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Impact of surgical management of upper tract urothelial cancer in octogenarians:A population-based study

Current Urology 2024年第3期18卷 225-231页

作者： Shu Wang Michael Phelan Mohummad Minhaj Siddiqui Division of Urology Department of SurgeryUniversity of Maryland School of MedicineBaltimoreMDUSA veterans affairs maryland healthcare system BaltimoreMDUSA

Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression *** standardmanagement for this disease is *** sparing nonradical surgery is an alternative therapeutic *** men with limited life expectancy,the potential harm of UTUC progression must be weighed against surgical morbidity and mortality,and thus,more conservative approaches may be *** study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized *** and methods A search was conducted in the Surveillance,Epidemiology,and End Results database for patients older than 80 years who were diagnosed with localized(T1–2N0M0)cancer in the renal pelvis or ureter as the only malignancy from 2004 to *** were divided into 3 therapeutic groups:no surgery,local intervention(ie,local tumor excision or segmented ureterectomy),and radical surgery(nephroureterectomy).Demographic and cancer-related parameter data were *** regression analysis was conducted to investigate predictors for surgical ***-Meier curves and Cox regression were used to analyze survival *** Data from 774 patients were analyzed,including 205 in the no-surgery group,181 in the local intervention group,and 388 in the radical surgery ***,African American patients with T1 stage disease were less likely to receive surgical *** surgically treated patients,renal pelvic tumors,and high-grade and T2 stage disease were associated with radical *** treated patients had a longer median overall survival(OS)than in those treated nonsurgically(13,35,and 47 months in no-surgery,local intervention,and radical surgery groups,respectively;p<0.001).Although surgically treated patients demonstrated higher 5-year OS(8.8%[no surgery],23.2%[local intervention],and 23.5%[radical surgery],p<0.001)and 5-year disease-specif

关键词： Older adults Surgery Surveillance,Epidemiology,and End Results Survival Upper tract urothelial carcinoma

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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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Severe aspiration pneumonia in the elderly

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Journal of Intensive Medicine 2024年第3期4卷 307-317页

作者： Sebastian Ocrospoma Marcos I.Restrepo Division of Pulmonary Diseases&Critical Care Medicine University of Texas Health San AntonioSan AntonioTXUSA Section of Pulmonary&Critical Care Medicine South Texas Veterans Health Care SystemSan AntonioTXUSA

The global population is aging at an unprecedented rate,resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing *** this context,severe aspiration pneumonia,a condition that carries substantial morbidity,mortality,and financial burden,especially among elderly patients requiring admission to the intensive care unit,has attracted greater *** pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in *** episodes of coughing on food or liquid intake,a history of relevant underlying conditions,abnormalities on videofluoroscopy or water swallowing,and gravity-dependent shadow distribution on chest imaging are among the clues that suggest *** with aspiration pneumonia tend to be elderly,frail,and suffering from more comorbidities than those without this ***,we comprehensively address the epidemiology,clinical characteristics,diagnosis,treatment,prevention,and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic,enhance outcomes,and minimize the healthcare costs associated with this *** preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

关键词： Aspiration pneumonia Aged Critical illness Swallowing disorders Frailty Antibacterial agents

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Differentiation of human embryonic stem cells derived mesenchymal stem cells into corneal epithelial cells after being seeded on decellularized SMILE-derived lenticules

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International Journal of Ophthalmology(English edition) 2019年第5期12卷 717-724页

作者： Yao Chen Ye-Wei Yin Yang Zhao Xiao-Ying Wu Kelly Young Wei-Tao Song Xiao-Bo Xia Dan Wen Department of Ophthalmology Xiangya HospitalCentral South University Department of veterans affairs Miami VA Healthcare System

AIM: To evaluate the feasibility of mesenchymal stem cells(MSCs) to differentiate into corneal epithelial cells after being seeded on the decellularized small incision lenticule extraction(SMILE)-derived lenticules. METHODS: The fresh lenticules procured from patients undergoing SMILE for the correction of myopia were decellularized. The MSCs were subsequently cultivated on those denuded lenticules. The MSCs without lenticules were used as a control. The proliferation activity of the MSCs after seeding 24 h was quantitatively determined with the Cell Counting Kit-8(CCK-8) assay. Immunofluorescence staining and quantitative reverse transcription polymerase chain reaction(qRT-PCR) were used to assess the marker expression in differentiated MSCs. RESULTS: The data showed that both fresh and decellularized lenticules could significantly promote the proliferation of MSCs, compared to that in control(P=0.02 for fresh lenticules, P=0.001 for decellularize ones, respectively). The MSCs seeded on both lenticules were positive for cytokeratin 3(CK3) staining. The expression of CK3 increased 5-fold in MSCs seeded on fresh lenticules and 18-fold on decellularized ones, compared to that in control. There was a significant difference in the expression of CK3 in MSCs seeded on fresh and decellularized lenticules(P0.05), while the expression of these markers was decreased in MSCs seeded on decellularized ones. CONCLUSION: These results suggest that the decellularized lenticules might be more suitable for MSCs to differentiate into corneal epithelial cells, which offersthe prospect of a novel therapeutic modality of SMILEderived lenticules in regenerative corneal engineering.

关键词： mesenchymal stem cells small incision lenticule extraction lenticules decellularization corneal epithelial cells

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Multimodal comparison of plasma proteins associated with blood-brain barrier impairment in Alzheimer’s disease

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Aging Communications 2024年第1期6卷 1-9页

作者： Elisa Giunti Roberto Collu Joel Reisman Jong Soo Lee Noureddine Melikechi Weiming Xia Geriatric Research Education and Clinical Center Bedford VA Healthcare SystemBedfordMA 01730U.S.A Department of Pharmacology Physiology and BiophysicsBoston University Chobanian&Avedisian School of MedicineBostonMA 02118U.S.A Center for healthcare Organization and Implementation Research Bedford VA Healthcare SystemBedfordMA 01730U.S.A Kennedy College of Science University of Massachusetts LowellLowellMA 01854U.S.A.

Background:Vascular impairment is one of the major contributors to *** aimed to identify blood biomarkers suggestive of potential impairment of the blood-brain barrier(BBB)in subjects with Alzheimer’s disease(AD).Methods:We used administrative data from the VA Informatics and Computing Infrastructure Resource Center to study both inpatients and outpatients with *** samples from healthy control and AD individuals were analyzed using enzyme-linked immunosorbent assay and proteomics approaches to identify differentially expressed *** analysis was applied to explore significantly enriched ***:In the same cohort of patients with AD,we found twice number of subjects with cerebral amyloid angiopathy in the two-year period after the onset of AD,compared to the number of subjects with cerebral amyloid angiopathy in the two-year period prior to AD *** pathways related to BBB,like cell adhesion,extracellular matrix organization and Wnt signaling,were activated and differentially expressed proteins such as ADAM22,PDGFR-α,DKK-4,Neucrin and RSOP-1 were ***,matrix metalloproteinase-9,which is implicated in causing degradation of basal lamina and BBB disruption,was significantly increased in the plasma of AD ***:Alteration of proteins found in AD subjects could provide new insights into biomarkers regulating permeability and BBB integrity.

关键词： Alzheimer’s disease blood-brain barrier peripheral biomarkers matrix metalloproteinases cerebral amyloid angiopathy

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ADAM8 inactivation retards intervertebral disc degeneration in mice

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Genes & Diseases 2024年第3期11卷 91-94页

作者： Zuozhen Tian Frances S.Shofer Mingyue Fan Alec Z.Sandroni Lutian Yao Lin Han Ling Qin Motomi Enomoto-lwamoto Yejia Zhang Department of Physical Medicine&Rehabilitation Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA19146USA Department of Emergency Medicine Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA 19104USA Department of Orthopedic Surgery Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA 19104USA School of Biomedical Engineering Science&Health SystemsDrexel UniversityPhiladelphiaPA 19104USA Department of Orthopedics/Sports Medicine and Joint Surgery the First Hospital of China Medical UniversityShenyangLiaoning 110001China Department of Orthopedics University of Maryland School ofMedicineBaltimoreMD21201USA Section of Rehabilitation Medicine Corporal Michael J.Crescenz Veterans Affairs Medical CenterPhiladelphiaPA 19104USA

ADAM8 has been identified as the fibronectin-cleaving enzyme in human degenerative intervertebral disc(IVD)tissues.^(1)Increase of the active form of ADAM8 and its cleavage product,fibronectin fragment,correlated with an increased degree of IVD degeneration.1 Furthermore,fibronectin fragments have been shown to accelerate the progression of IVD degeneration.^(2)These findings suggest that ADAM8 may play a role in degenerative disc disease,a clinical problem with tremendous socioeconomic burdens in the United States.

关键词： ADAM8 degeneration intervertebral

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Carcinoma of the gastroesophageal junction in Chinese patients

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World Journal of Gastroenterology 2012年第48期18卷 7134-7140页

作者： Qin Huang Department of Pathology Nanjing Drum Tower Hospital Department of Pathology and Laboratory Medicine Veterans Affairs Boston Healthcare System and Harvard Medical School

Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is *** group of cancer is rare but *** on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to *** such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese *** emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of *** conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from *** investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.

关键词： Esophagus Stomach Cancer Gastroesophageal junction Staging Barrett's esophagus

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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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Emerging role of microRNAs in lipid metabolism

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Acta Pharmaceutica Sinica B 2015年第2期5卷 145-150页

作者： Zhihong Yang Tyler Cappello Li Wang Department of Physiology and Neurobiology and the Institute for Systems Genomics University of Connecticut veterans affairs Connecticut healthcare system Department of Internal Medicine Section of Digestive Diseases Yale University

micro RNAs(mi RNAs or mi Rs) are small non-coding RNAs that are involved in posttranscriptional regulation of their target genes in a sequence-specific manner. Emerging evidence demonstrates that mi RNAs are critical regulators of lipid synthesis, fatty acid oxidation and lipoprotein formation and secretion. Dysregulation of mi RNAs disrupts gene regulatory network, leading to metabolic syndrome and its related diseases. In this review, we introduced epigenetic and transcriptional regulation of mi RNAs expression. We emphasized on several representative mi RNAs that are functionally involved into lipid metabolism, including mi R-33/33 n, mi R122, mi R27a/b, mi R378/378 n, mi R-34 a and mi *** the function of mi RNAs in lipid homeostasis may provide potential therapeutic strategies for fatty liver disease.

关键词： Lipid metabolism microRNAs Nuclear receptors

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The art of building bone: emerging role of chondrocyte-to-osteoblast transdifferentiation in endochondral ossification

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Bone Research 2018年第3期6卷 217-225页

作者： Patrick Aghajanian Subburaman Mohan Musculoskeletal Disease Center Veterans Affairs Loma Linda Healthcare System Department of Medicine Loma Linda University Department of Orthopedics Loma Linda University Department of Biochemistry Loma Linda University

There is a worldwide epidemic of skeletal diseases causing not only a public health issue but also accounting for a sizable portion of healthcare expenditures. The vertebrate skeleton is known to be formed by mesenchymal cells condensing into tissue elements(patterning phase) followed by their differentiation into cartilage(chondrocytes) or bone(osteoblasts) cells within the condensations. During the growth and remodeling phase, bone is formed directly via intramembranous ossification or through a cartilage to bone conversion via endochondral ossification routes. The canonical pathway of the endochondral bone formation process involves apoptosis of hypertrophic chondrocytes followed by vascular invasion that brings in osteoclast precursors to remove cartilage and osteoblast precursors to form bone. However, there is now an emerging role for chondrocyte-to-osteoblast transdifferentiation in the endochondral ossification process. Although the concept of "transdifferentiation" per se is not recent,new data using a variety of techniques to follow the fate of chondrocytes in different bones during embryonic and post-natal growth as well as during fracture repair in adults have identified three different models for chondrocyte-to-osteoblast transdifferentiation(direct transdifferentiation, dedifferentiation to redifferentiation, and chondrocyte to osteogenic precursor). This review focuses on the emerging models of chondrocyte-to-osteoblast transdifferentiation and their implications for the treatment of skeletal diseases as well as the possible signaling pathways that contribute to chondrocyte-to-osteoblast transdifferentiation processes.

关键词： cartilage(chondrocytes)or bone(osteoblasts) chondrocyte-to-osteoblast

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