|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 1 | 胰外并发症尤其是血液透析可预测ICU急性胰腺炎患者的病死率和住院时间显示文摘背景和目的:入住ICU的急性胰腺炎患者因疾病严重和住院时间延长,胰外并发症风险增高。我们旨在评估ICU急性胰腺炎患者胰外并发症发生率及其对住院时间和病死率的影响。方法:本研究为回顾性队列研究,研究对象来自一家三级转诊中心的287例ICU急性胰腺炎患者,其中163例满足纳入标准入组研究。计算胰外并发症发生率,并通过单因素和多因素分析评估胰外并发症对住院时间和病死率的影响。结果:163例患者共出现158例次胰外并发症,平均每例患者出现0.97种胰外并发症。95例患者出现至少1种胰外并发症,另外68例未出现胰外并发症。在排除胰腺局部并发症患者后,胰外并发症患者住院时间较无并胰外发症患者显著延长(14.7天vs.8.8天,P<0.01)。非感染性胰外并发症患者病死率显著增高(24.0%vs.16.2%,P=0.04)。多因素分析结果显示,需要透析是住院时间(IRR=1.73,95%CI:1.2632.378,P<0.01)和病死率(IRR=1.50,95%CI:1.6236.843,P<0.01)的独立预测因素。同时,冠脉事件也是病死率的一个预测因素(P=0.05)。而其他胰外并发症的预测价值未获证实。结论:ICU急性胰腺炎患者常会发生胰外并发症,从而影响住院时间。非感染性胰外并发症还会增加病死率。在消除了胰腺局部并发症的干扰后,需要透析治疗被证实为ICU急性胰腺炎患者住院时间延长和病死率增高的独立预测因素。 | Darshan Kothari Maarten R.Struyvenberg Michael C.Perillo Ghideon Ezaz Steven D.Freedman Sunil G.Sheth | 2018 | Gastroenterology Report2018，6，3： | 2 |
| 2 | Natural history,clinical characteristics,outcomes,and long-term follow-up of pain-free chronic pancreatitis显示文摘Background:Chronic pancreatitis(CP)is characterized by chronic abdominal pain and functional insufficiency.However,a small subset of patients with prior acute pancreatitis(AP)and/or underlying risk factors for developing CP may be pain-free at diagnosis and may have a different clinical course.We aimed to compare the clinical characteristics,outcomes,and healthcare utilization between CP patients with and without pain.Methods:Reviewed patients with established CP were followed in our Pancreas Center between January 2016 and April 2021.Patients without risk factors for developing CP and/or without AP prior to their diagnosis and only with incidental radiologic features of CP were excluded,so as tominimize confounding factors of pancreatopathy unrelated to CP.Patients were divided into painful and pain-free groups to analyze differences in demographics,outcomes,and healthcare utilization.Results:Of 368 CP patients,49(13.3%)were pain-free at diagnosis and had remained so for>9 years.There were no significant differences in body mass index,race,sex,or co-morbidities between the two groups.Pain-free patients were older at diagnosis(53.9 vs 45.7,P=0.004)and had less recurrent AP(RAP)(43.8%vs 72.5%,P<0.001)and less exocrine pancreatic insufficiency(EPI)(34.7%vs 65.7%,P<0.001).Pain-free patients had less disability(2.2%vs 22.0%,P=0.003),mental illness(20.4%vs 61.0%,P<0.001),surgery(0.0%vs 15.0%,P=0.059),and therapeutic interventions(0.0%vs 16.4%,P=0.005)for pain.Conclusions:We described a unique subset of patients with underlying risk factors for CP and/or prior AP who were painfree at diagnosis.They were older at diagnosis,had less EPI and RAP,and overall favorable outcomes with minimal resource utilization. | Awais Ahmed Ishani Shah Rachel Bocchino Steven D.Freedman Darshan J.Kothari Sunil G.Sheth | 2023 | Gastroenterology Report2023，11，1： | 0 |
| 3 | Tackling clinical complexity: how inpatient subspecialty gastroenterology services enhance patient care显示文摘Introduction Over the past three decades,the field of gastroenterology(GI)has undergone tremendous transformation.Advances in research have led to a substantial growth in clinical knowledge across many GI conditions.Additionally,over this time,the prevalence of patient complexity,including the number of co-morbidities,mental illness burden,socioeconomic factors,and multidisciplinary needs,have continued to increase.Thus,subspecialization within GI has been an adaptive response to keep pace with the rapid expansion of medical knowledge and evolving patient needs. | Cinthana Kandasamy Darshan J.Kothari Sunil G.Sheth | 2021 | Gastroenterology Report2021，9，6： | 0 |
| 4 | Burden of bone disease in chronic pancreatitis:A systematic review and meta-analysis显示文摘BACKGROUND Bone disease is an under-recognized cause of morbidity in chronic pancreatitis(CP).Over the past decade,publications of original studies on bone disease in CP has warranted synthesis of the evidence to ascertain the true burden of the problem.AIM To quantify the prevalence of osteopenia,osteoporosis,and fragility fractures in CP patients and investigate the associated clinical features and outcomes.METHODS A systematic search identified studies investigating bone disease in CP patients from Cochrane Library,Embase,Google Scholar,Ovid Medline,PubMed,Scopus,and Web of Science,from inception until October 2022.The outcomes included prevalence of osteopenia,osteoporosis,and fragility fractures,which were metaanalyzed using a random-effects model and underwent metaregression to delineate association with baseline clinical features.RESULTS Twenty-one studies were included for systematic review and 18 studies were included for meta-analysis.The pooled prevalence of osteopenia and osteoporosis in CP patients was 41.2%(95%CI:35.2%-47.3%)and 20.9%(95%CI:14.9%-27.6%),respectively.The pooled prevalence of fragility fractures described among CP was 5.9%(95%CI:3.9%-8.4%).Metaregression revealed significant association of pancreatic enzyme replacement therapy(PERT)use with prevalence of osteoporosis[coefficient:1.7(95%CI:0.6-2.8);P<0.0001].We observed no associations with mean age,sex distribution,body mass index,alcohol or smoking exposure,diabetes with prevalence of osteopenia,osteoporosis or fragility fractures.Paucity of data on systemic inflammation,CP severity,and bone mineralization parameters precluded a formal metaanalysis.CONCLUSION This meta-analysis confirms significant bone disease in patients with CP.Other than PERT use,we observed no patient or study-specific factor to be significantly associated with CP-related bone disease.Further studies are needed to identify confounders,at-risk population,and to understand the mechanisms of CP-related bone disease and the implications of treatment response. | Ankit Chhoda Maria Jose Hernandez-Woodbine Nana Afua Akkya Addo Syed Alishan Nasir Alyssa Grimshaw Craig Gunderson Awais Ahmed Steven D.Freedman Sunil G.Sheth | 2023 | World Journal of Gastroenterology2023，29，8： | 0 |
| 5 | 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 |
您所在的机构暂未开通此部分的功能，请联系管理员