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Treatment of inflammatory bowel disease:A review of medical therapy 被引量:21
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作者 Patricia L Kozuch Stephen B Hanauer 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第3期354-377,共24页
Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract. While a cure remains elusive, both can be treated with medications that induce and maintain remission.... Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract. While a cure remains elusive, both can be treated with medications that induce and maintain remission. With the recent advent of therapies that inhibit tumor necrosis factor (TNF) alpha the overlap in medical therapies for UC and CD has become greater. Although 5-ASA agents have been a mainstay in the treatment of both CD and UC, the data for their efficacy in patients with CD, particularly as maintenance therapy, are equivocal. Antibiotics may have a limited role in the treatment of colonic CD. Steroids continue to be the first choice to treat active disease not responsive to other more conservative therapy; non- systemic steroids such as oral and rectal budesonide for ileal and right-sided CD and distal UC respectively are also effective in mild-moderate disease. 6-mercaptopurine (6-MP) and its prodrug azathioprine are steroid-sparing immunomodulators effective in the maintenance of remission of both CD and UC, while methotrexate may be used in both induction and maintenance of CD. Infliximab and adalimumab are anti-TNF agents approved in the US and Europe for the treatment of Crohn's disease, and infliximab is also approved for the treatment of UC. 展开更多
关键词 Inflammatory bowel disease Crohn's disease Ulcerative colitis Medical therapy
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Dissecting novel mechanisms of hepatitis B virus related hepatocellular carcinoma using meta-analysis of public data 被引量:1
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作者 Jihad Aljabban Michael Rohr +15 位作者 Saad Syed Eli Cohen Naima Hashi Sharjeel Syed Kamal Khorfan Hisham Aljabban Vincent Borkowski Michael Segal Mohamed Mukhtar Mohammed Mohammed Emmanuel Boateng Mary Nemer Maryam Panahiazar Dexter Hadley Sajid Jalil Khalid Mumtaz 《World Journal of Gastrointestinal Oncology》 SCIE 2022年第9期1856-1873,共18页
BACKGROUND Hepatitis B virus(HBV) is a cause of hepatocellular carcinoma(HCC). Interestingly, this process is not necessarily mediated through cirrhosis and may in fact involve oncogenic processes. Prior studies have ... BACKGROUND Hepatitis B virus(HBV) is a cause of hepatocellular carcinoma(HCC). Interestingly, this process is not necessarily mediated through cirrhosis and may in fact involve oncogenic processes. Prior studies have suggested specific oncogenic gene expression pathways were affected by viral regulatory proteins. Thus, identifying these genes and associated pathways could highlight predictive factors for HCC transformation and has implications in early diagnosis and treatment.AIM To elucidate HBV oncogenesis in HCC and identify potential therapeutic targets.METHODS We employed our Search, Tag, Analyze, Resource platform to conduct a meta-analysis of public data from National Center for Biotechnology Information’s Gene Expression Omnibus. We performed meta-analysis consisting of 155 tumor samples compared against 185 adjacent nontumor samples and analyzed results with ingenuity pathway analysis.RESULTS Our analysis revealed liver X receptors/retinoid X receptor(RXR) activation and farnesoid X receptor/RXR activation as top canonical pathways amongst others. Top upstream regulators identified included the Ras family gene rab-like protein 6(RABL6). The role of RABL6 in oncogenesis is beginning to unfold but its specific role in HBV-related HCC remains undefined. Our causal analysis suggests RABL6 mediates pathogenesis of HBV-related HCC through promotion of genes related to cell division, epigenetic regulation, and Akt signaling. We conducted survival analysis that demonstrated increased mortality with higher RABL6 expression. Additionally, homeobox A10(HOXA10) was a top upstream regulator and was strongly upregulated in our analysis. HOXA10 has recently been demonstrated to contribute to HCC pathogenesis in vitro. Our causal analysis suggests an in vivo role through downregulation of tumor suppressors and other mechanisms.CONCLUSION This meta-analysis describes possible roles of RABL6 and HOXA10 in the pathogenesis of HBV-related HCC. RABL6 and HOXA10 represent potential therapeutic targets and warrant further investigation. 展开更多
关键词 Hepatitis B virus Hepatocellular carcinoma GENOMICS META-ANALYSIS
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Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis
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作者 Stephanie M McGregor W James Chon +2 位作者 Lisa Kim Anthony Chang Shane M Meehan 《World Journal of Transplantation》 2015年第4期292-299,共8页
AIM: To describe the clinicopathologic features of concurrent polyomavirus nephropathy(PVN) and endarteritis due to rejection in renal allografts.METHODS: We searched our electronic records database for cases with tra... AIM: To describe the clinicopathologic features of concurrent polyomavirus nephropathy(PVN) and endarteritis due to rejection in renal allografts.METHODS: We searched our electronic records database for cases with transplant kidney biopsies demonstrating features of both PVN and acute rejection(AR). PVN was defined by the presence of typical viral cytopathic effect on routine sections and positive polyomavirus SV40 large-T antigen immunohistochemistry. AR was identified by endarteritis(v1 by Banff criteria). All cases were subjected to chart review in order to determine clinical presentation, treatment course and outcomes. Outcomes were recorded with a length of follow-up of at least one year or time to nephrectomy. RESULTS: Of 94 renal allograft recipients who developed PVN over an 11-year period at our institution, we identified 7(7.4%) with viral cytopathic changes, SV40 large T antigen staining, and endarteritis in the same biopsy specimen, indicative of concurrent PVN and AR. Four arose after reduction of immunosuppression(IS)(for treatment of PVN in 3 and tuberculosis in 1), and 3 patients had no decrease of IS before developing simultaneous concurrent disease. Treatment consisted of reduced oral IS and leflunomide for PVN, and antirejection therapy. Three of 4 patients who developed endarteritis in the setting of reduced IS lost their grafts to rejection. All 3 patients with simultaneous PVN and endarteritis cleared viremia and were stable at 1 year of follow up. Patients with endarteritis and PVN arising in a background of reduced IS had more severe rejection and poorer outcome.CONCLUSION: Concurrent PVN and endarteritis may be more frequent than is currently appreciated and may occur with or without prior reduction of IS. 展开更多
关键词 Acute REJECTION BK POLYOMAVIRUS Kidney TRANSPLANT POLYOMAVIRUS NEPHROPATHY
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小儿难治性癫癎的手术治疗 被引量:2
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作者 廖建湘 陈乾 +2 位作者 秦炯 林庆 KurtE.Hecox 《实用儿科临床杂志》 CAS CSCD 北大核心 2005年第10期1042-1044,i0003,共4页
如果精心挑选的3种抗癫癎药(单用或联合用药)治疗失败,则可认为是小儿药物难治性癫癎,应尽早考虑手术治疗。手术原则是:1.切除或隔离发作起始区;2.切除或隔离癫癎源病变区;3.未见结构影像学病变,应作功能影像学检查,颅内电极录像脑电图... 如果精心挑选的3种抗癫癎药(单用或联合用药)治疗失败,则可认为是小儿药物难治性癫癎,应尽早考虑手术治疗。手术原则是:1.切除或隔离发作起始区;2.切除或隔离癫癎源病变区;3.未见结构影像学病变,应作功能影像学检查,颅内电极录像脑电图监测等定位出发作起始区和早期扩布区。 展开更多
关键词 儿童 癫痫 手术 治疗
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儿童难治性癫痫的外科治疗 被引量:5
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作者 陈乾 廖建湘 +4 位作者 付桂兵 毛建雄 陈彦 谭启富 Kurt E.Hecox 《临床小儿外科杂志》 CAS 2006年第1期54-56,共3页
目的探讨儿童难治性癫痫的外科治疗方法。方法采用128导视频脑电图进行头皮及皮层电极描记,结合临床表现、颅脑CT、MRI等影象学检查精确定位,并根据不同部位采取不同的术式。结果手术4例,术后无中枢性感染、脑脊液漏等并发症出现,随访6... 目的探讨儿童难治性癫痫的外科治疗方法。方法采用128导视频脑电图进行头皮及皮层电极描记,结合临床表现、颅脑CT、MRI等影象学检查精确定位,并根据不同部位采取不同的术式。结果手术4例,术后无中枢性感染、脑脊液漏等并发症出现,随访6月~10月,1例发作减少75%以上,余3例未再发作;智力均有不同程度的好转。结论多导联的皮层电极视频脑电监测是儿童难治性癫痫术前精确定位的较好的方法,而手术方法的正确选择是手术成败的关键。智力低下不应成为癫痫手术的禁忌症。 展开更多
关键词 癫痫/外科学
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口服凝血酶抑制剂预防脑卒中试验(SPORTIF)中非瓣膜性心房颤动女性患者的抗凝治疗 被引量:1
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作者 Gomberg-Maitland M. Feyzi J. 吴晓燕 《世界核心医学期刊文摘(心脏病学分册)》 2007年第1期52-53,共2页
目的:女性心房颤动(AF)患者脑卒中的风险高于男性。华法林可预防脑卒中,但是由治疗引起的出血在女性中比男性中更多见。方法与结果:SPORTIF III试验(公开标记,n=3410)和SPORTIF V试验(双盲,n=3922)共纳入2257例伴有至少一个脑卒中危险... 目的:女性心房颤动(AF)患者脑卒中的风险高于男性。华法林可预防脑卒中,但是由治疗引起的出血在女性中比男性中更多见。方法与结果:SPORTIF III试验(公开标记,n=3410)和SPORTIF V试验(双盲,n=3922)共纳入2257例伴有至少一个脑卒中危险因素的女性AF患者,受试者被随机分配到华法林治疗组[目标国际标准化比值(INR)2.0~3.0]或希美加群组(36m g,2次/d)。主要终点事件为所有脑卒中(包括缺血性和出血性)和全身性栓塞事件。女性患者的平均年龄较男性大(73.4±8.0岁vs69.8±9.0岁,P【0.0001)。 展开更多
关键词 预防脑卒中 SPORTIF 脑卒中危险因素 凝血酶抑制剂 全身性栓塞 国际标准化比值 心房颤动 加群
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医院内心脏骤停的心肺复苏质量 被引量:1
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作者 Bonjamin S. Abella Jason P. Alvarado +7 位作者 Helge Myklebust, Beng Dana P. Edelson Anne Barry, RN, MBA Nicholas O' Hearn, RN, MSN Terry L Vanden Hoek Lance B. Becker 方跃华(译) 沈卫峰(校) 《美国医学会杂志(中文版)》 2006年第1期17-21,共5页
背景:正确进行心肺复苏(cardiopulmory resuscitation,CPR)能提高存活率已被公认,但尚缺乏心脏骤停时实际CPR质量的客观资料。最近的研究已对按照现行国际指南统一实施CPR这一观念提出了挑战。 目的:测定院内CPR质量的多个参数... 背景:正确进行心肺复苏(cardiopulmory resuscitation,CPR)能提高存活率已被公认,但尚缺乏心脏骤停时实际CPR质量的客观资料。最近的研究已对按照现行国际指南统一实施CPR这一观念提出了挑战。 目的:测定院内CPR质量的多个参数,确定临床对美国心脏病协会和国际指南的依从性。设计和对象:对2002年12月11日至2004年4月5日芝加哥大学医院内发生的67例心脏骤停患者进行前瞻性观察研究。使用一种新的附加感应功能的监护/除颤仪,记录的CPR质量参数包括胸外按压频率、按压深度、通气频率和无胸外按压的停搏时间段(无血流分数)。 主要观察指标:对美国心脏病协会和国际CPR指南的坚持程度。结果:按照30秒时段对每例复苏最初5分钟进行分析发现,在28.1%的时段胸外按压频率低于90次/min。37.4%按压深度过浅(〈38mm)。通气频率较高,60.9%的时段频率超过20次/min。此外,平均(sD)无血流分数为0.24(0.18)。心脏骤停时每分钟有10秒钟的停顿将产生0.17的无血流分数。总共27例(40.3%)成功恢复自主循环,并有7例(10.4%)出院。 结论:在本医院内心脏骤停研究,即使CPR由曾受良好训练的医务人员实施,CPR多项参数的质量亦不一致,而且常常与指南的建议不符。高质量CPR的重要性提示,在实施复苏期间需要救护人员的反馈和监测CPR质量。 展开更多
关键词 质量参数 心脏骤停 心肺复苏 医院内 RESUSCITATION 美国心脏病协会 国际指南 按压频率 胸外按压 CPR
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儿童金黄色葡萄球菌脓毒症与沃-弗综合征
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作者 Adem P.V. Montgomery C.P. +1 位作者 Husain A.N. 郭俊 《世界核心医学期刊文摘(神经病学分册)》 2006年第1期3-3,共1页
Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection... Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection, with necrotizing pneumonia and multiple-organsystem involvement. The identification of bilateral adrenal hemorrhage at autopsy was characteristic of the Waterhouse-Friderichsen syndrome, a constellation of findings usually associated with fulminant meningococcemia. The close genetic relationship among the three responsible isolates of S. aureus, one susceptible to methicillin and two resistant to methicillin, underscores the close relationship between virulent methicillin-suscepti-ble S. aureus and methicillin-resistant S. aureus isolates now circulating in the community. 展开更多
关键词 耐甲氧西林金黄色葡萄球菌 儿童患者 综合征 脓毒症 甲氧西林敏感 侵袭性疾病 坏死性肺炎 肾上腺出血 遗传关联性 系统受累
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化脓性金黄色葡萄球菌与儿童沃-弗综合征
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作者 Adem P.V. Montgomery C.P. +1 位作者 Husain A.N. 张振 《世界核心医学期刊文摘(儿科学分册)》 2006年第2期2-3,共2页
Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection... Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection, with necrotizing pneumonia and multiple-organsystem involvement. The identification of bilateral adrenal hemorrhage at autopsy was characteristic of the Waterhouse-Friderichsen syndrome, a constellation of findings usually associated with fulminant meningococcemia. The close genetic relationship among the three responsible isolates of S. aureus, one susceptible to methicillin and two resistant to methicillin, underscores the close relationship between virulent methicillin-suscepti-ble S. aureus and methicillin-resistant S. aureus isolates now circulating in the community. 展开更多
关键词 金黄色葡萄球菌 综合征 化脓性 二甲氧基 儿童 致病菌株 侵袭性疾病 多系统受累 坏死性肺炎 青霉素
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院内心脏骤停期间心肺复苏的质量
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作者 Abella B.S. Alvarado J.P. +2 位作者 Myklebust H. L.B. Becker 腾增辉 《世界核心医学期刊文摘(心脏病学分册)》 2005年第6期21-21,共1页
Context: The survival benefit of well-performed cardiopulmonary resuscitation(CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged... Context: The survival benefit of well-performed cardiopulmonary resuscitation(CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. Objectives: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. Design and Setting: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/-defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions(no-flow fraction) were recorded. Main Outcome Measure: Adherence to American Heart Association and international CPR guidelines. Results: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1%of segments. Compression depth was too shallow(defined as< 38 mm) for 37.4%of compressions. Ventilation rates were high, with 60.9%of segments containing a rate of more than 20/min. Additionally, the mean(SD) no-flow fraction was 0.24(0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients(40.3%) achieved return of spontaneous circulation and 7(10.4%) were discharged from the hospital. Conclusions: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts. 展开更多
关键词 心脏骤停 心肺复苏 胸部按压 美国心脏学会 国际指南 自主循环 美国心脏病学会 传感功能 芝加哥大学 前瞻性观察
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镰状细胞贫血患者出现骨化软组织平滑肌瘤
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作者 Lacouture M. Petronic-Rosic V. +1 位作者 C.R. Shea 沈斌 《世界核心医学期刊文摘(皮肤病学分册)》 2006年第5期11-11,共1页
Osseous metaplasia in leiomyomas is extremely rare. Here, we report the case of an ossified subcutaneous leiomyoma in a 34-year-old African American man with sickle cell thalassemia who presented with a painful nodule... Osseous metaplasia in leiomyomas is extremely rare. Here, we report the case of an ossified subcutaneous leiomyoma in a 34-year-old African American man with sickle cell thalassemia who presented with a painful nodule of the scapular region, which appeared as a heavily mineralized soft tissue mass on chest radiographs. Histopathologic and immunohistochemical examination of the resected nodule revealed a benign soft tissue leiomyoma composed of intersecting fascicles of spindle cells that strongly expressed smooth muscle actin and caldesmon. Extensive intratumoral calcification and ossification were noticed. Only eight cases of ossified leiomyoma have been reported, of which two arose in the deep soft tissue. Those cases are briefly reviewed and discussed. 展开更多
关键词 平滑肌瘤 镰状细胞贫血 地中海贫血 钙调结合蛋白 梭形细胞 痛性结节 平滑肌肌动蛋白 深部软组织
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HCV基因1型感染者接受聚乙二醇α-2a/利巴韦林治疗24周后的疗效观察
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作者 Jensen D.M. Morgan T.R. +1 位作者 Marcellin P. 王铮 《世界核心医学期刊文摘(胃肠病学分册)》 2006年第10期52-53,共2页
Approximately one third of hepatitis C virus (HCV) genotype 1 patients achieved a sustained virological response (SVR) after 24 weeks of treatment with peginterferon α-2a (40 kd) plus ribavirin in a randomized, multi... Approximately one third of hepatitis C virus (HCV) genotype 1 patients achieved a sustained virological response (SVR) after 24 weeks of treatment with peginterferon α-2a (40 kd) plus ribavirin in a randomized, multinational trial. We aimed to identify factors associated with a rapid virological response (RVR) at week 4 (HCV RNA < 50 IU/mL) and a SVR (HCV RNA < 50 IU/mL at the end of follow-up) in these patients. Stepwise multiple logistic regression analysis was used to explore the prognostic factors for a RVR and SVR in genotype 1 patients treated for 24 weeks. Fifty-one of 216 (24%) genotype 1 patients in the 24-week treatment groups had a RVR. SVR rates were considerably higher in patients without a RVR (89%vs. 19%, respectively). Patients with a baseline HCV RNA of less than 200,000 IU/mL (OR 9.7, 95%CI 4.2-22.5; P < .0001) or 200,000-600,000 IU/mL (OR 3.6, 95%CI 1.5-9.1; P = .0057) were more likely to achieve a RVR than those with HCV RNA greater than 600,000 IU/mL. HCV subtype (1b vs. 1a) was also independently associated with RVR (OR 1.8, 95%CI 0.9-3.7; P = .0954). RVR (OR 23.7 vs. no RVR, 95%CI 9.1-61.7) and baseline HCV RNA less than 200,000 IU/mL (OR 2.7 vs. >600,000 IU/mL, 95%CI 1.1-6.3; P < .026) were significant and independent predictors of SVR in patients treated for 24 weeks. In conclusion, patients infected with HCV genotype 1 and treated with peginterferon α-2a/ ribavirin sustained a RVR 24%of the time. This portends an 89%probability of a SVR after 24 weeks of treatment. 展开更多
关键词 HCV基因1 病毒学应答 丙型肝炎病毒 RNA 回归方法 随机研究
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