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1自发性脑出血管理指南 美国心脏协会/美国卒中协会针对医疗专业人员的指南显示文摘目的本指南旨在为自发性脑出血的诊断和治疗提供最新的全面推荐意见。方法利用PubMed进行规范化文献检索,检索时间至2013年8月底。撰写委员会成员通过远程电信会议讨论指南内容及推荐意见,采用美国心脏协会/美国卒中协会的疗效确定性水平和证据分级方案对推荐意见进行分级。由6位同行评议专家以及卒中委员会科学声明监督委员会和卒中委员会领导委员会成员对指南草案进行发表前审阅。结果本文为急性脑出血患者的医疗诊治提供了循证指南,重点包括诊断、凝血功能障碍和血压管理、继发性脑损伤防治、颅内压控制、外科治疗的作用、转归预测、康复、二级预防以及将来需要考虑的问题。本指南已纳入最新的3期临床试验结果。结论脑出血是一种需要进行早期积极救治的危重疾病。本指南为脑出血患者的目标导向治疗提供了一个框架。J. Claude Hemphill Ⅲ Steven M. Greenberg Craig S. Anderson Kyra Beckelr Bernard R. Bendok Mary Cushman Gordon L. Fung Joshua N. Goldstein R. LochMacdonald Pamela H Mitchell, Phillip A Scott,Magdy H Selim, Daniel Woo 高圆圆 徐欣 2015国际脑血管病杂志2015,23,10:444
2Two-dimensional speckle tracking echocardiography for the assessment of atrial function显示文摘Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique.Tomás Francisco Cianciulli María Cristina Saccheri Jorge Alberto Lax Alejandra Marina Bermann Daniel Ernesto Ferreiro 2010World Journal of Cardiology2010,2,7:39
3Percutaneous endoscopic gastrostomy:Indications,technique,complications and management显示文摘Percutaneous endoscopic gastrostomy(PEG)is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition.Besides its wellknown advantages over parenteral nutrition,PEG offers superior access to the gastrointestinal system over surgical methods.Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide,knowing its indications and contraindications is of paramount importance in current medicine.PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish.Broadly,the two main indications of PEG tube placement are enteral feeding and stomach decompression.On the other hand,distal enteral obstruction,severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients.Although generally considered to be a safe procedure,there is the potential for both minor and major complications.Awareness of these potential complications,as well as understanding routine aftercare of the catheter,can improve the quality of care for patients with a PEG tube.These complications can generally be classified into three major categories:endoscopic technical difficulties,PEG procedure-related complications and late complications associated with PEG tube use and wound care.In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance.Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the'pull'technique being the most common method.In the last section of this review,the reader is presented with a brief discussion of these procedures,techniques and related issues.Despite the mentioned PEG tube placement complications,this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.Ata A Rahnemai-Azar Amir A Rahnemaiazar Rozhin Naghshizadian Amparo Kurtz Daniel T Farkas 2014World Journal of Gastroenterology2014,20,24:38
4Methylation-dependent loss of RIP3 expression in cancer represses programmed necrosis in response to chemotherapeutics显示文摘交往受体的蛋白质 kinase-3 (RIP3 或 RIPK3 ) 是执行 “ 的细胞的机械的必要部分; programmed”或 “ regulated”坏死。这里,我们证明那规划坏死响应许多化学疗法的代理人被激活并且贡献导致化疗的房间死亡。然而,我们证明那 RIP3 表情经常在化学疗法的死亡期间由于它的 transcriptional 开始地点, MLKL 的这样 RIP3 依赖的激活和下游地规划的坏死附近的 genomic methylation 是在癌症房间的 silenced 大部分被镇压。不过,有 hypomethylating 代理人的治疗恢复 RIP3 表示,并且从而以一种 RIP3 依赖的方式把敏感提升到 chemotherapeutics。RIP3 表示在 85% 乳癌病人与正常织物相比在肿瘤被减少,建议那 RIP3 缺乏断然在肿瘤生长 / 发展期间被选择。因为 hypomethylating 代理人在病人是相当容忍得好的,我们建议病人们可以从收到 hypomethylating 代理人与常规 chemotherapeutics 在治疗以前导致 RIP3 表示有益于的那 RIP3 缺乏的癌症。Gi-Bang Koo Michael J Morgan Da-Gyum Lee Woo-Jung Kim Jung-Ho Yoon Ja Seung Koo Seung I1 Kim Soo Jung Kim Mi Kwon Son Soon Still Hong Jean M Mulcahy Levy Daniel A Pollyea Craig T Jordan Pearlly Yan David Frankhouser Deedra Nicolet Kati Maharry Guido Marcucci Kyeong Sook Choi Hyeseong Cho ndrew Thorbum You-Sun Kim 2015Cell Research2015,25,6:20
5XRCC1 and DNA polymerase β in cellular protection against cytotoxic DNA single-strand breaks显示文摘Julie K Horton Mary Watson Donna F Stefanick Daniel T Shaughnessy Jack A Taylor Samuel H Wilson 2008Cell Research2008,18,1:17
6Design of 16S rRNA gene primers for 454 pyrosequencing of the human foregut microbiome显示文摘AIM:To design and validate broad-range 16S rRNA primers for use in high throughput sequencing to classify bacteria isolated from the human foregut microbiome.METHODS:A foregut microbiome dataset was constructed using 16S rRNA gene sequences obtained from oral,esophageal,and gastric microbiomes produced by Sanger sequencing in previous studies represented by 219 bacterial species.Candidate primers evaluated were from the European rRNA database.To assess the effect of sequence length on accuracy of classification,16S rRNA genes of various lengths were created by trimming the full length sequences.Sequences spanning various hypervariable regions were selected to simulate the amplicons that would be obtained using possible primer pairs.The sequences were compared with full length 16S rRNA genes for accuracy in taxonomic classification using online software at the Ribosomal Database Project (RDP).The universality of the primer set was evaluated using the RDP 16S rRNA database which is comprised of 433 306 16S rRNA genes,represented by 36 phyla.RESULTS:Truncation to 100 nucleotides(nt)downstream from the position corresponding to base 28 in the Escherichia coli 16S rRNA gene caused misclassification of 87(39.7%)of the 219 sequences,compared with misclassification of only 29(13.2%)sequences with truncation to 350 nt.Among 350-nt sequence reads within various regions of the 16S rRNA gene,the reverse read of an amplicon generated using the 343F/798R primers had the least(8.2%)effect on classification.In comparison,truncation to 900 nt mimicking single pass Sanger reads misclassified 5.0%of the 219 sequences.The 343F/798R amplicon accurately assigned 91.8%of the 219 sequences at the species level.Weighted by abundance of the species in the esophageal dataset,the 343F/798R amplicon yielded similar classification accuracy without a significant loss in species coverage(92%).Modification of the 343F/798R primers to 347F/803R increased their universality among foregut species.Assuming that a typicalpolymerase chain reaction can tolerate 2 mismatches between a primer and a template,the modified 347F and 803R primers should be able to anneal 98%and 99.6%of all 16S rRNA genes in the RDP database.CONCLUSION:347F/803R is the most suitable pair of primers for classification of foregut 16S rRNA genes but also possess universality suitable for analyses of other complex microbiomes.Carlos W Nossa William E Oberdorf Jφrn A Aas Bruce J Paster Todd Z DeSantis Eoin L Brodie Daniel Malamud Michael A Poles Zhiheng Pei 2010World Journal of Gastroenterology2010,16,33:16
7Role of matrix metalloproteinase,tissue inhibitor of metalloproteinase and tumor necrosis factor-α single nucleotide gene polymorphisms in inflammatory bowel disease显示文摘AIM:To study the (functional) relevance of single nucleotide polymorphisms (SNPs) in genes encoding matrix metalloproteinases (MMP)-1,-2,-3,-9,tissue inhibitors of metalloproteinases (TIMP)-1,-2 and tumor necrosis factor (TNF)-α in the etiopathogenesis of inflammatory bowel diseases (IBD),that may enhance susceptibility and/or disease severity. METHODS:Genomic DNA from 134 Crohn's disease (CD),111 ulcerative colitis (UC) patients and 248 control subjects was isolated from resected intestinal tissue or blood. Allelic composition at SNP loci was determined by PCR-RFLP or tetra primer ARMS PCR. RESULTS:The TIMP-1 genotype TT in women and T in men at SNP +372 T/C was found to increase CD susceptibility (39% vs 23.8%,P=0.018 and 67.9% vs 51.6%,P=0.055,respectively),while women with this genotype were less prone to development of fistulae during follow-up (41.4% vs 68.3%,P=0.025). Male IBD or CD patients carrying the TIMP-1 +372 T-allele expressed lower levels of TIMP-1 in surgically resected macroscopically inflamed tissue (0.065 < P < 0.01). The 5T5T genotype at MMP-3 SNP -1613 5T/6T increased the chance of stenotic complications in CD during follow-up (91.2% vs 71.8%,P = 0.022) but seemed to protect against colonic involvement of this disease at first endoscopic/radiologic examination (35.3% vs 59.5%,P=0.017). CONCLUSION:Allelic composition at the examinedSNPs in genes coding for TIMP-1 and MMP-3 affect CD susceptibility and/or phenotype,i.e.,fistulizing disease,stricture pathogenesis and first disease localisation. These findings reinforce the important role of these proteins in IBD.Martin JW Meijer Marij AC Mieremet-Ooms Ruud A van Hogezand Cornelis BHW Lamers Daniel W Hommes Hein W Verspaget 2007World Journal of Gastroenterology2007,13,21:15
8Anterior cruciate ligament reconstruction best practice: A review of graft choice显示文摘There is much literature about differing grafts used in anterior cruciate ligament(ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear 'best' graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.Daniel A Shaerf Philip S Pastides Khaled M Sarraf Charles A Willis-Owen 2014World Journal of Orthopedics2014,5,1:14
9Inhibition of Mcl-1 enhances cell death induced by the Bcl-2-selective inhibitor ABT-199 in acute myeloid leukemia cells显示文摘Acute myeloid leukemia(AML)is a serious disease.The 5-year survival rates remain frustratingly low(65%for children and 26%for adults).Resistance to frontline chemotherapy(usually cytarabine)often develops;therefore a new treatment modality is needed.Bcl-2 family proteins play an important role in balancing cell survival and apoptosis.The antiapoptotic Bcl-2 family proteins have been found to be dysregulated in AML.ABT-199,a BH3 mimetic,was developed to target antiapoptotic protein Bcl-2.Although ABT-199 has demonstrated promising results,resistance occurs.Previous studies in AML show that ABT-199 alone decreases the association of proapoptotic protein Bim with Bcl-2,but this is compensated by increased association of Bim with prosurvival protein Mcl-1,stabilizing Mcl-1,resulting in resistance to ABT-199.In this study,we investigated the antileukemic activity of the Mcl-1-selective inhibitor A-1210477 in combination with ABT-199 in AML cells.We found that A-1210477 synergistically induced apoptosis with ABT-199 in AML cell lines and primary patient samples.The synergistic induction of apoptosis was decreased upon Bak,Bax and Bim knockdown.While A-1210477 treatment alone also increased Mcl-1 protein levels,combination with ABT-199 reduced binding of Bim to Mcl-1.Our results demonstrate that sequestration of Bim by Mcl-1,a mechanism of ABT-199 resistance,can be abrogated by combined treatment with the Mcl-1 inhibitor A-1201477.Daniel A Luedtke Xiaojia Niu Yihang Pan Jianyun Zhao Shuang Liu Holly Edwards Kang Chen Hai Lin Jeffrey W Taub Yubin Ge 2017Signal Transduction and Targeted Therapy2017,2,1:11
10Inflammatory bowel disease serology in Asia and the West显示文摘AIM:To study serological antibodies in Caucasians and Asians,in health and inflammatory bowel disease(IBD),in Australia and Hong Kong(HK).METHODS:Anti-glycan antibodies[anti-chitobioside(ACCA),anti-laminaribioside(ALCA)],and anti-mannobioside(AMCA),anti-Saccharomyces cervisiae(gASCA);and atypical perinuclear anti-neutrophil cytoplasmic antibody(pANCA)were tested in IBD patients,their unaffected relatives,and healthy controls in Australia and HK(China).Antibody status(positive or negative)and titre was compared between subjects of different geography,ethnicity and disease state.RESULTS:Ninety subjects were evaluated:21 Crohn’s disease(CD),32 ulcerative colitis(UC),29 healthy controls,and 8 IBD patient relatives.Forty eight subjects were Australian(29 Caucasian and 19 ethnic Han Chinese)and 42 were from HK(all Han Chinese).Caucasian CD patients had a significantly higher antibody prevalence of gASCA(67%vs 3%,P<0.001),ALCA(44%vs 6%,P=0.005),and AMCA(67%vs 15%,P=0.002),whereas HK CD patients had a higher prevalence of only AMCA(58%vs 25%,P=0.035),when compared with UC and healthy subjects in both countries.Caucasian CD had significantly higher gASCA prevalence(67%vs 0%,P<0.001)and titre(median59 vs 9,P=0.002)than HK CD patients.Prevalence and titres of ALCA,ACCA and AMCA did not differ between CD in the two countries.Presence of at least one antibody was higher in Caucasian than HK CD patients(100%vs 58%,P=0.045).pANCA did not differ between countries or ethnicity.CONCLUSION:Serologic CD responses differ between HK Asian and Australian Caucasian patients.Different genetic,environmental or disease pathogenic factors may account for these differences.Lani Prideaux Michael A Kamm Peter De Cruz Daniel R van Langenberg Siew C Ng Iris Dotan 2013World Journal of Gastroenterology2013,19,37:10
11Accuracy of clinical diagnosis of idiopathic Parkinson's disease:a clinicopathologic study of 100 cases显示文摘Hughes A J Daniel SE Kilford L 1992J Neurol Neurosurg Psychiatry1992,55,3:10
12Colorectal cancer in patients under 50 years of age:A retrospective analysis of two institutions' experience显示文摘AIM:To investigate the epidemiological characteristics of colorectal cancer(CRC)in patients under 50 years of age across two institutions.METHODS:Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two institutions.The following documents where reviewed:admission notes,operative notes,and discharge summaries.The main study variables included:age,presenting symptoms,family history,tumor location,operation,stage/differentiation of disease,and post operative complications.Stage of disease was classified according to the American Joint Committee on Cancer TNM staging system:tumor depth;node status;and metastases.RESULTS:CRC was found in 180 patients under age50 years(87 females,93 males;mean age 41.4±6.2years).Young patients accounted for 11.2%of cases during a 6 year period for which the full data set wasavailable.Eight percent had a 1stdegree and 12%a 2nd degree family CRC history.Almost all patients(94%)were symptomatic at diagnosis;common symptoms included:bleeding(59%),obstruction(9%),and abdominal/rectal pain(35%).Evaluation was often delayed and bleeding frequently attributed to hemorrhoids.Advanced stage CRC(Stage 3 or 4)was noted in 53%of patients.Most tumors were distal to the splenic flexure(77%)and 39%involved the rectum.Most patients(95%)had segmental resections;6 patients had subtotal/total colectomy.Poorly differentiated tumors were noted in 12%and mucinous lesions in 19%of patients of which most had Stage 3 or 4 disease.Twenty-two patients(13%)developed recurrence and/or progression of disease to date.Three patients(ages 42,42and 49 years)went on to develop metachronous primary colon cancers within 3 to 4 years of their initial resection.CONCLUSION:CRC was common in young patients with no family history.Young patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.Elizabeth A Myers Daniel L Feingold Kenneth A Forde Tracey Arnell Joon Ho Jang Richard L Whelan 2013World Journal of Gastroenterology2013,19,34:9
13Taking advantage of the potential of mesenchymal stromal cells in liver regeneration:Cells and extracellular vesicles as therapeutic strategies显示文摘Cell-based therapies for acute and chronic liver diseases are under continuous progress. Mesenchymal stem/stromal cells(MSCs) are multipotent cells able to migrate selectively to damaged tissue and contribute to its healing and regeneration. The MSC pro-regenerative effect occurs due to their immunomodulatory capacity and their ability to produce factors that promote cell protection and survival. Likewise,it has been observed that part of their paracrine effect is mediated by MSC-derived extracellular vesicles(EVs). EVs contain proteins,lipids and nucleic acids(DNA,m RNA,mi RNA,lnc RNA) from the cell of origin,allowing for intercellular communication. Recently,different studies have demonstrated that MSC-derived EVs could reproduce,at least in part,the biological effects obtained by MSCbased therapies. Moreover,due to EVs' stability for long periods of time and easy isolation methods they have become a therapeutic option to MSCs treatments. This review summarizes the latest results achieved in clinical trials using MSCs as cell therapy for liver regeneration,the role of EVs in liver physiopathology and the potential of MSC-derived EVs as intercellular mediators and therapeutic tools in liver diseases.Esteban Juan Fiore Luciana María Domínguez Juan Bayo Mariana Gabriela García Guillermo Daniel Mazzolini 2018World Journal of Gastroenterology2018,24,23:9
14Gastroenteropancreatic 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 2008Lancet Oncology2008,,1:8
15Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice?显示文摘Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored. Here, a case of carcinoma-in-situ is presented in a 7 mm gallbladder polyp. A 25-year-old woman, who had undergone a routine cholecystectomy, was found to have an incidental 7 mm polyp containing carcinoma in situ. She had few to no risk factors to alert to her condition. There are few reported cases of cancer transformation in gallbladder polyps smaller than 10 mm reported in the literature. The overwhelming consensus, barring significant risk factors for cancer being present, is that such lesions should be monitored until they become symptomatic or develop signs suspicious for malignancy. In our patient's case this could have led to the possibility of missing a neoplastic lesion, which could then have gone on to develop invasive cancer. As gallbladder carcinoma is an aggressive cancer, this may have led to a tragic outcome.David Kasle Amir A Rahnemai-Azar Shahida Bibi Vinaya Gaduputi Brian F Gilchrist Daniel T Farkas 2015World Journal of Gastrointestinal Endoscopy2015,7,9:8
16Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C显示文摘AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C virus(HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography(TE) [FibroS can~/ARFI technology(Virtual Touch~)] and SM [FIB-4/aspartate aminotransferase-toplatelet ratio index(APRI)].The diagnostic performance of these tests was assessed using receiver operating characteristic curves.The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2,F ≥ 3 and F = 4.The Kappa index set the concordance analysis.RESULTS Fifty point six percent were female and the median age was 51 years(30-78).Fifty-six patients(70%) weretreatment-na?ve.The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kP a,for acoustic radiation force impulse(ARFI) 1.22 m/s,for APRI 0.75 and for FIB-4 1.47.For F ≥ 3 TE was 8.9 kP a,ARFI was 1.48 m/s,APRI was 0.75,and FIB-4 was 2.For F = 4,TE was 12.2 kP a,ARFI was 1.77 m/s,APRI was 1.46,and FIB-4 was 3.91.The APRI could not distinguish between F2 and F3,P = 0.92.The negative predictive value for F = 4 for TE and ARFI was 100%.Kappa index values for F ≥ 3 METAVIR score for TE,ARFI and FIB-4 were 0.687,0.606 and 0.654,respectively.This demonstrates strong concordance between all three screening methods,and moderate to strong concordance between them and APRI(Kappa index = 0.507).CONCLUSION Given the costs and accessibility of LSM methods,and the similarity with the outcomes of SM,we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis.This is of particular importance to developing countries.Denise C Paranaguá-Vezozzo Adriana Andrade Daniel F C Mazo Vinicius Nunes Ana L Guedes Taisa G Ragazzo Renata Moutinho Lucas S Nacif Suzane K Ono Venancio A F Alves Flair J Carrilho 2017World Journal of Hepatology2017,9,8:7
17Complications associated with prone positioning in elective spinal surgery显示文摘Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity.Although many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ systems.Perioperative visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral cortex.Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery.Peripheral nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative events.Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit rarely.Other uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been reported.Many of these are well-understood and largely avoidable through thoughtful attention to detail.Other complications,such as POVL,remain incompletely understood and thus more difficult to predict or prevent.Here,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.J Mason De Passe Mark A Palumbo Maahir Haque Craig P Eberson Alan H Daniels 2015World Journal of Orthopedics2015,6,3:7
18Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis显示文摘We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.Emily K Smith Edmund Ek Daniel Croagh Lavinia A Spain Stephen Farrell 2009World Journal of Gastroenterology2009,15,38:7
19Juvenile polyposis syndrome显示文摘Juvenile polyposis syndrome is a rare autosomal dominant syndrome characterized by multiple distinct juvenile polyps in the gastrointestinal tract and an increased risk of colorectal cancer.The cumulative life-time risk of colorectal cancer is 39% and the relative risk is 34.Juvenile polyps have a distinctive histology characterized by an abundance of edematous lamina propria with inflammatory cells and cystically dilated glands lined by cuboidal to columnar epithelium with reactive changes.Clinically,juvenile polyposis syndrome is defined by the presence of 5 or more juvenile polyps in the colorectum,juvenile polyps throughout the gastrointestinal tract or any number of juvenile polyps and a positive family history of juvenile polyposis.In about 50%-60% of patients diagnosed with juvenile polyposis syndrome a germline mutation in the SMAD4 or BMPR1A gene is found.Both genes play a role in the BMP/TGF-beta signalling pathway.It has been suggested that cancer in juvenile polyposis may develop through the socalled 'landscaper mechanism' where an abnormal stromal environment leads to neoplastic transformation of the adjacent epithelium and in the end invasive carcinoma.Recognition of this rare disorder is important for patients and their families with regard to treatment,follow-up and screening of at risk individuals.Each clinician confronted with the diagnosis of a juvenile polyp should therefore consider the possibility of juvenile polyposis syndrome.In addition,juvenile polyposis syndrome provides a unique model to study colorectal cancer pathogenesis in general and gives insight in the molecular genetic basis of cancer.This review discusses clinical manifestations,genetics,pathogenesis and management of juvenile polyposis syndrome.Lodewijk AA Brosens Danielle Langeveld W Arnout van Hattem Francis M Giardiello G Johan A Offerhaus 2011World Journal of Gastroenterology2011,17,44:7
20Chronic stress sensitizes rats to pancreatitis induced by cerulein:Role of TNF-α显示文摘AIM:To investigate chronic stress as a susceptibility factor for developing pancreatitis,as well as tumor necrosis factor-α (TNF-α) as a putative sensitizer.METHODS:Rat pancreatic acini were used to analyze the influence of TNF-α on submaximal (50 pmol/L) cholecystokinin (CCK) stimulation.Chronic restraint (4 h every day for 21 d) was used to evaluate the effects of submaximal (0.2 μg/kg per hour) cerulein stimulation on chronically stressed rats.RESULTS:In vitro exposure of pancreatic acini toTNF-α disorganized the actin cytoskeleton.This was further increased by TNF-α/CCK treatment,which additionally reduced amylase secretion,and increased trypsin and nuclear factor-κB activities in a protein-kinase-C δ and ε-dependent manner.TNF-α/CCK also enhanced caspases' activity and lactate dehydrogenase release,induced ATP loss,and augmented the ADP/ATP ratio.In vivo,rats under chronic restraint exhibited elevated serum and pancreatic TNF-α levels.Serum,pancreatic,and lung inflammatory parameters,as well as caspases' activity in pancreatic and lung tissue,were substantially enhanced in stressed/cerulein-treated rats,which also experienced tissues' ATP loss and greater ADP/ATP ratios.Histological examination revealed that stressed/cerulein-treated animals developed abundant pancreatic and lung edema,hemorrhage and leukocyte infiltrate,and pancreatic necrosis.Pancreatitis severity was greatly decreased by treating animals with an anti-TNF-αantibody,which diminished all inflammatory parameters,histopathological scores,and apoptotic/necrotic markers in stressed/cerulein-treated rats.CONCLUSION:In rats,chronic stress increases susceptibility for developing pancreatitis,which involves TNF-α sensitization of pancreatic acinar cells to undergo injury by physiological cerulein stimulation.Marcelo G Binker Andres A Binker-Cosen Daniel Richards Herbert Y Gaisano Rodica H de Cosen Laura I Cosen-Binker 2010World Journal of Gastroenterology2010,16,44:7
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