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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 | Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease显示文摘BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity. | Nadia Mazen Hijaz Thomas Mario Attard Jennifer Marie Colombo Neil Joseph Mardis Craig Alan Friesen | 2019 | World Journal of Gastroenterology2019，25，28： | 3 |
| 4 | Pathological Changes to the Subcortical Visual System and its Relationship to Visual Hallucinations in Dementia with Lewy Bodies显示文摘Introduction Recurrent complex visual hallucinations are a core clinical feature of dementia with Lewy bodies(DLB)and are typically well-formed,often consisting of figures,such as people or animals(1)Despite the profound impact upon patients and caregivers in DLB,the aetiopathology of visual hallucinations remains largely unknown.In this article we discuss the anatomy of the human visual system,hypotheses of the genesis of visual hallucinations in DLB,and imaging and neuropathological studies that have attempted to understand visual hallucinations on a functional and anatomical basis. | Daniel Erskine John-Paul Taylor Alan Thomas Daniel Collerton Ian McKeith Ahmad Khundakar Johannes Attems Christopher Morris | 2019 | Neuroscience Bulletin2019，35，2： | 3 |
| 5 | Risk of Intestinal Cancer in Inflammatory Bowel Disease: A Population-Based Study From Olmsted County, Minnesota显示文摘 | Tine Jess Edward V. Loftus Fernando S. Velayos W. Scott Harmsen Alan R. Zinsmeister Thomas C. Smyrk Cathy D. Schleck William J. Tremaine L. Joseph Melton Pia Munkholm William J. Sandborn | 2006 | Gastroenterology2006，，4： | 3 |
| 6 | Diagnostic accuracy of tests for Helicobacter pylori in an Alaska Native population显示文摘AIM:To evaluate the accuracy of two non-invasivetests in a population of Alaska Native persons. Highrates of Helico bacter pylori(H. pylori) infection,H. pylori treatment failure,and gastric cancer in this population necessitate documentation of infection status atmultiple time points over a patient's life.METHODS:In 280 patients undergoing endoscopy,H. pylori was diagnosed by culture,histology,rapidurease test,13C urea breath test(UBT) ,and immuno-globulin G antibodies to H. pylori in serum. The performances of 13C-UBT and antibody test were compared to a gold standard defined by a positive H. pylori testby culture or,in case of a negative culture result,bypositive histology and a positive rapid urease test.RESULTS:The sensitivity and specificity of the 13C-UBT were 93% and 88%,respectively,relative to thegold standard. The antibody test had an equivalents ensitivity of 93% with a reduced specificity of 68%.The false positive results for the antibody test were as-sociated with previous treatment for an H. pylori infection [relative risk(RR) = 2.8]. High levels of antibodiesto H. pylori were associated with chronic gastritis and male gender,while high scores in the 13C-UBT testwere associated with older age and with the H. pyloribacteria load on histological examination(RR = 4.4) .CONCLUSION:The 13C-UBT out performed the anti-body test for H. pylori and could be used when a non-invasive test is clinically necessary to document treatment out come or when monitoring for reinfection. | Dana L Bruden Michael G Bruce Karen M Miernyk Julie Morris Debby Hurlburt Thomas W Hennessy Helen Peters Frank Sacco Alan J Parkinson Brian J McMahon | 2011 | World Journal of Gastroenterology2011，17，42： | 3 |
| 7 | Pulmonary radiation injury显示文摘 | Benjamin M Raffin Thomas A Epstein Alan H | 1997 | Chest1997，111，4： | 2 |
| 8 | Comparing Methods of Racial and Ethnic Disparities Measurement across Different Settings of Mental Health Care显示文摘 | BenjaminLê Cook Thomas G.McGuire KariLock Alan M.Zaslavsky | 2010 | Health Services Research2010，，3： | 2 |
| 9 | Adjusting for health status in non-linear models of health care disparities显示文摘 | Benjamin L. Cook Thomas G. McGuire Ellen Meara Alan M. Zaslavsky | 2009 | Health Services and Outcomes Research Methodology2009，，1： | 2 |
| 10 | Principles for retrofitting coal burners for oxy-combustion显示文摘 | Andrew Fry Brad Adams Alan Paschedag Paul Kazalski Casey Carney Danylo Oryshchyn Rigel Woodside Steve Gerdemann Thomas Ochs | 2011 | International Journal of Greenhouse Gas Control2011，，： | 2 |
| 11 | Epidemiology of Eosinophilic Esophagitis Over Three Decades in Olmsted County, Minnesota显示文摘 | Ganapathy A. Prasad Jeffery A. Alexander Cathy D. Schleck Alan R. Zinsmeister Thomas C. Smyrk Richard M. Elias G. Richard Locke Nicholas J. Talley | 2009 | Clinical Gastroenterology and Hepatology2009，，10： | 2 |
| 12 | The International Position on Laparoscopic Liver Surgery: The Louisville Statement, 2008显示文摘 | Joseph F. Buell Daniel Cherqui David A. Geller Nicholas O’Rourke David Iannitti Ibrahim Dagher Alan J. Koffron Mark Thomas Brice Gayet Ho Seong Han Go Wakabayashi Giulio Belli Hironori Kaneko Chen-Guo Ker Olivier Scatton Alexis Laurent Eddie K. Abdalla Pr | 2009 | Annals of Surgery2009，，3： | 2 |
| 13 | A Controlled Trial of Gluten-Free Diet in Patients With Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function显示文摘 | Maria I. Vazquez–Roque Michael Camilleri Thomas Smyrk Joseph A. Murray Eric Marietta Jessica O’Neill Paula Carlson Jesse Lamsam Denise Janzow Deborah Eckert Duane Burton Alan R. Zinsmeister | 2013 | Gastroenterology2013，，5： | 2 |
| 14 | A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation显示文摘 | Stacey J. Wieczorek Alan H.B. Wu Robert Christenson Padma Krishnaswamy Stephen Gottlieb Thomas Rosano David Hager Nancy Gardetto Albert Chiu Kathryn R. Ba illy Alan Maisel | 2002 | American Heart Journal2002，，5： | 2 |
| 15 | The International Position on Laparoscopic Liver Surgery: The Louisville Statement, 2008显示文摘 | Joseph F. Buell Daniel Cherqui David A. Geller Nicholas O'Rourke David Iannitti Ibrahim Dagher Alan J. Koffron Mark Thomas Brice Gayet Ho Seong Han Go Wakabayashi Giulio Belli Hironori Kaneko Chen-Guo Ker Olivier Scatton Alexis Laurent Eddie K. Abdalla Pr | 2009 | Annals of Surgery2009，，3： | 2 |
| 16 | Trace and minor element variations and sulfur isotopes in crystalline and coUoform ZnS: Incorporation mechanisms and implications for their genesis显示文摘 | Katharina P Alan K Thomas W | | Chemical Geology0，286，3： | 1 |
| 17 | Arterial Switch Operation: Early and Late Outcome for Intramural Coronary Arteries显示文摘 | Steven F. Thrupp Thomas L. Gentles Alan R. Kerr Kirsten Finucane | 2012 | The Annals of Thoracic Surgery2012，，6： | 1 |
| 18 | Leaching irrigated saline sandy to sandy loam apedal soils with water of a constant salinity显示文摘 | Johannes Hendrikus Bamard Leon Daniel van Rensburg Alan Thomas Peter Bennie | 2010 | Irrigation Science2010，28，2： | 1 |
| 19 | High-Density Lipoprotein: Vascular Protective Effects, Dysfunction, and Potential as Therapeutic Target显示文摘 | Thomas F. Lüscher Ulf Landmesser Arnold von Eckardstein Alan M. Fogelman | 2014 | Circulation Research2014，，1： | 1 |
| 20 | A randomized phase Ⅱ trial comparing two different sequence combinations of autologous vaccine and human recombinant interferon γ and human recombinant interferon α2b therapy in patients with metastatic renal cell carcinoma:clinical outcome and analysis of immunological parameters显示文摘 | Thomas S John A H Alan R S | 2000 | J Urology2000，163，： | 1 |
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