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1恶意的腹水: 预示的因素, pathophysiology 和治疗学的措施的评论显示文摘 Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites.Suma L Sangisetty Thomas J Miner 2012World Journal of Gastrointestinal Surgery2012,4,4:45
2Diabetic nephropathy:Is it time yet for routine kidney biopsy?显示文摘Diabetic nephropathy(DN)is one of the most important long-term complications of diabetes.Patients with diabetes and chronic kidney disease have an increased risk of all-cause mortality,cardiovascular mortality,and kidney failure.The clinical diagnosis of DN depends on the detection of microalbuminuria.This usually occurs after the first five years from the onset of diabetes,and predictors of DN development and progression are being studied but are not yet implemented into clinical practice.Diagnostic tests are useful tools to recognize onset,progression and response to therapeutic interventions.Microalbuminuria is an indicator of DN,and it is considered the only noninvasive marker of early onset.However,up to now there is no diagnostic tool that can predict which patients will develop DN before any damage is present.Pathological renal injury is hard to predict only with clinical and laboratory findings.An accurate estimate of damage in DN can only be achieved by the histological analysis of tissue samples.At the present time,renal biopsy is indicated on patients with diabetes under the suspicion of the presence of nephropathies other than DN.Results from renal biopsies in patients with diabetes had made possible the classification of renal biopsies in three major groups associated with different prognostic features:diabetic nephropathy,non-diabetic renal disease(NDRD),and a superimposed non-diabetic condition on underlying diabetic nephropathy.In patients with type 2 diabetes with a higher degree of suspicion for NDRD,it is granted the need of a renal biopsy.It is important to identify and differentiate these pathologies at an early stage in order to prevent progression and potential complications.Therefore,a more extensive use of biopsy is advisable.Maria L Gonzalez Suarez David B Thomas Laura Barisoni Alessia Fornoni 2013World Journal of Diabetes2013,4,6:29
3高光谱遥感在农作物长势监测中的应用显示文摘该研究是加拿大Saskatchewan Scott农作物轮作系统(ACS)研究的一部分。研究始于1994年,历时18a,评价9个可耕种农作物产量系统的可靠性。由3种处理水平(organic,reduced,high)和3种作物多样性水平(low,diversified annual grains,diversified annual perennials)结合而产生的9个农作物产量系统,被用于监测和评价加拿大牧场不同处理和不同作物种植轮作下可耕种农作物的产量。在2003年生长季共收集了3次叶面积指数和光谱反射率的数据:生长季前期(6月)、生长季旺盛期(7月)、生长季后期(8月)。叶面积指数是由LAI-2000植物冠层分析仪监测的,光谱测量是由覆盖了350-2500 nm波长范围共2215个波段的ADS便携式高光谱仪完成的。结果显示,光学测量可以用于监测农作物生长状况的差异。从生长季的早期到中期,光谱和叶面积指数在不同处理下有显著差异。7月中期是用遥感资料监测农作物长势的最佳季节;红光波段与近红外波段反射率的比值和基于这两个波段构造的归一化植被指数,是检测农作物长势的最佳植被指数。郑有飞 Guo X Olfert O Brandt S Thomas G Weiss R Sproule L 2007气象与环境科学2007,30,1:22
4子宫颈癌筛查异常妇女处理的共识指南(2006版)显示文摘2001年,美国阴道镜与宫颈病理学会(American Society for Colposcopyand Cervical Pathology,ASCCP)联合其他专业学会以及联邦与国际组织.制订了2001版的宫颈癌细胞学筛查结果异常妇女处理的共识指南。这是全面的、以循证医学为依据的指南,其目的是帮助所有亚专业的临床医生,处理每年约480万诊断为细胞学异常的美国妇女。李志刚(翻译) Thomas C. Wright Jr L Stewart Massad Charles J. Dunton MarkSpitzer Edward J. Wilkinson DianeSolomon 2008循证医学2008,8,4:16
5Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis显示文摘To assess the value of magnetic resonance elastography(MRE) in detecting advanced fibrosis/cirrhosis in autoimmune hepatitis(AIH).METHODS In this retrospective study, 36 patients(19 treated and 17 untreated) with histologically confirmed AIH and liver biopsy performed within 3 mo of MRE were identified at a tertiary care referral center. Liver stiffness(LS) with MRE was calculated by a radiologist, and inflammation grade and fibrosis stage in liver biopsy was assessed by a pathologist in a blinded fashion. Two radiologistsevaluated morphological features of cirrhosis on conventional magnetic resonance imaging(MRI). Accuracy of MRE was compared to laboratory markers and MRI for detection of advanced fibrosis/cirrhosis.RESULTS Liver fibrosis stages of 0, 1, 2, 3 and 4 were present in 4, 6, 7, 6 and 13 patients respectively. There were no significant differences in distribution of fibrosis stage and inflammation grade between treated and untreated patient groups. LS with MRE demonstrated stronger correlation with liver fibrosis stage in comparison to laboratory markers for chronic liver disease(r = 0.88 vs-0.48-0.70). A trend of decreased mean LS in treated patients compared to untreated patients was observed(3.7 k Pa vs 3.84 k Pa) but was not statistically significant. MRE had an accuracy/sensitivity/specificity/positive predictive value/negative predictive value of 0.97/90%/100%/100%/90% and 0.98/92.3%/96%/92.3%/96% for detection of advanced fibrosis and cirrhosis, respectively. The performance of MRE was significantly better than laboratory tests for detection of advanced fibrosis(0.97 vs 0.53-0.80, P < 0.01), and cirrhosis(0.98 vs 0.58-0.80, P < 0.01) and better than conventional MRI for diagnosis of cirrhosis(0.98 vs 0.78, P = 0.002).CONCLUSION MRE is a promising modality for detection of advanced fibrosis and cirrhosis in patients with AIH with superior diagnostic accuracy compared to laboratory assessment and MRI.Jin Wang Neera Malik Meng Yin Thomas C Smyrk Albert J Czaja Richard L Ehman Sudhakar K Venkatesh 2017World Journal of Gastroenterology2017,23,5:15
6Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand?显示文摘Diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.Ajaykumar C Morani Khaled M Elsayes Peter S Liu William J Weadock Janio Szklaruk Jonathan Russell Dillman Asra Khan Thomas L Chenevert Hero K Hussain 2013World Journal of Radiology2013,5,3:12
7No association between cyclooxygenase-2 and uridine diphosphate glucuronosyltransferase 1A6 genetic polymorphisms and colon cancer risk显示文摘AIM:To investigate the association of variations in the cyclooxygenase-2(COX2) and uridine diphosphate glucuronosyltransferase 1A6(UGT1A6) genes and non-steroidal anti-inflammatory drugs(NSAIDs) use with risk of colon cancer.METHODS:NSAIDs,which are known to reduce the risk of colon cancer,act directly on COX2 and reduce its activity.Epidemiological studies have associated variations in the COX2 gene with colon cancer risk,but others were unable to replicate this finding.Similarly,enzymes in the UGT1A6 gene have been demonstrated to modify the therapeutic effect of NSAIDs on colon adenomas.Polymorphisms in the UGT1A6 gene have been statistically shown to interact with NSAID intake to influence risk of developing colon adenomas,but not colon cancer.Here we examined the association of tagging single nucleotide polymorphisms(SNPs) in the COX2 and UGT1A6 genes,and their interaction with NSAID consumption,on risk of colon cancer in a population of 422 colon cancer cases and 481 population controls.RESULTS:No SNP in either gene was individually statistically significantly associated with colon cancer,nor did they statistically significantly change the protective effect of NSAID consumption in our sample.Like others,we were unable to replicate the association of variants in the COX2 gene with colon cancer risk(P > 0.05),and we did not observe that these variants modify the protective effect of NSAIDs(P > 0.05).We were able to confirm the lack of association of variants in UGT1A6 with colon cancer risk,although further studies will have to be conducted to confirm the association of these variants with colon adenomas.CONCLUSION:Our study does not support a role of COX2 and UGT1A6 genetic variations in the development of colon cancer.Cheryl L Thompson Sarah J Plummer Alona Merkulova Iona Cheng Thomas C Tucker Graham Casey Li Li 2009World Journal of Gastroenterology2009,15,18:11
8Characterisation and risk assessment of venous thromboembolism in gastrointestinal cancers显示文摘AIM To characterise venous thromboembolism(VTE) in gastrointestinal cancer and assess the clinical utility of risk stratification scoring. METHODS We performed a retrospective analysis using electronic patient records of 910 gastro-oesophageal(GO) cancer and 1299 colorectal cancer(CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on survival.VTE risk scores were calculated using the Khorana index. Patients were classified as low risk(0 points), intermediate risk(1 to 2 points) or high risk(3 points). Data was analysed to determine the sensitivity of the Khorana score to predict VTE. RESULTS The incidence of VTE was 8.9% for CRC patients and 9.7% for GO cancer patients. Pulmonary emboli(PE) were more common in advanced than in localised CRC(50% vs 21% of events respectively) and lower limb deep vein thrombosis(DVT) were more common in localised than in advanced CRC(62% vs 39% of events respectively). The median time to VTE from cancer diagnosis was 8.3 mo for CRC patients compared to 6.7 mo in GO cancer. In localised CRC median time to VTE was 7.1 mo compared with 10.1 mo in advanced CRC. In contrast in GO cancer, the median time to VTE was 12.5 mo in localised disease and 6.8 mo in advanced disease. No survival difference was seen between patients with and without VTE in this cohort. The majority of patients with CRC in whom VTE was diagnosed had low or intermediate Khorana risk score(94% for localised and 97% in advanced CRC). In GO cancer, all patients scored either intermediate or high risk due to the primary site demonstrating a limitation of the risk assessment score in discriminating high and low risk patients with GO cancers. Additional risk factors were identified in this cohort including surgery, chemotherapy or hospital admission. Overall, 81% of patients with CRC and 77% of patients with GO cancer had one or more of these factors within 4 wk prior to diagnosis VTE. These should be factored into clinical risk assessment scores. CONCLUSION The Khorana score has low sensitivity for thrombotic events in CRC and cannot discriminate low risk patients in high risk cancer sites such as GO cancer.Robert L Metcalf Eamon Al-Hadithi Nicholas Hopley Thomas Henry Clare Hodgson Antony McGurk Wasat Mansoor Jurjees Hasan 2017World Journal of Gastrointestinal Oncology2017,9,9:10
9Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease显示文摘AIM:To investigate the relationship between sense of coherence,psychological distress and health related quality of life in inflammatory bowel disease(IBD).METHODS:This cross-sectional study enrolled a consecutive sample of 147 IBD(aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service.Sixty-four participants met diagnostic criteria for Crohn's disease,while eightythree patients had ulcerative colitis.Socio-demographic data(education,age,race,gender,gross monthly income and marital status),disease-related variables(illness activity,relapse rate in past 2 years,history of surgery and time since diagnosis),sense of coherence(Antonovsky's SOC scale),psychological distress symptoms(Hospital Anxiety and Depression Scale) and health-related quality of life(HRQo L; WHOQOLBref) were assessed.Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQo L in patients with IBD and to provide indications for possible moderating or mediating effects.In addition,formal moderation and mediation analyses(Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC,psychological distress symptoms and HRQoL.RESULTS:Lower SOC scores(std beta=-0.504; P < 0.001),female gender(std beta = 0.176; P = 0.021) and White race(std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms,while lower levels of SOC(std beta =-0.438; P < 0.001) and higher relapse rate(std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms.A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms,as the interaction term(time since diagnosis X SOC) had beta coefficients of-0.191(P = 0.009) and-0.172(P = 0.026),respectively.Lower levels of anxiety symptoms(std beta =-0.369; P < 0.001),higher levels of SOC(std beta = 0.231; P = 0.016) and non-White race(std beta =-0.229; P = 0.006),i.e.,mixed-race,which represented the reference category,were independently associated with higher levels of overall HRQoL.Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL.In addition,anxiety mediated the association between SOC and satisfaction with health,as well as its relationship with physical,mental,and social relations HRQo L.Depressive symptoms also mediated the association between SOC and mental HRQoL.CONCLUSION:Our data indicated that SOC is an important construct,as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.Thiago H Freitas Elias Andreoulakis Gilberto S Alves Hesley LL Miranda Lúcia LBC Braga Thomas Hyphantis André F Carvalho 2015World Journal of Gastroenterology2015,21,21:10
10In vivo radiometric analysis of glucose uptake and distribution in mouse bone显示文摘Bone formation and remodeling occurs throughout life and requires the sustained activity of osteoblasts and osteoclasts,particularly during periods of rapid bone growth.Despite increasing evidence linking bone cell activity to global energy homeostasis,little is known about the relative energy requirements or substrate utilization of bone cells.In these studies,we measured the uptake and distribution of glucose in the skeleton in vivo using positron-emitting^(18)F-fluorodeoxyglucose([^(18)F]-FDG) and non-invasive,high-resolution positron emission tomography/computed tomography(PET/CT) imaging and ex vivo autoradiography.Assessment of [^(18)F]-FDG uptake demonstrated that relative to other tissues bone accumulated a significant fraction of the total dose of the glucose analog.Skeletal accumulation was greatest in young mice undergoing the rapid bone formation that characterizes early development.PET/CT imaging revealed that [^(18)F]-FDG uptake was greatest in the epiphyseal and metaphyseal regions of long bones,which accords with the increased osteoblast numbers and activity at this skeletal site.Insulin administration significantly increased skeletal accumulation of [^(18)F]-FDG,while uptake was reduced in mice lacking the insulin receptor specifically in osteoblasts or fed a high-fat diet.Our results indicated that the skeleton is a site of significant glucose uptake and that its consumption by bone cells is subject to regulation by insulin and disturbances in whole-body metabolism.Meredith L Zoch Diane S Abou Thomas L Clemens Daniel LJ Thorek Ryan C Riddle 2016Bone Research2016,4,1:9
11Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study显示文摘AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) patients.METHODS In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin(FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire. RESULTS Twenty patients were included(mean age: 42.7 ± 14.8 years, females: 55%). Seven patients(35%) experienced a clinical relapse during the follow-up period. While 6 patients(66.7%) with normal body weight developed a clinical relapse, 1 UC patient(9.1%) who was overweight/obese relapsed during the follow-up(P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up(0.9 oz vs 0.2 oz, P = 0.002). Five patients(71.4%) with FCP > 150 μg/g and 2 patients(15.4%) with normal FCP(≤ 150 μg/g) at baseline relapsed during the follow-up(P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum. CONCLUSION A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.Ammar Hassanzadeh Keshtel iFloris F van den Brand Karen L Madsen Rupasri Mandal Rosica ValchevaKaren I Kroeker Beomsoo Han Rhonda C Bell Janis Cole Thomas Hoevers David S Wishart Richard N Fedorak Levinus A Dieleman 2017World Journal of Gastroenterology2017,23,21:9
12Elevated blood pressure: Our family's fault?The genetics of essential hypertension显示文摘AIM: To provide an updated review on current genetic aspects possibly affecting essential hypertension(EH), and to further elucidate their role in EH. METHODS: We searched for genetic and epigenetic factors in major studies associated with EH between Jan 2008-Oct 2013 using PubMed. We limited our search to reviews that discussed mostly human studies, and were accessible through the university online re-source. We found 11 genome wide association studies(GWAS), as well as five methylation and three miRNA studies that fit our search criteria. A distinction was not made between genes with protective effects or nega-tive effects, as this article is only meant to be a sum-mary of genes associated with any aspect of EH.RESULTS: We found 130 genes from the studies that met our inclusion/exclusion criteria. Of note, genes withmultiple study references include: STK39, CYP17A1, MTHFR-NPPA, MTHFR-NPPB, ATP2B1, CSK, ZNF652, UMOD, CACNB2, PLEKHA7, SH2B3, TBX3-TBX5, ULK4, CSK-ULK3, CYP1A2, NT5C2, CYP171A, PLCD3, SH2B3, ATXN2, CACNB2, PLEKHA7, SH2B3, TBX3-TBX5, ULK4, and HFE. The following genes overlapped between the genetic studies and epigenetic studies: WNK4 and BDKRB2. Several of the identified genes were found to have functions associated with EH. Many epigenetic factors were also correlated with EH. Of the epigenetic factors, there were no articles discussing siRNA and its effects on EH that met the search criteria, thus the topic was not included in this review. Among the miRNA tar-gets found to be associated with EH, many of the genes involved were also identified in the GWAS studies.CONCLUSION: Genetic hypertension risk algorithms could be developed in the future but may be of limited benefit due to the multi-factorial nature of EH. With emerging technologies, like next-generation sequenc-ing, more direct causal relationships between genetic and epigenetic factors affecting EH will likely be discov-ered creating a tremendous potential for personalized medicine using pharmacogenomics.Aniket Natekar Randi L Olds Meghann W Lau Kathleen Min Karra Imoto Thomas P Slavin 2014World Journal of Cardiology2014,6,5:7
13Tectonic contrast between the conjugate margins of the South China Sea and the implication for the differential extensional model显示文摘The extensional model of the South China Sea(SCS)has been widely studied,but remains under debate.Based on the latest high-quality multi-channel seismic data,bathymetric data,and other obtained seismic profiles,the asymmetric characteristics between the conjugate margins of the SCS are revealed and extensional model of the SCS margin is discussed further.Spatial variation of morphology,basement structure,and marginal faults are discovered among the SCS margin profiles.As for the NS-trending variation,the basement of northern margin displays in the shape of step downwards to the sea,while the basement of southern margin is composed of wide rotated and tilted blocks,without any obvious bathymetric change.The variation also exists in the development of marginal faults between the conjugate margins,and detachment fault system is identified on the southern margin.Along the southern margin from east to west,the Eastern and Southwestern Basins developed different structural units.Based on the tectonic contrast of the conjugate margins,differential extensional model is proposed to explain the spatial variation of the SCS structure,which introduces detachment faults controlling the evolution of the SCS.The upper crust above the detachment fault was deformed by simple shear,while the lower crust and upper mantle below the detachment fault was deformed by pure shear.Because of the different lateral transfer between the upper brittle faulting and the lower ductile extensional regions,there developed marginal plateau(Liyue basin)and outer rise(Zhenghe massif)on the lower plate margin of the Eastern Basin and the Southwestern Basin,respectively.The evolution of the present SCS may be influenced by the diachronous close of the paleo-SCS.DONG DongDong WU ShiGuo LI JiaBiao Thomas LüDMANN 2014Science China Earth Sciences2014,57,6:7
14Trends in Monthly Temperature and Precipitation Extremes in the Zhujiang River Basin,South China(1961-2007)显示文摘Monthly temperature and precipitation time-series for the Zhujiang River Basin are analyzed in order to identify changes in climate extremes.Daily temperature and precipitation data from 1961 to 2007 of 192 meteorological stations are used.Two temperature indicators(monthly mean and monthly maximum mean) and three precipitation indicators (monthly total,monthly maximum consecutive 5-day precipitation,and monthly dry days) are analyzed.Tendencies in all five indicators can be observed.Many stations show significant positive trends(above the 90%confidence level) for monthly mean temperatures and monthly maximum mean temperatures.For all months,a significant increase in temperature from 1961 to 2007 can be observed in the entire basin with the coastal area in particular.Positive trends of precipitation extremes can be observed from January to March.Negative trends are detected from September to November. The number of dry days in October increased significantly at 40%of all meteorological stations.Stations with changes of monthly precipitation extremes are scattered over the Zhujiang River Basin.An aggregation of heat waves and droughts can be detected which is accompanied by significant increases of temperature extremes and the negative tendencies in precipitation extremes.The detection of tendencies in climate extremes essentially relies on a good data quality and high station density.Thomas Fischer Marco Gemmer Lliu Liu Buda Su 2010Advances in Climate Change Research2010,1,2:6
15The hypoxia-inducible factor-1α activates ectopic production of fibroblast growth factor 23 in tumor-induced osteomalacia显示文摘Tumor-induced osteomalacia(TIO) is a rare paraneoplastic syndrome in which ectopic production of fibroblast growth factor 23(FGF23) by non-malignant mesenchymal tumors causes phosphate wasting and bone fractures. Recent studies have implicated the hypoxia-inducible factor-1α(HIF-1α) in other phosphate wasting disorders caused by elevated FGF23, including X-linked hypophosphatemic rickets and autosomal dominant hypophosphatemia. Here we provide evidence that HIF-1α mediates aberrant FGF23 in TIO by transcriptionally activating its promoter. Immunohistochemical studies in phosphaturic mesenchymal tumors resected from patients with documented TIO showed that HIF-1α and FGF23 were co-localized in spindleshaped cells adjacent to blood vessels. Cultured tumor tissue produced high levels of intact FGF23 and demonstrated increased expression of HIF-1α protein. Transfection of MC3T3-E1 and Saos-2 cells with a HIF-1α expression construct induced the activity of a FGF23 reporter construct. Prior treatment of tumor organ cultures with HIF-1α inhibitors decreased HIF-1α and FGF23 protein accumulation and inhibited HIF-1α-induced luciferase reporter activity in transfected cells. Chromatin immunoprecipitation assays confirmed binding to a HIF-1α consensus sequence within the proximal FGF23 promoter, which was eliminated by treatment with a HIF-1α inhibitor. These results show for the first time that HIF-1α is a direct transcriptional activator of FGF23 and suggest that upregulation of HIF-1α activity in TIO contributes to the aberrant FGF23 production in these patients.Qian Zhang Michele Doucet Ryan E Tomlinson Xiaobin Han L Darryl Quarles Michael T Collins Thomas L Clemens 2016Bone Research2016,4,2:6
16Randomized trial in malignant biliary obstruction:Plastic vs partially covered metal stents显示文摘AIM:To compare efficacy and complications of par-tially covered self-expandable metal stent(pcSEMS)to plastic stent(PS)in patients treated for malignant,infrahilar biliary obstruction.METHODS:Multicenter prospective randomized clinical trial with treatment allocation to a pcWallstent(SEMS)or a 10 French PS.Palliative patients aged≥18,for infrahilar malignant biliary obstruction and a Karnofsky performance scale index>60%from 6 participating North American university centers.Primary endpoint was time to stent failure,with secondary outcomes of death,adverse events,Karnofsky performance score and short-form-36 scale administered on a three-monthly basis for up to 2 years.Survival analyses were performed for stent failure and death,with Cox proportional hazards regression models to determine significant predictive characteristics.RESULTS:Eighty-five patients were accrued over 37mo,42 were randomized to the SEMS group and 83patients were available for analyses.Time to stent failure was 385.3±52.5 d in the SEMS and 153.3±19.8 d in the PS group,P=0.006.Time to death did not differ between groups(192.3±23.4 d for SEMS vs211.5±28.0 d for PS,P=0.70).The only significant predictor was treatment allocation,relating to the time to stent failure(P=0.01).Amongst other measured outcomes,only cholangitis differed,being more common in the PS group(4.9%vs 24.5%,P=0.029).The small number of patients in follow-up limits longitudinal assessments of performance and quality of life.From an initially planned 120 patients,only 85 patients were recruited.CONCLUSION:Partially covered SEMS result in a longer duration till stent failure without increased complication rates,yet without accompanying measurable benefits in survival,performance,or quality of life.Peter L Moses Khalid M AlNaamani Alan N Barkun Stuart R Gordon Roger D Mitty M Stanley Branch Thomas E Kowalski Myriam Martel Viviane Adam 2013World Journal of Gastroenterology2013,19,46:6
17Hepatitis B virus mutations potentially conferring adefovir/ tenofovir resistance in treatment-naive patients显示文摘Anti-hepatitis B virus(HBV)therapy leads to the emer- gence of mutant viral strains during the treatment of chronic hepatitis B with nucleos(t)ides analogues. The existence of HBV variants with primary antiviral resistance may be important for treatment choice. We studied two patients with chronic HBV infection by sequencing the HBV polymerase gene.They had adefovir-and tenofovir-related mutations in the viral polymerase,although they had never been treated. These mutations were rtV214A/rtN238T in one patient and rtA194T in the other.Thus,mutations in untreated patients deserve cautious surveillance.These data indicate that mutations that can theoretically confer adefovir or tenofovir resistance may emerge in treatmentnaive patients.Rebecca Pastor Franois Habersetzer Samira Fafi-Kremer Michel Doffoёl Thomas F Baumert Jean-Pierre Gut Franoise Stoll-Keller Evelyne Schvoerer 2009World Journal of Gastroenterology2009,15,6:6
18Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer显示文摘AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.Mohamad A Mouchli Lidia Ouk Marianne R Scheitel Alisha P Chaudhry Donna Felmlee-Devine Diane E Grill Shahrooz Rashtak Panwen Wang Junwen Wang Rajeev Chaudhry Thomas C Smyrk Ann L Oberg Brooke R Druliner Lisa A Boardman 2018World Journal of Gastroenterology2018,24,8:5
19Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup显示文摘The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the 'gold standard' invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.Pupalan Iyngkaran Nagesh S Anavekar Christopher Neil Liza Thomas David L Hare 2017World Journal of Methodology2017,7,4:5
20Gastric emptying, postprandial blood pressure, glycaemia and splanchnic flow in Parkinson's disease显示文摘AIM: To determine gastric emptying, blood pressure, mesenteric artery blood flow, and blood glucose responses to oral glucose in Parkinson's disease. METHODS: Twenty-one subjects(13 M, 8 F; age 64.2 ± 1.6 years) with mild to moderate Parkinson's disease(Hoehn and Yahr score 1.4 ± 0.1, duration of known disease 6.3 ± 0.9 years) consumed a 75 g glucose drink, labelled with 20 MBq 99mTc-calcium phytate. Gastric emptying was quantified with scintigraphy, blood pressure and heart rate with an automated device, superior mesenteric artery blood flow by Doppler ultrasonography and blood glucose byglucometer for 180 min. Autonomic nerve function was evaluated with cardiovascular reflex tests and upper gastrointestinal symptoms by questionnaire. RESULTS: The mean gastric half-emptying time was 106 ± 9.1 min, gastric emptying was abnormally delayed in 3 subjects(14%). Systolic and diastolic blood pressure fell(P < 0.001) and mesenteric blood flow and blood glucose(P < 0.001 for both) increased, following the drink. Three subjects(14%) had definite autonomic neuropathy and 8(38%) had postprandial hypotension. There were no significant relationships between changes in blood pressure, heart rate or mesenteric artery blood flow with gastric emptying. Gastric emptying was related to the score for autonomic nerve function(R = 0.55, P < 0.01). There was an inverse relationship between the blood glucose at t = 30 min(R =-0.52, P < 0.05), while the blood glucose at t = 180 min was related directly(R = 0.49, P < 0.05), with gastric emptying. CONCLUSION: In mild to moderate Parkinson's disease, gastric emptying is related to autonomic dysfunction and a determinant of the glycaemic response to oral glucose.Laurence G Trahair Thomas E Kimber Katerina Flabouris Michael Horowitz Karen L Jones 2016World Journal of Gastroenterology2016,22,20:5
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