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1欧洲新生儿呼吸窘迫综合征防治指南-2010版显示文摘呼吸窘迫综合征(RDS)是由于肺表面活性物质(PS)缺乏及肺结构发育不成熟所致,多见于早产儿,自然病程为生后当时或很快发病,并在生后2d内进行性恶化,如不及时治疗,因进行性缺氧和呼吸衰竭而死亡,存活者,在生后2—4d病情开始改善。胎龄越小,RDS发生率越高,2006年EuroNeoStat的数据显示:胎龄23~25周的早产儿RDS发生率为91%,Sweet DG Carnielli V Greisen G Hallman M Ozek E Plavka R Saugstad OD Simeoni U Speer CP Halliday HL 袁琳(翻译) 陈超(审校) 2011中华儿科杂志2011,49,1:137
2BCLC策略:预后预测和治疗推荐2022版更新显示文摘2018版BCLC预后和治疗推荐策略发布后,肝细胞癌(简称HCC)的研究又取得了重大进展。本次更新基于肝癌各领域的研究进展结果。重点关注影响策略的重要研究进展。虽然近年的研究结果成绩斐然,但将其引入为临床医生和研究者提供行动依据的循证模型指南来说证据效力依然不够确切。本文对该问题进行分析,阐述了为HCC患者制定个体化治疗临床决策所需的批判性思维和专业知识。Reig M Forner A Rimola J Ferrer-Fabrega J Burrel M Garcia-Criado A Kelley RK Galle PR Mazzaferro V Salem R Sangro B Singal AG Vogel A Fuster J Ayuso C Bruix J 刘永凡(摘译) 崔笑(摘译) 耿小平(审校) 2022肝胆外科杂志2022,30,5:80
3帕博利珠单抗单用或与放疗联用治疗转移性非小细胞肺癌:两个随机试验的汇总分析显示文摘背景放疗可以提高整个机体对免疫治疗的应答。在Ⅱ期PEMBRO-RT研究和Ⅰ/Ⅱ期MDACC研究中,患有转移性非小细胞肺癌(NSCLC)的患者被随机分配入组,接受免疫治疗(帕博利珠单抗)+放疗联合疗法,或免疫治疗单一疗法。当上述2个研究单独分析时,联合疗法组显示出潜在获益。由于每个研究的样本量较小,缓解率和结局并未显示出统计学意义,然而却有显著的临床获益。因此,本研究进行汇总分析,来判断放疗是否会改善转移性NSCLC患者的免疫治疗应答。方法PEMBRO-RT和MDACC研究纳入标准:患者年龄≥18岁,患有转移性NSCLC,且有≥1处未经放疗照射的病灶,以便进行射野外应答监测。PEMBRO-RT研究纳入曾接受过化疗患者,MDACC研究纳入曾接受过治疗或新诊断患者。2个研究中的患者均未接受过免疫治疗。在PEMBRO-RT研究中患者被等比例随机分配入组,并根据吸烟状态进行分层(分为<10年组和≥10年组)。MDACC研究的患者根据放疗计划可行性被等比例随机分配入2个受试组。由于联合治疗组的干预本质,每个研究中的放疗均不适用盲法。在2个研究中,不论是否进行放疗,均静脉滴入帕博利珠单抗(每3周200 mg)。在PEMBRO-RT研究中,在放疗(24 Gy 3次分割照射)结束后1周给予第1剂帕博利珠单抗。在MDACC研究中,在第1次放疗(50 Gy 4次分割照射或45 Gy 15次分割照射)同时给予帕博利珠单抗。仅检测未经照射病灶的应答。本研究的终点为最佳射野外(远隔)应答率(ARR)、最佳射野外疾病控制率(ACR)、12周时ARR、12周时ACR、无进展生存期(PFS)和总生存期(OS)。2个研究的意向治疗(ITT)人群均纳入分析。PEMBRO-RT研究(NCT02492568)和MDACC研究(NCT02444741)均在ClinicalTrials.gov上注册。发现纳入148例患者,76例接受帕博利珠单抗治疗,72例接受帕博利珠单抗+放疗治疗。所有患者随访时间中位数为33个月[四分位距(IQR):32.4~33.6]。148例患者中124例(84%)组织学特征为非鳞癌,111例(75%)患者曾经接受过化疗。组间没有基线特征差异,包括PD-L1表达状态和转移灶体积。最常见的照射部位为肺转移灶(39%,28/72)、胸腔内淋巴结(21%,15/72)和非原发灶(17%,12/72)。帕博利珠单抗组和联合治疗组的最佳ARR分别为19.7%(15/76)和41.7%(30/72),OR=2.96,95%CI:1.42~6.20,P=0.0039;最佳ACR分别为43.4%(33/76)和65.3%(47/72),OR=2.51,95%CI:1.28~4.91,P=0.0071;PFS中位数分别为4.4(IQR:2.9~5.9)和9.0个月(IQR:6.8~11.2),HR=0.67,95%CI:0.45~0.99,P=0.045;OS中位数分别为8.7(IQR:6.4~11.0)和19.2个月(IQR:14.6~23.8),OR=0.67,95%CI:0.54~0.84,P=0.0004。在汇总分析中没有发现新的安全问题。解读帕博利珠单抗免疫疗法+放疗显著提高转移性NSCLC患者的应答和改善治疗结局。这些结果需要在三期临床试验中进行验证。陈大卫(翻译) 于金明(校对) Willemijn S M E Theelen Vivek Verma Brian P Hobbs Heike M U Peulen Joachim G J V Aerts Idris Bahce Anna Larissa N Niemeijer Joe Y Chang Patricia M de Groot Quynh-Nhu Nguyen Nathan I Comeaux George R Simon Ferdinandos Skoulidis Steven H Lin Kewen He Roshal Patel John Heymach Paul Baas James W Welsh 2021中华肿瘤防治杂志2021,28,24:49
4欧洲早产儿呼吸窘迫综合征防治共识指南(2013版)显示文摘本次指南更新包括了自2010年以来Cochrane系统评价和医学文献中的最新证据,并采纳了一种新的证据评估分级系统(GRADE)。以往关于早期肺表面活性物质和持续气道正压通气治疗的推荐目前拥有了更坚定的循证依据。对产房复苏、稳定生命体征等内容进行了较大扩充。生命体征稳定后的氧疗目前仍存在一定的争议,但是在获得更多的证据之前,血氧饱和度的目标范围不应低于90%,支持治疗对于超早早产儿仍然极为重要。指南对其他注意事项进行了缩减。Sweet D Carnielli V Greisen G Hallman M Ozek E Plavka R Saugstad OD Simeoni U Speer CP Halliday HL 王敏婕 袁琳 陈超 2014中华儿科杂志2014,52,10:34
5Pediatric functional constipation treatment with Bifi dobacterium-containing yogurt:A crossover,double-blind,controlled trial显示文摘AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015).Paula VP Guerra Luiza N Lima Tassia C Souza Vanessa Mazochi Francisco J Penna Andreia M Silva Jacques R Nicoli Elizabet V Guimares 2011World Journal of Gastroenterology2011,17,34:25
62018加拿大心境障碍与焦虑障碍治疗协作组/国际双相障碍学会指南:双相障碍的管理显示文摘加拿大心境障碍与焦虑障碍治疗协作组(Canadian Network for Mood and Anxiety Treatments,CANMAT)曾于2005年发布了第1版双相障碍管理指南,并分别于2007、2009和2013年对该指南进行了更新,其中最近的2次更新是与国际双相障碍学会(International Society for Bipolar Disorders,ISBD)合作完成。2018版CANMAT/ISBD双相障碍治疗指南(以下简称指南)反映了自2005年首版指南发表以来本领域取得的重大进展,包括疾病诊断与疾病管理的更新以及药物治疗与心理治疗的近期研究进展。这些前沿进展中综合考虑了循证证据的级别,并基于治疗疗效、临床实践经验、安全性、耐受性和药物导致的转相风险等,对一线、二线及三线治疗方案进行了简明而清晰的推荐。本指南中新增内容涵盖了双相Ⅰ型障碍(BD-Ⅰ)的躁狂发作急性期、抑郁发作急性期和双相障碍维持期的一线及二线治疗推荐等级划分。这种对治疗推荐等级的划分综合考虑了治疗方法对双相障碍不同时相的影响,将进一步帮助临床医生做出基于循证证据的治疗决策。锂盐、喹硫平、双丙戊酸盐、阿塞那平、阿立哌唑、帕利哌酮、利培酮和卡利拉嗪单药或联合使用被推荐为躁狂发作急性期的一线治疗选择。BD-Ⅰ抑郁期的一线治疗选择包括喹硫平、鲁拉西酮、锂盐、拉莫三嗪单药,鲁拉西酮联合锂盐或双丙戊酸盐或拉莫三嗪辅助治疗。尽管急性期治疗有效的药物通常应继续用于BD-Ⅰ的维持期治疗,但也存在一些特殊情况(例如抗抑郁药)。现有数据表明,锂盐、喹硫平、双丙戊酸盐、拉莫三嗪、阿塞那平和阿立哌唑单药或联合治疗应被视为维持治疗的初始或更换治疗方案时的一线选择。除了探讨BD-Ⅰ的相关问题外,本指南中还对双相Ⅱ型障碍(BD-Ⅱ)的临床管理进行了系统回顾并给予治疗推荐,同时针对特殊人群也有相关推荐,如处于各个生殖周期的女性、儿童、青少年和老年人。此外,本指南中还讨论了特定精神疾病及共病(如物质滥用、焦虑障碍和代谢性疾病)的影响。最后,本指南中概述了安全性和药物监测的相关问题。CANMAT/ISBD工作组希望本指南能够成为全球临床医生的实用工具。Lakshmi N Yatham Sidney H Kennedy Sagar V Parikh Ayal Sehaffer David J Bond Benicio N Frey Verinder Sharma Benjamin I Goldstein Soham Rej Serge Beaulieu Martin Alda Glenda MaeQueen Roumen V Milev Arun Ravindran Claire O'Donovan Diane Mclntosh Raymond W Lam Gustavo Vazquez Flavio Kapczinski Roger S Melntyre Jan Kozicky Shigenobu Kanba Beny Lafer Trisha Suppes Joseph R Calabrese Eduard Vieta Gin Malhi Robert M Post Michael Berk 胡晨(译) 王刚(译) 2019中华精神科杂志2019,52,1:25
7A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol显示文摘BACKGROUND: Laparoscopic pancreaticoduodenectomy(LPD)is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy(OPD).METHODS: Between November 2005 and April 2009, 12LPDs(9 ampullary and 3 distal common bile duct tumors)were performed. A cohort of 12 OPDs were matched for age,gender, body mass index(BMI) and American Society of Anesthesiologists(ASA) score and tumor site.RESULTS: Mean tumor size LPD vs OPD(19.8 vs 19.2 mm,P=0.870). R0 resection was achieved in 9 LPD vs 8 OPD(P=1.000). The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1(P=0.140)and 20.7 vs 18.5(P=0.534) respectively. Clavien complications grade I/II(5 vs 8), III/IV(2 vs 6) and pancreatic leak(2 vs 1)were statistically not significant(LPD vs OPD). The mean high dependency unit(HDU) stay was longer in OPD(3.7 vs 1.4 days,P<0.001). There were 2 recurrences each in LPD and OPD(logrank,P=0.983). Overall mortality for LPD vs OPD was 3 vs 6(log-rank, P=0.283) and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS: Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.Abdul R Hakeem Caroline S Verbeke Alison Cairns Amer Aldouri Andrew M Smith Krishna V Menon 2014Hepatobiliary & Pancreatic Diseases International2014,13,4:24
8Evaluation of clinical relevance of examining K-ras, p16 and p53 mutations along with allelic losses at 9p and 18q in EUS-guided fine needle aspiration samples of patients with chronic pancreatitis and pancreatic cancer显示文摘AIM: To establish an optimum combination of molecular markers resulting in best overall diagnostic sensitivity and specificity for evaluation of suspicious pancreatic mass. METHODS: Endoscopic ultrasound (EUS)-guided fine needle aspiration cytology (FNA) was performed on 101 consecutive patients (63 males, 38 females, 60 ± 12 years; 81 with subsequently diagnosed pancreatic cancer, 20 with chronic pancreatitis) with focal pancreatic mass. Samples were evaluated on-site by an experienced cytopathologist. DNA was extracted from Giemsa stained cells selected by laser microdissection and the presence of K-ras, p53 and p16 somatic mutations was tested by cycling-gradient capillary electrophoresis (CGCE) and single-strand conformation polymorphism (SSCP) techniques. In addition, allelic losses of tumor suppressor genes p16 (INK4, CDKN2A) and DPC4 (MADH4, SMAD4) were detected by monitoring the loss of heterozygosity (LOH) at 9p and 18q, respectively. RESULTS: Sensitivity and specificity of EUS-guided FNA were 75% and 85%, positive and negative predictivevalue reached 100%. The remaining 26% samples were assigned as inconclusive. Testing of molecular markers revealed sensitivity and specificity of 70% and 100% for K-ras mutations (P < 0.001), 24% and 90% for p53 mutations (NS), 13% and 100% for p16 mutations (NS), 85% and 64% for allelic losses at 9p (P < 0.001) and 78% and 57% for allelic losses at 18q (P < 0.05). When tests for different molecular markers were combined, the best results were obtained with K-ras + LOH at 9p (92% and 64%, P < 0.001), K-ras + LOH at 18q (92% and 57%, P < 0.001), and K-ras + LOH 9q + LOH 18q (96% and 43%, P < 0.001). When the molecular markers were used as complements to FNA cytology to evaluate inconclusive samples only, the overall sensitivity of cancer detection was 100% in all patients enrolled in the study. CONCLUSION: EUS-guided FNA cytology combined with screening of K-ras mutations and allelic losses of tumor suppressors p16 and DPC4 represents a very sensitive approach in screening for pancreatic malignancy. Molecular markers may find its use particularly in cases where FNA cytology has been inconclusive.C Salek L Benesova M Zavoral V Nosek L Kasperova M Ryska R Strnad E Traboulsi M Minarik 2007World Journal of Gastroenterology2007,13,27:18
9High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound显示文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.Roman Schumann Nikola S Natov Klifford A Rocuts-Martinez Matthew D Finkelman Tom V Phan Sanjay R Hegde Robert M Knapp 2016World Journal of Gastroenterology2016,22,47:9
10Alcohol dehydrogenase: A potential new marker for diagnosis of intestinal ischemia using rat as a model显示文摘AIM: Intestinal ischemia (Ii) is an abdominal emergency due to blockade of the superior mesenteric artery resulting in 60-100% mortality if diagnosed late. Changes in several biochemical parameters such as D (-)-lactate, Creatinine kinase isoenzymes and lactate dehydrogenase suggested for early diagnosis, lack specificity and sensitivity. Therefore a biochemical parameter with greater sensitivity needs to be identified.METHODS: Wistar male rats were randomly assigned into two groups; control sham operated (n = 24) and ischemic test (n = 24) group. Superior mesenteric arterial occlusion was performed in the ischemic test group for 1 h. Alcohol dehydrogenase (ADH) was estimated in blood from portal vein, right ventricle of heart, dorsal aorta (DA) and inferior vena cava (IVC). The Serum glutamic acid pyruvate transaminase (SGPT) was also estimated in blood from portal vein and right ventricle of heart.RESULTS: A significant increase (P<0.001) in the levels of ADH in both portal blood as well as heart blood of the test group (232.72±99.45 EU and 250.85±95.14 EU, respectively)as compared to the control group (46.39±21.69 EU and 65.38±30.55 EU, respectively) were observed. Similarly,increased levels of ADH were observed in blood samples withdrawn from DA and IVC in test animals (319.52±80.14EU and 363.90±120.68 EU, respectively) as compared to the control group (67.68±63.22 EU and 72.50±58.45 EU,respectively). However, in test animals there was significant increase in SGPT in portal blood (P = 0.054) without much increase in heart blood.CONCLUSION: Significant increase in the levels of ADH in portal and heart blood within 1 h of SMA occlusion without increase in SGPT in heart blood, suggests that the origin of ADH is from ischemic intestine and not from liver. Similarly, raised ADH levels were found in DA and IVC as well. IVC blood does represent peripheral blood sample. A raised level of ADH in test animals confirms it to be a potential marker in the early diagnosis of Ii.Upendra R Gumaste Mukund M Joshi Devendra T Mourya Pradip V Barde Ghanshyam K Shrivastav Vikram S Ghole 2005World Journal of Gastroenterology2005,11,6:9
11Bemisia tabaci Phylogenetic Groups in India and the Relative Transmission Efficacy of Tomato leaf curl Bangalore virus by an Indigenous and an Exotic Population显示文摘Bemisia tabaci adults from various host-plant species were collected from 31 regions across India.266 B.tabaci samples were first screened by RAPD-PCR to examine molecular variability and to select individuals with different fingerprints.Host-plant and region of collection were then used to select 25 individuals for PCR amplification and sequencing of their partial mitochondrial cytochrome oxidase subunit one(mtCOI)genes.Pairwise comparisons with mtCOI consensus sequences showed that the majority of these samples had <3.5% sequence divergence from groups currently termed Asia I,Asia II-5,Asia II-7,and Asia II-8.The biotype-B B.tabaci from India clustered into the Middle East-Asia Minor 1 group.A new group of B.tabaci from Coimbatore,collected from pumpkin,was related most closely to the Asia I group(6.2% sequence divergence from the consensus Asia I sequence).To increase our understanding of the epidemiology of tomato leaf curl disease(ToLCD)and the key B.tabaci genetic groups involved in virus spread,the indigenous Asia I and the exotic biotype-B population from South India were used to carry out transmission experiments using Tomato leaf curl Bangalore virus(ToLCBV).The acquisition access periods(AAP),inoculation access periods(IAP),latent periods(LP),and ToLCBV transmission efficiencies of the two populations were compared and the biotype-B had the more efficient transmission characteristics.These results are discussed in relation to recent changes in the epidemiology of tomato leaf curl disease in South India.R V Chowda-Reddy M Kirankumar Susan E Seal V Muniyappa Girish B Valand M R Govindappa John Colvin 2012Journal of Integrative Agriculture2012,11,2:8
12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
13Viral hepatitis update: Progress and perspectives显示文摘Viral hepatitis,secondary to infection with hepatitis A,B,C,D,and E viruses,are a major public health problem and an important cause of morbidity and mortality.Despite the huge medical advances achieved in recent years,there are still points of conflict concerning the pathogenesis,immune response,development of new and more effective vaccines,therapies,and treatment.This review focuses on the most important research topics that deal with issues that are currently being solved,those that remain to be solved,and future research directions.For hepatitis A virus we will address epidemiology,molecular surveillance,new susceptible populations as well as environmental and food detections.In the case of hepatitis B virus,we will discuss host factors related to disease,diagnosis,therapy,and vaccine improvement.On hepatitis C virus,we will focus on pathogenesis,immune response,direct action antivirals treatment in the context of solid organ transplantation,issues related to hepatocellular carcinoma development,direct action antivirals resistance due to selection of resistanceassociated variants,and vaccination.Regarding hepatitis D virus,we describe diagnostic methodology,pathogenesis,and therapy.Finally,for hepatitis E virus,we will address epidemiology(including new emerging species),diagnosis,clinical aspects,treatment,the development of a vaccine,and environmental surveillance.María B Pisano Cecilia G Giadans Diego M Flichman Viviana E Ré María V Preciado Pamela Valva 2021World Journal of Gastroenterology2021,27,26:8
14固定低剂量三联抗高血压药物与常规治疗对斯里兰卡轻度至中度高血压患者血压控制的疗效差异:一项随机临床试验显示文摘控制不良的高血压是全球领先的公共卫生问题,需要新的治疗策略。该研究评估低剂量三联抗高血压药物治疗是否能达到比常规治疗更好的血压控制。研究者纳入2016年2月至2017年5月在斯里兰卡11所城市医院诊所就诊的需要开始抗高血压治疗(未治疗的患者)或接受单药治疗的患者,进行低剂量三联降压与常规治疗比较的随机、开放性试验,随访至2017年10月。Web-ster R Salam A de Silva HA Selak V Stepien S Rajapakse S Amarasekara S Amarasena N Billot L de Silva AP Fernando M Guggilla R Jan S Jayawardena J Maulik PK Mendis S Munasinghe J Naik N Prabhakaran D Ranasinghe G Thom S Tisserra N Senaratne V Wijekoon S Wijeyasingam S Rodgers A Patel A 刘莉 叶鹏 2018中华高血压杂志2018,26,12:7
15Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy显示文摘AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 patients with periampullary tumors that were surgically resected at our department between March 2005and October 2012.A cephalic duodenopancreatectomy (DP)was performed on all patients.Two closed suction drains were placed at the end of the surgery.The highest postoperative DFA value was recorded and analyzed during the first three postoperative days and on subsequent days if the drains were kept longer.Pancreatic fistula(PF)was classified according to the International Study Group of Pancreatic Fistula(ISGPF)criteria.Postoperative complications were defined according to the Dindo-Clavien classification.All data were statistically analyzed.The optimal thresholds of DFA levels on the first,second and third postoperative days were estimated by constructing receiver operating curves,generated by calculating the sensitivities and specificities of the DFA levels.The DFA level limits were used to differentiate between the group without PF and the groups with biochemical pancreatic fistula(BPF)and CRPF.RESULTS:Pylorus-preserving duodenopancreatectomy was performed on 289(75.6%)patients,while the remaining patients underwent a classic Whipple procedure(CW).The total incidence of PF was 37.7%(grade A22.8%,grade B 11.0%and grade C 3.9%).Soft pancreatic texture(SPT)was present in 58.3%of patients who developed PF.Mortality was 4.2%.The median DFA value on the first postoperative day(DFA1)in patients who developed PF was 4520 U/L(range 350-99000 U/L)for grade A fistula(BPF)with a SPT and a diameter of the main pancreatic duct(MPD)of≤3 mm.For grade B/C(CRPF),the median DFA1 value was 8501 U/L(range377-92060 U/L)with a SPT and MPD of≤3 mm.These values were significantly higher when compared to the patients who did not have PF(122;range 5-37875 U/L).The upper limit of DFA values for the first 3 postoperative days in the examined stages of PF were:DFA1 1200U/L for the BPF and CRPF;DFA3 350 U/L for BPF and DFA3 800 U/L for CRPF.The determined values were highly significant and demonstrated a reliable diagnostic test for both BPF and CRPF.CONCLUSION:DFA1≥1200 U/L is an important predictive factor for PF of any degree.The trend of DFA3(decrease of<50%)compared to DFA1 is a significant factor in the differentiation of CRPF from transient BPF.Vladimir D Dugalic Djordje M Knezevic Vladan N Obradovic Miroslava G Gojnic-Dugalic Slavko V Matic Aleksandra R Pavlovic-Markovic Predrag D Dugalic Srbislav M Knezevic 2014World Journal of Gastroenterology2014,20,26:7
16Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy显示文摘Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.Vyacheslav I Egorov Roman V Petrov Michail V Lozhkin Olga A Maynovskaya Natalia S Starostina Natalia R Chernaya Ekaterina M Filippova 2013World Journal of Gastrointestinal Surgery2013,5,3:7
17一种miRNA标记在胶质瘤侵袭性表型的确定与预后评估中的价值(英文)显示文摘Gliomas represent a disparate group of tumours for which there are to date no cure. Thus,there is a recognized need for new diagnostic and therapeutic approaches based on increased understanding of their molecular nature. We performed the comparison of the microRNA( miRNA) profile of 8 WHO grade II gliomas and 24 higher grade tumours( 2 WHO grade III and 22 glioblastomas) by using the Affymetrix Gene Chip miRNA Array v. 1. 0. A relative quantification method( RT-q PCR) with standard curve was used to confirm the 22 miRNA signature resulted by array analysis. The prognostic performances of the confirmed miRNAs were estimated on the Tumor Cancer Genome Atlas( TCGA) datasets. We identified 22 miRNAs distinguishing grade II gliomas from higher grade tumours.RT-q PCR confirmed the differential expression in the two patients' groups for 13 out of the 22 miRNAs. The analysis of the Glioblastoma Multiforme( GBM) and Lower Grade Glioma( LGG) datasets from TCGA demonstrated the association with prognosis for 6 of those miRNAs. Moreover,in the GBM dataset miR-21 and miR-210 were predictors of worse prognosis in both univariable and multivariable Cox regression analyses( HR 1. 19,P = 0. 04,and HR 1. 18,P = 0. 029 respectively). Our results support a direct contribution of miRNAs to glioma cancerogenesis and suggest that miR-21 and miR-210 may play a role in the aggressive clinical behaviour of glioblastomas.Barbano R Palumbo O Pasculli B Galasso M Volinia S D'Angelo V Icolaro N Coco M Dimitri L Graziano P Copetti M Valori VM Maiello E Carella M Fazio VM Parrella P 2014中华神经外科疾病研究杂志2014,13,5:6
18Transcranial direct current stimulation in psychiatric disorders显示文摘The interest in non-invasive brain stimulation techniques is increasing in recent years. Among these techniques, transcranial direct current stimulation(t DCS) has been the subject of great interest among researchers because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in the field. This interest has generated several studies and randomized clinical trials, particularly in psychiatry. In this review, we provide a summary of the development of the technique and its mechanism of action as well as a review of the methodological aspects of randomized clinical trials in psychiatry, including studies in affective disorders, schizophrenia, obsessive compulsive disorder, child psychiatry and substance use disorder. Finally,we provide an overview of t DCS use in cognitive enhancement as well as a discussion regarding its clinical use and regulatory and ethical issues. Although many promising results regarding t DCS efficacy were described, the total number of studies is still low, highlighting the need of further studies aiming to replicate these findings in larger samples as to provide a definite picture regarding t DCS efficacy in psychiatry.Gabriel Tortella Roberta Casati Luana V M Aparicio Antonio Mantovani Natasha Senco Giordano D’Urso Jerome Brunelin Fabiana Guarienti Priscila Mara Lorencini Selingardi Débora Muszkat Bernardo de Sampaio Pereira Junior Leandro Valiengo Adriano H Moffa Marcel Simis Lucas Borrione André R Brunoni 2015World Journal of Psychiatry2015,5,1:6
19Focus on the gut-brain axis: multiple sclerosis, the intestinal barrier and the microbiome显示文摘The brain-gut axis serves as the bidirectional connection between the gut microbiome, the intestinal barrier and the immune system that might be relevant for the pathophysiology of inflammatory demyelinating diseases. People with multiple sclerosis have been shown to have an altered microbiome, increased intestinal permeability and changes in bile acid metabolism. Experimental evidence suggests that these changes can lead to profound alterations of peripheral and central nervous system immune regulation. Besides being of pathophysiological interest, the brain-gut axis could also open new avenues of therapeutic targets. Modification of the microbiome, the use of probiotics, fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers are all promising candidates. Hopefully, pre-clinical studies and clinical trials will soon yield significant results.Carlos R Camara-Lemarroy Luanne M Metz V Wee Yong 2018World Journal of Gastroenterology2018,24,37:6
20血管紧张素Ⅱ2型受体的基因多态性(+1675G/A)对已接受治疗高血压患者的左心室肥大和左心室构型的作用显示文摘已有报道显示血管紧张素Ⅱ2型受体的基因多态性(AGTR2+1675G/A)与左心室肥大(left ventric-ular hypertrophy,LVH)相关。研究者检验这种基因多态性是否影响已按高血压治疗指南治疗的原发性高血压和心血管疾病患者的LVH和左心室构型参数。张玲玉 叶鹏 Huber M V ller H Jakob S Reibis R Do V Bol-brinker J Zergibel I Schmieder RE Treszl A Wegscheider K Kreutz R 2010中华高血压杂志2010,18,12:6
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