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| 1 | 血管性认知损害诊断的进一步规范化:血管性认知损害分类共识研究组指南显示文摘引言血管性认知损害(vascular cognitive impairment,VCI)诊断共识的缺乏(体现为多种不同评估方案的使用),妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究(Vascular Impairment of Cognition Classification Consensus Study,VICCCS),旨在就VCI的诊断原则(VICCCS-1)和诊断方案(VICCCS-2)达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲(Delphi)调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65~79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网(National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN)发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作. | Olivia A. Skrobot Sandra E. Black Christopher Chen Charles DeCarli Timo Erkinjuntti Gary A. Ford Rajesh N. Kalaria John O'Brien Leonardo Pantoni Florence Pasquier Gustavo C. Roman Anders Wallin Perminder Sachdev Ingmar Skoog the VICCCS group Yoav Ben-Shlomo Anthony P. Passmore Seth Love Patrick G. Kehoe 朱婷珂 徐俊 | 2018 | 国际脑血管病杂志2018，26，4： | 58 |
| 2 | 胆囊癌的临床诊疗现状与挑战显示文摘胆囊癌在胃肠道癌症中位居第五位,同时它也是胆道最常见的恶性肿瘤,约占80%~95%。这种肿瘤预后不佳,总体5年生存率低于5%,平均中位生存期〈6个月。因为胆囊癌在进展时可以没有任何症状,所以早期诊断是至关重要。术前诊断为胆囊结石,而术后确诊为胆囊癌的发生率为0.5%~1.5%。如果术前怀疑患者胆囊癌,则不应通过腹腔镜手术。流行病学研究已经确定了胆囊癌的发病率有地理和种族的显著差异:美洲的印第安人高发,东南亚地区也比较高,但在美洲和世界的其他地区发病率较低。环境诱发因素在胆囊癌的发展过程中发挥关键作用,胆石症、胆道和寄生虫感染的慢性炎症是最好的例证。在过去的10年里,改进成像技术和改良根治的手术方法可改善患者的预后,并帮助延长胆囊癌患者的存活时间。对于R0切除的胆囊癌患者,其总体5年生存率为21%~69%。在将来,潜在的诊断标志物的发展将对那些种族易感性或已知胆道解剖异常的人群提供早期筛查诊断的机会。 | Mislav Raki? Leonardo Patrlj Mario Kopljar Robert Kli?ek Marijan Kolovrat Bozo Loncar Zeljko Busic 冯铁诚 | 2016 | 中国普通外科杂志2016，25，2： | 24 |
| 3 | Laparoscopic liver resection:Experience based guidelines显示文摘Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. | fabricio ferreira coelho jaime arthur pirola kruger gilton marques fonseca raphael leonardo cunha araújo vagner birk jeismann marcos vinícius perini renato micelli lupinacci ivan cecconello paulo herman | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 22 |
| 4 | Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings显示文摘AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates. | Estuardo Salgado Yepez Maria M Bovera Victor D Rosenthal Hugo A González Flores Leonardo Pazmino Francisco Valencia Nelly Alquinga Vanessa Ramirez Edgar Jara Miguel Lascano Veronica Delgado Cristian Cevallos Gasdali Santacruz Cristian Pelaéz Celso Zaruma Diego Barahona Pinto | 2017 | World Journal of Biological Chemistry2017，8，1： | 23 |
| 5 | Gut microbiota and metabolic syndrome显示文摘Gut microbiota exerts a significant role in the pathogenesis of the metabolic syndrome,as confirmed by studies conducted both on humans and animal models.Gut microbial composition and functions are strongly influenced by diet.This complex intestinal'superorganism'seems to affect host metabolic balance modulating energy absorption,gut motility,appetite,glucose and lipid metabolism,as well as hepatic fatty storage.An impairment of the fine balance between gut microbes and host’s immune system could culminate in the intestinal translocation of bacterial fragments and the development of'metabolic endotoxemia',leading to systemic inflammation and insulin resistance.Diet induced weight-loss and bariatric surgery promote significant changes of gut microbial composition,that seem to affect the success,or the inefficacy,of treatment strategies.Manipulation of gut microbiota through the administration of prebiotics or probiotics could reduce intestinal low grade inflammation and improve gut barrier integrity,thus,ameliorating metabolic balance and promoting weight loss.However,further evidence is needed to better understand their clinical impact and therapeutic use. | Davide Festi Ramona Schiumerini Leonardo Henry Eusebi Giovanni Marasco Martina Taddia Antonio Colecchia | 2014 | World Journal of Gastroenterology2014，20，43： | 23 |
| 6 | 华北强震断层面解和震源深度特征显示文摘本文利用远震P波及SH波和区域地震P_(nl)波波形反演方法,测定了华北9次强震的断层面解、震源深度及地震矩.结合其他作者测定的7次地震的结果,分析了华北16次强震断层面解及华北地震震源深度特征.结果表明,华北多数强震为走滑型地震,也有个别正断层型及逆断层型地震;16次地震多数发生在地壳中部10—25km深度范围内. | 汪素云 James Ni 马宗晋 张郢珍 Leonardo Seeber John G. Armbruster 张立人 | 1991 | 地球物理学报1991，34，1： | 21 |
| 7 | Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging显示文摘BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma(HCC)that underwent liver transplant(LT)after drug-eluting beads transarterial chemoembolization(DEB-TACE)for downstaging versus bridging.Overall survival and tumor recurrence rates were calculated,eligibility for LT,time on the waiting list and radiological response were compared.After TACE,only patients within Milan Criteria(MC)were transplanted.More patients underwent LT in bridging group.Five-year post-transplant overall survival,recurrence-free survival has no difference between the groups.Complete response was observed more frequently in bridging group.Patients in DS group can achieve posttransplant survival and HCC recurrence-free probability,at five years,just like patients within MC in patients undergoing DEB-TACE.AIM To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.METHODS Prospective cohort study of 200 patients included from April 2011 through June 2014.Bridging group included patients within MC.Downstaging group(out of MC)was divided in 5 subgroups(G1 to G5).Total tumor diameter was≤8 cm for G1,2,3,4(n=42)and was>8 cm for G5(n=22).Downstaging(n=64)and bridging(n=136)populations were not significantly different.Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method.Additionally,eligibility for LT,time on the waiting list until LT and radiological response were compared.RESULTS After TACE,only patients within MC were transplanted.More patients underwent LT in bridging group 65.9%(P=0.001).Downstaging population presented:higher number of nodules 2.81(P=0.001);larger total tumor diameter 8.09(P=0.001);multifocal HCC 78%(P=0.001);more post-transplantation recurrence 25%(P=0.02).Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT(P=0.005).Median time on the waiting list was significantly longer in downstaging group 10.6 mo(P=0.028).Five-year posttransplant overall survival was 73.5%in downstaging and 72.3%bridging groups(P=0.31),and recurrence-free survival was 62.1%in downstaging and 74.8%bridging groups(P=0.93).Radiological response:complete response was observed more frequently in bridging group(P=0.004).CONCLUSION Tumors initially exceeding the MC down-staged after DEB-TACE,can achieve post-transplant survival and HCC recurrence-free probability,at five years,just like patients within MC in patients undergoing DEB-TACE. | Breno Boueri Affonso Francisco Leonardo Galastri Joaquim Mauricio da Motta Leal Filho Felipe Nasser Priscila Mina Falsarella Rafael Noronha Cavalcante Marcio Dias de Almeida Guilherme Eduardo Goncalves Felga Leonardo Guedes Moreira Valle Nelson Wolosker | 2019 | World Journal of Gastroenterology2019，25，37： | 21 |
| 8 | Gastric cancer, Helicobacter pylori infection and other risk factors显示文摘Gastric cancer incidence is declining. However, it is too early to consider this neoplastic disease as rare and the worldwide mortality rate still remains high. Several risk factors have been identif ied for non-cardia gastric cancer and primary prevention is feasible since most of the risk factors can be removed. Helicobacter pylori eradication treatment reduces but does not abolish gastric cancer risk. Indeed, gastric cancer is a multifactorial disease and removing one factor does not therefore prevent all cases. Endoscopic surveillance is still needed, especially in subjects at higher risk. The def inition of high-risk patients will be the future challenge as well as identifying the best surveillance strategy for such patients. | Lorenzo Fuccio Leonardo Henry Eusebi Franco Bazzoli | 2010 | World Journal of Gastrointestinal Oncology2010，2，9： | 17 |
| 9 | Liver transplantation for hepatocellular carcinoma: Where do we stand?显示文摘Hepatocellular carcinoma represents an important cause of morbidity and mortality worldwide. It is the sixth most common cancer and the fourth leading cause of cancer death. Liver transplantation is a key tool for the treatment of this disease in human therefore hepatocellular carcinoma is increasing as primary indication for grafting. Although liver transplantation represents an outstanding therapy for hepatocellular carcinoma, due to organ shortage, the careful selection and management of patients who may have a major survival benefit after grafting remains a fundamental question. In fact, only some stages of the disease seem amenable of this therapeutic option, stimulating the debate on the appropriate criteria to select candidates. In this review we focused on current criteria to select patients with hepatocellular carcinoma for liver transplantation as well as on the strategies (bridging) to avoid disease progression and exclusion from grafting during the stay on wait list. The treatments used to bring patients within acceptable criteria (down-staging), when their tumor burden exceeds the standard criteria for transplant, are also reported. Finally, we examined tumor reappearance following liver transplantation. This occurrence is estimated to be approximately 8%-20% in different studies. The possible approaches to prevent this outcome after transplant are reported with the corresponding results. | Francesco Santopaolo Ilaria Lenci Martina Milana Tommaso Maria Manzia Leonardo Baiocchi | 2019 | World Journal of Gastroenterology2019，25，21： | 15 |
| 10 | Ten years of sorafenib in hepatocellular carcinoma: Are there any predictive and/or prognostic markers?显示文摘Sorafenib has been considered the standard of care for patients with advanced unresectable hepatocellular carcinoma(HCC) since 2007 and numerous studieshave investigated the role of markers involved in the angiogenesis process at both the expression and genetic level and clinical aspect. What results have ten years of research produced? Several clinical and biological markers are associated with prognosis. The most interesting clinical parameters are adverse events, Barcelona Clinic Liver Cancer stage, and macroscopic vascular invasion, while several single nucleotide polymorphisms and plasma angiopoietin-2 levels represent the most promising biological biomarkers. A recent pooled analysis of two phase III randomized trials showed that the neutrophil-to-lymphocyte ratio, etiology and extra-hepatic spread are predictive factors of response to sorafenib, but did not identify any predictive biological markers. After 10 years of research into sorafenib there are still no validated prognostic or predictive factors of response to the drug in HCC. The aim of the present review was to summarize 10 years of research into sorafenib, looking in particular at the potential of associated clinical and biological markers to predict its efficacy in patients with advanced HCC. | Giorgia Marisi Alessandro Cucchetti Paola Ulivi Matteo Canale Giuseppe Cabibbo Leonardo Solaini Francesco G Foschi Serena De Matteis Giorgio Ercolani Martina Valgiusti Giovanni L Frassineti Mario Scartozzi Andrea Casadei Gardini | 2018 | World Journal of Gastroenterology2018，24，36： | 14 |
| 11 | Central role of the LEAFY COTYLEDON1 transcription factor in seed development显示文摘Seed development is a complex period of the flowering plant life cycle.After fertilization,the three main regions of the seed,embryo,endosperm and seed coat,undergo a series of developmental processes that result in the production of a mature seed that is developmentally arrested,desiccated,and metabolically quiescent.These processes are highly coordinated,both temporally and spatially,to ensure the proper growth and development of the seed.The transcription factor,LEAFY COTYLEDON1(LEC1),is a central regulator that controls several aspects of embryo and endosperm development,including embryo morphogenesis,photosynthesis,and storage reserve accumulation.Thus,LEC1 regulates distinct sets of genes at different stages of seed development.Despite its critical importance for seed development,an understanding of the mechanisms underlying LECi's multifunctionality is only beginning to be obtained.Recent studies describe the roles of specific transcription factors and the hormones,gibberellic acid and abscisic acid,in controlling the activity and transcriptional specificity of LEC1 across seed development.Moreover,studies indicate that LEC1 acts as a pioneer transcript!on factor to promote epigenetic reprogramming during embryogenesis.In this review,we discuss the mechanisms that enable LEC1 to serve as a central regulator of seed development. | Leonardo Jo Julie M.Pelletier John J.Harada | 2019 | Journal of Integrative Plant Biology2019，61，5： | 14 |
| 12 | 气象卫星云图的多分辨小波分解及人工神经网络降水估计研究显示文摘采用多分辨小波分析对卫星图象进行预处理 ,在保留其特征信息的同时 ,减小了数据量 ,改善了神经网络训练过程的收敛性能 ,提高了处理速度。采用这一方法根据 GOES- 8的红外亮温图象和气象雷达资料对巴西圣保罗州中部的降水量估计进行了试验 ,取得了良好的效果。 | 李伟钢 Maria C V Ramirez Nelson J Ferreira 石立华 Leonardo D de A Sá | 2000 | 南京气象学院学报2000，23，2： | 13 |
| 13 | Neural EGF-like protein 1(NELL-1):Signaling crosstalk in mesenchymal stem cells and applications in regenerative medicine显示文摘Bone tissue regeneration holds the potential to solve both osteoporosis and large skeletal defects,two problems associated with significant morbidity.The differentiation of mesenchymal stem cells into the osteogenic lineage requires a specific microenvironment and certain osteogenic growth factors.Neural EGF Like-Like molecule 1(NELL-1)is a secreted glycoprotein that has proven,both in vitro and in vivo,to be a potent osteo-inductive factor.Furthermore,it has been shown to repress adipogenic differentiation and inflammation.NELL-1 can work synergistically with other osteogenic factors such as Bone Morphogenic Protein(BMP)2 and9,and has shown promise for use in tissue engineering and as a systemically administered drug for the treatment of osteoporosis.Here we provide a comprehensive up-to-date review on the molecular signaling cascade of NELL-1 in mesenchymal stem cells and potential applications in bone regenerative engineering. | Mikhail Pakvasa Alex Alverdy Sami Mostafa Eric Wang Lucy Fu Alexander Li Leonardo Oliveira Aravind Athiviraham Michael J.Lee Jennifer Moriatis Wolf Tong-Chuan He Guillermo A.Ameer Russell R.Reid | 2017 | Genes & Diseases2017，4，3： | 13 |
| 14 | Sessile serrated adenoma/polyps: Where are we at in 2016?显示文摘It is currently known that colorectal cancers(CRC) arise from 3 different pathways: the adenoma to carcinoma chromosomal instability pathway(50%-70%); the mutator 'Lynch syndrome' route(3%-5%); and the serrated pathway(30%-35%). The World Health Organization has classified serrated polyps into three types of lesions: hyperplastic polyps(HP),sessile serrated adenomas/polyps(SSA/P) and traditional serrated adenomas(TSA),the latter two strongly associated with development of CRCs. HPs do not cause cancer and TSAs are rare. SSA/P appear to be the responsible precursor lesion for the development of cancers through the serrated pathway. Both HPs and SSA/Ps appear morphologically similar. SSA/P are difficult to detect. The margins are normally inconspicuous. En bloc resection of these polyps can hence be troublesome. A careful examination of borders,submucosal injection of a dye solution(for larger lesions) and resection of a rim of normal tissue around the lesion may ensure total eradication of these lesions. | Rajvinder Singh Leonardo Zorrón Cheng Tao Pu Doreen Koay Alastair Burt | 2016 | World Journal of Gastroenterology2016，22，34： | 13 |
| 15 | Non-invasive diagnosis of liver fibrosis in chronic hepatitis C显示文摘Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold standard for staging liver fibrosis,it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability.Over the last decade,several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection,with variable performance.Besides the clear advantage of being noninvasive,a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy.In addition,these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk.However,in general,these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions.These methods are either serum markers(usually combined in a mathematical model)or imaging modalities that can be used separately or combined in algorithms to improve accuracy.In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C,their advantages,limitations and application in clinical practice. | Leonardo de Lucca Schiavon Janaína Luz Narciso-Schiavon Roberto José de Carvalho-Filho | 2014 | World Journal of Gastroenterology2014，20，11： | 11 |
| 16 | Adverse reactions of Amiodarone显示文摘Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug reactions—because of changes in pharmacodynamics,concurrent use of multiple medications and the related drug interactions.However,adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs.Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people.While amiodarone is an efficient drug for rhythm control,it’s a carrier of different adverse reactions,and pro and cons must be carefully evaluated before its use especially in older people. | Ruben ML Colunga Biancatelli Viviana Congedo Leonardo Calvosa Marco Ciacciarelli Alessandro Polidoro Luigi Iuliano | 2019 | Journal of Geriatric Cardiology2019，16，7： | 11 |
| 17 | Bedaquiline-containing regimens in patients with pulmonary multidrug-resistant tuberculosis in China:focus on the safety显示文摘Background:World Health Organization recommends countries introducing new drug and short treatment regimen for drug resistant tuberculosis(DR-TB)should develop and implement a system for active pharmacovigilance that allows for detection,reporting and management of adverse events.The aim of the study is to evaluate the frequency and severity of adverse events(AEs)of bedaquiline-containing regimen in a cohort of Chinese patients with multidrug-resistant(MDR)/extensively drug-resistant(XDR)-TB based on active drug safety monitoring(aDSM)system of New Drug Introduction and Protection Program(NDIP). | Jing-Tao Gao Juan Du Gui-Hui Wu Yi Pei Meng-Qiu Gao Leonardo Martinez Lin Fan Wei Chen Li Xie Yu Chen Hua Wang Long Jin Guo-Bao Li Pei-Lan Zong Yu Xiong Qian-Hong Wu Ming-Wu Li Xiao-Feng Yan Yan-Fang Miao Qing-Shan Cai Xin-Jie Li Da-Peng Bai Shu-Jun Geng Guo-Li Yang Pei-JunTang Yi Zeng Xiao-Hong Chen Tong-Xia Li Cui Cai Yun Zhou Ma Zhuo Jian-Yun Wang Wen-Long Guan Lin Xu Ji-Chan Shi Wei Shu Li-Li Cheng FeiTeng Yu-Jia Ning Shi-Heng Xie Yu-Xian Sun Li-Jie Zhang Yu-Hong Liu | 2021 | Infectious Diseases of Poverty2021，10，2： | 11 |
| 18 | Autoantibodies in chronic hepatitis C: A clinical perspective显示文摘Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chronic carriers of hepatitis C virus(HCV). With respect to endomysial antibodies and tissue transglutaminase, it is controversial whether the prevalence of glutenrelated seromarkers is higher in patients with HCV. In such cases, in addition to acknowledging any currently existing autoimmune disease, recognizing the risk of the patient developing an autoimmune disease during interferon(IFN)-based treatment must be a principle concern. From a clinical point-of-view, the presence of autoantibodies arouses suspicion that an autoimmunedisease may be present or may be precipitated by IFNbased HCV treatment. In this paper, we review the prevalence of autoantibodies in individuals with hepatitis C, the clinical significance of these autoantibodies, and the approach recommended for such situations. | Janaína Luz Narciso-Schiavon Leonardo de Lucca Schiavon | 2015 | World Journal of Hepatology2015，7，8： | 11 |
| 19 | Laparoscopic fundoplication for gastroesophageal reflux disease显示文摘Gastroesophageal reflux disease(GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor(PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total(360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior(Toupet) fundoplication, and the anterior(Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard. | Marzio Frazzoni Micaela Piccoli Rita Conigliaro Leonardo Frazzoni Gianluigi Melotti | 2014 | World Journal of Gastroenterology2014，20，39： | 10 |
| 20 | Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis显示文摘AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary outcomes.RESULTS: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis, SEMS had lower overall stent dysfunction compared to PS(21.6% vs 46.8%, P < 0.00001) and fewer re-interventions(21.6% vs 56.6%, P < 0.00001), with no difference in complications(13.7% vs 15.9%, P = 0.16). In the secondary analysis, the mean survival rate was higher in the SEMS group(182 d vs 150 d, P < 0.0001), with a higher patency period(250 d vs 124 d, P < 0.0001) and a lower cost per patient(4193.98 vs 4728.65 Euros, P < 0.0985).CONCLUSION: SEMS are associated with lower stent dysfunction, lower re-intervention rates, better survival, and higher patency time. Complications and costs showed no difference. | Leonardo Zorrón Pu Eduardo Guimaraes Hourneaux de Moura Wanderley Marques Bernardo Felipe Iankelevich Baracat Ernesto Quaresma Mendonca AndréKondo Gustavo Oliveira Luz Carlos Kiyoshi Furuya Júnior Everson Luiz de Almeida Artifon | 2015 | World Journal of Gastroenterology2015，21，47： | 10 |
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