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| 1 | Ampullary carcinoma:Effect of preoperative biliary drainage on surgical outcome显示文摘AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage (PBD group), and 47 were not drained (non-PBD group). The mode of biliary drainage was endoscopic retrograde cholangiopancreatography (n = 33) or percutaneous biliary drainage (n = 2). The following parameters were analyzed: wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d (hospital mortality) and also longterm. The statistical endpoint of this study was patient survival after surgery. RESULTS: The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non-PBD group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group).Of the parameters assessing postoperative morbidity, incidence of wound infection was signif icantly less in the PBD than the non-PBD group [1 (2.9%) vs 12 (25.5%)]. However, the rest of the parameters did not differ signif icantly between the groups, i.e. sepsis [10 (28.6%) vs 14 (29.8%)], intra-abdominal bleeding [1 (2.9%) vs 5 (10.6%)], intra-abdominal abscess [1 (2.9%) vs 8 (17%)], gastrointestinal bleeding [3 (8.6%) vs 5 (10.6%)], pancreatic leakage [2 (5.7%) vs 3 (6.4%)], biliary leakage [2 (5.7%) vs 3 (6.4%)], pancreatitis [2 (5.7%) vs 2 (4.3%)], gastroparesis [6 (17.1%) vs 10 (21.3%)], need for blood transfusion [10 (28.6%) vs 17 (36.2%)] and re-operation rate [1 (2.9%) vs 5 (10.6%)]. There was no early mortality in either group. Median survival was 44 mo (95% CI: 34.2-53.8) in the PBD group and 41 mo (95% CI: 27.7-54.3; P = 0.86) in the non-PBD group. CONCLUSION: Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage. | Sheikh Anwar Abdullah Tarun Gupta Khairul Azhar Jaafar Yaw Fui Alexander Chung London Lucien Peng Jin Ooi Steven Joseph Mesenas | 2009 | World Journal of Gastroenterology2009，15，23： | 16 |
| 2 | l Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome 显示文摘 | Sheikh Anwar Abdullah Tarun Gupta Khairul Azhar Jaafar Yaw Fui Alexander Chung eta | 2008 | World Joural ofGastroenterology2008，53，72： | 1 |
| 3 | Paternal environmental exposure-induced spermatozoal small noncoding RNA alteration meditates the intergenerational epigenetic inheritance of multiple diseases显示文摘Studies of human and mammalian have revealed that environmental exposure can affect paternal health conditions as well as those of the offspring.However,studies that explore the mechanisms that meditate this transmission are rare.Recently,small noncoding RNAs(sncRNAs)in sperm have seemed crucial to this transmission due to their alteration in sperm in response to environmental exposure,and the methodology of microinjection of isolated total RNA or sncRNAs or synthetically identified sncRNAs gradually lifted the veil of sncRNA regulation during intergenerational inheritance along the male line.Hence,by reviewing relevant literature,this study intends to answer the following research concepts:(1)paternal environmental factors that can be passed on to offspring and are attributed to spermatozoal sncRNAs,(2)potential role of paternal spermatozoal sncRNAs during the intergenerational inheritance process,and(3)the potential mechanism by which spermatozoal sncRNAs meditate intergenerational inheritance.In summary,increased attention highlights the hidden wonder of spermatozoal sncRNAs during intergenerational inheritance.Therefore,in the future,more studies should focus on the origin of RNA alteration,the target of RNA regulation,and how sncRNA regulation during embryonic development can be sustained even in adult offspring. | Xin Yin Azhar Anwar Yanbo Wang Huanhuan Hu Gaoli Liang Chenyu Zhang | 2022 | Frontiers of Medicine2022，16，2： | 0 |
| 4 | Knowledge and practices of primary care physicians on the current referral system of diabetic retinopathy in Islamabad and Rawal-Pindi, Pakistan显示文摘AIM: To assess the current knowledge and practices in diabetic eye care and referral system regarding diabetic retinopathy(DR) in health centers of Islamabad and RawalPindi. METHODS: A cross-sectional study was carried out in 4 government and private health centers in RawalpindiIslamabad from May 2018 to Oct. 2018. A total of 38 Primary Care Physicians(general practitioners, family physicians, and internists) were recruited out of which data for 2 were either not returned, or were missing partially. Data were collected through a 27-item consented & validated, multiple-choice questionnaire based on physician characteristics, knowledge and practice of diabetic eye care and challenges faced due current DR referral system. Descriptive analyses for all variables were performed including, mean and standard deviation. Analytical analyses were also conducted to study association between different study variables. RESULTS: Mean scores of knowledge for general practitioners, family physicians, and internists were 41.7%, 42.0% and 46.6% respectively. A lack of knowledge, and suboptimal practices were observed regarding signs, symptoms, screening, testing, evaluation and referral of DR regardless of physicians’ specialty, or years in practice. Lack of expertise regarding direct ophthalmoscopy, interpretation of findings, and referral to an ophthalmologist were noted. Physicians who performed consultation and counselling according to patients’ needs referred more patients to an ophthalmologist than those who restricted their consultationto a fixed amount of time and had more patients per unit time(P=0.01). Physicians who had taken care of less than 5 number of patients with DR marked less incorrect answers with no significantly greater number or correct answers compared to physicians who had taken care of more than 5 number of patients with DR(P=0.044). An association of more than 5 patients with DR taken care of with more need based patient consultation and counselling was also noted(P=0.017). An evaluation of the current referral system for DR revealed major loopholes in the health care infrastructure, proper guidelines, properly functioning equipment, check and balances, and lack of guidance to physicians regarding acquiring and updating knowledge regarding DR. CONCLUSION: Lack of updated and adequate knowledge, practices among primary care physicians, and suboptimal diabetic eye care and referral system have contributed to late presentation of DR. Interventions are needed to improve current diabetic eye care, and knowledge and practices of primary care physicians. | Muhammad Shakaib Anwar Baila Shakaib Waseem Akhtar Erum Yusufzai Maham Zehra Hajira Munawar Kinza Azhar | 2019 | International Journal of Ophthalmology(English edition)2019，12，12： | 0 |
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