and anticarcinogenic *** has been some promising research concerning curcumin as a safe therapeutic agent for many cancers,colorectal cancer being among *** has been shown through research in cell cultures,animal models,and *** this time,it appears that curcumin’s anti-carcinogenic properties are most likely due to its effects on multiple molecular targets,such as nuclear factorκ-light-chain-enhancer of activated B cells(NF-κB)and activator protein 1(AP-1).NF-κB and AP-1 are both major transcription factors that regulate inflammation and thus affect cell proliferation,differentiation and even *** has also been shown to affect a variety of other key players involved in carcinogenesis,such as cyclooxygenase-2,matrix metallopeptidases 2 and 9 and tumor necrosis factorαinduced vascular cell adhesion molecule,just to name a *** many molecular targets are involved,curcumin has been well tolerated in many studies:doses up to 8 g a day have been confirmed to be safe for *** this brief review,we will examine the current studies and literature and touch upon many molecular pathways affected by curcumin,and demonstrate the exciting possibility of curcumin as a chemopreventive agent for colorectal cancer.

关键词： Chemopreventive Anti-inflammatory Anticarcinogenic Curcumin Turmeric Cancer Colorectal cancer

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Relationship between self-reported residential indoor remodeling and semen quality： a case-control study

引用

Asian Journal of Andrology 2015年第6期17卷 981-984,I0009,I0010页

作者： Mao-Hua Miao Zheng Li De-Kun Li Bei Yan Hong Liang Er-Lei Zhi Hong-Wei Du Wei Yuan Department of Reproductive Epidemiology and Social Science National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices ShanghaiI~stitue of Planned Pa[enthood Rese.arch Shanghai China Department of Urology Shanghai Human Sperm Bank Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai China division of Reseaich Kaiser Foundation Research Institute Kaiser Permanente Northern California CA USA.

The present study examined the association between residential indoor remodeling and poor semen quality. Sperm donors aged 18-45 years old were recruited in Shanghai, China. Semen specimens were collected and analyzed. An in-person interview was conducted to obtain information on the history of indoor remodeling and potential confounders. A total of 70 participants with abnormal semen quality （case group） and 68 controls were examined. A total of 20 subjects reported indoor remodeling in the recent 24 months, and among them 17 subjects reported indoor remodeling in the recent 12 months. Compared with participants with no history of indoor remodeling, participants with a history of indoor remodeling in the recent 24 months were more than three times as likely to have poor sperm quality （adjusted odds ratio = 3.8, 95% confidence interval： 1.3-12.0） after controlling for potential confounders. The association was strengthened when the analysis was restricted to those who had indoor remodeling in the recent 12 months. Our findings provide preliminary evidence that indoor remodeling has an adverse effect on semen quality.

关键词： case-control study chemicals health effect indoor remodeling semen quality

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Hodgkin's lymphoma coexisting with liver failure secondary to acute on chronic hepatitis B

引用

World Journal of Clinical Cases 2013年第1期1卷 37-40页

作者： Renee Palta Amy McClune Karl Esrason division of Gastrointestinal and Liver Disease Department of Transplant Hepatology Kaiser Permanente Los Angeles Medical Center Los Angeles CA 90027 United States division of Hepatology University of California Los Angeles CA 94607 United States

Acute on chronic liver failure(ACLF) is rarely the initial manifestation of a malignant process or precipitated by the initiation of anti-viral treatment with a nucleoside or nucleotide agent. We report an unusual case of ACLF temporally associated with initiation of Entecavir for treatment of chronic hepatitis B. Early Hodgkin's lymphoma(HL) was unmasked with initiation of the antiviral treatment which may have exacerbated ACLF. To the best of our knowledge, this has not been described in the literature. In reviewing our patients clinical course and liver autopsy, he developed a severe acute exacerbation of his chronic hepatitis B virus coinciding with the institution of antiviral therapy and the underlying HL perhaps modulating the overall degree of hepatic injury.

关键词： Entecavir Hepatic flare Fulminant hepatic failure Chronic hepatitis Acute liver failure Hodgkin’s lymphoma

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：