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1最新AD研究用诊断标准:IWG-2标准显示文摘在过去的8年中,国际工作组织(IWG)和美国国立老化研究院-阿尔茨海默协会(NIA-AA)建立了阿尔茨海默病(AD)诊断标准,它能更好地定义AD的临床表型,整合了生物标记物于诊断流程中,并覆盖了疾病的全程。本意见书充分地权衡了IWG标准的优缺点,建议改进诊断框架。依据这些改进,AD的诊断变得简单,只要有恰当的AD临床表型(典型或不典型)和与AD的病理相一致的病理生理学生物标志物出现。我们认为疾病的下游的定位性生物标志,如容积性磁共振成像(MRI)和氟脱氧葡萄糖-正电子发射型计算机断层成像(FDG-PET)等,适合更好地测量和监测疾病过程。本文还详述了非典型性AD、混合性AD和AD临床前期的特异诊断标准。陈刚 曹雯炜 俞羚 糜建华 Dubois B Feldman HH Jacova C Hampel H Molinuevo JL Blennow K DeK osky ST Gauthier S Selkoe D Bateman R Cappa S Crutch S Engelborghs S Frisoni GB Fox NC Galasko D Habert MO Jicha GA Nordberg A Pasquier F Rabinovici G Robert P Rowe C Salloway S Sarazin M Epelbaum S de Souza LC Vellas B Visser PJ Schneider L Stern Y Scheltens P Cummings JL 2014神经病学与神经康复学杂志2014,11,3:31
2中国花生核心种质的建立及与ICRISAT花生微核心种质的比较显示文摘以中国花生种质资源数据库中记录的6390份花生资源为材料,以其基本数据、特征数据和评价数据为信息,采用分层分组聚类以及随机取样与必选资源相结合的方法,构建了由576份资源组成的花生核心种质,占基础收集品的9.01%。除出仁率外,核心种质与基础收集品种间的其他14个性状平均值和多样性指数差异均不明显,表明本研究建立的核心种质是有效的。与ICRISAT花生微核心种质的比较,中国花生资源在龙生型和珍珠豆型方面具有优势,叶片长、叶片宽、种子长、种子宽的遗传多样性丰富;而ICRISAT花生资源在多粒型和普通型方面具有优势,且植株高度和总分枝数的遗传多样性比中国花生资源丰富。姜慧芳 任小平 廖伯寿 黄家权 雷永 陈本银 GUO B Z HOLBROOK C C UPADHYAYA H D 2008作物学报2008,34,1:28
3Experimental obstructive jaundice alters claudin-4 expression in intestinal mucosa: Effect of bombesin and neurotensin显示文摘瞄准:调查试验性的妨碍的黄疸和外长的 bombesin 和 neurotensin (NT )(BBS ) 的影响紧密的连接(TJ ) 的表示上的管理在老鼠的肠上皮的蛋白质 claudin-4。方法:四十只男 Wistar 老鼠随机被划分成五个组:我 = 控制, II = 假冒操作, III = 胆汁管结扎(BDL ) , IV = BDL+BBS (30 microg/kg 每 d ) , V = BDL+NT (300 microg/kg 每 d ) 。在 d 的实验的结束 10,内毒素在门和大动脉的血被测量。终端回肠的织物节组织学地被检验并且免疫组织化学地为在肠上皮的 claudin-4 表示的评估。结果:妨碍的黄疸导致了重要的门和大动脉的 endotoxemia 表明的肠的障碍失败。Claudin-4 表示显著地被增加在上面在 jaundiced 老鼠的第三根绒毛并且一起来它的侧面的分发的规定被注意。BBS 或 NT 的管理恢复了 claudin-4 表示到控制状态并且显著地减少了门和大动脉的 endotoxemia。结论:在肠上皮的试验性的妨碍的黄疸增加 claudin-4 表示,它可以是贡献粘膜障碍的混乱的一个关键因素。毁坏规章的肽 BBS, NT 能阻止这扇改变和还原剂门和全身的 endotoxemia。Stelios F Assimakopoulos Constantine E Vagianos Aristides S Charonis Ilias H Alexandris Iris Spiliopoulou Konstantinos C Thomopoulos Vassiliki N Nikolopoulou Chrisoula D Scopa 2006World Journal of Gastroenterology2006,12,21:21
4世界卫生组织(WHO)造血与淋巴组织肿瘤分类方案:临床顾问委员会会议报告显示文摘引言 :从 1995年开始 ,欧洲病理学工作者协会和血液病理学会一直致力于制定一个新的世界卫生组织 (WHO)血液恶性肿瘤分类方案 ,该分类方案包括淋巴系肿瘤、髓系肿瘤、组织细胞肿瘤和肥大细胞肿瘤。 材料与方法 :此项 WHO计划共组成十个病理学工作者委员会 ,负责确定病种和作出定义。另外还成立一个由国际血液学家和肿瘤学家组成的临床顾问委员会 (CAC)以保证该分类的临床实用性。 1997年 11月召开会议讨论了与该分类有关的临床问题。 结果 :WHO采纳了 1994年国际淋巴瘤研究组 (IL SG)报告的修订欧美淋巴系肿瘤分类 (REAL)方案作为淋巴系肿瘤的分类方案。该方案的分类方法遵循以下原则 :分类应是联合应用形态学、免疫表型、遗传特征及临床特征能够清楚界定的“真实存在”(“real”)病种的名录 ,上述各项特征的相对重要性因病种不同而异 ,不存在任何“金标准”。 WHO将 REAL分类原则延用于髓系肿瘤和组织细胞肿瘤 ,髓系肿瘤的分类包括联合应用细胞形态学和细胞遗传学异常能够界定的各个病种。围绕一系列临床问题召集的这次 CAC会议 ,就提交的大多数问题达成共识 ,这些问题及共识将详述于下。对于另外一些问题 ,CAC认为淋巴系肿瘤临床分组既无必要也不必需 ,患者的治疗取决于淋巴瘤的具体类型 ,如有?N L Harris E S Jaffe J Diebold G Flandrin H K Muller-Hermelink J Vardiman T A Lister C D Bloomfield 张凤奎 郝玉书 2001白血病.淋巴瘤2001,10,3:20
5延胡索酸水合酶缺陷型肾细胞癌32例临床病理和分子分析显示文摘延胡索酸水合酶缺陷型肾细胞癌属于罕见的、新近发现的与遗传性平滑肌瘤病和肾细胞癌综合征相关的肿瘤实体。延胡索酸水合酶缺陷型肾细胞癌可表现出多种临床和病理学表现,但通常表现为局部进展和转移性疾病,预后较差。作者通过延胡索酸水合酶免疫组化和(或)延胡索酸水合酶突变分析确定32例延胡索酸水合酶缺陷型肾细胞癌,并对其临床和病理特征进行回顾性分析。Lau H D Chan E Fan A C 魏建国(摘译) 方三高(审校) 2020临床与实验病理学杂志2020,36,3:19
6血管性认知障碍的诊断标准:国际血管性行为与认知障碍学会的申明显示文摘长期以来,脑血管病(CVD)就被认为是认知损害的一个重要原因,但是有关脑血管病后认知障碍的概念化却有着一段多变的历史。'动脉变硬'或脑的动脉粥样硬化是'老化'的原因,是存在已久的观点,在20世纪60年代受到了来自英格兰纽卡斯尔的神经病理学研究的质疑。这些研究表明,血管性痴呆(vascular dementia,Va D)与超过一定程度的多发性脑梗死有关。徐岩 郭起浩 Sachdev P Kalaria R O'Brien J Skoog I Alladi S Black SE Blacker D Blazer DG Chen C Chui H Ganguli M Jellinger K Jeste DV Pasquier F Paulsen J Prins N Rockwood K Roman G Scheltens P 2014神经病学与神经康复学杂志2014,11,3:19
7Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: A systematic review and meta analysis显示文摘AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model). RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall's tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.Srinivas R Puli Nikhil Kalva Matthew L Bechtold Smitha R Pamulaparthy Micheal D Cashman Norman C Estes Richard H Pearl Fritz-Henry Volmar Sonu Dillon Michael F Shekleton David Forcione 2013World Journal of Gastroenterology2013,19,23:14
8内脏脂肪组织通过产生骨桥蛋白调控成纤维细胞衰老促进心脏衰老显示文摘老化通过增加包括骨桥蛋白(osteopontin,OPN)在内的细胞外基质(extracellular matrix,ECM)蛋白的沉积引起心脏结构和功能改变进而导致进行性间质纤维化。虽然已知OPN参与各种病理状况,但其在心肌衰老中的作用仍不清楚。Sawaki D Czibik G Pini M Ternacle J Suffee N Mercedes R Marcelin G Surenaud M Marcos E Gual P Clément K Hue S Adnot S Hatem SN Tsuchimochi I Yoshimitsu T Hénégar C Derumeaux G 刘青 叶鹏 2018中华高血压杂志2018,26,3:14
9国际胃袖状切除专家共识:基于>12000手术病例的最佳操作指南显示文摘腹腔镜胃袖状切除术(1aparoscopic sleeve gastrectomy,LSG)系相对较新的减重手术方式。因其操作相对简单、治疗肥胖合并疾病及减重效果明显,逐步得以广泛接受。目前美国代谢与减重手术协会将其推荐为肥胖症治疗的单独标准术式。2011年3月25~26日,苏远涛 徐安安 朱江帆 Diaz AA Arvidsson D Baker RS Basso N Bellanger D Boza C El Mourad H France M Gagner M Galvao-Neto M Higa KD Himpens J Hutchinson CM Jacobs M Jorgensen JO Jossart G Lakdawala M Nguyen NT Nocca D Prager G Pomp A Ramos AC Rosenthal RJ Shah S Vix M Wittgrove A Zundel N 2013中国微创外科杂志2013,13,9:12
10非胰岛素依赖型糖尿病冠状动脉疾病的危险因素:英国糖尿病前瞻性研究(UKPDS:23)显示文摘目的:评价2型糖尿病患者冠状动脉疾病的基线危险因素。设计:对2 693例资料完整的患者进行年龄和性别调整的逐步选择过程分析,以确定哪些冠状动脉疾病的危险因素应纳入 Cox 比例风险模型。对象:3 055例白人患者,平均年龄52岁,均新近诊断为2型糖尿病,且无动脉粥样硬化相关疾病的证据。平均随访期7.9年。335例患者于10年内出现冠状动脉疾病。结局评定:具有明确异常心电图的心绞痛、致死或非致死性心肌梗塞。结果:冠状动脉疾病与低密度脂蛋白胆固醇浓度升高、高密度脂蛋白胆固醇浓度降低、甘油三酯浓度升高、高血红蛋白 A_(1c)、高收缩压、高空腹血糖以及吸烟史密切相关。低密度脂蛋白胆固醇较高1/3对较低1/3区间的估计风险比为2.26(95%可信区间为1.70~3.00),高密度脂蛋白胆固醇为0.55(0.41~0.73),血红蛋白 A_(1c)为1.52(1.15~2.01),收缩压为1.82(1.34~2.47)。吸烟者的估计风险比为1.41(1.06~1.88)。结论:2型糖尿病患者中,存在冠状动脉疾病潜在的、可变的5种危险因素的交叉重叠影响。它们是低密度脂蛋白胆固醇浓度升高、高密度脂蛋白胆固醇浓度降低、高血压、高血糖和吸烟。R C Turner H Millns H A W Neil I M Stratton S E Manley D R Matthews R R Holman 赵维纲 1998英国医学杂志中文版1998,0,3:11
11蛋白酶激活受体2在载脂蛋白E缺陷小鼠的血管炎症和动脉粥样硬化中发挥关键作用显示文摘凝血系统与血管炎症密切相关,尽管其潜在机制仍不清楚。最近的研究结果表明,蛋白酶激活受体(protease-activated receptor,PAR)2——活化因子X(activated factor X,FXa)的主要受体之一——在血管细胞和白细胞中均有表达,这提示PAR-2可能参与炎症性疾病的发病机制。Hara T Phuong PT Fukuda D Yamaguchi K Murata C Nishimoto S Yagi S Kusunose K Yamada H Soeki T Wakatsuki T Imoto I Shimabukuro M Sata M 刘青 叶鹏 2018中华高血压杂志2018,26,6:11
12大斜度井和水平井地层评价中的经验、问题和发展方向显示文摘大斜度井和水平井(HA/HZ)测井组合的选择原则主要是指导地质导向钻井。有时(HA/HZ)井所穿过的地层或油藏某部分没有垂直评价井,只能用HA/HZ测井数据评价常规有效厚度/总厚度比、孔隙度和含水饱和度。对同一地层,HA/HZ测井响应与垂直井响应存在很大差异。研究表明,由于视倾角误差,孔隙度值偏差可达6P.u.,含水饱和度误差超过50%,大斜度井中真地层厚度偏差达到200%~300%。垂直井的常规地层评价方法不太适用于HA/HZ井地层和流体性质评价。HA/HZ井与垂直井测井响应差异的主要原因是很多测井仪器是专为探测垂直井地层而设计的,因此在HA/HZ井中,必须对解释方案进行修改,这时需考虑井眼附近地层的几何形状;测量方位;地层各向异性对电阻率、声波和核测井响应的影响;异常侵入剖面;重力引起的仪器偏心以及井眼底部聚积的岩屑。虽然井眼成像测井能有效地测量大斜度井相对地层倾角,但当井斜超过80°时地层倾角的测量仍存在很多问题。中子和密度测井响应又相当程度地受岩屑的影响。这种井的测井难度很大,将差质量测井响应与因几何形状、各向异性以及井眼影响引起的异常测井响应区分开来显得相当重要。HA/HZ井用于地质导向的定性标准测井难以满足未来地层评价的要求。许多地方不能钻垂直评价井,因此利用大位移井信息评价地层很关键。作业公司和测井服务公司必须相互协作,共同解决HA/HZ井仪器响应和数据解释问题,开发出能定量描述HA/HZ井的新仪器。Quinn R Passey H Yin C M Rendeiro D E Fitz 唐宇 王昌学 2006测井技术2006,30,1:10
13论思维和STEM教育显示文摘随着全球化的STEM教育领域的迅速发展,各国对跨学科研究以及开发更新、更深入的STEM教育的学术研究的呼声也越来越高.文章聚焦思维这个话题,首先从历史发展的视角,简要概括分析了有关思维的不同观点,包括哲学的、心理的和学科的,揭示了思维概念和研究的历史传承.但在新兴的STEM教育背景下,思维需要重新概念化.文章提出了思维是多元的观点,初步探讨了STEM融合教育的这种方式,能够为学生提供充分的机会来有效地发展多元思维模式,并对未来关于思维的研究提出了可能的新研究领域和方向.李业平 SCHOENFELD A H DISESSA A A GRAESSER A C BENSON L C ENGLISH L D DUSCHL R A 2019数学教育学报2019,0,3:10
14静脉血栓栓塞症的抗血栓治疗:美国《胸科学》杂志指南显示文摘包括深静脉血栓和肺栓塞在内的静脉血栓栓塞症是癌症患者的主要并发症,发生率为4%~20%,并且是常见的潜在致命性急症。本文介绍了美国《胸科学》杂志指南中VET的抗血栓治疗的部分内容,其以第9版《美国胸内科医师学会循证临床实践指南》中的《静脉血栓栓塞症的抗血栓治疗:抗血栓治疗和阻止血栓形成》一文为参照,基于静脉血栓栓塞症治疗的Ⅲ期试验的发表年份,对口服抗凝剂(达比加群、利伐沙班、阿哌沙班、依度沙班)进行先后阐述(但是这一排序并不是指南专家组对药剂的优劣排序),以为临床医生提供参考。Kearon C Akl EA Ornelas J Blaivas A Jimenez D Bounameaux H Huisman M King CS MorrisT Sood N Stevens SM Vintch JRE Wells P Woller SC Moores CL 本刊编辑部 2016中国全科医学2016,19,9:10
15Potent antitumor efficacy of an E1B 55kDa-deficient adenovirus carrying murine endostatin in hepatocellular carcinoma显示文摘Li G Sham J Yang J Su C Xue H Chua D Sun L Zhang Q Cui Z Wu M Qian Q 2005第二军医大学学报2005,26,11:9
16Effect of bombesin and neurotensin on gut barrier function in partially hepatectomized rats显示文摘AIM: To investigate the effect of regulatory peptides bombesin (BBS) and neurotensin (NT) on intestinal barrier function in partially hepatectomized rats.METHODS: Ninety male Wistar rats were randomly divided into five groups: Ⅰ (n = 10): controls, Ⅱ (n =20): sham operated, Ⅲ (n = 20): partial hepatectomy 70% (PHx), Ⅳ (n = 20): PHx+BBS (30 μg/kg/d), Ⅴ (n= 20): PHx+NT (300 μg/kg/d). Groups Ⅳ and Ⅴ were treated for 8 days before PHx and 48 h post surgery.At the end of the experiment, on day 10, intestinal barrier function was assessed by measuring endotoxin concentrations in portal and aortic blood. Tissue sections of the terminal ileum were examined histologically and villus density, mucosal thickness, mitotic activity and apoptosis in crypts were assessed. In addition, ileal mucosa was analyzed for DNA and protein content and microbiological analysis was performed in cecal contents.To estimate intestinal oxidative stress, lipid peroxidation was determined on tissue homogenates from terminal ileum.RESULTS: BBS or NT administration significantly reduced portal and systemic endotoxemia observed 48 h after partial hepatectomy. In hepatectomized rats (group Ⅲ), a trend towards induction of mucosal atrophy was observed, demonstrated by the reduction of villus density, mucosal thickness, protein content and significant reduction of DNA, while these alterations were reversed by regulatory peptides administration.This trophic effect of BBS and NT was accompanied by induction of mitoses above control levels and a significant reduction of apoptosis in intestinal crypts.Intestinal lipid peroxidation was found significantly lower in PHx group and regulatory peptides exerted an antioxidant action, further decreasing this parameter of oxidative stress. The bacterial population of E. coli and aerobic Gram (+) cocci was increased in cecal content of hepatectomized rats, while this parameter was not affected by the administration of BBS or NT.CONCLUSION: Gut regulatory peptides BBS and NT improve intestinal barrier function and reduce endotoxemia in experimental partial hepatectomy. This effect is, at least in part, mediated by their trophic,antiapoptotic, mitogenic, and antioxidant effect on the intestinal epithelium. This observation might be of potential value in patients undergoing liver resection.Stelios F Assimakopoulos Ilias H Alexandris Chrisoula D Scopa Panagiotis G Mylonas Konstantinos C Thomopoulos Christos D Georgiou Vassiliki N Nikolopoulou Constantine E Vagianos 2005World Journal of Gastroenterology2005,11,43:8
17INT-767 improves histopathological features in a dietinduced ob/ob mouse model of biopsy-confirmed nonalcoholic steatohepatitis显示文摘AIM To characterize the efficacy of the dual FXR/TGR5 receptor agonist INT-767 upon histological endpoints in a rodent model of diet-induced and biopsy-confirmed non-alcoholic steatohepatitis(NASH).METHODS The effects of INT-767 on histological features of NASH were assessed in two studies using Lep^(ob/ob)(ob/ob) NASH mice fed the AMLN diet(high fat with transfat, cholesterol and fructose). In a proof-of-conceptstudy, Lep^(ob/ob)(ob/ob) NASH mice were first dosed with INT-767(3 or 10 mg/kg for 8 wk). A second ob/ob NASH study compared INT-767(3 and 10 mg/kg) to obeticholic acid(OCA)(10 or 30 mg/kg; 16 wk). Primary histological endpoints included qualitative and quantitative assessments of NASH. Other metabolic and plasma endpoints were also assessed. A comparative assessment of INT-767 and OCA effects on drug distribution and hepatic gene expression was performed in C57 Bl/6 mice on standard chow. C57 Bl/6 mice were orally dosed with INT-767 or OCA(1-30 mg/kg) for 2 wk, and expression levels of candidate genes were assessed by RNA sequencing and tissue drug levels were measured by liquid chromatography tandem-mass spectrometry.RESULTS INT-767 dose-dependently(3 and 10 mg/kg, PO, QD, 8 wk) improved qualitative morphometric scores on steatohepatitis severity, inflammatory infiltrates and fibrosis stage. Quantitative morphometric analyses revealed that INT-767 reduced parenchymal collagen area, collagen fiber density, inflammation(assessed by Galectin-3 immunohistochemistry) and hepatocyte lipid droplet area following INT-767 treatment. In a comparative study(16 wk), the FXR agonists OCA(10 and 30 mg/kg) and INT-767(3 and 10 mg/kg) both improved NASH histopathology, with INT-767 exerting greater therapeutic potency and efficacy than OCA. Mechanistic studies suggest that both drugs accumulate similarly within the liver and ileum, however, the effects of INT-767 may be driven by enhanced hepatic, but not ileal, FXR function. CONCLUSION These findings confirm the potential utility of FXR and dual FXR/TGR5 activation as disease intervention strategies in NASH.Jonathan D Roth Michael Feigh Sanne S Veidal Louise KD Fensholdt Kristoffer T Rigbolt Henrik H Hansen Li C Chen Mathieu Petitjean Weslyn Friley Niels Vrang Jacob Jelsing Mark Young 2018World Journal of Gastroenterology2018,24,2:7
18螺内酯与可乐定作为难治性高血压第4种治疗药物的比较:难治性高血压的最佳治疗随机研究显示文摘该研究旨在通过一个多中心随机试验对作为难治性高血压患者的第4种治疗药物的螺内酯与可乐定进行比较。采用药丸计数评估药物治疗依从性。难治性高血压患者(定义为包括1种利尿剂在内的3种药物治疗12周,诊室及动态血压监测血压仍未控制)随机给予螺内酯(12.5~50 mg/d)或可乐定(0.1~0.3mg,2次/d)继续治疗12周。Krieger EM Drager LF Giorgi DMA Pereira AC Barreto-Filho JAS Nogueira AR Mill JG Lotufo PA Amodeo C Batista MC Bodanese LC Carvalho ACC Castro I Chaves H Costa EAS Feitosa GS Franco RJS Fuchs FD Guimarāes AC Jardim PC Machado CA Magalhāes ME Mion D Jr Nascimento RM Nobre F Nóbrega AC Ribeiro ALP Rodrigues-Sobrinho CR Sanjuliani AF Teixeira MDCB Krieger JE ReHOT Investigators 赵狄 练桂丽 2018中华高血压杂志2018,26,3:7
19物种分布模型在古生物学研究中的应用显示文摘物种分布模型(Species distribution models,SDMs)是基于物种的生态位要求,通过将物种已知的分布数据和对应地区的环境数据联系起来,以预测该物种在不同时间和空间下的地理分布的一种数学工具。它为地史时期生物地理分布的重建、生物生态特征的分析及生物与地球环境协同演化研究等提供了一种新的途径。此方法具有研究精度高、预测效果好及应用广泛等优点,尤其适合开展高精度的古生物地理、古生态及生物宏演化等相关研究。文章着重介绍物种分布模型的基本原理及建模流程,在此基础上以笔石种Tang yagraptus typicus Mu作为建模实例进一步说明物种分布建模的详细步骤,最后概述此方法在古生物研究中的适用性及存在的问题。张琳娜 樊隽轩 Melchin M J 陈清 Wu Shuang-ye Goldman D Mitchell C M Sheets H D 2013古生物学报2013,52,2:6
20Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup显示文摘AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye Retroscope Randomized Clinical Evaluation(TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy(SC) and Third Eye colonoscopy(TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects(51.0%),surveillance after previous polypectomy in 87(25.2%) and diagnostic workup in 82(23.8%).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to SC.Relative risk(RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92(P = 0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11(P = 0.815) for screening,3.15(P = 0.014) for surveillance,8.64(P = 0.039) for diagnostic and 3.34(P = 0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically significant.Age,bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC.Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm,respectively(P = NS).CONCLUSION:TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup,but not in screening patients(ClinicalTrials.gov Identifier:NCT01044732).Peter D Siersema Amit Rastogi Anke M Leufkens Paul A Akerman Kassem Azzouzi Richard I Rothstein Frank P Vleggaar Alessandro Repici Giacomo Rando Patrick I Okolo Olivier Dewit Ana Ignjatovic Elizabeth Odstrcil James East Pierre H Deprez Brian P Saunders Anthony N Kalloo Bradley Creel Vikas Singh Anne Marie Lennon Daniel C DeMarco 2012World Journal of Gastroenterology2012,18,26:6
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