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| 1 | 帕博利珠单抗单用或与放疗联用治疗转移性非小细胞肺癌:两个随机试验的汇总分析显示文摘背景放疗可以提高整个机体对免疫治疗的应答。在Ⅱ期PEMBRO-RT研究和Ⅰ/Ⅱ期MDACC研究中,患有转移性非小细胞肺癌(NSCLC)的患者被随机分配入组,接受免疫治疗(帕博利珠单抗)+放疗联合疗法,或免疫治疗单一疗法。当上述2个研究单独分析时,联合疗法组显示出潜在获益。由于每个研究的样本量较小,缓解率和结局并未显示出统计学意义,然而却有显著的临床获益。因此,本研究进行汇总分析,来判断放疗是否会改善转移性NSCLC患者的免疫治疗应答。方法PEMBRO-RT和MDACC研究纳入标准:患者年龄≥18岁,患有转移性NSCLC,且有≥1处未经放疗照射的病灶,以便进行射野外应答监测。PEMBRO-RT研究纳入曾接受过化疗患者,MDACC研究纳入曾接受过治疗或新诊断患者。2个研究中的患者均未接受过免疫治疗。在PEMBRO-RT研究中患者被等比例随机分配入组,并根据吸烟状态进行分层(分为<10年组和≥10年组)。MDACC研究的患者根据放疗计划可行性被等比例随机分配入2个受试组。由于联合治疗组的干预本质,每个研究中的放疗均不适用盲法。在2个研究中,不论是否进行放疗,均静脉滴入帕博利珠单抗(每3周200 mg)。在PEMBRO-RT研究中,在放疗(24 Gy 3次分割照射)结束后1周给予第1剂帕博利珠单抗。在MDACC研究中,在第1次放疗(50 Gy 4次分割照射或45 Gy 15次分割照射)同时给予帕博利珠单抗。仅检测未经照射病灶的应答。本研究的终点为最佳射野外(远隔)应答率(ARR)、最佳射野外疾病控制率(ACR)、12周时ARR、12周时ACR、无进展生存期(PFS)和总生存期(OS)。2个研究的意向治疗(ITT)人群均纳入分析。PEMBRO-RT研究(NCT02492568)和MDACC研究(NCT02444741)均在ClinicalTrials.gov上注册。发现纳入148例患者,76例接受帕博利珠单抗治疗,72例接受帕博利珠单抗+放疗治疗。所有患者随访时间中位数为33个月[四分位距(IQR):32.4~33.6]。148例患者中124例(84%)组织学特征为非鳞癌,111例(75%)患者曾经接受过化疗。组间没有基线特征差异,包括PD-L1表达状态和转移灶体积。最常见的照射部位为肺转移灶(39%,28/72)、胸腔内淋巴结(21%,15/72)和非原发灶(17%,12/72)。帕博利珠单抗组和联合治疗组的最佳ARR分别为19.7%(15/76)和41.7%(30/72),OR=2.96,95%CI:1.42~6.20,P=0.0039;最佳ACR分别为43.4%(33/76)和65.3%(47/72),OR=2.51,95%CI:1.28~4.91,P=0.0071;PFS中位数分别为4.4(IQR:2.9~5.9)和9.0个月(IQR:6.8~11.2),HR=0.67,95%CI:0.45~0.99,P=0.045;OS中位数分别为8.7(IQR:6.4~11.0)和19.2个月(IQR:14.6~23.8),OR=0.67,95%CI:0.54~0.84,P=0.0004。在汇总分析中没有发现新的安全问题。解读帕博利珠单抗免疫疗法+放疗显著提高转移性NSCLC患者的应答和改善治疗结局。这些结果需要在三期临床试验中进行验证。 | 陈大卫(翻译) 于金明(校对) Willemijn S M E Theelen Vivek Verma Brian P Hobbs Heike M U Peulen Joachim G J V Aerts Idris Bahce Anna Larissa N Niemeijer Joe Y Chang Patricia M de Groot Quynh-Nhu Nguyen Nathan I Comeaux George R Simon Ferdinandos Skoulidis Steven H Lin Kewen He Roshal Patel John Heymach Paul Baas James W Welsh | 2021 | 中华肿瘤防治杂志2021，28，24： | 49 |
| 2 | Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis显示文摘AIM To evaluate the prognostic value of the phase angle(PA)obtained from bioelectrical impedance analysis(BIA) for mortality prediction in patients with cirrhosis. METHODS In total, 134 male cirrhotic patients prospectively completed clinical evaluations and nutritional assessment by BIA to obtain PAs during a 36-mo follow-up period. Mortality risk was analyzed by applying the PA cutoff point recently proposed as a malnutrition marker(PA ≤ 4.9°) in Kaplan-Meier curves and multivariate Cox regression models. RESULTS The patients were divided into two groups according to the PA cutoff value(PA > 4.9°, n = 73; PA ≤ 4.9°, n = 61). Weight, height, and body mass index were similar in both groups, but patients with PAs > 4.9° were younger and had higher mid-arm muscle circumference, albumin, and handgrip-strength values and lower severe ascites and encephalopathy incidences, interleukin(IL)-6/IL-10 ratios and C-reactive protein levels than did patients with PAs ≤ 4.9°(P ≤ 0.05). Forty-eight(35.80%) patients died due to cirrhosis, with a median of 18 mo(interquartile range, 3.3-25.6 mo) follow-up until death. Thirty-one(64.60%) of these patients were from the PA ≤ 4.9° group. PA ≤ 4.9° significantly and independently affected the mortality model adjusted for Model for End-Stage Liver Disease score and age(hazard ratio = 2.05, 95%CI: 1.11-3.77, P = 0.021). In addition, Kaplan-Meier curves showed that patients with PAs ≤ 4.9° were significantly more likely to die. CONCLUSION In male patients with cirrhosis, the PA ≤ 4.9° cutoff was associated independently with mortality and identified patients with worse metabolic, nutritional, and disease progression profiles. The PA may be a useful and reliable bedside tool to evaluate prognosis in cirrhosis. | Giliane Belarmino Maria Cristina Gonzalez Raquel S Torrinhas Priscila Sala Wellington Andraus Luiz Augusto Carneiro D'Albuquerque Rosa Maria R Pereira Valéria F Caparbo Graziela R Ravacci Lucas Damiani Steven B Heymsfield Dan L Waitzberg | 2017 | World Journal of Hepatology2017，9，7： | 11 |
| 3 | Immune checkpoint inhibitor-related hepatotoxicity:A review显示文摘The application of immune checkpoint inhibitors(ICI)in advanced cancer has been a major development in the last decade.The indications for ICIs are constantly expanding into new territory across different cancers,disease stages and lines of therapy.With this increased use,adverse events including immune checkpoint inhibitor-related hepatotoxicity(ICH)have emerged as an important clinical problem.This along with the introduction of ICI as first-and second-line treatments for advanced hepatocellular carcinoma makes ICH very relevant to gastroenterologists and hepatologists.The incidence of ICH varies between 1%-20%depending on the number,type and dose of ICI received.Investigation and management generally involve excluding differential diagnoses and following a stepwise escalation of withholding or ceasing ICI,corticosteroid treatment and adding other immunosuppressive agents depending on the severity of toxicity.The majority of patients with ICH recover and some may even safely recommence ICI therapy.Guideline recommendations are largely based on evidence derived from retrospective case series which highlights a priority for future research. | Devika Remash David S Prince Catriona McKenzie Simone I Strasser Steven Kao Ken Liu | 2021 | World Journal of Gastroenterology2021，27，32： | 9 |
| 4 | One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality:role of the multidisciplinary approach显示文摘BACKGROUND:Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers.This,however,is a major undertaking in most patients and is associated with a significant morbidity and mortality.A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis,resection rate,mortality and morbidity.We undertook the study to assess the effect of this approach on diagnosis,resection rates and short-term outcomes such as morbidity and mortality.METHODS:A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed.All cases were discussed at a multidisciplinary meeting comprising surgeons,gastroenterologists,radiologists,oncologists,radiation oncologists,pathologists and nursing staff.A standardized investigation and management algorithm was followed.Complications were graded according to the Clavien-Dindo classification.RESULTS:A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%).Sixty-one patients (34%) required either a vascular or an additional organ resection.Eighty-nine patients experienced complications,of which the commonest was blood transfusion (12%).Thirty-four patients (19%) had major complications,i.e.grade 3 or above.There was no in-hospital,30-day or 60-day mortality.CONCLUSIONS:Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality.The surgeon's role should be careful patient selection,intensive preoperative investigations,use of a team approach,and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients. | Jaswinder S Samra Raul Alvarado Bachmann Julian Choi Anthony Gill Michael Neale Vikram Puttaswamy Cameron Bell Ian Norton Sarah Cho Steven Blome Ritchie Maher Sivakumar Gananadha Thomas J Hugh | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，4： | 8 |
| 5 | Circular smooth muscle contributes to esophageal shortening during peristalsis显示文摘AIM:To study the angle between the circular smooth muscle(CSM) and longitudinal smooth muscle(LSM) fibers in the distal esophagus.METHODS:In order to identify possible mechanisms for greater shortening in the distal compared to proximal esophagus during peristalsis,the angles between the LSM and CSM layers were measured in 9 cadavers.The outer longitudinal layer of the muscularis propria was exposed after stripping the outer serosa.The inner circular layer of the muscularis propria was then revealed after dissection of the esophageal mucosa and the underlying muscularis mucosa.Photographs of each specimen were taken with half of the open esophagus folded back showing both the outer longitudinal and inner circular muscle layers.Angles were measured every one cm for 10 cm proximal to the squamocolumnar junction(SCJ) by two independent investigators.Two human esophagi were obtained from organ transplant donors and the angles between the circular and longitudinal smooth muscle layers were measured using micro-computed tomography(micro CT) and Image J software.RESULTS:All data are presented as mean ± SE.The CSM to LSM angle at the SCJ and 1 cm proximal to SCJ on the autopsy specimens was 69.3 ± 4.62 degrees vs 74.9 ± 3.09 degrees,P = 0.32.The CSM to LSM angle at SCJ were statistically significantly lower than at 2,3,4 and 5 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 82.58 ± 1.34 degrees,84.04 ± 1.64 degrees,84.87 ± 1.04 degrees and 83.72 ± 1.42 degrees,P = 0.013,P = 0.008,P = 0.004,P = 0.009 respectively.The CSM to LSM angle at SCJ was also statistically significantly lower than the angles at 6,7 and 8 cm proximal to the SCJ,69.3 ± 4.62 degrees vs 80.18 ± 2.09 degrees,81.81 ± 1.75 degrees and 80.96 ± 2.04 degrees,P = 0.05,P = 0.02,P = 0.03 respectively.The CSM to LSM angle at 1 cm proximal to SCJ was statistically significantly lower than at 3,4 and 5 cm proximal to the SCJ,74.94 ± 3.09 degrees vs 84.04 ± 1.64 degrees,84.87 ± 1.04 degrees and 83.72 ± 1.42 degrees,P = 0.019,P = 0.008,P = 0.02 respectively.At 10 cm above SCJ the angle was 80.06 ± 2.13 degrees which is close to being perpendicular but less than 90 degrees.The CSM to LSM angles measured on virtual dissection of the esophagus and the stomach on micro CT at the SCJ and 1 cm proximal to the SCJ were 48.39 ± 0.72 degrees and 50.81 ± 1.59 degrees.Rather than the angle of the CSM and LSM being perpendicular in the esophagus we found an acute angulation between these two muscle groups throughout the lower 10 cm of the esophagus.CONCLUSION:The oblique angulation of the CSM may contribute to the significantly greater shortening of distal esophagus when compared to the mid and proximal esophagus during peristalsis. | Anil K Vegesna Keng-Yu Chuang Ramashesai Besetty Steven J Phillips Alan S Braverman Mary F Barbe Michael R Ruggieri Larry S Miller | 2012 | World Journal of Gastroenterology2012，18，32： | 7 |
| 6 | Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections显示文摘Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompt-ing increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor. | Christopher S Kovacs Jr Christine E Koval David van Duin Amanda Guedes de Morais Blanca E Gonzalez Robin K Avery Steven D Mawhorter Kyle D Brizendine Eric D Cober Cyndee Miranda Rabin K Shrestha Lucileia Teixeira Sherif B Mossad | 2014 | World Journal of Transplantation2014，4，2： | 7 |
| 7 | CaMKII in cerebral ischemia显示文摘神经原上的 Ischemic 侮辱触发引起 Ca 导致 neuronal 房间死亡(excitotoxicity ) 的 2+ 超载的过多的、病理学的 glutamate 版本。Ca 2+/calmodulin (凸轮) 依赖者蛋白质 kinase II (CaMKII ) 是位于 neuronal 粘性下面并且学习的生理的有刺激性的 glutamate 信号的一个主要调停人。Glutamate 刺激在 T286 触发 CaMKII 的 autophosphorylation,使 kinase 成为 “ 的一个过程; autonomous”(从 Ca 2+ 刺激的部分活跃的独立人士) 并且那为 synaptic 的形式被要求粘性。最近的研究为侮辱以后的 neuroprotection 作为潜在的药目标也建议了自治 CaMKII 活动,在在 neuronal 文化的 glutamate 侮辱以后并且在在 vivo 的焦点的服的局部缺血以后。然而, CaMKII 和凸轮 kinase 家庭的另外的成员在 neuronal 死亡和幸存的规定被含有。这里,我们在 excitotoxicity 和服的局部缺血讨论过去的调查结果和凸轮 kinase 功能的可能的机制,与 CaMKII 和它的规定的一个焦点。 | Steven J COULTRAP Rebekah S VEST Nicole M ASHPOLE Andy HUDMON K Ulrich BAYEF | 2011 | Acta Pharmacologica Sinica2011，32，7： | 6 |
| 8 | Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis显示文摘Systemic corticosteroids represent the standard treatment for autoimmune pancreatitis with IgG4-associated cholangitis.For steroid-dependent disease,azathioprine has been used for maintenance of remission.Mycophenolate mofetil has been used for transplant immunosuppression and more recently for autoimmune hepatitis;however,there are no case reports to date on the use of mycophenolate mofetil in adult patients with autoimmune pancreatitis.A patient with IgG4-mediated autoimmune pancreatitis and IgG4-associated cholangitis refractory to steroids and intolerant of azathioprine was treated with mycophenolate mofetil,which inhibits de novo guanosine synthesis and blockade of both B and T lymphocyte production.Introduction of mycophenolate mofetil and uptitration to 1000 mg by mouth twice daily over a treatment period of 4 mo was associated with improvement in the patient's energy level and blood glucose control and was not associated with any adverse events.The patient was managed without a biliary stent.However,there was a return of symptoms,jaundice,increase in transaminases,and hyperbilirubinemia when the prednisone dose reached 11 mg per day.In the first report of mycophenolate mofetil use in an adult patient with IgG4-associated autoimmune pancreatitis and IgG4-associated cholangitis,the introduction of mycophenolate mofetil was safe and well-tolerated without adverse events,but it did not enable discontinuation of the steroids.Mycophenolate mofetil and other immunomodulatory therapies should continue to be studied for maintenance of remission in the large subset of patients with refractory or recurrent autoimmune pancreatitis. | Jamie B Sodikoff Steven A Keilin Sheila J Bharmal Melinda M Lewis Gottumukkala S Raju Field F Willingham | 2012 | World Journal of Gastroenterology2012，18，18： | 6 |
| 9 | Dyslipidemia management in primary prevention of cardiovascular disease:Current guidelines and strategies显示文摘Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making costeffective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk. | Aditya D Hendrani Tolulope Adesiyun Renato Quispe Steven R Jones Neil J Stone Roger S Blumenthal Seth S Martin | 2016 | World Journal of Cardiology2016，8，2： | 5 |
| 10 | Crohn’s and colitis in children and adolescents显示文摘Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases(IBD).These conditions have become increasingly common in recent years,including in children and young people.Although much is known about aspects of the pathogenesis of these diseases,the precise aetiology is not yet understood,and there remains no cure.Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life,including in infancy.Pain,diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children.However,atypical symptoms may occur in both conditions:these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythema nodosum.Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis.Consideration of possible IBD and completion of appropriate investi-gations are essential to ensure prompt diagnosis,thereby avoiding the consequences of diagnostic delay.Patterns of disease including location and progression of IBD in childhood differ substantially from adultonset disease.Various treatment options are available for children and adolescents with IBD.Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease.Medical and surgical therapies need to considered within the context of a growing and developing child.The overall management of these chronic conditions in children should include multi-disciplinary expertise,with focus upon maintaining control of gut inflammation,optimising nutrition,growth and quality of life,whilst preventing disease or treatment-related complications. | Andrew S Day Oren Ledder Steven T Leach Daniel A Lemberg | 2012 | World Journal of Gastroenterology2012，18，41： | 4 |
| 11 | Status review of mercury control options for coal-fired power plants显示文摘 | John H Pavlish Everett A Sondreal Michael D Mann Edwin S Olson Kevin C Galbreath Dennis L Laudal Steven A Benson | 2003 | Fuel Processing Technology2003，，2： | 4 |
| 12 | Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder显示文摘AIM:To classify gallstone disease as a basis for assessment of post-cholecystectomy symptoms.METHODS:One hundred and fifty three patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder (FGID) before and at six months after cholecystectomy.Symptom frequency groups (SFG) were categorized according to frequency of pain attacks.According to certain pain characteristics in gallstone patients,a gallstone symptom score was accorded on a scale from one to ten.A visual analogue scale was used to quantify pain.Operative specimens were examined for size and magnitude of stone contents as well as presence of bacteria.Follow-up took place after six months with either a consultation or via a mailed questionnaire.Results were compared with those obtained pre-operatively to describe and analyze symptomatic outcome.RESULTS:SFG groups were categorized as severe (24.2%),moderate (38.6%) and mild (22.2%) attack frequency,and a chronic pain condition (15%).Pain was cured or improved in about 90% of patients and two-thirds of patients obtained complete symptom relief.Patients with the most frequent pain episodes were less likely to obtain symptom relief.FGID was present in 88% of patients pre-operatively and in 57% postoperatively (P=0.244).Those that became asymptomatic or improved with regard to pain also had most relief from FGID (P=0.001).No pre-operative FGID meant almost complete cure.CONCLUSION:Only one third of patients with FGID experienced postoperative relief,indicating that FGID was a dominant cause of post-cholecystectomy symptoms. | Malte Schmidt Karl Sφndenaa John A Dumot Steven Rosenblatt Trygve Hausken Maria Ramnefjell Gro Njφlstad Geir Egil Eide | 2012 | World Journal of Gastroenterology2012，18，12： | 4 |
| 13 | Neuroprotective and anti-inflammatory effects of a therapy combining agonists of nicotinic α7 and σ1 receptors in a rat model of Parkinson’s disease显示文摘To date there is no treatment able to stop or slow down the loss of dopaminergic neurons that characterizes Parkinson’s disease.It was recently observed in a rodent model of Alzheimer’s disease that the interaction between the α7 subtype of nicotinic acetylcholine receptor(α7-nAChR)and sigma-1 receptor(σ1-R)could exert neuroprotective effects through the modulation of neuroinflammation which is one of the key components of the pathophysiology of Parkinson’s disease.In this context,the aim of the present study was to assess the effects of the concomitant administration of N-(3R)-1-azabicyclo[2.2.2]oct-3-yl-furo[2,3-c]pyridine-5-carboxamide(PHA)543613 as an α7-nAChR agonist and 2-(4-morpholinethyl)1-phenylcyclohexanecarboxylate(PRE)-084 as aσ1-R agonist in a well-characterized 6-hydroxydopamine rat model of Parkinson’s disease.The animals received either vehicle separately or the dual therapy PHA/PRE once a day until day 14 postlesion.Although no effect was noticed in the amphetamine-induced rotation test,our data has shown that the PHA/PRE treatment induced partial protection of the dopaminergic neurons(15-20%),assessed by the dopamine transporter density in the striatum and immunoreactive tyrosine hydroxylase in the substantia nigra.Furthermore,this dual therapy reduced the degree of glial activation consecutive to the 6-hydroxydopamine lesion,i.e,the 18 kDa translocation protein density and glial fibrillary acidic protein staining in the striatum,and the CD11b and glial fibrillary acidic protein staining in the substantia nigra.Hence,this study reports for the first time that concomitant activation of α7-nAChR andσ1-R can provide a partial recovery of the nigro-striatal dopaminergic neurons through the modulation of microglial activation.The study was approved by the Regional Ethics Committee(CEEA Val de Loire n°19)validated this protocol(Authorization N°00434.02)on May 15,2014. | Steven Vetel Laura Foucault-Fruchard Claire Tronel Frédéric Buron Jackie Vergote Sylvie Bodard Sylvain Routier Sophie Sérrière Sylvie Chalon | 2021 | Neural Regeneration Research2021，16，6： | 3 |
| 14 | Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis显示文摘BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures. | Supisara Tintara Ishani Shah William Yakah Awais Ahmed Cristina S Sorrento Cinthana Kandasamy Steven D Freedman Darshan J Kothari Sunil G Sheth | 2022 | World Journal of Gastroenterology2022，28，16： | 3 |
| 15 | Constitutive androstane receptor agonist, TCPOBOP,attenuates steatohepatitis in the methionine choline-deficientdiet-fed mouse显示文摘AIM:To ascertain whether constitutive androstane receptor(CAR)activation by 1,4-bis-2-(3,5,-dichloropyridyloxy)benzene(TCPOBOP)modulates steatohepatitis in the methionine choline-deficient(MCD)diet-fed animal.METHODS:C57/BL6 wild-type mice were fed the MCD or standard diet for 2 wk and were treated with either the CAR agonist,TCPOBOP,or the CAR inverse agonist,androstanol.RESULTS:Expression of CYP2B10 and CYP3A11,known CAR target genes,increased 30-fold and 45-fold,respectively,in TCPOBOP-treated mice fed the MCD diet.TCPOBOP treatment reduced hepatic steatosis(44.6 ± 5.4% vs 30.4 ± 4.5%,P < 0.05)and serum triglyceride levels(48 ± 8 vs 20 ± 1 mg/dL,P < 0.05)in MCD diet-fed mice as compared with the standard diet-fed mice.This reduction in hepatic steatosis was accompanied by an increase in enzymes involved in fatty acid microsomal ω-oxidation and peroxisomal β-oxidation,namely CYP4A10,LPBE,and 3-ketoacyl-CoA thiolase.The reduction in steatosis was also accompanied by a reduction in liver cell apoptosis and inflammation.In contrast,androstanol was without effect on any of the above parameters.CONCLUSION:CAR activation stimulates induction of genes involved in fatty acid oxidation,and ameliorates hepatic steatosis,apoptosis and inflammation. | Edwina S Baskin-Bey Akira Anan Hajime Isomoto Steven F Bronk Gregory J Gores | 2007 | World Journal of Gastroenterology2007，13，42： | 3 |
| 16 | The use of ultrasonic cleaning for ultrafiltration membranes in the dairy industry显示文摘 | S Muthukumaran K Yang A Seuren S Kentish M Ashokkumar G.W Stevens F Grieser | 2004 | Separation and Purification Technology2004，，1： | 2 |
| 17 | Metastatic recurrence to a solitary lymph node four years after hepatic lobectomy for primary hepatocellular carcinoma显示文摘This report describes a patient that developed recurrent metastatic hepatocellular carcinoma(HCC) to a suprapancreatic lymph node four years after being treated for primary HCC via complete left hepatectomy. Metastatic HCC was proven by pathologic confirmation. The report addresses the role of surgical resection as a treatment modality for recurrent HCC to solitary lymph nodes. The role of biological chemotherapy as adjuvant treatment is also addressed. | Michael L Caparelli Nathan J Roberts Timothy S Braverman Robert M Stevens Edward R Broun Shyam Allamaneni | 2016 | World Journal of Hepatology2016，8，23： | 2 |
| 18 | A randomized, double blind study of interleukin 10 for the prevention of ERCP-induced pancreatitis显示文摘 | John A Dumot Darwin L Conwell Gregory Zuccaro John J Vargo Steven S Shay Kirk A Easley Jeffrey L Ponsky | 2001 | The American Journal of Gastroenterology2001，，7： | 2 |
| 19 | Pathophysiology and treatment of Barrett's esophagus显示文摘Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the United States. About 10%-15% of patients with GERD develop Barrett’s esophagus, which can progress to adenocarcinoma, currently the most prevalent type of esophageal cancer. The esophagus is normally lined by squamous mucosa, therefore, it is clear that for adenocarcinoma to develop, there must be a sequence of events that result in transformation of the normal squamous mucosa into columnar epithelium. This sequence begins with gastroesophageal reflux, and with continued injury metaplastic columnar epithelium develops. This article reviews the pathophysiology of Barrett’s esophagus and implications for its treatment. The effect of medical and surgical therapy of Barrett’s esophagus is compared. | Daniel S Oh Steven R DeMeester | 2010 | World Journal of Gastroenterology2010，16，30： | 2 |
| 20 | Preclinical Profile and Characterization of the Hepatitis C Virus NS3 Protease Inhibitor Asunaprevir (BMS-650032)显示文摘 | Fiona McPhee Amy K. Sheaffer Jacques Friborg Dennis Hernandez Paul Falk Guangzhi Zhai Steven Levine Susan Chaniewski Fei Yu Diana Barry Chaoqun Chen Min S. Lee Kathy Mosure Li-Qiang Sun Michael Sinz Nicholas A. Meanwell Richard J. Colonno Jay Knipe Paul S | 2012 | Antimicrobial Agents and Chemotherapy2012，，10： | 2 |
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