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| 1 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 2 | Novel concepts in radiation-induced cardiovascular disease显示文摘Radiation-induced cardiovascular disease(RICVD) is the most common nonmalignant cause of morbidity and mortality among cancer survivors who have undergone mediastinal radiation therapy(RT).Cardiovascular complications include effusive or constrictive pericarditis,cardiomyopathy,valvular heart disease,and coronary/vascular disease.These are pathophysiologically distinct disease entities whose prevalence varies depending on the timing and extent of radiation exposure to the heart and great vessels.Although refinements in RT dosimetry and shielding will inevitably limit future cases of RICVD,the increasing number of long-term cancer survivors,including those treated with older higher-dose RT regimens,will ensure a steady flow of afflicted patients for the foreseeable future.Thus,there is a pressing need for enhanced understanding of the disease mechanisms,and improved detection methods and treatment strategies.Newly characterized mechanisms responsible for the establishment of chronic fibrosis,such as oxidative stress,inflammation and epigenetic modifications,are discussed and linked to potential treatments currently under study.Novel imaging modalities may serve as powerful screening tools in RICVD,and recent research and expert opinion advocating their use is introduced.Data arguing for the aggressive use of percutaneous interventions,such as transcutaneous valve replacement and drug-eluting stents,are examined and considered in the context of prior therapeutic approaches.RICVD and its treatment options are the subject of a rich and dynamic body of research,and patients who are at risk or suffering from this disease will benefit from the care of physicians with specialty expertise in the emerging field of cardiooncology. | Jason R Cuomo Gyanendra K Sharma Preston D Conger Neal L Weintraub | 2016 | World Journal of Cardiology2016，8，9： | 17 |
| 3 | Atrial fibrillation in obstructive sleep apnea显示文摘Atrial fibrillation(AF) is a common arrhythmia with rising incidence.Obstructive sleep apnea(OSA) is prevalent among patients with AF.This observation has prompted significant research in understanding the relationship between OSA and AF.Multiple studies support a role of OSA in the initiation and progression of AF.This association has been independent of obesity,body mass index and hypertension.Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA.These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period,promoting pulmonary vein discharges and atrial dilation.OSA not only promotes initiation of AF but also makes management of AF difficult.Drug therapy and electrical cardioversion for AF are less successful in presence of OSA.There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA.Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF.However,additional studies are needed to establish a stronger relationship between OSA treatment and success ofAF therapies.There should be heightened suspicion of OSA in patients with AF.There is a need for guidelines to screen for OSA as a part of AF management. | Sandeep K Goyal Abhishek Sharma | 2013 | World Journal of Cardiology2013，5，6： | 16 |
| 4 | Endoscopic management of acute cholangitis in elderly patients显示文摘AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage. | Naresh Agarwal Barjesh Chander Sharma Shiv K Sarin | 2006 | World Journal of Gastroenterology2006，12，40： | 14 |
| 5 | MicroRNAs:a new ray of hope for diabetes mellitus显示文摘Diabetes mellitus has become one of the most common chronic diseases,thereby posing a major challenge to global health.Characterized by high levels of blood glucose(hyperglycemia),diabetes usually results from a loss of insulin-producing β-cells in the pancreas,leading to a deficiency of insulin(type 1 diabetes),or loss of insulin sensitivity(type 2 diabetes).Both types of diabetes have serious secondary complications,such as microvascular abnormalities,cardiovascular dysfunction,and kidney failure.Various complex factors,such as genetic and environmental factors,are associated with the pathophysiology of diabetes.Over the past two decades,the role of small,single-stranded noncoding microRNAs in various metabolic disorders,especially diabetes mellitus and its complications,has gained widespread attention in the scientific community.Discovered first as an endogenous regulator of development in the nematode Caenorhabditis elegans,these small RNAs post-transcriptionally suppress mRNA target expression.In this review,we discuss the potential roles of different microRNAs in diabetes and diabetes-related complications. | Munish Kumar Sayantan Nath Himanshu K Prasad G D Sharma Yong Li | 2012 | Protein & Cell2012，3，10： | 14 |
| 6 | Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke:an updated systematic review显示文摘The optimal dose of recombinant tissue plasminogen activator(rtPA)for acute ischaemic stroke(AIS)remains controversial,especially in Asian countries.We aimed to update the evidence regarding the use of low-dose versus standard-dose rtPA.We performed a systematic literature search across MEDLINE,Embase,Cochrane Central Register of Controlled Trials(CENTRAL),PsycINFO and Cumulative Index to Nursing and Allied Health Literature(CINAHL)from inception to 22 August 2016 to identify all related studies.The outcomes were death or disability(defined by modified Rankin Scale 2-6),death,and symptomatic intracerebral haemorrhage(sICH).Where possible,data were pooled for meta-analysis with ORs and corresponding 95% CIs by means of random-effects or fixed-effects meta-analysis.We included 26 observational studies and 1 randomised controlled trial with a total of 23210 patients.Variable doses of rtPA were used for thrombolysis of AIS in Asia.Meta-analysis shows that low-dose rtPA was not associated with increased risk of death or disability(OR 1.13,95% CI 0.95 to 1.33),or death(OR 0.86,95% CI 0.74 to 1.01),or decreased risk of sICH(OR 1.06,95% CI 0.65 to 1.72).The results remained consistent when sensitivity analyses were performed including only low-dose and standard-dose rtPA or only Asian studies.Our review shows small difference between the outcomes or the risk profile in the studies using low-dose and/or standard-dose rtPA for AIS.Low-dose rtPA was not associated with lower risk of death or disability,death alone,or sICH. | Xia Wang Shoujiang You Shoichiro Sato Jie Yang Cheryl Carcel Danni Zheng Sohei Yoshimura Craig S Anderson Else Charlotte Sandset Thompson Robinson John Chalmers Vijay K Sharma | 2018 | Stroke & Vascular Neurology2018，3，1： | 10 |
| 7 | 具有低动脉粥样硬化风险特征的专业耐力运动员的亚临床冠状动脉疾病发病率显示文摘研究表明,具有冠状动脉疾病(coronary artery disease,CAD)危险因素的中老年(健将)运动员比久坐个体冠状动脉钙化(coronary artery calcium,CAC)评分更高。尚没有研究评估具有低动脉粥样硬化风险特征的专业运动员的CAD患病率。 | 刘莉 叶鹏 Merghani A Maestrini V Rosmini S Cox AT Dhutia H Bastiaenen R David S Yeo TJ Narain R Malhotra A Papadakis M Wilson MG Tome M AlFakih K Moon JC Sharma S | 2017 | 中华高血压杂志2017，25，6： | 8 |
| 8 | Anti-HBc screening in Indian blood donors:Still an unresolved issue显示文摘AIM:To study the seroprevalence of antibody to hepatitis B core antigen (anti-HBc) in healthy blood donors negative for HBsAg and to evaluate whether anti-HBc detection could be adopted in India as a screening assay for HBV in addition to HBsAg. METHODS: A total of 1700 serum samples collected from HBsAg-negative healthy blood donors were tested for the presence of anti-HBc antibody (IgM + IgG). All samples reactive for anti-HBc antibody were then investigated for presence of anti-HBs and for liver function tests (LFTs). One hundred serum samples reactive for anti-HBc were tested for HBV DNA by PCR method. RESULTS: Out of 1700 samples tested, 142 (8.4%) blood samples were found to be reactive for anti-HBc. It was signif icantly lower in voluntary (6.9%) as compared to replacement donors (10.4%, P = 0.011). Seventy- two (50.7%) anti-HBc reactive samples were also reactive for anti-HBs with levels > 10 mIU/mL and 70 (49.3%) samples were non-reactive for anti-HBs, these units were labeled as anti-HBc-only. These 142 anti-HBc reactive units were also tested for liver function test. HBV DNA was detected in only 1 of 100 samples tested. CONCLUSION: Keeping in view that 8%-18% of donor population in India is anti-HBc reactive, inclusion of anti- HBc testing will lead to high discard rate. Anti-HBs as proposed previously does not seem to predict clearance of the virus. Cost effectiveness of introducing universalanti-HBc screening and discarding large number of blood units versus considering ID NAT (Individual donor nuclic acid testing) needs to be assessed. | Hari Krishan Dhawan Neelam Marwaha Ratti Ram Sharma Yogesh Chawla Beenu Thakral Karan Saluja Sanjeev Kumar Sharma Manish K Thakur Ashish Jain | 2008 | World Journal of Gastroenterology2008，14，34： | 8 |
| 9 | Management of hypersplenism in non-cirrhotic portal hypertension:a surgical series显示文摘BACKGROUND:Hypersplenism is commonly seen in patients with non-cirrhotic portal hypertension(NCPH).While a splenectomy alone can effectively relieve the hypersplenism,it does not address the underlying portal hypertension.The present study was undertaken to analyze the impact of shunt and non-shunt operations on the resolution of hypersplenism in patients with NCPH.The relationship of symptomatic hypersplenism,severe hypersplenism and number of peripheral cell line defects to the severity of portal hypertension and outcome was also assessed.METHODS:A retrospective analysis of NCPH patients with hypersplenism managed surgically between 1999 and 2009 at our center was done.Of 252 patients with NCPH,64(45 with extrahepatic portal vein obstruction and 19 with non-cirrhotic portal fibrosis) had hypersplenism and constituted the study group.Statistical analysis was done using GraphPad InStat.Categorical and continuous variables were compared using the chi-square test,ANOVA,and Student's t test.The MannWhitney U test and Kruskal-Wallis test were used to compare non-parametric variables.RESULTS:The mean age of patients in the study group was 21.81±6.1 years.Hypersplenism was symptomatic in 70.3% with an incidence of spontaneous bleeding at 26.5%,recurrent anemia at 34.4%,and recurrent infection at 29.7%.The mean duration of surgery was 4.16±1.9 hours,intraoperative blood loss was 457±126(50-2000) mL,and postoperative hospital stay 5.5±1.9 days.Following surgery,normalization of hypersplenism occurred in all patients.On long-term followup,none of the patients developed hepatic encephalopathy and 4 had a variceal re-bleeding(2 after a splenectomy alone,1 each after an esophago-gastric devascularization and proximal splenorenal shunt).Patients with severe hypersplenism and those with defects in all three peripheral blood cell lineages were older,had a longer duration of symptoms,and a higher incidence of variceal bleeding and postoperative morbidity.In addition,patients with triple cell line defects had elevated portal pressure(P=0.001),portal biliopathy(P=0.02),portal gastropathy(P=0.005) and intraoperative blood loss(P=0.001).CONCLUSIONS:Hypersplenism is effectively relieved by both shunt and non-shunt operations.A proximal splenorenal shunt not only relieves hypersplenism but also effectively addresses the potential complications of underlying portal hypertension and can be safely performed with good long-term outcome.Patients with hypersplenism who have defects in all three blood cell lineages have significantly elevated portal pressures and are at increased risk of complications of variceal bleeding,portal biliopathy and gastropathy. | Rajesh Rajalingam Amit Javed Dharmanjay Sharma Puja Sakhuja Shivendra Singh Hirdaya H Nag Anil K Agarwal | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，2： | 7 |
| 10 | Genetic polymorphism in CD14 gene, a co-receptor of TLR4 associated with non-alcoholic fatty liver disease显示文摘AIM To evaluate the pathogenic role of toll-like receptor(TLR) gene polymorphisms in patients with nonalcoholic fatty liver disease(NAFLD).METHODS Two hundred and fifty subjects(NAFLD = 200, healthy volunteers = 50) underwent polymerase chain reaction and restriction fragment length polymorphism to assess one polymorphism in the toll-like receptor 2(TLR2) gene(A753G), two polymorphisms in the TLR4 gene(TLR4 Asp299 Gly and Thr399 Ile allele), and two polymorphisms in the cluster of differentiation 14(CD14)(C-159 T and C-550T) gene, a co-receptor of TLR4. Association of TLR gene polymorphisms with NAFLD and its severity was evaluated by genetic models of association.RESULTS On both multiplicative and recessive models of gene polymorphism association, there was significant association of CD14 C(-159) T polymorphism with NAFLD; patients with TT genotype had a 2.6 fold increased risk of developing NAFLD in comparison to CC genotype. There was no association of TLR2 Arg753 Gln, TLR4 Asp299 Gly, Thr399 Ile, and CD14 C(-550) T polymorphisms with NAFLD. None of the TLR gene polymorphisms had an association with histological severity of NAFLD.CONCLUSION Patients with CD14 C(-159) T gene polymorphism, a co-receptor of TLR4, have an increased risk of NAFLD development. | Shweta Kapil Ajay Duseja Bal Krishan Sharma Bhupesh Singla Anuradha Chakraborti Ashim Das Pallab Ray Radha K Dhiman Yogesh Chawla | 2016 | World Journal of Gastroenterology2016，22，42： | 7 |
| 11 | Role of early life exposure and environment on neurodegeneration: implications on brain disorders显示文摘Neurodegenerative diseases such as Alzheimer’s disease(AD),Parkinson’s disease(PD),Amyotrophic lateral sclerosis(ALS)and retinal degeneration have been studied extensively and varying molecular mechanisms have been proposed for onset of such diseases.Although genetic analysis of these diseases has also been described,yet the mechanisms governing the extent of vulnerability to such diseases remains unresolved.Recent studies have,therefore,focused on the role of environmental exposure in progression of such diseases especially in the context of prenatal and postnatal life,explaining how molecular mechanisms mediate epigenetic changes leading to degenerative diseases.This review summarizes both the animal and human studies describing various environmental stimuli to which an individual or an animal is exposed during in-utero and postnatal period and mechanisms that promote neurodegeneration.The SNPs mediating gene environment interaction are also described.Further,preventive and therapeutic strategies are suggested for effective intervention. | Shweta Modgil Debomoy K Lahiri Vijay L Sharma Akshay Anand | 2014 | Translational Neurodegeneration2014，3，1： | 5 |
| 12 | Membrane-bound mucins and mucin terminal glycans expression in idiopathic or Helicobacter pylori, NSAID associated peptic ulcers显示文摘AIM:To determine the expression of membrane-bound mucins and glycan side chain sialic acids in Helicobacter pylori(H.pylori)-associated,non-steroidal inflammatory drug(NSAID)-associated and idiopathic-gastric ulcers.METHODS:We studied a cohort of randomly selected patients with H.pylori(group 1,n=30),NSAID(group 2,n=18),combined H.pylori and NSAID associated gastric ulcers(group 3,n=24),and patients with idiopathic gastric ulcers(group 4,n=20).Immunohistochemistry for MUC1,MUC4,MUC17,and staining for Erythrina cristagalli agglutinin and Sambucus nigra agglutinin(SNA)lectins was performed on sections from the ulcer margins.RESULTS:Staining intensity of MUC17 was higher in H.pylori ulcers(group 1)than in idiopathic ulcers(group4),11.05±3.67 vs 6.93±4.00 for foveola cells,and10.29±4.67 vs 8.00±3.48 for gland cells,respectively(P<0.0001).In contrast,MUC1 expression was higher in group 4 compared group 1,9.89±4.17 vs 2.93±5.13 in foveola cells and 7.63±4.60 vs 2.57±4.50 for glands,respectively(P<0.0001).SNA lectin staining was increased in group 4,in parallel to elevated MUC1expression,indicating more abundantα2-6 sialylation in that group.CONCLUSION:Cytoplasmic MUC17 staining was sig-nificantly decreased in the cases with idiopathic ulcer.The opposite was observed for both MUC1 and SNA lectin.This observation may reflect important pathogenic mechanisms,since different mucins with altered sialylation patterns may differ in their protection efficiency against acid and pepsin. | Yaron Niv Doron Boltin Marisa Halpern Miriam Cohen Zohar Levi Alex Vilkin Sara Morgenstern Vahig Manugian Erica St Lawrence Pascal Gagneux Sukhwinder Kaur Poonam Sharma Surinder K Batra Samuel B Ho | 2014 | World Journal of Gastroenterology2014，20，40： | 5 |
| 13 | Association of NFKB1 gene polymorphism (rs28362491) with levels of inflammatory biomarkers and susceptibility to diabetic nephropathy in Asian Indians显示文摘AIM To investigate the association of NFKB1 gene-94 ATTG insertion/deletion(rs28362491) polymorphism with inflammatory markers and risk of diabetic nephropathy in Asian Indians.METHODS A total of 300 subjects were recruited(100 each), normoglycemic,(NG); type 2 diabetes mellitus(T2DM) without any complications(DM) and T2 DM with diabetic nephropathy [DM-chronic renal disease(CRD)]. Analysis was carried out by polymerase chain reaction-restriction fragment length polymorphism and ELISA. Pearson's correlation, analysis of variance and logistic regression wereused for statistical analysis.RESULTS The allelic frequencies of-94 ATTG insertion/deletion were 0.655/0.345(NG), 0.62/0.38(DM) and 0.775/0.225(DM-CRD). The-94 ATTG ins allele was associated with significantly increased levels of urinary monocyte chemoattractant protein-1(u MCP-1); u MCP-1(P = 0.026) and plasma tumor necrosis factor-alpha(TNF-α); TNF-α(P = 0.030) and almost doubled the risk of diabetic nephropathy(OR = 1.91, 95%CI: 1.080-3.386, P = 0.025).CONCLUSION-94 ATTG ins/ins polymorphism might be associated with increased risk of developing nephropathy in Asian Indian subjects with diabetes mellitus. | Amar Gautam Stuti Gupta Mohit Mehndiratta Mohini Sharma Kalpana Singh Om P Kalra Sunil Agarwal Jasvinder K Gambhir | 2017 | World Journal of Diabetes2017，8，2： | 4 |
| 14 | Imaging in pulmonary hydatid cysts显示文摘Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored. | Mandeep K Garg Madhurima Sharma Ajay Gulati Ujjwal Gorsi Ashutosh N Aggarwal Ritesh Agarwal Niranjan Khandelwal | 2016 | World Journal of Radiology2016，8，6： | 4 |
| 15 | Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction显示文摘BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome. | Pramod Kumar Mishra Sundeep Singh Saluja Ashok K Sharma Premanand Pattnaik | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，3： | 4 |
| 16 | Epidemiology of electrical burns and its impact on quality of life-the developing world scenario显示文摘BACKGROUND Electrical burns are devastating injuries and can cause deep burns with significant morbidity and delayed sequelae.Epidemiological data regarding the etiology,socioeconomic differences and geographic variation are necessary to assess the disease burden and plan an effective preventive strategy.These severe injuries often lead to amputations and thus hamper quality of life in the long term AIM To identify the population at maximum risk of sustaining electrical burns.We also studied the impact of electrical burns on these patients in terms of quality of life as well as return to work.METHODS The study was conducted at a tertiary referral teaching hospital over a period of eighteen months.All patients with a history of sustaining electrical burns and satisfying the inclusion criteria were included in the study.All relevant epidemiological parameters and treatment details were recorded.The patients were subsequently followed up at 3 mo,6 mo and 9 mo.The standardized Brief Version of the Burn Specic Health Scale(BSHS-B)was adopted to assess quality of life.Statistical analysis was conducted using IBM SPSS statistics(version 22.0).A P value of<0.05 was considered statistically significant.RESULTS A total of 103 patients were included in the study.The mean age of the patients was 31.83 years(range 18-75 years).A significant majority(91.3%)of patients were male.The mean total body surface area(TBSA)in these patients was 21.1%.In most of the patients(67%),the injury was occupation-related.High voltage injuries were implicated in 72.8%of patients.Among the 75 high voltage burn patients,31(41%)required amputation.The mean number of surgeries the patients underwent in hospital was 2.03(range 1 to 4).The quality of life parameters amongst the patients sustaining high voltage electrical burns were poorer when compared to low voltage injuries at all follow-up intervals across nine domains.In eight of these domains,the difference was statistically significant.Similarly,the scores among the amputees were poorer when compared to non-amputees.The difference was statistically significant in six domains.CONCLUSION Electrical burns remain a problem in the developing world.Most injuries are occupation-related.The quality of life in patients with high voltage burns and amputees remains poor.Work resumption was almost impossible for amputees.These patients could not regain pre-injury status.Steps should be taken to create awareness and to implement an effective preventive strategy to safeguard against electrical injuries. | Giriraj Gandhi Atul Parashar Ramesh K Sharma | 2022 | World Journal of Critical Care Medicine2022，11，1： | 3 |
| 17 | Regenerative medicine based applications to combat stress urinary incontinence显示文摘Stress urinary incontinence(SUI), as an isolated symptom, is not a life threatening condition. However, the fear of unexpected urine leakage contributes to a significant decline in quality of life parameters for afflicted patients. Compared to other forms of incontinence, SUI cannot be easily treated with pharmacotherapy since it is inherently an anatomic problem. Treatment options include the use of bio-injectable materials to enhance closing pressures, and the placement of slings to bolster fascial support to the urethra. However, histologic findings of degeneration in the incontinent urethral sphincter invite the use of tissues engineering strategies to regenerate structures that aid in promoting continence. In this review, we will assess the role of stem cells in restoring multiple anatomic and physiological aspects of the sphincter. In particular, mesenchymal stem cells and CD34+cells have shown great promise to differentiate into muscular and vascular components,respectively. Evidence supporting the use of cytokines and growth factors such as hypoxia-inducible factor1-alpha, vascular endothelial growth factor, basic fi-broblast growth factor, hepatocyte growth factor and insulin-like growth factor further enhance the viability and direction of differentiation. Bridging the benefits of stem cells and growth factors involves the use of synthetic scaffolds like poly(1,8-octanediol-co-citrate)(POC) thin films. POC scaffolds are synthetic, elastomeric polymers that serve as substrates for cell growth,and upon degradation, release growth factors to the microenvironment in a controlled, predictable fashion.The combination of cellular, cytokine and scaffold elements aims to address the pathologic deficits to urinary incontinence, with a goal to improve patient symptoms and overall quality of life. | Hatim Thaker Arun K Sharma | 2013 | World Journal of Stem Cells2013，5，4： | 3 |
| 18 | Prevalence and clinical characteristics associated with left atrial thrombus detection: Apixaban显示文摘BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients(apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included.RESULTS Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence ofLAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF(OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity(OR:1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA2 DS2-VASc score ≤ 1.CONCLUSION Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors. | Hoyle L Whiteside Arun Nagabandi Kristen Brown Deepak N Ayyala Gyanendra K Sharma | 2019 | World Journal of Cardiology2019，11，2： | 2 |
| 19 | Endoscopic ultrasound guided interventional procedures显示文摘Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunityto target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS. | Vishal Sharma Surinder S Rana Deepak K Bhasin | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，6： | 2 |
| 20 | Subtype specific induction of wild type p53 and apoptosis, but not cell cycle arrest, by human somatostatin receptor 3显示文摘 | Sharma K Patel YC Srikant C | 1996 | Mol Endocrinnol1996，10，： | 2 |
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