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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 | 术中应用荧光素钠有利于胶质母细胞瘤浸润边缘的手术切除(英文)显示文摘Objective Extent of resection is an important prognostic factor in patients undergoing surgery for glioblastoma( GBM).Recent evidence suggests that intravenously administered fluorescein sodium associates with tumor tissue,facilitating safe maximal resection of GBM. In this study,the authors evaluate the safety and utility of intraoperative fluorescein guidance for the prediction of histopathological alteration both in the contrast-enhancing( CE) regions,where this relationship has been established,and into the nonCE( NCE),diffusely infiltrated margins. Methods Thirty-two patients received fluorescein sodium( 3 mg/kg) intravenously prior to resection. Fluorescence was intraoperatively visualized using a Zeiss Pentero surgical microscope equipped with a YELLOW 560 filter.Stereotactically localized biopsy specimens were acquired from CE and NCE regions based on preoperative MRI in conjunction with neuronavigation. The fluorescence intensity of these specimens was subjectively classified in real time with subsequent quantitative image analysis,histopathological evaluation of localized biopsy specimens,and radiological volumetric assessment of the extent of resection.Results Bright fluorescence was observed in all GBMs and localized to the CE regions and portions of the NCE margins of the tumors,thus serving as a visual guide during resection. Gross-total resection( GTR) was achieved in 84% of the patients with an average resected volume of 95%,and this rate was higher among patients for whom GTR was the surgical goal( GTR achieved in 93. 1% of patients,average resected volume of 99. 7%). Intraoperative fluorescein staining correlated with histopathological alteration in both CE and NCE regions,with positive predictive values by subjective fluorescence evaluation greater than 96% in NCE regions. Conclusions Intraoperative administration of fluorescein provides an easily visualized marker for glioma pathology in both CE and NCE regions of GBM. These findingssupport the use of fluorescein as a microsurgical adjunct for guiding GBM resection to facilitate safe maximal removal. | Neira JA Ung TH Sims J Malone HR Chow DS Samanamud JL Zanazzi GJ Guo X Bowden SG Zhao B Sheth SA McKhann GM 2nd Sisti MB Canoll P D'Amico RS Bruce JN | 2016 | 中华神经外科疾病研究杂志2016，15，5： | 2 |
| 3 | Antecedents and consequences of the growth of customer - centric marketing显示文摘 | Sheth J Sisodia RS Sharma A | 2000 | Acad Mark Sci2000，28，： | 1 |
| 4 | Federated database system for managing distributed, heterogeneous, and autonomous database 显示文摘 | SHETH A P LARSON J A | 1990 | AGM Computing Suweys1990，22，3： | 1 |
| 5 | The spectrum of neuropathy in diabetes and impaired glucose tolerance 显示文摘 | Sumner C J Sheth S Griffin JW | 2003 | Neurology2003，60，1： | 1 |
| 6 | Clinical application of vorieonazole concentrations in the treatment of invasive aspergillosis显示文摘 | HOWARD A HOFFMAN J SHETH A | 2008 | Ann Pharmacother2008，42，12： | 1 |
| 7 | Why we buy what we buy: A theory of consumption values 显示文摘 | Sheth J N Newman B I Gross B L | 1991 | Journal of business research1991，22，2： | 1 |
| 8 | Impact of emerging markets on marketing: Rethinking existing perspectives and practices显示文摘 | Sheth J N | 2011 | Jour- nal of Marketing2011，75，4： | 1 |
| 9 | Authorization and access control of application data in workflow system显示文摘 | Wu S L Sheth A Miller J | 2002 | Journal of Intelligent Information System2002，18，1： | 1 |
| 10 | Children with new-onset epilepsy: neuropsychological status and brain structure显示文摘 | Hermann B Jones J Sheth R | 2006 | Brain2006，129，： | 1 |
| 11 | Development of Web work: METEOR - 2 's Web - based workflow management system 显示文摘 | MILLER J PALANISWAMI D SHETH A | 1998 | Journal of Intelligent Information Systems1998，10，2： | 1 |
| 12 | Quality of service for workflows and web service processes显示文摘 | Cardoso J Sheth A Miller J | 2004 | Journal of Web Semantics2004，3，1： | 1 |
| 13 | Quality of service for workflows and Web service processes显示文摘 | CARDOSO J SHETH A P MILLER J A | 2004 | Web Semantics2004，1，3： | 1 |
| 14 | Orientation maps of subjective contours invisual cortex显示文摘 | Sheth B.R Sharma J Rao S.C Sur M | | 0，，： | 1 |
| 15 | Marketing productivity, issues and analysis 显示文摘 | Sheth J N Sisodia R S | 2002 | Journal of Business Research2002，55，5： | 1 |
| 16 | Quality of service for workflows and Web service processes显示文摘 | Cardoso J Sheth A Miller J | 2004 | Journal of Web Semantics2004，，3： | 1 |
| 17 | Federated database systems for managing distributed, heterogeneous, and autonomous databases显示文摘 | Sheth A P Larson J A | 1990 | ACM Computing Surveys1990，22，3： | 1 |
| 18 | Consumer resistance to innova- tions: the marketing problem and its solutions显示文摘 | Ram S Sheth J N | 1989 | Journal of Consumer Marketing1989，6，2： | 1 |
| 19 | Managing malig- nant cerebral infarction 显示文摘 | Simard J M Sahuquillo J Sheth K N | 2011 | Current Treatment Options in Neurology2011，13，2： | 1 |
| 20 | Federated database systems for managing distributed, heterogeneous, and autonomous database 显示文摘 | Sheth A P Larson J A | 1990 | ACM Computing Surveys1990，922，3： | 1 |
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