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1Challenges in diagnosing mesenteric ischemia显示文摘Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.Teun C van den Heijkant Bart AC Aerts Joep A Teijink Wim A Buurman Misha DP Luyer 2013World Journal of Gastroenterology2013,19,9:31
2肩袖损伤的治疗进展显示文摘随着诊断技术水平的不断提高,肩袖损伤的发病率有上升趋势。肩袖损伤的治疗伴随关节镜外科的进步及临床上对肩袖损伤的认识不断深入,已成为骨科学、运动医学关注的热点。陈疾忤 陈世益 George AC Murrell 2004国外医学(骨科学分册)2004,25,2:30
3评估调质时间和温度对猪颗粒饲料淀粉糊化度和维生素沉积的影响显示文摘本论文研究了饲料加工的两个关键参数(调质温度和时间)对育肥猪颗粒饲料淀粉糊化度和维生素沉积的影响。日粮配方为含30%干酒糟及其可溶物的玉米-豆粕型基础日粮。整个试验中配方保持不变。本试验采用2×3双因子设计,调质温度分别为77℃和88℃,调质时间分别15秒、30秒和60秒。此外,本试验还设置一个对照组,对照组饲料不采用调质制粒工艺,而是采用粉料饲喂。因此,本试验共有7个处理组。采集调质后制粒前(热干粉)、制粒后冷却前(热制粒)、以及制粒冷却后(冷制粒)的样品,并分析这三种样品的总淀粉率。Lewis LL Stark CR Fahrenholz AC Bergstrom JR Jones CK 2015广东饲料2015,24,5:18
4Role of matrix metalloproteinase,tissue inhibitor of metalloproteinase and tumor necrosis factor-α single nucleotide gene polymorphisms in inflammatory bowel disease显示文摘AIM:To study the (functional) relevance of single nucleotide polymorphisms (SNPs) in genes encoding matrix metalloproteinases (MMP)-1,-2,-3,-9,tissue inhibitors of metalloproteinases (TIMP)-1,-2 and tumor necrosis factor (TNF)-α in the etiopathogenesis of inflammatory bowel diseases (IBD),that may enhance susceptibility and/or disease severity. METHODS:Genomic DNA from 134 Crohn's disease (CD),111 ulcerative colitis (UC) patients and 248 control subjects was isolated from resected intestinal tissue or blood. Allelic composition at SNP loci was determined by PCR-RFLP or tetra primer ARMS PCR. RESULTS:The TIMP-1 genotype TT in women and T in men at SNP +372 T/C was found to increase CD susceptibility (39% vs 23.8%,P=0.018 and 67.9% vs 51.6%,P=0.055,respectively),while women with this genotype were less prone to development of fistulae during follow-up (41.4% vs 68.3%,P=0.025). Male IBD or CD patients carrying the TIMP-1 +372 T-allele expressed lower levels of TIMP-1 in surgically resected macroscopically inflamed tissue (0.065 < P < 0.01). The 5T5T genotype at MMP-3 SNP -1613 5T/6T increased the chance of stenotic complications in CD during follow-up (91.2% vs 71.8%,P = 0.022) but seemed to protect against colonic involvement of this disease at first endoscopic/radiologic examination (35.3% vs 59.5%,P=0.017). CONCLUSION:Allelic composition at the examinedSNPs in genes coding for TIMP-1 and MMP-3 affect CD susceptibility and/or phenotype,i.e.,fistulizing disease,stricture pathogenesis and first disease localisation. These findings reinforce the important role of these proteins in IBD.Martin JW Meijer Marij AC Mieremet-Ooms Ruud A van Hogezand Cornelis BHW Lamers Daniel W Hommes Hein W Verspaget 2007World Journal of Gastroenterology2007,13,21:15
5轻量型网片可以提高腹腔镜全腹膜外腹股沟疝修补术后的功能结局显示文摘前瞻性研究旨在比较腹腔镜全腹膜外腹股沟疝修补术(TEP)中,采用新型轻量型网片和传统重量型网片的差异,所有手术均在同一疝中心完成。方法自2004年11月到2005年7月,共有250例病人接受了腹腔镜TEP,采用轻量型(Ultrapro,30g/m)2或重量型网片(Prolene,100g/m2)。通过病历资料回顾及电话问卷调查获得随访数据。术后早期及远期均对病人进行随访,以评估术后结局的变化。结果 250例中有188例(75%)获得随访。在术后平均4个月及15个月进行的随访中发现,轻量型网片组和重量型网片组在疼痛或不适感的发生率及程度上没有差别。轻量型网片组在术后早期及远期对体力活动的影响显著小于重量型网片组,尤其是举重(9%vs.21%,平均随访4个月,Mann-WhitneyU,P=0.024)、行走(1%vs.11%,平均随访5个月,Mann-WhitneyU,P=0.006)及剧烈运动(7%vs.19%,平均随访15个月,Mann-Whitney-U,P=0.012)。腹股沟区的网片感或不适感两组差异无统计学意义。结论采用轻量型网片行腹腔镜TEP可以改善术后早期及远期的功能结局。轻量型网片可以显著减少对所有体力活动的影响。两者的疼痛都较轻微,表明腹腔镜手术的优势。Khan LR Liong S de Beaux AC Kumar S Nixon SJ 2010中国实用外科杂志2010,30,7:14
6国际胃袖状切除专家共识:基于>12000手术病例的最佳操作指南显示文摘腹腔镜胃袖状切除术(1aparoscopic sleeve gastrectomy,LSG)系相对较新的减重手术方式。因其操作相对简单、治疗肥胖合并疾病及减重效果明显,逐步得以广泛接受。目前美国代谢与减重手术协会将其推荐为肥胖症治疗的单独标准术式。2011年3月25~26日,苏远涛 徐安安 朱江帆 Diaz AA Arvidsson D Baker RS Basso N Bellanger D Boza C El Mourad H France M Gagner M Galvao-Neto M Higa KD Himpens J Hutchinson CM Jacobs M Jorgensen JO Jossart G Lakdawala M Nguyen NT Nocca D Prager G Pomp A Ramos AC Rosenthal RJ Shah S Vix M Wittgrove A Zundel N 2013中国微创外科杂志2013,13,9:12
7合资企业的不稳定性显示文摘编者按:一个合资企业的成功,有赖于合资双方的相互依赖和协调发展,而当合资一方获取的知识和技能足以消除对其合资伙伴的依赖性时,合资双方的相对谈判实力就会发生变化。本文作者介绍了美国研究合资企业的专家学者在合资双方相互依赖性方面的研究,建立了一个合资企业...Inkp.,AC Beam.,PV 1999国际经济合作1999,,2:10
8术前联合使用口服抗生素的机械性肠道准备可显著降低结直肠手术后的术区感染、吻合口瘘及肠梗阻显示文摘目的 探讨术前肠道准备和不同肠道准备方法 [机械性肠道准备(mechanical bowel preparation,MBP)/口服抗生素]是否影响结直肠手术的特定结局。方法 从2012年启动的美国国家外科质量改进计划中的结肠切除术的数据库中提取研究对象的资料,包括是否使用肠道准备、肠道准备的类型以及结直肠术后特定的并发症。对于接受择期结直肠手术的患者,我们使用无校正的或校正的logistic回归分析来评估术前联合MBP与抗生素(MBP+/ABX+),单独使用MBP(MBP+/ABX-)以及不使用肠道准备(no-prep)对预后的影响,特别是对吻合口瘘、手术部位感染(surgical site infection,SSI)和肠梗阻的影响。结果本研究共纳入8442名患者,no-prep组2296例(27.3%)、MBP+/ABX组3822例(45.3%)和MBP+/ABX+组2324例(27.5%)。组间的基线资料基本相似,但no-pre组在既往败血症、腹水、糖皮质激素使用、出血和肿瘤播散上稍比其他两组多。与no-pre组相比,MBP无论是否联合使用抗生素都与术后肠梗阻(MBP+/ABX+:OR=0.57,95%CI:0.48~0.68;MBP+/ABX:OR=0.78,95%CI:0.68~0.91)和SSI(MBP+/ABX+:OR=0.39,95%CI:0.32~0.48;MBP+/ABX:OR=0.80,95%CI:0.69~0.93)发生率的降低相关。MBP+/ABX+组患者比no-pre组患者具有更低的吻合口瘘发生率(OR=0.45,95%CI:0.32~0.64)。多因素分析发现,联合使用抗生素的MBP方法与吻合口瘘(OR=0.57,95%CI:0.35~0.94)、SSI(OR=0.40,95%CI:0.31~0.53)及术后肠梗阻(OR=0.71,95%CI:0.56~0.90)发生率的降低独立相关。结论上述结果阐明了近50年来的一个争议——肠道准备是否可改善结直肠术后的结局。联合使用口服抗生素的MBP方法可有效降低接近一半的SSI、吻合口瘘及肠梗阻这些结直肠术后最常见最麻烦的并发症。Kiran RP Murray AC Chiuzan C 孙开宇 2015消化肿瘤杂志(电子版)2015,7,4:10
9机械响应干细胞在颌骨再生中获得神经嵴命运的机制显示文摘Ransom RC,Carter AC,Salhotra A,et a1.Mechanoresponsive stem cells acquire neural crestfate in jaw regeneration.Nature,2018Oct 24.在胚胎发育和成体组织再生期间.由主转录因子驱动的染色质结构的变化导致刺激响应性转录程序。彻底了解骨骼中的干细胞如何响应机械刺激并实现再生.将揭示在再生过程中力如何转换到细胞核中。在这里.作者开发了一种遗传上可分析的下颌骨牵引成骨小鼠模型:这是一种用于矫正人类小下颌的手术.包括手术分离颌骨,从而在间隙中触发新的骨骼生长。使用该模型显示新形成的骨的区域源自存在于骨架中的干细胞。染色质和转录分析显示.这些干细胞群在黏着斑激酶(FAK)信号通路内获得活性.并且抑制FAK消除新骨形成。在牵张期间.通过FAK在骨骼干细胞中的机械转导,激活基因调节程序和发育过程中原始神经嵴细胞中激活的反转录转座子。骨骼干细胞从原始神经嵴细胞中产生。这种向发育状态的逆转是促进成体骨骼组织基于干细胞再生的强大组织生长基础。Ransom RC Carter AC Salhotra A 赵泽亮 2018中国口腔颌面外科杂志2018,16,6:9
101型糖尿病患者的血糖控制,心脏自身免疫和心血管病的长期风险显示文摘血糖控制不佳与1型糖尿病(type 1diabetes mellitus,T1DM)患者的心血管病风险增加有关;然而,对T1DM的特异性机制知之甚少。在T1DM中,心肌损伤可诱发持续的心脏自身免疫。慢性高血糖症引起心肌损伤,高血糖诱导的心脏自身免疫可能导致长期心血管病并发症的可能性。Sousa GR Pober D Galderisi A Lv H Yu L Pereira AC Doria A Kosiborod M Lipes MA 刘莉 叶鹏 2019中华高血压杂志2019,27,1:8
11急性脊髓损伤患者治疗的临床操作指南:关于MRI基线在临床治疗决策与结果预测中作用的几点建议(英文)显示文摘The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as ' we recommend,' whereas a weaker recommendation is indicated by 'we suggest.' Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) 'We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making'(quality of evidence,very low) and(2) 'We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome '(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.Fehlings MG Martin AR Tetreault LA Aarabi B Anderson P Arnold PM Brodke D Burns AS Chiba K Dettori JR Furlan JC Hawryluk G Holly LT Howley S Jeji T Kalsi-Ryan S Kotter M Kurpad S Kwon BK Marino RJ Massicotte E Merli G Middleton JW Nakashima H Nagoshi N Palmieri K Singh A Skelly AC Tsai EC Vaccaro A Wilson JR Yee A Harrop JS 2017中华神经外科疾病研究杂志2017,16,6:8
12ConservativeapproachinPeutz-JeghersSyndrome:Single-balloon enteroscopyandsmallbowelpolypectomy显示文摘AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts(age 15-38 years) with PJS have been collected; six under-went polypectomy using single balloon enteroscopy(Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit(OBCU Olympus Balloon Control Unit) and a dispos-able silicone splinting tube with balloon(ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endos-copy(WCE). Prophylactic polypectomy was reservedmainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from-6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm(range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgi-cal resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussuscep-tions. No gastrointestinal tumors were found in sub-sequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper en-doscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps(> 15 mm).CONCLUSION: The effective of prophylactic polyp-ectomy of small bowel large polyps(> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.Torroni F Romeo E Rea F De Angelis P Foschia F Faraci S Federici di Abriola G Contini AC Caldaro T Dall’Oglio L 2014World Journal of Gastrointestinal Endoscopy2014,6,7:7
13人类减数分裂显示文摘自本世纪50年代中期染色体分析技术在卵巢组织和睾丸组织的应用,以及目前许多生殖细胞的细胞遗传学研究技术的出现,哺乳类减数分裂染色体研究已取得巨大成绩。然而在人类的研究主要受生殖腺标本取材所限。用于研究减数分裂染色体的新技术 1964年哺乳类减数分裂染色体研究发生了突破性进展。精母细胞经空气干燥、低渗和固定后,可精细地显示出每个减数分裂染色体,精确地计数MI期的交叉。正常男性每个细胞的交叉数平均为50个。由于人类卵母细胞的固定质量远不如精母细胞,至今女性的准确交叉数不十分清楚。Chandley AC 孙艳阳 1989国外医学(遗传学分册)1989,12,3:7
14螺内酯与可乐定作为难治性高血压第4种治疗药物的比较:难治性高血压的最佳治疗随机研究显示文摘该研究旨在通过一个多中心随机试验对作为难治性高血压患者的第4种治疗药物的螺内酯与可乐定进行比较。采用药丸计数评估药物治疗依从性。难治性高血压患者(定义为包括1种利尿剂在内的3种药物治疗12周,诊室及动态血压监测血压仍未控制)随机给予螺内酯(12.5~50 mg/d)或可乐定(0.1~0.3mg,2次/d)继续治疗12周。Krieger EM Drager LF Giorgi DMA Pereira AC Barreto-Filho JAS Nogueira AR Mill JG Lotufo PA Amodeo C Batista MC Bodanese LC Carvalho ACC Castro I Chaves H Costa EAS Feitosa GS Franco RJS Fuchs FD Guimarāes AC Jardim PC Machado CA Magalhāes ME Mion D Jr Nascimento RM Nobre F Nóbrega AC Ribeiro ALP Rodrigues-Sobrinho CR Sanjuliani AF Teixeira MDCB Krieger JE ReHOT Investigators 赵狄 练桂丽 2018中华高血压杂志2018,26,3:7
15Challenges in diagnosing adhesive small bowel obstruction显示文摘Adhesive small bowel obstruction(ASBO)is the most frequently encountered surgical disorder of the small intestine.Up to 80%of ASBO cases resolve spontaneously and do not require invasive treatment.It is important to identify such patients that will benefit from conservative treatment in order to prevent unnecessarily exposing them to the risks associated with surgical intervention,such as morbidity and further adhesion formation.For the remaining ASBO patients,timely surgical intervention is necessary to prevent small bowel strangulation,which may cause intestinal ischemia and bowel necrosis.While early identification of these patients is key to decreasing ASBO-related morbidity and mortality,the non-specific signs and laboratory findings upon clinic presentation limit timely diagnosis and implementation of appropriate clinical management.Combining the clinical presentation findings with those from other diagnostic imaging modalities,such as abdominal X-ray,computed tomography-scan and water-soluble contrast studies,will improve diagnosis of ASBO and help clinicians to better evaluate the potential of conservative management as a safe strategy for a particular patient.Nonetheless,patients who present with moderate findings by all these approaches continue to represent a challenge.A new diagnostic strategy is urgently needed to further improve our ability to identify early signs of strangulated bowel,and this diagnostic modality should be able to indicate when surgical management is required.A number of potential serum markers have been proposed for this purpose,including intestinal fatty acid binding protein andα-glutathione S transferase.On-going research is attempting to clearly define their diagnostic utility and to optimize their potential role in determining which patients should be managed surgically.Thijs R van Oudheusden Bart AC Aerts Ignace HJT de Hingh Misha DP Luyer 2013World Journal of Gastroenterology2013,19,43:7
16脊髓损伤后肠道功能障碍显示文摘回顾结肠、直肠动力和排便的基本生理学特征 ,阐述脊髓损伤对排便的影响 ,讨论目前临床上的治疗措施 ,并提出新的治疗和研究方向。AC Lynch AA ntony BR Dobbs FA Frizelle 王红星 2002中国康复理论与实践2002,8,3:7
17功能神经影像学——语言功能的脑磁图研究显示文摘脑磁图是近10年开始应用于功能神经影像学研究的,又被称为磁源成像,是利用超导技术制成的高敏感传感器可以在颅外及时探测大脑神经元的电活动所产生的磁场,并且把所探测到的磁源重叠到相应的MRI图像上从而确定磁源的位置。它不受组织导电率的影响,且具有极高的时间分辨率。研究表明,脑磁图在语言功能的定侧定位方面的研究是可行的、可信的,并且具有可重复性。此外,脑磁图在阅读困难症的病因研究和疗效观察方面也具有重要意义。张文波 祁吉 Papanicolaou AC 2002国外医学(临床放射学分册)2002,25,4:6
18D-二聚体预测稳定型冠状动脉性心脏病患者的长期病因特异性死亡率、心血管事件和癌症显示文摘交联纤维蛋白的降解产物D-二聚体是高凝状态和血栓形成事件的标志。D-二聚体水平中度升高与血管疾病患者静脉和动脉事件的风险相关。在缺血性疾病长期普伐他汀干预(long-term intervention with pravastatin in ischemic disease,LIPID)试验中,研究者在存在其他危险因素的背景下,评估了D-二聚体水平在预测长期血管转归、病因特异性死亡率和新发癌症中的作用。刘青 叶鹏 Simes J Robledo KP White HD Espinoza D Stewart RA Sullivan DR Zeller T Hague W Nestel PJ Glasziou PP Keech AC Elliott J Blankenberg S Tonkin AM LIPID study investigators 2018中华高血压杂志2018,26,3:6
19Hepatic ischemic preconditioning increases portal vein flow in experimental liver ischemia reperfusion injury显示文摘BACKGROUND: Ischemic preconditioning(IPC) has been shown to decrease liver injury and to increase hepatic microvascular perfusion after liver ischemia reperfusion. This study aimed to evaluate the effects of IPC on hemodynamics of the portal venous system. METHODS: Thirty-two rats were randomized into two groups: IPC group and control group. The rats of the IPC group underwent IPC by 10 minutes of liver ischemia followed by 10 minutes of reperfusion before liver ischemia, and the rats of the control group were subjected to 60 minutes of partial liver ischemia. Non-ischemic lobes were resected immediately after reperfusion. The animals were studied at 4 hours and 12 hours after reperfusion. Mean arterial pressure, heart rate, portal vein flow and pressure were analyzed. Blood was collected for the determination of the levels of aspartate aminotransferase, alanine aminotransferase, calcium, lactate, pH, bicarbonate, and base excess. RESULTS: IPC increased the mean portal vein flow at 4 hours and 12 hours after reperfusion. IPC recovered 78% of the meanportal vein flow at 12 hours after reperfusion. IPC decreased the levels of aspartate aminotransferase, alanine aminotransferase and lactate, and increased the levels of ionized calcium, bicarbonate and base excess at 12 hours after reperfusion. CONCLUSIONS: This study demonstrated that IPC increases portal vein flow and enhances hepatoprotective effects in liver ischemia reperfusion. The better recovery of portal vein flow after IPC may be correlated with the lower levels of transaminases and with the better metabolic profile.Estela RR Figueira Joel A Rocha-Filho Mauro Nakatani Marcelo FS Buto Eduardo R Tatebe Vitor O Andre Ivan Cecconello Luiz AC D'Albuquerque 2014Hepatobiliary & Pancreatic Diseases International2014,13,1:6
20瘦素通过醛固酮依赖机制,诱发肥胖雌性小鼠高血压和血管内皮功能障碍显示文摘肥胖是男性与女性心血管病的主要危险因素。然而,肥胖是否通过类似机制触发两性心血管病尚不清楚。在男性中,脂肪细胞因子瘦素通过增强交感神经活性,增加肥胖相关的心血管病。女性可分泌出高于男性3~4倍的瘦素,但未表现出与肥胖相关的较高的交感神经张力。刘莉 叶鹏 Huby AC Otvos L Jr Belin de Chantemèle EJ 2016中华高血压杂志2016,24,3:5
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