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| 1 | Current clinical approach to achalasia显示文摘Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus. These motor abnormalities lead to dysphagia, stasis, regurgitation, weight loss, or secondary respiratory complications. Although major strides have been made in understanding the pathogenesis of this rare disorder, including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals, a definite trigger has not been identified. The diagnosis of achalasia is suggested by clinical features and conf irmed by further diagnostic tests, such as esophagogastroduodenoscopy (EGD), manometry or barium swallow. These studies are not only used to exclude pseudoachalasia, but also might help to categorize the disease by severity or clinical subtype. Recent advances in diagnostic methods, including high resolution manometry (HRM), might allow prediction of treatment responses. The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods. Although limited high-quality data exist, it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients. However, the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease, but also on local expertise and patient preferences. | Alexander J Eckardt Volker F Eckardt | 2009 | World Journal of Gastroenterology2009，15，32： | 20 |
| 2 | Impact of lattice relaxations on phase transitions in a high-entropy alloy studied by machine-learning potentials显示文摘Recently,high-entropy alloys(HEAs)have attracted wide attention due to their extraordinary materials properties.A main challenge in identifying new HEAs is the lack of efficient approaches for exploring their huge compositional space.Ab initio calculations have emerged as a powerful approach that complements experiment.However,for multicomponent alloys existing approaches suffer from the chemical complexity involved.In this work we propose a method for studying HEAs computationally.Our approach is based on the application of machine-learning potentials based on ab initio data in combination with Monte Carlo simulations.The high efficiency and performance of the approach are demonstrated on the prototype bcc NbMoTaW HEA.The approach is employed to study phase stability,phase transitions,and chemical short-range order.The importance of including local relaxation effects is revealed:they significantly stabilize single-phase formation of bcc NbMoTaW down to room temperature.Finally,a so-far unknown mechanism that drives chemical order due to atomic relaxation at ambient temperatures is discovered. | Tatiana Kostiuchenko Fritz Körmann Jörg Neugebauer Alexander Shapeev | 2019 | npj Computational Materials2019，，1： | 17 |
| 3 | Anticancer immunotherapy by CTLA-4 blockade: obligatory contribution of IL-2 receptors and negative prognostic impact of soluble CD25显示文摘堵住抗体 ipilimumab 的细胞毒素的 T 淋巴细胞 antigen-4 (CTLA-4 ) 在很少的病人导致变形黑瘤的调停免疫者的长期的控制。尽管 ipilimumab 无疑经由 immunostimulation 施加它的治疗学的效果,这样远的临床上有用的、 immunologically 相关的 biomarkers 预言治疗效率是逃犯的。这里,我们显示出 IL-2 的那中立化或堵住 α并且 βIL-2 受体的子单元(CD25 和 CD122,分别地) 否则在现出症状之前的潜的老鼠模型由 CTLA-4 封锁导致了,废除了 antitumor 效果和 intratumoral T 受动器对规章的房间(Tregs ) 的比率的伴随的改进,它是。CTLA-4 封锁导致了在失去了 FoxP3 表示并且在 regressing 肿瘤积累了的 IL-2-producing 受动器房间与伴随物上升表示 Lag3, ICOS, IL-10 和 Egr2 的一个镇压 CD4 + T 房间子集的减小。当 recombinant IL-2 改进了 CTLA-4 封锁的治疗学的功效时,圈套 IL-2 受体 α(IL-2Rα, sCD25 ) 禁止了 CTLA-4 的 anticancer 效果封锁。在收到 ipilimumab 的 262 个变形黑瘤病人, sCD25 的基线浆液集中代表了全面幸存的独立指示物,与预言到治疗的抵抗的高水平。总的来说,这些结果解开为在 CTLA-4 的 anticancer 活动的 IL-2 和 IL-2 受体的一个角色封锁。重要地,我们的学习提供第一 immunologically 相关的 biomarker,也就是提高的浆液 sCD25,那与黑瘤在病人预言抵抗到 CTLA-4 封锁。 | Dalil Hannani Marie Vetizou David Enot Sylvie Rusakiewicz Nathalie Chaput David Klatzmann Melanie Desbois Nicolas Jacquelot Nadege Vimond Salem Chouaib Christine Mateus James P Allison Antoni Ribas Jedd D Wolchok Jianda Yuan Philip Wong Michael Postow Andrzej Mackiewicz Jacek Mackiewicz Dirk Schadendorff Dirk Jaeger Alan J Korman Keith Bahjat Michele Maio Luana Calabro Michele WL Teng Mark J Smyth Alexander Eggennont Caroline Robert Guido Kroemer Laurence Zitvogel | 2015 | Cell Research2015，25，2： | 14 |
| 4 | Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma显示文摘AIM: To assess the safety and efficacy of trans-arterial chemo-embolization (TACE) in very elderly patients. METHODS: A prospective cohort study, from 2001 to 2010, compared clinical outcomes following TACE between patients ≥ 75 years old and younger patients (aged between 65 and 75 years and younger than 65 years) with hepatocellular carcinoma (HCC), diagnosed according to the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases criteria. The decision that patients were not candidates for curative therapy was made by a multidisciplinary HCC team. Data collected included demographics, co-morbidities, liver disease etiology, liver disease severity and the number of procedures. The primary outcome was mortality; secondary outcomes included post-embolization syndrome (nausea, fever, abdominal right upper quadrant pain, increase in liver enzymes with no evidence of sepsis and with a clinical course limited to 3-4 d post procedure) and 30-d complications. Additionally, changes in liver enzyme measurements were assessed [alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transpeptidase and alkaline phosphatase] in the week following TACE. Analysis employed both univariate and multivariate methods (Cox regression models). RESULTS: Of 102 patients who underwent TACE as sole treatment, 10 patients (9.8%) were > 80 years old at diagnosis; 13 (12.7%) were between 75 and 80 years, 45 (44.1%) were between 65 and 75 years and 34 (33.3%) were younger than 65 years. Survival analysis demonstrated similar survival patterns between the elderly patients and younger patients. Age was also not associated with the adverse event rate. Survival rates at 1, 2 and 3 years from diagnosis were 74%, 37% and 31% among patients < 65 years; 83%, 66% and 48% among patients aged 65 to 75 years; and 86%, 41% and 23% among patients ≥ 75 years. There were no differences between the age groups in the pre-procedural care, including preventive treatment for contrast nephropathy and prophylactic antibiotics. Multivariate survival analysis, controlling for disease stage at diagnosis with the Barcelona Clinic Liver Cancer score, number of TACE procedures, sex and alphafetoprotein level at the time of diagnosis, found no significant difference in the mortality hazard for elderly vs younger patients, and there were no differences in post-procedural complications. Serum creatinine levels did not change after 55% of the procedures, in all age groups. In 42% of all procedures, serum creatinine levels increased by no more than 25% above the baseline levels prior to TACE. Overall, there were 69 post-embolization events (23%). Hepatocellular enzymes often increased following TACE, with no association with prognosis. In 40% of the procedures, ALT and AST levels rose by at least 100%. The increases in hepatocellular enzymes occurred similarly in all age groups. CONCLUSION: TACE is safe and effective in very elderly patients with HCC, and is not associated with decreased survival or increased complication rates. | Matan J Cohen Allan I Bloom Orly Barak Alexander Klimov Tova Nesher Daniel Shouval Izhar Levi Oren Shibolet | 2013 | World Journal of Gastroenterology2013，19，16： | 13 |
| 5 | Effect of 5-FU on modulation of disarrangement of immune-associated cytokines in experimental acute pancreatitis显示文摘AIM:To investigate the effects of 5-Fluorouracil (5-FU) on modulation of pro-inflammatory and anti-inflammatory cytokines in acute pancreatitis and the mechanism of it in the treatment of acute pancreatitis.METHODS: Male Sprague Dawley rats were assigned to 3 Groups: Group A, sham operated rats as controls (n=7); Group B, acute pancreatitis induced by ductal injection with 5% sodium cholate at a volume of 1.0 mL/kg without any other treatment; Group C, after the pancreatitis was induced as in Group B, the rats were injected intravenously with 5-FU 40 mg/kg. The animals in Groups B and C were killed at 2, 6 and 24 h after operation (n=7), and blood samples were taken for measurement of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6) (by bioas-say), and interleukin-10 (IL-10), transforming growth factor-β (TGF-β) (by ELISA). The wet weight of pancreatic tissue, serum amylase levels and white blood cells were also measured.RESULTS: Four rats in Group B and one in Group C died after pancreatitis was induced. Both pro-inflammatory cytokines (TNF-α, IL-1, IL-6) at the 2 and 6 h period and the anti-inflammatory cytokines (IL-10, TGF-β) at 24 h increased signif icantly (P<0.05) in rats of Group B. After treatment with 5-FU, TNF-α, IL-1, and IL-6 in serum of rats of Group C were inhibited at 2 and 6 h after operation (P<0.05), and IL-10, TGF-β were inhibited at 24 h compared to Group B (P<0.05). Obvious improvements in the severity of the acute pancreatitis, including the amylase levels, wet weight of pancreatic tissue and neutrophil counts, were also observed after treatment with 5-FU.CONCLUSION: 5-FU is an anti-metabolic and immu-nosuppressive agent which can minimize the abnormal immune cytokine response and relieve the pathophysiological disorders associated with experimental acute pancreatitis. | Xiao-Li Chen Sang-Zhu Ciren Hui Zhang Li-Geng Duan Alexander J Wesley | 2009 | World Journal of Gastroenterology2009，15，16： | 10 |
| 6 | Role of the endothelium in inflammatory bowel diseases显示文摘Inflammatory bowel diseases(IBD) are a complex group of diseases involving alterations in mucosal immunity and gastrointestinal physiology during both initiation and progressive phases of the disease.At the core of these alterations are endothelial cells,whose continual adjustments in structure and function coordinate vascular supply,immune cell emigration,and regulation of the tissue environment.Expansion of the endothelium in IBD(angiogenesis),mediated by inflammatory growth factors,cytokines and chemokines,is a hallmark of active gut disease and is closely related to disease severity.The endothelium in newly formed or inflamed vessels differs from that in normal vessels in the production of and response to inflammatory cytokines,growth factors,and adhesion molecules,altering coagulant capacity,barrier function and blood cell recruitment in injury.This review examines the roles of the endothelium in the initiation and propagation of IBD pathology and distinctive features of the intestinal endothelium contributing to these conditions. | Walter E Cromer J Michael Mathis Daniel N Granger Ganta V Chaitanya J Steven Alexander | 2011 | World Journal of Gastroenterology2011，17，5： | 10 |
| 7 | Return to sport following tibial plateau fractures: A systematic review显示文摘AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords 'tibial', 'plateau', 'fractures', 'knee', 'athletes', 'sports', 'non-operative', 'conservative', 'operative', 'return to sport'. All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded 'return to sport'rates. Only one study recorded a 'return to sport' time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation. | Greg A J Robertson Seng J Wong Alexander M Wood | 2017 | World Journal of Orthopedics2017，8，7： | 10 |
| 8 | Laparoscopic surgery for benign and malign diseases of the digestive system:Indications,limitations,and evidence显示文摘The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s.Since then,the development of this technique has been extraordinary.Triggered by technical innovations(stapling devices or coagulation/dissecting devices),nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition.This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence.Main indications remain the more common procedures,e.g.,appendectomy,cholecystectomy,bariatric procedures or colorectal resections.For all these indications,the laparoscopic approach has become the gold standard with less perioperative morbidity.Regarding oncological outcome there have been several highquality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections.Less common procedures like esophagectomy,oncological gastrectomy,liver and pancreatic resections can be performed successfully as well by anexperienced surgeon.However,the evidence for these special indications is poor and a general recommendation cannot be given.In conclusion,laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery. | Markus Alexander Küper Friederike Eisner Alfred K?nigsrainer J?rg Glatzle | 2014 | World Journal of Gastroenterology2014，20，17： | 9 |
| 9 | Glutamate reduces experimental intestinal hyperpermeability and facilitates glutamine support of gut integrity显示文摘AIM:To assess whether glutamate plays a similar role to glutamine in preserving gut wall integrity.METHODS:The effects of glutamine and glutamate on induced hyperpermeability in intestinal cell lines were studied.Paracellular hyperpermeability was induced in Caco2.BBE and HT-29CL.19A cell lines by adding phorbol-12,13-dibutyrate(PDB) apically,after which the effects of glutamine and glutamate on horseradish peroxidase(HRP) diffusion were studied.An inhibitor of glutamate transport(L-trans-pyrrolidine-2,4-dicarboxylic acid:trans-PDC) and an irreversible blocker(acivicin) of the extracellular glutamine to glutamate converting enzyme,γ-glutamyltransferase,were used.RESULTS:Apical to basolateral HRP flux increased significantly compared to controls not exposed to PDB (n=30,P<0.001).Glutamine application reduced hyperpermeability by 19%and 39%in the respective cell lines.Glutamate application reduced hyperpermeability by 30%and 20%,respectively.Incubation of HT29CL.19A cells with acivicin and subsequent PDB and glutamine addition increased permeability levels.Incubation of Caco2.BBE cells with trans-PDC followed by PDB and glutamate addition also resulted in high permeability levels.CONCLUSION:Apical glutamate-similar to glutaminecan decrease induced paracellular hyperpermeability.Extracellular conversion of glutamine to glutamate and subsequent uptake of glutamate could be a pivotal step in the mechanism underlying the protective effect of glutamine. | Mechteld AR Vermeulen Jeffrey de Jong Mathijs J Vaessen Paul AM van Leeuwen Alexander PJ Houdijk | 2011 | World Journal of Gastroenterology2011，17，12： | 9 |
| 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 | Highly efficient derivation of ventricular cardiomyocytes from induced pluripotent stem cells with a distinct epigenetic signature显示文摘从 pluripotent 干细胞导出的 Cardiomyocytes 能在药测试,疾病建模和基于房间的治疗被使用。没有 procardiogenic 生长因素,然而,从 pluripotent 干细胞的 cardiomyogenesis 的效率通常是低的,产生 cardiomyocyte 人口是异构的。这里,我们证明导致的 pluripotent 干细胞( iPSCs )能从鼠科的室的 myocytes ( VM )被导出,并且与从各种各样的体的房间类型导出的 iPSCs 的另外的报告一致,自发地作为与遗传上匹配的胚胎的干细胞(转换字符)或 iPSCs 相比区分 cardiomyocytes 进跳动的显著地更高的倾向从尾巴尖端成纤维细胞导出的 导出VM 的 iPSCs ( ViPSCs )展览。惊人地,导出 ViPSC 的 cardiomyocytes 显示的多数室的显型。在 ViPSCs 的提高的室的 myogenesis 在区别的早阶段经由心血管的祖先的增加的数字被调停。以便从 ViPSCs 调查提高的室的 myogenesis 的机制,我们执行了全球基因表示和 DNA methylation 分析,它揭示了可以涉及在 pluripotent 干细胞指定 VM 命运的不同 epigenetic 签名。 | Huansheng Xu B Alexander Yi Hao Wu Christoph Bock Hongcang Gu Kathy O Lui Joo-Hye C Park Ying Shao Alyssa K Riley Ibrahim J Domian Erding Hu Robert Willette John Lepore Alexander Meissner Zhong Wang Kenneth R Chien | 2012 | Cell Research2012，22，1： | 7 |
| 12 | Lower limb stress fractures in sport:Optimising their management and outcome显示文摘Stress fractures in sport are becoming increasing more common,comprising up to 10%of all of sporting injuries.Around 90%of such injuries are located in the lower limb.This articles aims to define the optimal management of lower limb stress fractures in the athlete,with a view to maximise return rates and minimise return times to sport.Treatment planning of this condition is specific to the location of the injury.However,there remains a clear division of stress fractures by'high'and'low'risk.'Low risk'stress fractures are those with a low probability of fracture propagation,delayed union,or non-union,and so can be managed reliably with rest and exercise limitation.These include stress fractures of the PosteroMedial Tibial Diaphysis,Metatarsal Shafts,Distal Fibula,Medial Femoral Neck,Femoral Shaft and Calcaneus.'High risk'stress fractures,in contrast,have increased rates of fracture propagation,displacement,delayed and non-union,and so require immediate cessation of activity,with orthopaedic referral,to assess the need for surgical intervention.These include stress fractures of the Anterior Tibial Diaphysis,Fifth Metatarsal Base,Medial Malleolus,Lateral Femoral Neck,Tarsal Navicular and Great Toe Sesamoids.In order to establish the optimal methods for managing these injuries,we present and review the current evidence which guides the treatment of stress fractures in athletes.From this,we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport.Following this,key recommendations are provided for the management of the common stress fracture types seen in the athlete.Five case reports are also presented to illustrate the application of sportfocussed lower limb stress fracture treatment in the clinical setting. | Greg A J Robertson Alexander M Wood | 2017 | World Journal of Orthopedics2017，8，3： | 7 |
| 13 | Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal metastases显示文摘AIM:To systematically review the available evidence regarding cytoreductive surgery(CRS) and intraperitoneal chemotherapy(IPC) for colorectal peritoneal metastases(CPM).METHODS:An electronic literature search was carried out to identify publications reporting oncological outcome data(overall survival and/or disease free survival and/or recurrence rates)following CRS and IPC for treatment of CPM.Studies reporting outcomes following CRS and IPC for cancer subtypes other than colorectal were only included if data were reported independently for colorectal cancer-associated cases;in addition studies reporting outcomes for peritoneal carcinomatosis of appendiceal origin were excluded.RESULTS:Twenty seven studies,published between1999 and 2013 with a combined population of 2838patients met the predefined inclusion criteria.Included studies comprised 21 case series,5 case-control studies and 1 randomised controlled trial.Four studies provided comparative oncological outcome data for patients undergoing CRS in combination with IPC vs systemic chemotherapy alone.The primary indication for treatment was CPM in 96%of cases(2714/2838)and recurrent CPM(rCPM)in the remaining 4%(124/2838).In the majority of included studies(20/27)CRS was combined with hyperthermic intraperitoneal chemotherapy(HIPEC).In 3 studies HIPEC was used in combination with early post-operative intraperitoneal chemotherapy(EPIC),and 2 studies used EPIC only,following CRS.Two studies evaluated comparative outcomes with CRS+HIPEC vs CRS+EPIC for treatment of CPM.The delivery of IPC was performed using an'open'or'closed'abdomen approach in the included studies.CONCLUSION:The available evidence presented in this review indicates that enhanced survival times can be achieved for CPM after combined treatment with CRS and IPC. | Reza Mirnezami Brendan J Moran Kate Harvey Tom Cecil Kandiah Chandrakumaran Norman Carr Faheez Mohamed Alexander H Mirnezami | 2014 | World Journal of Gastroenterology2014，20，38： | 6 |
| 14 | Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention显示文摘Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed. | Richard A Brogan Christopher J Malkin Philip D Batin Alexander D Simms James M McLenachan Christopher P Gale | 2014 | World Journal of Cardiology2014，6，8： | 6 |
| 15 | Appropriately adapted properties of hot-extruded Zn-0.5Cu-xFe alloys aimed for biodegradable guided bone regeneration membrane application显示文摘Appropriately adapted comprehensive mechanical properties,degradation behavior and biocompatibility are prerequisites for the application of Zn-based biodegradable implants.In this study,hot-extruded Zn-0.5Cu-xFe(x=0.1,0.2 and 0.4 wt%)alloys were fabricated as candidates for biodegradable materials for guided bone regeneration(GBR)membranes.The hot-extrusion process and Cu alloying were expected mostly to enhance the mechanical properties,and the Fe alloying was added mainly for regulating the degradation.The microstructure,mechanical properties and in vitro degradation behavior were systematically investigated.The ZnCuFe alloys were composed of a Zn matrix and FeZn13 phase.With increasing Fe content,a higher FeZn13 phase precipitation with larger particles was observed.Since elongation declined significantly until fracture with increasing Fe content up to 0.4 wt%,the ZnCuFe(0.2 wt%)alloy achieved a good balance between mechanical strength and ductility,with an ultimate tensile strength of 202.3 MPa and elongation at fracture of 41.2%.Moreover,the addition of Fe successfully accelerated the degradation of ZnCuFe alloys.The ZnCuFe(0.2 wt%)alloy showed relatively uniform corrosion in the long-term degradation test.Furthermore,extracts of the ZnCuFe(0.2 wt%)alloy showed no apparent cytotoxic effects against L929 fibroblasts,Saos-2 osteoblasts or TAg periosteal cells.The ZnCuFe(0.2 wt%)alloy exhibited the potential to inhibit bacterial adhesion of Streptococcus gordonii and mixed oral bacteria.Our study provides evidence that the ZnCuFe(0.2 wt%)alloy can represent a promising material for the application as a suitable GBR membrane. | Wentai Zhang Ping Li Gang Shen Xiaoshan Mo Chao Zhou Dorothea Alexander Frank Rupp Jürgen Geis-Gerstorfer Haijun Zhang Guojiang Wan | 2021 | Bioactive Materials2021，6，4： | 6 |
| 16 | Biliary complications following liver transplantation: Singlecenter experience over three decades and recent risk factors显示文摘AIM To identify independent risk factors for biliary complications in a center with three decades of experience in liver transplantation.METHODS A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease(MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logisticregression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate. RESULTS Biliary complications were observed in 227 cases(14.1%). Four hundred and seventeen(26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21%(n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46%(n = 41)], anastomotic strictures [25%(n = 22)], cholangitis [8%(n = 7)] and non-anastomotic strictures [3%(n = 3)]. The remaining 18%(n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation(P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively(P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation(P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of 0.702.CONCLUSION The parallel occurrence of high recipient MELD and impaired donor kidney function should be avoided. Risk is especially increased when post-transplant hepatic artery thrombosis occurs. | Alexander Kaltenborn André Gutcke Jill Gwiasda Jürgen Klempnauer Harald Schrem | 2017 | World Journal of Hepatology2017，9，3： | 6 |
| 17 | 纤维母细胞生长因子对复合皮肤移植成活和收缩的影响显示文摘我们曾报道应用同基因表层皮片(IE)和同种异基因真皮(AD)组成复合皮肤移植物(CSG)可一次完成全层皮肤缺损的永久性修复。但由于IE不能及时获得足够血运,IE常有部分坏死,CSG后期收缩仍较明显。在本研究中我们进一步用纤维母细胞生长因子(FGF)预先处理AD获得较好效果。经观察17周表明,FGF组皮片坏死率和坏死面积较对照组明显下降(P<0.05);FGF组CSG收缩较对照组明显减轻(P<0.001);皮片坏死面积与皮片最终面积呈负相关(r=-0.450,P<0.05)。实验预示,完全成活的CSG后期收缩较移植同等厚度的IE为轻。观察2年,AD未被排斥。 | 方承辉 Robb E C 于光曙 Alexander J W Warden G D | 1993 | 中华整形烧伤外科杂志1993，9，1： | 6 |
| 18 | Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography显示文摘AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. | Michael P Swan Michael J Bourke Stephen J Williams Sina Alexander Alan Moss Rick Hope David Ruppin | 2011 | World Journal of Gastroenterology2011，17，45： | 6 |
| 19 | 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 |
| 20 | Update in the treatment of intracranial atherosclerotic disease显示文摘This review highlights the recent evolution of the imaging,medical management,surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease(ICAD).Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed,not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment.Potential future developments in the treatment of ICAD are discussed,including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries,new iterations of self-expanding intracranial stents with easier delivery systems,and the re-examination of indirect surgical bypass techniques for revascularisation.In addition to these important technological developments,however,is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology. | Zachary R Barnard Michael J Alexander | 2020 | Stroke & Vascular Neurology2020，5，1： | 5 |
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