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| 1 | Computed tomography and patient risk:Facts,perceptions and uncertainties显示文摘Since its introduction in the 1970s, computed tomography(CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses. | Stephen P Power Fiachra Moloney Maria Twomey Karl James Owen J O'Connor Michael M Maher | 2016 | World Journal of Radiology2016，8，12： | 7 |
| 2 | Role of self-expanding metal stents in the management ofvariceal haemorrhage:Hype or hope?显示文摘Despite the advances of medical,endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However,there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Selfexpanding metal stents can be placed without the need for endoscopic or fluoroscopic control and,once in place,will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade(BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding,where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials,currently they provide an effective alternative to BT in selected patients. | Brian J Hogan James P O’Beirne | 2016 | World Journal of Gastrointestinal Endoscopy2016，8，1： | 5 |
| 3 | Effect of fiber supplementation on the microbiota in critically ill patients显示文摘AIM:To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and fermentation.METHODS:Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were studied.The study was divided into 2 parts:first,short-term (3-9 d)clinical tolerance and colonic fermentation as assessed by fecal short chain fatty acid(SCFA)concentrations and breath hydrogen and methane was measured in response to progressive fiber supplementation increasing from 4 g tid up to normal requirement levels of 8 g tid;second,4 patients with diarrhea were studied for 2-5 wk with maximal supplementation to additionally assess its influence on fecal microbiota quantitated by quantitative polymerase chain reaction (qPCR)of microbial 16S rRNA genes and Human Intestinal Tract Chip(HITChip)microarray analysis.Nearly all patients were receiving antibiotics(10/13)and acid suppressants(11/13)at some stage during the studies.RESULTS:In group 1,tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence(P=0.008 and P<0.0001,respectively)of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 patients.In group 2 before supplementation,fecal microbiota mass and their metabolites,SCFA,were dramatically lower in patients compared to healthy volunteers.From qPCR and HITChip analyses we calculated that there was a 97%reduction in the predominant potential butyrate producers and starch degraders.Following 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA(acetate 28.4±4.1μmol/g to 42.5±3.1μmol/g dry weight,P=0.01;propionate 1.6±0.5 vs 6.22±1.1,P=0.006 and butyrate 2.5±0.6 vs 5.9±1.1,P=0.04)and microbial counts of specific butyrate producers,with resolution of diarrhea in 3 of 4 patients.CONCLUSION:Conventional management of critically ill patients,which includes the use of elemental diets and broad-spectrum antibiotics,was associated with gross suppression of the colonic microbiota and their production of essential colonic fuels,i.e.,SCFA.Our investigations show that fiber supplementation of the feeds has the potential to improve microbiota mass and function,thereby reducing the risks of diarrhea due to dysbiosis. | Stephen JD O'Keefe Junhai Ou James P DeLany Scott Curry Erwin Zoetendal H Rex Gaskins Scott Gunn | 2011 | World Journal of Gastrointestinal Pathophysiology2011，2，6： | 3 |
| 4 | C-reactive protein and radiographic findings of lower respiratory tract infection in infants显示文摘AIM To evaluate the association between C-reactive protein(CRP) and radiological evidence of lower respiratory tract infection(LRTI) in infants.METHODS All patients aged less than 4 years who presented with suspected lower respiratory tract infection,who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study.Age,gender,source of referral,CRP,white cell count,neutrophil count along with the patients' symptoms and radiologist's report were recorded.RESULTS Three hundred and eleven patients met the inclusioncriteria.Abnormal chest radiographs were more common in patients with elevated CRP levels(P < 0.01).Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L.CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less.CONCLUSION CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph,thus reducing unnecessary chest radiographs. | Maria Twomey Hannah Fleming Fiachra Moloney Kevin P Murphy Lee Crush Siobhan B O’Neill Oisin Flanagan Karl James Conor Bogue Owen J O’Connor Michael M Maher | 2017 | World Journal of Radiology2017，9，4： | 2 |
| 5 | Multidisciplinary approach for multifocal, bilobar hepatocellular carcinoma: A case report and literature review显示文摘BACKGROUND Hepatocellular carcinoma(HCC) is the second most lethal malignancy worldwide. There has been virtually no change in the survivability of HCC in spite of improvement in therapies. Surgery is considered the ideal first, curative intervention, however most patients present in advanced stages with unresectable disease. Therefore, systemic and liver-directed non-operative therapies are initially offered to downstage the disease. To ensure optimal management, a multidisciplinary team approach is often warranted. Our case highlights the benefits of a multidisciplinary approach in a young woman with multifocal, bilobar HCC.CASE SUMMARY A 36-year-old Chinese woman with untreated hepatitis B was found to have large bilobar HCC during work up for abdominal pain. Her initial serum alphafetoprotein was significantly elevated to 311136 ng/mL. Computed tomography scan demonstrated bulky bilobar liver masses, consistent with intermediate stage HCC, Barcelona Clinic Liver Cancer Stage B. Her case was discussed and a personalized care plan was developed at the Multidisciplinary Center for Advanced Minimally Invasive Liver Oncologic Therapies at the University of Washington. She initially underwent bilobar transarterial chemoembolization with partial response of the left lobar tumor. Salvage hypofractionated proton beam radiation therapy was delivered to the right lobe followed by two additional transarterial chemoembolizations to the left lobe with good response.Finally, to remove left lobar residual disease, she was taken to the operating roomfor a left hepatectomy eleven months after her initial presentation. She continues to be without evidence of disease.CONCLUSION Coordinating the multiple HCC treatment modalities is complex and our case highlights the benefits of a multidisciplinary approach. | Kevin P Labadie Stephanie K Schaub Derek Khorsand Guy Johnson Smith Apisarnthanarax James O Park | 2019 | World Journal of Hepatology2019，11，1： | 2 |
| 6 | Lithoautotrophic microbial ecosystems in deep basalt aquifers显示文摘 | Todd O Stevens James P McKinley | 1995 | Science1995，270，： | 1 |
| 7 | Democracy and Government Performance: Holding Incumbents Accountable in English Local Governments显示文摘 | BOYNE G A JAMES O JOHN P | 2009 | The Journal of Politics2009，71，4： | 1 |
| 8 | An oilseed halophyte for seawater irrigation显示文摘 | Edward P G James W O | 1991 | Science1991，251，： | 1 |
| 9 | Steatohepatitis:a tale of two''hits''?显示文摘 | DAY C P JAMES O F | 1998 | J Gastroenterology1998，114，4： | 1 |
| 10 | Shear links in eccentrically braced flames 显示文摘 | James O Malley Egor P Popov | 1984 | Journal of Structural Engineering1984，110，9： | 1 |
| 11 | Biomass production of 'Alamo' switchgrass in response to nitrogen,phosphorous and row spacing显示文摘 | James P M Matt A S William R O | 2001 | Agronomy Journal2001，93，4： | 1 |
| 12 | Use of WL medium to profile native flora fermentations显示文摘 | CHRISTINA L P JAMES A B TAMMI L O | 2001 | American Journal of Enology and Viticulture2001，52，3： | 1 |
| 13 | Steatohepatitis:a tale of two ' hits '?显示文摘 | Day C P James O | 1998 | Gastroenterology1998，114，： | 1 |
| 14 | Sonic anemometer tilt correction algorithms显示文摘 | James M W P O Steven A S Steven | 2001 | Boundary-Layer Meteor2001，99，： | 1 |
| 15 | Chromatographic fingerprint analysis for evaluationof Ginkgo biloba products 显示文摘 | Chen P Mustafa O James H | 2007 | Anal Bioanal Chem2007，389，1： | 1 |
| 16 | 1,25 -Dihydroxyvitamin D3 stimulates the synthesis of matrix γ-carboxyglutamic acid protein by osteosarcoma cells显示文摘 | JAMES D F YOKO O PAUL A P | 1988 | J Biological Chemistry1988，263，： | 1 |
| 17 | Land and water interface zones显示文摘 | John P D Michel M James C O | 1993 | Water Air and Soil Pollution1993，70，14： | 1 |
| 18 | Impact of chronic congestive heart failure on pharmacokinetics and vasomotor effects of infused nitrite显示文摘 | Abdul R Maher Sayqa Arif Melanie Madhani Khalid Abozguia Ibrar Ahmed Bernadette O Fernandez Martin Feelisch AG O’Sullivan Arthur Christopoulos Aaron L Sverdlov Doan Ngo Rustem Dautov Philip E James John D Horowitz Michael P Frenneaux | 2013 | Br J Pharmacol2013，，3： | 1 |
| 19 | Use of WL medium to profile native flora fermentations显示文摘 | CHRISTINA L P JAMES A B TAMMI L O | 2001 | American Journal of Enology and Viticulture2001，52，3： | 1 |
| 20 | An oilseed halophyte for seawater irrigation显示文摘 | Edward P G James W O | 1991 | Science1991，251，： | 1 |
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