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1Comparative review of vertebroplasty and kyphoplasty显示文摘The aim of this review is to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain and improve functional outcome from ver-tebral fractures secondary to osteoporosis and tumor conditions. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating ver-tebral compression fractures. Nevertheless, the prac-tice of physicians treating these conditions has barely changed. The objective of this review is to try to clarify the most important issues, based on our own experi-ence and the reported evidence about both techniques, and to guide towards the most appropriate choice of treatment of vertebral fractures, although many ques-tions still remain unanswered.Ferno Ruiz Santiago Alicia Santiago Chinchilla Luis Guzmán álvarez Antonio Luis Pérez Abela Maria del Mar Castellano García Miguel Pajares López 2014World Journal of Radiology2014,6,6:30
2Diagnosis and treatment of hepatocellular carcinoma: An update显示文摘Hepatocellular carcinoma(HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium 'washout' in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and locoregional therapies(alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion's stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib.Javier Tejeda-Maldonado Ignacio García-Juárez Jonathan Aguirre-Valadez Adrián González-Aguirre Mario Vilatobá-Chapa Alejandra Armengol-Alonso Francisco Escobar-Penagos Aldo Torre Juan Francisco Sánchez-ávila Diego Luis Carrillo-Pérez 2015World Journal of Hepatology2015,7,3:22
3Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study显示文摘AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(LAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with LAM.METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and LAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed.RESULTS Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(ALT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs.Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes Martín Prieto Gloria Sánchez-Antolín Jose Luis Calleja Esther Molina María Luisa García-Buey María Angeles Blanco Javier Salmerón María Lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 2017World Journal of Gastroenterology2017,23,41:16
4Hyperthermic intraperitoneal chemotherapy:Rationale and technique显示文摘The combination of complete cytoreductive surgery and perioperative intraperitoneal chemotherapy provides the only chance for long-term survival for selected patients diagnosed with a variety of peritoneal neoplasms,either primary or secondary to digestive or gynecologic malignancy.Hyperthermic intraperitoneal chemotherapy (HIPEC) delivered in the operating room once the cytoreductive surgical procedure is fi nalized,constitutes the most common form of administration of perioperative intraperitoneal chemotherapy.This may be complemented in some instances with early postoperative intraperitoneal chemotherapy (EPIC).HIPEC combines the pharmacokinetic advantage inherent to the intracavitary delivery of certain cytotoxic drugs,which results in regional dose intensification,with the direct cytotoxic effect of hyperthermia.Hyperthermia exhibits a selective cell-killing effect in malignant cells by itself,potentiates the cytotoxic effect of certain chemotherapy agents and enhances the tissue penetration of the administered drug.The chemotherapeutic agents employed in HIPEC need to have a cell cycle nonspecific mechanism of action and should ideally show a heat-synergistic cytotoxic effect.Delivery of HIPEC requires an apparatus that heats and circulates the chemotherapeutic solution so that a stable temperature is maintained in the peritoneal cavity during the procedure.An open abdomen (Coliseum) or closed abdomen technique may be used,with no signif icant differences in eff icacy proven to date.Specif ic technical training and a solid knowledge of regional chemotherapy management are required.Concerns about safety of the procedure for operating room personnel are expected but are manageable if universal precautions and standard chemotherapy handling procedures are used.Different HIPEC drug regimens and dosages are currently in use.A tendency for concurrent intravenous chemotherapy administration (bidirectional chemotherapy,so-called 'HIPEC plus') has been observed in recent years,with the aim to further enhance the cytotoxic potential of HIPEC.Future trials to ascertain the ideal HIPEC regimen in different diseases and to evaluate the efficacy of new drugs or drug combinations in this context are warranted.Santiago González-Moreno Luis A González-Bayón Gloria Ortega-Pérez 2010World Journal of Gastrointestinal Oncology2010,2,2:15
5在有分散的胃的息肉的病人的 colorectal 息肉的风险: 盒子控制研究显示文摘 AIM:To assess the risk of colonic polyps,adenomas and advanced neoplastic lesions(ANL) in patients with sporadic gastric polyps,especially those with fundic gland polyps(FGP).METHODS:Clinical records of patients who had performed an upper and a lower digestive endoscopy between September 2007 and August 2008 were retrospectively analyzed.A case-control study was carried out,calling patients with gastric polyps as 'cases' and patients without gastric polyps as 'controls'.The risk of colonic polyps,adenomas and ANL(villous component ≥ 25%,size ≥ 10 mm,or high grade dysplasia) was assessed [odds ratio(OR) and its corresponding 95%CI].RESULTS:Two hundred and forty seven patients were analyzed:78 with gastric polyps(cases) and 169 without gastric polyps(controls).Among the cases,the majority of gastric polyps were FGP(80%,CI:69-88) and hyperplastic(20%,CI:12-31);25% had colonic polyps(25% hyperplastic and 68% adenomas,from which 45% were ANL).Among the controls,20% had colonic polyps(31% hyperplastic and 63% adenomas,from which 41% were ANL).The patients with sporadic FGP had an OR of 1.56(CI:0.80-3.04) for colonic polyps,an OR of 1.78(CI:0.82-3.84) for colonic adenomas,and an OR of 0.80(CI:0.21-2.98) for ANL.Similar results were found in patients with gastric polyps in general.CONCLUSION:The results of this study did not show more risk of colorectal adenomas or ANL neither in patients with sporadic gastric polyps nor in those with FGP.Daniel Gustavo Cimmino José Manuel Mella Pablo Luna Raquel González Lisandro Pereyra Carolina Fischer Adriana Mohaidle Beatriz Vizcaino Mario Andres Medrano Adrián Hadad Silvia Pedreira Luis Boerr 2013World Journal of Gastrointestinal Endoscopy2013,5,5:12
6Direct-fed microbes: A tool for improving the utilization of low quality roughages in ruminants显示文摘For many years, ruminant nutritionists and microbiologists have been interested in manipulating the microbial ecosystem of the rumen to improve production efficiency of different ruminant species. Removal and restriction of antibiotics subtherapeutic uses from ruminant diets has amplified interest in improving nutrient utilization and animal performance and search for more safe alternatives. Some bacterial and fungal microorganisms as a direct-fed microbial(DFM) can be the most suitable solutions. Microorganisms that are commonly used in DFM for ruminants may be classified mainly as lactic acid producing bacteria(LAB), lactic acid utilizing bacteria(LUB), or other microorganism's species like Lactobacillus, Bifidobacterium, Enterococcus, Streptococcus, Bacillus, Propionibacterium, Megasphaera elsdenii and Prevotellabryantii, in addition to some fungal species of yeast such as Saccharomyces and Aspergillus. A definitive mode of action for bacterial or fungal DFM has not been established; although a variety of mechanisms have been suggested. Bacterial DFM potentially moderate rumen conditions, and improve weight gain and feed efficiency. Fungal DFM may reduce harmful oxygen from the rumen, prevent excess lactate production, increase feed digestibility, and alter rumen fermentation patterns. DFM may also compete with and inhibit the growth of pathogens, immune system modulation, and modulate microbial balance in the gastrointestinal tract. Improved dry matter intake, milk yield, fat corrected milk yield and milk fat content were obtained with DFM administration. However, the response to DFM is not constant; depending on dosages, feeding times and frequencies, and strains of DFM. Nonetheless, recent studies have supported the positive effects of DFM on ruminant performance.Mona M Y Elghandour Abdelfattah Z M Salem Jose S Martínez Castaeda Luis M Camacho Ahmed E Kholif Juan C Vázquez Chagoyán 2015Journal of Integrative Agriculture2015,14,3:7
7Nrf2 and Snail-1 in the prevention of experimental liver fibrosis by caffeine显示文摘AIM:To determine the molecular mechanisms involved in experimental hepatic fibrosis prevention by caffeine(CFA).METHODS:Liver fibrosis was induced in Wistar rats by intraperitoneal thioacetamide or bile duct ligation and they were concomitantly treated with CFA(15 mg/kg per day).Fibrosis and inflammatory cell infiltrate were evaluated and classified by Knodell index.Inflammatory infiltrate was quantified by immunohistochemistry(anti-CD11b).Gene expression was analyzed by quantitative reverse transcription-polymerase chain reaction for collagenⅠ?(Col-1),connective tissue growth factor(CTGF),transforming growth factorβ1(TGF-β1),tumor necrosis factor alpha(TNF-α),interleukin-1(IL-1),IL-6,superoxide dismutase(SOD)and catalase(CAT).Activation of Nrf2 and Snail-1 was analyzed by Westernblot.TNF-αexpression was proved by enzyme-linked immunosorbant assay,CAT activity was performed by zymography.RESULTS:CFA treatment diminished fibrosis index in treated animals.The Knodell index showed both lower fibrosis and necroinflammation.Expression of profibrogenic genes CTGF,Col-1 and TGF-β1 and proinflammatory genes TNF-α,IL-6 and IL-1 was substantially diminished with CFA treatment with less CD11b positive areas.Significantly lower values of transcriptional factor Snail-1 were detected in CFA treated rats compared with cirrhotic rats without treatment;in contrast Nrf2was increased in the presence of CFA.Expression of SOD and CAT was greater in animals treated with CFA showing a strong correlation between mRNA expression and enzyme activity.CONCLUSION:Our results suggest that CFA inhibits the transcriptional factor Snail-1,down-regulating profibrogenic genes,and activates Nrf2 inducing antioxidant enzymes system,preventing inflammation and fibrosis.Daniela Gordillo-Bastidas Edén Oceguera-Contreras Adriana Salazar-Montes Jaime González-Cuevas Luis Daniel Hernández-Ortega Juan Armendáriz-Borunda 2013World Journal of Gastroenterology2013,19,47:7
8Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma显示文摘AIM: To compare the effect of phacoemulsification on intraocular pressure(IOP) in patients with primary open angle glaucoma(POAG) and pseudoexfoliation glaucoma(PXG). METHODS: A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens(IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12 mo postoperatively. RESULTS: The study enrolled 88 patients(88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients(P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP(postoperative changes in IOP) was evidenced between groups(P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group.CONCLUSION: In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction(20%) over a 12 mo follow-up period. The number of medications used is also significantly reduced up to 12 mo after surgery, especially in the PXG group.Jesus Jimenez-Roman Gabriel Lazcano-Gomez Karina Martínez-Baez Mauricio Turati Rosario Gulías-Canizo Luis F.Hernández-Zimbrón Lenin Ochoa-De la Paz Rubén Zamora Roberto Gonzalez-Salinas 2017International Journal of Ophthalmology(English edition)2017,10,9:7
9Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy显示文摘AIM To explore regional systolic strain of midwall and endocardial segments using speckle tracking echocardiography in patients with apical hypertrophic cardiomyopathy(HCM).METHODS We prospectively assessed 20 patients(mean age 53 ± 16 years,range:18-81 years,10 were male),with apical HCM. We measured global longitudinal peak systolic strain(GLPSS) in the midwall and endocardium of the left ventricle. RESULTS The diastolic thickness of the 4 apical segments was 16.25 ± 2.75 mm. All patients had a normal global systolicfunction with a fractional shortening of 50% ± 8%. In spite of supernormal left ventricular(LV) systolic function,midwall GLPSS was decreased in all patients,more in the apical(-7.3% ±-8.8%) than in basal segments(-15.5% ±-6.93%),while endocardial GLPPS was significantly greater and reached normal values(apical:-22.8% ±-7.8%,basal:-17.9% ±-7.5%). CONCLUSION This study shows that two-dimensional strain was decreased mainly confined to the mesocardium,while endocardium myocardial deformation was preserved in HCM and allowed to identify subclinical LV dysfunction. This transmural heterogeneity in systolic strain had not been previously described in HCM and could be explained by the distribution of myofibrillar disarray in deep myocardial areas. The clinical application of this novel finding may help further understanding of the pathophysiology of HCM.María Cristina Saccheri Tomás Francisco Cianciulli Luis Alberto Morita Ricardo JoséMéndez Martín Alejandro Beck Juan Enrique Guerra Alberto Cozzarin Luciana Jimena Puente Lorena Romina Balletti Jorge Alberto Lax 2017World Journal of Cardiology2017,9,4:7
10Recurrence of inflammatory pseudotumor in the distal bile duct: Lessons learned from a single case and reported cases显示文摘煽动性的 myofibroblastic 肿瘤(IMT ) 或煽动性的假肿瘤(IP ) 广泛地在文学被讨论了。他们通常在肺和上面的呼吸道被发现。然而,包含 biliopancreatic 区域的案例报导在最近的年增加了。限制到胰腺的头或远侧的胆汁管的这些损害的 Immunohistochemical 学习似乎与那些在称为自体免疫的胰腺炎的一个新实体观察了兼容,但是通常强烈的纤维变性反应(带状配列) 支配生产一个团。当这个条件限于胰腺的头时,胆总管可能被煽动性的过程包含,黄疸可以经常发生类似于胰的腺癌。我们以前报导了从与是一个极其稀罕的实体的自体免疫的胰腺炎联系的胆汁管产生的 IMT 的一个案例。在 Kaush-Whipple 切除术以后的四年,平淡的后续上的放射学的检查揭示了一个肿瘤团,建议本地复发。指导超声的 FNA 证实了我们的可疑诊断。作为其它,这个现在的案例建议坚持的后续是必要的以便在这个特定的地点阻止不可逆的肝损坏。EM López-Tomassetti Fernández H Díaz Luis A Martín Malagón I Arteaga González A Carrillo Pallarés 2006World Journal of Gastroenterology2006,12,24:7
11Enamel microabrasion: An overview of clinical and scientific considerations显示文摘Superficial stains and irregularities of the enamelare generally what prompt patients to seek dental intervention to improve their smile. These stains or defects may be due to hypoplasia, amelogenesis imperfecta, mineralized white spots, or fluorosis, for which enamel microabrasion is primarily indicated. Enamel microabrasion involves the use of acidic and abrasive agents, such as with 37% phosphoric acid and pumice or 6% hydrochloric acid and silica, applied to the altered enamel surface with mechanical pressure from a rubber cup coupled to a rotatory mandrel of a lowrotation micromotor. If necessary, this treatment can be safely combined with bleaching for better esthetic results. Recent studies show that microabrasion is a conservative treatment when the enamel wear is minimal and clinically imperceptible. The most important factor contributing to the success of enamel microabrasion is the depth of the defect, as deeper, opaque stains, such as those resulting from hypoplasia, cannot be resolved with microabrasion, and require a restorative approach. Surface enamel alterations that result from microabrasion, such as roughness and microhardness, are easily restored by saliva. Clinical studies support the efficacy and longevity of this safe and minimally invasive treatment. The present article presents the clinical and scientific aspects concerning the microabrasion technique, and discusses the indications for and effects of the treatment, including recent works describing microscopic and clinical evaluations.Núbia Inocencya Pavesi Pini Daniel Sundfeld-Neto Flavio Henrique Baggio Aguiar Renato Herman Sundfeld Luis Roberto Marcondes Martins José Roberto Lovadino Débora Alves Nunes Leite Lima 2015World Journal of Clinical Cases2015,3,1:6
12Conversion from calcineurin inhibitors to mTOR inhibitors stabilizes diabetic and hypertensive nephropathy after liver transplant显示文摘AIM: To investigate if conversion to the mammalian target of rapamycin inhibitors(mTORi) improves renal function in diabetic and/or hypertensive liver transplant patients immunosuppressed with tacrolimus or cyclosporine.METHODS: The study included 86 liver graft recipients immunosuppressed with mTORi treatment after orthotopic liver transplantation(OLT), including all liver recipients with worsening renal function before conversion to mTORi(n = 55 patients) and recipients with normal renal function who converted to m TORi for other reasons(n = 31 patients). We identified patients with diabetes mellitus(n = 28), arterial hypertension(n = 27), proteinuria(n = 27) and all three factors(n = 8)(some patients have hypertension and diabetes and no proteinuria). The primary endpoint was evolution in renal function defined as the development in plasma creatinine as a function of diabetes mellitus(DM), hypertension(HT) or proteinuria. We required elevated serum creatinine for at least two weeks to define renal dysfunction.RESULTS: Only patients that converted because of renal failure with plasma creatinine levels > 1.5 mg/dL showed an improvement of renal function(2.14 to 1.77 mg/dL)(P = 0.02). Patients with DM showed no improvement of serum creatinine levels(1.31 mg/dL to 1.37 mg/dL) compared with non DM patients(1.31 mg/dL to 1.15 mg/dL)(P = 0.01), HT patients(1.48 mg/dL to 1.5 mg/dL) with non HT patients(1.21mg/d L to 1.08 mg/dL) and patients with proteinuria(1.44 mg/dL to 1.41 mg/dL) and no proteinuria(1.31 mg/dL to 1.11 mg/dL). CONCLUSION: In OLT recipients with diabetes or hypertensive nephropathy, conversion to m TORi does not improve renal function but stabilizes plasma levels of creatinine. Proteinuria is not a contraindication to conversion to m TORi; it also stabilizes renal function. Conversion to m TORi should only be avoided in patients with diabetes, hypertension and proteinuria.José M álamo Claudia Olivares Lydia Barrera Luis M Marín Gonzalo Suarez Carmen Bernal Juan Serrano Jordi Muntané Francisco J Padillo Miguel A Gómez 2015World Journal of Transplantation2015,5,1:6
13Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation显示文摘AIM:To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy.METHODS:Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy.Laparoscopic surgery was planned after 5-8 wk.Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol.Patients with ypT1-2N0 or ypT3-4 or N+were offered 5-fluorouracil-based adjuvant treatment on an individual basis.An external cohort was used as a reference for the findings.RESULTS:One hundred and seventy six patients were treated with induction chemoradiotherapy and 170underwent total mesorectal excision.Cancer staging of ypT0N0 was achieved in 26/170(15.3%)patients.After a median follow-up of 58.3 mo,patients withypT0N0 had five-year disease-free and overall survival rates of 96%(95%CI:77-99)and 100%,respectively.We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation.The inherent good prognosis of these patients will have implications for clinical trial design and care of patients.CONCLUSION:Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.Xabier García-Albéniz Rosa Gallego Ralf Dieter Hofheinz Gloria Fernández-Esparrach Juan Ramón Ayuso-Colella Josep Antoni Bombí Carles Conill Miriam Cuatrecasas Salvadora Delgado Angels Ginés Rosa Miquel Mario Pagés Estela Pineda Verónica Pereira Aarón Sosa Oscar Reig Iván Victoria Luis Feliz Antonio María de Lacy Antoni Castells Iris Burkholder Andreas Hochhaus Joan Maurel 2014World Journal of Gastroenterology2014,20,42:5
14Management of oligometastatic non-small cell lung cancer patients:Current controversies and future directions显示文摘Oligometastatic non-small cell lung cancer(NSCLC)describes an intermediate stage of NSCLC between localized and widely-disseminated disease.This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology.Currently,the management of oligometastatic NSCLC involves radical treatment(radiotherapy or surgery)that targets the metastatic lesions and the primary tumor to achieve disease control.This approach offers the potential to achieve prolonged survival in patients who,in the past,would have only received palliative measures.The optimal therapeutic strategies for the different scenarios of oligometastatic disease(intracranial vs extracranial disease,synchronous vs metachronous)remain undefined.Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients,the decision to apply surgery or radiotherapy(with or without systemic treatment)must be based on prognostic factors that allow us to classify patients.This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis.In the future,the molecular or microRNA profiles will likely improve the treatment selection process.The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC,focusing on the role of radiotherapy and surgery.We also discuss areas of controversy and future directions.Felipe Counago Javier Luna Luis Leonardo Guerrero Blanca Vaquero María Cecilia Guillén-Sacoto Teresa González-Merino Begona Taboada Verónica Díaz Belén Rubio-Viqueira Ana Aurora Díaz-Gavela Francisco JoséMarcos Elia del Cerro 2019World Journal of Clinical Oncology2019,10,10:5
15Seven-year follow-up of posterior chamber phakic intraocular lens with central port design显示文摘Background:To assess the clinical outcomes of the Visian Implantable Collamer Lens(ICL)with a central port throughout 7 years of follow-up.Methods:Eighty-four eyes of 52 patients were evaluated over a follow-up period of 7 years after V4c ICL implantation.Uncorrected(UDVA)and corrected(CDVA)distance visual acuities,refraction,intraocular pressure(IOP),endothelial cell density(ECD)and vault were analysed.Results:The mean postoperative UDVA(logMAR)was 0.04±0.11,0.13±0.19 and 0.17±0.23 at 1-,5-and 7-years,respectively(P<0.0001).The mean CDVA(logMAR)remains unchanged throughout a 7-year follow-up period(0.02±0.08 and 0.02±0.08,at 5-and 7-years,respectively,P=0.2).At all follow-up visits,more than 95%of the eyes achieved a CDVA of 20/25 or better and more than 85%a CDVA of 20/20.At the end of the follow-up(7 years),no eye lost more lines of CDVA,56 eyes(66.7%)and 28 eyes(33.3%)gained lines of CDVA.At 7-years,the spherical equivalent was−0.62±0.62 D.No significant increase in IOP(>20 mmHg or an increase higher than 5 mmHg)occurred in any case throughout the 7-year of follow-up.The loss in ECD from the preoperative baseline at the last follow-up visit was 2.6%.No intraoperative or postoperative complications or adverse events occurred during the follow-up period.Conclusions:The outcomes of this study show the long-term viability of the V4c ICL implantation as a surgical option for the correction of myopia.Luis Fernández-Vega-Cueto Belén Alfonso-Bartolozzi Carlos Lisa David Madrid-Costa JoséF.Alfonso 2021Eye and Vision2021,8,1:4
16Fecal immunochemical test accuracy in average-risk colorectal cancer screening显示文摘AIM:To assess the fecal immunochemical test(FIT)accuracy for colorectal cancer(CRC)and advanced neoplasia(AN)detection in CRC screening.METHODS:We performed a multicentric,prospective,double blind study of diagnostic tests on asymptomatic average-risk individuals submitted to screening colonoscopy.Two stool samples were collected and the fecal hemoglobin concentration was determined in the first sample(FIT1)and the highest level of both samples(FITmax)using the OC-sensor.Areas under the curve(AUC)for CRC and AN were calculated.The best FIT1and FITmax cut-off values for CRC were determined.At this threshold,number needed to scope(NNS)to detect a CRC and an AN and the cost per lesion detected were calculated.RESULTS:About 779 individuals were included.An AN was found in 97(12.5%)individuals:a CRC in 5(0.6%)and an advanced adenoma(≥10 mm,villous histology or high grade dysplasia)in 92(11.9%)subjects.For CRC diagnosis,FIT1 AUC was 0.96(95%CI:0.95-0.98)and FITmax AUC was 0.95(95%CI:0.93-0.97).For AN,FIT1 and FITmax AUC were similar(0.72,95%CI:0.66-0.78 vs 0.73,95%CI:0.68-0.79,respectively,P=0.34).Depending on the number of determinations and the positivity threshold cut-off used sensitivity for AN detection ranged between 28%and 42%and specificity between 91%and 97%.At the best cut-off point for CRC detection(115 ng/mL),the NNS to detect a CRC were 10.2 and 15.8;and the cost per CRC was 1814€and 2985€on FIT1 and FITmax strategies respectively.At this threshold the sensitivity,NNS and cost per AN detected were 30%,1.76,and 306€,in FIT1 strategy,and 36%,2.26€and 426€,in FITmax strategy,respectively.CONCLUSION:Performing two tests does not improve diagnostic accuracy,but increases cost and NNS to detect a lesion.Vicent Hernandez Joaquin Cubiella M Carmen Gonzalez-Mao Felipe Iglesias Concepción Rivera M Begoa Iglesias Lucía Cid Ines Castro Luisa de Castro Pablo Vega Jose Antonio Hermo Ramiro Macenlle Alfonso Martínez-Turnes David Martínez-Ares Pamela Estevez Estela Cid M Carmen Vidal Angeles López-Martínez Elisabeth Hijona Marta Herreros-Villanueva Luis Bujanda Jose Ignacio Rodriguez-Prada the COLONPREV study investigators 2014World Journal of Gastroenterology2014,20,4:4
17Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis显示文摘Luis Ruiz-del-Arbol Jesús Urman Javier Fernández Mónica González Miguel Navasa Alberto Monescillo Agustín Albillos Wladimiro Jiménez Vicente Arroyo 2003Hepatology2003,,5:4
18Diabetic gastroenteropathy:An underdiagnosed complication显示文摘This article is an extensive review that provides an update on the pathophysiology,symptoms,diagnosis,and treatment of diabetic gastroenteropathy.There is no reported prevalence,but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%,and type 2 patients,1%.Also,in the group of type 1 diabetes,it has been observed that women are more likely to present this condition(5.8%vs 3.5%).Many factors are associate with its development(e.g.,hyperglycemia,vagal dysfunction,loss of expression of neural nitric oxide synthase in the myenteric plexus,alterations in the Cajal interstitial cell network,and oxidative stress).Gastrointestinal discomfort could be perceived 70% higher in diabetic patients,describing that 25%of diabetic patients experience gastrointestinal symptoms.Diabetic enteropathy could affect any portion of the gastrointestinal tract,but esophageal alterations were described in more than 60% of diabetic patients,also 60% of them present constipation,and 20%,diarrhea.Gastric emptying scintigraphy is useful to evaluate gastroparesis,therefore,gastric retention of more than 60%at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis;however,other studies such as breath tests,with a sensitivity of 89% and a specificity of 80%,or the endoscopic capsule contribute to the diagnosis.There is no cure;however,management must be multidisciplinary,focused on slowing the progression of diabetic gastroenteropathy,reducing symptoms,and restoring function;that includes nutritional recommendation,maintain glucose levels kept below 180 mg/dL,use of prokinetics,anti-emetics;nowadays,it has been special interest in surgical treatment,such as pyloroplasty,also gastric electrical stimulation appears to be another alternative.Marcio JoséConcepción Zavaleta Jhean Gabriel Gonzáles Yovera Diego Martín Moreno Marreros Luciana del Pilar Rafael Robles Kely Roxana Palomino Taype Karen Nohelly Soto Gálvez Luis Fernando Arriola Torres Julia Cristina Coronado Arroyo Luis Alberto Concepción Urteaga 2021World Journal of Diabetes2021,12,6:4
19Weber-Christian disease with ileocolonic involvement successfully treated with infliximab显示文摘Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneous adipose tissue the most frequent one,followed by liver,spleen,bone marrow and mesenteric adipose tissue.Systemic corticosteroids are first line treatment,but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation.We report herein a case with WCD showing orbital,mesenteric and ileocolonic involvement,which required surgical treatment and also developed postoperative recurrence.Symptoms were resolved by administration of thalidomide and,afterwards,infliximab.To our knowledge,this is the first report of Weber-Christian disease with luminal ileocolonic involvement,treated with infliximab.José Miranda-Bautista Alejandro Fernández-Simón Isabel Pérez-Sánchez Luis Menchén 2015World Journal of Gastroenterology2015,21,17:4
20New insights into the pathophysiology of achalasia and implications for future treatment显示文摘Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter(LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology. The most recent findings indicate an autoimmune component, as suggested by the presence of circulating anti-myenteric plexus autoantibodies, and a genetic predisposition, as suggested by observed correlations with other well-defined genetic syndromes such as Allgrove syndrome and multiple endocrine neoplasia type 2 B syndrome. Viral agents(herpes, varicella zoster) have also been proposed as causative and promoting factors. Unfortunately, the therapeutic approaches available today do not resolve the causes of the disease, and only target the consequential changes to the involved tissues, such as destruction of the LES, rather than restoring or modifying the underlying pathology. New therapies should aim to stop the disease at early stages, thereby preventing the consequential changes from developing and inhibiting permanent damage. This review focuses on the known characteristics of idiopathic achalasia that will help promote understanding its pathogenesis and improve therapeutic management to positively impact the patient's quality of life.Janette Furuzawa-Carballeda Samuel Torres-Landa Miguel ángel Valdovinos Enrique Coss-Adame Luis A Martín del Campo Gonzalo Torres-Villalobos 2016World Journal of Gastroenterology2016,22,35:4
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