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Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas

World Journal of Gastrointestinal Oncology 2024年第4期16卷 1374-1383页

作者： Laura Sahyoun Kay Chen Cynthia Tsay George Chen Petr Protiva Department of Gastroenterology and Hepatology Weill Cornell MedicineNew YorkNY 10065United States Gastroenterology Section Jennifer Moreno VA San Diego Healthcare SystemSan DiegoCA 92161United States Division of Gastroenterology Department of MedicineUniversity of California San DiegoLa JollaCA 92093United States Department of Gastroenterology and Hepatology John Hopkins HospitalBaltimoreMD 21287United States Department of Digestive Diseases Yale New Haven HospitalNew HavenCT 06520United States Department of Gastroenterology VA Connecticut Health Care SystemWest HavenCT 06516United States

BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival ***,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer *** from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to ***-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban *** was calculated with Cox proportional hazards models for death in the 5-year period following *** Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of vater adenocarcinoma *** analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,Pval rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.

关键词： Biliary tract cancers Survival Outcomes research Socioeconomic factors healthcare disparities

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Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient:A case report and review of literature

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World Journal of Clinical Cases 2024年第18期12卷 3561-3566页

作者： Binyamin Ravina Abramowitz Michael Coles Ayse Aytaman Bani Chander-Roland Daniel Anthony DiLeo Department of Gastroenterology and Hepatology SUNY Downstate Health Sciences UniversityBrooklynNY 11203United States Department of Gastroenterology and Hepatology Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare SystemBrooklynNY 11209United States

BACKGROUND It is well-described that the coronavirus disease 2019(COVID-19)infection is associated with an increased risk of thrombotic *** there have been many cases of pulmonary emboli and deep vein thrombosis in these patients,reports of COVID-19 associated portal vein thrombosis(PVT)have been *** present a unique case of concomitant PVT and splenic artery thrombosis in a COVID-19 *** SUMMARY A 77-year-old-male with no history of liver disease presented with three days of left-sided abdominal *** week earlier,the patient was diagnosed with mildly symptomatic COVID-19 and was treated with nirmatrelvir/*** exam revealed mild right and left lower quadrant tenderness,but was otherwise *** laboratory findings included white blood cell count 12.5 K/μL,total bilirubin 1.6 mg/dL,aminoaspartate transferase 40 U/L,and alanine aminotransferase 61 U/*** tomography of the abdomen and pelvis revealed acute PVT with thrombus extending from the distal portion of the main portal vein into the right and left *** noted was a thrombus within the distal portion of the splenic artery with resulting splenic *** workup including prothrombin gene analysis,factor V Leiden,cardiolipin antibody,and JAK2 mutation were all *** with enoxaparin was initiated,and the patient’s pain *** was discharged on *** It is quite uncommon for PVT to present simultaneously with an arterial thrombotic occlusion,as in the case of our *** thrombotic manifestations are classically linked to hypercoagulable states including malignancy and hereditary and autoimmune *** infections such as Epstein-Barr virus,cytomegalovirus,viral hepatitis,and COVID-19 have all been found to increase the risk of splanchnic venous occlusions,including *** our patient,prompt abdominal imaging led to early detection of thrombus,early treatment,and an exce

关键词： COVID-19 Thromboembolism Portal vein thrombosis Splenic artery thrombosis Anticoagulation Lovenox Thrombotic complication Case report

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Bilateral diffuse grade 5 radiation pneumonitis after intensity modulated radiation therapy for localized lung cancer

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World Journal of Clinical Oncology 2017年第3期8卷 285-288页

作者： Virginia W Osborn Andrea Leaf Anna Lee Elizabeth Garay Joseph Safdieh David Schwartz David Schreiber Veterans Affairs new york harbor healthcare system SUNY Downstate Medical Center

We are reporting a case of fatal radiation pneumonitis that developed six months following chemoradiation for limited stage small cell lung *** patient was a 67-year-old man with a past medical history of Hashimoto's thyroiditis and remote suspicion for CREST,neither of which were active in the years leading up to *** received 6600 cG y delivered in 200 cG y daily fractions via intensity modulated radiation therapy with concurrent cisplatin/etoposide followed by additional chemotherapy with dosereduced cisplatin/etoposide and carboplatin/etoposide and then received prophylactic cranial *** subsequent months were notable for progressively worsening episodes of respiratory compromise despite administration of prolonged steroids and he ultimately *** demonstrated bilateral interstitial and airspace *** findings were consistent with pneumonitis secondary to chemoradiation as well as lymphangitic spread of small cell *** process was diffuse bilaterally although his radiation was delivered focally to the right lung and mediastinum.

关键词： Radiation Pneumonitis Small cell lung cancer Intensity modulated radiation therapy

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Disruptive behavior in the workplace: Challenges for gastroenterology fellows

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World Journal of Gastroenterology 2017年第18期23卷 3315-3321页

作者： Nalinee Srisarajivakul Catherine Lucero Xiao-Jing Wang Michael Poles Colleen Gillespie Sondra Zabar Elizabeth Weinshel Lisa Malter Division of Gastroenterology VA New York Harbor Healthcare System Division of General Internal Medicine NYU School of Medicine Division of Gastroenterology and Hepatology Weill Cornell Medical College Department of Internal Medicine Emory University School of Medicine

To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment *** fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s *** must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.

关键词： Disruptive behavior Fellowship education and training Objective structured clinical examinations

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Lethal means and suicide prevention among military veterans

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Military Medical Research 2023年第1期10卷 139-140页

作者： Joshua Levine Leo Sher Veterans’Administration new york harbor healthcare system BrooklynNY 11209USA James J.Peters Veterans’Administration Medical Center BronxNY 10468USA

Dear Editor,Suicide amongst the military veteran population is a significant *** VeteranSuicidePreventionAnnualReportrevealedthat6261 died by suicide in 2019[1]. The lingering effects of the coronavirus disease 2019 (... 详细信息

关键词： Suicide Depression Public health Lethal means Military veterans

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Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones

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World Journal of Gastroenterology 2020年第11期26卷 1221-1230页

作者： Marianna Papademetriou Gabriel Perrault Max Pitman Colleen Gillespie Sondra Zabar Elizabeth Weinshel Renee Williams Division of Gastroenterology Georgetown University Medical CenterWashingtonDC 20007United States Division of Gastroenterology Washington DC VA Medical CenterWashingtonDC 20422United States Department of Medicine New York University Medical CenterNew YorkNY 10016United States Division of Gastroenterology New York University Medical CenterNew YorkNY 10016United States Department of Medicine New York University School of MedicineNew YorkNY 10016United States Department of Gastroenterology VA New York Harbor Healthcare SystemNew YorkNY 10010United States

BACKGROUND system based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless,structured assessment is required for training programs. We hypothesized that objective structured clinical examination(OSCE) would be an effective tool for assessment of *** To develop a novel method for SBP milestone assessment of gastroenterology fellows using the *** For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twentysix first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation *** Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22(SBP1), 4.34(SBP2), 3.35(SBP3), and 6.42(SBP4)out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training,and 83% stated that the cases were similar to actual clinical encoun

关键词： Objective structured clinical exams Medical education Medical error system based practice Milestones Gastroenterology

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Association of overexpression of TIF1γ with colorectal carcinogenesis and advanced colorectal adenocarcinoma

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World Journal of Gastroenterology 2011年第35期17卷 3994-4000页

作者： Shilpa Jain Shashideep Singhal Franto Francis Cristina Hajdu Jin-Hua Wang Arief Suriawinata Yin-Quan wang Miao Zhang Elizabeth H Weinshel Fritz Francois Zhi-Heng Pei Peng Lee Ru-Liang Xu Department of Pathology New York University School of Medicine New York NY 10016 United States Department of Medicine The Brooklyn Hospital Center Brooklyn NY 11201 United States Dartmouth-Hitchcock Medical Center Lebanon NH 03756 United States NYU Cancer Institute New York University School of Medicine New York NY 10016 United States Department of General Surgery the First Hospital of Shanxi Medical University 030001 Taiyuan Shanxi Province China Department of Medicine New York University School of Medicine New York NY 10016 United States NYU Cancer Institute New York University School of Medicine and New York Harbor Healthcare System New York NY 10016 United States

AIM:To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1γ),Smad4 and transforming growth factor-beta (TGFβR) across a spectrum representing colorectal cancer (CRC) ***:Tissue microarrays were prepared from archival paraffin embedded tissue,including 51 colorectal carcinomas,25 tubular adenomas (TA) and 26 HPs,each with matched normal colonic *** was performed using antibodies against TIF1γ,Smad4 and TGFβ RⅡ.The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4).RESULTS:Overexpression of TIF1γ was detected in 5/26 (19%) HP;however,it was seen in a significantly higher proportion of neoplasms,15/25 (60%) TAs and 24/51 (47%) CRCs (Pvalue=0.35,P<0.05).The levels of TIF1γ overexpression were significantly higher in stage Ⅲ than in stage Ⅰ and Ⅱ CRC (P<0.05).CONCLUSION:The findings suggest that over-expression of TIF1γ occurs in early stages of colorectal carcinogenesis,is inversely related with Smad4 loss,and may be a prognostic indicator for poor outcome.

关键词： Colorectal cancer Transcriptional intermediary factor 1 gamma Transforming growth factor-beta signaling pathway Smad4

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A new tool for monitoring brain function: eye tracking goes beyond assessing attention to measuring central nervous system physiology

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Neural Regeneration Research 2015年第8期10卷 1231-1233页

作者： Uzma Samadani Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center Departments of Neurosurgery Psychiatry Physiology and Neuroscience New York University School of Medicine New York new york harbor Health Care system USA

Concussion and other forms of brain injury are not always detectable with conventional means such as radiographic *** lack of accurate diagnostics,biomarkers,and outcome measures has a devastating *** patients may suffer in obscurity,self-medicate into an addictive spiral,have impaired professional activity,and develop failed interpersonal relationships.

关键词： interpersonal suffer impaired devastating diagnostics professional assessing spatially calibration tracked

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Diminished fracture initiation sites in ceramic layers bonded to glow-discharge treated substructure

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Open Journal of Stomatology 2013年第6期3卷 307-313页

作者： Hyeongil Kim Edward A. Monaco Jr. Frederick McIntyre Elaine L. Davis Robert E. Baier Department of Oral Diagnostic Sciences University at Buffalo New York USA Department of Restorative Dentistry University at Buffalo New York USA va Western new york healthcare system at Buffalo New York USA

A mechanically retentive structure and meticulous surface cleanliness are critical factors in providing fracture resistance and clinical success of metal ceramic restorations. This investigation compared the porcelain/metal interfaces of deliberate compressive fractures of ceramic crowns between conventional preparation and application of the Radio Frequency Glow Discharge Treatment (RFGDT) before each bonding step. It evaluated RFGDT’s capacity to improve wetting effectiveness and minimize porosity. Twelve metal ceramic crowns were fabricated identically. RFGDT was applied to the metal substructures of half the specimens before the ceramic layering process. All specimens were fractured in the same manner by an applied compressive force to simulate dental occlusive failure. Fracture surfaces were inspected by light and scanning electron microscopy. Quantitative analyses of images were performed to identify numbers, locations of cracks, porosity patterns, and other morphological correlates of the fracture zones. There were significantly fewer voids per millimeter at the interfaces in the RFGDT group than in the non-RFGDT group (t = 2.377, df = 9, p = 0.021). There was a significant difference in the number of horizontal cracks per millimeter between the groups (t = 2.132, df = 7, p = 0.035), with more cracks occurring in the non-RFGDT group. RFGDT can improve the integrity of metal ceramic crowns by increasing the substratum surface energy, improving porcelain wetting and spreading and thereby diminishing the numbers of interfacial voids available for initiation of fracture. Routine application of RFGDT should result in fewer cracks along metal/ceramic interfaces in all restorative preparations.

关键词： Porcelain Fracture Glow Discharge Treatment Metal Ceramic Crown Porosity Surface Energy

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Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding

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World Journal of Gastroenterology 2016年第31期22卷 6972-6986页

作者： Joseph Paul Weiner Andrew Thomas Wong David Schwartz Manuel Martinez Ayse Aytaman David Schreiber Department of Radiation Oncology VA NY Harbor Healthcare System Brooklyn Campus Department of Radiation Oncology SUNY Downstate Medical Center Department of Gastro-enterology VA NY Harbor Healthcare System Brooklyn Campus Department of Gastroenterology SUNY Downstate Medical Center

Pelvic radiation is a commonly utilized treatment for malignancy of the genitourinary and lower gastrointestinal tract. Radiation proctitis and the resultant clinical picture varies from asymptomatic to potentially life threatening. Similarly, treatment options also vary greatly, from medical therapy to surgical intervention. Commonly utilized medical therapy includes sucralfate enemas, antibiotics, 5-aminosalicylic acid derivatives, probiotics, antioxidants, short-chain fatty acids, formalin instillation and fractionated hyperbaric oxygen. More invasive treatments include endoscopic-based, focally ablative interventions such as dilation, heater and bipolar cautery, neodymium/yttrium aluminum garnet argon laser, radiofrequency ablation or argon plasma coagulation. Despite its relatively common frequency, there is a dearth of existing literature reporting headto-head comparisons of the various treatment options via a randomized controlled approach. The purpose of our review was to present the reader a consolidation of the existing evidence-based literature with the goal of highlighting the comparative effectiveness and risks of the various treatment approaches. Finally, we outline a pragmatic approach to the treatment of radiation proctitis. In light of the lack of randomized data, our goal is to pursue as least invasive an approach as possible, with escalation of care tailored to the severity of the patient's symptoms. For those cases that are clinicallyasymptomatic or only mildly symptomatic, observation or medical management can be considered. Once a patient fails such management or symptoms become more severe, invasive procedures such as endoscopically based focal ablation or surgical intervention can be considered. Although not all recommendations are supported by level I evidence, reported case series and single-institutional studies in the literature suggest that successful treatment with cessation of symptoms can be obtained in the majority of cases.

关键词： Prostate cancer Radiation therapy Radiation proctitis Radiation proctopathy Medical treatment Endoscopic treatment Hyperbaric oxygen Neodymium/ yttrium aluminum garnet argon laser Argon plasma coagulation

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