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| 1 | Gastroparesis: Current diagnostic challenges and management considerations显示文摘Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician. | Shamaila Waseem Baharak Moshiree Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，1： | 71 |
| 2 | Pancreatic pseudocyst显示文摘Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases. | Samir Habashi Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，1： | 46 |
| 3 | Recent advances and remaining gaps in our knowledge of associations between gut microbiota and human health显示文摘The complex gut microbial flora harbored by individuals(microbiota) has long been proposed to contribute tointestinal health as well as disease. Pre-and probioticproducts aimed at improving health by modifyingmicrobiota composition have already become widelyavailable and acceptance of these products appearsto be on the rise. However, although required forthe development of effective microbiota basedinterventions, our basic understanding of microbiotavariation on a population level and its dynamics withinindividuals is still rudimentary. Powerful new parallelsequence technologies combined with other efficientmolecular microbiota analysis methods now allow forcomprehensive analysis of microbiota composition inlarge human populations. Recent fi ndings in the fi eldstrongly suggest that microbiota contributes to thedevelopment of obesity, atopic diseases, inflammatorybowel diseases and intestinal cancers. Through theongoing National Institutes of Health Roadmap 'HumanMicrobiome Project' and similar projects in other partsof the world, a large coordinated effort is currentlyunderway to study how microbiota can impact humanhealth. Translating findings from these studies intoeffective interventions that can improve health,possibly personalized based on an individuals existingmicrobiota, will be the task for the next decade(s). | Volker Mai Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，1： | 21 |
| 4 | Endoscopic management of biliary strictures after liver transplantation显示文摘Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classifi ed as anastomotic or non-anastomotic strictures according to location and are defi ned by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is signifi cant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT. | Emmanuelle D Williams Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，30： | 20 |
| 5 | Colonoscopic polypectomy and associated techniques显示文摘Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and devices are available,and their use can vary greatly based on local availability and preferences.In general,cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps,and hot snare has been the method of choice for larger polyps.The use of hot forceps has mostly fallen out of favor.Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve.As a result,the vast majority of polyps today can be removed endoscopically.Since electrocautery is frequently used for polypectomy,endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy.Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance.The two most common post-polypectomy complications are bleeding and perforation.Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers.This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist. | Christopher J Fyock Peter V Draganov | 2010 | World Journal of Gastroenterology2010，16，29： | 19 |
| 6 | 肱骨干骨折后桡神经麻痹的系统评价显示文摘目的采用循证医学研究方法,系统评价肱骨干骨折后桡神经麻痹(radialnervepalsy,RNP)的不同处理方法,为临床治疗决策提供证据基础。方法采用PubMed、Datastar及CochraneDatabase等互联网公共搜索引擎作为检索工具,检索过去40年中发表的有关肱骨干骨折后桡神经麻痹的文献,再对入选文献的参考文献行手工检索,制定数据抽取问表,对入选文献进行数据抽取、汇总、归纳和荟萃分析。结果共检索到391篇原始文献,其中324篇得自电子检索,67篇得自手工检索。有35篇符合最终的入选标准,总计随访患者1045例。其中21篇文献共记录了发生于4517例肱骨干骨折中的532例桡神经麻痹,肱骨干骨折后桡神经麻痹的发生率为11.8%。肱骨干中1/5和中远1/5部位的桡神经麻痹发生率明显高于其他部位(P<0.05)。不同骨折类型中,横形和螺旋形骨折较斜形和粉碎性骨折更易于并发桡神经麻痹(P<0.0001)。肱骨干骨折后桡神经麻痹总的恢复率为88.1%,早期保守治疗的病例自发性恢复率为70.7%。观察等待组和早期手术探查组之间神经恢复的最终结果没有明显差别。结论对肱骨干骨折后桡神经麻痹采用早期保守治疗不会影响神经的最终恢复结果,可以避免许多不必要的手术。 | 邵云潮 Paul Harwood Martin RW Grotz Peter V Giannoudis 陈统一 张光健 | 2005 | 中华骨科杂志2005，25，10： | 19 |
| 7 | Evaluation and management of patients with refractory ascites显示文摘Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LVP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician. | Bahaa Eldeen Senousy Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，1： | 14 |
| 8 | Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility显示文摘Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The 'mother-baby' system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications. | Joel R Judah Peter V Draganov | 2008 | World Journal of Gastroenterology2008，14，20： | 12 |
| 9 | Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents显示文摘Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral intake which can lead to dehydration, malnutrition,and poor quality of life.Endoscopic stent placement has become the primary therapeutic modality because it is safe,minimally invasive,and a cost-effective option for palliation.Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement,shorter time to resumption of an oral diet,and shorter hospital stays as compared with surgical options.Recurrence of the obstructive symptoms resulting from stent occlusion,due to tumor ingrowth or overgrowth,can be successfully treated with repeat endoscopic stent placement in the majority of the cases.Both endoscopic stenting and surgical bypass are considered palliative treatments and,to date,no improvement in survival with either modality has been demonstrated.A tailored therapeutic approach,taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist,surgeon,medical oncologist, radiation therapist,and interventional radiologist, should be considered in all cases. | Jill KJ Gaidos Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，35： | 12 |
| 10 | Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma:Radiologic-pathologic correlation显示文摘AIM:To identify multi-detector computed tomography(MDCT) features most predictive of serous cystadenomas(SCAs),correlating with histopathology,and to study the impact of cyst size and MDCT technique on reader performance.METHODS:The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs.Accuracy in lesion characterization and reader conf idence were correlated with lesion size(≤3cm or≥3cm) and scanning protocols(dedicated vs routine).RESULTS:28/164 cysts(mean size,39 mm;range,8-92mm) were diagnosed as SCA on pathology.The MDCT features predictive of diagnosis of SCA were microcystic appearance(22/28,78.6%),surface lobulations(25/28,89.3%) and central scar(9/28,32.4%).Stepwise logistic regression analysis showed that only microcystic appearance was signifi cant for CT diagnosis of SCA(P=0.0001).The sensitivity,specificity and PPV of central scar and of combined microcystic appearance and lobulations were 32.4%/100%/100% and 68%/100%/100%,respectively.The reader confidence was higher for lesions>3cm(P=0.02) and for MDCT scans performed using thin collimation(1.25-2.5mm) compared to routine 5 mm collimation exams(P>0.05).CONCLUSION:Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs.Microcystic morphology is the most significant CT feature in diagnosis of SCA.A combination of microcystic appearance and surface lobulations offers accuracy comparable to central scar with higher sensitivity. | Anjuli A Shah Nisha I Sainani Avinash Kambadakone Ramesh Zarine K Shah Vikram Deshpande Peter F Hahn Dushyant V Sahani | 2009 | World Journal of Gastroenterology2009，15，22： | 11 |
| 11 | Endoscopic therapy of benign biliary strictures显示文摘Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of post- liver transplant anastomotic strictures and distal (Bismuth Ⅰand Ⅱ) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat, and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation. | Joel R Judah Peter V Draganov | 2007 | World Journal of Gastroenterology2007，13，26： | 11 |
| 12 | Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis显示文摘Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management. | Anthony J Michaels Peter V Draganov | 2007 | World Journal of Gastroenterology2007，13，26： | 10 |
| 13 | Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go?显示文摘AIM: To offer an up-to-date review of all availabletreatment strategies for patients with synchronous colorectal liver metastases(CLM).METHODS: A comprehensive literature search was performed to identify articles related to the management of patients with synchronous CLM. A search of the electronic databases PubMed, MEDLINE, and Google Scholar was conducted in September 2014.The following search terms were used: synchronous colorectal liver metastases, surgery, stage Ⅳ colorectal cancer, liver-first approach, and up-front hepatectomy.These terms were employed in various combinations to maximize the search. Only articles written in English were included. Particular attention was devoted to studies and review articles that were published within the last six years(2009-2014). Additional searches of the cited references from primary articles were performed to further improve the review. The full texts of all relevant articles were accessed by two independent reviewers.RESULTS: Poor long-term outcomes of patients with synchronous CLM managed by a traditional treatment strategy have led to questions about the timing and sequence of possible therapeutic interventions. Thus,alternative paradigms called reverse strategies have been proposed. Presently, there are four treatment strategies available:(1) primary first approach(or traditional approach) comprises resection of the primary colorectal tumor followed by chemotherapy;subsequent liver resection is performed 3-6 mo after colorectal resection(provided that CLM are still resectable);(2) simultaneous resection of the primary colorectal tumor and CLM during a single operation presents intriguing options for a highly select group of patients, which can be associated with significant postoperative morbidity;(3) liver-first(or chemotherapy-first) approach comprises preoperative chemotherapy(3-6 cycles) followed by liver resection,adjuvant chemotherapy, and resection of the primary colorectal tumor(it is best suited for patients withasymptomatic primary tumors and initially unresectable or marginally resectable CLM); and(4) up-front hepatectomy(or 'true' liver-first approach) includes liver resection followed by adjuvant chemotherapy,colorectal resection, and adjuvant chemotherapy(strategy can be offered to patients with asymptomatic primary tumors and initially resectable CLM).CONCLUSION: None of the aforementioned strategies appears inferior. It is necessary to establish individual treatment plans in multidisciplinary team meetings through careful appraisal of all strategies. | Peter Ihnát Petr Vávra Pavel Zonca | 2015 | World Journal of Gastroenterology2015，21，22： | 10 |
| 14 | Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis显示文摘BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding(DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection(EMR) of colorectal lesions ≥ 20 mm.METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I^2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB(1.4%) when compared to no clipping(5.2%)(pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm.There was no significant heterogeneity among the studies(I^2 = 0%, P = 0.67).CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions.Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy. | Fares Ayoub Donevan R Westerveld Justin J Forde Christopher E Forsmark Peter V Draganov Dennis Yang | 2019 | World Journal of Gastroenterology2019，25，18： | 9 |
| 15 | Training in endoscopic submucosal dissection显示文摘Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient' s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been pro-posed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide. | Roxana M Coman Takuji Gotoda Peter V Draganov | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，8： | 8 |
| 16 | Pancreatic function testing: Here to stay for the 21st century显示文摘The diagnosis of Chronic Pancreatitis (CP) is based on the detection of abnormal structure or function of the diseased pancreas. The pancreatic function tests more accurately determine the presence of CP than tests of structure, especially for early stage disease. The function tests can be divided into two categories: non- invasive and invasive. The invasive 'tube' tests can reliably detect mild, early CP, but are only available at a few referral centers and tend to be poorly tolerated by patients. The non-invasive tests are easy to obtain, but tend to perform poorly in patients with early, mild disease. Therefore, no one test is useful in all clinica situations, and a detailed understanding of the rational, pathophysiologic basis, strengths, and limitations of various tests is needed. This review highlights the role of various pancreatic function tests in the diagnosis of CP including fecal fat analysis, fecal elastase, feca chymotrypsin, serum trypsin, the secretin stimulation test, the cholecystokinin (CCK) stimulation test, the combined secretin-CCK stimulation test, the intraducta and endoscopic secretin stimulation tests, and the functional magnetic resonance imaging of the pancreas after secretin stimulation. | John G Lieb II Peter V Draganov | 2008 | World Journal of Gastroenterology2008，14，20： | 8 |
| 17 | Colorectal cancer surveillance in inflammatory bowel disease: The search continues显示文摘Patients with infl ammatory bowel disease (IBD) are at increased risk for colorectal cancer (CRC). Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC. | Anis Ahmadi Steven Polyak Peter V Draganov | 2009 | World Journal of Gastroenterology2009，15，1： | 7 |
| 18 | ampullary 腺瘤的诊断和管理: 内视镜检查法的膨胀角色显示文摘 Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often asymptomatic.It is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and surveillance.Multiple modalities are available for staging of these lesions to help guide the most appropriate therapy.Those that are used most commonly include computed tomography,endoscopic ultrasound,and endoscopic retrograde cholangiopancreatography.In recent years,endoscopy has become the primary modality for therapeutic management of the majority of ampullary adenomas.Surgery remains the standard curative procedure for confirmed or suspected adenocarcinoma.This review will provide the framework for the diagnosis and management of ampullary adenomas from the perspective of the practicing gastroenterologist. | Payam Chini Peter V Draganov | 2011 | World Journal of Gastrointestinal Endoscopy2011，3，12： | 7 |
| 19 | 3D palaeogeographic reconstructions of the Phanerozoic versus sea-level and Sr-ratio variations显示文摘A full global geodynamical model over 600 million years(Ma) has been developed at the University of Lausanne during the past 20 years. We show herein how the 2D maps were converted into 3D(i.e., full hypsometry and bathymetry), using a heuristic-based approach. Although the synthetic topography may be viewed as relatively crude, it has the advantage of being applicable anywhere on the globe and at any geological time. The model allows estimating the sea-level changes throughout the Phanerozoic, with the possibility, for the first time, to flood accordingly continental areas. One of the most striking results is the good correlation with 'measured' sea-level changes, implying that long-term variations are predominantly tectonically-driven. Volumes of mountain relief are also estimated through time and compared with strontium isotopic ratio(Sr-ratio), commonly thought to reflect mountain belt erosion. The tectonic impact upon the general Sr-ratio trend is shown herein for the first time, although such influence was long been inferred. | Christian Vérard Cyril Hochard Peter O.Baumgartner Gérard M.Stampfli | 2015 | Journal of Palaeogeography2015，4，1： | 7 |
| 20 | Meta-analysis of single strain probiotics for the eradication of Helicobacter pylori and prevention of adverse events显示文摘AIM:To assess the efficacy and safety of single strain probiotics for the:(1) eradication of Helicobacter pylori(H.pylori);(2) prevention of adverse events;and(3) prevention of antibiotic-associated diarrhea associated with eradication therapy.METHODS:We searched Pub Med(1960-2014),EMBASE(1974-2014),Cochrane Database of Systematic Reviews(1990-2014),and ISI Web of Science(2000-2014).Additionally,we conducted a grey literature search including contact with National Institutes of Health Clinical Trials Registry,abstracts from annual infectious disease and gastroenterology meetings,experts in the field and correspondence with authors.Randomized controlled trials of H.pylori positive adults or children treated with eradication therapy and assessing the adjunctive therapy with a single strain of probiotics were included.The primary outcomes were the rates of eradication of H.pylori and frequency of patients with adverse events or antibiotic-associated diarrhea.Outcomes were pooled using fixed or random-effects models to calculate the relative risk and corresponding 95%CI and weighted on study size.To explore possible explanations for heterogeneity,a priori subgroup analyses were conducted on daily probiotic dose,study population,and quality of the study.The overall quality of the evidence for each probiotic strain was assessed using the GRADE criteria.RESULTS:A total of 25 randomized controlled trials(28 treatment arms,with a total of 3769 participants) assessed one of six single probiotic strains as adjunctive treatments to standard eradication therapy.Only one probiotic strain significantly improved H.pylori eradication rates:Saccharomyces boulardii(S.boulardii) CNCM I-745 [pooled relative risks(p RR) = 1.11,95%CI:1.07-1.16].Only one probiotic strain(S.boulardii CNCM I-745) significantly prevented any adverse events(p RR = 0.42,95%CI:0.28-0.62).Both S.boulardii CNCM I-745 and Lactobacillus rhamnosus GG significantlyreduced antibiotic-associated diarrhea(p RR = 0.47,95%CI:0.37-0.60 and p RR = 0.29,95%CI:0.17-0.48,respectively) associated with H.pylori eradication therapy.Meta-regression of sub-groups did not detect significant differences by dose,adult vs pediatric,symptom status,or study quality,but did find significant differences by the strain of probiotic.Potential mild publication bias was found for antibiotic-associated diarrhea,but not for eradication or adverse event outcomes.Analysis of the study quality illuminated areas for improvement in future studies(use of placebos,study size calculations,attrition reasons and discussion of limitations and generalizability).CONCLUSION:The pooled evidence suggests that the adjunctive use of a few probiotic strains may improve H.pylori eradication rates and prevent the development of adverse events and antibiotic-associated diarrhea in those treated with standard eradication therapies.The type of probiotic strain was the most important factor in predicting efficacy. | Lynne V McFarland Peter Malfertheiner Ying Huang Lin Wang | 2015 | World Journal of Meta-Analysis2015，3，2： | 6 |
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