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11.
Background
Type 2 diabetes mellitus (T2DM) has become an epidemic health problem worldwide. Compared to Western countries, in Asia, T2DM occurs in patients with a lower body mass index (BMI) due to central obesity and decreased pancreatic β-cell function. The efficacy of laparoscopic mini-gastric bypass (LMGB) in obese patients with T2DM has been proven by numerous studies. Treatment outcomes of LMGB for non-obese T2DM patients are also estimated to be excellent. The aim of the present pilot study was to evaluate the efficacy and safety of LMBG in non-obese T2DM patients (BMI 25–30 kg/m2). 相似文献12.
13.
DS Keller RN Tahilramani JR Flores-Gonzalez S. Ibarra EM Haas 《Surgical endoscopy》2016,30(6):2192-2198
Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (p = 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control; p < 0.01). The experimental group had significantly lower initial (p < 0.01) and final PACU pain scores (p = 0.04) and shorter LOS (3.0 vs. 4.1 days, p = 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.Conclusions
Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.14.
Hyun Jeong Park Seong Sook Hong Jiyoung Hwang Kyung Yul Hur 《Korean journal of radiology》2015,16(2):325-333
Laparoscopic mini-gastric bypass surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently. Radiologists must be critical in their postoperative evaluation of these patients. In this pictorial review, we explain and illustrate the surgical technique, normal postoperative anatomy, and associated complications as seen on imaging examinations, including fluoroscopy and computed tomography. 相似文献
15.
K. Nael J. Hur A. Bauer R. Khan A. Sepahdari R. Inampudi M. Guerrero 《AJNR. American journal of neuroradiology》2015,36(11):2147
BACKGROUND AND PURPOSE:The hypervascular nature of parathyroid adenomas can be explored by proper dynamic imaging to narrow the target lesions for surgical exploration. The purpose of this study was to establish MR perfusion characteristics of parathyroid adenomas to differentiate them from their mimics, such as subjacent thyroid tissue and cervical lymph nodes.MATERIALS AND METHODS:Preoperative high-spatial and -temporal resolution dynamic 4D contrast-enhanced MR imaging in 30 patients with surgically proved parathyroid adenomas was evaluated retrospectively. Using coregistered images, we placed ROIs over the parathyroid adenoma, thyroid gland, and a cervical lymph node (jugulodigastric) to obtain peak enhancement, time-to-peak, wash-in, and washout in each patient. Data were analyzed by logistic regression and analysis of variance. Receiver operating characteristic analysis was performed to determine the optimal parameters for determination of parathyroid adenomas versus thyroid tissue and cervical lymph nodes.RESULTS:Parathyroid adenomas showed significantly (P < .05) faster time-to-peak, higher wash-in, and higher washout compared with cervical lymph nodes and significantly (P < .05) higher peak enhancement, faster time-to-peak, higher wash-in, and higher washout compared with thyroid tissue. Logistic regression analysis indicated significant contribution from time-to-peak (P = .02), wash-in (P = .03), and washout (P = .008) for differentiation of parathyroid adenomas from thyroid and cervical lymph nodes. Using receiver operating characteristic analysis, we obtained the best diagnostic accuracy from a combination of time-to-peak/wash-in/washout in the differentiation of parathyroid adenomas versus lymph nodes (area under the curve, 0.96; sensitivity/specificity, 88%/90%) and in distinguishing parathyroid adenomas versus thyroid tissue (area under the curve, 0.96; sensitivity/specificity, 91%/95%).CONCLUSIONS:Dynamic 4D contrast-enhanced MR imaging can be used to exploit the hypervascular nature of parathyroid adenomas. Multiparametric MR perfusion can distinguish parathyroid adenomas from subjacent thyroid tissue or lymph nodes with diagnostic accuracies of 96%.Single parathyroid adenoma (PTA) is the most common cause of primary hyperparathyroidism, accounting for approximately 80%–90% of all cases.1 Definitive treatment requires surgical excision, and preoperative localization with imaging is commonly used to decrease the size of surgical incisions and complication rates.2Imaging has been increasingly used for preoperative detection of parathyroid adenomas. While sonography and technetium Tc99m sestamibi scintigraphy have often been used as first-line imaging to localize PTA, these tests are often inconclusive. This situation has led to the development of multiphasic CT (4D CT), which identifies PTAs through their hypervascular perfusion pattern compared with lymph nodes and the thyroid gland. 4D CT has shown superior accuracy compared with scintigraphy,3 though the radiation dose remains as high as 5.56–10.4 mSv.4–6MR imaging is an attractive alternative to both scintigraphy and 4D CT due to the lack of radiation and has been used for the evaluation of PTAs with some success,7–9 though not with the same effectiveness as 4D CT. Traditional technical limitations to localizing PTAs with MR imaging have recently been addressed with modern MR imaging technology. These include limited spatial and temporal resolution for multiphase dynamic contrast-enhanced MR imaging over a large FOV required for parathyroid imaging. This limitation can be addressed by the use of fast imaging tools such as time-resolved imaging with stochastic trajectories (TWIST)10 and improved parallel imaging techniques such as controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA).11 The second limitation is inhomogeneity of fat suppression in the neck required for detection of small parathyroid adenomas. The Dixon fat-suppression technique12 can dramatically improve this shortcoming.13In this study by using a modified dynamic contrast-enhanced sequence with incorporation of a TWIST-CAIPIRINHA combination and the Dixon fat saturation technique, we sought to describe MR perfusion characteristics of PTAs in a cohort of patients with pathology-proved PTA. We hypothesized that MR perfusion biomarkers can differentiate PTA from PTA mimics, such as subjacent thyroid gland and cervical lymph nodes. 相似文献
16.
Usefulness of thin‐section single‐shot turbo spin echo with half‐fourier acquisition in evaluation of local invasion of lung cancer 下载免费PDF全文
17.
OBJECT: Deep brain stimulation (DBS) to treat advanced Parkinson disease (PD) has been focused on one of two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). Authors of more than 65 articles have reported on bilateral DBS outcomes. With one exception, these studies involved pre- and postintervention comparisons of a single target. Despite the paucity of data directly comparing STN and GPI DBS, many clinicians already consider the STN to be the preferred target site. In this study the authors conducted a metaanalysis of the existing literature on patient outcomes following DBS of the STN and the GPI. METHODS: This metaanalysis includes 31 STN and 14 GPI studies. Motor function improved significantly following stimulation (54% in patients whose STN was targeted and 40% in those whose GPI was stimulated), with effect sizes (ESs) of 2.59 and 2.04, respectively. After controlling for participant and study characteristics, patients who had undergone either STN or GPI DBS experienced comparable improved motor function following surgery (p = 0.094). The performance of activities of daily living improved significantly in patients with either target (40%). Medication requirements were significantly reduced following stimulation of the STN (ES = 1.51) but did not change when the GPI was stimulated (ES = -0.02). CONCLUSIONS: In this analysis the authors highlight the need for uniform, detailed reporting of comprehensive motor and nonmotor DBS outcomes at multiple time points and for a randomized trial of bilateral STN and GPI DBS. 相似文献
18.
Lee YS Sohn KC Kim KH Cho MJ Hur GM Yoon TJ Kim SK Lee K Lee JH Kim CD 《Experimental dermatology》2009,18(1):50-56
Abstract: In this study, we investigated the process of X-ray-induced apoptosis of skin keratinocyte, and the functional role of protein kinase C delta (PKCδ) and downstream signalling cascade. High-dose X-ray irradiation (10 Gy) led to the apoptosis of HaCaT keratinocyte, accompanied by PKCδ cleavage. Treatment with PKCδ inhibitor and adenoviral transduction of dominant-negative PKCδ clearly inhibited the X-ray-induced apoptosis of keratinocyte. In addition, X-ray induced the phosphorylation of extracellular signal-regulated kinases 1/2 (ERK1/2) and inhibition by ERK1/2 inhibitor abrogated the X-ray-induced apoptosis. Interestingly, overexpression of dominant-negative PKCδ markedly blocked the X-ray-induced phosphorylation of ERK1/2, suggesting that ERK1/2 is the functional downstream effector of PKCδ. Next, we investigated the difference between UVB and X-ray response. UVB induced the apoptosis of keratinocyte in a PKCδ-dependent manner, similar to X-ray response. However, UVB irradiation induced the phosphorylation of c-jun N-terminal kinases (JNK) and inhibition of JNK significantly protected the UVB-induced apoptosis. These results demonstrate that PKCδ is a key regulator in X-ray-induced apoptosis of keratinocyte and suggest that there is subtle difference in downstream signalling cascade between UVB and X-ray response of keratinocyte. 相似文献
19.
20.
Jung Eui-Gil Han Kook-Il Kwon Hyun-Jung Patnaik Bharat Bhusan Kim Wan-Jong Hur Gang Min Nam Kung-Woo Han Man-Deuk 《Archives of pharmacal research》2015,38(6):973-983
Archives of Pharmacal Research - Sappanchalcone, a bioactive flavonoid isolated from the heartwood of Caesalpinia sappan L. possesses anti-inflammatory effects. We studied the efficacy of... 相似文献