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1肛裂临床诊治指南(第三次修订)显示文摘“美国结直肠外科医师协会(American Societyof ColonandRectal Surgeons.ASCRS)”(协会)致力于推进结直肠和肛门疾病的相关理论以及预防和诊疗水平的提高,给患者提供优质的医疗服务。“标准委员会”由协会中在结直肠外科方面有显著专长的成员组成。该委员会的建立是为了引领国际结直肠和肛门疾病诊治的发展,以建立具有循证医学证据的临床诊疗指南。指南是涵盖性的,非指令性的,目的是为临床决策提供信息,而非具体的治疗方法。指南适用于所有相关的医护人员以及希望得到相应指南中疾病的相关诊治信息的患者。Farshid Araghizadeh ~ Robin Boushey Sridhar Chalasani George Chang Robert Cima Gary Dunn Daniel Feingold Philip Fleshner Daniel Geisler Jill Genua Sharon Gregorcyk Daniel Herzig Andreas Kaiser Ravin Kumar David Larson Steven Mills John Monson P. Terry Phang Feza Remzi David Rivadeneira Howard Ross Peter Senatore Elin Sigurdson Thomas Stahl Scott Steele Scott Strong Charles Tement Judith Trudel Madhulika Varnna Martin Weiser 丁义江(译) 皇甫少华(译) 丁曙晴(译) 2013中华胃肠外科杂志2013,16,7:70
22016年WHO泌尿系统和男性生殖器官肿瘤分类指南--第二部分:前列腺和膀胱肿瘤显示文摘自上次世界卫生组织(world health organization,WHO)公布前列腺和膀胱肿瘤分类,已有12年。在此期间,关于这些肿瘤的病理和遗传学出现了大量知识更新。2016年WHO分类指南中新增了前列腺导管内癌的内容。在大多数情况下,前列腺导管内癌是一种在导管内扩散且具有侵袭性的前列腺癌,需与高级别前列腺上皮内瘤进行区分。前列腺腺泡腺癌新增了两种类型,包括微囊腺癌和多形性巨细胞腺癌。修改后的Gleason分级系统也增补至新分类的前列腺癌分级中;对于评分为Gleason 7分的腺癌,建议诊断报告列出结构类型为4级(pattern 4)的比例。新分类进一步推荐近来提出的前列腺癌5级分类。对于膀胱癌,2016年WHO分类继续沿用国际泌尿病理协会(International Society of Urological Pathology,ISUP)1997年的分类指南。本次修订中更好地定义了非侵袭性的尿路上皮病变,包括尿路上皮异型增生和未知恶性潜能的尿路上皮增生,常见于有尿路上皮癌病史的患者,侵袭性尿路上皮癌的异向分化,指一定比例的'常见型'尿路上皮癌和其他形态变化同时存在。病理医生在病理报告中需注明不同组织的比例。Peter A.Humphrey Holger Moch Antonio L.Cubilla Thomas M.Ulbright Victor E.Reuter 张繁(译) 江宗睿(译) 王焕军(校) 2018影像诊断与介入放射学2018,27,2:62
3Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses:A multicenter study显示文摘AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical pathology.An interobserver study was performed.RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode images.The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode images.The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and accuracy.It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.Marc Giovannini Botelberge Thomas Bories Erwan Pesenti Christian Caillol Fabrice Esterni Benjamin Monges Geneviève Arcidiacono Paolo Deprez Pierre Yeung Robert Schimdt Walter Schrader Hanz Szymanski Carl Dietrich Christoph Eisendrath Pierre Van Laethem Jean-Luc Devière Jacques Vilmann Peter Saftoiu Andrian 2009World Journal of Gastroenterology2009,15,13:48
4The clinical impact of bacterial biofilms显示文摘Bacteria survive in nature by forming biofilms on surfaces and probably most, if not all, bacteria (and fungi) are capable of forming biofilms. A biofilm is a structured consortium of bacteria embedded in a self-produced polymer matrix consisting of polysaccharide, protein and extracellular DNA. Bacterial biofilms are resistant to antibiotics, disinfectant chemicals and to phagocytosis and other components of the innate and adaptive inflammatory defense system of the body. It is known, for example, that persistence of staphylococcal infections related to foreign bodies is due to biofilm formation. Likewise, chronic Pseudomonas aeruginosa lung infections in cystic fibrosis patients are caused by biofilm growing mucoid strains. Gradients of nutrients and oxygen exist from the top to the bottom of biofilms and the bacterial cells located in nutrient poor areas have decreased metabolic activity and increased doubling times. These more or less dormant cells are therefore responsible for some of the tolerance to antibiotics. Biofilm growth is associated with an increased level of mutations. Bacteria in biofilms communicate by means of molecules, which activates certain genes responsible for production of virulence factors and, to some extent, biofilm structure. This phenomenon is called quorum sensing and depends upon the concentration of the quorum sensing molecules in a certain niche, which depends on the number of the bacteria. Biofilms can be prevented by antibiotic prophylaxis or early aggressive antibiotic therapy and they can be treated by chronic suppressive antibiotic therapy. Promising strategies may include the use of compounds which can dissolve the biofilm matrix and quorum sensing inhibitors, which increases biofilm susceptibility to antibiotics and phagocytosis.Niels Hoiby Oana Ciofu Helle Krogh Johansen Zhi-jun Song Claus Moser Peter Ostrup Jenser Soren Molin Michael Givskov Tim Tolker-Nieisen Thomas Bjamsholt 2011International Journal of Oral Science2011,3,2:48
5TGF-β family co-receptor function and signaling显示文摘转变生长因素 --(TGF-) 家庭成员,它包括 TGF-s, activins 和骨头形态基因的蛋白质,是多种的 cytokines 得到细胞类型特定的效果在一高度在许多不同纸巾的上下文依赖者举止。经由 single-transmembrane 类型的这些分泌蛋白质 ligands 信号我和类型 II serine/threonine kinase 受体和细胞内部的 SMAD 抄写因素。在发信号的解除管制在疾病的一个宽广数组被含有,并且含有对复杂罚款在细胞的发信号的回答调节的需要。TGF- 家庭受体发信号紧张,持续时间,特性和差异被调整或调停的一重要出现机制通过房间表面合作受体。这里,我们提供为 TGF- 家庭成员被识别了的合作受体的概述。当一些看起来对 TGF- 家庭成员特定时,其它与另外的小径被分享并且为信号集成提供可能的方法。这评论集中于 TGF- 家庭合作受体的新奇功能,它继续发现。Joachim Nickel Peter ten Dijke Thomas D. Mueller 2018Acta Biochimica et Biophysica Sinica2018,50,1:26
6Application of poly-lactide-co-glycolide-microspheres in the transarterial chemoembolization in an animal model of hepatocellular carcinoma显示文摘AIM:To introduce an animal model of hepatocellular carcinoma (HCC) in ACI-rats, and to evaluate the therapeutic effects of Poly-lactide-co-glycolide(PIcg)-microspheres in the transarterial chemoembolization (TACE) in this model, as well the value of this model in the experiments of interventional therapy.Jochen Truebenbach Florian Graepler Philippe Pereira Peter Huppert Thomas Eul Gundula Wiemann Claus Claussen 2003World Journal of Gastroenterology2003,9,1:24
7Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma显示文摘AIM: To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS: Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995–2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively. RESULTS: Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ (n = 8), Ⅲ (n = 28) and Ⅳ (n = 40) was 496 ± 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806). CONCLUSION: Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.Andreas Weber Sonja Landrock Jochen Schneider Manfred Stangl Bruno Neu Peter Born Meinhard Classen Thomas Rsch Roland M Schmid Christian Prinz 2007World Journal of Gastroenterology2007,13,9:23
8On the combined effect of soil fertility and topography on tree growth in subtropical forest ecosystems—a study from SE China显示文摘Aims The aim of our research was to understand small-scale effects of topography and soil fertility on tree growth in a forest biodiversity and ecosystem functioning(BEF)experiment in subtropical SE China.Methods Geomorphometric terrain analyses were carried out at a spatial resolution of 5×5 m.Soil samples of different depth increments and data on tree height were collected from a total of 566 plots(667 m2 each).The soils were analyzed for carbon(soil organic carbon[SOC]),nitrogen,acidity,cation exchange capacity(CEC),exchangeable cations and base saturation as soil fertility attributes.All plots were classified into geomorphological units.Analyses of variance and linear regressions were applied to all terrain,soil fertility and tree growth attributes.Important Findings In general,young and shallow soils and relatively small differences in stable soil properties suggest that soil erosion has truncated the soils to a large extent over the whole area of the experiment.This explains the concurrently increasing CEC and SOC stocks downslope,in hollows and in valleys.However,colluvial,carbon-rich sediments are missing widely due to the convexity of the footslopes caused by uplift and removal of eroded sediments by adjacent waterways.The results showed that soil fertility is mainly influenced by topography.Monte-Carlo flow accumulation(MCCA),curvature,slope and aspect significantly affected soil fertility.Furthermore,soil fertility was affected by the different geomorphological positions on the experimental sites with ridge and spur positions showing lower exchangeable base cation contents,especially potassium(K),due to leaching.This geomorphological effect of soil fertility is most pronounced in the topsoil and decreases when considering the subsoil down to 50 cm depth.Few soil fertility attributes affect tree height after 1-2 years of growth,among which C stocks proved to be most important while pH_(KCl)and CEC only played minor roles.Nevertheless,soil acidity and a high proportion of Al on the exchange complex affected tree height even after only 1-2 years growth.Hence,our study showed that forest nutrition is coupled to a recycling of litter nutrients,and does not only depend on subsequent supply of nutrients from the mineral soil.Besides soil fertility,topography affected tree height.We found that especially MCCA as indicator of water availability affected tree growth at small-scale,as well as aspect.Overall,our synthesis on the interrelation between fertility,topography and tree growth in a subtropical forest ecosystem in SE China showed that topographic heterogeneity lead to ecological gradients across geomorphological positions.In this respect,small-scale soil-plant interactions in a young forest can serve as a driver for the future development of vegetation and biodiversity control on soil fertility.In addition,it shows that terrain attributes should be accounted for in ecological research.Thomas Scholten Philipp Goebes Peter Kühn Steffen Seitz Thorsten Assmann Jürgen Bauhus Helge Bruelheide Francois Buscot Alexandra Erfmeier Markus Fischer Werner Härdtle Jin-Sheng He Keping Ma Pascal A.Niklaus Michael Scherer-Lorenzen Bernhard Schmid Xuezheng Shi Zhengshan Song Goddert von Oheimb Christian Wirth Tesfaye Wubet Karsten Schmidt 2017Journal of Plant Ecology2017,10,1:22
9报告随机对照试验的CONSORT声明修订版:说明与详述(一)显示文摘有充分的证据表明目前随机对照试验(RCT)的报告质量不尽如人意。最近的方法学调查表明,不恰当的报告及试验设计将使治疗措施的效果产生偏倚。这种系统偏差正严重损害RCT本可摒弃系统偏差的特征。RCT中的系统偏差反映出了科学性差,而科学性差会严重影响正确的伦理标准。科学家和编辑们共同制定了CONSORT(试验报告统一标准,ConsolidatedStandardsofReportingTrials,)声明以提高RCT报告质量。CONSORT声明由清单和流程图组成,作者可用来报告RCT。许多优秀期刊和重要国际性编辑组织已经采用CONSORT声明。CONSORT声明为作者提高临床试验报告质量提供指南,使得评价和解释RCT结果更方便。此文旨在增强大家对CONSORT声明的理解、应用和传播,并对每个清单项目的意义和原理进行了说明。很多项目都列出优秀报告的示例,并尽可能参考相关的经验性研究,还列出几个流程图的示例。CONSORT声明的说明和详述文件在以下网址可找到:http://gffzzff905fc352db4ba6hok59k60fxxuw6von.ffgz.tsg.suse.edu.cn,这是提高随机对照试验报告质量的有益资源。Douglas G.Altman Kenneth F.Schulz David Moher Matthias Egger Frank Davidoff Diana Elbourne Peter C.Gφtzsch Thomas Lang the CONSORT Group 刘雪梅 2005中国循证医学杂志2005,5,9:19
10远程耦合世界的可持续性框架显示文摘远距离之间的相互作用及其影响日益广泛。这种远程相互作用往往会对可持续发展产生深远的影响并会造成意想不到的结果。很多可持续性研究都是针对某个特定地点进行的,很少注重多个地点之间远程相互作用对可持续性所产生的影响。虽然有些研究涉及到远程因素,但通常都把它们看作外在变量,而未把它们看作反馈。为了更好地理解和综合各种远程相互作用,本文提出了一种基于远程耦合的综合框架,它是一个远距离社会经济和环境相互作用的总体概念。人类与自然耦合系统是研究在特定地点发生的相互作用,远程耦合概念是对人类与自然耦合系统研究的自然延伸。远程耦合框架包括五个相关的组成部分,即:人类与自然耦合系统、流、代理、原因、和影响。本文通过农产品贸易和物种入侵两个远程相互作用的例子来解释远程耦合框架,重点阐述远程耦合框架的影响,并讨论促进远程耦合研究发展的研究条件和方法。这个框架有助于分析系统内各组成部分以及它们之间的相互关系,找出研究差距,探索其中的隐含成本以及尚未开发的优势,提供引入反馈及多系统(发送、接收和外溢系统)之间权衡和协同的有效手段,从本地到全球各个层面加深对远程相互作用的认识,并提高社会经济和环境可http://gffzz31576c8fc0de4618hok59k60fxxuw6von.ffgz.tsg.suse.edu.cn续发展政策的有效性。刘建国 Vanessa Hull Mateus Batistella Ruth DeFries Thomas Dietz 付峰 Thomas W.Hertel R.Cesar Izaurralde Eric F.Lambin 李舒心 Luiz A.Martinelli William J.McConnell Emilio F.Moran Rosamond Naylor 欧阳志云 KarenR.Polenske Anette Reenberg Gilberto de Miranda Rocha Cynthia S.Simmons Peter H.Verburg Peter M.Vitousek 张福锁 朱春全 2016生态学报2016,36,23:19
11Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound显示文摘AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis(AE).METHODS: Clinical data and ultrasonography(US) findings of 185 patients(100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.RESULTS: Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm(54.1%); pseudocystic(13.5%); ossification(13.0%); hemangioma-like(8.1%); and metastasis-like(6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.CONCLUSION: The sonomorphological classification proposed in the present study facilitates the diagnosis,interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.Wolfgang Kratzer Beate Gruener Tanja EM Kaltenbach Sarina Ansari-Bitzenberger Peter Kern Michael Fuchs Richard A Mason Thomas FE Barth Mark M Haenle Andreas Hillenbrand Suemeyra Oeztuerk Tilmann Graeter 2015World Journal of Gastroenterology2015,21,43:16
12Circulating predictive and diagnostic biomarkers for hepatitis B virus-associated hepatocellular carcinoma显示文摘Chronic hepatitis B virus(HBV) infected patients have an almost 100-fold increased risk to develop hepatocellular carcinoma(HCC). HCC is the fifth most common and third most deadly cancer worldwide. Up to 50% of newly diagnosed HCC cases are attributed to HBV infection. Early detection improves survival and can be achieved through regular screening. Six-monthly abdominal ultrasound, either alone or in combination with alphafetoprotein serum levels, has been widely endorsed for this purpose. Both techniques however yield limited diagnostic accuracy, which is not improved when they are combined. Alternative circulating or histological markers to predict or diagnose HCC are therefore urgently needed. Recent advances in systems biology technologies have enabled the identification of several new putative circulating biomarkers. Although results from studies assessing combinations of these biomarkers are promising, evidence for their clinical utility remains low. In addition, most of the studies conducted so far show limitations in design. Attention must be paid for instance to different ethnicities and different etiologies when studying biomarkers for hepatocellular carcinoma. This review provides an overview on the current understandings and recent progress in the field of diagnostic and predictive circulating biomarkers for hepatocellular carcinoma in chronically infected HBV patients and discusses the future prospects.Stijn Van Hees Peter Michielsen Thomas Vanwolleghem 2016World Journal of Gastroenterology2016,22,37:13
13人类与自然耦合系统显示文摘人类与自然系统不断地相互作用促使人类与自然耦合系统(CHANS)的形成与发展。近期的研究揭示了人类与自然耦合系统在组织、空间以及时间上耦合的复杂性。这些耦合在相互作用方面从直接演化到更间接;在联结方面从邻近演化到更远距离;在尺度上,从局部演化到全球;在模式和过程上,从简单演化到复杂。解开如相互影响和突发属性的复杂性,能够导致新的科学发现,并且对于开发生态和社会经济可持续性的有效政策是非常重要的。以解决关于人类与自然耦合系统的基本问题和迎接社会的空前挑战为目的的,真正整合不同学科的机会正显现出来。刘建国 Thomas Dietz Stephen R.Carpenter Carl Folke Marina Alberti Charles L.Redman Stephen H.Schneider Elinor Ostrom Alice N.Pell Jane Lubchenco William W.Taylor 欧阳志云 Peter Deadman Timothy Kratz William Provencher 张淑敏 2007AMBIO-人类环境杂志2007,36,B12:13
14Severe scrub typhus infection: Clinical features, diagnostic challenges and management显示文摘Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay(IFA) for the detection of Ig M antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.John Victor Peter Thomas I Sudarsan John Anthony J Prakash George M Varghese 2015World Journal of Critical Care Medicine2015,4,3:13
15Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand?显示文摘Diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.Ajaykumar C Morani Khaled M Elsayes Peter S Liu William J Weadock Janio Szklaruk Jonathan Russell Dillman Asra Khan Thomas L Chenevert Hero K Hussain 2013World Journal of Radiology2013,5,3:12
16Consequences of bullying victimization in childhood and adolescence:A systematic review and meta-analysis显示文摘AIM To identify health and psychosocial problems associated with bullying victimization and conduct a meta-analysis summarizing the causal evidence.METHODS A systematic review was conducted using Pub Med, EMBASE, ERIC and Psyc INFO electronic databases up to 28 February 2015. The study included published longitudinal and cross-sectional articles that examined health and psychosocial consequences of bullying victimization. All meta-analyses were based on qualityeffects models. Evidence for causality was assessed using Bradford Hill criteria and the grading system developed by the World Cancer Research Fund.RESULTS Out of 317 articles assessed for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis.Statistically significant associations were observed between bullying victimization and a wide range of adverse health and psychosocial problems. The evidence was strongest for causal associations between bullying victimization and mental health problems such as depression, anxiety, poor general health and suicidal ideation and behaviours. Probable causal associations existed between bullying victimization and tobacco and illicit drug use. CONCLUSION Strong evidence exists for a causal relationship between bullying victimization, mental health problems and substance use. Evidence also exists for associations between bullying victimization and other adverse health and psychosocial problems, however, there is insufficient evidence to conclude causality. The strong evidence that bullying victimization is causative of mental illness highlights the need for schools to implement effective interventions to address bullying behaviours.Sophie E Moore Rosana E Norman Shuichi Suetani Hannah J Thomas Peter D Sly James G Scott 2017World Journal of Psychiatry2017,7,1:12
17Helicobacter pylori vac A genotype is a predominant determinant of immune response to Helicobacter pylori CagA显示文摘AIM To evaluate the frequency of Helicobacter pylori(H. pylori) Cag A antibodies in H. pylori infected subjects and to identify potential histopathological and bacterial factors related to H. pylori Cag A-immune response.METHODS Systematic data to H. pylori isolates, blood samples, gastric biopsies for histological and molecular analyses were available from 99 prospectively recruited subjects. Serological profile(anti-H. pylori, anti-Cag A) was correlated with H. pylori isolates(cag A, EPIYA, vac A s/m genotype), histology(Sydney classification) and mucosal interleukin-8(IL-8) m RNA and protein expression. Selected H. pylori strains were assessed for H. pylori Cag A protein expression and IL-8 induction in co-cultivation model with AGS cells.RESULTS Thirty point three percent of microbiologically confirmed H. pylori infected patients were seropositive for Cag A. Majority of H. pylori isolates were cag A gene positive(93.9%) with following vac A polymorphisms: 42.4% vac A s1m1, 23.2% s1m2 and 34.3% s2m2. Anti-Cag AIg G seropositivity was strongly associated with atrophic gastritis, increased mucosal inflammation according to the Sydney score, IL-8 and cag A m RNA expression. V a c A s a n d m p o l y m o r p h i s m s w e r e t h e m a j o r determinants for positive(vac A s1m1) or negative(vac A s2m2) anti-Cag A serological immune response, which also correlated with the in vitro inflammatory potential in AGS cells. In vitro co-cultivation of representative H. pylori strains with AGS cells confirmed functional Cag A translocation, which showed only partial correlation with Cag A seropositivity in patients, supporting vac A as major co-determinant of the immune response.CONCLUSION Serological immune response to H. pylori cag A + strain in H. pylori infected patients is strongly associated with vac A polymorphism, suggesting the crucial role of bacterial factors in immune and clinical phenotype of the infection.Alexander Link Cosima Langner Wiebke Schirrmeister Wiebke Habendorf Jochen Weigt Marino Venerito Ina Tammer Dirk Schlüter Philipp Schlaermann Thomas F Meyer Thomas Wex Peter Malfertheiner 2017World Journal of Gastroenterology2017,23,26:12
18Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study显示文摘AIM To study the impact of hospital-acquired infections(HAIs) on cost and outcome from intensive care units(ICU) in India. METHODS Adult patients(> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed. RESULTS The mean(± SD) age of the cohort(n = 499) was42.3 ± 16.5 years. Acute physiology and chronic health evaluation-Ⅱ score was 13.9(95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76(15.3%) patients developed an infection(ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median(inter-quartile range, IQR) INR 92893(USD 1523)(IQR 57168-140286) vs INR 180469(USD 2958)(IQR 140030-237525); P < 0.001 and longer duration of ICU(6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay(12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality(31.6% vs 27.2%; P = 0.49).CONCLUSION An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.Binila Chacko Kurien Thomas Thambu David Hema Paul Lakshmanan Jeyaseelan John Victor Peter 2017World Journal of Critical Care Medicine2017,6,1:11
19Capecitabine and irinotecan with and without bevacizumab for advanced colorectal cancer patients显示文摘AIM:To investigate the efficacy and safety of capecitabine plus irinotecan±bevacizumab in advanced or metastatic colorectal cancer patients. METHODS:Forty six patients with previously untreated,locally-advanced or metastatic colorectal cancer(mCRC) were recruited between 2001-2006 in a prospective open-label phaseⅡtrial,in German community-based outpatient clinics.Patients received a standard capecitabine plus irinotecan(CAPIRI) or CAPIRI plus bevacizumab(CAPIRI-BEV) regimen every 3 wk. Dose reductions were mandatory from the first cycle in cases of>grade 2 toxicity.The treatment choice of bevacizumab was at the discretion of the physician.Theprimary endpoints were response and toxicity and secondary endpoints included progression-free survival and overall survival. RESULTS:In the CAPIRI group vs the CAPRI-Bev group there were more female than male patients(47% vs 24%) ,and more patients had colon as the primary tumor site(58.8%vs 48.2%) with fewer patients having sigmoid colon as primary tumor site(5.9%vs 20.7%) .Grade 3/4 toxicity was higher with CAPIRI than CAPIRI-Bev:82%vs 58.6%.Partial response rates were 29.4%and 34.5%,and tumor control rates were 70.6%and 75.9%,respectively.No complete responses were observed.The median progression-free survival was 11.4 mo and 12.8 mo for CAPIRI and CAPIRI-Bev,respectively.The median overall survival for CAPIRI was 15 mo(458 d) and for CAPIRI-Bev 24 mo(733 d) .These differences were not statistically different.In the CAPIRI-Bev,group,two patients underwent a full secondary tumor resection after treatment,whereas in the CAPIRI group no cases underwent this procedure. CONCLUSION:Both regimens were well tolerated and offered effective tumor growth control in this outpatient setting.Severe gastrointestinal toxicities and thromboembolic events were rare and if observed were never fatal.Markus Moehler Martin F Sprinzl Murad Abdelfattah Carl C Schimanski Bernd Adami Werner Godderz Klaus Majer Dimitri Flieger Andreas Teufel Juergen Siebler Thomas Hoehler Peter R Galle Stephan Kanzler 2009World Journal of Gastroenterology2009,15,4:10
20Proposal of a computed tomography classification for hepatic alveolar echinococcosis显示文摘AIM: To establish a computed tomography(CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study. METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis(AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography(PET)-CT examinations were evaluated. The diagnosis of AE was made in patientswith unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five 'primary morphologies' as well as to one out of six 'patterns of calcification'. 'primary morphology' and 'pattern of calcification' are primarily focussed on separately from each other and combined, whereas the 'primary morphology' V is not further characterized by a 'pattern of calcification'. Based on the five primary morphologies, further descriptive sub-criteria were appended to types Ⅰ-Ⅲ. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type Ⅳ primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification(EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.Tilmann Graeter Wolfgang Kratzer Suemeyra Oeztuerk Mark Martin Haenle Richard Andrew Mason Andreas Hillenbrand Thomas Kull Thomas F Barth Peter Kern Beate Gruener 2016World Journal of Gastroenterology2016,22,13:10
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