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| 1 | Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis显示文摘AIM:To conduct a meta-analysis to compare Rouxen-Y(R-Y) gastrojejunostomy with gastroduodenal Billroth Ⅰ(B-Ⅰ) anastomosis after distal gastrectomy(DG) for gastric cancer.METHODS:A literature search was performed to identify studies comparing R-Y with B-Ⅰ after DG for gastric cancer from January 1990 to November 2012 in Medline,Embase,Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library.Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed or random effects model.Operative outcomes such as operation time,intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture,bile reflux,remnant gastritis,reflux esophagitis,dumping symptoms,delayed gastric emptying and hospital stay were the main outcomes assessed.Meta-analyses were performed using RevMan 5.0 software(Cochrane library).RESULTS:Four randomized controlled trials(RCTs) and 9 non-randomized observational clinical studies(OCS) involving 478 and 1402 patients respectively were included.Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux(OR 0.04,95%CI:0.01,0.14;P < 0.00 001) and remnant gastritis(OR 0.43,95%CI:0.28,0.66;P = 0.0001),however needing a longer operation time(WMD 40.02,95%CI:13.93,66.11;P = 0.003).Metaanalysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux(OR 0.21,95%CI:0.08,0.54;P = 0.001),remnant gastritis(OR 0.18,95%CI:0.11,0.29;P < 0.00 001) and reflux esophagitis(OR 0.48,95%CI:0.26,0.89;P = 0.02).However,this reconstruction method was found to be associated with a longer operation time(WMD 31.30,95%CI:12.99,49.60;P = 0.0008).CONCLUSION:This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-Ⅰ reconstruction post DG.However there is a need for further adequately powered,welldesigned RCTs comparing the same. | Jun-Jie Xiong Kiran Altaf Muhammad A Javed Quentin M Nunes Wei Huang Gang Mai Chun-Lu Tan Rajarshi Mukherjee Robert Sutton Wei-Ming Hu Xu-Bao Liu | 2013 | World Journal of Gastroenterology2013，19，7： | 33 |
| 2 | 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 |
| 3 | Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting显示文摘AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used χ2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS: For rebleeding, the χ2 goodness-of-fit test indicated an acceptable fit for the model [χ2 (8) = 12.83, P = 0.12]. For surgical procedures [χ2 (8) = 5.3, P = 0.73] and death [χ2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing apoor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability. CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures. | Robert A Enns Yves M Gagnon Alan N Barkun David Armstrong Jamie C Gregor Richard N Fedorak RUGBE Investigators Group | 2006 | World Journal of Gastroenterology2006，12，48： | 14 |
| 4 | Radioembolization for the treatment of unresectable hepatocellular carcinoma:A clinical review显示文摘Hepatocellular carcinoma(HCC)is the sixth most common cancer in the world.The majority of patients with HCC present with unresectable disease.These patients have historically had limited treatment options secondary to HCC demonstrating chemoresistance to the currently available systemic therapies.Additionally, normal liver parenchyma has shown intolerance to tumoricidal radiation doses,limiting the use of external beam radiation.Because of these limitations,novel percutaneous liver-directed therapies have emerged. The targeted infusion of radioactive microspheres (radioembolization)represents one such therapy. Radioembolization is a minimally invasive transcatheter therapy through which radioactive microspheres are infused into the hepatic arteries that supply tumor. Once infused,these microspheres traverse the hepatic vascular plexus and selectively implant within the tumor arterioles.Embedded within the arterioles, the 90Y impregnated microspheres emit high energy and low penetrating radiation doses selectively to the tumor.Radioembolization has recently shown promise for the treatment of patients with unresectable HCC. The objective of this review article is to highlight twocurrently available radioembolic devices(90Y,188Rh)and provide the reader with a recent review of the literature. | Saad M Ibrahim Robert J Lewandowski Kent T Sato Vanessa L Gates Laura Kulik Mary F Mulcahy Robert K Ryu Reed A Omary Riad Salem | 2008 | World Journal of Gastroenterology2008，14，11： | 14 |
| 5 | Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization显示文摘AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE. | Johnathan C Chung Neel K Naik Robert J Lewandowski Mary F Mulcahy Laura M Kulik Kent T Sato Robert K Ryu Riad Salem Andrew C Larson Reed A Omary | 2010 | World Journal of Gastroenterology2010，16，25： | 13 |
| 6 | High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound显示文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation. | Roman Schumann Nikola S Natov Klifford A Rocuts-Martinez Matthew D Finkelman Tom V Phan Sanjay R Hegde Robert M Knapp | 2016 | World Journal of Gastroenterology2016，22，47： | 9 |
| 7 | Mycophenolate mofetil for drug-induced vanishing bile duct syndrome显示文摘Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil. | S Simona Jakab A Brian West Dennis M Meighan Robert S Brown Jr William B Hale | 2007 | World Journal of Gastroenterology2007，13，45： | 8 |
| 8 | Gastroenteropancreatic neuroendocrine tumours显示文摘 | Irvin M Modlin Kjell Oberg Daniel C Chung Robert T Jensen Wouter W de Herder Rajesh V Thakker Martyn Caplin Gianfranco Delle Fave Greg A Kaltsas Eric P Krenning Steven F Moss Ola Nilsson Guido Rindi Ramon Salazar Philippe Ruszniewski Anders Sundin | 2008 | Lancet Oncology2008，，1： | 8 |
| 9 | Altered vasoactive intestinal peptides expression in irritable bowel syndrome patients and rats with trinitrobenzene sulfonic acid-induced colitis显示文摘AIM: To investigate the vasoactive intestinal peptides(VIP) expression in irritable bowel syndrome(IBS) and trinitrobenzene sulfonic acid(TNBS) induced colitis.METHODS: The VIP gene expression and protein plasma levels were measured in adult participants(45.8% male) who met Rome Ⅲ criteria for IBS for longer than 6 mo and in a rat model of colitis as induced by TNBS.Plasma and colons were collected from naive and inflamed rats.Markers assessing inflammation(i.e.,weight changes and myeloperoxidase levels) were assessed on days 2,7,14 and 28 and compared to controls.Visceral hypersensitivity of the rats was assessed with colo-rectal distension and mechanical threshold testing on hind paws.IBS patients(n = 12) were age,gender,race,and BMI-matched with healthy controls(n = 12).Peripheral whole blood and plasma from fasting participants was collected and VIP plasma levels were assayed using a VIP peptide-enzyme immunoassay.Human gene expression of VIP was analyzed using a custom PCR array.RESULTS: TNBS induced colitis in the rats was confirmed with weight loss(13.7 ± 3.2 g) and increased myeloperoxidase activity.Visceral hypersensitivity tocolo-rectal distension was increased in TNBS treated rats up to 21 d and resolved by day 28.Somatic hypersensitivity was also increased up to 14 d post TNBS induction of colitis.The expression of an inflammatory marker myeloperoxidase was significantly elevated in the intracellular granules of neutrophils in rat models following TNBS treatment compared to naive rats.This confirmed the induction of inflammation in rats following TNBS treatment.VIP plasma concentration was significantly increased in rats following TNBS treatment as compared to naive animals(P < 0.05).Likewise,the VIP gene expression from peripheral whole blood was significantly upregulated by 2.91-fold in IBS patients when compared to controls(P < 0.00001; 95%CI).VIP plasma protein was not significantly different when compared with controls(P = 0.193).CONCLUSION: Alterations in VIP expression may play a role in IBS.Therefore,a better understanding of the physiology of VIP could lead to new therapeutics. | Arseima Y Del Valle-Pinero LeeAnne B Sherwin Ethan M Anderson Robert M Caudle Wendy A Henderson | 2015 | World Journal of Gastroenterology2015，21，1： | 7 |
| 10 | Efficacy and safety of tenofovir in chronic hepatitis B: Australian real world experience显示文摘AIM To evaluate the long-term treatment outcomes of tenofovir therapy in patients in a real world Australian tertiary care setting.METHODS We performed a retrospective analysis of treatment outcomes among treatment-na?ve and treatment-experienced patients receiving a minimum 3 mo tenofovir therapy through St Vincent's Hospital Melbourne, Australia. We included patients receiving tenofovir [tenofovir disoproxil fumarate(TDF)] monotherapy, as well as patients treated with TDF in combination with a second antiviral agent. Patients were excluded if they demonstrated human immune-deficiency virus/hepatitis C virus/hepatitis delta virus coinfection or were less than 18 years of age. We considered virological and biochemicalresponse, as well as safety outcomes. Virological response was determined by measurement of hepatitis B virus(HBV) DNA using sensitive assays; biochemical response was determined via serum liver function tests; histological response was determined from liver biopsy and fibroscan; safety analysis focused on glomerular renal function and bone mineral density. The primary efficacy endpoint was complete virological suppression over time, defined by HBV DNA < 20 IU/m L. Secondary efficacy endpoints included rates of biochemical response, and HB e antigen(HBe Ag)/HB surface antigen loss and seroconversion over time.RESULTS Ninety-two patients were identified who fulfilled the enrolment criteria. Median follow-up was 26 mo(range 3-114). Mean age was 46(24-78) years, 64(70%) were male and 77(84%) were of Asian origin. 55(60%) patients were treatment-na?ve and 62 patients(67%) were HBe Ag-negative. Complete virological suppression was achieved by 45/65(71%) patients at 12 mo, 37/46(80%) at 24 mo and 25/28(89%) at 36 mo. Partial virological response(HBV DNA 20-2000 IU/m L) was achieved by 89/92(96.7%) of patients. Multivariate analysis showed a significant relationship between virological suppression at end of follow-up and baseline HBV DNA level(OR = 0.897, 95%CI: 0.833-0.967, P = 0.0046) and HBe Ag positive status(OR = 0.373, 95%CI: 0.183-0.762, P = 0.0069). There was no difference in response comparing treatment-na?ve and treatment-experienced patients. Three episodes of virological breakthrough occurred in the setting of noncompliance. Tenofovir therapy was well tolerated.CONCLUSION Tenofovir is an efficacious, safe and well-tolerated treatment in an Australian real-world tertiary care setting. Our data are similar to the reported experience from registration trials. | Grace C Lovett Tin Nguyen David M Iser Jacinta A Holmes Robert Chen Barbara Demediuk Gideon Shaw Sally J Bell Paul V Desmond Alexander J Thompson | 2017 | World Journal of Hepatology2017，9，1： | 7 |
| 11 | Clinical outcomes following salvage Gamma Knife radiosurgery for recurrent glioblastoma显示文摘Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed. | Erik W Larson Halloran E Peterson Wayne T Lamoreaux Alexander R MacKay Robert K Fairbanks Jason A Call Jonathan D Carlson Benjamin C Ling John J Demakas Barton S Cooke Christopher M Lee | 2014 | World Journal of Clinical Oncology2014，5，2： | 5 |
| 12 | Subcurative radiation significantly increases cell proliferation, invasion, and migration of primary glioblastoma multiforme in vivo显示文摘Tumor cell proliferation, infiltration, migration, and neovascularization are known causes of treatment resistance in glioblastoma multiforme(GBM). The purpose of this study was to determine the effect of radiation on the growth characteristics of primary human GBM developed in a nude rat. Primary GBM cells grown from explanted GBM tissues were implanted orthotopically in nude rats. Tumor growth was confirmed by magnetic resonance imaging on day 77(baseline) after implantation. The rats underwent irradiation to a dose of 50 Gy delivered subcuratively on day 84 postimplantation(n = 8), or underwent no radiation(n = 8). Brain tissues were obtained on day 112(nonirradiated) or day 133(irradiated). Immunohistochemistry was performed to determine tumor cell proliferation(Ki-67) and to assess the expression of infiltration marker(matrix metalloproteinase-2, MMP-2) and cell migration marker(CD44). Tumor neovascularization was assessed by microvessel density using von-Willebrand factor(vWF) staining. Magnetic resonance imaging showed well-developed, infiltrative tumors in 11 weeks postimplantation. The proportion of Ki-67-positive cells in tumors undergoing radiation was(71 ± 15)% compared with(25 ± 12)% in the nonirradiated group(P = 0.02). The number of MMP-2-positive areas and proportion of CD44-positive cells were also high in tumors receiving radiation, indicating great invasion and infiltration. Microvessel density analysis did not show a significant difference between nonirradiated and irradiated tumors. Taken together, we found that subcurative radiation significantly increased proliferation, invasion, and migration of primary GBM. Our study provides insights into possible mechanisms of treatment resistance following radiation therapy for GBM. | Adarsh Shankar Sanath Kumar Asm Iskander Nadimpalli RS Varma Branislava Janic Ana deCarvalho Tom Mikkelsen Joseph A Frank Meser M Ali Robert A Knight Stephen Brown Ali S Arbab | 2014 | Chinese Journal of Cancer2014，33，3： | 5 |
| 13 | The importance of depression and alcohol use in coronary artery bypass graft surgery patients:risk factors for delirium and poorer quality of life显示文摘ObjectiveTo 调查消沉,焦虑和压力是否增加风险因为谵妄和在冠的动脉以后的生活(QOL ) 的差的质量绕过(CABG ) 180 个 CABG 病人的 surgery.MethodsA 总数(63.5 ± 的吝啬的年龄;10.1 年, 82.2% 男性) 完成了基线和手术后的自我报告问询表估计悲痛和 QOL。事件谵妄与结构化的临床的会见手术后地被诊断,病人们在在 63 个人(35% 样品) 开发的 consciousness.ResultsDelirium 为混乱和骚乱 post-operatively 每天被监视。在为 covariates 的调整以后,谵妄显著地与消沉被联系[机会比率(或) :1.08;95% 信心间隔(CI ) :1.03-1.13, P = 0.003 ] ,焦虑(或:1.07;95% CI:1.02-1.13, P = 0.01 ) 并且应力(或:1.05;95% CI:1.00-1.09, P = 0.03 ) 。外科手术前的消沉分数与更差的 QOL 包括被联系身体疼痛(β=− 0.39, P = 0.013 ) ,活力(β=− 0.32, P = 0.020 ) ,社会工作(β=− 0.51, P ≤0.001 ) ,感情的角色功能(β=− 0.44, P = 0.003 ) 并且一般健康(β=− 0.33, P = 0.038 ) 。在 covariates 之中,白酒使用的有害层次一致地与更差的 QOL.ConclusionsDepression 被联系,而消沉,焦虑和压力与谵妄风险被联系,白酒使用的有害层次一致地与更差的 QOL 被联系。这些调查结果点将推进在经历冠的 revascularization 的冠的心疾病人口检验消沉和白酒使用的有害层次的研究。 | Joanne M Humphreys Linley A Denson Robert A Baker Phillip J Tully | 2016 | Journal of Geriatric Cardiology2016，13，1： | 5 |
| 14 | 利拉鲁肽与格列美脲在单药治疗2型糖尿病中的比较(LEAD-3 Mono):一项随机、双盲、平行分组、52周的Ⅲ期临床试验显示文摘背景 2型糖尿病新的治疗策略,需要针对胰岛素-葡萄糖的相互作用,且同时要降低体重增加和发生低血糖的风险。本文作者旨在调查利拉鲁肽单药治疗2型糖尿病的安全性与有效性。
方法 采用双盲、双模拟、治疗一对照、平行分组的研究,746例早期2型糖尿病患者被随机分配到1次/d利拉鲁肽组[1.2mg(n=251)或1.8mg(n=247)]或格列美脲8mg组(n=248),分别治疗52周。主要结局指标为糖化血红蛋白(HbA1c)的改变程度。采用意向性治疗进行分析。该试验在ClinicalTrials.gov网站的注册编码为NTC00294723.
结果52周时,格列美脲组HbA,。下降了0.51%(s=1.20),而利拉鲁肽1.2mg组下降了0.84%(s=1.23)(差值为-0.33.95%CI-0.53~-0.13;P=0.0014),利拉鲁肽1.8mg组下降了1.14%(S=1.24)(差值为-062,95%CI-0.83—-0.42;P〈0.0001)。利拉鲁肽1.2mg组和1.8mg组各有5例和1例患者因呕吐停止治疗,而格列美脲组未出现这种情况。
结论 利拉鲁肽作为2型糖尿病的初始治疗药物安全有效,与格列美脲相比更能降低HbA1c以及体重、血压和低血糖的发生率。 | Alan Garber Robert Henry Robert Rather Pedro A Garcia-Hernandez Hiromi Rodriguez-Pattzi Israel Olvero-Alvarez Paula M Hale, Milan Zdravkovic Bruce Bode 邓斌(译) | 2009 | 世界临床医学2009，，6： | 5 |
| 15 | 睾酮缺乏症的诊断和治疗显示文摘近些年来,随着睾酮缺乏症(TD)发病率的上升、新药的不断开发、以及商业推广的深入,睾酮替代疗法(TST)的临床应用显著增多。然而,关于睾酮缺乏症的诊断标准以及TST的应用和监测,仍然不是很明确。此种现象主要源于睾酮的多重作用靶点。在人体内,睾酮参与了很多生理过程的调节,同时睾酮的表达水平也受很多疾病及药物的影响。因此,睾酮缺乏症的临床症状和体征具有多样性和非特异性,也就增加了睾酮缺乏症的诊断难度,尤其在老年人群中。临床上,关于血清睾酮水平的检测也存在争议,不同实验室之间存在一定的差异,因此也很难界定睾酮水平的诊断标准。很多医学专业组织试图制定睾酮缺乏症的诊断指南,但彼此间很难达成统一。另外,临床使用的睾酮制剂也层出不穷,相应的TST治疗方案也像TD的诊断标准一样不断更新和变化。临床上,随着TST的不断推进,专科医师必须不断更新对于TD和HTST的了解和治疗及应用。本文旨在阐述TD的最新概念及其诊断和治疗的新进展。 | James A McBride Culley C Carson Robert M Coward | 2015 | Asian Journal of Andrology2015，17，2： | 5 |
| 16 | Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models显示文摘AIM To assess the performance of BALAD, BALAD-2 and their component biomarkers in predicting outcome of hepatocellular carcinoma(HCC) patients after liver transplant.METHODS BALAD score and BALAD-2 class are derived from bilirubin, albumin, alpha-fetoprotein(AFP), Lens culinaris agglutinin-reactive AFP(AFP-L3), and des-gammacarboxyprothrombin(DCP). Pre-transplant AFP, AFP-L3 and DCP were measured in 113 patients transplanted for HCC from 2000 to 2008. Hazard ratios(HR) for recurrence and death were calculated. Univariate and multivariate regression analyses were conducted. C-statistics were used to compare biomarker-based to predictive models. RESULTS During a median follow-up of 12.2 years, 38 patients recurred and 87 died. The HRs for recurrence in patients with elevated AFP, AFP-L3, and DCP defined by BALAD cut-off values were 2.42(1.18-5.00), 1.86(0.98-3.52), and 2.83(1.42-5.61), respectively. For BALAD, the HRs for recurrence and death per unit increased score were 1.48(1.15-1.91) and 1.59(1.28-1.97). For BALAD-2, the HRs for recurrence and death per unit increased class were 1.45(1.06-1.98) and 1.38(1.09-1.76). For recurrence prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs. 0.64, 0.61, 0.53, and 0.53 for BALAD, BALAD-2, Milan, and UCSF, respectively. Similarly, for death prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs 0.65,0.61, 0.52, and 0.50 for BALAD, BALAD-2, Milan, and UCSF. A new model combining biomarkers with tumor size at the time of transplant(S-LAD) demonstrated the highest predictive capability with c-statistics of 0.71 and 0.69 for recurrence and death. CONCLUSION BALAD and BALAD-2 are valid in transplant HCC patients, but less predictive than the three biomarkers in combination or the three biomarkers in combination with maximal tumor diameter(S-LAD). | Nicha Wongjarupong Gabriela M Negron-Ocasio Roongruedee Chaiteerakij Benyam D Addissie Essa A Mohamed Kristin C Mara William S Harmsen J Paul Theobald Brian E Peters Joseph G Balsanek Melissa M Ward Nasra H Giama Sudhakar K Venkatesh Denise M Harnois Michael R Charlton Hiroyuki Yamada Alicia Algeciras-Schimnich Melissa R Snyder Terry M Therneau Lewis R Roberts | 2018 | World Journal of Gastroenterology2018，24，12： | 5 |
| 17 | Mental and physical symptoms associated with lower social support for patients with hepatitis C显示文摘AIM: To systematically examine the impact of the hepatitis C virus (HCV) diagnosis on patients' level of social support in a large-scale study. METHODS: Patients evaluated and treated for HCV in a tertiary referral center were enrolled in a cross-sectional study. Demographic data, functional and emotional status as measured by the Hospital Anxiety and Depression Scale (HAD) and the Sickness Impact Profile (SIP), severity of liver disease, mode of acquisition, and physical and psychiatric comorbidities were collected from patients or abstracted from the medical record. All participants completed a semi-structured interview, addressing questions of social support. RESULTS: A total of 342 patients (mean age 45.2 years; 37% women) were enrolled. Ninety-two (27%) patients described lower levels of support by family and friends. Nearly half of the participants (45%) noted the loss of at least one relationship due to the disease. Fears related to transmitting the disease (25%) were common and often associated with ignorance or even discrimination by others (19%). Nearly one fifth of the patients did not share information about their disease with others to avoid being stigmatized. Lower levels of social support were significantly associated with living alone, being unemployed, being excluded from antiviral therapy, having psychiatric comorbidities, contracting HCV through intravenous drug use, having high levels of anxiety and depression as measured by the HAD and negative mood state as measured by the SIP. Patients reporting lower levels of social support also noted more physical symptoms as measured by the SIP. CONCLUSION: Patients with hepatitis C often face significant social problems, ranging from social isolation to familial stress. The most common concerns reflect a limited insight of patients and their relatives and friends about the disease, the risk factors for its spread, and about potential consequences. Our data suggest that educational interventions targeting support persons and the stressors identified in our findings may lessen or alleviate the social strains patients with hepatitis C experience. | Julie A Blasiole Laura Shinkunas Douglas R LaBrecque Robert M Arnold Susan L Zickmund | 2006 | World Journal of Gastroenterology2006，12，29： | 5 |
| 18 | Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer显示文摘 | Douglas K Rex John H Bond Sidney Winawer Theodore R Levin Randall W Burt David A Johnson Lynne M Kirk Scott Litlin David A Lieberman Jerome D Waye James Church John B Marshall Robert H Riddell | 2002 | The American Journal of Gastroenterology2002，，6： | 3 |
| 19 | Outcomes and patients' perspectives of transition from paediatric to adult care in inflammatory bowel disease显示文摘AIM: To describe the disease and psychosocialoutcomes of an inflammatory bowel disease(IBD) transition cohort and their perspectives.METHODS: Patients with IBD, aged > 18 years, who had moved from paediatric to adult care within 10 years were identified through IBD databases at three tertiary hospitals. Participants were surveyed regarding demographic and disease specific data and their perspectives on the transition process. Survey response data were compared to contemporaneously recorded information in paediatric service case notes. Data were compared to a similar age cohort who had never received paediatric IBD care and therefore who had not undergone a transition process. RESULTS: There were 81 returned surveys from 46 transition and 35 non-transition patients. No statistically significant differences were found in disease burden, disease outcomes or adult roles and responsibilities between cohorts. Despite a high prevalence of mood disturbance(35%), there was a very low usage(5%) of psychological services in both cohorts. In the transition cohort, knowledge of their transition plan was reported by only 25/46 patients and the majority(54%) felt they were not strongly prepared. A high rate(78%) of discussion about work/study plans was recorded prior to transition, but a near complete absence of discussion regarding sex(8%), and other adult issues was recorded. Both cohorts agreed that their preferred method of future transition practices(of the options offered) was a shared clinic appointment with all key stakeholders. CONCLUSION: Transition did not appear to adversely affect disease or psychosocial outcomes. Current transition care processes could be optimised, with better psychosocial preparation and agreed transition plans. | Alice L Bennett David Moore Peter A Bampton Robert V Bryant Jane M Andrews | 2016 | World Journal of Gastroenterology2016，22，8： | 3 |
| 20 | Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians显示文摘 | Getchell Jane P Wroblewski Kelly E DeMaria Alfred Bean Christine L Parker Monica M Pandori Mark Dufour D Robert Busch Michael P Brecher Mark E Meyer William A Pesano Rick L Teo Chong-Gee Beckett Geoffrey A Araujo Aufra C Branson Bernard M D | 2013 | MMWR. Morbidity and Mortality Weekly Report2013，，18： | 3 |
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