• 【多达三分之一的心脏病患者的干预后生活质量下降。】 复制标题 收藏 收藏
    DOI:10.1080/14017430600784343 复制DOI
    作者列表:Hawkes AL,Mortensen OS
    BACKGROUND & AIMS: OBJECTIVE:To investigate clinically relevant intra-individual and mean changes in health-related quality of life (HRQoL) with the Short Form-36 Health Survey (SF-36) need to acknowledge that SF-36 is trademarked ie: SF-36(R) following cardiac intervention for Australian and Danish patients. DESIGN:Prospective observational study in tertiary cardiac centres in Townsville, Queensland, Australia and Copenhagen, Denmark. Two hundred coronary artery bypass graft surgery (CABG) patients of two Townsville hospitals, and 47 CABG or percutaneous coronary intervention (PCI) patients of a Copenhagen hospital. The main outcome measures are eight SF-36 health subscales at baseline and six months post-intervention. RESULTS:Australian and Danish patients experienced similar HRQoL pre-intervention. By six months post-intervention, patients experienced a significant mean improvement in all subscales of the SF-36 survey (p < or = 0.05), although up to 27% of patients had a clinically significant decline in HRQoL from baseline. CONCLUSIONS:These results demonstrate that it is necessary to investigate intra-individual changes in HRQoL as well as group mean changes as they produce different conclusions. In addition, establishing clinically significant intra-individual change standards may assist researchers and clinicians in determining whether an individual may benefit from therapy or intervention.
    背景与目标: 目的:要通过36型健康调查(SF-36)调查与健康相关的生活质量(HRQoL)的临床相关个体内和平均变化,需要承认SF-36是商标,即:SF-36( R)对澳大利亚和丹麦患者进行心脏干预后。
    设计:在澳大利亚昆士兰州汤斯维尔和丹麦哥本哈根的三级心脏中心进行前瞻性观察研究。两家汤斯维尔医院的200例冠状动脉搭桥术(CABG)患者,以及哥本哈根医院的47例CABG或经皮冠状动脉介入治疗(PCI)患者。主要结果指标是基线时和干预后六个月的八个SF-36健康子量表。
    结果:澳大利亚和丹麦患者经历了类似的HRQoL干预前。干预后六个月,患者在SF-36调查的所有子量表中均经历了显着的平均改善(p <或= 0.05),尽管高达27%的患者的HRQoL与基线相比有临床上的显着下降。
    结论:这些结果表明,有必要研究HRQoL的个体内部变化以及群体均值变化,因为它们会产生不同的结论。此外,建立具有临床意义的个体内部变更标准可能有助于研究人员和临床医生确定个人是否可以从治疗或干预中受益。
  • 【计算机辅助诊断方案,用于通过随访放大的乳房X线照片来识别簇状微钙化的组织学分类。】 复制标题 收藏 收藏
    DOI:10.1016/j.acra.2006.07.005 复制DOI
    作者列表:Nakayama R,Watanabe R,Namba K,Takeda K,Yamamoto K,Katsuragawa S,Doi K
    BACKGROUND & AIMS: RATIONALE AND OBJECTIVES:Our purpose in this study was to investigate the usefulness of follow-up magnification mammograms (i.e., both current and previous magnification mammograms) in a computer-aided diagnosis (CAD) scheme for identifying the histological classification of clustered microcalcifications. MATERIALS AND METHODS:Our database consisted of current and previous magnification mammograms obtained from 93 patients before and after 3-month follow-up: 11 invasive carcinomas, 19 noninvasive carcinomas of the comedo type, 25 noninvasive carcinomas of the noncomedo type, 23 mastopathies, and 15 fibroadenomas. In our CAD scheme, we extracted five objective features of clustered microcalcifications from each of the current and previous magnification mammograms by taking into account image features that experienced radiologists commonly use to identify histological classifications. These features were then merged by a modified Bayes discriminant function for distinguishing among five histological classifications. For the input of the modified Bayes discriminant function, we used five objective features obtained from the previous magnification mammogram (previous features), five objective features obtained from the current magnification mammogram (current features), and the set of the five previous features and the five current features. RESULTS:The classification accuracies with the five current features were higher than those with the five previous features. These classification accuracies were improved substantially by using the set of the five previous features and the five current features. For the set of the five previous features and the five current features, the classification accuracies of our CAD scheme were 81.8% (9 of 11) for invasive carcinoma, 84.2% (16 of 19) for noninvasive carcinoma of the comedo type, 76.0% (19 of 25) for noninvasive carcinoma of the noncomedo type, 73.9% (17 of 23) for mastopathy, and 86.8% (13 of 15) for fibroadenoma. CONCLUSION:Our CAD scheme with use of follow-up magnification mammograms improved classification performance for mammographic clustered microcalcifications.
    背景与目标: 理由和目的:我们在这项研究中的目的是研究在计算机辅助诊断(CAD)方案中对后续放大的乳房X线照片(即当前和以前的放大X线照片)的有效性,以识别簇状微钙化的组织学分类。
    材料和方法:我们的数据库包含从3个月的随访前后的93例患者获得的当前和以前的放大乳房X线照片:11个浸润性癌,19个粉刺型非浸润性癌,25个非粉刺型非浸润性癌,23个乳腺病,和15个纤维腺瘤。在我们的CAD方案中,我们通过考虑经验丰富的放射科医生通常用来识别组织学分类的图像特征,从当前和以前的放大倍数乳房X线照片中提取出簇状微钙化的五个客观特征。然后,通过改进的贝叶斯判别函数合并这些特征,以在五种组织学分类之间进行区分。对于修改的贝叶斯判别函数的输入,我们使用了从先前的放大倍数X线照片(先前的特征)获得的五个客观特征,从当前的放大倍数X线图(当前特征)获得的五个客观特征,以及五个先前的特征和当前的五个功能。
    结果:具有五个当前特征的分类准确度高于具有五个先前特征的分类准确度。通过使用五个先前功能和五个当前功能的集合,大大提高了这些分类的准确性。对于这五个先前特征和五个当前特征的集合,我们的CAD方案的分类准确度对于浸润性癌为81.8%(11个中的9个),粉刺型非浸润性癌为84.2%(19个中的16个),76.0%对于非粉刺型非侵袭性癌,其诊断率为(25分之19),对于乳腺病为73.9%(23分之17),对于纤维腺瘤则为86.8%(15分之13)。
    结论:我们的CAD方案采用了后续放大的乳腺X线照片,改善了乳腺X线照相群集微钙化的分类性能。
  • 【成人先天性心脏病患者的亚临床甲状腺功能减退症。】 复制标题 收藏 收藏
    DOI:10.1007/s00246-012-0571-6 复制DOI
    作者列表:Martínez-Quintana E,Rodríguez-González F,Nieto-Lago V
    BACKGROUND & AIMS: :Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.
    背景与目标: 亚临床甲状腺功能减退症通常无症状,但可能与各种不良心脏预后相关。为了深入了解甲状腺刺激激素(TSH)在先天性心脏病中的作用,本研究测量了不同类型的成年先天性心脏病(GUCHD)患者的血清TSH浓度。测量血清TSH(参考范围0.34-5.6 mIU / L),肌酐,胆固醇,C反应蛋白(CRP),N端proB型利钠肽(NT-pro-BNP)和24小时蛋白尿。 249位GUCHD患者。 TSH水平高于5.6 mUI / L的24名GUCHD患者(9.6%)中,有9名发(37.5%)和7名(29.1%)患有唐氏综合症。血清TSH超过5.6 mIU / L的GUCHD患者的血清NT-pro-BNP显着更高(195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001)和CRP(0.30 [0.06; 1.87) [] vs. 0.16 [0.00; 1.40]; p = 0.011],TSH水平为5.6 mIU / L或更低;两组之间的血清肌酐,脂质或24小时蛋白尿无显着差异。 TSH超过5.6 mIU / L的GUCHD患者的血药浓度在正常范围内(0.89±0.23 ng / dL)。在多变量分析中,紫((比值[OR]为6,399; 95%置信区间[CI]为2,296- 17,830; p <0.001),唐氏综合症(OR,6,208; 95%CI,1,963-19,636; p = 0.002)和NT-pro-BNP浓度(OR,1,001; 95%CI,1,000-1,002; p <0.026) )被证明是TSH水平高于5.6 mIU / L的危险因素。由于亚临床甲状腺功能减退症会引起心血管疾病风险,因此作者推测TSH筛查应包括在GUCHD的常规随访评估中紫osis或唐氏综合症患者。
  • 【进行部分或全部肩ectomy骨切除术后可获得出色的肩部功能。长时间随访时进行分析。】 复制标题 收藏 收藏
    DOI:10.1001/archsurg.1990.01410160125024 复制DOI
    作者列表:Ward B,McGarvey C,Lotze MT
    BACKGROUND & AIMS: :We reviewed six cases of primary sarcomas requiring scapulectomy within the past 13 years in the Surgery Branch of the National Cancer Institute, Bethesda, Md. Five of these patients returned for evaluation of disease status, evaluation of functional defects as determined by muscle group testing, and assessment of daily living skills and limitations. We demonstrated excellent shoulder function with partial scapulectomy and significant impairment with the additional loss of the glenoid fossa. In addition, we developed a thorough method of postoperative evaluation. Involvement of rehabilitation therapists before and after operatively is integral to this process in preparation for surgery and subsequent treatment.
    背景与目标: :我们在美国马里兰州贝塞斯达的国家癌症研究所外科分院回顾了过去13年中需要进行肩ectomy骨切除术的6例原发性肉瘤。其中5例患者返回进行了疾病状态评估,通过肌肉群测试确定了功能缺陷,并评估日常生活技能和局限性。我们证实了部分肩cap骨切除术具有出色的肩部功能,并且由于关节盂窝的丢失而导致了明显的损伤。此外,我们开发了一种彻底的术后评估方法。手术前后,康复治疗师的参与是此过程不可或缺的准备手术和后续治疗的过程。
  • 【p21活化激酶1的耗竭会上调APC∆14 /小鼠的免疫系统,并抑制肠道肿瘤的发生。】 复制标题 收藏 收藏
    DOI:10.1186/s12885-017-3432-0 复制DOI
    作者列表:Huynh N,Wang K,Yim M,Dumesny CJ,Sandrin MS,Baldwin GS,Nikfarjam M,He H
    BACKGROUND & AIMS: BACKGROUND:P21-activated kinase 1 (PAK1) stimulates growth and metastasis of colorectal cancer (CRC) through activation of multiple signalling pathways. Up-regulation of CRC stem cell markers by PAK1 also contributes to the resistance of CRC to 5-fluorouracil. The aim of this study was to investigate the effect of PAK1 depletion and inhibition on the immune system and on intestinal tumour formation in APC∆14/+ mice. METHODS:The PAK1 KO APC∆14/+ mice were generated by cross-breeding of PAK1 KO mice with APC∆14/+ mice. Splenic lymphocytes were analysed by flow cytometry, and immunohistochemical staining. The numbers of intestinal tumours were counted. Blood cells were also counted. RESULTS:Compared to APC+/+ mice, the numbers of both T- and B- lymphocytes were reduced in the spleen of APC∆14/+ mice. Depletion of PAK1 in APC∆14/+ mice increased the numbers of splenic T- and B- lymphocytes and decreased the numbers of intestinal tumours. Treatment of APC∆14/+ mice with PF-3758309, a PAK inhibitor reduced the numbers of intestinal tumours and increased the numbers of blood lymphocytes. CONCLUSION:Depletion of active PAK1 up-regulates the immune system of APC∆14/+ mice and suppresses intestinal tumour development. These observations suggest an important role for PAK1 in the immune response to tumours.
    背景与目标: 背景:P21激活的激酶1(PAK1)通过多种信号通路的激活刺激结直肠癌(CRC)的生长和转移。 PAK1对CRC干细胞标志物的上调也有助于CRC对5-氟尿嘧啶的抗性。这项研究的目的是研究PAK1的消耗和抑制对APC∆14 /小鼠免疫系统和肠道肿瘤形成的影响。
    方法:PAK1 KO APC∆14 /小鼠是通过将PAK1 KO小鼠与APC∆14 /小鼠杂交而产生的。通过流式细胞术和免疫组织化学染色分析脾淋巴细胞。计算肠道肿瘤的数量。还对血细胞计数。
    结果:与APC /小鼠相比,APC∆14 /小鼠脾脏中T淋巴细胞和B淋巴细胞的数量均减少。 APC∆14 /小鼠中PAK1的消耗增加了脾脏T-和B-淋巴细胞的数量,并减少了肠肿瘤的数量。用PAK抑制剂PF-3758309治疗APC∆14 /小鼠,可减少肠肿瘤的数量并增加血淋巴细胞的数量。
    结论:活性PAK1的耗尽可上调APC∆14 /小鼠的免疫系统,并抑制肠道肿瘤的发展。这些观察结果表明PAK1在对肿瘤的免疫应答中起重要作用。
  • 【长距离食管闭锁:空肠插入,结肠插入和胃上拉的荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1331459 复制DOI
    作者列表:Gallo G,Zwaveling S,Groen H,Van der Zee D,Hulscher J
    BACKGROUND & AIMS: AIM:There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU). METHODS:Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis software (Version 2.2.064). MAIN RESULTS:A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term follow-up. CONCLUSION:Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure.
    背景与目标: 目的:对于长间隙食管闭锁(LGEA)或广泛的腐蚀性狭窄,对于食管置换的最佳手术方法尚无共识。本文的目的是进行一项荟萃分析,比较儿童中最广泛使用的食道置换技术:空肠置入(JI),结肠置入(CI)和胃上拉(GPU)。
    方法:对近5年来发表的有关儿童食管置换术的英语文献进行回顾。重点是术后生存率,发病率(胃肠道并发症,如吻合口狭窄/渗漏和呼吸道并发症,如气胸,肺炎和肺不张),以及长期随访(如适用)。长期胃肠道疾病包括吞咽困难,反流和倾倒。长期呼吸结果包括复发性肺炎和反复吸入导致慢性肺部疾病。数据通过综合荟萃分析软件(版本2.2.064)进行计算。
    主要结果:共鉴定了15项研究(4项比较回顾性研究,8项回顾性研究和3项前瞻性研究),包括470例患者(264 LGEA)。 344(73%)名患者接受了CI,99(21%)名GPU和27(6%)JI。在这15项研究中,有9项提供了有关长期随访的数据。
    结论:缺乏适当的前瞻性比较研究。 GPU和CI在术后死亡率,吻合并发症和移植物丢失方面具有可比性。从长远来看,GPU似乎与CI相比具有更高的呼吸系统发病率,但胃肠道并发症更少。基于本文,只有两个系列提供了有关JI的数据,并且它们显示出截然不同的结果。由经验丰富的中心执行时,JI似乎是一种有效的替换技术;但是,需要更多的数字来评估此过程的结果。
  • 【儿童和青少年肥厚型心肌病的穿透性:一项为期12年的临床筛查和预测性基因检测随访研究。】 复制标题 收藏 收藏
    DOI:10.1161/CIRCULATIONAHA.111.090514 复制DOI
    作者列表:Jensen MK,Havndrup O,Christiansen M,Andersen PS,Diness B,Axelsson A,Skovby F,Køber L,Bundgaard H
    BACKGROUND & AIMS: BACKGROUND:The penetrance of hypertrophic cardiomyopathy (HCM) during childhood and adolescence has been only sparsely described. We studied the penetrance of HCM and the short- and long-term outcomes of clinical screening and predictive genetic testing of child relatives of patients with HCM. METHODS AND RESULTS:Ninety probands and 361 relatives were included in a family screening program for HCM (1994-2001). Eleven sarcomere genes, CRYAB, α-GAL, and titin were screened. Sixty-six relatives and 4 probands were <18 years of age at inclusion. Twelve child relatives were mutation carriers (age, 12 ± 5 years), and 26 had unknown genetic status, ie, relatives from families without identified mutations (n = 21) or not tested (n = 5) (age, 11 ± 5 years). Twenty-eight noncarriers (42%; age, 10 ± 4 years) served as control subjects. Two of 38 child relatives (5%) at risk of developing HCM fulfilled diagnostic criteria for HCM at inclusion. After 12 ± 1 years of follow-up, 2 of the 36 (6%; 95% confidence interval, 2-18) at-risk child relatives who were phenotype negative at inclusion had developed the HCM phenotype at 26 and 28 years of age. During follow-up, none of the child relatives experienced serious cardiac events. Participation in the screening program had no long-term negative psychological impact. CONCLUSIONS:The penetrance of HCM in phenotype-negative child relatives at risk of developing HCM was 6% after 12 years of follow-up. The finding of phenotype conversion in the mid-20s warrants continued screening into adulthood. Forty-two percent of the child relatives were noncarriers, and repeat clinical follow-up could be safely limited to the remaining children.
    背景与目标: 背景:在儿童和青少年时期肥厚型心肌病(HCM)的渗透率仅得到了很少的描述。我们研究了HCM的渗透率以及HCM患者的儿童亲属的临床筛查和预测性基因检测的短期和长期结果。
    方法与结果:1994年至2001年,在HCM家庭筛查计划中纳入了90名先证者和361名亲属。筛选了11个肌小节基因CRYAB,α-GAL和titin。六十六名亲戚和四名先证者年龄小于18岁。十二名儿童亲属是突变携带者(年龄为12±5岁),有26名遗传状况未知,即来自未发现突变的家庭的亲属(n = 21)或未经测试(n = 5)(年龄为11±5岁) )。对照组为28名非携带者(42%;年龄为10±4岁)。 38名患HCM的儿童亲属中有2名(5%)符合入选HCM的诊断标准。经过12±1年的随访,在纳入时表现型为阴性的36名高危儿童亲戚中,有2名(6%; 95%置信区间为2-18)在26岁和28岁时出现了HCM表型。 。在随访期间,没有任何一个儿童亲属经历过严重的心脏事件。参与筛查程序不会对心理产生长期负面影响。
    结论:随访12年后,表型阴性儿童亲属中HCM的外显率为6%。在20年代中期发现表型转化的情况值得继续筛选,直至成年。 42%的儿童亲属是非携带者,重复进行的临床随访可以安全地限于其余儿童。
  • 【步态,坐立姿势转移和逐步转移的惯性传感器运动分析:将膝盖患者与健康对照区分开来。】 复制标题 收藏 收藏
    DOI:10.1088/0967-3334/33/11/1947 复制DOI
    作者列表:Bolink SA,van Laarhoven SN,Lipperts M,Heyligers IC,Grimm B
    BACKGROUND & AIMS: :Patients undergoing total knee replacement for end stage knee osteoarthritis (OA) become increasingly younger and more demanding. Consequently, outcome assessment tools need to evolve toward objective performance-based measures. We applied a novel approach toward ambulatory biomechanical assessment of physical function using a single inertial sensor located at the pelvis to derive various motion parameters during activities of daily living. We investigated the potential of a clinically feasible battery of tests to define relevant parameters of physical function. We compared preoperative measures of end stage knee OA patients to healthy subjects. Our results show that measures of time yield the highest discriminative capacity to differentiate between groups. Additionally we found disease-dependent and task-specific alterations of movement for inertial sensor-derived motion parameters with good discriminative capacity. The inertial sensor's output quantities seem to capture another clinically relevant dimension of physical function that is supplementary to time. This study demonstrates the potential of inertial sensor-based motion analysis and provides a standardized test feasible for a routine clinical application in the longitudinal follow-up.
    背景与目标: :正在接受全膝关节置换以治疗终末期膝骨关节炎(OA)的患者变得越来越年轻,要求也越来越高。因此,结果评估工具需要朝着基于绩效的客观指标发展。我们应用了一种新颖的方法,通过使用位于骨盆的单个惯性传感器来对身体功能进行动态生物力学评估,以得出日常生活活动中的各种运动参数。我们研究了临床上可行的一系列测试的潜力,以定义相关的身体机能参数。我们比较了晚期膝骨关节炎患者与健康受试者的术前措施。我们的结果表明,时间量度具有最高的区分人群的区分能力。此外,我们发现了惯性传感器衍生的运动参数具有良好的判别能力的疾病相关和任务特定的运动变化。惯性传感器的输出量似乎捕获了另一项与临床相关的物理功能,是对时间的补充。这项研究证明了基于惯性传感器的运动分析的潜力,并为纵向随访中的常规临床应用提供了可行的标准化测试方法。
  • 【在两年的随访中,缺乏管状腺瘤的自发消退。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Bersentes K,Fennerty MB,Sampliner RE,Garewal HS
    BACKGROUND & AIMS: OBJECTIVE:Change in colon polyp size over time has not been well characterized. It has been inferred that some polyps will increase in size, leading to an increased risk of progressing to cancer, whereas other polyps may spontaneously regress. To develop a better understanding of the natural history of colon polyps, we prospectively investigated change in polyp size over a 2-yr period.

    METHODS:Patients were enrolled if they had an endoscopically detected proximal rectal or sigmoid polyp measuring 3-9 mm. The index polyp site was then permanently marked with an adjacent India ink tattoo to allow definitive future localization of the polyp. Patients underwent flexible sigmoidoscopy at 6-month intervals, and at each examination, the polyp size was carefully measured with open biopsy forceps. After a maximum of 2 yr, each polyp was removed and the histology determined.

    RESULTS:Thirty polyps were followed in 26 patients who completed the study. Twelve polyps were tubular adenomas (TA), one was tubulovillous, 14 were hyperplastic polyps (HP), two had no pathological diagnosis, and one was a leiomyoma. HP were more likely to decrease in size than were TA. Three polyps demonstrated fast growth rates (2-4 mm/yr), and all were TA. Two polyps were removed early because their size had reached 1 cm or more. Both of those polyps were TA. No polyps regressed completely during the 2 yr of the study; neither did we find consistent linear growth rates.

    CONCLUSIONS:In contrast to prior reports, in this study, after polyps had been definitively localized with India ink, we observed no complete polyp regressions.

    背景与目标: 目的:对结肠息肉大小随时间的变化尚无定论。已经推断出某些息肉的大小会增加,导致患癌症的风险增加,而其他息肉则可能自发地消退。为了更好地了解结肠息肉的自然病史,我们前瞻性研究了两年内息肉大小的变化。

    方法:如果患者具有内窥镜检查,则入组检出近端直肠或乙状结肠息肉,大小为3-9毫米。然后将索引息肉部位永久性地标记上相邻的印度墨水纹身,以确保将来可以明确定位息肉。患者每6个月进行一次乙状结肠镜检查,每次检查时,均应使用开放式活检钳仔细测量息肉大小。最长2年后,将每个息肉切除并确定组织学。

    结果:在完成研究的26例患者中,对30例息肉进行了随访。十二个息肉是肾小管腺瘤(TA),一个是肾小管性腺癌,十四个是增生性息肉(HP),两个没有病理诊断,一个是平滑肌瘤。与TA相比,HP更有可能减小尺寸。三个息肉显示出快速的生长速度(2-4毫米/年),并且全部为TA。由于息肉的大小已达到1厘米或更大,因此较早地将其移除。这些息肉都是TA。在研究的2年中,没有息肉完全消退。我们都没有找到一致的线性增长率。

    结论:与先前的报告相比,在本研究中,在使用印度墨水对息肉进行了明确定位之后,我们没有观察到息肉完全消失。

  • 【OP-1(rhBMP-7)替代auto外侧自体for骨移植治疗后外侧腰椎关节置换术的安全性和有效性:至少4年的随访研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.spinee.2007.03.012 复制DOI
    作者列表:Vaccaro AR,Whang PG,Patel T,Phillips FM,Anderson DG,Albert TJ,Hilibrand AS,Brower RS,Kurd MF,Appannagari A,Patel M,Fischgrund JS
    BACKGROUND & AIMS: BACKGROUND CONTEXT:Although autogenous bone is still considered to be the gold standard graft material for promoting spinal fusion, other bone graft substitutes have been developed in an attempt to improve arthrodesis rates and avoid the complications associated with the procurement of autograft. The bone morphogenetic proteins (BMPs) represent a family of osteoinductive growth factors that are known to stimulate the osteoblastic differentiation of stem cells. Osteogenic protein-1 (OP-1) Putty is a commercially available BMP preparation that is already approved for use in humans. Previous clinical studies involving patients with degenerative spondylolisthesis have reported that the efficacy and safety of OP-1 Putty is comparable to that of autograft at both 1- and 2-year follow-up. PURPOSE:The purpose of this study was to evaluate the intermediate-term efficacy and safety of OP-1 Putty as an alternative to autogenous bone by comparing the 4-year radiographic, clinical, and safety data of these same patients who underwent decompression and uninstrumented fusion with either OP-1 Putty or iliac crest autograft. STUDY DESIGN/SETTING:A prospective, randomized, controlled, multicenter clinical pilot study. PATIENT SAMPLE:Thirty-six patients undergoing decompressive laminectomy and single-level uninstrumented fusion for degenerative spondylolisthesis and symptomatic spinal stenosis were randomized in a 2:1 fashion to receive either OP-1 Putty (24 patients) or autogenous iliac crest bone graft (12 patients). OUTCOME MEASURES:Patient-reported outcome measures consisting of Oswestry Disability Index and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) scores were used to evaluate clinical efficacy. Perioperative data including operative time, estimated blood loss, and duration of hospital stay were also recorded for each surgery. Postoperatively, a neurological examination and an assessment of donor-site pain (if applicable) were performed at every follow-up visit. Radiographic fusion success was defined as the presence of continuous bridging bone formation between the transverse processes at the level of the spondylolisthesis with minimal motion evident on dynamic lateral x-ray films. The primary efficacy endpoint was the overall success rate, a composite measure derived from both radiographic and clinical parameters. The safety of OP-1 Putty was confirmed by comparing the nature and frequency of all adverse events and complications that were prospectively observed in either of the groups. METHODS:Thirty-six patients with degenerative spondylolisthesis and symptoms of neurogenic claudication underwent decompressive laminectomy and single-level uninstrumented fusion with either OP-1 Putty or autograft. All patients were evaluated at 6 weeks and 3, 6, 9, 12, and 24 months, after which time they were instructed to return on a yearly basis. Multiple neuroradiologists blinded to the assigned treatment reviewed static and dynamic X-ray films with digital calipers to assess fusion status according to the presence of continuous bridging bone across the transverse processes as well as the amount of residual motion evident at the level of interest. Oswestry Disability Index surveys and SF-36 questionnaires were used to assess clinical outcomes. RESULTS:At the 48-month time point, complete radiographic and clinical data were available for 22 of 36 patients (16 OP-1 Putty and 6 autograft) and 25 of 36 patients (18 OP-1 Putty and 7 autograft), respectively. Radiographic evidence of a solid arthrodesis was present in 11 of 16 OP-1 Putty patients (68.8%) and 3 of 6 autograft patients (50%). Clinically successful outcomes defined as at least a 20% improvement in preoperative Oswestry scores were experienced by 14 of 19 OP-1 Putty patients (73.7%) and 4 of 7 autograft patients (57.1%); these clinical findings were corroborated by similar increases in SF-36 scores. The respective overall success rates of the OP-1 Putty and autograft group were 62.5% and 33.3%. In this study, there were no incidents of local or systemic toxicity, ectopic bone production, or other adverse events directly related to the use of OP-1 Putty. CONCLUSION:Despite the challenges associated with obtaining a solid uninstrumented fusion in patients with degenerative spondylolisthesis, the rates of radiographic fusion, clinical improvement, and overall success associated with the use of OP-1 Putty were at least comparable to that of the autograft controls for at least 48 months after surgery. These results appear to validate the short-term results previously reported for OP-1 Putty and suggest that this material may potentially represent a viable bone graft substitute for certain fusion applications.
    背景与目标: 背景技术:尽管自体骨仍被认为是促进脊柱融合的金标准移植材料,但已开发出其他替代骨的方法,以试图提高关节固定率并避免与自体移植相关的并发症。骨形态发生蛋白(BMP)代表一类骨诱导生长因子,已知这些因子可刺激干细胞的成骨细胞分化。成骨蛋白1(OP-1)腻子是一种可商购的BMP制剂,已被批准用于人类。先前涉及退行性脊椎滑脱患者的临床研究报告,在1年和2年的随访中,OP-1油灰的功效和安全性与自体移植相当。
    目的:本研究的目的是通过比较这些接受减压和不使用仪器的相同患者的4年影像学,临床和安全性数据来评估OP-1油灰替代自体骨的中期疗效和安全性与OP-1油灰或骨自体融合。
    研究设计/设置:一项前瞻性,随机,对照,多中心临床试验研究。
    患者样本:36例行减压椎板切除术和单级非器械融合治疗退行性腰椎滑脱和症状性椎管狭窄的患者以2:1方式随机接受OP-1腻子(24例)或自体骨植骨(12例)耐心)。
    结局指标:采用Oswestry残疾指数和医学结局研究36项简表健康调查(SF-36)评分组成的患者报告结局指标,用于评估临床疗效。每次手术还记录了围手术期数据,包括手术时间,估计的失血量和住院时间。术后,每次随访均进行神经系统检查和对供体部位疼痛的评估(如果适用)。放射照相融合成功定义为在横向滑突之间在脊椎滑脱水平上存在连续桥接的骨形成,而在动态侧向X射线胶片上可见的运动极小。主要功效终点是总体成功率,这是一项从放射学和临床参数中得出的综合指标。 OP-1腻子的安全性通过比较两组中预期观察到的所有不良事件和并发症的性质和频率来确定。
    方法:36例退行性腰椎滑脱并伴有神经源性symptoms行症状的患者接受减压椎板切除术和单层非器械融合OP-1腻子或自体移植。在第6周和第3、6、9、12和24个月对所有患者进行评估,然后指示他们每年返回一次。多家神经放射科医生对指定的治疗方法视而不见,并用数字卡尺检查了静态和动态X射线胶片,以根据横断过程中连续桥接骨的存在以及感兴趣水平上明显的残余运动量来评估融合状态。 Oswestry残疾指数调查和SF-36问卷用于评估临床结局。
    结果:在48个月的时间点,分别可获得36例患者中的22例(16例OP-1腻子和6例自体移植)和36例患者中的25例(18例OP-1腻子和7例自体移植)的完整影像学和临床资料。 16例OP-1油灰患者中有11例(68.8%)和6例自体移植患者中有3例(50%)出现了牢固的关节固定的影像学证据。 19例OP-1腻子患者中的14例(73.7%)和7例自体移植患者中的4例(57.1%)经历了临床上成功的结果,即术前Oswestry评分至少提高了20%。这些临床发现被SF-36分数的类似提高所证实。 OP-1腻子和自体移植组的总体总体成功率分别为62.5%和33.3%。在这项研究中,没有发生局部或全身毒性,异位骨生成或与使用OP-1腻子直接相关的其他不良事件的事件。
    结论:尽管在退行性脊椎滑脱患者中获得牢固的非器械融合具有挑战性,但与使用OP-1腻子相关的放射成像融合率,临床改善率和总体成功率至少可与自体植骨对照用于手术后至少48个月。这些结果似乎证实了先前报道的OP-1油灰的短期结果,并表明该材料可能是某些融合应用中可行的骨移植替代品。
  • 【氯氮平在大鼠额叶皮层诱导的GLT-1下调与突触素上调相关。】 复制标题 收藏 收藏
    DOI:10.1111/j.1471-4159.2006.04030.x 复制DOI
    作者列表:Bragina L,Melone M,Fattorini G,Torres-Ramos M,Vallejo-Illarramendi A,Matute C,Conti F
    BACKGROUND & AIMS: :In rat frontal cortex, extracellular levels of glutamate are raised by the anti-psychotic drug clozapine. We have recently shown that a significant reduction in the levels of the glutamate transporter GLT-1 may be one of the mechanisms responsible for this elevation. Here we studied whether GLT-1 down-regulation induced by chronic clozapine treatment is associated with changes in the expression of synaptophysin, synaptosome-associated protein of 25 kDa (SNAP-25) and vesicular glutamate transporter 1 (VGLUT1), three major presynaptic proteins involved in neurotransmitter release. Quantitative high-resolution confocal microscopy studies in vivo showed that GLT-1 down-regulation is closely associated with a significant increase in synaptophysin, but not SNAP-25 and VGLUT1, expression. This was confirmed in vitro studies, and in western blotting studies of synaptophysin, SNAP-25 and VGLUT1. In addition, our results show that, following clozapine treatment, synaptophysin expression increases in the very cortical regions in which GLT-1 expression is down-regulated. These findings suggest that part of the effects of clozapine may be exerted via an action on the presynaptic machinery involved in neurotransmitter release.
    背景与目标: 在大鼠额叶皮层,抗精神病药物氯氮平可提高细胞外谷氨酸水平。我们最近表明,谷氨酸转运蛋白GLT-1水平的显着降低可能是造成这种升高的机制之一。在这里,我们研究了慢性氯氮平治疗引起的GLT-1下调是否与突触素,25kDa突触体相关蛋白(SNAP-25)和水泡谷氨酸转运蛋白1(VGLUT1)(三种主要的突触前蛋白)的表达变化有关。参与神经递质的释放。体内定量高分辨率共聚焦显微镜研究表明,GLT-1的下调与突触素的显着增加密切相关,而与SNAP-25和VGLUT1的表达却没有显着相关。这在体外研究以及突触素,SNAP-25和VGLUT1的蛋白质印迹研究中得到了证实。此外,我们的结果表明,在氯氮平治疗后,突触素表达在GLT-1表达下调的非常皮质的区域增加。这些发现表明,氯氮平的部分作用可能是通过对涉及神经递质释放的突触前机制的作用来发挥的。
  • 【进行性系统性硬化症的体外光化学疗法:一项后续研究。】 复制标题 收藏 收藏
    DOI:10.1046/j.1365-4362.1997.00066.x 复制DOI
    作者列表:Schwartz J,Gonzalez J,Palangio M,Klainer AS,Bisaccia E
    BACKGROUND & AIMS: BACKGROUND:Extracorporeal photochemotherapy (photopheresis), an immune-modulating therapy, has been demonstrated to elicit a therapeutic response in the treatment of several autoimmune disorders. We evaluated the use of photopheresis in the treatment of patients with progressive systemic sclerosis (PSS; scleroderma).

    METHODS:Five patients with early-onset, diffuse PSS were treated with photopheresis on 2 successive days monthly for an average of 59 months (range 54-89 months). We initially reported the response this group of patients had to photopheresis treatment at an average of 11 months (range 6-21 months).

    RESULTS:An improvement or stabilization was noted in most patients in skin thickening, joint mobility, pulmonary function studies, oral aperture, functional index, as well as symptoms including Raynaud's phenomenon, dyspnea, fatigue, dysphagia, arthralgias, and cutaneous ulcers. Renal function tests remained within normal range. A total of 296 monthly treatments were administered without significant toxicity.

    CONCLUSIONS:This study suggests that extended use of extracorporeal photochemotherapy in the management of early-onset, diffuse PSS is well tolerated and may provide an increasingly beneficial clinical outcome.

    背景与目标: 背景:体外光化学疗法(光透疗法)是一种免疫调节疗法,已被证明在多种自身免疫性疾病的治疗中引起治疗反应。我们评估了光采疗法在进行性系统性硬化症(PSS;硬皮病)患者中的应用。

    方法:对5例早发,弥漫性PSS患者进行了光采疗法。每月连续2天,平均59个月(范围54-89个月)。我们最初报告了该组患者平均11个月(6到21个月)对光穿刺治疗的反应。

    结果:大多数患者均出现了改善或稳定皮肤增厚,关节活动度,肺功能研究,口腔孔径,功能指数以及包括雷诺现象,呼吸困难,疲劳,吞咽困难,关节痛和皮肤溃疡在内的症状的患者。肾功能检查保持在正常范围内。总共进行了296个月的每月治疗,无明显毒性。

    结论:这项研究表明,在早期发作,弥漫性PSS的管理中长期使用体外光化学疗法具有良好的耐受性,并且可能会提供越来越有益的临床结果。

  • 【TTYH2是果蝇果蝇基因tweety的人类同源物,在结肠癌中上调,并参与细胞增殖和细胞聚集。】 复制标题 收藏 收藏
    DOI:10.3748/wjg.v13.i19.2717 复制DOI
    作者列表:Toiyama Y,Mizoguchi A,Kimura K,Hiro J,Inoue Y,Tutumi T,Miki C,Kusunoki M
    BACKGROUND & AIMS: AIM:To investigate the expression patterns of TTYH2 in the human colon cancer and colon cancer cell lines and to evaluate the inhibitory effect of small interfering RNA (siRNA) on the expression of TTYH2 in colon cancer cell lines. METHODS:We investigated the expression patterns of TTYH2 in colon cancer, adjacent non-tumorous colon mucosa, and cancer cell lines (DLD-1, caco-2, and Lovo) by RT-PCR. Furthermore, a siRNA plasmid expression vector against TTYH2 was constructed and transfected into DLD-1 and Caco-2 with Lipofectamine 2000. The down regulation of TTYH2 expression was detected by RT-PCR and the role of siRNA in inducing cell proliferation and cell aggregation was evaluated by MTT and aggregation assay. RESULTS:TTYH2 gene expression in colon cancer tissue was significantly up-regulated compared with normal colonic mucosa (1.23 +/- 0.404 vs 0.655 +/- 0.373, P = 0.0103). Colon cancer derived cell lines including DLD-1, Caco-2, and Lovo also expressed high levels of TTYH2. In contrast, transfection with siRNA-TTYH2 significantly inhibited both proliferation and scattering of these cancer cell lines. CONCLUSION:The present work demonstrates, for the first time, that the TTYH2 gene expression is significantly up-regulated in colon cancer. The TTYH2 gene may play an important role in regulating both proliferating and metastatic potentials of colorectal cancer.
    背景与目标: 目的:研究TTYH2在人结肠癌和结肠癌细胞系中的表达模式,并评估小干扰RNA(siRNA)对TTYH2在结肠癌细胞系中表达的抑制作用。
    方法:我们通过RT-PCR研究了TTYH2在结肠癌,邻近的非肿瘤结肠粘膜和癌细胞系(DLD-1,caco-2和Lovo)中的表达模式。此外,构建了针对TTYH2的siRNA质粒表达载体,并用Lipofectamine 2000将其转染到DLD-1和Caco-2中。通过RT-PCR检测了TTYH2表达的下调,并且siRNA在诱导细胞增殖和细胞聚集中的作用为:通过MTT和聚集分析进行评估。
    结果:与正常结肠粘膜相比,结肠癌组织中TTYH2基因表达显着上调(1.23 /-0.404对0.655 /-0.373,P = 0.0103)。结肠癌衍生的细胞系(包括DLD-1,Caco-2和Lovo)也表达高水平的TTYH2。相反,用siRNA-TTYH2转染可显着抑制这些癌细胞系的增殖和扩散。
    结论:本研究首次证明了TTYH2基因的表达在结肠癌中显着上调。 TTYH2基因可能在调节结直肠癌的增殖和转移潜能中起重要作用。
  • 【随访5年以上对男性尿道狭窄治疗效果的评价】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Khenifar E,Guerder L,Jeldi A,Bittard H
    BACKGROUND & AIMS: :149 cases of urethral stricture were treated in the Urology Department from 1971 to 1984. All of these patients have therefore been treated with a minimal follow-up of 5 years. There were 87 cases of post-traumatic stricture, 53 of whom were lost to follow-up during the survey, 8 died and 26 patients were able to be reviewed. The remaining 62 cases consisted of post-infectious strictures, with 37 patients lost to follow-up during the survey, 1 patient who died and 24 patients who were reviewed. The patients reviewed were assessed according to the criteria of the SFU (French Urology Society) survey. Direct vision internal urethrotomy was performed in 33 cases with 18 very good or good results (54%), segmental resection was performed in 10 cases with 7 very good or good results, urethroplasty was performed in 4 cases with 2 good results and 2 urethral dilatations were performed with 2 good results. The failures were essentially treated by more complex surgery (urethroplasty).
    背景与目标: 从1971年至1984年,泌尿外科对149例尿道狭窄患者进行了治疗。因此,所有这些患者均接受了最少5年的随访。共有87例创伤后狭窄病例,其中53例在随访期间遗失随访,8例死亡,26例能够接受检查。其余62例由感染后狭窄组成,在调查期间遗失37例患者,其中1例死亡,24例接受了复查。根据SFU(法国泌尿外科学会)调查的标准对接受检查的患者进行评估。直视内尿道切开术33例,非常好或好(18%)(54%),节段性切除10例,好或好7例,行尿道成形术4例,好转2例,尿道扩张2例进行了2项良好结果。失败基本上是通过更复杂的手术(尿道成形术)来治疗的。
  • 【参加过性犯罪者治疗小组的智障男性:随访。】 复制标题 收藏 收藏
    DOI:10.1111/jar.12038 复制DOI
    作者列表:Heaton KM,Murphy GH
    BACKGROUND & AIMS: BACKGROUND:There have been a number of studies of treatment for men with intellectual disabilities and sexually abusive behaviour but few follow-up studies. Our aim was to follow up men with intellectual disabilities who had attended group cognitive behavioural treatment (CBT) for sexually abusive behaviour. METHOD:Thirty-four men (from seven treatment sites) were followed up. All had attended SOTSEC-ID groups. The mean length of follow-up, since the end of the treatment group, was 44 months (SD 28.7, range 15-106 months). RESULTS:The statistically significant improvements in sexual knowledge, empathy and cognitive distortions that occurred during treatment were maintained at follow-up. In all, 11 of the 34 (32%) men showed further sexually abusive behaviour, but only two of these men received convictions. Analyses of the variables associated with further sexually abusive behaviour indicated that a diagnosis of autism was associated with a higher likelihood of further sexually abusive behaviour. CONCLUSIONS:This study provides some evidence of the longer-term effectiveness of group CBT for men with intellectual disabilities and sexually abusive behaviour.
    背景与目标: 背景:已有许多针对智障和性虐待行为的男性的治疗研究,但随访研究很少。我们的目的是跟进曾参加过针对性虐待行为的集体认知行为治疗(CBT)的智障男性。
    方法:对34名男性(来自7个治疗部位)进行了随访。所有人都参加了SOTSEC-ID组。自治疗组结束以来,平均随访时间为44个月(SD 28.7,范围15-106个月)。
    结果:随访期间,在治疗过程中发生的性知识,同理心和认知扭曲方面的统计学显着改善得以维持。在这34名男性中,有11名(32%)表现出进一步的性虐待行为,但其中只有2名被定罪。对与进一步的性虐待行为有关的变量的分析表明,自闭症的诊断与进一步的性虐待行为的可能性更高有关。
    结论:这项研究提供了一些证据,表明集体CBT对于智力残疾和性虐待行为的长期有效性。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录