The liver is a tolerogenic organ with exquisite mechanisms of immune regulation that ensure upkeep of local and systemic immune tolerance to self and foreign antigens, but that is also able to mount effective immune r...The liver is a tolerogenic organ with exquisite mechanisms of immune regulation that ensure upkeep of local and systemic immune tolerance to self and foreign antigens, but that is also able to mount effective immune responses against pathogens. The immune privilege of liver allografts was recognized first in pigs in spite of major histo-compatibility complex mismatch, and termed the ＂liver tolerance effect＂. Furthermore, liver transplants are spontaneously accepted with only low-dose immunosuppression, and induce tolerance for non-hepatic co-transplanted allografts of the same donor. Although this immunotolerogenic environment is favorable in the setting of organ transplantation, it is detrimental in chronic infectious liver diseases like hepatitis B or C, malaria, schistosomiasis or tumorigenesis, leading to pathogen persistence and weak anti-tumor effects. The liver is a primary site of T-cell activation, but it elicits poor or incomplete activation of T cells, leading to their abortive activation, exhaustion, suppression of their effector function and early death. This is exploited by pathogens and can impair pathogen control and clearance or allow tumor growth. Hepatic priming of T cells is mediated by a number of local conventional and nonconventional antigen-presenting cells （APCs）, which promote tolerance by immune deviation, induction of T-cell anergy or apoptosis, and generating and expanding regulatory T cells. This review will focus on the communication between classical and nonclassical APCs and lymphocytes in the liver in tolerance induction and will discuss recent insights into the role of innate lymphocytes in this process.展开更多
Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance(IR), early diabetes, hypertension ...Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance(IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease(NAFLD). NAFLD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis(NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFLD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFLD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFLD. In the interim, clinicians should be aware of this connection and consider screening for NAFLD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.展开更多
Microparticles are small cell vesicles that can be released by almost all eukaryotic cells during cellular stress and cell activation. Within the last 1-2 decades it has been shown that microparticles are useful blood...Microparticles are small cell vesicles that can be released by almost all eukaryotic cells during cellular stress and cell activation. Within the last 1-2 decades it has been shown that microparticles are useful blood surrogate markers for different pathological conditions, such as vascular inflammation, coagulation and tumour diseases. Several studies have investigated the abundance of microparticles of different cellular origins in multiple cardiovascular diseases. It thereby has been shown that microparticles released by platelets, leukocytes and endothelial cells can be found in conditions of endothelial dysfunction, acute and chronic vascular inflammation and hypercoagulation. In addition to their function as surrogate markers, several studies indicate that circulating microparticles can fuse with distinct target cells, such as endothelial cells or leukocyte, and thereby deliver cellular components of their parental cells to the target cells. Hence, microparticles are a novel entity of circulating, paracrine, biological vectors which can influence the phenotype, the function and presumably even the transcriptome of their target cells.This review article aims to give a brief overview about the microparticle biology with a focus on endothelial activation and arterial hypertension. More detailed information about the role of microparticles in pathophysiology and disease can be found in already published work.展开更多
Almost every experimental treatment strategy using non-autologous cell, tissue or organ transplantation is tested in small and large animal models before clinical translation. Because these strategies require immunosu...Almost every experimental treatment strategy using non-autologous cell, tissue or organ transplantation is tested in small and large animal models before clinical translation. Because these strategies require immunosuppression in most cases, immunosuppressive protocols are a key element in transplantation experiments. However, standard immunosuppressive protocols are often applied without detailed knowledge regarding their efficacy within the particular experimental setting and in the chosen model species. Optimization of such protocols is pertinent to the translation of experimental results to human patients and thus warrants further investigation. This review summarizes current knowledge regarding immunosuppressive drug classes as well as their dosages and application regimens with consideration of species-specific drug metabolization and side effects. It also summarizes contemporary knowledge of novel immunomodulatory strategies, such as the use of mesenchymal stem cells or antibodies. Thus, this review is intended to serve as a state-of-the-art compendium for researchers to refine applied experimental immunosuppression and immunomodulation strategies to enhance the predictive value of preclinical transplantation studies.展开更多
AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if th...AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t -test and Pearson's χ2 test, as appropriate.RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P -value < 0.1 were checked for inclusion in a multivariable logbinomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.展开更多
AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography proce...AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to proto-col implementation in July 2011, after which, a new 9 French wire-guided cytology brush(Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pa-thologists who determined whether the sample waspositive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular find-ings consistent with malignancy as compared to 17 of 46(37%) in the historical control group(P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes(21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to his-torical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased di-agnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clus-ters obtained.展开更多
For decades,researchers in information visualisation and graph drawing have focused on developing techniques for the layout and display of very large and complex networks.Experiments involving human participants have ...For decades,researchers in information visualisation and graph drawing have focused on developing techniques for the layout and display of very large and complex networks.Experiments involving human participants have also explored the readability of different styles of layout and representations for such networks.In both bodies of literature,networks are frequently referred to as being‘large’or‘complex’,yet these terms are relative.From a human-centred,experiment point-of-view,what constitutes‘large’(for example)depends on several factors,such as data complexity,visual complexity,and the technology used.In this paper,we survey the literature on human-centred experiments to understand how,in practice,different features and characteristics of node–link diagrams affect visual complexity.展开更多
Pancreatic ductal adenocarcinoma(PDAC) is a worldwide public health concern. Despite extensive research efforts toward improving diagnosis and treatment, the 5-year survival rate at best is approximately 15%. This dis...Pancreatic ductal adenocarcinoma(PDAC) is a worldwide public health concern. Despite extensive research efforts toward improving diagnosis and treatment, the 5-year survival rate at best is approximately 15%. This dismal figure can be attributed to a variety of factors including lack of adequate screening methods, late symptom onset, and treatment resistance. Pancreatic ductal adenocarcinoma remains a grim diagnosis with a high mortality rate and a significant psychological burden for patients and their families. In recent years artificial intelligence(AI) has permeated the medical field at an accelerated pace, bringing potential new tools that carry the promise of improving diagnosis and treatment of a variety of diseases. In this review we will summarize the landscape of AI in diagnosis and treatment of PDAC.展开更多
AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive ...AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in serie展开更多
Initiation and progression of hepatocellular carcinoma （HCC） is intimately associated with a chronically diseased liver tissue. This diseased liver tissue background is a drastically different microenvironment from ...Initiation and progression of hepatocellular carcinoma （HCC） is intimately associated with a chronically diseased liver tissue. This diseased liver tissue background is a drastically different microenvironment from the healthy liver, especially with regard to immune cell prevalence and presence of mediators of immune function. To better understand the consequences of liver disease on tumor growth and the interplay with its mi- croenvironment, we utilized two standard methods of fi- brosis induction and orthotopic implantation of tumors into the inflamed and fibrotic liver to mimic the liver condition in human HCC patients. Compared to non-diseased con- trols, tumor growth was significantly enhanced under fi- brotic conditions. The immune cells that infiltrated the tumors were also drastically different, with decreased numbers of natural killer cells but greatly increased num- bers of immune-suppressive CDllb^＋ Gr1^hi myeloid cells in both models of fibrosis. In addition, there were model- specific differences： Increased numbers of CD11b^＋ mye- loid cells and CD4^＋ CD25^＋ T cells were found in tumors in the bile duct ligation model but not in the carbon te- trachloride model. Induction of fibrosis altered the cytokine production of implanted tumor cells, which could have far- reaching consequences on the immune infiltrate and its functionality. Taken together, this work demonstrates that the combination of fibrosis induction with orthotopic tumor implantation results in a markedly different tumor mi- croenvironment and tumor growth kinetics, emphasizing the necessity for more accurate modeling of HCC pro- gression in mice, which takes into account the drastic changes in the tissue caused by chronic liver disease.展开更多
Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after s...Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus(3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.展开更多
OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental va...OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses. METHODS: In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancieswith severe mid-trimester twin-twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9- 25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system. RESULTS: The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1- 40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200). CONCLUSION: These data show that laser therapy is an effective therapeutic option for all stages of severe twin-twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.展开更多
AIM:To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient survival.METHODS:This single center retrospective study included 39 patients who had...AIM:To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient survival.METHODS:This single center retrospective study included 39 patients who had their first liver transplant directly from the intensive care unit and 927 non-ICU patients who were transplanted from hospital ward or home between January 2005 and December 2010.RESULTS:In comparison to non-ICU patients,ICU patients had a higher model for end-stage liver disease (MELD) at transplant (median:37 vs 20,P < 0.001).Fourteen out of 39 patients (36%) required vasopressor support immediately prior to liver transplantation (LT) with 6 patients (15%) requiring both vasopressin and norepinephrine.Sixteen ICU patients (41%) were ventilator dependent immediately prior to LT with 9 patients undergoing percutaneous tracheostomy prior to transplantation.Twenty-five ICU patients (64%) required dialysis preoperatively.At 1,3 and 5 years after LT,graft survival was 76%,68% and 62% in ICU patients vs 90%,81% and 75% in non-ICU patients.Patient survival at 1,3 and 5 years after LT was 78%,70% and 65% in ICU patients vs 94%,85% and 79% in non-ICU patients.When formally comparing graft survival and patient survival between ICU and nonICU patients using Cox proportional hazards regression models,both graft survival [relative risk (RR):1.94,95%CI:1.09-3.48,P=0.026] and patient survival (RR:2.32,95%CI:1.26-4.27,P=0.007) were lower in ICU patients vs non-ICU patients in single variable analysis.These findings were consistent in multivariable analysis.Although not statistically significant,graft survival was worse in both patients with cryptogenic cirrhosis (RR:3.29,P=0.056) and patients who received donor after cardiac death (DCD) grafts (RR:3.38,P=0.060).These findings reached statistical significance when considering patient survival,which was worse for patients with cryptogenic cirrhosis (RR:3.97,P=0.031) and patients who were transplanted with DCD livers (RR:4.19,P=0.033).Graft survival and patient surv展开更多
Verticillium dahliae induced wilt disease in strawberry can cause severe yield losses and thus lead to inevitable negative economic impacts. Inoculation of plants with non-pathogenic strains of Verticillium was conduc...Verticillium dahliae induced wilt disease in strawberry can cause severe yield losses and thus lead to inevitable negative economic impacts. Inoculation of plants with non-pathogenic strains of Verticillium was conducted as a biologic control agent (BCA) according to the concept that preoccupation of the ecologic niche rendered strawberry plants immune to infection with soil-borne pathogenic Verticillium. This concept was tested for economic viability in a field trial under commercial conditions. Results were reported for 2 years of field trials under practice conditions in two locations in Brandenburg, Germany. Inoculation was shown to have a positive effect of 20% of plants, while 30% of plants remain unaffected and of equally high vitality. However, 50%-0% of plants were impacted negatively, showing severe wilt symptoms up to total loss. The characteristic progression of wilt symptoms suggested an infestation caused by Phytophtora sp. and other pathogens. Further results showed that the main factor of the side effects was caused by different qualities of plant material in interaction to the inoculation with the BCA and only to a minor extent depended on pre-infestation of soils. We conclude that specific conditions, such as certified plant material or soil analysis for other pathogens besides Verticillium, avoided these side-effects relevant for commercial farming.展开更多
文摘The liver is a tolerogenic organ with exquisite mechanisms of immune regulation that ensure upkeep of local and systemic immune tolerance to self and foreign antigens, but that is also able to mount effective immune responses against pathogens. The immune privilege of liver allografts was recognized first in pigs in spite of major histo-compatibility complex mismatch, and termed the ＂liver tolerance effect＂. Furthermore, liver transplants are spontaneously accepted with only low-dose immunosuppression, and induce tolerance for non-hepatic co-transplanted allografts of the same donor. Although this immunotolerogenic environment is favorable in the setting of organ transplantation, it is detrimental in chronic infectious liver diseases like hepatitis B or C, malaria, schistosomiasis or tumorigenesis, leading to pathogen persistence and weak anti-tumor effects. The liver is a primary site of T-cell activation, but it elicits poor or incomplete activation of T cells, leading to their abortive activation, exhaustion, suppression of their effector function and early death. This is exploited by pathogens and can impair pathogen control and clearance or allow tumor growth. Hepatic priming of T cells is mediated by a number of local conventional and nonconventional antigen-presenting cells （APCs）, which promote tolerance by immune deviation, induction of T-cell anergy or apoptosis, and generating and expanding regulatory T cells. This review will focus on the communication between classical and nonclassical APCs and lymphocytes in the liver in tolerance induction and will discuss recent insights into the role of innate lymphocytes in this process.
文摘Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance(IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease(NAFLD). NAFLD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis(NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFLD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFLD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFLD. In the interim, clinicians should be aware of this connection and consider screening for NAFLD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.
文摘Microparticles are small cell vesicles that can be released by almost all eukaryotic cells during cellular stress and cell activation. Within the last 1-2 decades it has been shown that microparticles are useful blood surrogate markers for different pathological conditions, such as vascular inflammation, coagulation and tumour diseases. Several studies have investigated the abundance of microparticles of different cellular origins in multiple cardiovascular diseases. It thereby has been shown that microparticles released by platelets, leukocytes and endothelial cells can be found in conditions of endothelial dysfunction, acute and chronic vascular inflammation and hypercoagulation. In addition to their function as surrogate markers, several studies indicate that circulating microparticles can fuse with distinct target cells, such as endothelial cells or leukocyte, and thereby deliver cellular components of their parental cells to the target cells. Hence, microparticles are a novel entity of circulating, paracrine, biological vectors which can influence the phenotype, the function and presumably even the transcriptome of their target cells.This review article aims to give a brief overview about the microparticle biology with a focus on endothelial activation and arterial hypertension. More detailed information about the role of microparticles in pathophysiology and disease can be found in already published work.
文摘Almost every experimental treatment strategy using non-autologous cell, tissue or organ transplantation is tested in small and large animal models before clinical translation. Because these strategies require immunosuppression in most cases, immunosuppressive protocols are a key element in transplantation experiments. However, standard immunosuppressive protocols are often applied without detailed knowledge regarding their efficacy within the particular experimental setting and in the chosen model species. Optimization of such protocols is pertinent to the translation of experimental results to human patients and thus warrants further investigation. This review summarizes current knowledge regarding immunosuppressive drug classes as well as their dosages and application regimens with consideration of species-specific drug metabolization and side effects. It also summarizes contemporary knowledge of novel immunomodulatory strategies, such as the use of mesenchymal stem cells or antibodies. Thus, this review is intended to serve as a state-of-the-art compendium for researchers to refine applied experimental immunosuppression and immunomodulation strategies to enhance the predictive value of preclinical transplantation studies.
文摘AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t -test and Pearson's χ2 test, as appropriate.RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P -value < 0.1 were checked for inclusion in a multivariable logbinomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.
文摘AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to proto-col implementation in July 2011, after which, a new 9 French wire-guided cytology brush(Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pa-thologists who determined whether the sample waspositive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular find-ings consistent with malignancy as compared to 17 of 46(37%) in the historical control group(P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes(21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to his-torical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased di-agnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clus-ters obtained.
基金This survey began as part of a working group output of the NII Shonan Seminar No.2015-1 Big Graph Drawing:Metrics and Methods,and we would like to thank this seminar series for the role it played in this surveyWe would like to thank Tamara Munzner for her ideas and feedback at this seminar which helped focus the topic of this paper.The second author would like to thank EPSRC First Grant EP/N005724/1+1 种基金The last author would like to thank the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 747985This work was supported by the Australian Research Council Discovery Project grant DP140100077.
文摘For decades,researchers in information visualisation and graph drawing have focused on developing techniques for the layout and display of very large and complex networks.Experiments involving human participants have also explored the readability of different styles of layout and representations for such networks.In both bodies of literature,networks are frequently referred to as being‘large’or‘complex’,yet these terms are relative.From a human-centred,experiment point-of-view,what constitutes‘large’(for example)depends on several factors,such as data complexity,visual complexity,and the technology used.In this paper,we survey the literature on human-centred experiments to understand how,in practice,different features and characteristics of node–link diagrams affect visual complexity.
文摘Pancreatic ductal adenocarcinoma(PDAC) is a worldwide public health concern. Despite extensive research efforts toward improving diagnosis and treatment, the 5-year survival rate at best is approximately 15%. This dismal figure can be attributed to a variety of factors including lack of adequate screening methods, late symptom onset, and treatment resistance. Pancreatic ductal adenocarcinoma remains a grim diagnosis with a high mortality rate and a significant psychological burden for patients and their families. In recent years artificial intelligence(AI) has permeated the medical field at an accelerated pace, bringing potential new tools that carry the promise of improving diagnosis and treatment of a variety of diseases. In this review we will summarize the landscape of AI in diagnosis and treatment of PDAC.
文摘AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in serie
文摘Initiation and progression of hepatocellular carcinoma （HCC） is intimately associated with a chronically diseased liver tissue. This diseased liver tissue background is a drastically different microenvironment from the healthy liver, especially with regard to immune cell prevalence and presence of mediators of immune function. To better understand the consequences of liver disease on tumor growth and the interplay with its mi- croenvironment, we utilized two standard methods of fi- brosis induction and orthotopic implantation of tumors into the inflamed and fibrotic liver to mimic the liver condition in human HCC patients. Compared to non-diseased con- trols, tumor growth was significantly enhanced under fi- brotic conditions. The immune cells that infiltrated the tumors were also drastically different, with decreased numbers of natural killer cells but greatly increased num- bers of immune-suppressive CDllb^＋ Gr1^hi myeloid cells in both models of fibrosis. In addition, there were model- specific differences： Increased numbers of CD11b^＋ mye- loid cells and CD4^＋ CD25^＋ T cells were found in tumors in the bile duct ligation model but not in the carbon te- trachloride model. Induction of fibrosis altered the cytokine production of implanted tumor cells, which could have far- reaching consequences on the immune infiltrate and its functionality. Taken together, this work demonstrates that the combination of fibrosis induction with orthotopic tumor implantation results in a markedly different tumor mi- croenvironment and tumor growth kinetics, emphasizing the necessity for more accurate modeling of HCC pro- gression in mice, which takes into account the drastic changes in the tissue caused by chronic liver disease.
文摘Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus(3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.
文摘OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses. METHODS: In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancieswith severe mid-trimester twin-twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9- 25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system. RESULTS: The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1- 40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200). CONCLUSION: These data show that laser therapy is an effective therapeutic option for all stages of severe twin-twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.
文摘AIM:To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient survival.METHODS:This single center retrospective study included 39 patients who had their first liver transplant directly from the intensive care unit and 927 non-ICU patients who were transplanted from hospital ward or home between January 2005 and December 2010.RESULTS:In comparison to non-ICU patients,ICU patients had a higher model for end-stage liver disease (MELD) at transplant (median:37 vs 20,P < 0.001).Fourteen out of 39 patients (36%) required vasopressor support immediately prior to liver transplantation (LT) with 6 patients (15%) requiring both vasopressin and norepinephrine.Sixteen ICU patients (41%) were ventilator dependent immediately prior to LT with 9 patients undergoing percutaneous tracheostomy prior to transplantation.Twenty-five ICU patients (64%) required dialysis preoperatively.At 1,3 and 5 years after LT,graft survival was 76%,68% and 62% in ICU patients vs 90%,81% and 75% in non-ICU patients.Patient survival at 1,3 and 5 years after LT was 78%,70% and 65% in ICU patients vs 94%,85% and 79% in non-ICU patients.When formally comparing graft survival and patient survival between ICU and nonICU patients using Cox proportional hazards regression models,both graft survival [relative risk (RR):1.94,95%CI:1.09-3.48,P=0.026] and patient survival (RR:2.32,95%CI:1.26-4.27,P=0.007) were lower in ICU patients vs non-ICU patients in single variable analysis.These findings were consistent in multivariable analysis.Although not statistically significant,graft survival was worse in both patients with cryptogenic cirrhosis (RR:3.29,P=0.056) and patients who received donor after cardiac death (DCD) grafts (RR:3.38,P=0.060).These findings reached statistical significance when considering patient survival,which was worse for patients with cryptogenic cirrhosis (RR:3.97,P=0.031) and patients who were transplanted with DCD livers (RR:4.19,P=0.033).Graft survival and patient surv
文摘Verticillium dahliae induced wilt disease in strawberry can cause severe yield losses and thus lead to inevitable negative economic impacts. Inoculation of plants with non-pathogenic strains of Verticillium was conducted as a biologic control agent (BCA) according to the concept that preoccupation of the ecologic niche rendered strawberry plants immune to infection with soil-borne pathogenic Verticillium. This concept was tested for economic viability in a field trial under commercial conditions. Results were reported for 2 years of field trials under practice conditions in two locations in Brandenburg, Germany. Inoculation was shown to have a positive effect of 20% of plants, while 30% of plants remain unaffected and of equally high vitality. However, 50%-0% of plants were impacted negatively, showing severe wilt symptoms up to total loss. The characteristic progression of wilt symptoms suggested an infestation caused by Phytophtora sp. and other pathogens. Further results showed that the main factor of the side effects was caused by different qualities of plant material in interaction to the inoculation with the BCA and only to a minor extent depended on pre-infestation of soils. We conclude that specific conditions, such as certified plant material or soil analysis for other pathogens besides Verticillium, avoided these side-effects relevant for commercial farming.
