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| 1 | Risk of cardiovascular,cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease显示文摘Non-alcoholic fatty liver disease(NAFLD)has emerged as a public health problem of epidemic proportions worldwide.Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease(CHD),abnormalities of cardiac function and structure(e.g.,left ventricular dysfunction and hypertrophy,and heart failure),valvular heart disease(e.g.,aortic valve sclerosis)and arrhythmias(e.g.,atrial fibrillation).Experimental evidence suggests that NAFLD itself,especially in its more severe forms,exacerbates systemic/hepatic insulin resistance,causes atherogenic dyslipidemia,and releases a variety of pro-inflammatory,pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications.Collectively,these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications.The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular,cardiac and arrhythmic complications,to briefly examine the putative biological mechanisms underlying this association,and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications. | Stefano Ballestri Amedeo Lonardo Stefano Bonapace Christopher D Byrne Paola Loria Giovanni Targher | 2014 | World Journal of Gastroenterology2014，20，7： | 55 |
| 2 | 聚合酶链反应检测乙型肝炎患者肝外组织中的乙型肝炎病毒DNA显示文摘应用巢式聚合酶链(PCR)技术对18例石蜡包埋的胆囊、肾、脾、肾上腺、心、睾丸、胰腺及肝脏组织的乙型肝炎病毒(HBV)DNA进行了检测,并与其免疫组化及原位杂交方法作比较。二组引物检测的结果表明:肝组织中均有HBV感染,其中5例有HBV的复制。肝外组织中HBV检出率分别为胆囊85.7%、75.0%、肾72.7%、肾上腺66.7%、心脏55.6%、睾丸55.6%和胰腺54.5%,但均未检测出HBV的复制,PCR检测发现与免疫组化及原位杂交结果基本一致。HBV可以感染肝外组织但并不在这些组织中复制的发现可以解释受感染的肝外组织可以作为肝外感染源,但并不引起这些脏器出现明显的病理变化。 | 郎振为 闫惠平 黄德在 王健 吴和 Zhang JL Perry A Byrne SK Stiver GH | 1994 | 中华内科杂志1994，33，4： | 33 |
| 3 | Effectiveness of exercise in hepatic fat mobilization in nonalcoholic fatty liver disease: Systematic review显示文摘AIM: To investigate the efficacy of exercise interventions on hepatic fat mobilization in non-alcoholic fatty liver disease(NAFLD) patients.METHODS: Ovid-Medline, Pub Med, EMBASE and Cochrane database were searched for randomized trials and prospective cohort studies in adults aged ≥ 18 which investigated the effects of at least 8 wk of exercise only or combination with diet on NAFLD from 2010 to 2016. The search terms used to identify articles, in which exercise was clearly described by type, duration, intensity and frequency were: 'NASH', 'NAFLD', 'nonalcoholic steatohepatitis', 'non-alcoholic fatty liver disease', 'fat', 'steatosis', 'diet', 'exercise', 'MR spectroscopy' and 'liver biopsy'. NAFLD diagnosis, as well as the outcome measures, was confirmed by either hydrogen-magnetic resonance spectroscopy(H-MRS) or biopsy. Trials that included dietary interventions along with exercise were accepted if they met all criteria. RESULTS: Eight studies met selection criteria(6 with exercise only, 2 with diet and exercise with a total of 433 adult participants). Training interventions ranged between 8 and 48 wk in duration with a prescribed exercise frequency of 3 to 7 d per week, at intensities between 45% and 75% of VO2 peak. The most commonly used imaging modality was H-MRS and one study utilized biopsy. The effect of intervention on fat mobilization was 30.2% in the exercise only group and 49.8% in diet and exercise group. There was no difference between aerobic and resistance exercise intervention, although only one study compared thetwo interventions. The beneficial effects of exercise on intrahepatic triglyceride(IHTG) were seen even in the absence of significant weight loss. Although combining an exercise program with dietary interventions augmented the reduction in IHTG, as well as improved measures of glucose control and/or insulin sensitivity, exercise only significantly decreased hepatic lipid contents.CONCLUSION: Prescribed exercise in subjects with NAFLD reduces IHTG independent of dietary intervention. Diet and exercise was more effective than exercise alone in reducing IHTG. | Pegah Golabi Cameron T Locklear Patrick Austin Sophie Afdhal Melinda Byrns Lynn Gerber Zobair M Younossi | 2016 | World Journal of Gastroenterology2016，22，27： | 30 |
| 4 | 聚合酶链反应检测乙型肝炎患者心肌组织中 HBV DNA显示文摘应用巢式聚台酶链反应(PCR)技术检测了18例乙型肝炎(乙肝)患者石蜡包埋心、肝组织中的HBVDNA,并与其免疫组化及原位杂交结果作了比较。二组引物检测的结果表明:在肝组织中均有HBV感染,其中5例有HBV复制。心肌组织HBVDNA的检出率为55.6%,不存在HBV的复制。心脏病理检查可见一些非特异性改变,如脂变、水肿和纤维素样坏死等。病理变化与心电图、临床症状、体征及PCR检测结果无相关件。以上结果提示:乙肝患者心脏出现的一些病变可能是由于沉积于心肌内的免疫复合物介导损伤的结果。 | 郎振为 阎惠平 李俊强 Zhang JL Perry A Byrne SK Stiver GH | 1994 | 中华传染病杂志1994，12，1： | 19 |
| 5 | Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound显示文摘Compared to standard endoscopy,endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS)are often lengthier and more complex,thus requiring higher doses of sedatives for patient comfort and compliance.The aim of this review is to provide the reader with information regarding the use,safety profile,and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS,based on the current literature. | Danny G Cheriyan Michael F Byrne | 2014 | World Journal of Gastroenterology2014，20，18： | 11 |
| 6 | Therapeutic regulation of autophagy in hepatic metabolism显示文摘Metabolic homeostasis requires dynamic catabolic and anabolic processes. Autophagy, an intracellular lysosomal degradative pathway, can rewire cellular metabolism linking catabolic to anabolic processes and thus sustain homeostasis. This is especially relevant in the liver, a key metabolic organ thatgoverns body energy metabolism. Autophagy’s role in hepatic energy regulation has just begun to emerge and autophagy seems to have a much broader impact than what has been appreciated in the field. Though classically known for selective or bulk degradation of cellular components or energy-dense macromolecules, emerging evidence indicates autophagy selectively regulates various signaling proteins to directly impact the expression levels of metabolic enzymes or their upstream regulators. Hence, we review three specific mechanisms by which autophagy can regulate metabolism: A) nutrient regeneration, B) quality control of organelles, and C) signaling protein regulation. The plasticity of the autophagic function is unraveling a new therapeutic approach. Thus, we will also discuss the potential translation of promising preclinical data on autophagy modulation into therapeutic strategies that can be used in the clinic to treat common metabolic disorders. | Katherine Byrnes Sophia Blessinger Niani Tiaye Bailey Russell Scaife Gang Liu Bilon Khambu | 2022 | Acta Pharmaceutica Sinica B2022，12，1： | 11 |
| 7 | Endoscopic stenting-Where are we now and where can we go?显示文摘Self expanding metal stents (SEMS) play an important role in the management of malignant obstructing lesions in the gastrointestinal tract. Traditionally,they have been used for palliation in malignant gastric outlet and colonic obstruction and esophageal malignancy. The development of the polyflex stent,which is a removable self expanding plastic stent,allows temporary stent insertion for benign esophageal disease and possibly for patients undergoing neoadjuvant chemotherapy prior to esophagectomy. Potential complications of SEMS insertion include perforation,tumour overgrowth or ingrowth,and stent migration. Newer stents are being developed with the aim of increasing technical and clinical success rates,while reducing complication rates. Other areas of development include biodegradable stents for benign disease and radioactive or drug-eluting stents for malignant disease. It is hoped that,in the future,newer stents will improve our management of these diffi cult conditions and,possibly,provide prognostic as well as symptomatic benefi t in the setting of malignant obstruction. | Mark Terence McLoughlin Michael Francis Byrne | 2008 | World Journal of Gastroenterology2008，14，24： | 11 |
| 8 | Isolation of circulating tumor cells in non-small-cell-lung-cancer patients using a multi-flow microfluidic channel显示文摘Circulating tumor cells(CTCs)carry a wealth of information on primary and metastatic tumors critical for precise cancer detection,monitoring,and treatment.Numerous microfluidic platforms have been developed in the past few years to capture these rare cells in patient bloodstream for deciphering the critical information needed.However,the practical need for a high-quality method of CTC isolation remains to be met.Herein,we demonstrate a novel multi-flow microfluidic device that is able to sensitively provide high purity(>87%)of separation outcome without labeling.Our device is constructed and configured based on the phenomenal effect of size-dependent inertial migration.The recovery rate of>93%has been achieved using spiked cancer cells at clinically relevant concentrations(10 cells per 5 mL and above).We have also successfully detected CTCs from 6 out of 8 non-small-cell-lung-cancer(NSCLC)patients,while none for 5 healthy control subjects.With these results,we envision our approach is a promising alternative for reliable CTC capture,and thus for facilitating the progress of extracting information from CTCs to personalize treatment strategies for solid tumor patients. | Jian Zhou Arutha Kulasinghe Amanda Bogseth Ken O’Byrne Chamindie Punyadeera Ian Papautsky | 2019 | Microsystems & Nanoengineering2019，5，1： | 9 |
| 9 | A Dialectal Chinese Speech Recognition Framework显示文摘为方言的汉语语音识别的一个框架被建议并且学习,在哪个相对小的方言的中国人(或换句话说,汉语由本国的方言影响了)讲话语料库和方言相关的知识被采用转变标准中国人( orPutonghua ,作为 PTH 缩短了)语音识别器进一个方言的中国语音识别器。知识源的 Twokinds 被探索:一个人是专家知识,其它是一个小方言的中国语料库。这些知识源在四个层次提供信息:语音的水平,词典水平,语言级别,和声学的解码器水平。这篇论文作为一种例子目标语言花吴方言的汉语(WDC ) 。目标是基于中国语言的起始期末考试的结构和方言的中国扬声器怎么说的研究从一个存在 PTHspeech 识别器建立一个 WDC 语音识别器 Putonghua。作者建议使用上下文无关的 PTH-IFmappings (在哪儿如果也意味着起始的中国人或中国期末考试),上下文无关的 WDC-IFmappings ,和音节依赖者 WDC --如果地图砰(从专家或数据获得了),并且把他们与监督最大似然线性回归( MLLR )相结合声学的模型改编方法。为了减少多发音词典的尺寸,由 IF 地图砰介绍了,它可能也扩大词典混乱并且因此导致性能退化,基于积累的 uni 克,概率(AUP ) 被建议的 aMulti 发音扩大(MPE ) 方法。另外,一些通常使用的 WDC 词被选择并且增加了词典。Comparedwith 原来的 PTH 语音识别器,产生 WDC 语音识别器完成 10-18%absolute 字符出错率(CER ) 减小当认出 WDC 时,当认出 PTH 时,与仅仅 0.62% CER 增加。建议框架和方法被期望不仅为 Wudialectal 汉语而且为另外的方言的中国语言甚至另外的语言工作。 | 李净 郑方 William Byrne Dan Jurafsky | 2006 | Journal of Computer Science & Technology2006，21，1： | 7 |
| 10 | Obstructive sleep apnea syndrome and fatty liver: Association or causal link?显示文摘Obstructive sleep apnea (OSA) is a complex disorder that consists of upper airway obstruction, chronic intermittent hypoxia and sleep fragmentation. OSA is well known to be associated with hypoxia, insulin resistance and glucose intolerance, and these factors can occur in the presence or absence of obesity and metabolic syndrome. Although it is well established that insulin resistance, glucose intolerance and obesity occur frequently with non-alcoholic fatty liver disease (NAFLD), it is now becoming apparent that hypoxia might also be important in the development of NAFLD, and it is recognized that there is increased risk of NAFLD with OSA. This review discusses the association between OSA, NAFLD and cardiovascular disease, and describes the potential role of hypoxia in the development of NAFLD with OSA. | Mohamed H Ahmed Christopher D Byrne | 2010 | World Journal of Gastroenterology2010，16，34： | 7 |
| 11 | Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation显示文摘BACKGROUND:Endoscopic therapy has been successful in the management of biliary complications after both deceased donor liver transplantation(DDLT) and living donor liver transplantation(LDLT).LDLT is thought to be associated with higher rates of biliary complications,but there are few studies comparing the success of endoscopic management of anastomotic strictures between the two groups.This study aims to compare our experience in the endoscopic management of anastomotic strictures in DDLT versus LDLT.METHODS:This is a retrospective database review of all liver transplant patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) after liver transplantation.The frequency of anastomotic stricture and the time to develop and to resolve anastomotic stricture were compared between DDLT and LDLT.The response of anastomotic stricture to endoscopic therapy was also analyzed.RESULTS:A total of 362 patients underwent liver transplantation between 2003 and 2011,with 125 requiring ERCP to manage biliary complications.Thirty-three(9.9%) cases of DDLT and 8(27.6%) of LDLT(P=0.01) were found to have anastomotic stricture.When comparing DDLT and LDLT,there was no difference in the mean time to the development of anastomotic strictures(98±17 vs 172±65 days,P=0.11),likelihood of response to ERCP [22(66.7%) vs 6(75.0%),P=0.69],mean time to the resolution of anastomotic strictures(268±77 vs 125±37 days,P=0.34),and the number of ERCPs required to achieve resolution(3.9±0.4 vs 4.7±0.9,P=0.38).CONCLUSIONS:Endoscopic therapy is effective in the majority of biliary complications relating to liver transplantation.Anastomotic strictures occur more frequently in LDLT compared with DDLT,with equivalent endoscopic treatment response and outcomes for both groups. | Calvin HY Chan Fergal Donnellan Michael F Byrne Alan Coss Mazhar Haque Holly Wiesenger Charles H Scudamore Urs P Steinbrecher Alan A Weiss Eric M Yoshida | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，5： | 7 |
| 12 | 阿片成瘾者中的人格障碍问题显示文摘本文采用多种人格障碍筛查表对接受戒毒治疗的80例阿片成瘾者进行了测查。结果显示,各种人格障碍(personalitydisorders,PDs)的现患率为86%,其中戏剧性PD、依赖性PD、回避性PD和边缘性PD各分别占44%、36%、35%和76%。具有统计学意义的多种PD为:(1)依赖性-回避性(OR值=13.9;95%可信限范围=4.55,42.83);(2)戏剧性-依赖性(OR值=2.8;95%可信限范围=1.11,7.26);(3)边缘性-戏剧性(OR值=5.5;95%可信限范围=1.45,20.87);(4)边缘性-依赖性(OR值=3.9;95%可信限范围=1.04,15.04)。此结果提示,在阿片成瘾者中存在着各种严重的人格障碍。 | Adenekan Oyefeso, Hamid Ghodse, Carmel Clancy, Vanessa Crawford, Stephen Byrne(Research Evaluation and Monitoring Unit Department of Psychiatry of Addictive Behaviour St George’s Hospital Medical School London SW17 ORE) | 1998 | 中国药物依赖性杂志1998，7，2： | 6 |
| 13 | Blue LED growth from 2 inch to 8 inch显示文摘Growth of blue InGaN based LED structures on sapphire wafers from 2 inch to 8 inch in diameter was investigated using the Veeco K465 MOCVD platform. Our results indicate that the same pressure,rotation rate and hydride flows can be used for all wafer sizes. AFM and X-ray studies reveal that all wafer sizes have comparable high-quality crystallinity and defect levels for GaN and InGaN/GaN MQW growth. Although the larger diameter wafers exhibit larger wafer bow due to lattice and thermal mismatch,with proper wafer pocket design,good wavelength and thickness uniformity can be obtained for all wafer sizes. | Frank LU Dong LEE Dan BYRNES | 2011 | Science China(Technological Sciences)2011，54，1： | 5 |
| 14 | Mechanical and cellular processes driving cervical myelopathy显示文摘Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy. | Roisin T Dolan Joseph S Butler John M O'Byrne Ashley R Poynton | 2016 | World Journal of Orthopedics2016，7，1： | 5 |
| 15 | Dysfunction of cognition patterns measured by MATRICS Consensus Cognitive Battery (MCCB) among first episode schizophrenia patients and their biological parents显示文摘背景:精神分裂症的临床表现为特征性的知觉、思维、情感和行为等障碍。认知障碍也是精神分裂症核心症状之一。20世纪70年代早期Gallhofer曾提出过,精神分裂症除有阳性或阴性症状,也存在认知障碍。许多研究表明,精神分裂症的一级亲属中存在遗传易感性。认知障碍不仅急性期存在,维持巩固期也会有。有研究还显示,精神分裂症健康的一级亲属亦存在认知缺陷。但对精神分裂症及其生物学父母的认知特征研究仍缺乏。本研究,我们假设精神分裂症及其生物学父母存在特定的认知功能障碍,拟采用认知功能成套测验共识版(MATRICS Consensus Cognitive Battery,MCCB)中文版,以探讨精神分裂症患者及其生物学父母的认知模式。目的:精神分裂症的认知特征可能受到其生物学父母认知模式的影响。研究旨在描绘精神分裂症患者与其父母之间的功能失调的认知模式。方法:采用认知功能成套测验共识版(MCCB,一种新的测量工具)评估29例首发精神分裂症(符合ICD-10精神分裂症诊断标准,年龄17-45岁),58例精神分裂症患者的生物学父母(年龄40-70岁)和46例健康对照(年龄40-70岁)的认知功能,以探讨精神分裂症患者及其生物学父母之间的认知功能障碍之间的关系。所有数据使用SPSS18.0统计软件进行分析。结果:1)男性精神分裂症患者与其父亲相比在MCCB认知功能测定的6个维度有明显认知缺陷(除社会认知功能外)。女性患者的工作记忆和问题推理能力都低于其母亲。2)患者父亲和健康对照组之间的工作记忆和推理问题也存在显著差异。3)与健康对照组相比,患者母亲在问题推理方面没有明显的差异,但视觉记忆有异常。结论:首发精神分裂症患者及其生物学父母在6个维度存在认知功能障碍。患者父母在工作记忆、问题推理和视觉记忆等方面也存在明显功能障碍。仍需深入研究以揭示首发精神分裂症及其生物学父母存在认知功能障碍的潜在机制。 | Aiai CAO Ting SHEN Haibin LI Chuangxin WU Marita MCCABE David MELLOR Linda BYRNE Jie ZHANG Jia HUANG Daihui PENG Yifeng XU | 2017 | 上海精神医学2017，29，3： | 5 |
| 16 | Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy显示文摘Hepatocellular carcinoma(HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation(LT) is considered the most feasible pathway to cure. Resection- even with favorable survival- is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, locoregional therapy(LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT(and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT. | Thomas J Byrne Jorge Rakela | 2016 | World Journal of Transplantation2016，6，2： | 5 |
| 17 | Nonalcoholic Fatty Liver Disease: A Novel Cardiometabolic Risk Factor for Type 2 Diabetes and Its Complications显示文摘 | Giovanni Targher Christopher D. Byrne | 2013 | The Journal of Clinical Endocrinology & Metabolism2013，，2： | 5 |
| 18 | Atypical features and treatment choices in bipolar disorders:a result of the National Bipolar Mania Pathway Survey in China显示文摘In this study,we examined the point prevalence rate of atypical features in bipolar disorder,and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association(DSM-IV),we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches,including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B,the overall rate increased to 11.8%. Interestingly,among patients with the mixed state and remission subtypes,there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These fi ndings indicate a trend of using antidepressants for these two types of patients with atypical features. Further,for both mixed state and remission patients,treatment approaches were related to atypicalfeatures B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses. | Daihui Peng Ting Shen Linda Byrne Chen Zhang Yueqi Huang Xin Yu Jingping Zhao Marita McCabe David Mellor Yiru Fang | 2015 | Neuroscience Bulletin2015，31，1： | 4 |
| 19 | Refining pathological evaluation of neoadjuvant therapy for adenocarcinoma of the esophagus显示文摘AIM:To assess tumour regression grade(TRG)and lymph node downstaging to help define patients who benefit from neoadjuvant chemotherapy.METHODS:Two hundred and eighteen consecutive patients with adenocarcinoma of the esophagus or gastro-esophageal junction treated with surgery alone or neoadjuvant chemotherapy and surgery between 2005and 2011 at a single institution were reviewed.Triplet neoadjuvant chemotherapy consisting of platinum,fluoropyrimidine and anthracycline was considered for operable patients(World Health Organization performance status≤2)with clinical stage T2-4 N0-1.Response to neoadjuvant chemotherapy(NAC)was assessed using TRG,as described by Mandard et al.In addition lymph node downstaging was also assessed.Lymph node downstaging was defined by cN1 at diagnosis:assessed radiologically(computed tomography,positron emission tomography,endoscopic ultrasonography),then pathologically recorded as N0 after surgery;ypN0 if NAC given prior to surgery,or pN0if surgery alone.Patients were followed up for 5 years post surgery.Recurrence was defined radiologically,with or without pathological confirmation.An association was examined between t TRG and lymph node downstaging with disease free survival(DFS)and a comprehensive range of clinicopathological characteristics.RESULTS:Two hundred and eighteen patients underwent esophageal resection during the study interval with a mean follow up of 3 years(median follow up:2.552,95%CI:2.022-3.081).There was a 1.8%(n=4)inpatient mortality rate.One hundred and thirty-six(62.4%)patients received NAC,with 74.3%(n=101)of patients demonstrating some signs of pathological tumour regression(TRG 1-4)and 5.9%(n=8)having a complete pathological response.Forty four point one percent(n=60)had downstaging of their nodal disease(cN1 to ypN0),compared to only 15.9%(n=13)that underwent surgery alone(pre-operatively overstaged:cN1 to pN0),(P<0.0001).Response to NAC was associated with significantly increased DFS(mean DFS;TRG 1-2:5.1years,95%CI:4.6-5.6 vs TRG 3-5:2.8 years,95%CI:2.2-3.3,P<0.0001).Nodal down-staging conferred a significant DFS advantage for those patients with a poor primary tumour response to NAC(median DFS;TRG 3-5 and nodal down-staging:5.533 years,95%CI:3.558-7.531 vs TRG 3-5 and no nodal down-staging:1.114 years,95%CI:0.961-1.267,P<0.0001).CONCLUSION:Response to NAC in the primary tumour and in the lymph nodes are both independently associated with improved DFS. | Fergus Noble Luke Nolan Adrian C Bateman James P Byrne Jamie J Kelly Ian S Bailey Donna M Sharland Charlotte N Rees Timothy J Iveson Tim J Underwood Andrew R Bateman | 2013 | World Journal of Gastroenterology2013，19，48： | 4 |
| 20 | 早产治疗的临床证据显示文摘截止至2002年5月,现有早产治疗的临床证据如下: (1) 高危早产:在一些国家实施的RCT发现,在降低早产危险方面,加强产前保健与普通产前保健没有明显差异.包括5个RCT的1个系统评价发现,对有宫颈改变的妇女行宫颈环扎术有不同的结果,没有明确的结论.1个大样本的RCT发现,孕9~29周宫颈功能可能不全的妇女进行预防性宫颈环扎手术与不环扎相比,能明显降低早产(<33孕周),但也会明显增加产褥感染的危险.另外4篇较小样本的RCT发现,孕10~30周、具各种早产高危因素的妇女,进行预防性宫颈环扎手术与不环扎相比,并不能降低早产(<34孕周).1篇系统评价的2个RCT报告,对有宫颈改变的妇女进行环扎术有不同的结果,其中1个RCT发现其并不能明显降低早产(<34孕周),而另外1个较小样本的RCT却发现宫颈环扎手术加卧床休息与单纯卧床休息比较,能明显降低34周前的早产.没有1个RCT证实行环扎术加卧床休息与单纯卧床休息相比,能降低围生儿死亡率. (2) 胎膜早破:1个系统评价发现,对胎膜早破的妇女,抗生素较安慰剂能明显延长孕周、降低新生儿发病率的危险,如新生儿感染、出生后氧疗、脑部超声异常等.阿莫西林加克拉维酸治疗与新生儿坏死性小肠结肠炎的发生率明显增加有关.一个基于1个RCT的系统评价发现,没有充足的证据证实羊膜腔灌注与不灌注比较能改善胎膜早破后的新生儿结局. (3) 先兆早产的治疗:①β-肾上腺素兴奋剂:1个系统评价发现,β-肾上腺素兴奋剂与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、呼吸窘迫综合征及低体重儿(<2 500 g)发生率,且与与安慰剂或不治疗相比,β-肾上腺素兴奋剂增加孕母副反应,如胸痛、心悸、呼吸困难、震颤、恶心、呕吐、头痛、高血糖、低钾血症.②钙离子通道拮抗剂: 没有关于钙离子通道拮抗剂与安慰剂比较的系统评价或RCT.1个系统评价发现,钙离子通道抑制剂与其它保胎药(主要是β-肾上腺受体兴奋剂)比较,能显著降低48 h内的早产分娩,减少因孕母副反应退出治疗和新生儿发病率.③硫酸镁:1个系统评价发现,硫酸镁与安慰剂比较,并不能明显降低孕36周前的早产率、围生儿死亡率、呼吸窘迫综合征的发生率.另一个系统评价发现,硫酸镁和其他宫缩抑制剂(β-肾上腺素兴奋剂、钙离子通道拮抗剂、前列腺素合成抑制剂、硝化甘油、酒精和葡萄糖注射剂)比较,并不能明显降低48 h内早产率(尽管结果没有差异).④垂体受体拮抗剂(阿托西班):1个系统评价纳入 2个RCT,对阿托西班和安慰剂治疗早产进行比较有不同的结果.较大样本的RCT发现,阿托西班较安慰剂能延长孕周,但阿托西班增加了孕28周以下的胎儿死亡率.另一个RCT发现,阿托西班增加了48 h内的早产.⑤前列腺素抑制剂(消炎痛):1个系统评价发现,消炎痛与安慰剂比较,能明显降低孕37周前的48 h和7天的早产率的证据有限.然而,同时发现消炎痛与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、新生儿呼吸窘迫综合征、肺支气管发育不良、坏死性小肠结肠炎、新生儿败血症或低体重儿.但这个系统评价样本太小,尚不能发现有临床意义的差异. (4) 择期或非择期剖宫产对早产妇女治疗效果:1个系统评价结果发现,择期剖宫产较非择期剖宫产会增加孕母的发病率,却不能降低新生儿的发病率和死亡率.但尚不能证明此效果是否对新生儿有临床意义. (5) 改善早产妊娠结局的干预措施:①对早产者采用皮质类固醇:1个系统评价认为,对可能发生早产的妇女使用皮质激素较安慰剂或不处理能明显降低早产儿出生后呼吸窘迫综合征、新生儿死亡率和颅内出血的发生.②促甲状腺激素释放激素在早产中的运用:1个系统评价发现,在早产的高危妇女中,促甲状腺激素释放激素和类固醇激素联合应用与单用皮质类固醇激素比较,对新生儿结局的影响无明显差异,但会明显增加孕母和胎儿的不良反应.③抗生素:1个系统评价发现,抗生素与安慰剂比较,不能延长孕周、降低新生儿死亡率,但可降低孕母感染率. | Bridgette Byrne John Morrison 李蓉 | 2005 | 中国循证医学杂志2005，5，3： | 4 |
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