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1.  Dysregulated inflammation as a risk factor for pneumonia in the elderly 
Aging and disease  2011;2(6):487-500.
Advances in modern medicine have led to an increase in the median life span and an expansion of the world’s population over the age of 65. With increasing numbers of the population surviving to the extreme of age, those at risk for the development of pneumonia will approach 2 billion by the year 2050. Numerous age-related changes in the lung likely contribute to the enhanced occurrence of pneumonia in the elderly. Inflammation in the elderly has been shown to increase risk prior to infection; age-associated inflammation enhances bacterial ligand expression in the lungs which increases the ability of bacteria to attach and invade host cells. Conversely, the elaboration of the acute inflammatory response during early infection has been found to decrease with age resulting in a delayed immune response and diminished bacterial killing. Finally, the resolution of the inflammatory response during the convalescent stage back to “baseline” is often prolonged in the elderly and associated with negative outcomes, such as adverse cardiac events. The focus of this review will be to discuss our current understanding of the potential mechanisms by which dysregulated inflammation (both prior to and following an infectious insult) enhances susceptibility to and severity of community acquired pneumonia (CAP) in the elderly with an emphasis on pneumococcal pneumonia, the leading cause of CAP.
PMCID: PMC3265328  PMID: 22288022
Aging; Pneumonia; Inflammation; Toll-like Receptors; Statins
2.  Dysregulated Inflammation as a Risk Factor for Pneumonia in the Elderly 
Aging and Disease  2011;2(6):487-500.
Advances in modern medicine have led to an increase in the median life span and an expansion of the world’s population over the age of 65. With increasing numbers of the population surviving to the extreme of age, those at risk for the development of pneumonia will approach 2 billion by the year 2050. Numerous age-related changes in the lung likely contribute to the enhanced occurrence of pneumonia in the elderly. Inflammation in the elderly has been shown to increase risk prior to infection; age-associated inflammation enhances bacterial ligand expression in the lungs which increases the ability of bacteria to attach and invade host cells. Conversely, the elaboration of the acute inflammatory response during early infection has been found to decrease with age resulting in a delayed immune response and diminished bacterial killing. Finally, the resolution of the inflammatory response during the convalescent stage back to “baseline” is often prolonged in the elderly and associated with negative outcomes, such as adverse cardiac events. The focus of this review will be to discuss our current understanding of the potential mechanisms by which dysregulated inflammation (both prior to and following an infectious insult) enhances susceptibility to and severity of community acquired pneumonia (CAP) in the elderly with an emphasis on pneumococcal pneumonia, the leading cause of CAP.
PMCID: PMC3265328  PMID: 22288022
Aging; Pneumonia; Inflammation; Toll-like Receptors; Statins
3.  The Virtual Screening of the Drug Protein with a Few Crystal Structures Based on the Adaboost-SVM 
Using the theory of machine learning to assist the virtual screening (VS) has been an effective plan. However, the quality of the training set may reduce because of mixing with the wrong docking poses and it will affect the screening efficiencies. To solve this problem, we present a method using the ensemble learning to improve the support vector machine to process the generated protein-ligand interaction fingerprint (IFP). By combining multiple classifiers, ensemble learning is able to avoid the limitations of the single classifier's performance and obtain better generalization. According to the research of virtual screening experiment with SRC and Cathepsin K as the target, the results show that the ensemble learning method can effectively reduce the error because the sample quality is not high and improve the effect of the whole virtual screening process.
PMCID: PMC4834164  PMID: 27127534
4.  Efficacy of Chinese Herbal Medicine as an Adjunctive Therapy on in-Hospital Mortality in Patients with Acute Kidney Injury: A Systematic Review and Meta-Analysis 
Objective. We aimed to systematically assess the efficacy of Chinese herbal medicine (CHM) as an adjunctive therapy on in-hospital mortality in patients with acute kidney injury (AKI). Methods. We did a systematic review of articles published in any language up until Jun 23, 2015, by searching PubMed, Embase, the Cochrane Library, CBM, and CNKI. We included all RCTs that compared outcomes of patients with AKI taking CHM plus Western treatment (WT) with those taking WT alone. We applied Cochrane risk-of-bias tool to assess the methodological quality of the included trials. Results. Of 832 citations, 15 studies involving 966 patients met inclusion criteria. The methodological quality was assessed with unclear risk of bias. In the primary outcome of meta-analysis, pooled outcome of in-hospital mortality showed that patients randomly assigned to CHM treatment group were associated with low risk of in-hospital mortality compared with those randomly assigned to WT alone (RR = 0.41; 95% CI = 0.24 to 0.71; P = 0.001). Conclusions. CHM as an adjunctive therapy is associated with a decreased risk of in-hospital mortality compared with WT in patients with AKI. Further studies with high quality and large sample size are needed to verify our conclusions.
PMCID: PMC4834165  PMID: 27127528
5.  Prevalence of Hypertension and Determination of Its Risk Factors in Rural Delhi 
Introduction. Hypertension is an important public health challenge in both economically developing and developed countries. It is one of the risk factors for cardiovascular mortality. Data is available on hypertension in urban population but few studies are reported in rural areas. Materials and Methods. It was a community based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects selected using systematic random sampling method. WHO STEPS approach was used to collect data. Blood pressure, body mass index, and blood sugar were measured. Data analysis was done using SPSS version 16. Odds of hypertension among subjects with risk factors were calculated. p value less than 0.05 was considered significant. Results. The prevalence of hypertension was 14.1% among study subjects. Hypertension was significantly higher in individuals more than 35 years than those less than 35 years. Hypertension was significantly higher in those who take alcohol and in subjects with raised total cholesterol level but in multivariate analysis only age, education, and cholesterol levels were independently associated with hypertension. Conclusion. There is significant burden of hypertension in rural areas in Delhi. Age, education, and cholesterol levels were independent risk factors of hypertension.
PMCID: PMC4834167  PMID: 27127646
6.  Roots and Tuber Crops as Functional Foods: A Review on Phytochemical Constituents and Their Potential Health Benefits 
Starchy roots and tuber crops play a pivotal role in the human diet. There are number of roots and tubers which make an extensive biodiversity even within the same geographical location. Thus, they add variety to the diet in addition to offering numerous desirable nutritional and health benefits such as antioxidative, hypoglycemic, hypocholesterolemic, antimicrobial, and immunomodulatory activities. A number of bioactive constituents such as phenolic compounds, saponins, bioactive proteins, glycoalkaloids, and phytic acids are responsible for the observed effects. Many starchy tuber crops, except the common potatoes, sweet potatoes, and cassava, are not yet fully explored for their nutritional and health benefits. In Asian countries, some edible tubers are also used as traditional medicinal. A variety of foods can be prepared using tubers and they may also be used in industrial applications. Processing may affect the bioactivities of constituent compounds. Tubers have an immense potential as functional foods and nutraceutical ingredients to be explored in disease risk reduction and wellness.
PMCID: PMC4834168  PMID: 27127779
7.  Using MALDI-TOF Mass Spectrometry to Identify Drug Resistant Staphylococcal Isolates from Nonhospital Environments in Brunei Darussalam 
Drug resistant bacteria have been a growing threat to the community and hospitals due to the misuse of antibiotics by humans, industrialization, and lack of novel antimicrobials currently available. Little is known about the prevalence of drug resistant bacteria in nonhealthcare environments in Brunei Darussalam and about how antibiotic resistant genes are transferred within these environments. Human contact points from different types of environments in Brunei Darussalam, varying from urban to jungle settings, were swabbed and cultured onto selective media to isolate staphylococci bacteria before performing antimicrobial susceptibility testing on the isolates. The identity of the isolates was determined using MALDI-TOF mass spectrometry (MS). Staphylococci isolates resistant to oxacillin were further tested for their minimum inhibitory concentration (MIC). PCR analysis of the mecA gene, a gene that confers resistance to oxacillin, is done to determine the level of resistance to oxacillin. Ten different staphylococcal species were identified by MALDI-TOF-MS analysis. Out of the 36 staphylococci isolates, 24 were resistant to multiple antibiotics including two isolates which were oxacillin resistant. Some staphylococci isolates had similar antibiotic resistance profiles to other staphylococci isolates of different species in the same location. This work provides the first-ever evidence of drug resistant staphylococci in the nonhospital environment in Brunei Darussalam.
PMCID: PMC4834169  PMID: 27127505
8.  Tolerability of Nasal Delivery of Humidified and Warmed Air at Different Temperatures: A Randomised Double-Blind Pilot Study 
Pulmonary Medicine  2016;2016:7951272.
Objectives. Delivery of warmed, humidified air via nasal high flow therapy could potentially reduce replication of temperature-sensitive viruses in the upper respiratory tract. This study investigates whether nasal high flow therapy is well tolerated by healthy adults at 37°C and 41°C. Methods. In this randomised, double-blind, controlled crossover pilot trial, nasal high flow therapy was used to deliver humidified air at 35 L/min, at either 37°C or 41°C, for three one-hour sessions of use over one day. The alternative was delivered at least 14 days later. Ten healthy, nonsmoking adults were asked, via questionnaire after each day's use, whether they would use nasal high flow therapy while being unwell with a cold or flu if it was demonstrated to improve symptoms. Results. All participants completed both interventions. Eighty percent responded “yes” to future use of nasal high flow therapy, for both 37°C and 41°C. There was no significant change from baseline in saccharin times following either intervention or in the following morning. Conclusions. Delivering humidified air via nasal high flow therapy at both 37°C and 41°C is well tolerated by healthy adults. This supports investigation into the potential use of nasal high flow therapy as treatment in viral upper respiratory tract infections. Trial Registration. This trial is registered with ACTRN12614000183684 (tolerability study of nasal delivery of humidified & warmed air).
PMCID: PMC4834170  PMID: 27127650
9.  Prevalence of Intestinal Parasitic Infection among Food Handlers in Northwest Iran 
Journal of Parasitology Research  2016;2016:8461965.
Parasitic diseases are among the most important infectious diseases and pose health problems in many countries, most especially in developing countries. Workers at food centers could transmit parasitic infections in the absence of sanitation. This is a descriptive study conducted to determine the prevalence of intestinal parasitic infections in food clerks in the city of Tabriz in 2014. Data was recorded in the offices of the health center for all food handlers who were referred to the laboratory for demographic and stool tests to receive the health card. Parasitic infection was observed in 172 cases (3.73%) of 4612 samples. A total of 156 positive samples (90.69%) were related to protozoa and 16 (9.3%) were related to helminthes. Most of the parasitic infections were related to Giardia and Entamoeba coli and the lowest infection was related to H. nana. Also, there was a significant relationship between level of education and parasitic infection rate (P = 0.0044). But there was no significant difference between the type of infection and amount of intestinal parasites. The results show that the prevalence of intestinal parasites, especially pathogenic protozoa, is common in some food handlers. Therefore, more sanitary controls are required and increasing of education will play a crucial role in improving the health of these people.
PMCID: PMC4834171  PMID: 27127643
10.  Oxidative Stress in Children with Chronic Spontaneous Urticaria 
The pathogenesis of chronic spontaneous urticaria (CSU) has not been fully understood; nevertheless, significant progress has been achieved in recent years. The aim of this study was to investigate the possible role of reactive oxygen species (ROS) in the pathogenesis of CSU. Sixty-two children with CSU and 41 healthy control subjects were enrolled in the study. An extensive evaluation of demographic and clinical features was done, and serum oxidative stress was evaluated by plasma total oxidant status (TOS) and total antioxidant status (TAS) measurements. The median value of plasma TOS was found to be 10.49 μmol H2O2 equiv./L (interquartile range, 7.29–17.65) in CSU patients and 7.68 μmol H2O2 equiv./L (5.95–10.39) in the control group. The difference between the groups was statistically significant (p = 0.003). Likewise, the median plasma TAS level in the CSU group was decreased significantly compared to that of the control group (2.64 [2.30–2.74] versus 2.76 [2.65–2.86] mmol Trolox equiv./L, resp., p = 0,001). Our results indicated that plasma oxidative stress is increased in children with CSU when compared to healthy subjects, and plasma oxidative stress markers are positively correlated with disease activity.
PMCID: PMC4834172  PMID: 27127547
11.  Usefulness of [18F]-DA and [18F]-DOPA for PET imaging in a mouse model of pheochromocytoma 
Nuclear medicine and biology  2011;39(2):215-226.
To evaluate the usefulness of [18F]-6-fluorodopamine ([18F]-DA) and [18F]-L-6-fluoro-3,4-dihydroxyphenylalanine ([18F]-DOPA) positron emission tomography (PET) in the detection of subcutaneous (s.c.) and metastatic pheochromocytoma in mice; to assess the expression of the norepinephrine transporter (NET) and vesicular monoamine transporters 1 and 2 (VMAT1 and VMAT2), all important for [18F]-DA and [18F]-DOPA uptake. Furthermore, to compare tumor detection by micro-computed tomography (microCT) to magnetic resonance imaging (MRI) in individual mouse.
SUVmax values were calculated from [18F]-DA and [18F]-DOPA PET, tumor-to-liver ratios (TLR) were obtained and expression of NET, VMAT1 and VMAT2 was evaluated.
[18F]-DA detected less metastatic lesions compared to [18F]-DOPA. TLR values for liver metastases were 2.26–2.71 for [18F]-DOPA and 1.83–2.83 for [18F]-DA. A limited uptake of [18F]-DA was found in s.c. tumors (TLR=0.22-0.27) compared to [18F]-DOPA (TLR=1.56-2.24). Overall, NET and VMAT2 were expressed in all organ and s.c. tumors. However, s.c. tumors lacked expression of VMAT1. We confirmed [18F]-DA’s high affinity for the NET for its uptake and VMAT1 and VMAT2 for its storage and retention in pheochromocytoma cell vesicles. In contrast, [18F]-DOPA was found to utilize only VMAT2.
MRI was superior in the detection of all organ tumors compared to microCT and PET. [18F]-DOPA had overall better sensitivity than [18F]-DA for the detection of metastases. Subcutaneous tumors were localized only with [18F]-DOPA, a finding that may reflect differences in expression of VMAT1 and VMAT2, perhaps similar to some patients with pheochromocytoma where [18F]-DOPA provides better visualization of lesions than [18F]-DA.
PMCID: PMC4713029  PMID: 21958851
Pheochromocytoma; PET; MicroCT; MRI; Metastatic mice model; Fluorodopamine; Fluorodopa; Norepinephrine transporter; Vesicular monoamine transporter
12.  Measuring Ability, Speed, or Both? Challenges, Psychometric Solutions, and What Can Be Gained From Experimental Control 
Measurement  2015;13(3-4):133-164.
The main challenge of ability tests relates to the difficulty of items, whereas speed tests demand that test takers complete very easy items quickly. This article proposes a conceptual framework to represent how performance depends on both between-person differences in speed and ability and the speed-ability compromise within persons. Related measurement challenges and psychometric models that have been proposed to deal with the challenges are discussed. It is argued that addressing individual differences in the speed-ability trade-off requires the control of item response times. In this way, response behavior can be captured exclusively with the response variable remedying problems in traditional measurement approaches.
PMCID: PMC4706043  PMID: 26807063
ability; experimental control; item response modeling; response time modeling; speed; speed-ability trade-off
13.  Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study 
Endoscopy International Open  2015;4(1):E51-E55.
Background and study aims: Colonic endoscopic submucosal dissection (ESD) is a challenging procedure because it is often difficult to maintain good visualization of the submucosal layer. To facilitate colonic ESD, we designed a novel traction method, namely traction-assisted colonic ESD using clip and line (TAC), and investigated its feasibility.
Patients and methods: We retrospectively analyzed 23 patients with large colonic superficial lesions who had undergone TAC. The main outcome was the procedural success rate of TAC, which we defined as successful, sustained application of clip and line to the lesion until the end of the procedure.
Results: The procedural success rate of TAC was 87 % (20/23). In all three unsuccessful cases, the lesions were in the proximal colon and the procedure times over 100 minutes. The overall mean procedure time was 61 min (95 % confidence interval, 18 – 172 min). We achieved en bloc resections of all lesions. There were no perforations or fatal adverse events.
Conclusions: TAC is feasible and safe for colonic ESD and may improve the ease of performing this procedure.
PMCID: PMC4713171  PMID: 26793785
14.  ESGE Survey: worldwide practice patterns amongst gastroenterologists regarding the endoscopic management of Barrett’s esophagus 
Endoscopy International Open  2016;4(1):E36-E41.
Background and study aims: Barrett’s esophagus is a common condition that is widely encountered in clinical practice. This European Society of Gastrointestinal Endoscopy (ESGE) survey aimed to determine practice patterns amongst European clinicians with regard to the diagnosis and management of Barrett’s esophagus.
Methods: Clinicians attending the ESGE learning area at the United European Gastroenterology Week in 2014 were invited to complete a 10-question survey. This survey was programed on to two Apple iPads. Information was gathered with regard to demographics, practice settings, and diagnosis and management strategies for Barrett’s esophagus.
Results: In total, 163 responses were obtained. Over half of respondents (61 %) were based in university hospitals, the majority (78 %) were aged 30 – 50 and half had more than 10 years’ experience; 66 % had attended courses on Barrett’s esophagus and more than half (60 %) used the Prague C & M classification. Advanced imaging was used by 73 % of clinicians and 72 % of respondents stated that their group practiced ablation therapy. Most (76 %) practiced surveillance for non-dysplastic Barrett’s, 6 % offered ablation therapy in some situations, and 18 % offered no intervention. For low grade dysplasia, 56 % practiced surveillance, 19 % ablated some cases and 15 % ablated all cases. In total, 32 % of clinicians referred high grade dysplasia to expert centers, with 20 % referring directly for surgery and 46 % using ablation therapy in certain cases. Endoscopic mucosal resection was the most commonly used ablation technique (44 %).
Conclusions: There has been reasonable uptake of the Prague C & M classification for describing Barrett’s esophagus, and ablation is widely practiced. However, practice patterns for Barrett’s esophagus vary widely between clinicians with clear guidance and quality standards required.
PMCID: PMC4713172  PMID: 26793783
15.  Evaluating the efficacy and safety of a novel endoscopic fluorescence imaging modality using oral 5-aminolevulinic acid for colorectal tumors 
Endoscopy International Open  2016;4(1):E30-E35.
Background and study aims: Five-aminolevulinic acid (5-ALA) is being increasingly used for photodynamic diagnosis and therapy of various types of tumors including brain, urologic, and other neoplasias. The use of 5-ALA to treat Barrett’s carcinomas has been documented, but its clinical effectiveness for diagnosis of gastrointestinal tumors, particularly early cancers, remains unknown.
Patients and methods: The aim of our feasibility study was to evaluate the visibility of colorectal tumors using endoscopic fluorescence imaging (EFI) after oral administration of 5-ALA. The lesions identified by direct visualization and by the spectrums produced using EFI modality with 5-ALA were compared to the clinicopathologic features of resected specimens.
Results: Twenty-three patients with a total of 27 known colorectal lesions were enrolled in the study. The median tumor size was 30 mm (range 10 – 75). Eleven of the lesions were flat or depressed lesions and 16 were sessile. Red fluorescence was observed in 22 out of 27 lesions. Red fluorescence was negative in 4 out of 11 flat or depressed lesions. In comparison with histopathologic findings, the rates of red fluorescence visibility were 62.5 % in low-grade intraepithelial neoplasia, 77.8 % in high-grade neoplasia, and 100 % in submucosal carcinoma. Red fluorescence visibility increased with the degree of dysplasia. There were no significant adverse events identified in this study.
Conclusions: This feasibility study using EFI with 5-ALA demonstrated high visibility of superficial colorectal neoplasia. EFI with 5-ALA appears to be a novel, safe technique for improving real-time colorectal tumor imaging.
PMCID: PMC4713173  PMID: 26793782
16.  Implementation of a program to improve the quality of colonoscopy increases the neoplasia detection rate: a prospective study 
Endoscopy International Open  2016;4(1):E68-E72.
Background and study aims: Endoscopists worldwide have been encouraged to report quality indicators in order to evaluate their performance. We aimed to determine whether a program to improve the quality of colonoscopy results in better rates of neoplasia detection.
Patients and methods: This is a prospective study set in a private endoscopy center. From May 2009 to March 2010, we evaluated 1573 consecutive colonoscopies (group 1). After the implementation of a quality program, from February 2011 to January 2012, we prospectively evaluated 1583 colonoscopies (group 2). Our quality-enhancing intervention consisted of instructing both patients and endoscopists. We measured the cecal intubation rate and the neoplasia detection rate. Overall neoplasias, high-risk adenomas, carcinomas, right colon adenomas, and adenomas detected in screening studies were analyzed.
Results: Cecal intubation was documented in 1384 cases from group 1 (88 %) and 1534 from group 2 (96.9 %) (P < 0.0001). The neoplasia detection rates in groups 1 and 2 were, respectively: neoplasias 288 (18.3 %) and 427 (27 %) (P < 0.0001), high-risk adenomas 76 (4.8 %) and 142 (9 %) (P < 0.0001), carcinomas 16 (1 %) and 21 (1.3 %) (P = 0.52), right colon adenomas 112 (7.1 %) and 154 (9.7 %) (P = 0.01), and adenomas 141 (16.5 %) and 233 (28 %) (P < 0.0001).
Conclusions: Implementation of a quality program improves the neoplasia detection rate. Because of the small number of cancerous lesions found in both groups, we were unable to identify differences in the carcinoma detection rate.
PMCID: PMC4713174  PMID: 26793787
17.  Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions (ENES): a pilot study 
Endoscopy International Open  2015;4(1):E17-E23.
Background and study aims: Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) has been shown to aid in the diagnosis of cystic pancreatic lesions. This is a pilot project to study its findings in patients with solid pancreatic lesions (SPLs) with a prospective single-blinded study design.
Methods: Patients with SPLs undergoing trans-gastric EUS fine needle aspiration (EUS-FNA) from July 2013 to March 2014 were prospectively enrolled. The nCLE diagnoses were compared with the final diagnoses. Researchers learned about the EUS-nCLE findings from previously published studies and applied it to diagnose SPLs. In the meantime, the findings were recorded.
Results: In total, 22 patients were recruited (mean age 62.7 years, SD 13.8 years; 14 men and eight women). The mean maximal tumor diameter was 36.0 mm (SD 10.9 mm). EUS-nCLE yielded satisfactory images in all patients during the first EUS procedure and diagnosed benign and malignant SPLs in 3 and 19 patients, respectively. Final diagnoses of malignant SPLs were made in 19 patients. Benign SPLs were eventually diagnosed in three patients, with confirmed the cytology and disease stability during the 12-month follow-up period. At the end of the project, based on the results of this current study, EUS-nCLE findings for malignant SPLs were dark clumping with or without dilated vessels (> 40 μm). There were two criteria for diagnosing benign lesions which were white fibrous bands and normal acini cells. The accuracy rate of EUS-nCLE was 90.9 % (20/22). One falsely diagnosed malignant SPL was an inflammatory mass from a recent acute pancreatitis. Another one with a pancreatic neuroendocrine tumor presenting with a symptomatic pseudocyst was incorrectly diagnosed as an inflammatory mass. This was likely from sampling error of the EUS-nCLE probe in an inflammatory area. Only one patient had post EUS-FNA bleeding but did not require a blood transfusion. The inter-observer agreement among three blinded endoscopists was almost perfect (Kappa 0.82).
Conclusion: EUS-nCLE is a promising technique for the diagnosis of SPLs with good inter-observer agreement.
Study registration‎: TCTR20140402001
PMCID: PMC4713175  PMID: 26793780
18.  Percutaneous debridement and washout of walled-off abdominal abscess and necrosis using flexible endoscopy: a large single-center experience 
Endoscopy International Open  2015;4(1):E102-E106.
Background and study aims: Direct percutaneous endoscopic necrosectomy has been described as a minimally invasive intervention for the debridement of walled-off pancreatic necrosis (WOPN). In this retrospective cohort study, we aimed to confirm these findings in a US referral center and evaluate the clinical value of this modality in the treatment of pancreatic necrosis as well as other types of intra-abdominal fluid collections and necrosis.
Patients and methods: Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent computed tomography (CT)-guided drainage catheter placement. Each patient then underwent direct percutaneous endoscopic necrosectomy and washout with repeat debridement performed until complete. Drains were then removed once output fell below 30 mL/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution and sustained resolution at 1-year follow up. 
Results: Ten patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. The median time to intervention was 85 days with an average of 2.3 necrosectomies performed. Complete removal of drains was accomplished in 11 patients (92 %). The median time to resolution was 57 days. No serious adverse events occurred; however, one patient developed pancreaticocutaneous fistulas. Ten patients completed 1-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy.
Conclusions: This series supports the premise that direct percutaneous endoscopic necrosectomy is a safe and effective intervention for intra-abdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal adverse events. This modality offers several potential advantages over surgical and transgastric approaches including use of improved accessibility, an excellent safety profile, and requirement for only deep or moderate sedation.
PMCID: PMC4713176  PMID: 26793778
19.  Long- and short-term outcomes of ERCP for bile duct stones in patients over 80 years old compared to younger patients: a propensity score analysis 
Endoscopy International Open  2015;4(1):E83-E90.
Backgrounds and study aims: Endoscopic sphincterotomy (ES) is widely accepted as first-line therapy for bile duct stones (BDS). The major long-term pancreaticobiliary complication is BDS recurrence. Whether cholecystectomy should be performed after ES, especially in elderly patients, remains controversial. The aim of this study is to investigate the short-term and long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for BDS and to analyze risk factors for pancreaticobiliary complications. We also compared long-term outcomes in patients older and younger than age 80.
Patients and methods: A total of 1210 patients who underwent therapeutic ERCP for BDS were retrospectively reviewed to identify risk factors for pancreaticobiliary complications. We divided these patients into two groups: Group Y (< 80 years; 960 patients) and Group O (≥ 80 years; 250 patients). There were 192 matched pairs in the propensity score analysis.
Results: The incidence of pancreaticobiliary complications was 13.1 % (126/960) in Group Y and 20.4 % (51/250) in Group O (P < 0.00001). Multivariate analysis showed that a gallbladder left in situ with stones was a significant independent risk factor (hazard ratio, 2.81; 95 % confidence interval, 1.62 – 4,89; P = 0.0002). There were no significant differences in the incidence of pancreaticobiliary complications between the propensity score-matched groups.
Conclusions: A gallbladder in situ with stones was the only significant risk factor for pancreaticobiliary complications after treatment for BDS. Age per se should not be the major factor when deciding on treatment that minimizes the occurrence of pancreaticobiliary disease.
PMCID: PMC4713177  PMID: 26793790
20.  Calcium Alginate and Calcium Alginate-Chitosan Beads Containing Celecoxib Solubilized in a Self-Emulsifying Phase 
Scientifica  2016;2016:5062706.
In this work alginate and alginate-chitosan beads containing celecoxib solubilized into a self-emulsifying phase were developed in order to obtain a drug delivery system for oral administration, able to delay the drug release in acidic environment and to promote it in the intestinal compartment. The rationale of this work was linked to the desire to improve celecoxib therapeutic effectiveness reducing its gastric adverse effects and to favor its use in the prophylaxis of colon cancer and as adjuvant in the therapy of familial polyposis. The systems were prepared by ionotropic gelation using needles with different diameters (400 and 600 μm). Morphology, particle size, swelling behavior, and in vitro drug release performance of the beads in aqueous media with different pH were investigated. The experimental results demonstrated that the presence of chitosan in the formulation caused an increase of the mechanical resistance of the bead structure and, as a consequence, a limitation of the bead swelling ability and a decrease of the drug release rate at neutral pH. Alginate-chitosan beads could be a good tool to guarantee a celecoxib colon delivery.
PMCID: PMC4834166  PMID: 27127680
21.  The Antibody Two-Step Solution 
F1000Research  2015;4:810.
Problems with antibody quality have been described in numerous recent publications.  In the present commentary it is argued that these quality problems are due primarily to issues of antibody variability and antibody validation.  Further it is argued that the problem of antibody variability must be solved before validation can be useful.  A two-step solution to the antibody problem is thus proposed.
PMCID: PMC4706045  PMID: 26834990
Polyclonal; Monoclonal; Antibody; Variability; Validation; Pooled Serum
22.  A new polystomatid (Monogenea, Polystomatidae) from the mouth of the North American freshwater turtle Pseudemys nelsoni 
ZooKeys  2015;1-9.
Based on material collected from Pseudemys nelsoni (Reptilia: Chelonia: Emydidae) during a parasite survey of the herpetofauna around Gainesville, Florida, USA, Polystomoides nelsoni sp. n. is described as a new polystome species. This parasite was found in the oral and pharyngeal region of the host. In a sample of nine Pseudemys nelsoni, three specimens were found to release polystome eggs. One turtle was euthanized and dissected and found to be infected in the oral region with 19 specimens belonging to an as-yet-unknown Polystomoides. This is only the fifth Polystomoides recorded from the Nearctic realm. This species is distinguished from known species by a combination of characteristics including marginal hooklet morphology, body length and haptor dimensions.
PMCID: PMC4714053  PMID: 26798243
Monogenea; Polystomatidae; Polystomoides; freshwater turtle; Florida; USA
23.  Contributions to the knowledge of oribatid mites (Acari, Oribatida) of Indonesia. 3. The genus Galumna (Galumnidae) with description of a new subgenus and seven new species 
ZooKeys  2015;11-51.
Seven new species of oribatid mites of the genus Galumna are described from litter and soil materials of Sumatra, Indonesia. A new subgenus, Galumna (Atypicogalumna) subgen. n., is proposed; it differs from all galumnid genera and subgenera by the simultaneous presence of porose areas and sacculi on the notogaster (vs. either porose areas or sacculi present). Galumna (Galumna) calva Starý, 1997 is recorded for the first time in the Oriental region, and Galumna (Galumna) sabahna Mahunka, 1995 is recorded for the first time in the Indonesian fauna.
PMCID: PMC4714054  PMID: 26798244
Oribatid mites; systematics; morphology; Galumna; new subgenus and species; record; fauna; Indinesia
24.  Looking back on a decade of barcoding crustaceans 
ZooKeys  2015;53-81.
Species identification represents a pivotal component for large-scale biodiversity studies and conservation planning but represents a challenge for many taxa when using morphological traits only. Consequently, alternative identification methods based on molecular markers have been proposed. In this context, DNA barcoding has become a popular and accepted method for the identification of unknown animals across all life stages by comparison to a reference library. In this review we examine the progress of barcoding studies for the Crustacea using the Web of Science data base from 2003 to 2014. All references were classified in terms of taxonomy covered, subject area (identification/library, genetic variability, species descriptions, phylogenetics, methods, pseudogenes/numts), habitat, geographical area, authors, journals, citations, and the use of the Barcode of Life Data Systems (BOLD). Our analysis revealed a total number of 164 barcoding studies for crustaceans with a preference for malacostracan crustaceans, in particular Decapoda, and for building reference libraries in order to identify organisms. So far, BOLD did not establish itself as a popular informatics platform among carcinologists although it offers many advantages for standardized data storage, analyses and publication.
PMCID: PMC4714055  PMID: 26798245
Barcode of Life Data Systems; Crustacea; cytochrome c oxidase subunit I; DNA barcoding; mitochondrial DNA; specimen identification
25.  Leucothoe kawesqari, a new amphipod from Bernardo O’Higgins National Park (Chile), with remarks on the genus in the Magellan Region (Crustacea, Peracarida) 
ZooKeys  2015;83-95.
Although the genus Leucothoe has been reported repeatedly in the Magellan Region, the citations in the Channels and Fjords Ecoregion were either unidentified or attributed to the previously considered cosmopolitan Leucothoe spinicarpa. In this work, Leucothoe kawesqari sp. n. is described, which can be distinguished from other species of the genus in the Southern Ocean by having eyes present, epimeral plates with no setae, anterior coxae not acutely produced or excavate, coxa 5 slightly bilobed, accessory flagellum present, mandibular palp article 3 shorter than ½ article 2, pereopods 5–7 basis expanded, ovoid, posterior margin weakly crenulate and telson apex irregularly truncated. The new species was found in hard substrates, both unvegetated and with macroalgae, mainly in kelp forest of Macrocystis pyrifera.
PMCID: PMC4714056  PMID: 26798246
Pacific Ocean; channels and fjords; Southern Ocean; benthos; Macrocystis pyrifera; Océano Pacífico; Canales y Fiordos; Océano Antártico; bentos; Macrocystis pyrifera

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