Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux dis...Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon Consensus.Recently an updated second version has been released.Mean nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD diagnosis.Originally a cut-off of 2292 Ohms was proposed,a value revised in the second edition.The updated Consensus recommended that an MNBI<1500 Ohms strongly suggests GERD while a value>2500 Ohms can be used to refute GERD.The proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic patients.However,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass index.Also,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one proposed.Finally,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now exist.Therefore,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.展开更多
一、语境概述什么是语境?又何谓语言语境? 语言学家对语境的解释大体有两种:一种把语境解释为从具体的情景中抽象出来的对语言活动参与者产生影响的一些因素,这些因素系统地决定了话语的形式,话语的合适性以及话语的意义。这是John Lyon...一、语境概述什么是语境?又何谓语言语境? 语言学家对语境的解释大体有两种:一种把语境解释为从具体的情景中抽象出来的对语言活动参与者产生影响的一些因素,这些因素系统地决定了话语的形式,话语的合适性以及话语的意义。这是John Lyons对语境所作的界定。他在其《语义学》一书中写道: ...Context,it must be emphasized,is a theoretical construct,in the postulation 0f which展开更多
参考文献1)Rollet,E.De la mensuration des os longs des membres.Lyons.2)Manouvrier,L.Determination de la taille d’ appres les os longs.Rev.E.d’anthrop.paris.11.277.1892.3)Pearson,K.Ⅳ.Mthematical contributions to the ...参考文献1)Rollet,E.De la mensuration des os longs des membres.Lyons.2)Manouvrier,L.Determination de la taille d’ appres les os longs.Rev.E.d’anthrop.paris.11.277.1892.3)Pearson,K.Ⅳ.Mthematical contributions to the theory of evolution.展开更多
文摘Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions.One of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon Consensus.Recently an updated second version has been released.Mean nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD diagnosis.Originally a cut-off of 2292 Ohms was proposed,a value revised in the second edition.The updated Consensus recommended that an MNBI<1500 Ohms strongly suggests GERD while a value>2500 Ohms can be used to refute GERD.The proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic patients.However,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass index.Also,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one proposed.Finally,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now exist.Therefore,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.
文摘一、语境概述什么是语境?又何谓语言语境? 语言学家对语境的解释大体有两种:一种把语境解释为从具体的情景中抽象出来的对语言活动参与者产生影响的一些因素,这些因素系统地决定了话语的形式,话语的合适性以及话语的意义。这是John Lyons对语境所作的界定。他在其《语义学》一书中写道: ...Context,it must be emphasized,is a theoretical construct,in the postulation 0f which
文摘参考文献1)Rollet,E.De la mensuration des os longs des membres.Lyons.2)Manouvrier,L.Determination de la taille d’ appres les os longs.Rev.E.d’anthrop.paris.11.277.1892.3)Pearson,K.Ⅳ.Mthematical contributions to the theory of evolution.
