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| 1 | 钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南显示文摘临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生率、终末期肾病或肾衰竭的发生率(中等至高等质量的证据)。在不同的亚组中这些药物对卒中、因心力衰竭所致住院和其他主要不良事件有不同的影响。药物绝对获益的程度因患者个体风险的不同有很大的差异。(例如,对于接受了超过5年药物治疗的1000例患者,在最低风险人群中死亡人数减少了5人,在最高风险人群中死亡人数减少了48人)。一项关于预后的综述确认了14种风险预测模型,其中一种(RECODe)在证据总结中报告了大部分基线风险评估数据,小组利用该模型以支持风险分层的建议。考虑到患者的价值观及个体差异,指南推荐的支撑证据包括一项对已发表论文的系统综述、一项患者焦点小组研究、一项临床问题总结,以及一项指南调查。指南解读我们依据不同的CVD和CKD风险水平,综合考虑获益、风险和其他因素的平衡,以及每一个风险组别的实际问题,来对推荐意见进行分层。本指南强烈建议CVD和CKD患者使用SGLT-2抑制剂治疗,这说明专家组认为其具有显著的获益。而对于其他成人2型糖尿病患者,推荐等级较弱,这说明专家组想要在获益、风险及治疗花费上取得一个更好的平衡。临床医生通过该指南可以使用可靠的风险计算模型,如RECODe,来明确其患者的个体心血管和肾脏疾病风险。医患交互式总结临床证据和制订决策有助于患者知晓治疗选择,包括进行共同决策。2型糖尿病人群(全球患病率不断增长1-2)正面临着不断增加的心血管疾病、肾脏病和其他并发症的风险3。数十年来,2型糖尿病的管理始终以控制血糖及糖化血红蛋白(HbA1c)为治疗目标4-5,但是,最近的高质量随机对照研究已经对这种以血糖为中心的治疗模式发起了挑战。研究结果显示,强化血糖控制未必会降低大血管不良事件,它还可能带来不利影响监管机构现在要求新型糖尿病药物必须证明其具有心血管和肾脏获益才能获得批准。对两类新药--钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂(见框图1)的临床试验结果显示,在现有治疗方案(常规治疗)之上加用这些药物,对死亡、心肌梗死、卒中、心力衰竭和肾脏的结局(如进展为终末期肾病)都有获益8-12。 | Sheyu Li Per Olav Vandvik Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer Rene Rodriguez-Gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David J Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand Jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren Emma Jane Cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 无 郭鹤鸣(译) | 2021 | 英国医学杂志中文版2021，24，9： | 7 |
| 2 | Randomized trial in malignant biliary obstruction:Plastic vs partially covered metal stents显示文摘AIM:To compare efficacy and complications of par-tially covered self-expandable metal stent(pcSEMS)to plastic stent(PS)in patients treated for malignant,infrahilar biliary obstruction.METHODS:Multicenter prospective randomized clinical trial with treatment allocation to a pcWallstent(SEMS)or a 10 French PS.Palliative patients aged≥18,for infrahilar malignant biliary obstruction and a Karnofsky performance scale index>60%from 6 participating North American university centers.Primary endpoint was time to stent failure,with secondary outcomes of death,adverse events,Karnofsky performance score and short-form-36 scale administered on a three-monthly basis for up to 2 years.Survival analyses were performed for stent failure and death,with Cox proportional hazards regression models to determine significant predictive characteristics.RESULTS:Eighty-five patients were accrued over 37mo,42 were randomized to the SEMS group and 83patients were available for analyses.Time to stent failure was 385.3±52.5 d in the SEMS and 153.3±19.8 d in the PS group,P=0.006.Time to death did not differ between groups(192.3±23.4 d for SEMS vs211.5±28.0 d for PS,P=0.70).The only significant predictor was treatment allocation,relating to the time to stent failure(P=0.01).Amongst other measured outcomes,only cholangitis differed,being more common in the PS group(4.9%vs 24.5%,P=0.029).The small number of patients in follow-up limits longitudinal assessments of performance and quality of life.From an initially planned 120 patients,only 85 patients were recruited.CONCLUSION:Partially covered SEMS result in a longer duration till stent failure without increased complication rates,yet without accompanying measurable benefits in survival,performance,or quality of life. | Peter L Moses Khalid M AlNaamani Alan N Barkun Stuart R Gordon Roger D Mitty M Stanley Branch Thomas E Kowalski Myriam Martel Viviane Adam | 2013 | World Journal of Gastroenterology2013，19，46： | 6 |
| 3 | Methane Emissions from Grazing Holstein-Friesian Heifers at Different Ages Estimated Using the Sulfur Hexafluoride Tracer Technique显示文摘动物和日粮因素对牛肠道甲烷排放量影响的相关研究已经很普遍,但是关于放牧青年奶牛的甲烷排放量的可参考数据较少。本研究评估了荷斯坦奶牛在多年生黑麦草草地放牧时的生理状态对甲烷排放量的影响,分别进行了以下两个试验:试验1从2011年5月开始,为期11个星期,试验2从2011年8月开始,为期10个星期。在每个试验中,将荷斯坦奶牛分成三个处理组(每组12头),分别由小牛犊、一岁的母牛犊和妊娠母牛组成(平均年龄分别为8.5、14.5和20.5月龄)。在每个试验的最后一个星期利用六氟化硫示踪技术预估每头牛的甲烷排放量。干物质摄入量由代谢能需要量除以牧草中的代谢能含量计算而得。正如预期一样,活体重随年龄的增加而增加(P<0.001),然而试验1中三个分组的体增重没有差异,试验2中的体增重随着年龄增加有不同程度的减少(P<0.001)。在试验1中,妊娠母牛高于小牛犊的甲烷排放量(P<0.001),而一岁母牛犊的甲烷排放量最高(g·d^(-1))。当用单位活体重、干物质摄入量和总能摄入量表示甲烷排放量时,一岁母牛犊比小牛犊和妊娠母牛的排放速率更高(P<0.001)。在试验2中,甲烷排放量(g·d^(-1))随着年龄增加呈线性上升(P<0.001),但是这种差异在一岁母牛犊和妊娠母牛中并不显著。妊娠母牛的甲烷/活体重的比值低于另外两组(P<0.001),小牛犊的总能摄入量中甲烷能量输出的比值低于一岁母牛犊和妊娠母牛(P<0.05)。根据所有数据建立甲烷排放量的预测方程。所有关系均为显著(P<0.001),R2值的分布范围为0.630~0.682。这些模型表明:每增加1 kg活体重,甲烷排放量增加0.252 g·d^(-1);每增加1 kg·d^(-1)干物质摄入量,甲烷排放量增加14.9 g·d^(-1);每增加1 MJ·d^(-1)总能摄入量,甲烷能量输出增加0.046 MJ·d^(-1)。当实际甲烷排放量不可测时,这些结果为我们提供了预估放牧母牛甲烷排放量的另一种方法。 | Steven J. Morrisonn Judith McBride Alan W. Gordon Alastair R. G. Wylie Tianhai Yan | 2017 | Engineering2017，3，5： | 4 |
| 4 | Increased catabolism and decreased unsaturation of ganglioside in patients with inflammatory bowel disease显示文摘AIM: To investigate whether accelerated catabolism of ganglioside and decreased ganglioside content contribute to the etiology of pro-inflammatory intestinal disease. METHODS: Intestinal mucosa from terminal ileum or colon was obtained from patients with ulcerative colitis or inflammatory Crohn's disease(n = 11) undergoing bowel resection and compared to control samples of normal intestine from patients with benign colon polyps(n = 6) and colorectal cancer(n = 12) in this observational case-control study. Gangliosides and phospholipids of intestinal mucosa were characterized by class and ceramide or fatty acid composition using liquid chromatography triple-quad mass spectrometry. Content and composition of ganglioside classes GM1, GM3, GD3, GD1 a, GT1 and GT3 were compared among subject groups. Content and composition of phospholipid classes phosphatidylcholine(PC) and phosphatidylethanolamine were compared among subject groups. Unsaturation index of individual ganglioside and phospholipid classes was computed and compared among subject groups. Ganglioside catabolism enzymes beta-hexosaminidase A(HEXA) and sialidase-3(NEU3) were measured in intestinal mucosa using western blot and compared among subject groups. RESULTS: Relative GM3 ganglioside content was 2-fold higher(P < 0.05) in intestine from patients with inflammatory bowel disease(IBD) compared to control intestine. The quantity of GM3 and ratio of GM3/GD3 was also higher in IBD intestine than control tissue(P < 0.05). Control intestine exhibited 3-fold higher(P < 0.01) relative GD1 a ganglioside content than IBD intestine. GD3 and GD1 a species of ganglioside containing three unsaturated bonds were present in control intestine, but were not detected in IBD intestine. The relative content of PC containing more than two unsaturated bonds was 30% lower in IBD intestine than control intestine(P < 0.05). The relative content of HEXA in IBD intestine was increased 1.7-fold(P < 0.05) and NEU3 was increased 8.3-fold(P < 0.01) compared to normal intestine. Intestinal mucosa in IBD is characterized by increased GM3 content, decreased GD1 a, and a reduction in polyunsaturated fatty acid constituents in GD3, GD1 a and PC.CONCLUSION: This study suggests a new paradigm by proposing that IBD occurs as a consequence of increased metabolism of specific gangliosides. | John J Miklavcic Glen K Shoemaker Vera C Mazurak M Tom Clandinin Tasha DL Hart Kareena L Schnabl Gordon M Lees Bodil MK Larsen Oliver F Bathe Alan BR Thomson M Tom Clandinin | 2015 | World Journal of Gastroenterology2015，21，35： | 3 |
| 5 | 艺术的扩张旧金山现代博物馆扩建项目显示文摘自成立的25年以来,Sn(o)hetta建筑事务所一直致力于大型公共文化空间的设计开发,它们坚持跨学科的设计实践理念,将建筑和周围景观进行融合式设计.2016年5月14日开馆的旧金山当代艺术博物馆(SFMOMA)扩建项目是他们最新的设计力作. | violet(编译) Craig Dykers Aaron Dorf Lara Kauiman Jon McNeal Simon Ewings Alan Gordon Marianne Lau Elaine Molinar Kjetil Traedal Thorsen Nick Anderson Behrang Behin Sam Brisette Chad Carpenter Michael Cotton Aroussiak Gabrielian Kyle Johnson Nick Koster Mario Mohan Neda Mostafavi Anne-Rachel Schiffmann Carrie Tsang Giancarlo Valle Henrik Kam(摄影) Iwan Baan(摄影) 无 | 2016 | 室内设计与装修2016，0，7： | 2 |
| 6 | Modeling of the wind turbine with a doubly fed induction generator for grid integration studies显示文摘 | Lei Yazhou Mullane Alan Lightbody Gordon | | 0，，01： | 1 |
| 7 | Effects of Short-Term Treatment of Hyperlipidemia on Coronary Vasodilator Function and Myocardial Perfusion in Regions Having Substantial Impairment of Baseline Dilator Reverse显示文摘 | Gordon S. Huggins Richard C. Pasternak Nathaniel M. Alpert Alan J. Fischman Henry Gewirtz | 1998 | Circulation1998，，13： | 1 |
| 8 | Complementarities and Spillovers in Mergers: an Empirical Investigation Using Patent Data显示文摘 | Alan C M Gordon C R | 2011 | Eco- nomics of Innovation and New Technology2011，20，3： | 1 |
| 9 | Modeling of the wind turbine with a doubly fed induction generator for grid integration studies显示文摘 | YAZHOU LEI ALAN Mullane GORDON LIGHTBODY | 2006 | IEEE Transactions on Energy Conversion2006，21，1： | 1 |
| 10 | Modeling of the wind turbine with a doubly fed induction generator for grid integration studies 显示文摘 | Lei Yazhou Mullane Alan Lightbody Gordon | 2006 | IEEE Trans on Energy Conversion2006，21，1： | 1 |
| 11 | Ionic liquid crystals:hexafluorophosphate salts显示文摘 | Charles M Gordon John D Holbrey Alan R Kennedy | | 0，，12： | 1 |
| 12 | Phase III trial of induction gemcitabine or paclitaxel plus carboplatin followed by paclitaxel consolidation in ovarian cancer显示文摘 | Alan N. Gordon Michael Teneriello Mike F. Janicek Jeffrey Hines Peter C. Lim M. Dwight Chen Luis Vaccarello Howard D. Homesley Scott McMeekin Tiana L. Burkholder Yanping Wang Luping Zhao Mauro Orlando Coleman K. Obasaju John F. Gill Datchen F. Tai | 2011 | Gynecologic Oncology2011，，3： | 1 |
| 13 | Perceived earnings functions and ex ante rates of return to post compulsory education in England显示文摘 | Gareth Williams Alan Gordon | 1981 | Higher Education1981，，2： | 1 |
| 14 | Modeling of the wind turbine with a doubly fed induction generator for grid integration studies显示文摘 | Lei Yazhou Mullane Alan Lightbody Gordon | 2006 | IEEE Transactions on Energy Conversion2006，21，1： | 1 |
| 15 | Early changes in CA125 after treatment with pegylated liposomal doxorubicin or topotecan do not always reflect best response in recurrent ovarian cancer patients显示文摘 | Robert L Coleman Alan Gordon | 2007 | Oncologist2007，12，1： | 1 |
| 16 | Modeling of the wind turbine with a doubly fed induction gen- erator for grid integration studies 显示文摘 | Lei Ya-zhou Alan Mullane Gordon Lightbody | 2006 | IEEE Transactions on Energy Conversion2006，21，1： | 1 |
| 17 | Guidelines of care for the management of psoriasis and psoriatic arthritis显示文摘 | Alan Menter Neil J. Korman Craig A. Elmets Steven R. Feldman Joel M. Gelfand Kenneth B. Gordon Alice Gottlieb John Y.M. Koo Mark Lebwohl Henry W. Lim Abby S. Van Voorhees Karl R. Beutner Reva Bhushan | 2009 | Journal of the American Academy of Dermatology2009，，4： | 1 |
| 18 | Windturbine fault ride-through enhancement显示文摘 | Gordon Lightbody R Yacamini | 2005 | IEEE Trans on Power Systems2005，20，4： | 1 |
| 19 | Slips of the tongue in the London-Lund corpus of spontaneous conversation显示文摘 | ALAN GARNHAM RICHARD C. SHILLCOCK GORDON D. A. BROWN ANDREW I. D. MILL ANNE CUTLER | 2009 | 2009 (7-8)2009，，7： | 1 |
| 20 | Molecular flexibility of citrus pectins by combined sedimentation and viscosity analysis显示文摘 | Gordon A. Morris José García de al Torre Alvaro Ortega Jonathan Castile Alan Smith Stephen E. Harding | 2007 | Food Hydrocolloids2007，，8： | 1 |
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