Utilization of resource leveling to optimize ERCP efficiency

Hendrick, L. M.; Harewood, Gavin C.; Patchett, Stephen; Murray, Frank E.

doi:10.1007/s11845-010-0570-7

Cited by 6 publications

(4 citation statements)

References 22 publications

(18 reference statements)

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“…Indeed, endoscopic retrograde cholangiopancreatography (ERCP) [63] is commonly used in the clinical setting to study and treat problems of bile and pancreatic ducts. The existence of an established procedure to reach the human pancreas in a minimally-invasive manner opens the possibility of safe gene transfer to the pancreas of diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

AAV-mediated pancreatic overexpression of Igf1 counteracts progression to autoimmune diabetes in mice

Mallol

Casana

Jiménez

et al. 2017

Molecular Metabolism

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ObjectiveType 1 diabetes is characterized by autoimmune destruction of β-cells leading to severe insulin deficiency. Although many improvements have been made in recent years, exogenous insulin therapy is still imperfect; new therapeutic approaches, focusing on preserving/expanding β-cell mass and/or blocking the autoimmune process that destroys islets, should be developed. The main objective of this work was to test in non-obese diabetic (NOD) mice, which spontaneously develop autoimmune diabetes, the effects of local expression of Insulin-like growth factor 1 (IGF1), a potent mitogenic and pro-survival factor for β-cells with immunomodulatory properties.MethodsTransgenic NOD mice overexpressing IGF1 specifically in β-cells (NOD-IGF1) were generated and phenotyped. In addition, miRT-containing, IGF1-encoding adeno-associated viruses (AAV) of serotype 8 (AAV8-IGF1-dmiRT) were produced and administered to 4- or 11-week-old non-transgenic NOD females through intraductal delivery. Several histological, immunological, and metabolic parameters were measured to monitor disease over a period of 28–30 weeks.ResultsIn transgenic mice, local IGF1 expression led to long-term suppression of diabetes onset and robust protection of β-cell mass from the autoimmune insult. AAV-mediated pancreatic-specific overexpression of IGF1 in adult animals also dramatically reduced diabetes incidence, both when vectors were delivered before pathology onset or once insulitis was established. Transgenic NOD-IGF1 and AAV8-IGF1-dmiRT-treated NOD animals had much less islet infiltration than controls, preserved β-cell mass, and normal insulinemia. Transgenic and AAV-treated islets showed less expression of antigen-presenting molecules, inflammatory cytokines, and chemokines important for tissue-specific homing of effector T cells, suggesting IGF1 modulated islet autoimmunity in NOD mice.ConclusionsLocal expression of Igf1 by AAV-mediated gene transfer counteracts progression to diabetes in NOD mice. This study suggests a therapeutic strategy for autoimmune diabetes in humans.

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Section: Discussionmentioning

confidence: 99%

AAV-mediated pancreatic overexpression of Igf1 counteracts progression to autoimmune diabetes in mice

Mallol

Casana

Jiménez

et al. 2017

Molecular Metabolism

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“…Importantly, the retrograde pancreatic intraductal injection can be performed in large animals and humans through a less invasive, nonsurgical clinical procedure called endoscopic retrograde cholangiopancreatography [39], opening the possibility for a future translation of successful treatments to humans. In addition, this approach provides a shortcut to the generation of relevant animal models of the disease.…”

Section: Discussionmentioning

confidence: 99%

In vivo genetic engineering of murine pancreatic beta cells mediated by single-stranded adeno-associated viral vectors of serotypes 6, 8 and 9

et al. 2011

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“…Davies et al (122) found that introducing a non-urgent upper GI endoscopy service at the weekend reduced length of inpatient stay without increased mortality. Resource leveling studies on ERCP have also proposed a half-day Saturday list (123).…”

Section: Proposed Ways Of Reducing Time To Cholecystectomymentioning

confidence: 99%

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

et al. 2020

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Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

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Utilization of resource leveling to optimize ERCP efficiency

Abstract: Resource leveling can be applied to balance procedure provision with demand to cope with fluctuations in demand. The impact of resource leveling can be truly measured only by implementing these changes and prospectively studying the effect.

Cited by 6 publications

References 22 publications

AAV-mediated pancreatic overexpression of Igf1 counteracts progression to autoimmune diabetes in mice

AAV-mediated pancreatic overexpression of Igf1 counteracts progression to autoimmune diabetes in mice

In vivo genetic engineering of murine pancreatic beta cells mediated by single-stranded adeno-associated viral vectors of serotypes 6, 8 and 9

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

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