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| 1 | 钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南显示文摘临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生率、终末期肾病或肾衰竭的发生率(中等至高等质量的证据)。在不同的亚组中这些药物对卒中、因心力衰竭所致住院和其他主要不良事件有不同的影响。药物绝对获益的程度因患者个体风险的不同有很大的差异。(例如,对于接受了超过5年药物治疗的1000例患者,在最低风险人群中死亡人数减少了5人,在最高风险人群中死亡人数减少了48人)。一项关于预后的综述确认了14种风险预测模型,其中一种(RECODe)在证据总结中报告了大部分基线风险评估数据,小组利用该模型以支持风险分层的建议。考虑到患者的价值观及个体差异,指南推荐的支撑证据包括一项对已发表论文的系统综述、一项患者焦点小组研究、一项临床问题总结,以及一项指南调查。指南解读我们依据不同的CVD和CKD风险水平,综合考虑获益、风险和其他因素的平衡,以及每一个风险组别的实际问题,来对推荐意见进行分层。本指南强烈建议CVD和CKD患者使用SGLT-2抑制剂治疗,这说明专家组认为其具有显著的获益。而对于其他成人2型糖尿病患者,推荐等级较弱,这说明专家组想要在获益、风险及治疗花费上取得一个更好的平衡。临床医生通过该指南可以使用可靠的风险计算模型,如RECODe,来明确其患者的个体心血管和肾脏疾病风险。医患交互式总结临床证据和制订决策有助于患者知晓治疗选择,包括进行共同决策。2型糖尿病人群(全球患病率不断增长1-2)正面临着不断增加的心血管疾病、肾脏病和其他并发症的风险3。数十年来,2型糖尿病的管理始终以控制血糖及糖化血红蛋白(HbA1c)为治疗目标4-5,但是,最近的高质量随机对照研究已经对这种以血糖为中心的治疗模式发起了挑战。研究结果显示,强化血糖控制未必会降低大血管不良事件,它还可能带来不利影响监管机构现在要求新型糖尿病药物必须证明其具有心血管和肾脏获益才能获得批准。对两类新药--钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂(见框图1)的临床试验结果显示,在现有治疗方案(常规治疗)之上加用这些药物,对死亡、心肌梗死、卒中、心力衰竭和肾脏的结局(如进展为终末期肾病)都有获益8-12。 | Sheyu Li Per Olav Vandvik Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer Rene Rodriguez-Gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David J Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand Jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren Emma Jane Cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 无 郭鹤鸣(译) | 2021 | 英国医学杂志中文版2021，24，9： | 7 |
| 2 | 直肠癌术后低位前切除综合征的发生率及其对生活质量的影响:一项基于人群的研究显示文摘背景:据报道,直肠癌术后严重的低位前切除综合征(low anterior resection syndrome, LARS)的发生率为17.8%~56.0%,但来自高质量研究的数据较少。本项研究的目的是在一个大型的、明确的、基于人群的队列研究中,确定LARS的发生率及其与患者生活质量(quality of life,Qo L)的关系。方法:这是一项基于人群的队列研究,纳入了2007年至2013年在瑞典斯德哥尔摩市所有接受直肠系膜全部或部分切除的直肠癌根治术的患者。 | 佟伟华(评论) PIENIOWSKI E H A NORDENVALL C PALMER G | 2020 | 结直肠肛门外科2020，26，4： | 5 |
| 3 | New fecal test for non-invasive Helicobacter pylori detection:A diagnostic accuracy study显示文摘AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13 C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test). The detection of bacterial 23 S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive(PPV) and negative(NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio(LR), together with 95% confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninetyfive(32.3%) participants had a positive ^(13)C-urea breath test. Twenty-three(7.8%) participants underwent upper endoscopy with histology, with a full concordance between ^(13)C-urea breath test and histology in detecting H. pylori infection. Four(1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2%(CI: 84.2%-96.3%), specificity 98.5%(CI:96.8%-100%), PPV 96.5%(CI: 92.6%-100%), NPV 95.6%(CI: 92.8%-98.4%), accuracy 95.9%(CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10(CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34(41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27(32.5%) had bacterial strains resistant to clarithromycin, 3(3.6%) to levofloxacin, and 4(4.8%) to both antibiotics. CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances. | Andrea Iannone Floriana Giorgio Francesco Russo Giuseppe Riezzo Bruna Girardi Maria Pricci Suetonia C Palmer Michele Barone Mariabeatrice Principi Giovanni FM Strippoli Alfredo Di Leo Enzo Ierardi | 2018 | World Journal of Gastroenterology2018，24，27： | 5 |
| 4 | Femtojoule electro-optic modulation using a silicon– organic hybrid device显示文摘Energy-efficient electro-optic modulators are at the heart of short-reach optical interconnects,and silicon photonics is considered the leading technology for realizing such devices.However,the performance of all-silicon devices is limited by intrinsic material properties.In particular,the absence of linear electro-optic effects in silicon renders the integration of energy-efficient photonic–electronic interfaces challenging.Silicon–organic hybrid(SOH)integration can overcome these limitations by combining nanophotonic silicon waveguides with organic cladding materials,thereby offering the prospect of designing optical properties by molecular engineering.In this paper,we demonstrate an SOH Mach–Zehnder modulator with unprecedented efficiency:the 1-mm-long device consumes only 0.7 fJ bit^(-1) to generate a 12.5 Gbit s^(-1) data stream with a bit-error ratio below the threshold for hard-decision forward-error correction.This power consumption represents the lowest value demonstrated for a non-resonant Mach–Zehnder modulator in any material system.It is enabled by a novel class of organic electro-optic materials that are designed for high chromophore density and enhanced molecular orientation.The device features an electro-optic coefficient of r33<180 pm V^(-1) and can be operated at data rates of up to 40 Gbit s^(-1). | Sebastian Koeber Robert Palmer Matthias Lauermann Wolfgang Heni Delwin L Elder Dietmar Korn Markus Woessner Luca Alloatti Swen Koenig Philipp C Schindler Hui Yu Wim Bogaerts Larry R Dalton Wolfgang Freude Juerg Leuthold Christian Koos | 2015 | Light(Science & Applications)2015，4，1： | 4 |
| 5 | Estimates of global terrestrial isoprene emissions using MEGAN (Model of Emissions of Gases and Aerosols from Nature)显示文摘 | Guenther A. Karl T. Harley P. Wiedinmyer C. Palmer P. I. Geron C | 2006 | Atmospheric Chemistry and Physics2006，，68： | 2 |
| 6 | Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy显示文摘AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in series.For both oral and anal DBE,fluoroscopy time was reduced by greater than 50% over the course of 802 total procedures performed.Sub-group analysis was conducted on therapeutic and diagnostic groups.Out of 802 procedures,a total of 434 were considered therapeutic.Argon plasma coagulation was by far the most common therapeutic intervention performed.There was no evidence of a difference in length examined or fluoroscopy exposure among oral DBE for diagnostic and therapeutic procedures,P = 0.91 and P = 0.32 respectively.The median(IQR) for length was 235 cm(range:178-280 cm) for diagnostic vs 230 cm(range:180-275 cm) for therapeutic procedures;additionally,fluoroscopy time median(IQR) was 180 s(range:110-295 s) and 162 s(range:102-263 s) for no intervention and intervention.However,there was a significant difference in procedure duration among oral DBE(P < 0.001).The median(IQR) was 80 min(range:60-97 min) and 94 min(range:77-110 min) for diagnostic and therapeutic interventions respectively.CONCLUSION:For a single endoscopist,increased DBE experience with number of performed procedures is associated with increased efficiency and decreased resource utilization. | Neal C Patel William C Palmer Kanwar R Gill David Cangemi Nancy Diehl Mark E Stark | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，3： | 2 |
| 7 | Large-scale asymmetric synthesis of the 3,6,7,8-tetrahydrochromeno imidazole BYK 405879 : a promising candidate for the treatment of acid-related diseases显示文摘 | PALMER A M WEBEL M SCHEUFLER C | 2008 | Org Process Res Dev2008，12，6： | 1 |
| 8 | Diagnosis of in- vasive aspergillosis in bone marrow transplant recipients by polymer- ase chain reaction显示文摘 | Williamson E C Lee ming J P Palmer H M | 2000 | Br J Haematol2000，108，： | 1 |
| 9 | Deferoxamine posttreatment reduces ischemic brain injury in neonatal rats 显示文摘 | Palmer C Roberts R L Bero C | 1994 | Stroke1994，25，5： | 1 |
| 10 | Inhibition of interleukin -33 signaling attenuates the severity of experimental arthritis显示文摘 | Palmer G Talabot Ayer D Lamacchia C | 2009 | Arth Rheum2009，60，3： | 1 |
| 11 | Evaluation of clinical management of gonorrhoea using enhanced surveillance in South East Queensland 显示文摘 | Field E Heel K Palmer C | 2010 | Sex Health2010，7，4： | 1 |
| 12 | Head circumference of children with Down syndrome (0-36 months) 显示文摘 | Palmer CG Cronk C Pueschel SM | 1992 | Am J Med Genet1992，42，： | 1 |
| 13 | Failure of passive immunoglobulin transfer:a major determinant of mortality in newborn alpacas (Lama pacos)显示文摘 | Garmendia A E Palmer G H DeMartini J C | | 0，，： | 1 |
| 14 | Continuum secondary structure captures protein flexibility 显示文摘 | ANDERSEN C A F PALMER A G BRUNAK S | 2002 | Structure2002，10，2： | 1 |
| 15 | Dieulafoy's lesion of gastrointestinal bleeding from the esophagus:successful endoscopic therapy显示文摘 | CHOUDARI C PALMER K | 1993 | Endoscopy1993，25，4： | 1 |
| 16 | Differential expression of chemokines and chemokine receptors during microglial activation and inhibition 显示文摘 | Kremlev SG Roberts RL Palmer C | 2004 | J Neuroimmunol2004，149，12： | 1 |
| 17 | Combustion and leaching behavior of elements in the Argonne premium coal samples显示文摘 | Finkelman R B Palmer C A Krasnow M R | 1990 | Energy Fuels1990，4，： | 1 |
| 18 | The atp6 coding region has been disrupted and novel reading frame generated in the mitochondrial genome of cytoplasmic male-sterile radish 显示文摘 | Makaroff C A Apel I J Palmer J D | 1989 | J Biol Chem1989，264，11： | 1 |
| 19 | Emotional intelligence and life satisfaction显示文摘 | PALMER B DONALDSON C STOUGH C | 2002 | Pers Individ Dif2002，33，7： | 1 |
| 20 | The boron isotope systematics of the Yellowstone National Park (Wyoming) hydrothermal system: a reconnaissance显示文摘 | PALMER M R STURCHIO N C | 1990 | Geochim Cosmochim Acta1990，54，： | 1 |
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