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Use of doppler ultrasound to predict need for transjugular intrah.patic portosystemic sh.nt revision

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World Journal of h.patology 2022年第6期14卷 1200-1209页

作者： Nikki Duong Marcus h.aley Kunal Patel Brian J Strife Rich.rd K Sterling Division of Gastroenterology Hepatologyand NutritionVirginia Commonwealth University Medical CenterRichmondVA 23219United States Department of Internal Medicine Virginia Commonwealth University Medical CenterRichmondVA 23219United States Division of Interventional Radiology Virginia Commonwealth University Medical CenterRichmondVA 23219United States

BACKGROUND Transjugular intrah.patic portosystemic sh.nt(TIPS)is used to treat complications of portal h.pertension,such.as ascites and variceal bleeding(VB).Wh.le liver doppler ultrasound(DUS)is used to assess TIPS patency,trans-sh.nt venograph.(TSV)is th. gold *** To determine th. accuracy of DUS to assess TIPS dysfunction and for need for *** Retrospective review of patients referred for TIPS revision from ***,DUS parameters at baseline and at th. DUS preceding TIPS revision,TSV data were *** operating ch.racteristics curves,sensitivity,specificity,performance for doppler to predict need for revision were *** and multivariate analyses were used to predict clinical factors associated with.need for TIPS *** Th. coh.rt consisted of 89 patients with.cirrh.sis(64%men,76%wh.te,31%alcoh.l as etiology);median age 59 *** for initial TIPS were VB(41%),refractory ascites(51%),and oth.r(8%).TIPS was revised in 44%.On univariate analysis,factors associated with.need for TIPS revision were male(P=0.03),initial indication for TIPS(P=0.05)and indication for revision(P=0.01).Revision of TIPS was associated with.lower mortality(26%vs 46%)and significantly lower rates of transplant(13%vs 24%;P=0.1).In predicting need for TIPS revision,DUS h.s a 40%sensitivity,45%specificity,PPV 78%,and NPV 14%.Th. most accurate location for sh.nt velocity measure was distal velocity(Area under th. curve:0.79;P=0.0007).CONCLUSION DUS h.s poor overall sensitivity and specificity in predicting need for TIPS ***-invasive meth.ds of predicting TIPS dysfunction are needed since th.se needing TIPS revision h.d better survival.

关键词： Transjugular intrah.patic portosystemic sh.nt Doppler ultrasound Portal h.pertension

Management of diabetic dyslipidemia: An update

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World Journal of Diabetes 2019年第5期10卷 280-290页

作者： Ish.arlal Jialal Gurdeep Singh California North.state University College of Medicine VA Medical Center Lady of Lourdes Memorial h.spital

Diabetic dyslipidemia is a cluster of lipoprotein abnormalities ch.racterized by increased triglyceride level, decreased h.gh.density lipoprotein-ch.lesterol levels and increase in small dense low-density lipoprotein(LDL) particles. It is extremely common in type 2 diabetes(T2DM) affecting around 70 % of *** is a significant risk factor for ath.rosclerotic cardiovascular disease(ASCVD) wh.ch.is th. most common cause of death.in th. United States and LDL-ch.lesterol is th. number 1 predictor of ASCVD events in T2DM. Th. purpose of th.s review is to discuss th. path.ph.siology and treatment of diabetic dyslipidemia. In th.s review, we h.ve discussed both.nonph.rmacological and ph.rmacological treatment modalities including major treatment trials wh.ch.h.ve impacted th. cardiovascular outcomes in patients with.diabetes. Statin th.rapy is th. mainstay of treatment to reduce ASCVD by decreasing LDL-C by 30%-49% or at least 50% depending on risk level. Attractive adjunctive th.rapies include Ezetimibe wh.ch.is more cost effective and PCSK9 inh.bitors wh.ch.display potent LDL-ch.lesterol lowering and ASCVD event reduction. For severe h.pertriglyceridemia, to avert th. risk of pancreatitis, both.fish.oil and fenofibrate in concert with.diet is th. best strategy.

关键词： Diabetes Dyslipidemia Statins Ath.rosclerosis Ezetimibe PCSK9

Nuances of oblique lumbar interbody fusion at L5-S1:Th.ee case reports

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World Journal of Orth.pedics 2021年第6期12卷 445-455页

作者： Ch.rag A Berry Department of Orth.paedics Cincinnati VA Medical CenterCincinnatiOH 45220United States

BACKGROUND Oblique lumbar interbody fusion is a mini-open retroperitoneal approach.th.t uses a wide corridor between th. left psoas muscle and th. aorta above *** approach.avoids th. limitations of lateral lumbar interbody fusion,is considered less invasive th.n anterior lumbar interbody fusion,and is similarly effective for indirect decompression and improving lordosis wh.le maintaining a low complication *** L5-S1,wh.n required,adds to th.se advantages,as th.s allows single-position ***,variations in vascular anatomy can affect th. ease of access to th. L5-S1 *** nuances of th.ee different oblique anterolateral tech.iques to access L5-S1 for interbody fusion,namely,left-sided intra-bifurcation,left-sided pre-psoas,and righ.-sided pre-psoas approach.s,are illustrated using th.ee representative case *** SUMMARY Cases of th.ee patients wh. underwent multilevel oblique lumbar interbody fusion including L5-S1,using one of th. th.ee different tech.iques,are *** patients presented with.symptomatic degenerative lumbar path.logy and failed conservative management prior to *** anatomical considerations th.t affected th. decisions to utilize each.approach.are *** pros and cons of each.approach.are also discussed.A parasagittal facet line objectively assesses th. relationsh.p between th. left common iliac vein and th. L5-S1 disc and assists in ch.osing th. approach.to *** Oblique retroperitoneal access to L5-S1 in th. lateral decubitus position is possible th.ough.th.ee different *** ch.ice of approach.to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative *** most surgeons will rely on th.ir experience and comfort level in ch.osing th. approach.th.s article elucidates th. nuances of each.tech.ique.

关键词： Oblique lumbar interbody fusion Prepsoas approach Anterior to psoas Common iliac vein Iliolumbar vein Case report

Approach.s to improve quality of care in inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第28期20卷 9281-9285页

作者： Rajesh.Sh.h.Jason K h.u Department of Medicine Baylor College of Medicine h.uston va h.R&D center of Excellence Michael E DeBakey Veterans Affairs Medical Center

Studies across medical disciplines h.ve sh.wn gaps in th. care recommended in evidence based guidelines and th. care actually delivered. Quality improvement projects using systematic audit and feedback interventions such.as quality measures, will become increasingly important tools to address th.se gaps in care. Th.se gaps are also apparent in th. care of patients with.inflammatory bowel disease. Multiple organizations, including th. American Gastroenterology Association and th. Croh.’s and Colitis Foundation of America, h.ve developed programs designed to implement quality measures to improve th. care of inflammatory bowel disease (IBD) patients. Early results sh.w promise of improving quality, but numerous barriers remain. Gastroenterologists need to be aware of th.se processes to provide th. h.gh.st care possible to patients with.IBD. We review th. existing literature on approach.s to quality improvement and th.ir potential application and barriers wh.n applied to IBD care.

关键词： Inflammatory bowel disease Croh.'s disease Ulcerative colitis Quality

Preoperative ph.siological esoph.geal assessment for anti-reflux surgery:A guide for surgeons on h.gh.resolution manometry and ph.testing

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World Journal of Gastroenterology 2021年第16期27卷 1751-1769页

作者： Mich.el Yodice Alexandra Mignucci Virali Sh.h.Ch.istoph.r Ash.ey Mich.al Tadros Department of Gastroenterology Albany Medical CollegeAlbanyNY 12208United States Section of Gastroenterology Stratton VA Medical CenterAlbanyNY 12208United States Department of Gastroenterology Albany Medical CenterSchenectadyNY 12309United States

Gastroesoph.geal reflux disease (GERD) is one of th. most commonlyencountered digestive diseases in th. world, with.th. prevalence continuing toincrease. Many patients are successfully treated with.lifestyle modifications andproton pump inh.bitor th.rapy, but a subset of patients require more aggressiveintervention for control of th.ir symptoms. Surgical treatment with.fundoplicationis a viable option for patients with.GERD, as it attempts to improve th. integrityof th. lower esoph.geal sph.ncter (LES). Wh.le surgery can be as effective asmedical treatment, it can also be associated with.side effects such.as dysph.gia,bloating, and abdominal pain. Th.refore, a th.rough.pre-operative assessment iscrucial to select appropriate surgical candidates. Newer tech.ologies arebecoming increasingly available to h.lp clinicians identify patients with.true LESdysfunction, such.as ph.impedance studies and h.gh.resolution manometry(h.M). Pre-operative evaluation sh.uld be aimed at confirming th. diagnosis ofGERD, ruling out any major motility disorders, and selecting appropriate surgicalcandidates. h.M and ph.testing are key tests to consider for patients with.GERDlike symptoms, and th. addition of provocative measures such.as straigh. legraises and multiple rapid swallows to h.M protocol can assess th. presence ofunderlying h.atal h.rnias and to test a patient’s peristaltic reserve prior tosurgery.

关键词： Gastroesoph.geal reflux disease Fundoplication h.gh.resolution manometry ph.impedance Anti-reflux surgery Pre-operative assessment

Mortality in patients with.h.art failure and suicidal ideation disch.rged to skilled nursing facilities

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Journal of Geriatric Cardiology 2022年第3期19卷 198-208页

作者： Melanie L Bozzay Lan Jiang Andrew R Zullo Melissa R Riester Jacob A Lafo Zach.ry J Kunicki James L Rudolph.Caroline Madrigal Rach.l Clements Sebh.t Erqou Wen-Ch.h.Wu Steph.n Correia Jennifer M Primack Department of Psych.atry&h.man Beh.vior Alpert Medical School of Brown UniversityBox G-BHProvidenceRhode IslandUnited States va RR&D center for Neurorestoration and Neurotech.ology Providence VA Medical Center830 Chalkstone BoulevardProvidenceRhode IslandUnited States va center of Innovation in Long Term Services Providence VA Medical Center830 Chalkstone BoulevardProvidenceRhode IslandUnited States Department of h.alth.Services Policyand PracticeBrown University School of Public HealthBox G-S121-8ProvidenceRhode IslandUnited States Department of Medicine Alpert Medical School of Brown UniversityBox G-BHProvidenceRhode IslandUnited States

h.art failure(h.)is a leading cause of morbidity and mortality in th. United States.[1]A ch.onically,disabling and debilitating condition,h. often results in h.spital admission and subsequent readmission.[2]After h.s-pitalization,nearly 25%of older adults with.h. are disch.rged to skilled nursing facilities(SNFs)for re-h.bilitation due to difficulties with.functioning in-dependently.[3]Critically,patients with.h. dis-ch.rged to SNFs also sh.w significantly h.gh.r rates of mortality.[2]Identifying factors th.t predict mortality among th.s important patient population,especially factors th.t could be addressed in th. h.spital setting,is an important step toward im-proving survivability among th.se patients.

关键词： patients mortality nursing

Identification of microbial contaminants in sinus rinse squeeze bottles used by allergic rh.nitis patients

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World Journal of Otorh.nolaryngology-h.ad and Neck Surgery 2019年第1期5卷 26-29页

作者： Sh.un A.Nguyen Marc P.Camilon Rodney J.Sch.osser medical University of South.Carolina Department of OtolaryngologyHead&Neck SurgeryCharlestonSCUSA medical University of South.Carolina Department of OtolaryngologyHead&Neck SurgeryCharlestonSCUSARalph H.Johnson VA Medical CenterCharlestonSCUSA

Objective:To identify wh.th.r irrigation devices become contaminated wh.n used by patients with.allergic rh.nitis (AR).Meth.ds:Ten AR patients with.no clinical or endoscopic evidence of active sinonasal infection were given a sinus rinse system and instructed on its proper use,cleaning,and *** squeeze bottles (bottle A and bottle B) were given to each.patient for twice-a-day *** A was used in th. morning and analyzed after four *** B was used in th. evening and analyzed after 8 weeks of *** contaminants were cultured from th. nose pieces and th. inner surface of th. bottles obtained from ***:Seventeen sinus rinse devices (17/20) from all individuals in th.s study grew bacteria commonly in th. ***-four bacterial isolates consisting of 14 different species were cultured and identified with.most common organisms being bacilli and *** addition,no correlation was apparent between th. length.of bottle use and th. degree of contamination (r =0.13,p =0.76).During th. study period,no patient developed acute sinus ***:Microbial contamination of th. sinus rinse system occurs commonly,even in uninfected AR patients;h.wever no evidence exists linking th.s to clinically relevant sinus infections.

关键词： Allergic rh.nitis Microbial contaminants Sinus irrigation Sinus rinse Squeeze bottles

Early versus delayed necrosectomy in pancreatic necrosis:A population-based coh.rt study on readmission,h.alth.are utilization,and in-h.spital mortality

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World Journal of Meth.dology 2024年第3期14卷 55-67页

作者： h.ssam Ali Faisal Inayat Vinay Jah.girdar Fouad Jaber Arslan Afzal Pratik Patel h.mza Tah.r Muh.mmad Sajeel Anwar Attiq Ur Reh.an Muh.mmad Sarfraz Ah.sh.mullah.Ch.udh.y Gul Nawaz Dush.ant Singh.Dah.ya Amir h.Soh.il Muh.mmad Aziz Division of Gastroenterology and h.patology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Division of Gastroenterology and h.patology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology and h.patology The University of ToledoToledoOH 43606United States

BACKGROUND Acute necrotizing pancreatitis is a severe and life-th.eatening *** poses a considerable ch.llenge for clinicians due to its complex nature and th. h.gh.risk of *** minimally invasive and open necrosectomy procedures h.ve been *** advancements in treatment modalities,th. optimal timing to perform necrosectomy lacks *** To evaluate th. impact of necrosectomy timing on patients with.pancreatic necrosis in th. United *** A national retrospective coh.rt study was conducted using th. 2016-2019 Nationwide Readmissions *** with.non-elective admissions for pancreatic necrosis were *** participants were divided into two groups based on th. necrosectomy timing:Th. early group received intervention with.n 48 h.urs,wh.reas th. delayed group underwent th. procedure after 48 *** various intervention tech.iques included endoscopic,percutaneous,or surgical *** major outcomes of interest were 30-day readmission rates,h.alth.are utilization,and inpatient *** A total of 1309 patients with.pancreatic necrosis were *** propensity score match.ng,349 cases treated with.early necrosectomy were match.d to 375 controls wh. received delayed *** early coh.rt h.d a 30-day readmission rate of 8.6% compared to 4.8%in th. delayed coh.rt(P=0.040).Early necrosectomy h.d lower rates of mech.nical ventilation(2.9%vs 10.9%,Ph.ck(8%vs 19.5%,Ph.spital mortality(1.1%vs 4.3%,P=0.01).Patients in th. early intervention group incurred lower h.alth.are costs,with.median total ch.rges of $52202 compared to$147418 in th. delayed *** in th. early coh.rt also h.d a relatively sh.rter median length.of stay(6 vs 16 days,Ph. timing of necrosectomy did not significantly influence th. risk of 30-day readmission,with.a h.zard ratio of 0.56(95%confidence interval:0.31-1.02,P=0.06).CONCLUSION Our findings sh.w th.t

关键词： Acute necrotizing pancreatitis Pancreatic necrosis Early necrosectomy Delayed necrosectomy Readmission,h.alth.are costs Mortality

Battle of th. sexes: contrasting roles of testis-specific protein Y-encoded (TSPY) and TSPX in h.man oncogenesis

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Asian Journal of Andrology 2019年第3期21卷 260-269页

作者： Yun-Fai Ch.is Lau Yunmin Li Tatsuo Kido Division of Cell and Developmental Genetics Department of Medicine VA Medical Center and Institute for Human Genetics University of California San Francisco CA 94121 USA

Th. Y-located testis-specific protein Y-encoded (TSPY) and its X-h.mologue TSPX originated from th. same ancestral gene, but act as a proto-oncogene and a tumor suppressor gene, respectively. TSPY h.s specialized in male-specific functions, wh.le TSPX h.s assumed th. functions of th. ancestral gene. Both.TSPY and TSPX h.rbor a conserved SET/NAP domain, but are divergent at flanking structures. Specifically, TSPX contains a C-terminal acidic domain, absent in TSPY. Th.y possess contrasting properties, in wh.ch.TSPY and TSPX, respectively, accelerate and arrest cell proliferation, stimulate and inh.bit cyclin B-CDK1 ph.sph.rylation activities, h.ve no effect and promote proteosomal degradation of th. viral h.x oncoprotein, and exacerbate and repress androgen receptor (AR) and constitutively active AR variant, such.as AR-V7, gene transactivation. Th. inh.bitory domain h.s been mapped to th. carboxyl acidic domain in TSPX, truncation of wh.ch.results in an abbreviated TSPX exerting positive actions as TSPY. Transposition of th. acidic domain to th. C-terminus of TSPY results in an inh.bitory protein as intact TSPX. h.nce, genomic mutations/aberrant splicing events could generate TSPX proteins with.truncated acidic domain and oncogenic properties as th.se for TSPY. Furth.r, TSPY is upregulated by AR and AR-V7 in ligand-dependent and ligand-independent manners, respectively, suggesting th. existence of a positive feedback loop between a Y-located proto-oncogene and male sex h.rmone/receptors, th.reby amplifying th. respective male oncogenic actions in h.man cancers and diseases. TSPX counteracts such.positive feedback loop. h.nce, TSPY and TSPX are h.mologues on th. sex ch.omosomes th.t function at th. two extremes of th. h.man oncogenic spectrum.

关键词： androgen receptor AR-V7 cell cycle regulation cyclin B-CDK1 oncogene sex ch.omosomes sex differences TSPX TSPY tumor suppressor