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Capsule endoscopy in Crohn's disease: Are we seeing any better?

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World Journal of Gastroenterology 2014年第36期20卷 13044-13051页

作者： David Hudesman Jonathan Mazurek Arun Swaminath inflammatory bowel disease Center Division of Digestive Diseases Mount Sinai Beth Israel New York NY 10003 United States Division of Digestive diseases Mount Sinai Beth Israel New York NY 10003 United States Division of Gastroenterology NSLIJ Lenox Hill Hospital New York NY 10075 United States

Crohn’s disease (CD) is a complex, immune-mediated disorder that often requires a multi-modality approach for optimal diagnosis and management. While traditional methods include ileocolonoscopy and radiologic modalities, increasingly, capsule endoscopy (CE) has been incorporated into the algorithm for both the diagnosis and monitoring of CD. Multiple studies have examined the utility of this emerging technology in the management of CD, and have compared it to other available modalities. CE offers a noninvasive approach to evaluate areas of the small bowel that are difficult to reach with traditional endoscopy. Furthermore, CE maybe favored in specific sub segments of patients with inflammatory bowel disease (IBD), such as those with IBD unclassified (IBD-U), pediatric patients and patients with CD who have previously undergone surgery.

关键词： Crohn’ s disease Diagnosis Prognosis Capsule endoscopy inflammatory bowel disease disease monitoring

Non-invasive diagnosis of advanced fibrosis and cirrhosis

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World Journal of Gastroenterology 2014年第45期20卷 16820-16830页

作者： Suraj Sharma Korosh Khalili Geoffrey Christopher Nguyen Toronto centre for Liver disease Toronto Western Hospital Department of Medical Imaging University Health Network Joseph and Wolf Lebovic Health Complex Mount Sinai Hospital

Liver cirrhosis is a common and growing public health problem *** diagnosis of cirrhosis portends an increased risk of morbidity and *** biopsy is considered the gold standard for diagnosis of cirrhosis and staging of ***,despite its universal use,liver biopsy is an invasive and inaccurate gold standard with numerous *** order to overcome the limitations of liver biopsy,a number of non-invasive techniques have been investigated for the assessment of *** review will focus on currently available non-invasive markers of *** evidence behind the use of these markers will be highlighted,along with an assessment of diagnostic accuracy and performance characteristics of each ***-invasive markers of cirrhosis can be radiologic or *** techniques based on ultrasound,magnetic resonance imaging and elastography have been used to assess liver ***-based biomarkers of cirrhosis have also been *** are broadly classified into indirect and direct *** biomarkers reflect liver function,which may decline with the onset of *** biomarkers,reflect extracellular matrix turnover,and include molecules involved in hepatic *** the whole,radiologic and serum markers of fibrosis correlate well with biopsy scores,especially when excluding cirrhosis or excluding *** feature is certainly clinically useful,and avoids liver biopsy in many cases.

关键词： Cirrhosis Biomarker Non-invasive Fibrosis Viral Non-alcoholic fatty liver disease Primary biliary cirrhosis Autoimmune hepatitis Hepatitis B virus Hepatitis C virus

Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care

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World Journal of Gastroenterology 2013年第38期19卷 6375-6382页

作者： Adam V Weizman Geoffrey C Nguyen Division of Gastroenterology Women’s College HospitalUniversity of TorontoTorontoON M5S 1B2Canada mount sinai hospital centre for inflammatory bowel disease University of TorontoTorontoON M5G 1X5Canada Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21205United States

Over the past decade,there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases,including inflammatory bowel *** bowel disease is a complex,chronic condition with associated morbidity,health care costs,and reductions in quality of *** condition is managed primarily in the outpatient *** delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity,the use of steroid-sparing agents,screening prior to anti-tumor necrosis factor therapy,and monitoring thiopurine *** review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs,quality improvement frameworks,collaborative efforts in quality improvement,and the use of healthcare information technology.

关键词： Ambulatory care Crohn’s disease inflammatory bowel disease Quality improvement Ulcerative colitis

Quality of care delivered to hospitalized inflammatory bowel disease patients

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World Journal of Gastroenterology 2013年第38期19卷 6360-6366页

作者： Adam V Weizman Geoffrey C Nguyen Division of Gastroenterology Women’s College HospitalUniversity of TorontoTorontoM5S 1B2OntarioCanada mount sinai hospital centre for inflammatory bowel disease University of TorontoTorontoM5G 1X5OntarioCanada Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21201United States

hospitalized patients with inflammatory bowel disease(IBD)are at high risk for morbidity,mortality,and health care utilization *** the literature on trends in hospitalization rates for this disease is conflicting,there does appear to be significant variation in the delivery of care to this complex group,which may be a marker of suboptimal quality of *** is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce ***,appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is *** review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as payfor-performance models,quality improvement frameworks,and healthcare information technology.

关键词： Crohn’s disease hospitalization inflammatory bowel disease Quality improvement Ulcerative colitis

Fetal therapy for congenital diaphragmatic hernia:past,present and future

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World Journal of Pediatric Surgery 2024年第3期7卷 198-208页

作者： Nimrah Abbasi Tim Van Mieghem Greg Ryan Fetal Medicine Unit and Ontario Fetal centre Department of Obstetrics and GynaecologyMount Sinai HospitalTorontoOntarioCanada

Congenital diaphragmatic hernia(CDH)affects 1/2500-5000 infants and is associated with significant neonatal morbidity and mortality related to pulmonary hypoplasia and pulmonary *** estimates of perinatal mortality are between 30-40%.With advances in neonatal and surgical management and now improvements in prenatal diagnosis and intervention,further reduction in mortality is *** from the international Tracheal Occlusion to Accelerate Lung Growth(TOTAL)trials,have demonstrated the efficacy of fetal endoscopic tracheal occlusion(FETO)in severe left CDH(LCDH).Although promising,this intervention also has potential for significant morbidity related to prematurity and iatrogenic mortality if reversal of tracheal occlusion is *** implementation of FETO must proceed cautiously within LevelⅢfetal therapy centers and with rigorous outcomes monitoring of centers offering this therapy,ensuring that they are experienced in antenatal severity assessment of CDH,FETO insertion and removal and are integrated with expert,standardized neonatal CDH centers with availability of Extracorporeal life support(ECLS).Further research is needed to better understand the impact of prematurity on FETO survivors,the role of FETO in moderate LCDH,Right CDH(RCDH)and non-isolated CDH in carefully selected circumstances as well as the development of alternative,less invasive,fetal therapies that can specifically target both pulmonary hypoplasia and pulmonary hypertension.

关键词： fetal hernia diagnosis

Colectomy is a risk factor for venous thromboembolism in ulcerative colitis

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World Journal of Gastroenterology 2015年第4期21卷 1251-1260页

作者： Gilaad G Kaplan Allen Lim Cynthia H Seow Gordon W Moran Subrata Ghosh Yvette Leung Jennifer Debruyn Geoffrey C Nguyen James Hubbard Remo Panaccione inflammatory bowel disease Clinic University of CalgaryCalgary AB T2N 4N1Canada Division of Gastroenterology University of CalgaryCalgary AB T2N 4N1Canada Departments of Medicine University of CalgaryCalgary AB T2N 4N1Canada Community Health Sciences University of CalgaryCalgary AB T2N 4N1Canada Paediatrics University of CalgaryCalgary AB T2N 4N1Canada mount sinai centre for inflammatory bowel disease University of TorontoToronto ON M5SCanada Institute for Clinical Evaluative Sciences Toronto ON M5SCanada

AIM: To compare venous thromboembolism(VTE) in hospitalized ulcerative colitis(UC) patients who respond to medical management to patients requiring colectomy. METHODS: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. UC patients were stratified by:(1) responsive to inpatient medical therapy(n = 382);(2) medically refractory requiring emergent colectomy(n = 309); and(3) elective colectomy(n = 329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course(i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications(i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios(OR) with 95%***: The prevalence of VTE among patients with UC who responded to medical therapy was 1.3% and only 16% of these patients received heparinprophylaxis. In contrast, VTE was higher among patients who underwent an emergent(8.7%) and elective(4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal(45.8%) followed by lower extremity(19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective(adjusted OR = 3.69; 95%CI: 1.30-10.44) and emergent colectomy(adjusted OR = 5.28; 95%CI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive UC patients. Furthermore, the odds of a VTE significantly increased across time(adjusted OR = 1.10; 95%CI: 1.01-1.20). Age, sex, c

关键词： inflammatory bowel diseases Ulcerative colitis Dee

Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China

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World Journal of Pediatrics 2017年第2期13卷 144-151页

作者： Xiao-Ying Li Shoo Lee Hua-Feng Yu Xiang Y Ye Ruth Warre Xiang-Hong Liu Jian-Hong Liu Neonatalogy Department Qilu Children’s Hospital Shandong UniversityJinanChina Maternal—Infant Care Research centre Mount Sinai HospitalTorontoOntarioCanada Department of Pediatrics University ofTorontoOntarioCanada

Background:Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across *** is not usually permitted or may be strictly limited,and NICU care for most neonates is provided by health-care professionals with little participation of the *** exception to this rule is the level 2 'Room-In' ward in Qilu Children's hospital,Shandong University,where parents have 24-hour access to their infants and participate in providing ***:This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group,n=428),admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group,n=1018),or admitted straight to the Room-In ward (RIn only group,n=629).Results:There were no significant differences in the rates of nosocomial infection,bronchopulmonary dysplasia,intraventricular hemorrhage,and retinopathy of prematurity between the NICU-NICU and NICURIn *** rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04),while weight gain and duration of hospital stay were significantly higher (both P<0.001).Rates of adverse outcomes were lower in RIn-only infants due to their low severity of illness on ***:Allowing parents access to their infant in the NICU is feasible and safe in China,and may result in improvements in infant *** studies are required to generate stronger evidence that can inform changes to neonatal care in China.

关键词： care-by-parent family-centered care infant newborn neonatal intensive care unit parental involvement

Plasma and wound fluid levels of eight proangiogenic proteins are elevated after colorectal resection

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World Journal of Gastrointestinal Oncology 2019年第6期11卷 470-488页

作者： HMC Shantha Kumara Xiao-Hong Yan Erica Pettke Vesna Cekic Nipa Dilip Gandhi Geoffrey A Bellini Richard L Whelan Division of Colon and Rectal Surgery Department of SurgeryMount Sinai West HospitalNew YorkNY 10019United States Department of Surgery Mount Sinai Icahn School of MedicineNew YorkNY 10029United States

BACKGROUND Colorectal resection is associated with 3-5 wk long elevations in the plasma levels of at least 11 proangiogenic proteins that may stimulate tumor angiogenesis *** increases during the first week after surgery may be related to the acute inflammatory response;the cause(s)of the week 2-5 increases is *** wounds are a possible source because of the important role that angiogenesis plays in the healing *** main hypothesis of the study is that wound fluid levels of the proteins studied will be elevated well beyond plasma levels which,in turn,are elevated from preoperative baseline *** To determine plasma and wound fluid levels of 8 proangiogenic proteins after colorectal resection for cancer and benign *** Blood and wound fluid samples were taken simultaneously on postoperative(postop)day 1,3,and later time points until wound drain removal in 35 colorectal cancer patients and 31 benign disease patients undergoing colorectal resection in whom closed wound drains had been placed in either the pelvis or the subcutaneous space of the abdominal *** plasma levels were compared to preop plasma and postop wound fluid levels(separate analyses for cancer and benign groups).RESULTS Sixty-six colorectal disease patients were studied(35 cancer,31 benign pathology).Most patients underwent minimally invasive surgery(open surgery in 11%of cancer and 6%of benign patients).The majority in the cancer group had rectal resections while in the benign group sigmoid or right colectomy *** levels of all 8 proteins were significantly elevated from baseline (P<0.05) at all post-operative time points in the cancer group and at 90% of time points(29/32) in the benign *** levels of all 8 proteins were 3-106 times higher (P<0.05) than plasma levels at 87-90 percent of postop time points;of note,wound levels were more than 10 times higher at 47-50% of time *** Plasma protein levels were elevat

关键词： Effects of surgery Colorectal resection Colorectal cancer Plasma protein levels Wound protein levels Angiogenesis

Burning Mouth Syndrome

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International Journal of Oral Science 2010年第1期2卷 1-4页

作者： David Mock Deepika Chugh Faculty of Dentistry University of TorontoWasser Pain Management CentreMount Sinai Hospital

Most clinicians dread seeing the patient presenting with a primary complaint of a burning pain on one or more oral mucosal surfaces. Unlike most other clinical conditions presenting in a dental office, burning mouth syndrome is poorly understood with few evidence based remedies. More recently, advances have been made towards clarifying the possible etiology of the disorder and testing the possible therapeutic modalities available. This article attempts to summarize the ＂state of the art＂ today.

关键词： orofacial pain burning mouth syndrome (BMS),stomatodynia neuropathic pain