Systematic treatment in gastric cancer patients with overt bleeding:A propensity score matching analysis

BACKGROUND Hemorrhage,which is not a rare complication in patients with gastric cancer(GC)/gastroesophageal junction cancer(GEJC),can lead to a poor prognosis.However,no study has examined the effectiveness and safety of chemotherapy as an initial therapy for GC/GEJC patients with overt bleeding(OB).AIM To investigate the impact of OB on the survival and treatment-related adverse events(TRAEs)of GC/GEJC patients.METHODS Patients with advanced or metastatic GC/GEJC who received systematic treatment at Peking University Third Hospital were enrolled in this study.Propensity score matching(PSM)analysis was performed.RESULTS After 1:2 PSM analysis,93 patients were assessed,including 32 patients with OB before treatment(OBBT)and 61 patients without OBBT.The disease control rate was 90.6%in the group with OBBT and 88.5%in the group without OBBT,and this difference was not statistically significant.There was no difference in the incidence of TRAEs between the group with OBBT and the group without OBBT.The median overall survival(mOS)was 15.2 months for patients with OBBT and 23.7 months for those without OBBT[hazard ratio(HR)=1.101,95%confidence interval(CI):0.672-1.804,log rank P=0.701].The mOS was worse for patients with OB after treatment(OBAT)than for those without OBAT(11.4 months vs 23.7 months,HR=1.787,95%CI:1.006-3.175,log rank P=0.044).CONCLUSION The mOS for GC/GEJC patients with OBBT was similar to that for those without OBBT,but the mOS for patients with OBAT was worse than that for those without OBAT.

Cellular and molecular overview of gestational diabetes mellitus:Is it predictable and preventable?

BACKGROUND In contrast to overt diabetes mellitus(DM),gestational DM(GDM)is defined as impaired glucose tolerance induced by pregnancy,which may arise from exaggerated physiologic changes in glucose metabolism.GDM prevalence is reported to be as high as 20%among pregnancies depending on the screening method,gestational age,and the population studied.Maternal and fetal effects of uncontrolled GDM include stillbirth,macrosomia,neonatal diabetes,birth trauma,and subsequent postpartum hemorrhage.Therefore,it is essential to find the potential target population and associated predictive and preventive measures for future intensive peripartum care.AIM To review studies that explored the cellular and molecular mechanisms of GDM as well as predictive measures and prevention strategies.METHODS The search was performed in the Medline and PubMed databases using the terms“gestational diabetes mellitus,”“overt diabetes mellitus,”and“insulin resistance.”In the literature,only full-text articles were considered for inclusion(237 articles).Furthermore,articles published before 1997 and duplicate articles were excluded.After a final review by two experts,all studies(1997-2023)included in the review met the search terms and search strategy(identification from the database,screening of the studies,selection of potential articles,and final inclusion).RESULTS Finally,a total of 79 articles were collected for review.Reported risk factors for GDM included maternal obesity or overweight,pre-existing DM,and polycystic ovary syndrome.The pathophysiology of GDM involves genetic variants responsible for insulin secretion and glycemic control,pancreaticβcell depletion or dysfunction,aggravated insulin resistance due to failure in the plasma membrane translocation of glucose transporter 4,and the effects of chronic,low-grade inflammation.Currently,many antepartum measurements including adipokines(leptin),body mass ratio(waist circumference and waist-to-hip ratio),and biomarkers(microRNA in extracellular vesicles)have been studied and confirmed to be useful markers for predicting GDM.For preventing GDM,physical activity and dietary approaches are effective interventions to control body weight,improve glycemic control,and reduce insulin resistance.CONCLUSION This review explored the possible factors that influence GDM and the underlying molecular and cellular mechanisms of GDM and provided predictive measures and prevention strategies based on results of clinical studies.

An Empirical Study on the Differences between Overt Translation and Covert Translation in Legal

Currently,it is key to convey precise meanings to readers for translators.Observing expressing habits between different languages is the precondition to make target texts more readable.It is crucial to ensure the exactness and seriousness of legal texts,but it does not mean that translators have to take machined way to leave out and even give up transmitting in-deep cultural implications for the intention of achieving the all-inclusive integrity of target content.It is a correct choice for translators to take overt translation and covert translation in line with traits of source language and target language and differences between civil law system and common law system.The intention of the article is to make an empirical study between overt translation and covert translation.

母语表层显性迁移和深层隐性迁移

一、研究设计(一)研究问题笔者在本研究中提出了母语迁移可分为"表层显性迁移"和"深层隐性迁移"的假说。所谓显性迁移。

Natural history of covert hepatic encephalopathy: An observational study of 366 cirrhotic patients

AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.

Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding

AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ndings.RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding

AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.

Advances in cirrhosis: Optimizing the management of hepatic encephalopathy

Hepatic encephalopathy(HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided into covert HE(CHE) and overt HE(OHE). CHE is a subclinical, less severe manifestation of HE and requires psychometric testing for diagnosis. Due to the time consuming screening process and lack of standardized diagnostic criteria, CHE is frequently underdiagnosed despite its recognized role as a precursor to OHE. Screening for CHE with the availability of the Stroop test has provided a pragmatic method to promptly diagnose CHE. Management of acute OHE involves institution of lactulose, the preferred first-line therapy. In addition, prompt recognition and treatment of precipitating factors is critical as it may result in complete resolution of acute episodes of OHE. Treatment goals include improvement of daily functioning, evaluation for liver transplantation, and prevention of OHE recurrence. For secondary prophylaxis, intolerance to indefinite lactulose therapy may lead to non-adherence and has been identified as a precipitating factor for recurrent OHE. Rifaximin is an effective add-on therapy to lactulose for treatment and prevention of recurrent OHE. Recent studies have demonstrated comparable efficacy of probiotic therapy to lactulose use in both primary prophylaxis and secondary prophylaxis.

Non-small bowel lesion detection at small bowel capsule endoscopy: A comprehensive literature review

Small bowel capsule endoscopy is a minimally-invasive endoscopic investigation that is often used in clinical practice to investigate overt or occult gastrointestinal(GI) bleeding among other clinical indications. International guidance recommends small bowel capsule endoscopy as a first-line investigation to detect abnormalities in the small bowel, when gastroscopy and colonoscopy fail to identify a cause of GI bleeding. It can diagnose with accuracy abnormalities in the small bowel. However, there has been increasing evidence indicating that small bowel capsule endoscopy may also detect lesions outside the small intestine that are within the reach of conventional endoscopy and have been probably missed during prior endoscopic investigations. Such lesions vary from vascular deformities to malignancy and their detection often alters patient management, leading to further endoscopic and/or surgical interventions. The current study attempts to review all available studies in the literature and summarise their relevant findings.

Overt gastrointestinal bleeding because of hookworm infection

Hookworm infection is a relatively common cause of anemia in endemic areas.The most common hookworm species are Ancylostoma duodenale and Necator americanus.In this report we present a case of overt gastrointestinal bleeding Wause of hookworm infection.Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.

Hypothyroidism during pregnancy: Controversy over screening and intervention

Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.

Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia

TimeslipsTM is a group storytelling program that encourages creative expression among dementia patients without the pressure to recall the past. Analysis of the literature was conducted to determine the nine most relevant agitation and anxiety scales most appropriate for use with Timeslips in nursing home patients with dementia, who experience agitation and anxiety. Qualitative assessment of the nine scales was conducted to identify six criteria to determine the most pertinent characteristics for implementation of Timeslips within this patient population: 1) validity/reliability, 2) observation period, 3) training required, 4) time to administer, 5) most appropriate administrator and 6) accessibility/cost. Utilizing these six criteria, quantitative assessment was conducted using the Analytical Hierarchical Process (AHP) to identify that the Overt Agitation Severity Scale (OASS) was optimal. IRB approvals have been attained to investigate use of the OASS with Timeslips in the nursing home setting for patients with dementia, who experience agitation and anxiety.

Short-term overt hypothyroidism affect on lipids after thyroxine-withdrawal in patients with differentiated thyroid carcinoma

Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatment for differentiated thyroid carcinoma (DTC). Methods: Thirty patients with a history of differentiated thyroid carcinoma on thyroid-stimulating hormone (TSH)-suppressive thyroxine replacement therapy were studied. Blood sample were taken before and 4 weeks after withdrawal of thyroxine substitution. Venous blood was drawn after an overnight fast and analyzed for serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB). Fifty healthy people matched for age and gender were controls. Their blood samples were taken only once. Results: After thyroxine-withdrawal, the patients presented with increased serum TSH and low serum FT4 and FT3 levels compared with controls. Serum TG, TC, LDL, HDL, ApoB and Lp(a) increased after thyroxine withdrawal, reaching statistical significant differences with previous evaluation. However, when compared to euthyroid controls, only TC, LDL and ApoB were increased when patients were hypothyroidism. No changes were observed in ApoA1 in patients during thyroxine withdrawal, or when comparing the values observed in patients to those of euthyroid controls. Conclusion: TG, TC, LDL, HDL, ApoB and Lp(a) were increased during short-term overt hypothyroidism.

Comparative Study on Clinical Characteristics and Outcomes of Overt Diabetes Mellitus and Gestational Diabetes Mellitus in Late Pregnancy

Background: With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes. Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus (ODM) and gestational diabetes mellitus (GDM) at the late pregnancy. Methods: From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study. Patients were classified into two groups. 31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group. Clinical characteristics and outcomes were compared between ODM and GDM. We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use, blood pressure, clinical nutrition indexes, blood pressure. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total protein (TP), albumin (ALB), prealbumin (PALB), hemoglobin (HGB), urea nitrogen (BUN), serum creatinine (CREA), and dynamic blood glucose monitoring were measured. And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. Results: In the ODM group, HbA1c, FBG, average blood glucose, two-hour postprandial blood glucose (2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than those of GDM and two groups compared with statistical significance (P < 0.05). The number of patients treated with insulin (10/31) in ODM is significantly more than that in GDM (1/32) (P < 0.05). 45% (14/31) of ODM have a family history of diabetes patients. The ratio is significantly higher than 13% (4/32) of GDM (P < 0.05). There was significant difference in urinary ketone positive rate between the two groups (P < 0.05), but there was no significant difference in urinary microalbumin abnormal rate between them (P > 0.05). The number of preeclampsia in ODM (8/31) is significantly higher than that of GDM (P < 0.05). The level of HGB in ODM is lower than that of GDM (P < 0.05). There was no difference in the pregnancy outcomes between the two groups. Conclusion: Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner, higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher risk of preeclampsia, lower HGB level than GDM, while GDM has higher positive rate of urine ketone than ODM.

Fetomaternal Outcome in Maternal Hypothyroidism Complicating Pregnancies at Paropakar Maternity and Women’s Hospital

Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, especially in Nepal, a low-income region where women have an increased risk of developing iodine deficiency during pregnancy. Hence this study is to analyze fetomaternal outcomes in maternal hypothyroidism complicating pregnancies. Methods: This retrospective observational study was carried out at Paropakar Maternity and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal women with a singleton pregnancy with hypothyroidism admitted for delivery in the obstetrics ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including heart disease, diabetes, and hypertension were excluded. Routine hematological parameters and estimations of T3, T4, and thyroid stimulating hormone (TSH) were conducted. Patients with hypothyroidism were divided into overt and subclinical and were subsequently assessed for maternal and fetal complications. The occurrence of maternal outcomes and perinatal outcomes were recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled in the study and the remaining 140 were excluded. In our study, the incidence of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio placenta, and postpartum hemorrhage were the adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant. Concerning fetal outcome APGAR score <6 in 5 min, Intrauterine growth restriction (IUGR), NICU admission, neonatal Respiratory distress syndrome (RDS), Intrauterine fetal death (IUFD), and congenital anomaly were found with a higher percentage in overt hypothyroidism. Conclusion: Since the impact of hypothyroidism on fetomaternal morbidities have been identified so screening for hypothyroidism to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcome.

Main Menu

One evening,when I asked my six-year-old daughter whichbedtime story she wanted,she replied,“I don’t know.Let’s open tothe main menu and see what stories are in the book.”Amused,Iexplained that “main menu” is a computer term;in books,it’scalled the “table contents.”

浅谈几组同义词

在英语学习中,我们常常会遇到许多同义词,这些同义词在语气、文体与使用范围上都有一定的差异,仔细辨析这些差异对准确地领会语句的意思将会有很大的帮助。现总结几例如下:1.adequate。

羊年话“羊”

根据十二生肖,1991年出生的人属“羊”,1991年为羊年。我们中国有“羊肠小道”、“亡羊补牢”之说等等。那么,西洋人有关“羊”又怎么表达呢?本文将就此作两点探讨。一、与“羊”有关的常用英语词汇:

The Acquisition Phenomenon of Null and Overt Subjects in the Early Speech of Arabic-Speaking Children

This paper examines the early acquisition of null subjects and overt subjects and how they are distributed and realized in the early speech of Arabic dialect-speaking children.①The study accounts for the phenomenon of subjects by examining a longitudinal corpus of two children,Wala and Ibraheem,who were around two years old,speaking Yemeni Ibbi Arabic(YIA)dialect.The production and elicited production data collection methods were used in the study to collect the corpus during five months.The results of the study showed that null-subjects appear with a high proportion compared to the overt subjects.It was found that null subjects and overt subjects in the speech of Ibraheem and Wala had a similar distribution in the imperfective and the perfective,of which 86-87%are null subjects and 12-14%are overt subjects.The paper examined the widespread linguistic phenomenon of Null Subject Parameter acquisition,(Rizzi,1982;Hyams,1986,1989)that is emergence of null subjects in line with overt subjects.The paper supports Hyam’s(1982)argument on the acquisition of Null Subject Parameter where we can find children acquire null subjects early around 2 years of age.In contrast to non-null subject languages(like English),Null Subject Languages(NSLs)like Arabic happen to have null subjects appear more frequently and this is due to the rich inflectional morphology of NSLs.