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Benign course of residual inflammation at end of treatment of liver transplant recipients after sofosbuvir based therapy

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World Journal of Hepatology 2022年第3期14卷 602-611页

作者： Bahaaeldeen Ismail Karim M Benrajab Pablo Bejarano Phillip Ruiz Debbie Sears Andreas Tzakis Xaralambos Bobby Zervos Division of Digestive Diseases and Nutrition University of Kentucky College of MedicineLexingtonKY 40536United States Department of Pathology Cleveland Clinic FloridaWestonFL 33331United States Department of Pathology University of Miami Miller School of MedicineMiamiFL 33136United States Department of Liver Transplant Cleveland Clinic FloridaWestonFL 33331United States

BACKGROUND Persistent inflammation on histology after successful hepatitis C(HCV)treatment has been ***,data regarding the long-term impact in liver transplant recipients is limited,particularly after using direct-acting antiviral(DAA)*** To evaluate the impact of successful treatment with DAAs on histological changes and occult HCV and to describe the clinical course of residual inflammation in liver transplant *** We conducted a case series of 13 chronic HCV infected liver transplant recipients successfully treated with DAAs between December 2013 and May *** patients were treated for 24 wk and had non-detectable serum HCV RNA by the time of *** patients with at least one liver biopsy at or after treatment were *** examined liver biopsies for evidence of residual inflammation and the presence of intrahepatic HCV *** Persistent inflammation was seen in 12/13 patients on end of treatment *** was still seen in the available five follow-up biopsies(range 38-48 wk after the end of treatment).Intrahepatic HCV RNA was undetectable in all *** patients had preserved graft function for a mean follow-up of 2.5 years,except one that developed chronic *** After successful HCV treatment with DAAs,liver transplant recipients may have persistent inflammation on biopsy without evidence of intracellular *** clinical outcome remained favorable in most *** studies with a larger number and longer follow-up are needed to establish the implication of this finding on long-term graft function.

关键词： Immunosuppression Liver transplantation Recurrent hepatitis C Sustained virologic response Interferon

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Errors in visual estimation of flexion contractures during total knee arthroplasty

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World Journal of Orthopedics 2013年第3期4卷 120-123页

作者： Cale A Jacobs Christian P Christensen Peter W Hester David M Burandt Aaron D Sciascia lexington clinic LexingtonKY 40504United States

AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was ***: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error assoc

关键词： Extension Knee Arthroplasty Flexion contracture

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Coinciding anomalous coronary artery and papillary fibroelastoma

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Journal of Geriatric Cardiology 2016年第11期13卷 924-926页

作者： Saif Ibrahim Nachiket Patel Farah Al-Saffar Jean Touchan Division of Cardiology Department of Medicine University of Florida-Jacksonville Jacksonville Florida USA Division of Cardiology DePartment of Medicine Mayo Clinic Scottsdale Arizona USA Division of Cardiology Department of Medicine University of Kentucky Lexington Kentucky USA

The primary cardiac tumors are extremely rare tumors that arise from the normal cardiac tissues. There are benign variants (mostly myxoma) and malignant tumors. Fibroelastoma (FE) is the most common primary tumor, of which myxoma is the most common subtype followed by papillary fibroelastomas (PFE).They account for the majority of primary heart valvular tumors that mainly involve the left (mitral and aortic) valves, and only few cases reported pulmonary valve PFE.[1] We present a case of 61 year old female who had incidental pulmonary valve papillary FE finding on echo along with anomalous coronary arteries.

关键词：纤维瘤弹力冠状动脉乳头恶性肿瘤异常心脏组织良性肿瘤

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核心稳定性在人体运动中的作用

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北京体育大学学报 2008年第12期31卷 1710-1714页

作者： W. Ben Kibler Joel Press Aaron Sciascia 周瑾(译) lexington clinic Sports Medicine Center Lexington KentuckyUSA Rehabilitation Institute of Chicago Chicago Illinois USA 北京体育大学北京100084

在体育运动中,核心的主要作用是稳定身体、是肌肉发力的基础,这一点日益得到公认。从跑步到投掷等各项体育运动中,稳定的核心是有效发挥人体生物力学功能的关键因素,从而使肌肉发力最大化并最大限度减小关节负荷。我们将核心肌群的功能... 详细信息

在体育运动中,核心的主要作用是稳定身体、是肌肉发力的基础,这一点日益得到公认。从跑步到投掷等各项体育运动中,稳定的核心是有效发挥人体生物力学功能的关键因素,从而使肌肉发力最大化并最大限度减小关节负荷。我们将核心肌群的功能理解为中枢神经系统预设的程序,这个程序整合局部的、单关节和多个关节上的肌群活动,在保持整体稳定的同时完成体育动作。近端的稳定性是远端灵活性的基础,在这个基础上可以建立从近端向远端的发力模式,并且可以通过肌群的协同作用力在完成远端动作的同时保护远端关节。评估动态核心能力是一项重要任务,其中包括对躯干特定功能和三维运动能力的评估。运动康复训练计划应该包括核心能力的重建,并且应该将核心视为远端肢体运动的基础。

关键词：核心稳定性人体运动运动康复

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Radiation Therapy Prophylaxis for Heterotopic Ossification in Non-Hip Sites

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Journal of Cancer Therapy 2018年第1期9卷 1-8页

作者： Ajaykumar B. Patel Katherine S. Tzou Megan Single Laeticia Hollant Bridget Smart Katherine Gaines Courtney E. Sherman Jennifer L. Peterson Stephen J. Ko Laura A. Vallow Robert C. Miller Steven J. Buskirk Northside Radiation Oncology Consultants Atlanta GA USA Department of Radiation Oncology Mayo Clinic Jacksonville FL USA College of Medicine University of Kentucky Lexington KY USA University of Central Florida Orlando FL USA University of Florida Gainesville FL USA University of North Florida Jacksonville FL USA Department of Orthopedic Surgery Mayo Clinic Jacksonville FL USA

Background: Radiation therapy prophylaxis for heterotopic ossification is well-established for the hip, either pre or post-operatively. There is limited data for this treatment in non-hip sites. We report our institution’s experience. Methods: From October 2004 to August 2015, a total of 39 non-hip sites in 38 patients were treated with prophylactic radiation therapy for heterotopic ossification at our institution. An IRB approved retrospective review was performed. There were 15 patients who received treatments to the elbow, 13 to the knee (1 bilateral for a total of 14 knees), and 10 to other sites (leg stump (2), pubic symphysis (2), femur (1), foot (1), humerus stump (1), abdominal wall (1), shoulder (1), thigh (1)). All but 1 patient were treated with a single fraction treatment with 700 or 800 cGy. One patient received 2000 cGy in 10 fractions to the abdominal wall for heterotopic ossification extending from the xiphoid process. Results: Fifteen patients underwent treatment to the elbow with a median follow-up of 5 months (0 - 99). Median age for this group was 50 years (37 - 69). Nine (60.0%) patients had evidence of heterotopic ossification prior to surgery. All (100%) of the elbow patients were free from recurrence at last follow-up. There were no acute or late toxicities noted. For treatment to the knee, there were 4 (28.6%) recurrences, all in cases where there were pre-operative heterotopic ossification. There were two other recurrences in the non-hip, elbow or knee sites: one patient who received radiation therapy to the abdominal wall and one patient who underwent treatment to the thigh. Conclusions: Prophylactic radiation therapy with 700 cGy or 800 cGy in 1 fraction either before or after surgery remains a safe and effective treatment for both hip and most non-hip sites. Fractionated treatment may be used for larger treatment fields, however experience is limited.

关键词： Heterotopic Ossification Radiation Therapy Knee Elbow

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No association between cyclooxygenase-2 and uridine diphosphate glucuronosyltransferase 1A6 genetic polymorphisms and colon cancer risk

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World Journal of Gastroenterology 2009年第18期15卷 2240-2244页

作者： Cheryl L Thompson Sarah J Plummer Alona Merkulova Iona Cheng Thomas C Tucker Graham Casey Li Li Departments of Family Medicine and Epidemiology and Biostatistics Case Centerfor Transdisciplinary Research on Energetics and CancerCase Comprehensive Cancer Center Case Western Reserve University. Cleveland OH 44106-7136 United States Department of Preventive Medicine University of Southern California Los Angeles CA90033-1006 United States Department of Cancer Biology Cleveland Clinic Foundation Cleveland OH 44195-0001 United States Department of Epidemiology and Biostatisticsand Institute for Human Genetics University of California SanFrancisco San Francisco CA 94143-0644 United States Markey Cancer Center University of Kentucky Lexington KY 40504-3381 United States

AIM:To investigate the association of variations in the cyclooxygenase-2(COX2) and uridine diphosphate glucuronosyltransferase 1A6(UGT1A6) genes and non-steroidal anti-inflammatory drugs(NSAIDs) use with risk of colon ***:NSAIDs,which are known to reduce the risk of colon cancer,act directly on COX2 and reduce its *** studies have associated variations in the COX2 gene with colon cancer risk,but others were unable to replicate this ***,enzymes in the UGT1A6 gene have been demonstrated to modify the therapeutic effect of NSAIDs on colon *** in the UGT1A6 gene have been statistically shown to interact with NSAID intake to influence risk of developing colon adenomas,but not colon *** we examined the association of tagging single nucleotide polymorphisms(SNPs) in the COX2 and UGT1A6 genes,and their interaction with NSAID consumption,on risk of colon cancer in a population of 422 colon cancer cases and 481 population ***:No SNP in either gene was individually statistically significantly associated with colon cancer,nor did they statistically significantly change the protective effect of NSAID consumption in our *** others,we were unable to replicate the association of variants in the COX2 gene with colon cancer risk(P > 0.05),and we did not observe that these variants modify the protective effect of NSAIDs(P > 0.05).We were able to confirm the lack of association of variants in UGT1A6 with colon cancer risk,although further studies will have to be conducted to confirm the association of these variants with colon ***:Our study does not support a role of COX2 and UGT1A6 genetic variations in the development of colon cancer.

关键词：尿苷二磷酸葡萄糖醛酸转移酶基因多态性环氧合酶-2 结肠癌风险非甾体抗炎药 COX2基因单核苷酸多态性

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手术部位感染和麻醉从业者的微生物群：我们全身都布满了细菌!现在我们该怎么办？

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麻醉与镇痛 2012年第3期8卷 94-97页

作者： -Raymond C. Roy, MD Sorin J. BruU, MD John H. Eichhorn, MD 符强(译) 蒋宗滨(校) Department of Anesthesiology Wake Forest University School of Medicine Winston-Salem North Carolina Department of Anesthesiology Mayo Clinic College of Medicine Jacksonville Horida Department of Anesthesiology College of Medicine University of Kentucky Lexington I(~enmcky 不详

我们身上的数字极其庞大!我们每个人由大约10万亿个细胞构成，伴随着的是共生在我们体内或体表的由100万亿个微生物构成的个人微生物群。手术部位感染只是这种众多和平共处的复杂特性之一。这些微生物影响了我们的进化，它们对消化、代... 详细信息

我们身上的数字极其庞大!我们每个人由大约10万亿个细胞构成，伴随着的是共生在我们体内或体表的由100万亿个微生物构成的个人微生物群。手术部位感染只是这种众多和平共处的复杂特性之一。这些微生物影响了我们的进化，它们对消化、代谢和免疫至关重要；同时它们也充当了我们的传染源。从2007年，国立卫生研究院已经资助国际人类微生物群的研究项目，该项目致力于研究我们身上的微生物群对人类每一个个体的独特性和对人类这一种群的普遍性。

关键词：手术部位感染微生物群从业者国立卫生研究院细菌全身麻醉细胞构成

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Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients

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Family Medicine and Community Health 2023年第3期11卷 86-101页

作者： Jennifer A Lucas Miguel Marino Steffani R Bailey Audree Hsu Roopradha Datta Erika Cottrell Ye Ji Kim Shakira F Suglia Andrew Bazemore John Heintzman Department of Family Medicine Oregon Health&Science UniversityPortlandOregonUSA California University of Science and Medicine ColtonCaliforniaUSA OCHIN Inc PortlandOregonUSA Department of Epidemiology Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA American Board of Family Medicine LexingtonKentuckyUSA

Objective The objective of this research was to examine how different measurements of poverty(household-level and neighborhood-level)were associated with asthma care utilisation outcomes in a community health centre setting among Latino,non-Latino black and non-Latino white ***,setting and participants We used 2012–2017 electronic health record data of an open cohort of children agedclinic *** patients had household FPL200%FPL(55%).Overall,neighbourhood poverty(<100%FPL)was associated with more asthma visits(covariate-adjusted OR 1.26,95%CI 1.12 to 1.41),and living in a low-income neighbourhood(≥100%to<200%FPL)was associated with more albuterol prescriptions(covariate-adjusted rate ratio 1.07,95%CI 1.02 to 1.13).When stratified by race/ethnicity,we saw differences in both directions in associations of household/neighbourhood income and care outcomes between *** This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income,revealing different associations of living in low-income neighbourhoods and households for Latino,non-Latino white and non-Latino black children with *** implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare *** to measure both kinds of poverty(family and

关键词： prescription income Latin

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低温保存血小板临床应用效应研究

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解放军医学杂志 2001年第3期26卷 222-223页

作者：刘景汉王青梅李锡金石群骆群韩玮欧阳锡林高大勇解放军总医院 100853 University of Kentuky lexington

对 15 6 0例输注低温保存血小板的临床患者进行了研究。其中急性白血病 5 36例 ;再生障碍性贫血2 85例 ;化疗和放疗及其他原因所致的血小板减少 2 5 3例 ;围手术期患者 438例 ;DIC、肝硬化食管静脉曲张破裂出血 48例。输注的低温保存血... 详细信息

对 15 6 0例输注低温保存血小板的临床患者进行了研究。其中急性白血病 5 36例 ;再生障碍性贫血2 85例 ;化疗和放疗及其他原因所致的血小板减少 2 5 3例 ;围手术期患者 438例 ;DIC、肝硬化食管静脉曲张破裂出血 48例。输注的低温保存血小板保存时间为 1周～ 8个月居多 ,保存时间最长 13个月。输注的血小板基本上未经洗涤。结果显示 ,输注低温保存的血小板具有升高血小板作用和显著的止血效果 ,且无明显副作用。低温保存血小板在临床应用中 ,从数量保证、供给形式和及时有效等方面都是其他方法获得的血小板所不能比拟的。

关键词：血液保存成份输血低温保藏

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Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

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Family Medicine and Community Health 2021年第3期9卷 47-53页

作者： Jennifer A Lucas Miguel Marino Sophia Giebultowicz Katie Fankhauser Shakira F Suglia Steffani R Bailey Andrew Bazemore John Heintzman Department of Family Medicine Oregon Health&Science UniversityPortlandOregonUSA OCHIN Inc PortlandOregonUSA Department of Epidemiology Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA American Board of Family Medicine LexingtonKentuckyUSA Center for Professionalism&Value in Health Care WashingtonDCUSA

Objective Asthma care is negatively impacted by neighbourhood social and environmental factors,and moving is associated with undesirable asthma ***,little is known about how movement into and living in areas of high deprivation relate to primary care *** examined associations between neighbourhood characteristics,mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care *** In this cohort study,we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal *** models were adjusted for patient-level *** We used data from community health centres in 15 OCHIN *** The sample included 23773 children with asthma aged 3-17 across neighbourhoods with different levels of social deprivation from 2012 to *** conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal *** models were adjusted for patient-level *** clinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation(rate ratio(RR)1.09,95%CI 1.02 to 1.17;RR 1.05,95%CI 1.00 to 1.11).Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination(RR 1.13,95%CI 1.03 to 1.23)than those who moved but stayed in neighbourhoods of low *** Movement into and living within areas of high deprivation is associated with more primary care use,and presumably greater opportunity to reduce undesirable asthma *** results highlight the need to attend to patient movement in primary care visits,and increase neighbourhood-targeted population management to improve equity and care f

关键词： deprivation asthma vaccination

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