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| 1 | Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis显示文摘BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures. | Supisara Tintara Ishani Shah William Yakah Awais Ahmed Cristina S Sorrento Cinthana Kandasamy Steven D Freedman Darshan J Kothari Sunil G Sheth | 2022 | World Journal of Gastroenterology2022，28，16： | 3 |
| 2 | Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation显示文摘 | Jun D Timm D Darshan D | 2006 | J Cardovasc Eletrophysiol2006，17，： | 1 |
| 3 | Long-term efficacy of catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular dysp-Lasia/cardiomyopathy显示文摘 | Darshan D Rahul J Harikrishna T | 2007 | J Am Coll Cardiol2007，50，： | 1 |
| 4 | Regulation of systemic iron homeostasis : How the body responds to changes in iron demand 显示文摘 | Anderson G J Darshan D Wilkins SJ | 2007 | Biometals2007，20，34： | 1 |
| 5 | Mo?lecular basis of iron-loading disorders显示文摘 | DARSHAN D FRAZER D M ANDERSON GJ | 2010 | Expert Rev Mol Med2010，12，： | 1 |
| 6 | Comprehensive Desmosome Mutation Analysis in North Americans With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy显示文摘 | A Dénise den Haan Boon Yew Tan Michelle N. Zikusoka Laura Iba?ez Lladó Rahul Jain Amy Daly Crystal Tichnell Cynthia James Nuria Amat-Alarcon Theodore Abraham Stuart D. Russell David A. Bluemke Hugh Calkins Darshan Dalal Daniel P. Judge | 2009 | Circulation: Cardiovascular Genetics2009，，5： | 1 |
| 7 | Interacting signals in the control of hepcidin expression显示文摘 | Darshan D Anderson GJ | 2009 | Biometals2009，22，1： | 1 |
| 8 | Ultrasound fields in an attenuating medium显示文摘 | Jensen JA Darshan G William D | 1993 | Proceedings of the IEEE 1993 Ultrasonics Symposium1993，2，： | 1 |
| 9 | Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation显示文摘 | Jun D Timm D Darshan D Cheema A Vasamreddy C R Henrikson C A | 2006 | J Cardo vasc Eletrophysiol2006，17，： | 1 |
| 10 | Stimulated Erythropoiesis with Secondary Iron Loading Leads to a Decrease lnhepeidin Despite an Increase in Bone Morphogenetie Protein 6 Expression 显示文摘 | FRAZER D M WILKINS S J DARSHAN D | 2012 | Haematol2012，157，5： | 1 |
| 11 | Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation 显示文摘 | Jun D Timm D Darshan D | 2006 | J Cardovasc Eletrophysiol2006，17，： | 1 |
| 12 | Interacting signals in the control of hepcidin expression显示文摘 | Darshan D Anderson GJ | 2009 | Biometals2009，22，1： | 1 |
| 13 | Interacting signals in the controlof hepcidin expression显示文摘 | Darshan D Anderson GJ | 2009 | Biometals2009，22，1： | 1 |
| 14 | Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation显示文摘 | Jun D Timm D Darshan D | 2006 | J Cardiovasc Eletrophysiol2006，17，： | 1 |
| 15 | Interacting signals in the control of hepcidin expression显示文摘 | Darshan D Anderson G J | 2009 | Biometals2009，22，1： | 1 |
| 16 | Stimulated erythropoiesis with secondary iron loading leads to a de- crease in hepcidin despite an increase of bone morphogenetic protein 6 expression 显示文摘 | Frazer DM Willkins S J Darshan D | 2012 | Br J Hematol2012，157，5： | 1 |
| 17 | Molecular basis of iron-load- ing disorders 显示文摘 | Darshan D Frazer DM Anderson GJ | 2010 | Expert Rev Mol Med2010，12，： | 1 |
| 18 | Regulation of systemic iron homeostasis : how the body responds to changes in iron demand 显示文摘 | Anderson GJ Darshan D Wilkins SJ | 2007 | Biometals2007，20，34： | 1 |
| 19 | 开放获取内镜筛查能准确安全地筛选出可清醒镇静的病例显示文摘背景与目的:开放获取内镜筛查能很好地应用于普通低风险的内镜操作。内镜操作前的筛查重点是镇静需求,但筛查结果欠准确将有损内镜的安全性。本研究旨在论证我们的开放获取内镜筛查系统能否准确筛选出可清醒镇静的病例。方法:前瞻性连续入组经开放获取筛查系统或在胃肠科办公室咨询后进行预约的门诊内镜操作病例。收集错误预约为清醒镇静的病例,对其病例特征进行分析。结果:共计有8063例门诊病例预约行清醒镇静状态下的内镜操作,其中5959例通过开放获取系统进行预约。仅78例(0.97%,78/8063)后续被认为需要麻醉医生支持下的镇静处理,其中44例(56.4%,44/78)是通过开放获取筛查系统预约的,长期服用鸦片(47.7%,21/44)和苯二氮(34.1%,15/44)是需要麻醉医生支持镇静的主要原因。长期服用苯二氮者较未服用者在清醒镇静时需要更高剂量的咪达唑仑(P=0.03),长期服用鸦片者镇静时则需要更高剂量的芬太尼(P=0.04)。进展期肝病和长期饮酒是胃肠科办公室咨询后预约病例需要麻醉医生支持镇静的常见原因,其所占比例明显高于开放获取筛查系统预约病例(均P<0.01)。结论:我们观察到经过多层筛查,绝大多数病例都适合于清醒镇静,更重要的是,只有很少一部分(<1.0%)病例清醒镇静预约不当。需要麻醉医生辅助镇静的主要原因包括鸦片和苯二氮的长期服用和/或长期饮酒和进展期肝病,提示这些病例应纳入开放获取筛查系统中。 | Darshan Kothari Joseph D.Feuerstein Laureen Moss Julie D’Souza Kerri Montanaro Daniel A.Leffler Sunil G.Sheth | 2016 | Gastroenterology Report2016，4，4： | 0 |
| 20 | Computational design for 4D printing of topology optimized multi-material active composites显示文摘Recent efforts on design for four-dimensional(4D)printing have considered the spatial arrangement of smart materials and energy stimuli.The development of multifunctional structures and their desired mechanical/actuation performances require tackling 4D printing from a multi-material design perspective.With the materials distributions there is an opportunity to increase the spectrum of design concepts with computational approaches.The main goal being to achieve the“best”distribution of material properties in a voxelized structure,a computational framework that consists of a finite element analysis-based evolutionary algorithm is presented.It fuses the advantages of optimizing both the materials distribution and material layout within a design space via topology optimization to solve the inverse design problem of finding an optimal design to achieve a target shape change by integrating void voxels.The results demonstrate the efficacy of the proposed method in providing a highly capable tool for the design of 4D-printed active composites. | Darshan Athinarayanarao Romaric Prod’hon Dominique Chamoret H.Jerry Qi Mahdi Bodaghi Jean-Claude André Frédéric Demoly | 2023 | npj Computational Materials2023，，1： | 0 |
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