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Sedated vs unsedated colonoscopy:A prospective study

World Journal of Gastroenterology 2014年第17期20卷 5113-5118页

作者： Abdulrahman M Aljebreen Majid A Almadi Felix W Leung Gastroenterology Division King Khalid University HospitalKing Saud UniversityRiyadh 11461Saudi Arabia Gastroenterology Division McGill University Health Center McGill University MontrealQuebec H3G 1A4Canada Research and Medical Services Sepulveda Ambulatory Care CenterVeterans Affairs Greater Los Angeles Healthcare Systemand David Geffen School of Medicine at UCLALos AngelesCaliforniaCA 91343United States

AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the ***:Consecutive patients who underwent colonoscopies over a 2-year period were invited to *** patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was *** details were *** patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were ***:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly *** was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing *** option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.

关键词： Sedation Colonoscopy Unsedated Screening Endoscopy

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WJSC 6^(th) Anniversary Special Issues(2):Mesenchymal stem cells “Ins” and “Outs” of mesenchymal stem cell osteogenesis in regenerative medicine

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World Journal of Stem Cells 2014年第2期6卷 94-110页

作者： Dean T Yamaguchi Research Service Veteran Administration Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California at Los Angeles

Repair and regeneration of bone requires mesenchymal stem cells that by self-renewal,are able to generate a critical mass of cells with the ability to differentiate into osteoblasts that can produce bone protein matrix(osteoid)and enable its *** number of human mesenchymal stem cells(hMSCs)diminishes with age and ex vivo replication of hMSCs has limited *** propagating hMSCs under hypoxic conditions may maintain their ability to self-renew,the strategy of using human telomerase reverse transcriptase(hTERT)to allow for hMSCs to prolong their replicative lifespan is an attractive means of ensuring a critical mass of cells with the potential to differentiate into various mesodermal structural tissues including ***,this strategy must be tempered by the oncogenic potential of TERT-transformed cells,or their ability to enhance already established cancers,the unknown differentiating potential of high population doubling hMSCs and the source of hMSCs(e.g.,bone marrow,adipose-derived,muscle-derived,umbilical cord blood,etc.)that may provide peculiarities to self-renewal,differentiation,and physiologic function that may differ from non-transformed native *** engineering approaches to use hMSCs to repair bone defects utilize the growth of hMSCs on three-dimensional scaffolds that can either be a base on which hMSCs can attach and grow or as a means of sequestering growth factors to assist in the chemoattraction and differentiation of native *** use of whole native extracellular matrix(ECM)produced by hMSCs,rather than individual ECM components,appear to be advantageous in not only being utilized as a three-dimensional attachment base but also in appropriate orientation of cells and their differentiation through the growth factors that native ECM harbor or in simulating growth factor *** origin of native ECM,whether from hMSCs from young or old individuals is a critical factor in"rejuvenating"hMSCs from older individuals

关键词： Mesenchymal stem cell Telomerase reverse transcriptase Extracellular matrix Osteogenesis Regenerative medicine Tissue engineering Proliferation Differentiation

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Dynamic responses of bridge-approach embankment transition section of high-speed rail

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Journal of Central South University 2013年第10期20卷 2830-2839页

作者：杨长卫孙海玲张建经朱传彬颜利平 Civil Engineering School Southwest Jiaotong University Department of Engineering Management Henan University of Urban Construction Geotechnical Engineering Group Los Angeles Department of Water and Power

Based on the vehicle track coupling dynamics theory, a new spatial dynamic numerical model of vehicle track subgrade coupling system was established considering the interaction among different structural layers in the subgrade system. The dynamic responses of the coupled system were analyzed when the speed of train was 350 km/h and the transition was filled with graded broken stones mixed with 5% cement. The results indicate that the setting form of bridge-approach embankment section has little effect on the dynamic responses, thus designers can choose it on account of the practical circumstances. Because the location about 5 m from the bridge abutment has the greatest deformation, the stiffness within 0 5 m zone behind the abutment should be specially designed. The results of the study from vehicle track dynamics show that the maximum allowable track deflection angle should be 0.09% and the coefficient of subgrade reaction(K30) is greater than 190 MPa within the 0 5 m zone behind the abutment and greater than 150 MPa in other zones.

关键词： high-speed rail bridge-approach embankment section numerical model track deflection angle

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甲状腺激素在小鼠胚胎干细胞分化为大脑皮层锥体细胞过程中机制的探讨

甲状腺激素在小鼠胚胎干细胞分化为大脑皮层锥体细胞过程中机制的...

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中华医学会第十一次全国内分泌学学术会议

作者：滕晓春 Yan-yun Liu 胡晓娜单忠艳滕卫平 Gregory A.Brent 中国医科大学附属第一医院内分泌科、内分泌研究所辽宁省内分泌疾病重点实验室 Molecular Endocrinology Laboratory and Research Service Veterans Affairs Greater Los Angeles Healthcare SystemDepartment of MedicineUniversity of California Los Angeles School of Medicine

目的:甲状腺激素在脑发育中发挥重要作用。临床研究发现在母体妊娠早期,即使是轻微的甲状腺激素缺乏也会导致后代智力水平的下降。由于胎鼠或仔鼠出生时脑组织结构不易区分,且结构复杂,目前关于甲状腺激素对脑发育的早期事件知之甚少。...

目的:甲状腺激素在脑发育中发挥重要作用。临床研究发现在母体妊娠早期,即使是轻微的甲状腺激素缺乏也会导致后代智力水平的下降。由于胎鼠或仔鼠出生时脑组织结构不易区分,且结构复杂,目前关于甲状腺激素对脑发育的早期事件知之甚少。孕早、中期的甲状腺激素调控的基因报道几乎没有。本研究利用小鼠胚胎干细胞为研究模型,建立小鼠胚胎干细胞分化为大脑皮层锥体神经细

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1项子宫动脉栓塞与子宫肌瘤切除术的多中心对比性研究

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世界核心医学期刊文摘（妇产科学分册） 2006年第4期2卷 22-23页

作者： Goodwin S.C. Bradley L.D. Lipman J.C. 李跃萍 Imaging Services Veterans Administration Greater Los Angeles Health Care System Mail Code 114 11301 Wilshire Boulevard Los Angeles CA 90073 United States Dr.

Objective: To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE)-and to compare UAE and myomectomy outcomes. Design: Prospective cohort controlled study. Setting: Sixteen medical centers in the United States. Patient(s): One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow up examinations at 1 year. Intervention(s): Myomectomy or *** Outcome Measure(s): Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. Result(s): Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1%of the myomectomy patients, compared with 22.1%in the UAE group. Conclusion(s): The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

关键词：子宫肌瘤切除术子宫动脉栓塞对比性研究生活质量术后生活患者群观察时间无显著性差异恢复时

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阿尔茨海默病

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美国医学会杂志（中文版） 2003年第6期22卷 327-330页

作者：张继志 Department of Neurology Department of Psychiatry and Biobehavioral Sciences Department of Neurology University of califomla Los Angeles School of Medicine and Veterans Affairs Greater Los Angees Health Care System

阿尔茨海默病(Alzheimer disease,AD)为老年痴呆最常见的原因,是一种进行性神经退行性疾病,可使患者逐渐丧失认知功能并最终导致死亡.我们复习了AD的流行病学、临床表现、病理生理和治疗.

关键词：阿尔茨海默病发病率诊断病理学分子遗传学治疗

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Hypocretin(orexin) pathology in Alzheimer's disease

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World Journal of Neurology 2015年第3期5卷 64-67页

作者： Thomas C Thannickal Department of Psychiatry and Biobehavioral Sciences University of California Veterans Administration greater los angeles healthcare system Neurobiology Research (151A3)

Alzheimer's disease(AD) is a growing health problem. It has enormous public health impact. Sleep problems show an early component of this disease. Hypocretin hasa major function in sleep-wake cycle. The total number of hypocretin neurons in the normal humans ranges from 51000-83000, located exclusively in the hypothalamus. Deficiency in hypocretins neurotransmission results in narcolepsy, Parkinson's disease, and other neurological and psychological disorders. Cerebrospinal fluid(CSF) hypocretin levels were directly related with t-tau protein amount in AD. Increased hypocretin CSF in AD suggest that hypocretin is involved in the mechanism of AD pathology.

关键词： Hypocretin Orexin Alzheimer’s disease Neurological disorders

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Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes

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Health 2018年第2期10卷 171-180页

作者： June F. O’Leary Janelle Howe Jeremy Rich Glenn Melnick Sol Price School of Public Policy University of Southern California Los Angeles CA USA DaVita healthcare Partners Medical Group El Segundo CA USA healthcare Partners Institute for Applied Research and Education El Segundo CA USA

Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita healthcare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if 9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater los angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.

关键词： Diabetes Glycemic Control Financial Incentives Behavioral Economics Group Appointments

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An Analysis of the Potential Benefits of Metformin on Disease Recurrence in Oral and Oropharyngeal Squamous Cell Carcinoma

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Journal of Cancer Therapy 2013年第5期4卷 961-965页

作者： Christopher F. Thompson Marilene B. Wang Yas Sanaiha Chi Lai Tristan Grogan David Elashoff Maie A. St. John Department of Head and Neck Surgery University of California Los Angeles USA Department of Medicine Statistics Core University of California Los Angeles USA Department of Pathology and Laboratory Medicine University of Cali- fornia Los Angeles USA

Objective: Diabetes mellitus type 2 has been associated with increased cancer risk and cancer related mortality. Metformin, one of the most widely used anti-diabetic medications, has been found to have important anticancer properties in addition to hypoglycemic effects. The effects of metformin on clinical outcomes in oral cavity (OC) and oropharyngeal (OP) squamous cell carcinoma (SCC) have not been thoroughly analyzed. The purpose of this study was to evaluate the effects of metformin use on cancer recurrence in diabetic patients with oral cavity and oropharyngeal squamous cell carcinoma. Design: Retrospective review. Setting: Academic tertiary medical center. Patients: Seventy-seven patients with diabetes mellitus type 2 and oral cavity or oropharyngeal squamous cell carcinoma were treated and followed at our tertiary academic institution and the Veterans Affairs greater los angeles healthcare system from 1998 to 2012. Main Outcome Measure: Cox proportional hazards models and Kaplan-Meier curves were constructed to determine if metformin has an effect on disease recurrence after primary cancer treatment. Results: Metformin does not appear to have a significant effect on disease recurrence in patients with OC/OP SCC and diabetes mellitus type 2 (p = 0.53). Even when including only patients with stage I or II disease, metformin still did not decrease recurrence (p = 0.60). Conclusion: Herein, our data suggest that metformin use does not significantly impact time until recurrence for diabetic patients with OC/OP SCC.

关键词： Metformin Head and Neck Cancer Oral Squamous Cell Carcinoma Oropharyngeal Squamous Cell Carcinoma

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氩离子电凝术与多极电凝用于Barrett食管消融术的随机临床试验

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世界核心医学期刊文摘（胃肠病学分册） 2005年第8期1卷 28-29页

作者： Dulai G.S Jensen D.M Cortina G 郝筱倩 va Gtr. los angeles H lthcare. system CURE Digest. Dis.Research Center Bldg. 115 11301 Wilshire Blv d. Los Angeles CA 90073 United States.Dr

Background: Endoscopic ablation of Barrett’s esophagus has been described in which various thermocoagulation modalities are used in combination with a high d ose of a proton pump inhibitor. No randomized comparison of ablation strategies has been published. Methods: Referred patients were screened to identify those w ith Barrett’s es- ophagus 2 to 7 cmin length,without high-grade dysplasia or cancer. Included p atients received pantoprazole (40 mg twice a day), followed by randomization to treatment with argon plasma coagulation (APC) or multipolar electrocoagulation ( MPEC). The primary outcome measure was the number of treatment sessions required for endoscopic ablation. Results: Of 235 patients screened, 52 were randomized. The mean length of Barrett’s esophagus was 3.1 cm in the MPEC group vs. 4.0 cm in the APC group (p = 0.03). Otherwise,the treatment groups were similar with re gard to baseline characteristics. The mean number of treatment sessions required for endoscopic ablation was 2.9 for MPEC vs. 3.8 for APC (p = 0.04) in an inten tion-to-treat analysis (p = 0.249, after adjustment for the difference in leng th of Barrett’s esophagus).The proportion of patients in which ablationwas endo scopically achieved proximal to the gastroesophageal junction was 88%for the MP EC group vs. 81%for the APC group (p = 0.68) and histologically achieved in 81%for MPEC vs. 65%for APC (p= 0.21). The mean ti me required for the first treatment session was 6 minutes with MPEC vs. 10 minut es with APC (p =0.01) in per protocol analysis. There was no serious adverse eve nt, but transient moderate to severe upper-GI symptoms occurred after MPEC in 8 %vs. 13%after APC (p = 0.64).Conclusions: Although there were no statistically significant differences, ablation of Barrett’s esophagus with pantoprazole and MPEC required numerically fewer treatment sessions, and endoscopic and histolog ic ablation was achieved in a greater proportion of patients compared with treat ment with pantop

关键词： Barrett 电凝术氩离子随机临床试验潘托拉唑治疗次数治疗周期长度差异随机筛选异常增生

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