BACKGROUND & AIMS: :Leiomyosarcoma of the innominate vein is a rare but usually lethal disease. We report the case of a 50-year-old woman, undergoing a curative resection of the tumor. She is alive and free of disease at 88-month follow-up. Surgical excision remains the current optimal treatment able to provide a chance of cure. KEY WORDS: Late survival, Venous leiomyosarcoma.

背景与目标： 无名静脉平滑肌肉肉瘤是一种罕见但通常致命的疾病。我们报道了一名50岁妇女的病例，该患者正在接受根治性切除肿瘤。在88个月的随访中，她还活着并且没有疾病。手术切除仍然是目前能够提供治愈机会的最佳治疗方法。关键词：晚期生存，静脉平滑肌肉肉瘤。

BACKGROUND & AIMS: :The immune-releasing effects of L-glutamine (Gln) supplementation in duck plague virus (DPV)-infected ducklings were evaluated in 120 seven-day-old ducklings that were divided into 8 groups. The ducklings in control and DPV, 0.5Gln and DPV + 0.5Gln, 1.0Gln and DPV + 1.0Gln, and 2.0Gln and DPV + 2.0Gln received 0, 0.5, 1.0, and 2.0 g of Gln/kg feed/d by gastric perfusion, respectively. Then, the ducklings in control to 2.0Gln were injected with 0.2 mL of phosphate-buffered saline, while those in DPV to DPV + 2.0Gln were injected with DPV at 0.2 mL of 2000 TCID50 (50% tissue culture infection dose) 30 minutes after gavage with Gln, sampled at 12 hours and days 1, 2, 4, and 6. Glutamine supplementation under physiological conditions enhanced immune function and toll-like receptor 4 (TLR4) expressions in a dose-dependent manner. An increase in Gln supplementation under DPV-infected conditions enhanced growth performance, decreased immunoglobulin (Ig) release in plasma and secretory IgA in the duodenum, ameliorated plasma cytokine levels, and suppressed overexpressions of the TLR4 pathway in the duodenum. The positive effects of Gln on the humoral immunity- and intestinal inflammation-related damage should be considered a mechanism by which immunonutrition can assist in the recovery from DPV infection.

背景与目标： ：在120只7日龄小鸭中，分为8组，评估了补充L-谷氨酰胺（Gln）对鸭瘟病毒（DPV）感染的小鸭的免疫释放作用。对照和DPV，0.5Gln和DPV 0.5Gln，1.0Gln和DPV 1.0Gln以及2.0Gln和DPV 2.0Gln的小鸭通过胃灌注分别获得0、0.5、1.0和2.0 g Gln / kg饲料。然后，在管饲后30分钟，向对照组的2.0Gln的小鸭注射0.2 mL磷酸盐缓冲液，向DPV至DPV 2.0Gln的小鸭注射0.2 mL的2000 TCID50（50％组织培养物感染剂量）的DPV。在生理条件下补充谷氨酰胺在12小时和第1、2、4和6天取样，以剂量依赖的方式增强了免疫功能和toll样受体4（TLR4）的表达。在DPV感染的条件下增加Gln的添加可以增强生长性能，降低十二指肠血浆中的免疫球蛋白（Ig）释放和分泌型IgA，改善血浆细胞因子水平，并抑制十二指肠TLR4途径的过表达。 Gln对与体液免疫和肠道炎症相关的损害的积极作用应被认为是免疫营养可以帮助从DPV感染中恢复的机制。

BACKGROUND & AIMS: BACKGROUND:The outcome of sclerotherapy for bleeding oesophageal varices may be influenced by injection technique. In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection tract was introduced in an attempt to reduce injection-related complications. METHODS:To determine the outcome and effectiveness of injection tract embolisation in reducing injection-related complications, we retrospectively reviewed a series of 59 children who underwent injection sclerotherapy for oesophageal varices (29 for extrahepatic portal vein obstruction (EHPVO) and 30 for intrahepatic disease) in our centre. RESULTS:Sclerotherapy resulted in variceal eradication in only 11.8% of the children (mean follow-up duration: 38.4 months). Variceal eradication with sclerotherapy alone was achieved in 20.7% and 3.3% of EHPVO and intrahepatic disease patients, respectively. Injection tract embolisation was successful in reducing the number of complications and re-bleeding rates. Complications that arose included: transient pyrexia (16.7%); deep oesophageal ulcers (6.7%); stricture formation (3.3%); and re-bleeding before variceal sclerosis (23%). CONCLUSION:Injection sclerotherapy did not eradicate oesophageal varices in most children. Injection tract embolisation by sclerosant was associated with fewer complications and reduced re-bleeding rates.

背景与目标： 背景：硬化治疗食管静脉曲张破裂出血的结果可能受到注射技术的影响。在我们机构的先前研究中，硬化疗法与高再出血率和食道溃疡相关。为了减少与注射相关的并发症，引入了栓塞栓塞术。
方法：为了确定注射栓塞栓塞术在减少注射相关并发症方面的效果和有效性，我们回顾性分析了59例接受食管静脉曲张注射硬化治疗的儿童（29例肝外门静脉阻塞（EHPVO）和30例肝内疾病）在我们的中心。
结果：硬化疗法仅导致11.8％的儿童根除静脉曲张（平均随访时间：38.4个月）。仅EHPVO和肝内疾病患者分别采用硬化疗法根除静脉曲张。注射道栓塞术成功减少了并发症的数量和再出血率。引起的并发症包括：短暂性发热（16.7％）;深食道溃疡（6.7％）;狭窄形成（3.3％）;并在静脉曲张硬化之前再次出血（23％）。
结论：注射硬化疗法未根除大多数儿童的食管静脉曲张。硬化剂引起的注射道栓塞与较少的并发症和降低的再出血率相关。

BACKGROUND & AIMS: :We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.

背景与目标： ：我们进行了首次荟萃分析，比较了胰腺假性囊肿的内镜超声引导引流术（EUD）和常规透壁引流术（CTD）的技术成功率和临床结果。我们搜索了PubMed，Embase，Scopus和Cochrane库，以确定相关的前瞻性试验。比较了技术上的成功率，短期（4-6周）成功率和长期（6个月时）症状的成功率以及假性囊肿的放射学分辨率，并发症发生率和死亡率。检索了两项合格的随机对照试验和两项前瞻性研究，其中包括229例患者。 EUD的技术成功率显着高于CTD [风险比（RR）= 12.38，95％置信区间（CI）：1.39-110.22]。当CTD由于假性囊肿的非膨隆性而失败时，便与EUD进行了交叉（n = 18），在所有这些情况下均成功进行了交叉。所有患有门静脉高压症和出血倾向的患者均应接受EUD治疗，以避免严重的并发症。就短期成功率（RR = 1.03，95％CI：0.95-1.11）或长期成功率（RR = 0.98，95％CI：0.76-1.25）而言，EUD并不优于CTD。两组的总并发症相似（RR = 0.98，95％CI：0.52-1.86）。最常见的并发症是出血和感染。 CTD后有两人因出血死亡。仅当在特定的临床情况下选择了适当的引流方式时，这两种方法的短期和长期治疗成功率才具有可比性。对于隆起的假性囊肿，可以选择EUD或CTD，而EUD是不隆起的假性囊肿，门脉高压或凝血病的治疗选择。

BACKGROUND & AIMS: OBJECTIVE:To explore the prognostic value of the postsurgical half-life (HL) of serum alpha-fetoprotein (AFP). BACKGROUND:There is still a paucity of early surrogate indicators of clinical endpoints after liver resection of hepatocellular carcinoma (HCC). METHODS:The analysis was based on cohorts of 225 (exploration set) and 117 (validation set) treatment-naïve HCC patients undergoing curative liver resection. We defined 3 categories of AFP HL: early complete resolution of AFP, normal HL, and prolonged HL if the HL exceeded 7 days. Overall, probabilities of recurrence and survival were estimated and compared across the AFP HL categories. RESULTS:In the exploration cohort, 48 patients (21.3%) achieved early AFP complete resolution, 116 (51.6%) had normal HL, and 61 (27.1%) had prolonged HL. Long AFP HL was significantly associated with early postoperative recurrence (P < 0.001), as was microvascular invasion. Early recurrence within 2 years of resection was observed in 59% of the patients with prolonged AFP HL compared with only 29.3% of those with normal AFP HL (P < 0.001). A log-rank test followed by multivariate Cox analysis identified an independent function of prolonged AFP HL in predicting shorter recurrence-free survival and overall survival time after HCC resection (hazard ratios, 2.81 and 3.58; P < 0.001). When AFP HL analysis was applied to the validation cohort, the association between prolonged AFP HL and survival endpoints (hazard ratio, 11.63 and 16.39; P < 0.001) was confirmed.

背景与目标： 目的：探讨血清甲胎蛋白（AFP）的术后半衰期（HL）的预后价值。
背景：肝切除肝细胞癌（HCC）后仍缺乏临床终点的早期替代指标。
方法：该分析基于225例（探索组）和117例（验证组）未进行过根治性肝切除的未接受治疗的HCC患者的分析。我们定义了AFP HL的3个类别：AFP的早期完全消退，正常HL和如果HL超过7天则延长HL。总体而言，在AFP HL类别中估计并比较了复发和生存的可能性。
结果：在探索队列中，有48例（21.3％）的患者达到了AFP的早期完全缓解，HL正常的116例（51.6％），HL延长的61例（27.1％）。长期AFP HL与微血管浸润与术后早期复发显着相关（P <0.001）。 AFP HL延长的患者中有59％的患者在切除的2年内出现了早期复发，而AFP HL正常的患者只有29.3％的患者出现了早期复发（P <0.001）。对数秩检验和多变量Cox分析确定了AFP HL延长在预测肝癌切除术后较短的无复发生存期和总生存期方面具有独立的功能（危险比，2.81和3.58； P <0.001）。当将AFP HL分析应用于验证队列时，证实了延长的AFP HL与生存终点之间的关联（风险比分别为11.63和16.39； P <0.001）。

BACKGROUND & AIMS: INTRODUCTION:Transrectal natural orifice translumenal endoscopic surgery (NOTES) requires a good endoluminal view and adequate intrarectal bacterial clearance in the working area. We developed a new occlusion balloon unit with an easily detachable inflation device, which allows the surgeon a clear working area distal to the balloon. MATERIAL AND METHODS:The effectiveness of the sealing balloon and the extent of macroscopic and histopathological injury to the bowel wall at the site of balloon placement were examined in 12 pigs. RESULTS:The mean time to place and inflate the balloon unit was 12.0 ± 3.5 min, effective air-tightness lasted for 21.0 ± 12.0 min. There was no leakage of dye (methylene blue) past the balloon when pressure was maintained >6.70 ± 0.08 kPa (6.62-6.78 kPa). After gut irrigation, good visibility was maintained in the working area for six hours, and adequate bacterial clearance was maintained for three hours. There were no macroscopic signs of intestinal wall damage at the site of balloon placement. Histopathological examination showed only patchy mucosal damage and submucosal thrombus at the site of balloon placement. CONCLUSION:This newly-developed occlusion balloon unit helps to establish good visibility and adequate bacterial clearance for endoluminal surgical procedures.

背景与目标： 简介：经直肠自然孔腔内镜手术（NOTES）需要良好的腔内视野，并在工作区域内有足够的直肠内细菌清除率。我们开发了一种带有易于拆卸的充气装置的新型阻塞球囊装置，使外科医生在球囊远端有一个清晰的工作区域。
材料与方法：检查了12只猪的密封球囊的有效性以及球囊放置部位肠壁的宏观和组织病理学损伤程度。
结果：气囊装置的平均放置时间和充气时间为12.0±3.5分钟，有效气密性持续21.0±12.0分钟。当压力保持> 6.70±0.08 kPa（6.62-6.78 kPa）时，没有染料（亚甲蓝）通过球囊泄漏。灌肠后，在工作区域内保持六个小时的良好可见度，并在三个小时内保持足够的细菌清除率。在球囊放置部位没有肉眼可见的肠壁损伤迹象。组织病理学检查仅在球囊放置部位发现斑块状的粘膜损伤和粘膜下的血栓。
结论：这种新开发的闭塞气囊装置有助于为腔内外科手术建立良好的可见性和足够的细菌清除率。

BACKGROUND & AIMS: BACKGROUND AND STUDY AIMS:Following noncurative endoscopic resection of early gastric cancer (EGC), the patient should be observed when the underlying disease is severe, the patient is elderly, or the patient refuses further treatment. The aim of this study was to analyze the clinical outcomes of patients with differentiated EGC who underwent noncurative endoscopic resection without additional treatment. PATIENTS AND METHODS:Included patients underwent noncurative endoscopic resection for differentiated EGC without additional treatment at the Asan Medical Center between July 1994 and January 2009. Clinical and oncological outcomes were analyzed. RESULTS:A total of 159 patients were included in the analysis. The median follow-up period was 33 months (interquartile range [IQR] 22 - 52 months). In total, 40 patients died (25.2 %) - 3 due to stomach cancer, 34 due to other causes, and 3 from unknown causes; the median survival time after endoscopic treatment for these patients was 27.5 months (IQR 13.8 - 48.3 months). Multivariate analysis showed that the rates of underlying disease (P < 0.001) and lymphovascular invasion (P = 0.005) were higher among the 40 patients who died than among the 119 survivors. The overall 3-  and 5-year survival rates were 82.9 % and 77.1 %, respectively; the rates of the patients with lymphovascular invasion were 61.9 % and 42.4 %, respectively, and the rates of patients without lymphovascular invasion were 86.1 % and 81.8 %, respectively (P < 0.001). CONCLUSIONS:Additional treatment provides fewer benefits to patients who do not have long life expectancies. Additional surgery can be considered for patients with lymphovascular invasion because of its high mortality rate; however, the benefits and risks of surgery should be considered carefully.

背景与目标： 背景与研究目的：在早期胃癌（EGC）的非根治性内镜切除术之后，当潜在疾病严重，患者年老或患者拒绝进一步治疗时，应观察患者。这项研究的目的是分析未经治疗的内镜下切除术而无需额外治疗的分化型EGC患者的临床结局。
患者与方法：1994年7月至2009年1月间，在Asan医疗中心对包括EGC在内镜下进行非根治性内镜切除术的患者进行了分化EGC治疗，无额外治疗。分析了临床和肿瘤学结局。
结果：总共159例患者被纳入分析。中位随访期为33个月（四分位间距[IQR] 22±52个月）。共有40例患者（25.2 %%）died- 3因胃癌死亡，34因其他原因死亡，3因不明原因死亡；这些患者经内镜治疗后的中位生存时间为27.5个月（IQR 13.8±48.3个月）。多因素分析显示，死亡的40例患者的基础疾病（P（<0.001）和淋巴管浸润（P = 0.005）的发生率高于119名幸存者。 3年和5年总生存率分别为82.9％和77.1％。淋巴管浸润患者的发生率分别为61.9％和42.4％，无淋巴管浸润的患者分别为86.1％和81.8％（P <0.001）。
结论：额外治疗对没有预期寿命的患者提供的益处较少。由于其高死亡率，可以考虑对淋巴管侵犯的患者进行额外的手术。但是，应仔细考虑手术的益处和风险。

BACKGROUND & AIMS: Fourteen patients with suspected leiomyoma of the esophagus were studied by endoscopic ultrasonography, computed tomography, endoscopy and barium swallow. The results were correlated with the histology of the resected specimensin 2 patients with a peduncolated leiomyoma originating from the second echographic layer, endoscopic resection was performed. Endoscopic ultrasonography was superior to other imaging techniques in detection and staging of leiomyoma because it can determine the layer of origin, the direction of the growth and the consistency of the tumor.

背景与目标： 通过内镜超声检查，计算机断层扫描，内窥镜检查和钡餐检查了14例疑似食管平滑肌瘤的患者。结果与2例来自第二回声层的足钉状平滑肌瘤的切除标本的组织学相关，进行了内窥镜切除。内镜超声检查在平滑肌瘤的检测和分期方面优于其他成像技术，因为它可以确定起源层，生长方向和肿瘤的一致性。

BACKGROUND & AIMS: BACKGROUND:Professional societies recommend posttreatment surveillance for colorectal cancer (CRC) survivors. This study describes the use of surveillance over time, with a particular focus on racial/ethnic disparities, and also examines the role of area characteristics, such as capacity for CRC screening, on surveillance. METHODS:Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify individuals aged 66 to 85 years who were diagnosed with CRC from 1993 to 2005 and treated with surgery. The study examined factors associated with subsequent receipt of a colonoscopy, carcinoembryonic antigen (CEA) testing, primary care (PC) visits, and a composite measure of overall surveillance. RESULTS:Of eligible subjects, 61.0% had a colonoscopy, 68.0% had CEA testing, 77.1% had PC visits, and 43.0% received overall surveillance. After adjustment, blacks were less likely than whites to undergo colonoscopy (odds ratio [OR] 0.76, 95% confidence interval [CI] = 0.69-0.83) and to receive CEA testing and overall surveillance, whereas white/Hispanic rates did not differ. Rates for all outcomes increased from 1993 to 2005, but black/white disparities remained. Individuals in areas with greatest capacity for CRC screening were more likely (OR = 1.09, 95% CI = 1.02-1.18) to receive colonoscopy, and those in areas with the greatest percentage of blacks were less likely (OR = 0.89, 95% CI = 0.83-0.95) to receive colonoscopy. Those living in areas with shortage of PC were less likely to receive PC visits (OR = 0.55, 95% CI = 0.48-0.64) and overall surveillance (OR = 0.83, 95% CI = 0.71-0.98). CONCLUSIONS:Many CRC survivors do not get recommended surveillance, and black/white disparities in rates of surveillance have not improved. Characteristics of the area where an individual lives contribute to the use of surveillance.

背景与目标： 背景：专业协会建议对结直肠癌（CRC）幸存者进行治疗后监测。这项研究描述了随着时间的推移对监视的使用，特别关注种族/族裔差异，并且还研究了区域特征（例如CRC筛查的能力）对监视的作用。
方法：采用监测，流行病学和最终结果（SEER）-医疗保险数据来鉴定1993年至2005年诊断为CRC并接受手术治疗的66至85岁的个体。这项研究检查了与随后接受结肠镜检查，癌胚抗原（CEA）测试，初级保健（PC）访问以及综合监测的综合指标有关的因素。
结果：在符合条件的受试者中，有61.0％的人接受了结肠镜检查，68.0％的人进行了CEA测试，77.1％的人进行了PC访视，而43.0％的人接受了总体监测。调整后，黑人比白人更不可能接受结肠镜检查（几率[OR]为0.76，95％置信区间[CI] = 0.69-0.83）并接受CEA测试和总体监测，而白人/西班牙裔美国人的患病率没有差异。从1993年到2005年，所有结果的发生率都有所增加，但是黑白差异仍然存在。具有CRC筛查能力最大的地区的患者接受结肠镜检查的可能性更高（OR = 1.09，95％CI = 1.02-1.18），黑人比例最高的地区的患者接受结肠镜检查的可能性较小（OR = 0.89，95％CI = 0.83-0.95）接受结肠镜检查。生活在缺乏PC的地区的人接受PC访问（OR = 0.55，95％CI = 0.48-0.64）和总体监测（OR = 0.83，95％CI = 0.71-0.98）的可能性较小。
结论：许多CRC幸存者没有得到推荐的监视，并且监视率的黑白差异没有改善。个人生活所在地区的特征有助于监视的使用。

BACKGROUND & AIMS: :This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

背景与目标： ：本文重新评估了最近报道的与传统的开放性切除术（OPEN）相比，经尿道前列腺良性肥大手术（TURP）后的额外死亡率。我们通过将出院数据与丹麦整个男性人口（1977-85年）的死亡率数据相联系来研究生存率。在长达10.5年的时间里，对38,067例前列腺切除术患者进行了随访。调整手术前的年龄和健康状况后，TURP患者的死亡率要比OPEN患者高得多（RR = 1.19，95％置信区间（1.15-1.24）。两组患者在年龄和术前健康状况方面都存在很大差异，可用的数据可能不足以通过统计分析来控制这种差异；另一方面，死亡率的差异在整个日历时间内仍然存在，即使在这两种方法的使用方式发生显着变化的时期（恒定RR = 1.19，已根据年龄和合并症进行了调整），丹麦TURP患者中最重要的死亡原因也不同于先前报道的加拿大所建议的原因。因此，目前的证据对于超过T的超额死亡率背后的假设生物学机制尚不明确。 URP患者。需要进一步的研究以评估前列腺手术的安全性和有效性。

BACKGROUND & AIMS: BACKGROUND:It is often difficult to distinguish gallbladder cancers (GBC) from benign gallbladder diseases, which show thickened walls. OBJECTIVES:To evaluate the efficacy of bile cytology using endoscopic transpapillary gallbladder drainage (ETGD) and CT. DESIGN:Retrospective study. SETTING:Division of Gastroenterology, Tokyo Medical University, Tokyo, Japan. PATIENTS AND INTERVENTIONS:Eighty-five patients with gallbladder diseases, consisting of 27 GBC and 58 benign gallbladder diseases, were reviewed. A pigtail-type nasobilliary drainage tube was left indwelling in the gallbladder, and through this drainage tube washing cytology was performed with an ETGD tube. MAIN OUTCOME MEASUREMENTS:Diagnostic accuracy of CT and cytology. Complications and outcome were also evaluated. RESULTS:CT and cytology with the ETGD tube had 81% and 81% sensitivity, 91% and 83% specificity, and 88% and 82% accuracy, respectively (P > .05). Looking only at the 71 successful ETGD cases, CT and ETGD cytology had 82% and 100% sensitivity, 92% and 98% specificity, and 89% and 99% accuracy, respectively (P = .036 and .025, respectively). Four patients with GBC in whom CT showed benign findings underwent open cholecystectomy because ETGD cytology revealed malignant findings. In contrast, 4 patients with benign diseases in whom CT suggested malignant finding underwent LC because the findings of ETGD cytology suggested benign disease. CONCLUSIONS:Cytology using an ETGD tube is very useful in the diagnosis and management of gallbladder diseases.

背景与目标： 背景：通常很难将胆囊癌（GBC）与良性胆囊疾病相鉴别，后者显示壁增厚。
目的：通过内镜经乳头胆囊引流术（ETGD）和CT评估胆汁细胞学的疗效。
设计：回顾性研究。
单位：日本东京医科大学胃肠病学系。
病人与干预措施：对包括27例GBC和58例良性胆囊疾病的85例胆囊疾病患者进行了回顾。一根猪尾型鼻腔引流管留在胆囊中，并通过该引流管用ETGD管进行洗涤细胞学检查。
主要观察指标：CT和细胞学检查的诊断准确性。并发症和结局也进行了评估。
结果：ETGD管的CT和细胞学检查分别具有81％和81％的敏感性，91％和83％的特异性以及88％和82％的准确性（P> 0.05）。仅查看71例成功的ETGD患者，CT和ETGD细胞学检查分别具有82％和100％的敏感性，92％和98％的特异性以及89％和99％的准确性（分别为P = .036和.025）。因为ETGD细胞学检查显示恶性，所以4例CT表现为良性病变的GBC患者接受了开腹胆囊切除术。相比之下，有4例CT提示有恶性发现的良性疾病患者进行了LC检查，因为ETGD细胞学检查结果表明存在良性疾病。
结论：使用ETGD管进行细胞学检查对胆囊疾病的诊断和治疗非常有用。

BACKGROUND & AIMS: BACKGROUND:Pentavalent antimony (Sb(v)) is the mainstay therapy for mucosal leishmaniasis (ML), but it is toxic, and relapses are common. Immunotherapy using a mixture of killed parasites, with or without bacille Calmette-Guerin, is an alternative but is used sporadically because of inconsistent results. METHODS:We developed a defined immunotherapeutic antigen preparation for use in an observational, open-label trial to treat 6 patients with ML with a history of Sb(v) therapy failure. All patients were treated with the antigens thiol-specific antioxidant, Leishmania major stress inducible protein 1, Leishmania elongation initiation factor, and Leishmania heat shock protein 83, plus granulocyte-macrophage colony-stimulating factor. Patients underwent clinical and pathological evaluations before the initiation of immunotherapy and at 3, 6, 9, 12, 18, 24, and 60 months after. RESULTS:One month after the third injection, 1 patient showed complete clinical remission (CC) and remained disease free for the duration of the study. At the 9-month follow-up examination, 5 patients showed CC, and all patients were asymptomatic at a subsequent 5-year follow-up examination. CONCLUSIONS:These data support the concept that vaccine therapy with a defined antigen combination, used with standard chemotherapy, is a safe and effective approach to treat drug-refractory ML.

背景与目标： 背景：五价锑（Sb（v））是黏膜利什曼病（ML）的主要治疗方法，但它具有毒性，而且复发很常见。使用杀死的寄生虫的混合物进行免疫疗法，并伴或不伴杆菌Calmette-Guerin，是一种替代方法，但由于结果不一致而偶尔使用。
方法：我们开发了一种明确的免疫治疗性抗原制剂，用于观察性开放标签试验，用于治疗6例具有Sb（v）治疗失败史的ML患者。所有患者均接受了硫醇特异性抗氧化剂，利什曼原虫主要应激诱导蛋白1，利什曼原虫延伸起始因子和利什曼原虫热休克蛋白83以及粒细胞-巨噬细胞集落刺激因子的治疗。在开始免疫治疗之前以及术后3、6、9、12、18、24和60个月，对患者进行临床和病理学评估。
结果：第三次注射后一个月，有1名患者表现出完全的临床缓解（CC），并且在研究期间没有疾病。在9个月的随访检查中，有5例患者显示CC，所有患者在随后的5年随访检查中均无症状。
结论：这些数据支持这样的概念，即与标准化学疗法一起使用的具有确定抗原组合的疫苗疗法是治疗药物难治性ML的一种安全有效的方法。

BACKGROUND & AIMS: BACKGROUND:Hypertensive intracerebral haemorrhage (HICH) is the most common form of haemorrhagic stroke with the highest morbidity and mortality of all stroke types. The choice of surgical or conservative treatment for patients with HICH remains controversial. In recent years, minimally invasive surgeries, such as endoscopic evacuation and stereotactic aspiration, have been attempted for haematoma removal and offer promise. However, research evidence on the benefits of endoscopic evacuation or stereotactic aspiration is still insufficient. METHODS/DESIGN:A multicentre, randomised controlled trial will be conducted to compare the efficacy of endoscopic evacuation, stereotactic aspiration and craniotomy in the treatment of supratentorial HICH. About 1350 eligible patients from 10 neurosurgical centres will be randomly assigned to an endoscopic group, a stereotactic group and a craniotomy group at a 1:1:1 ratio. Randomisation is undertaken using a 24-h randomisation service accessed by telephone or the Internet. All patients will receive the corresponding surgery based on their grouping. They will be followed-up at 1, 3 and 6 months after surgery. The primary outcome is the modified Rankin Scale at 6-month follow-up. Secondary outcomes include: haematoma clearance rate; Glasgow Coma Scale 7 days after surgery; rebleeding rate; intracranial infection rate; hospitalisation time; mortality at 1 month and 3 months after surgery; the Barthel Index and the WHO quality of life at 3 months and 6 months after surgery. DISCUSSION:The trial aims to investigate whether endoscopic evacuation and stereotactic aspiration could improve the outcome of supratentorial HICH compared with craniotomy. The trial will help to determine the best surgical method for the treatment of supratentorial HICH. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT02811614 . Registered on 20 June 2016.

背景与目标： 背景：高血压脑出血（HICH）是出血性中风的最常见形式，在所有中风类型中发病率和死亡率最高。对于HICH患者，手术或保守治疗的选择仍存在争议。近年来，已经尝试了微创手术，例如内窥镜排空和立体定向抽吸术，以去除血肿并提供了希望。但是，关于内窥镜排空或立体定向抽吸术的益处的研究证据仍然不足。
方法/设计：将进行一项多中心，随机对照试验，以比较内镜排空，立体定向抽吸和开颅手术治疗幕上HICH的疗效。来自10个神经外科中心的约1350名合格患者将以1：1：1的比例随机分配到内窥镜组，立体定位组和颅骨切开术组。随机化是通过电话或互联网访问的24小时随机化服务进行的。所有患者将根据其分组接受相应的手术。他们将在手术后的1、3和6个月进行随访。主要结果是修订后的6个月随访中的Rankin量表。次要结果包括：血肿清除率；手术后7天的格拉斯哥昏迷量表;再出血率颅内感染率；住院时间；术后1个月和3个月的死亡率;术后3个月和6个月的Barthel指数和WHO的生活质量。
讨论：该试验旨在研究内镜腔内抽空和立体定向抽吸术是否比开颅手术能改善幕上HICH的预后。该试验将有助于确定治疗幕上HICH的最佳手术方法。
试用注册：ClinicalTrials.gov，ID：NCT02811614。 2016年6月20日注册。

BACKGROUND & AIMS: STUDY DESIGN:Retrospective review of institutional data. OBJECTIVE:The aim of this study was to assess the utility of somatosensory-evoked potentials (SSEP) and transcranial electric motor-evoked potentials (MEP) in the resection of spine tumors and evaluate the ability of both single and multi-modal monitoring to predict postoperative neurological deficits. SUMMARY OF BACKGROUND DATA:Although the utility of intraoperative monitoring (IOM) is well established in scoliosis and degenerative surgery, studies in spine tumor patients have been limited. METHODS:A series of consecutive patients who underwent resection with the use of IOM at a single institution between August 2009 and March 2013 was identified. Demographic, clinical, and neuromonitoring data were collected preoperatively, during surgery, at the moment of discharge, and at a 6-month follow-up visit. Three cohorts were established based on the anatomical location of the tumor: intramedullary, intradural extramedullary, and extradural. Additional groupings were formed based on spinal region. Patients with significant changes in SSEPs or MEPs during surgery were identified and the rate of neurological deficits was assessed. RESULTS:A total of 52 patients were analyzed. A change in SSEPs or MEPs was detected in 11 (21.2%) cases whereas 14 patients (26.9%) developed permanent postoperative deficits. SSEPs predicted deficits in the resection of intramedullary tumors (P = 0.015) (area under cover, AUC = 0.83), and intradural extramedullary tumors (P = 0.048; AUC = 0.70). MEP monitoring did not predict postoperative deficits in the resection of intramedullary (P = 0.21; AUC = 0.69) or intradural extramedullary tumors (P = 0.31; AUC = 0.63). Neither SSEPs nor MEPs predicted deficits for extradural tumors. CONCLUSION:The efficacy of IOM in spine tumor resection is dependent on tumor location relative to the spinal cord and dura. The accuracy of SSEPs and their ability to predict postoperative deficits was greatest for intramedullary lesions. For this series, MEP and multi-modal monitoring did not confer a benefit in predicting permanent neurological deficits. LEVEL OF EVIDENCE:4.

背景与目标： 研究设计：回顾性机构数据。
目的：本研究旨在评估体感诱发电位（SSEP）和经颅电动诱发电位（MEP）在脊柱肿瘤切除术中的作用，并评估单模式和多模式监测的预测能力术后神经功能缺损。
背景资料摘要：尽管在脊柱侧弯和退行性手术中已经确立了术中监测（IOM）的效用，但对脊柱肿瘤患者的研究仍然很有限。
方法：确定了一系列连续患者，这些患者在2009年8月至2013年3月期间在单个机构中使用IOM进行了切除。术前，手术期间，出院时和6个月的随访期间均收集了人口统计学，临床和神经监测数据。根据肿瘤的解剖位置建立了三个队列：髓内，硬膜内髓外和硬膜外。根据脊柱区域形成其他分组。确定手术期间SSEP或MEP有明显变化的患者，并评估神经功能缺损的发生率。
结果：共分析52例患者。在11例（21.2％）病例中发现SSEP或MEP发生了变化，而14例（26.9％）患者出现了永久性术后缺陷。 SSEPs预测髓内肿瘤切除的缺陷（P = 0.015）（隐蔽区域，AUC = 0.83）和硬膜内髓外肿瘤（P = 0.048； AUC = 0.70）。 MEP监测不能预测髓内（P = 0.21; AUC = 0.69）或硬膜内髓外肿瘤（P = 0.31; AUC = 0.63）的切除术后缺陷。 SSEP和MEP均未预测硬膜外肿瘤的缺陷。
结论：IOM在脊柱肿瘤切除术中的疗效取决于相对于脊髓和硬脑膜的肿瘤位置。对于髓内病变，SSEPs的准确性及其预测术后缺陷的能力最大。对于该系列，MEP和多模式监测在预测永久性神经功能缺损方面无益。
证据级别：4。