GROSS ANATOMICAL VARIATIONS IN THE THEBESIAN VALVE COVERING THE CORONARY SINUS OSTIUM: A CASE STUDY

2016-07-11T22-52-48Z
Source: International Journal of Current Research and Review
Anitha Thillai, Anjana TSR, Sivakami Thiagarajan.
Objectives: The Coronary Sinus (CS) is a widely employed structure for cannulation during electrophysiologic procedures like catheter ablation of arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair. The present study aims to evaluate the variations in the Thebesian valve covering the coronary sinus ostium. Materials and Methods: The present study was conducted in randomly selected 100 human cadaveric hearts from the Department of Anatomy and autopsied bodies of Department of Forensic Medicine, Thanjavur Medical College. The presence or absence of Thebesian valve, shape of the valve, presence or absence of fenestrations in Thebesian valve were noted. Results: The Thebesian valve was present in 84% and was absent in 16%.The shape of the valve was semicircular in 84.7%, strands in 8.3% and bands in7%.The valve was fenestrated in 20.2%. An interesting variation of double crescentic Thebesian valve was present in one specimen. Conclusion: This study showed that the Thebesian valve was present in 84% of heart specimens. The prominent Thebesian valve or a fenestrated valve or a large band may be an under recognised problem interfering with cannulation. It may pose a significant challenge with regards to cannulation of coronary sinus ostium during various invasive procedures like catheter ablation for arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair and coronary lead placement.


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Ileal or Anastomotic Location of Lesions Does Not Impact Rate of Postoperative Recurrence in Crohn’s Disease Patients Classified i2 on the Rutgeerts Score

Abstract

Background

The Rutgeerts score with 5 grades of severity (i0–i4) is a suitable endoscopic model to predict clinical recurrence following ileocolonic resection in Crohn's disease (CD). Definition of grade i2 includes lesions confined to the ileocolonic anastomosis (i2a) or moderate lesions on the neo-terminal ileum (i2b). The aim of the present study was to evaluate the probability of clinical recurrence in i2a and i2b patients.

Methods

This multicenter retrospective study included all CD patients classified i2 at the first postoperative ileocolonoscopy. The primary outcome was to evaluate the probability of clinical recurrence in patients classified i2a and i2b. The secondary outcome was to compare the rate of global recurrence of CD.

Results

Fifty patients were included: 23 were classified i2a and 27 were classified i2b. The median duration of follow-up was 40 (18.0–80.4) months in the i2a group and 53.5 (25.0–69.0) months in the i2b group (p = 0.9). The probability of clinical recurrence was not significantly different between patients classified i2a and i2b (p = 0.64). Median time to clinical recurrence after the first ileocolonoscopy and probability of global CD recurrence were not different between the two groups (p ≥ 0.19).

Conclusions

The rate of clinical postoperative recurrence is not different in i2a and i2b patients. These results suggest that the same therapeutic strategy should be used in all patients classified i2 on the Rutgeerts score whatever the location of postoperative CD recurrence.

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Efficacy and Safety of Endoscopic Balloon Dilation for Upper Gastrointestinal Strictures of Crohn’s Disease

Abstract

Background

Few articles focused on endoscopic balloon dilation (EBD) in the management of Crohn's strictures in the upper gastrointestinal (GI) tract.

Aims

The purpose of this study was to evaluate the long-term efficacy and safety of EBD for Crohn's strictures in the upper GI tract and to determine early predictors of response and surgical intervention.

Methods

All eligible patients who underwent EBD for Crohn's strictures in the upper GI tract were retrospectively reviewed. The long-term success was defined as the recovery of normal diets without surgical intervention over the follow-up period. In order to seek early predictors, patients who achieved long-term success were compared with those who didn't.

Results

A total of 67 dilations of upper GI strictures were performed between June 2011 and March 2015 on 24 patients (mean age 25.6 ± 6.7, 20 male) with Crohn's disease. Technical success was achieved in 62 of 67 dilations (92.5 %) with a complication rate of 3 %. After the median follow-up period of 23.0 months (range 6.2–51.2 months), nine patients underwent surgical intervention, nine patients were still depending on tube feeding; in the meantime, only six (25 %) patients achieved long-term success. Additionally, patients who remained 1 month intervention-free (55.6 vs. 5.9 %, P = 0.015) were more likely to achieve long-term success.

Conclusions

EBD was a safe procedure, but not a potent therapy for Crohn's upper GI strictures. Meanwhile, 1-month response could serve as an early predictor of the long-term response.

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Inmates break out of holding cell to save corrections officer in cardiac arrest

The corrections officer was watching over the inmates and joking with them when he lost consciousness

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Amniotic membrane as a scaffold in wound healing and diabetic foot ulcer: an experimental technique and recommendations

2016-07-11T06-38-24Z
Source: International Journal of Research in Medical Sciences
Jaianand Kannaiyan, SuriyaNarayanan S., Palaniyandi M., Rajangam B., Hemlata Chhabra, Anubhav Pandey.
Background: Human amniotic membrane has been used clinically in a variety of applications for over the past 100 years and produced a significant amount of data in multiple areas of medicine. Its clinical usage ranges from wound coverage for burn victims to healing of the conjunctiva after pterygium repair. The amniotic membrane natural properties provide an easy to use, safe option for various medical applications. There is need to develop a method for storage of amniotic membrane which can retain the biological properties and as well have long shelf life too. Methods: The experimental technique was standardized for cryopreservation of amniotic membrane. For this, amniotic membrane was obtained from mothers who had delivered through caesarean section with their consent. Results: The standardized protocol for cryopreservation of amniotic membrane was found to be safe and preserved amniotic membrane is expected to have long shelf life. Conclusions: The advantages associated with amniotic membrane such as easily available, inexpensive, non-immunogenic and antimicrobial, anti-inflammatory properties make it a suitable graft to be used in wound healing and diabetic foot ulcers.


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Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

2016-07-11T06-38-24Z
Source: International Journal of Research in Medical Sciences
Ashish Jitendranath, Sudin Koshy.
Background: Gram negative bacteria along with Pseudomonas constitute a significant cause of morbidity and mortality due to pneumonia. As a result it is essential to have appropriate empirical antimicrobial treatment strategies based on the sensitivity pattern of a particular region. In cases with high likelihood of gram negative pneumonia it is essential to start appropriate empirical antibiotics as early as possible to reduce the morbidity and mortality. This study is done to know the antibiotic pattern of gram negative organisms isolated from the institute so that the study can constitute an empirical antibiotic regimen. Methods: A retrospective study was done from January to March 2016. Patients admitted in the medicine and pulmonology department of the hospital who were diagnosed to have pneumonia symptoms. Patients with symptoms, signs and radiological features of pneumonia and sputum cultures with gram negative organisms were included in the study. Gram staining of all samples were taken and bartlet grading was done. All the sputum samples were cultured on blood agar, chocolate agar and macconkey agar. The colonies were then identified using biochemical tests. Antibiotic sensitivity was done following CLSI 2015 guidelines. We also tested for Amp C, ESBL and MBL using standard testing protocol. Results: During the study period in 120 cases of pneumonia, there was growth of pathogenic organism. Among the GNB isolated Klebsiella spp was the most common organism isolated at 33.9% followed by Pseudomonas aeruginosa and Escherichia coli at 22.1%. Out of the 53 gram negative samples isolated 4 (7%) were Amp C positive, 10 (18.8%) were ESBL positive and there was one single case of MBL. The antibiotic sensitivity showed that all the isolates were sensitive to colisitin (100%), while Klebsiella spp, Pseudomonas spp, and Escherichia coli were 100% sensitive to imipenem and meropenem. Resistance pattern of all the isolates showed that the isolates exhibited high resistance to amoxycillin-clavulunate, cefuroxime and cotrimoxazole. While resistance against ceftazidime and cefipime was >40%. On the other hand, isolates showed a low level of resistance against piperacillin tazobactam and cefoperazone-sulbactam. Extremely low level of resistance was observed against imipenem and meropenem, while colistin showed no resistance among the isolates obtained in this study. Conclusions: The study showed that gram-negative bacteria and P. aeruginosa form a relevant part of the microbial pattern of CAP in patients who require hospitalization, particularly those with severe CAP. Initiating antibiotics with gram negative coverage should be considered in this subgroup of patients since initiating the correct antibiotic plays a critical role in the outcome of pneumonia.


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A study to assess availability of basic infrastructure of anganwadi centers in a rural area

2016-07-11T06-21-04Z
Source: International Journal of Community Medicine and Public Health
Ipsita Debata, Anand P., Ranganath T. S..
Background: The integrated child development service (ICDS) was launched on 2nd October, 1975 as an effort to meet the holistic needs of children below 6 years, adolescent girls, expectant and nursing mothers through the network of anganwadis. Purpose of the study was to assess the availability of basic infrastructure for AWCs under ICDS. Methods: This cross-sectional study was conducted in 21 AWCs in Sondekoppa area, rural field practice area of Bangalore medical college and research institute, Bangalore, India. Results: All anganwadi centers were found to be located within the village locality, favouring easy access for the beneficiaries. 17(81%) AWCs were functioning in government allotted buildings. Compound wall or fence all around the anganwadis were found to be present in only 10 (47.6%) centers. Toilet facilities were found to be present in 12(57.1%) centers. When cleanliness of room and kitchen was assessed, it was found to be good in 13 (61.9%) centers. Assessment of area surrounding the anganwadi centers revealed that 12 (52.1%) centers were free from any nuisance causing factors around. Conclusions: Since anganwadi centre is nodal point for service delivery under ICDS programme, infrastructures like toilet facilities were found to be present in 57.1%, cleanliness of room and kitchen was assessed, it was found to be good in 61.9%.


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Inmates break out of holding cell to save corrections officer in cardiac arrest

The corrections officer was watching over the inmates and joking with them when he lost consciousness

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Inmates break out of holding cell to save corrections officer in cardiac arrest

The corrections officer was watching over the inmates and joking with them when he lost consciousness

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The Administration of Hydroethanolic Extract of Cordia Ecalyculata Vell., At Different Doses, Promotes Reproductive Toxicity in Adult Male Rats

2016-07-11T05-35-24Z
Source: Journal of Interdisciplinary Histopathology
Lucas Giglio Colli, Mirian Campos dos Santos, Jéssica Tambor, Isabel Cristina Cherici Camargo.
Popular use of Cordia ecalyculata extract is increasing due to its potential in inhibiting appetite. Its side effects on reproduction have not yet been reported. Thus, for the first time, this study investigated the potential reproductive toxicity of different doses of C. ecalyculata extract in adult male rats (n = 12/group), which received hydroethanolic extract of C. ecalyculata at 20, 100, or 400 mg/kg of body weight (b.w.) or distilled water (control group), orally (gavage) for 60 consecutive days. The testicular and epididymal tissue, sperm morphology, fertility, and pregnancy outcome were evaluated. The results showed that food consumption decreased significantly in the groups that received 20 or 400 mg/kg of extract, but b.w. was similar (P > 0.05) in all experimental groups. No significant alteration was observed in testicular weight. At the 400 mg/kg dose, the epididymal relative weight increased (P

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Elevated uric acid levels: a predictor of pulmonary hypertension

2016-07-11T05-03-46Z
Source: International Journal of Advances in Medicine
Nagaraju Boyilla, Swetha Madas.
Background: Pulmonary hypertension is a chronic, progressive and a fatal disease. Uric Acid is elevated in case of myelo and lymphoproliferative diseases, decreases uric acid excretion or as a part of metabolic syndrome (insulin resistance). It is also said to be associated in patients with heart failure leading to severe symptoms and fatality. This study was conducted to identify if elevated uric acid levels can be a predictor of pulmonary hypertension. Methods: After taking the detailed demographic data of 62 patients, a thorough clinical and physical examination, postero-anterior chest X-rays, pulmonary function testing, ventilation or perfusion scintigraphy and Electro Cardiograph was also done for all the patients. Blood was drawn for testing uric acid, creatinine and total bilirubin levels. Results: Out of the 62 patients, 43.5% were males and 56.5% were females. Out of the NYHA classes, most of the patients 58% belonged to the Class II, 34% to class III and 8% to Class IV. . The total bilirubin and creatinine levels were higher in patients with hyperuricemia than that of the controls. The blood saturation levels were significantly lower with only 67% and heart rate was on average more than 89 beats per minute. A positive correlation with NYHA class and MPAP, and a negative correlation with LVEF and RVEF were observed. Conclusions: In conclusion, the results of this study establish that hyperuricemia is common in patients with severe PH.


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Relationship between diabetes mellitus and pulmonary tuberculosis and the outcome of treatment

2016-07-11T05-03-46Z
Source: International Journal of Advances in Medicine
Nagaraju Boyilla, Swetha Madas.
Background: Diabetes mellitus (DM) TB co-infection is associated with poor glycemic control in DM patients. The dual curse of these two diseases may have an impact on the outcome of treatment. Methods: 72 out of 164 patients above 18 years of age were had Diabetes mellitus and 92 of them were non diabetic. Demographic details, physical and clinical examination, Blood tests for Hb1Ac, chest x rays, and sputum for AFB were done for all the patients. Antitubercular treatment was given for all of them. To the diabetics, in addition to the ATT, anti-diabetic drugs were also given. Follow up was done after 2 and 6 months. Results: The most common age group to be affected was 55-64 years among the diabetic group and 45-54 among the non-diabetic group. Most of the patients with diabetes had an elevated HbA1c levels which was significantly prominent among 35-64 years of age group. Most of the diabetics had 3+ sputum positivity. 54.2% had far advanced severity on chest X-rays. Sputum conversion was seen in 77.7% of the cases among the diabetic patients, 16.7% of these patients had failed treatment and 2 of the persons died during the study period. Conclusions: Screening for DM in patients with TB could improve case detection, early treatment, and prevention of DM complications.


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A double blinded comparative study of oral premedication in children with midazolam alone or in combination with ketamine

2016-07-11T04-52-25Z
Source: International Journal of Contemporary Pediatrics
Jyoti Magar, Manish B. Kotwani, Suhas Kotak.
Background: Surgery and anaesthesia induction cause considerable emotional stress upon children. In children pre-anaesthetic medications are frequently administered as pharmacological adjunction to alleviate the stress and fear of surgery as well as to ease child-parent separation and promote a smooth induction of anaesthesia. Methods: Prospective double blinded randomized comparative study of oral premedication in children with midazolam alone or combination of midazolam with low dose ketamine in the age group of 3-10 years undergoing surgical procedures under standardized general anesthesia. Results: In group M success rate of satisfactory sedation was 68.99% as against 76.59% in group MK, whereas success rate of anxiolysis was 80.00% in group M compared to 93.33% in group MK. 93.32% children were easily separated from parents in M Group compared to 96.66% in MK group. Also 73.32% children co-operated for IV line insertion in M group as against 96.66% in group MK and 83.33% children showed better mask acceptance in M group compared to 93.33% in MK group. Conclusions: From present study, it was concluded that addition of low dose of ketamine improves quality and success rate of satisfactory sedation, anxiolysis, parental separation, co-operation for IV line and mask acceptance.


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Study of efficacy of oral ivermectin in comparison to commonly used topical antiscabetic drugs gamma benzene hexachloride and permethrin

2016-07-11T04-36-21Z
Source: International Journal of Basic & Clinical Pharmacology
Suman Kanwar, Sunil K. Mathur, Sanjay Sankhla.
Background: Scabies is an infectious disease, contagious in nature and caused by Sarcoptes Scabiei, is transmitted readily, often throughout an entire household, by prolonged skin-to-skin contact with an infected person. The objective was to know the efficacy of oral ivermectin in the treatment of scabies infection in comparison to commonly used topical antiscabetic drugs gamma benzene hexachloride and permethrin. Methods: Using prospective, longitudinal, comparative randomized design, study was conducted for a period of one year in 299 patients, in the age group of 5 to 60 years, belonging to both sexes, attending outpatient department of dermatology of J.L.N. Medical College and associated hospitals Ajmer (RAJ), India. Pregnant and lactating women, children below 5 years, elderly patients more than 60 year, patients not willing to come for follow-up and patients with any serious systemic illness were excluded. Data so collected, were analyzed as per the aims and objectives with the help of appropriate statistical software (primer statistical software version 6). Results: Efficacy of oral ivermectin therapy was comparable with topical permethrin therapy but more efficacious (statistically significant) than topical gama benzene hexachloride therapy. Conclusions: Ivermectin can be a very useful weapon in patients who do not show compliance with topical therapy.


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Store-operated calcium entry is required for sustained contraction and Ca2+ oscillations of airway smooth muscle

Abstract

Asthma is characterized by airway hyper-responsiveness – the excessive contraction of airway smooth muscle. The extent of this airway contraction is proportional to the frequency of Ca²⁺ oscillations within airway smooth muscle cells (ASMCs). Sustained Ca²⁺ oscillations require a Ca²⁺ influx to replenish Ca²⁺ losses across the plasma membrane. Our previous studies implied store-operated calcium entry (SOCE) as the major pathway for this Ca²⁺ influx. Here, we explore this hypothesis, by examining the effects of SOCE inhibitors (GSK7975A and GSK5498A) as well as L-type voltage-gated Ca²⁺ channel (VGCC) inhibitors (nifedipine and nimodipine) on airway contraction and Ca²⁺ oscillations and SOCE-mediated Ca²⁺ influx in ASMCs within mouse precision-cut lung slices (PCLS). We found that both GSK7975A and GSK5498A were able to fully relax methacholine (MCh)-induced airway contraction by abolishing the Ca²⁺ oscillations, in a manner similar to that observed in zero extracellular Ca²⁺ ([Ca²⁺]_e). In addition, GSK7975A and GSK5498A inhibited increases in intracellular Ca²⁺ ([Ca²⁺]_i) in ASMCs with depleted Ca²⁺-stores in response to increased [Ca²⁺]_e, a response consistent with an inhibition of SOCE. However, GSK7975A and GSK5498A did not reduce Ca²⁺ release via IP₃ receptors stimulated with IP₃ released from caged-IP₃. By contrast, nifedipine and nimodipine only partially reduced airway contraction, Ca²⁺ oscillation frequency and SOCE-mediated Ca²⁺ influx. These data implicate that SOCE is the major Ca²⁺ influx pathway for ASMCs to sustain agonist-induced airway contraction and the underlying Ca²⁺ oscillations. The mechanisms of SOCE may therefore form novel targets for new bronchodilators.

This article is protected by copyright. All rights reserved

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Superior mitochondrial adaptations in human skeletal muscle after interval compared to continuous single-leg cycling matched for total work

Abstract

We employed counterweighted single-leg cycling as a unique model to investigate the role of exercise intensity in human skeletal muscle remodelling. Ten young active men performed unilateral graded-exercise tests to measure single-leg VO_2peak and peak power (W_peak). Each leg was randomly assigned to complete six sessions of high-intensity interval training (HIIT; 4 x [5 min at 65% W_peak and 2.5 min at 20% W_peak]) or moderate-intensity continuous training (MICT; 30 min at 50% W_peak), which were performed 10 min apart on each day, in an alternating order. The work performed per session was matched for MICT (143 ± 8.4 kJ) and HIIT (144 ± 8.5 kJ, P > 0.05). Post-training, citrate synthase (CS) maximal activity (10.2 ± 0.8 vs. 8.4 ± 0.9 mmol kg protein⁻¹ min⁻¹) and mass-specific (pmol O₂•[s•mg ww]⁻¹) oxidative phosphorylation capacities (complex I: 23.4 ± 3.2 vs. 17.1 ± 2.8; complexes I and II: 58.2 ± 7.5 vs. 42.2 ± 5.3) were greater in HIIT relative to MICT (interaction effects, P < 0.05); however, mitochondrial function (i.e., pmol O₂•[s•CS maximal activity]⁻¹) measured under various conditions was unaffected by training (P > 0.05). In whole muscle, the protein content of COXIV (24%), NDUFA9 (11%), and MFN2 (16%) increased similarly across groups (training effects, P < 0.05). COXIV and NDUFA9 were more abundant in type I than type II fibres (P < 0.05), but training did not increase the content of COXIV, NDUFA9, or MFN2 in either fibre type (P > 0.05). Single-leg VO_2peak was also unaffected by training (P > 0.05). In summary, single-leg cycling performed in an interval compared to a continuous manner elicited superior mitochondrial adaptations in human skeletal muscle despite equal total work.

This article is protected by copyright. All rights reserved

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Does stenting as a bridge to surgery in left-sided colorectal cancer obstruction really worsen oncological outcomes?

Diseases of the Colon and Rectum

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Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: A randomized, controlled trial

Annals of Internal Medicine

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Successful Re-resection for Locally Recurrent Retroperitoneal Liposarcoma at Four Years After Ex Vivo Tumor Resection and Autotransplantation of the Liver: A Case Report

Transplantation Proceedings

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IgE-associated food allergy alters the presentation of pediatric eosinophilic esophagitis

Clinical & Experimental Allergy

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No benefit from the obesity paradox for diabetic patients with heart failure

European Journal of Heart Failure

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Obesity and Cardiovascular Risk in Adults With Celiac Disease

Journal of Clinical Gastroenterology

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Indications and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury

Colorectal Disease

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Clonorchis sinensis co-infection could affect the disease state and treatment response of HBV patients

PLoS Neglected Tropical Diseases

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Impact of EUS-guided fine-needle biopsy with a new core needle on the need for on-site cytopathological assessment: A preliminary study

Gastrointestinal Endoscopy

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Nonalcoholic fatty liver disease (NAFLD)—a new cardiovascular risk factor in peritoneal dialysis patients

Peritoneal Dialysis International

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A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery

Obesity

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Hospitalization and mortality due to hepatitis A in Taiwan: A 15-year nationwide cohort study

Journal of Viral Hepatitis

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Short-term outcomes of laparoscopic surgery for Crohn’s disease patients treated with anti-tumor necrosis factor alpha agents

Surgery Today

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Prone position in thoracoscopic esophagectomy improves postoperative oxygenation and reduces pulmonary complications

Surgical Endoscopy

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Monitoring of liver function tests after Roux-en-Y gastric bypass: An examination of evidence base

Obesity Surgery

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Randomized trial of endoscopist-controlled vs. assistant-controlled wire-guided cannulation of the bile duct

The American Journal of Gastroenterology

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Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease

Digestive and Liver Diseases

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Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: An analysis of 68 cases

Surgical Endoscopy

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Acceptance of living liver donation among medical students: A multicenter stratified study from Spain

World Journal of Gastroenterology

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The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis

Surgery

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