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Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

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World Journal of Gastrointestinal Endoscopy 2010年第3期2卷 81-89页

作者： Felix W Leung Abdulrahman M Aljebreen Emilio Brocchi Eugene B Chang Wei-Chih Liao Takeshi Mizukami Melvin Schapiro Konstantinos Triantafyllou Research and Medical Services Sepulveda Ambulatory Care CenterVeterans Affairs Greater Los Angeles Healthcare SystemNorth Hills David Geffen School of Medicine University of CaliforniaLos Angeles King Khalid University Hospital Department of Internal Medicine and Gastro-enterology University of Bologna Department of Medicine University of Chicago School of MedicineChicago Department of Internal Medicine National Taiwan University Hospital Endoscopy center Yokohama Municipal Citizen's Hospital Hepatogastroenterology Unit 2nd Dep artment of Internal Medicine-PropaedeuticAttikon Univer-sity General HospitalMedical SchoolAthens University

Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer *** data from 1966 to 2009 were searched to identify relevant articles on the *** were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and *** colonoscopy was initially dev eloped as an unsedated ***-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice *** increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated *** use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer *** to assess its applicability in diverse practice settings deserve to be conducted and supported.

关键词： Unsedated colonoscopy Sedation-risk-free colonoscopy Colon cancer screening

Evidence to suggest adoption of water exchange deservesbroader consideration:Its pain alleviating impact occurs in90%of investigators

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World Journal of Gastrointestinal Endoscopy 2016年第2期8卷 113-121页

作者： Sergio Cadoni Mauro Liggi Premysl Falt Stefano Sanna Mariangela Argiolas Viviana Fanari Paolo Gallittu Donatella Mura Maria L Porcedda Vit Smajstrla Matteo Erriu Felix W Leung Digestive Endoscopy Unit St.Barbara Hospital09016 IglesiasItaly Digestive Diseases center Vitkovice Hospital703 84 OstravaCzech Republic Digestive Endoscopy Unit N.S.di Bonaria Hospital09037 San Gavino MonrealeItaly Department of Surgical Sciences University of Cagliari09121 CagliariItaly sepulveda ambulatory care center Veterans Affairs Greater Los Angeles Healthcare SystemNorth HillsCA 91343United States David Geffen School of Medicine University of California at Los AngelesLos AngelesCA 90024United States

AIM: To determine variations in colonoscopy real-time insertion pain among investigators using three different insertion ***: From March 2013 through June 2014, 18-85-year-old diagnostic and 50-70-year-old screening patients were enrolled at each center to on-demand sedation colonoscopy with water exchange(WE), water immersion(WI) and insufflation with air or CO2 for insertion and withdrawal [air or carbon dioxide(AICD)]. Data were aggregated for analysis. Primary outcome: Variations in real-time maximum insertion pain(0 = none, 1-2 = discomfort, 10 = worst).RESULTS: One thousand and ninety-one cases analyzed: WE(n = 371); WI(n = 338); AICD(n = 382). Demographics and indications were comparable. The WE group had the lowest real-time maximum insertion pain score, mean(95%CI): WE 2.8(2.6-3.0), WI 3.8(3.5-4.1) and AICD 4.4(4.1-4.7), P < 0.0005. Ninety percent of the colonoscopists were able to use water exchange to significantly decrease maximum insertion pain scores. One investigator had high insertion pain in all groups, nonetheless WE achieved the lowest real-time maximum insertion pain score. WE had the highest proportions of patients with painless unsedated colonoscopy(vs WI, P = 0.013; vs AICD, P < 0.0005); unsedated colonoscopy with only minor discomfort(vs AICD, P < 0.0005), and completion without sedation(vs AICD, P < 0.0005).CONCLUSION: Aggregate data confirm superiority of WE in lowering colonoscopy real-time maximum insertion pain and need for sedation. Ninety percent of investigators were able to use water exchange to significantly decrease maximum insertion pain scores. Our results suggest that the technique deserves consideration in a broader scale.

关键词： Colonoscopy Painless colonoscopy Waterimmersion Water exchange Colonoscopy pain

Score Evaluation of MRI Sequence Type Related Artifacts after Interbody Fusion with Metallic Implants—A Spine Specimen Study

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Open Journal of Medical Imaging 2012年第2期2卷 57-63页

作者： Thorsten Ernstberger Gottfried Buchhorn Gabert Heidrich Clinic for Spinal Surgery Klinikum Bad BramstedtBad BramstedtGermany Biomaterial Laboratory Department of Orthopaedic SurgeryUniversity of GottingenGottingenGermany center of Radiology Weilheim Ambulatory Healthcare CenterWeilheim i.ObbGermany

Introduction: According to anterior spine fusion intervertebral disc spacers made of titanium or cobalt-chromium al-loys are of special interest. With regard to postoperative problems implant related artifacts can lead to a decreased MRI evaluation. The focus of this study was to compare the respective implant artifact artifact range dependend on different MRI sequences. To simplify artifact evaluation we introduced in this study a new developed 0-1-2 score. Material and Methods: We performed an MRI artifact evaluation of 2 different metallic intervertebral disc spacers (cobalt-chromium and titanium alloy). A carcass porcine spine was employed. Considering 12 defined spinal regions of interest we evaluated the respective implant artifact properties independent from the total artifact volume by using a new developed 0-1-2 score. The artifact range was documented for 15 different MRI-sequences. Results: For the titanium spacer as well as the cobalt-chromium-spacer an MRI evaluation of the implant/disc space situation could not be carried out. In contrast to the cobalt chromium spacer the titanium spacer allowed a good differentiation of the spinal canal opposite to the implant. Optimal MRI imaging results for both metallic intervertebral disc spacers could be achieved considering TSE sequences. Conclusion: A comparison of these two metallic spacers showed in all examined sequences clear advantages in favour of the titanium spacer. The best MRI representation of both tested implants by reducing implant related artifacts could be achieved with fast spin echo (TSE-) sequences. In spite of the use of TSE sequences a variability of susceptibility artifacts has to be included with regard to implant shape and material. With regard to the results of this study the easy use of a new developed artifact score represented a useful help to compare implant related MRI artifact properties independent from the actual implant related total artifact volume.

关键词： Metallic Intervertebral Disc Spacer Artifact Score MRI Susceptibility Artifacts

Ultrasound-Guided Subparaneural Axillary Block in Sub-Saharan Africa: A Prospective Multicenter Study and Review of Literature

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Open Journal of Anesthesiology 2022年第9期12卷 279-288页

作者： Ghislain Edjo Nkilly Amilcar Gombako Nicolas Saumier Raphael Okoue Ondo Stéphane Oliveira Richard Obame Romain Tchoua Department of Anaesthesia and Intensive care Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon ambulatory Anaesthesia Unit of the Operating Room Surgical Resuscitation of the Regional Hospital Emile Muller of Mulhouse Mulhouse France Department of Anaesthesia and Intensive care Akanda Army Training Hospital Libreville Gabon Department of Anaesthesia and Intensive care Owendo University Hospital (CHUO) Libreville Gabon

Context: Subparaneural injection (under the nerve sheath) has reduced the onset of action and the effectiveness of local anesthetics in sciatic blocks. The objective of this work was to assess the effectiveness of this technique in axillary blocks in two hospitals in France and Gabon. Method: From January 1 to February 28, 2019, patients were included for upper limb surgery under xylocaine or Ropivacaine. The installation time, effectiveness, occurrence of paresthesia, and vascular breaches were assessed. Results: 141 patients were included, mostly male (64.55%), with an ASA 1 score (46.1%), hand surgery predominated (95%) most often performed as scheduled surgery (68.1%). Block was performed by the anesthesiologist in 39% of patients and by the anesthesiologist student in 61% of patients. The success rate was 88.66% with an installation time of 15 min, some paresthesias were noted. Despite the lack of expertise from a Gabonese hospital center, the data were compared to the literature. Conclusion: Ultrasound-guided subparaneural injection axillary block is an effective, safe technique with a rapid learning curve.

关键词： Axillary Block Perineural Ultrasound Guided

Clinical significance of glycemic parameters on venous thromboembolism risk prediction in gastrointestinal cancer

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World Journal of Gastroenterology 2017年第28期23卷 5187-5195页

作者： Fiorella Guadagni Silvia Riondino Vincenzo Formica Girolamo Del Monte Anna Maria Morelli Jessica Lucchetti Antonella Spila Roberta D’Alessandro David Della-Morte Patrizia Ferroni Mario Roselli San Raffaele Roma Open University Interinstitutional Multidisciplinary Biobank IRCCS San Raffaele Pisana Department of Systems Medicine Medical Oncology UnitTor Vergata Clinical CenterUniversity of Rome Tor Vergata Department of Palliative care San Raffaele CassinoClinical Center Department of Systems Medicine University of Rome Tor Vergata

To investigate the possible predictive role of routinely used glycemic parameters for a first venous thromboembolism (VTE) episode in gastrointestinal (GI) cancer ambulatory patients - with or without clinically diagnosed type 2 diabetes (T2D) or obesity - treated with ***-treatment fasting blood glucose, insulin, glycated hemoglobin (HbA1c) and homeostasis model of risk assessment (HOMA) were retrospectively evaluated in a cohort study of 342 GI cancer patients. Surgery was performed in 142 (42%) patients with primary cancer, 30 (21%) and 112 (79%) of whom received neoadjuvant and adjuvant therapies, respectively. First-line chemotherapy was administered in 200 (58%) patients with metastatic disease. The study outcome was defined as the occurrence of a first symptomatic or asymptomatic VTE episode during active *** glucose tolerance (IGT) or T2D were diagnosed in 30% of GI cancer patients, while overweight/obesity had an incidence of 41%. VTE occurred in 9.4% of patients (7% of non-diabetic non-obese), especially in those with a high ECOG score (P = 0.025). No significant association was found between VTE incidence and T2D, obesity, different tumor types, metastatic disease, Khorana class of risk, or different anti-cancer drugs, although VTE rates were substantially higher in patients receiving bevacizumab (17% vs 8%, P = 0.044). Conversely, all glucose metabolic indexes were associated with increased VTE risk at ROC analysis. Multivariate Cox proportional analyses confirmed that HOMA index (HR = 4.13, 95%CI: 1.63-10.5) or fasting blood glucose (HR = 3.56, 95%CI: 1.51-8.39) were independent predictors of VTE occurrence during *** results here reported demonstrate that evaluating glucose metabolic asset may allow for VTE risk stratification in GI cancer, helping to identify chemotherapy-treated patients who might benefit from thromboprophylaxis. Further multicenter prospective studies involv

关键词： Gastrointestinal cancer Type 2 diabetes Venous thromboembolism Chemotherapy Insulin resistance

Score based assessment of implant-related post fusion MRI artifacts focused on different interbody disc spacers: An <i>in vitro</i>study

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Open Journal of Clinical Diagnostics 2012年第2期2卷 23-29页

作者： Thorsten Ernstberger Gabert Heidrich Hans-Michael Klinger Mike Herbert Baums center of Radiology Weilheim Ambulatory Healthcare Center Weilheim Germany Clinic for Spinal Surgery Klinikum Bad Bramstedt Bad Bramstedt Germany Department of Orthopaedic Surgery Friedrichsheim University of Frankfurt Frankfurt Germany Department of Orthopaedic Surgery University of Gottingen Gottingen Germany

Interbody disc spacers for anterior spine fusion are made of different materials, such as titanium alloys or carbon fiber reinforced polymers (CFRP). Implant-related susceptibility artifacts can decrease the quality of MRI scans. This cadaveric study aimed to demonstrate the extent that implant-related MRI artifacting affects the post fusion differentiation of the spinal canal (SC) and intervertebral disc space (IDS). In 6 cadaveric porcine spines, we evaluated the post-im- plantation MRI scans of a titanium and CFRP spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into regions of interest (ROI) to characterize the SC and IDS. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists artifact-affected image quality of the median MRI slice was rated on a modified score of 0-1-2-3. A maximum score of 15 points for the SC and 9 points for the IDS (100%) was possible. Turbo spin echo sequences produced the best scores for both spacers and the control. Only the control achieved a score of 100%. For the IDS the titanium and CFRP spacer maximally scored 0% and 74%, for the SC 80% and 99%, respectively. By using favored T1 TSE sequences the CFRP-spacer represented clear advantages in post fusion spinal imaging. Independent of artifact dimensions the used scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

关键词： Interbody Disc Spacer Post Fusion MRI Imaging Artifacts Artifact Score

New Era: Endoscopic treatment options in obesity–a paradigm shift

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World Journal of Gastroenterology 2019年第32期25卷 4567-4579页

作者： Jason Glass Ahson Chaudhry Muhammad S Zeeshan Zeeshan Ramzan Department of Digestive and Liver Diseases University of Texas Southwestern Medical CenterDallasTX 75390United States Division of Gastroenterology and Hepatology Department of MedicineDallas VA Medical CenterVA North Texas Health Care SystemDallasTX 75216United States School of Medicine Temple University HospitalPhiladelphiaPA 19140United States

The prevalence of obesity continues to rise,and along with it comes a multitude of health-related *** healthcare community has consistently struggled with providing treatment options to obese patients,in part due to the reluctance of patients in pursuing the more effective(yet invasive)surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric *** the other hand,the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy(Orlistat,Phenteramine,Phentermine/Topiramate,Locaserin,Naltrexon/Buproprion,and Liraglutide)have very limited efficacy,especially in the morbidly obese *** our best efforts,the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and *** endoscopy is an evolving field generated to combat this epidemic through minimally invasive *** procedures can be performed in an ambulatory setting,are potentially reversible,repeatable,and pose less complications than their invasive surgical *** modalities are designed to alter gut metabolism by means of space occupation,malabsorption,or *** this review we will discuss different bariatric endoscopic options(such as intragastric balloons,endoscopic sleeve gastroplasty,endoscopic aspiration therapies and gastrointestinal bypass sleeves),their advantages and disadvantages,and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.

关键词： Bariatric endoscopy Bariatrics Obesity Intragastric balloon Bariatric medicine AspireAssist Endoscopic sleeve gastroplasty

The RAMA Ped Card： Does it work for actual weight estimation in child patients at the emergency department

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World Journal of Emergency Medicine 2017年第2期8卷 126-130页

作者： Thavinee Trainarongsakul Pitsucha Sanguanwit Supawan Rojcharoenchai Kittisak Sawanyawisuth Yuwares Sittichanbuncha Department of Emergency Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand Department of Medicine Faculty of Medicine Khon Kaen University Khon Kaen Thailand Research center in Back Neck Other Joint Pain and Human Performance (BNOJPH) Khon Kaen University Khon Kaen Thailand ambulatory Medicine Research Group Faculty of Medicine Khon Kean University Khon Kaen Thailand

BACKGROUND: In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young ***: This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department(ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were ***: During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16% agreement with the actual weight with a kappa of 0.54(P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59% agreement. Sub-group analysis found kappa scores with good range in two categories: in cases of accidents and in the infant group(kappa of 0.68 and 0.65, respectively).CONCLUSION: The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.

关键词： Child Weight estimation Card Kappa

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糖尿病足溃疡短期局部外用维A酸治疗的疗效

世界核心医学期刊文摘（皮肤病学分册） 2006年第2期2卷 21-22页

作者： Tom W.L. Peng D.H. Allaei A. T.R. Hata 党倩丽 University of California San Diego Perlman Ambulatory Care CenterMailcode 0974 9350 Campus Point Dr San Diego CA 92037 United StatesDr.

Objective: To determine the efficacy and safety of short- contact administration of topical tretinoin on foot ulcers in patients with diabetes. Design: Randomized, double- blind, placebocontrolled trial. Setting: Outpatient clinic at a Veterans Affairs medical center. Patients: Twenty- four volunteers with diabetic foot ulcers but without evidence of peripheral arterial disease or infection. Interventions: Patients were randomized to 4 weeks of daily treatment with either topical 0.05% tretinoin solution (Retin- A) or placebo saline solution. Photographs and assessment of wound size and appearance were assessed every 2 weeks for a total of 16 weeks. Main Outcome Measures: The proportion of ulcers that healed in each group and the degree of change in ulcer size. Results: Twenty- two patients, with a total of 24 foot ulcers, completed the study. At the end of 16 weeks, 2 (18% ) of 11 ulcers in the control group and 6 (46% ) of 13 ulcers in the tretinoin treatment group healed completely. Topical tretinoin therapy significantly decreased ulcer area and depth compared with placebo treatment over the 16weeks of the study (P < .01 for surface area; P=.02 for depth). Adverse effects mainly consisted of mild pain at the ulcer site. Conclusions: Short- contact application of topical tretinoin improved the healing of foot ulcers in patients with diabetes. The tretinoin therapy was generally well tolerated, without serious local or systemic adverse effects.

关键词：糖尿病足溃疡溃疡面积足部溃疡安慰剂对照周围动脉酸洗剂临床门诊不良反应