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Roux-en-Y jejunostomy in gastroparesis:Insight into patient perspectives and outcomes

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World Journal of Gastrointestinal Surgery 2025年第3期17卷 106-115页

作者： Omar Salehi Wei-Lun Gao Christian Kenfield Geoff Hebbard Department of Gastroenterology and Hepatology Royal Melbourne HospitalParkville 3052VictoriaAustralia Department of General Surgery Melbourne Private HospitalParkville 3052VictoriaAustralia

BACKGROUND Gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical *** with refractory gastroparesis often require enteral nutrition support,but traditional feeding methods such as nasojejunal tubes and percutaneous gastrojejunostomy tubes have significant limitations including frequent displacement,infection,and impact on quality of *** To explore patients’experience post insertion of laparoscopic Roux-en-Y jejunostomy in a cohort of eight adult patients with idiopathic *** Eight patients with idiopathic gastroparesis who underwent Roux-en-Y jejunostomy placement between 2019-2022 were interviewed about their pre-and post-procedure *** procedure involves creating a jejunal limb anastomosed to the proximal jejunum in a Y-configuration,with the limb brought to the abdominal wall for feeding tube *** is designed to reduce leakage by diverting intestinal contents away from the *** included symptoms,nutrition,quality of life,and comparison to previous feeding *** Post-procedure,all patients reported improvements in nausea/vomiting,and 87.5%noted reduced abdominal *** stabilized and oral intake improved in 75%of ***(87.5%)described improved social confidence,increased energy,and better work/school *** patients(37.5%)eventually maintained adequate oral nutrition without *** complications included leakage(37.5%)and hypergranulation *** the cohort used supplemental gastric *** patients(87.5%)preferred Roux-en-Y jejunostomy over previous feeding tubes and would undergo the procedure *** Despite some challenges,Roux-en-Y jejunostomy led to notable improvements in symptoms,nutrition,and quality of life for most patients with refractory *** may be a viable option for long-term enteral nutrition support in carefully selected *** research

关键词： Gastroparesis Jejunostomy Enteral nutrition Quality of life Feeding tube

Solitary Osteolytic Bone Metastatic Lesion from Prostate Carcinoma: A Case Report

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Open Journal of Urology 2025年第1期15卷 19-25页

作者： Sumaiya Al Siyabi Noor Muhammad Fazaldad Khalid Al Busaidi Department of Nuclear Royal Hospital Muscat Sultanate of Oman Oman Medical Specialty Board (OMSB) Muscat Sultanate of Oman

Prostate cancer is one of the most common cancers among males worldwide and a common cause of cancer related mortality in males. Bone metastasis from prostate cancer is common in advanced stage disease leading to major complications including severe bone pain and fractures. Here, we present a case of 79-year-old male newly diagnosed metastatic prostate cancer, with metastasis to the lungs, liver and lymph nodes, and a solitary osteolytic bone metastasis seen in bone scan. It is well known that osseous metastasis from prostate cancer is primarily sclerotic, although lytic bone metastasis is rare, but it can also be seen as in our case.

关键词： Prostate Cancer Osteolytic Osseous Metastasis Bone Scan

Effect of dietary fibre on the gastrointestinal microbiota during critical illness:A scoping review

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World Journal of Critical Care Medicine 2025年第1期14卷 49-59页

作者： Angajendra N Ghosh Calum J Walsh Matthew J Maiden Tim P Stinear Adam M Deane Department of Intensive Care The Northern HospitalEpping 3076VictoriaAustralia Department of Microbiology and Immunology The Peter Doherty Institute for Infection and ImmunityMelbourne 3052VictoriaAustralia Department of Intensive Care The Royal Melbourne HospitalThe University of MelbourneParkville 3050VictoriaAustralia Department of Intensive Care Medicine The Royal Melbourne HospitalParkville 3050VictoriaAustralia

The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly *** strategies to modulate the GI microbiota during chronic diseases have demonstrated *** changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain *** fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI *** aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical *** controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were *** show dietary fibres have an impact on faecal microbiota in health and *** fibre,inulin,has a marked and specific effect on increasing the abundance of faecal *** chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient *** few trials have evaluated the effect of dietary fibre on the GI microbiota during critical *** research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.

关键词： Gastrointestinal microbiota Dietary fibre Health Critical illness Short chain fatty acids

Gene therapy for spinal muscular atrophy:perspectives on the possibility of optimizing SMN1 delivery to correct all neurological and systemic perturbations

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Neural Regeneration Research 2025年第7期20卷 2011-2012页

作者： Sharon J.Brown Rafael J.Yáñez-Muñoz Heidi R.Fuller School of Pharmacy and Bioengineering Keele UniversityKeeleUK Wolfson Center for Inherited Neuromuscular Disease TORCH BuildingRJAH Orthopaedic HospitalOswestryUK *** Center of Gene and Cell TherapyDepartment of Biological SciencesSchool of Life Sciences and the EnvironmentRoyal Holloway University of LondonEghamUK

Spinal muscular atrophy(SMA)is a genetic condition that results in selective lower motor neuron loss with concomitant muscle weakness and *** genetic cause of SMA was understood in 1995 when loss or impairment of the survival motor neuron 1(SMN1)gene was identified as the main contributing factor(Lefebvre et al.,1995).This,in combination with the discovery that humans have a“back-up”gene,SMN2,which can produce low levels(approximately 10%)of the full-length functional SMN protein,has led to the generation of SMA-specific gene *** was traditionally classified according to age of symptom onset and developmental milestones achieved,with life expectancy and severity varying between ***,SMN2 copy number is used as a proxy for the prediction of disease severity,with higher SMN2 copy number typically being associated with reduced severity of SMA,although this relationship is not absolute:some individuals with low SMN2 copy number have less severe SMA phenotypes and vice ***,the etiology of SMA is further complicated by other factors,such as non-typical nucleotide variants and SMN2-independent modifiers of disease severity.

关键词： atrophy traditionally absolute

Current trends in urethral stricture management

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Asian Journal of Urology 2014年第1期1卷 46-54页

作者： Christopher J.Hillary Nadir I.Osman Christopher R.Chapple Department of Urology Royal Hallamshire HospitalSheffieldUK

The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption *** possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation *** is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of *** recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz *** urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable *** is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.

关键词： Urethral stricture Stricture Lichen sclerosus Pelvic fracture Urethral injury Bladder outflow obstruction Urethroplasty Buccal mucosa graft

Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

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World Journal of Gastroenterology 2018年第26期24卷 2893-2901页

作者： Hey-Long Ching Ailish Healy Victoria Thurston Melissa F Hale Reena Sidhu Mark E McAlindon Academic Department of Gastroenterology and Hepatology Royal Hallamshire Hospital Sheffield Teaching Hospitals NHS Trust

AIM To test the feasibility and performance of a novel upper gastrointestinal(GI) capsule endoscope using a nurse-led protocol. METHODS We conducted a prospective cohort analysis of patients who declined gastroscopy(oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water(containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was *** Fifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved(graded 1-5: Poor to excellent): Oesophagus, 4.8(± 0.5); gastro-oesophageal junction(GOJ), 4.8(± 0.8); cardia, 4.8(± 0.8); fundus, 3.8(± 1.2); body, 4.5(± 1); antrum, 4.5(± 1); pylorus, 4.7(± 0.8); duodenal bulb, 4.7(± 0.7); second part of the duodenum(D2), 4.7(± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview(P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule. CONCLUSION The upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.

关键词： Capsule endoscopy Upper gastrointestinal Gastroscopy Oesophagus Stomach

Natural history of hepatic metastases from colorectal cancer-pathobiological pathways with clinical significance

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World Journal of Gastroenterology 2014年第14期20卷 3719-3737页

作者： Konstantinos A Paschos Ali W Majeed Nigel C Bird Liver Research Group Department of OncologySchool of MedicineRoyal Hallamshire HospitalThe University of Sheffield Department of Surgery General Hospital of Drama

Colorectal cancer hepatic metastases represent the final stage of a multi-step biological *** process starts with a series of mutations in colonic epithelial cells,continues with their detachment from the large intestine,dissemination through the blood and/or lymphatic circulation,attachment to the hepatic sinusoids and interactions with the sinusoidal cells,such as sinusoidal endothelial cells,Kupffer cells,stellate cells and pit *** metastatic sequence terminates with colorectal cancer cell invasion,adaptation and colonisation of the hepatic *** these events,termed the colorectal cancer invasion-metastasis cascade,include multiple molecular pathways,intercellular interactions and expression of a plethora of chemokines and growth factors,and adhesion molecules,such as the selectins,the integrins or the cadherins,as well as enzymes including matrix *** review aims to present recent advances that provide insights into these cell-biological events and emphasizes those that may be amenable to therapeutic targeting.

关键词： Colorectal cancer Metastatic cascade Liver metastasis Liver sinusoids Neovascularization

Capsule endoscopy:Current practice and future directions

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World Journal of Gastroenterology 2014年第24期20卷 7752-7759页

作者： Melissa F Hale Reena Sidhu Mark E McAlindon Department of Gastroenterology Royal Hallamshire HospitalSheffield S10 2JFUnited Kingdom

Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.

关键词： Capsule endoscopy Small bowel Indications Technology Oesophageal Colon

The choice of surgical approach in the treatment of vesico-vaginal fistulae

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Asian Journal of Urology 2018年第3期5卷 155-159页

作者： Christopher J.Hillary Christoper R.Chapple Academic Unit of Urology Royal Hallamshire HospitalSheffieldUK

Vesico-vaginal fistula is a global healthcare problem that has a high prevalence in sub-Saharan Africa,where obstetric complications lead to the development of this *** this,comparatively few fistula repairs are performed in well-resourced countries,where iatrogenic injury is the leading aetiological *** a consequence,much of our knowledge results from the experience of relatively few fistula surgeons in areas of high prevalence borne out of large case series or retrospective cohorts rather than high level *** present,debate surrounds the exact timing of repair and the most appropriate surgical approach for this *** fistulae can be selected for conservative management,while those that do not demonstrate factors associated with spontaneous closure can be selected for *** surgeons should be aware of several potential repair options and the principles of contemporary fistula surgery,as the first attempt at repair is likely to be the best opportunity to achieve a successful *** review the available literature and provide evidence on the optimal timing of repair,the appropriate surgical approach and the use of tissue interpositioning in fistula surgery.

关键词： Martius flap Reconstructive urology Urogenital fistula Vesico-vaginal fistula