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1Endoscopic submucosal dissection for gastrointestinal neoplasms显示文摘Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en- bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects:(1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics.Naomi Kakushima Mitsuhiro Fujishiro 2008World Journal of Gastroenterology2008,14,19:95
2高尿酸血症/痛风患者实践指南显示文摘高尿酸血症/痛风是我国日趋递增的常见代谢性疾病,严重威胁人民健康。临床上,该病诊断的规范性及临床治疗达标率均有待提高,其中还欠缺针对患者对该病专家临床指南的理解、疾病知识普及和配合医生执行规范诊疗的重要性的教育。为此,从患者最关切的问题出发,成立多学科专家和患者共同参与的患者实践指南工作组,采用《世界卫生组织指南制订手册》相关原则,按照国际规范流程,提出高尿酸血症/痛风患者实践指南的意见17条,旨在提高患者诊治的依从性,提高该病健康管理水平。黄叶飞 杨克虎 陈澍洪 谢雅 黄慈波 青玉凤 何东仪 武丽君 詹锋 王小琴 周宇麒 孔庆聪 王昆 Schlesinger Naomi 徐大同 马小建 古洁若 2020中华内科杂志2020,59,7:83
3体位策略与呼吸机相关性肺炎的循证护理进展显示文摘呼吸机相关性肺炎(ventilator-associated pneumonia.VAP)是指无肺部感染的患者在接受机械通气48h后所并发的肺部感染。有文献报道,VAP在ICU的发生率达9%。27%.病死率高达20%~50%,在多重耐药菌感染的病例可高达70%。机械通气的最初5d每日获得VAP的机会是3%.张旭媛 Naomi Morick 2011中华护理杂志2011,46,12:52
42500年来艾比湖的环境演变信息显示文摘通过对艾比湖缘 1.8m浅孔的沉积相和孢粉组合 ,结合14 C测年资料分析 ,指出近 2 5 0 0年来艾比湖的沉积环境总体是比较稳定的 ,但由于气候波动引起艾比湖水位曾发生较明显的变化。约在公元前 30 0~ 4 0 0年 ,是艾比湖面积缩小时期 ;约公元前 30 0~公元 30 0年 ,即东周末至西晋 ,是艾比湖水位较高时期 ;约公元 30 0~ 14 0 0年 ,即东晋至 15世纪初 ,是艾比湖的高水位时期 ;约 15世纪初至 17世纪中是艾比湖的水位下降期 ,但水位比现代仍然高 ;约 17世纪中至 19世纪初的小冰期是艾比湖的水位上升期。阎顺 穆桂金 远藤邦彦 Nobuhiko Handa Masao Uchida Naomi Harada 2003干旱区地理2003,26,3:55
5胃癌预防亚太地区共识指南显示文摘背景与目的:胃癌是亚太地区的主要健康负担之一,但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法:多学科专家组应用德尔菲(Delphi)法制订共识条文,提呈相关数据,对证据等级、推荐强度以及共识水平予以分级。结果:幽门螺杆菌(H.pylori)感染是非贲门胃腺癌必要但非充分的致病因子。盐的高摄入与胃癌强烈相关。新鲜果蔬对胃癌具有预防作用,但维生素和其他饮食补充并不能预防胃癌。H.pylori感染中的宿主-细菌相互作用导致不同类型的胃炎和胃酸分泌,从而决定疾病结局。胃癌阳性家族史是一个重要的危险因素。低血清胃蛋白酶原反映胃萎缩程度,可作为检出胃癌高危人群的标志物。H.pylori筛查和治疗被推荐作为减少高危人群胃癌危险性的一种策略,该策略在萎缩性胃炎发生前实施最为有效,但并不排除对胃癌高危人群的内镜监测。对胃癌低危人群不推荐行H.pylori筛查。H.pylori感染的一线治疗应遵循国家治疗指南。结论:高危人群中H.pylori筛查和根除策略可能会减少胃癌的发生率,本共识根据现有证据予以推荐。Kwong Ming Fock Nick Talley Paul Moayyedi Richard Hunt Takeshi Azuma Kentaro Sugano Shu Dong Xiao Shiu Kum Lam Khean Lee Goh Tsutomu Chiba Naomi Uemura Jae G Kim Nayoung Kim Tiing Leong Ang Varocha Mahachai Hazel Mitchell Abdul Aziz Rani Jyh Ming Liou Ratha-korn Vilaichone Jose Sollanor 钱本余 2008胃肠病学2008,13,4:37
6Endothelial dysfunction in diabetes mellitus: Molecular mechanisms and clinical implications显示文摘Corey E. Tabit William B. Chung Naomi M. Hamburg Joseph A. Vita 2010Reviews in Endocrine and Metabolic Disorders2010,,1:19
7Predictive findings forHelicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: Validation study显示文摘AIM:To validate the usefulness of screening endoscopy findings for predictingHelicobacter pylori (H. pylori) infection status. METHODS:H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori -uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings:regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS:Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases:uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION:The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.Kazuhiro Watanabe Naoyoshi Nagata Ryo Nakashima Etsuko Furuhata Takuro Shimbo Masao Kobayakawa Toshiyuki Sakurai Koh Imbe Ryota Niikura Chizu Yokoi Junichi Akiyama Naomi Uemura 2013World Journal of Gastroenterology2013,19,27:17
8Effect of resistance training on non-alcoholic fatty-liver disease a randomized-clinical trial显示文摘AIM:To evaluate the effect of resistance training(RT)on non alcoholic liver disease(NAFLD)patients.METHODS:A randomized clinical trial enrolling NAFLD patients without secondary liver disease(e.g.,without hepatitis B virus,hepatitis C virus or excessive alcohol consumption).Patients were randomly allocated either to RT,three times weekly,for 3 mo or a control arm consisting of home stretching.The RT included leg press,chest press,seated rowing,latissimus pull down etc.with 8-12 repetitions,3 sets for each exercise,for a total duration of 40 min.Hepatic ultrasound,fasting blood tests,anthropometrics and body composition by dual energy X-ray absorptiometry were assessed.At baseline and follow-up,patients filled out a detailed semi-quantitative food frequency questionnaire reporting their habitual nutritional intake.Steatosis was quantified by the hepatorenal-ultrasound index(HRI)representing the ratio between the brightness level of the liver and the right kidney.The HRI has been previously demonstrated to be highly reproducible and was validated against liver biopsy and proton magnetic resonance spectroscopy.RESULTS:Eighty two patients with primary NAFLD were randomized to receive 3 mo of either RT or stretching.After dropout or exclusion from analysis because of protocol violation(weight change>3 kg),thirty three patients in the RT arm and 31 in the stretching arm completed the study per protocol.All baseline characteristics were similar for the two treatment groups with respect to demographics,anthropometrics and body composition,blood tests and liver steatosis on imaging.HRI score was reduced significantly in the RT arm as compared to the stretching arm(-0.25±0.37 vs-0.05±0.28,P=0.017).The RT arm had a significantly higher reduction in total,trunk and android fat with increase in lean body mass.There was no correlation between the reduction in HRI in the RT arm and weight change during the study,but it was positively correlated with the change in trunk fat(r=0.37,P=0.048).The RT arm had a significant reduction in serum ferritin and total cholesterol.There was no significant difference between arms in dietary changes and these did not correlate with HRI change.CONCLUSION:Three months RT improves hepatic fat content accompanied by favorable changes in body composition and ferritin.RT may serve as a complement to treatment of NAFLD.Shira Zelber-Sagi Assaf Buch Hanny Yeshua Nahum Vaisman Muriel Webb Gil Harari Ofer Kis Naomi Fliss-Isakov Elena Izkhakov Zamir Halpern Erwin Santo Ran Oren Oren Shibolet 2014World Journal of Gastroenterology2014,20,15:17
9Diagnosis of autoimmune pancreatitis显示文摘Autoimmune pancreatitis(AIP) is a distinct form of chronic pancreatitis that is increasingly being reported. The presentation and clinical image findings of AIP sometimes resemble those of several pancreatic malignancies, but the therapeutic strategy differs appreciably. Therefore, accurate diagnosis is necessary for cases of AIP. To date, AIP is classified into two distinct subtypes from the viewpoints of etiology, serum markers, histology, other organ involvements, and frequency of relapse: type 1 is related to Ig G4(lymphoplasmacytic sclerosing pancreatitis) and type 2 is related to a granulocytic epithelial lesion(idiopathic duct-centric chronic pancreatitis). Both types of AIP are characterized by focal or diffuse pancreatic enlargement accompanied with a narrowing of the main pancreatic duct, and both show dramatic responses to corticosteroid. Unlike type 2, type 1 is characteristically associated with increasing levels of serum Ig G4 and positive serum autoantibodies, abundant infiltration of Ig G4-positive plasmacytes, frequent extrapancreatic lesions, and relapse. These findings have led several countries to propose diagnostic criteria for AIP, which consist of essentially similar diagnostic items; however, several differences exist for each country, mainly due to differences in the definition of AIP and the modalities used to diagnose this disease. An attempt to unite the diagnostic criteria worldwide was made with the publication in 2011 of the international consensus diagnostic criteria for AIP, established at the 2010 Congress of the International Association of Pancreatology(IAP).Hiroyuki Matsubayashi Naomi Kakushima Kohei Takizawa Masaki Tanaka Kenichiro Imai Kinichi Hotta Hiroyuki Ono 2014World Journal of Gastroenterology2014,20,44:17
10Metabolomic Screening Applied to Rice FOX Arabidopsis Lines Leads to the Identification of a Gene-Changing Nitrogen Metabolism显示文摘植物 metabolomics 作为一个强大的工具发展了检验基因功能并且获得更深的卓见进植物房间的生理学。在这研究,我们屏蔽了 Arabidopsis 线 overexpressing 米饭全身(FL ) 用煤气的 chromatographytime-of-flight 团 spectrometry (GCTOF/MS ) 的 cDNAs (米饭狐狸 Arabidopsis 线) 基于技术识别引起了新陈代谢的变化的米饭基因。这个屏蔽系统允许显示出改变的代谢物侧面的候选人线的快、可靠的鉴定。我们执行了怀有 Arabidopsis 的侧面的机关边界(高球) 领域(LBD )/Asymmetric 象 Leaves2 一样(ASL ) 基因的米饭 ortholog 的 FL cDNA 的一根米饭狐狸 Arabidopsis 线的 metabolomic 和 transcriptomic 分析, At-LBD37/ASL39。调查米饭狐狸 Arabidopsis 线在与氮新陈代谢有关的代谢物的层次显示出突出的变化。象从 Arabidopsis At-LBD37/ASL39-overexpressor 植物的代谢物分析的结果一样的 transcriptomic 数据与这些调查结果一致。而且, Os-LBD37/ASL39-overexpressing 米饭植物的 metabolomic 和 transcriptomic 分析显示 Os-LBD37/ASL39 在米饭与与氮新陈代谢有关的过程被联系。因此,一个基于 metabolomics 的屏蔽方法的联合和一条 gain-of-function 途径为在 Arabidopsis 和米饭的新奇基因的快速的描述是有用的。Doris Albinsky Miyako Kusano Mieko Higuchi Naomi Hayashi Makoto Kobayashi Atsushi Fukushima Masaki Mori Takanari Ichikawa Keiko Matsui Hirofumi Kuroda Yoko Horii Yuko Tsumoto Hitoshi Sakakibara Hirohiko Hirochika Minami Matsui Kazuki Saito 2010Molecular Plant2010,3,1:15
11Human Acyl-CoA:cholesterol Acyltransferase (ACAT) and its Potential as a Target for Pharmaceutical Intervention against Atherosclerosis显示文摘Acyl-CoA:cholesterol acyltransferase (ACAT ) 从胆固醇和长链的 fatty-acyl-coenzyme A 催化 cholesteryl 酉旨的形成。在单个房间的水平, ACAT 用作细胞内部的胆固醇动态平衡的一个管理者。另外, ACAT 在肝和小肠为脂蛋白汇编供应 cholesteryl 酉旨。在病理学的条件下面, ACAT 在巨噬细胞生产的 cholesteryl 酉旨的累积贡献泡沫房间形成,动脉粥样硬化的早阶段的一个特点。探讨 ACAT 和 ACAT 禁止者的各种各样的方面的几评论是可得到的。这评论简短在人的 ACAT 的生物化学的性质上构画出当前的知识,然后集中于对动脉粥样硬化为药品的干预作为一个药目标讨论 ACAT 的优点。Catherine CHANG Ruhong DONG Akira MIYAZAKI Naomi SAKASHITA Yi ZHANG Jay LIU Michael GUO Bo-Liang LI Ta-Yuan CHANG 2006Acta Biochimica et Biophysica Sinica2006,38,3:13
12Treatment for superficial non-ampullary duodenal epithelial tumors显示文摘Because of the low prevalence of non-ampullary duodenal epithelial tumors(NADETs),standardized clinical management of sporadic superficial NADETs,including diagnosis,treatment,and follow-up,has not yet been established.Retrospective studies have revealed certain endoscopic findings suggestive of malignancy.Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery.The use of endoscopic treatment including endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),for the treatment for superficial NADETs is increasing.EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection.ESD provides an excellent complete resection rate,however it remains a challenging method,considering the high risk of intraoperative or delayed perforation.Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment.Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion,which presents a risk of lymph node metastasis.Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory.Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.Naomi Kakushima Hideyuki Kanemoto Masaki Tanaka Kohei Takizawa Hiroyuki Ono 2014World Journal of Gastroenterology2014,20,35:13
13Endoscopic ultrasonography guided-fine needle aspirationfor the diagnosis of solid pancreaticobiliary lesions:Clinicalaspects to improve the diagnosis显示文摘Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990 s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUSFNA. Studies conducted on pancreaticobiliary EUSFNA have focused on selection of suitable instruments(e.g., needle selection) and sampling techniques(e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer(PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUSFNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.Hiroyuki Matsubayashi Toru Matsui Yohei Yabuuchi Kenichiro Imai Masaki Tanaka Naomi Kakushima Keiko Sasaki Hiroyuki Ono 2016World Journal of Gastroenterology2016,22,2:12
14Acute pancreatitis associated with peroral double-balloon enteroscopy: A case report显示文摘人有的一个 58 岁的日本人逗留凳子和严重贫血症。既不上面也不更低胃肠(官方补给) 内视镜检查法显示出任何局部性的损害。因此,他的官方补给的流血的来源被怀疑在小肠,并且他用 EN-450T5 每口头的双汽球肠寄生物(DBE ) 经历了(Fujinon 东芝 ES 系统公司,东京,日本) 。没有损害,考虑是官方补给的流血的来源。在过程以后,病人开始经历了腹的疼痛。实验室测试揭示了血淀粉酶过多,腹的计算断层摄影术揭示了胰和仙子胰的发炎。他因此被诊断有尖锐胰腺炎。保守疗法导致了临床并且实验室改善。他没有白酒摄取,胆石疾病或胰腺炎的历史。磁性的回声 cholangiopancreatography 没在 pancreatobiliary 管的系统表明结构的改变和没有石头。当他的腹的疼痛在过程以后开始了,他的尖锐胰腺炎因此被认为与 per 有关是口头的 DBE。这是可能与联系的尖锐胰腺炎的首先报导的案例每口头的 DBE。Kuniomi Honda Takahiro Mizutani Kazuhiko Nakamura Naomi Higuchi Kenji Kanayama Yorinobu Sumida Shigetaka Yoshinaga Soichi Itaba Hirotada Akiho Ken Kawabe Yoshiyuki Arita Tetsuhide Ito 2006World Journal of Gastroenterology2006,12,11:11
15Co-effect of Demand-control-support Model and Effort-reward Imbalance Model on Depression Risk Estimation in Humans: Findings from Henan Province of China显示文摘Objective To investigate the co-effect of Demand-control-support(DCS) model and Effort-reward Imbalance(ERI) model on the risk estimation of depression in humans in comparison with the effects when they are used respectively. Methods A total of 3 632 males and 1 706 females from 13 factories and companies in Henan province were recruited in this cross-sectional study. Perceived job stress was evaluated with the Job Content Questionnaire and Effort-Reward Imbalance Questionnaire(Chinese version). Depressive symptoms were assessed by using the Center for Epidemiological Studies Depression Scale(CES-D). Results DC(demands/job control ratio) and ERI were shown to be independently associated with depressive symptoms. The outcome of low social support and overcommitment were similar. High DC and low social support(SS), high ERI and high overcommitment, and high DC and high ERI posed greater risks of depressive symptoms than each of them did alone.ERI model and SS model seem to be effective in estimating the risk of depressive symptoms if they are used respectively. Conclusion The DC had better performance when it was used in combination with low SS. The effect on physical demands was better than on psychological demands. The combination of DCS and ERI models could improve the risk estimate of depressive symptoms in humans.YU Shan Fa NAKATA Akinori GU Gui Zhen SWANSON Naomi G ZHOU Wen Hui HE Li Hua WANG Sheng 2013Biomedical and Environmental Sciences2013,26,12:8
16Structural, optical, and electrical properties of phase- controlled cesium lead iodide nanowires显示文摘铯铅碘化物(在它的黑 perovskite 阶段的 CsPbI 3), ,为光电的应用有合适的 bandgap 和高量效率。然而, CsPbI 3 趋于到 crystalize 进一个黄 non-perovskite 阶段,它有差的 optoelectronic 性质,在房间温度。因此,在 CsPbI 3 控制阶段转变为这材料的实际申请是批评的。这里,我们报导一个维的 CsPbI 3 nanowires 和他们的相应结构、光、电的性质的阶段转变的系统的研究。我们通过快速的热熄灭从 non-perovskite 黄阶段显示出 perovskite 黑人阶段 CsPbI 3 nanowires 的形成。transformed 以后黑阶段 CsPbI 3 nanowires 展览与一从 2.78 ~ 1.76 eV 缩小 bandgap 增加了光致发光排放紧张。perovskite nanowires 是光导的并且在房间温度显示出快 photoresponse 和优秀稳定性。这些有希望的光、电的性质为许多 nanoscale optoelectronic 设备使 perovskite CsPbI3 nanowires 吸引人。Minliang Lai Qiao Kong Connor G. Bischak Yi Yu Letian Dou Samuel W. Eaton Naomi S. Ginsberg Peidong Yang 2017Nano Research2017,10,4:8
17Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial显示文摘Kazutoshi Fukase Mototsugu Kato Shogo Kikuchi Kazuhiko Inoue Naomi Uemura Shiro Okamoto Shuichi Terao Kenji Amagai Shunji Hayashi Masahiro Asaka 2008The Lancet2008,,9636:7
18Advanced hepatocellular carcinoma responds to MK615, a compound extract from the Japanese apricot “Prunus mume ”显示文摘MK615, a compound extracted from the Japanese apricot 'Prunus mume ' has been reported to have in vitro anti-tumor activities against several cancer cell lines,including hepatocellular carcinoma(HCC). However, the clinical effects and feasibility of administering MK615for patients with HCC were unknown. We experienced a case with advanced HCC for which MK615 was effective against both lymph node and pulmonary metastases. A 60-year-old female underwent surgical resection of a 9 cm HCC in the right lobe. The pathological diagnosis was moderately differentiated HCC with vascular invasion. The HCC recurred in the liver 8 mo after the surgery. Radiofrequency ablation and transarterial infusion chemotherapy were performed, but the recurrence was not controlled. One year after the intrahepatic recurrence, pulmonary and lymph metastasis appeared.Sorafenib was administered, but was not effective.Then, MK615 was administered as a final alternative therapy after informed consent was obtained from the patient. Three months later, her alpha-fetoprotein level decrease and both the lymph node and pulmonary metastases decreased in size. The patient has survived for more than 17 mo after the MK615 administration, and was in good condition. Although further investigations are necessary to clarify its safety and efficacy in humans, MK615 may be useful for the treatment of HCC,without serious adverse effects.Takashi Hoshino Hitoshi Takagi Atsushi Naganuma Eri Koitabashi Sanae Uehara Naomi Sakamoto Tomohiro Kudo Ken Sato Satoru Kakizaki 2013World Journal of Hepatology2013,5,10:7
19Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography显示文摘AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth Ⅱ reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth Ⅱ anastomosis.CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy.Takashi Osoegawa Yasuaki Motomura Kazuya Akahoshi Naomi Higuchi Yoshimasa Tanaka Terumasa Hisano Souichi Itaba Junya Gibo Mariko Yamada Masaru Kubokawa Yorinobu Sumida Hirotada Akiho Eikichi Ihara Kazuhiko Nakamura 2012World Journal of Gastroenterology2012,18,46:7
20Prevalence of anal fistula in the United Kingdom显示文摘BACKGROUND Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated. AIM To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe. METHODS A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported. RESULTS The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44;95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare. CONCLUSION This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.Suvi RK Hokkanen Naomi Boxall Javaria Mona Khalid Dimitri Bennett Haridarshan Patel 2019World Journal of Clinical Cases2019,7,14:7
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