骨折相关性感染（fracture related infection,FRI）是创伤骨科一种常见的严重并发症.迄今为止,尚无明确定义,因此很难对该并发症带来的影响进行准确评估和对现有的研究展开比较.为解决这一难题,在AO基金会的支持下,我们成立了一个由科...骨折相关性感染（fracture related infection,FRI）是创伤骨科一种常见的严重并发症.迄今为止,尚无明确定义,因此很难对该并发症带来的影响进行准确评估和对现有的研究展开比较.为解决这一难题,在AO基金会的支持下,我们成立了一个由科学家和医学专家组成的专家组,旨在对FRI定义达成的共识.展开更多
AIM: To determine the expression of membrane-bound mucins and glycan side chain sialic acids in Helicobacter pylori (H. pylori)-associated, non-steroidal inflammatory drug (NSAID)-associated and idiopathic-gastric ulc...AIM: To determine the expression of membrane-bound mucins and glycan side chain sialic acids in Helicobacter pylori (H. pylori)-associated, non-steroidal inflammatory drug (NSAID)-associated and idiopathic-gastric ulcers.展开更多
AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 9...AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 92 patients with H. pylori-associated (n = 30), NSAID-associated (n = 18), combined H. pylori and NSAID-associated gastric ulcers (n = 24), and patients with idiopathic gastric ulcers (n = 20). Immunohistochemistry for T-cell CD4/CD8, andfor mucin 5AC (MUC5AC) and mucin 6 (MUC6), was performed on sections of the mucosa from the ulcer margin. Inflammation score was assessed according to the Sydney system. RESULTS: MUC5AC was expressed on the surface epithelium (98.9%) and neck glands (98.9%) with minimal expression in the deep glands (6.5%). MUC6 was strongly expressed in the deep glands (97.8%), variable in the neck glands (19.6%) and absent in the surface epithelium (0%). The pattern of mucin expression in idiopathic ulcer margins was not different from the expression in ulcers associated with H. pylori, NSAIDs, or combined H. pylori and NSAIDs. CD4/CD8 ratio was higher in H. pylori-positive patients (P = 0.009). Idiopathic ulcers are associated with hospitalized patients and have higher bleeding and mortality rates. CONCLUSION: Idiopathic ulcers have a unique clinical profile. Gastric mucin expression in idiopathic gastric ulcers is unchanged compared with H. pylori and/or NSAID-associated ulcers.展开更多
AIM： To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy. METHODS： An op...AIM： To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy. METHODS： An open label multicenter study was carried out in 39 patients with active ulcerative colitis （CAI 6-8） despite continuous use of steroids （a minimum total dose of 400 mg prednisone within the last 4 wk）. Patients received a total of five aphereses using a granulocyte adsorptive technique （Adacolumn, Otsuka Pharmaceutical Europe, UK）. Assessments at wk 6 and during follow-up until 4 mo comprised clinical （CAI） and endoscopic （EI） activity index, histology, quality of life （IBDQ）, and laboratory tests. RESULTS： Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 （37.1%） patients achieved clinical remission and 10/35 （28.6%） patients had endoscopic remission （CAI〈4, EI〈4）. Quality of life （IBDQ） increased significantly （24 points, P〈0.01） at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia. CONCLUSION： In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/ monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.展开更多
ROS1 oncogenic fusion is reported to be 1%</span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"...ROS1 oncogenic fusion is reported to be 1%</span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> - </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">2% of non-small cell lung cancers (NSCLCs) of the adenocarcinoma subgroup. Meanwhile, there are no records of squamous cell cancer patients with tumors harboring ROS1 fusions. The Foundation Medicine database indicates a frequency of ROS1 rearrangements is 0.2% among squamous NSCLC. Crizotinib is known to be very effective in these patients</span><b><span style="font-family:Verdana;">.</span></b></span></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Here we present a non-smoker patient who had pure squamous NSCLC that was treated by combinational immunotherapy under a clinical trial and progressed after 2 cycles. Surprisingly, comprehensive genomic profiling detected a rare oncogenic EZR-ROS1 fusion, and the patient was treated by crizotinib with a significant response within 6 weeks. To date, the patient has been on therapy for 42 months</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and has achieved</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a complete metabolic response.展开更多
Accurate and temporally consistent modeling of human bodies is essential for a wide range of applications,including character animation,understanding human social behavior,and AR/VR interfaces.Capturing human motion a...Accurate and temporally consistent modeling of human bodies is essential for a wide range of applications,including character animation,understanding human social behavior,and AR/VR interfaces.Capturing human motion accurately from a monocular image sequence remains challenging;modeling quality is strongly influenced by temporal consistency of the captured body motion.Our work presents an elegant solution to integrating temporal constraints during fitting.This increases both temporal consistency and robustness during optimization.In detail,we derive parameters of a sequence of body models,representing shape and motion of a person.We optimize these parameters over the complete image sequence,fitting a single consistent body shape while imposing temporal consistency on the body motion,assuming body joint trajectories to be linear over short time.Our approach enables the derivation of realistic 3D body models from image sequences,including jaw pose,facial expression,and articulated hands.Our experiments show that our approach accurately estimates body shape and motion,even for challenging movements and poses.Further,we apply it to the particular application of sign language analysis,where accurate and temporally consistent motion modelling is essential,and show that the approach is well-suited to this kind of application.展开更多
Numerical simulation approaches have been widely applied to study mining induced subsidence,and they are potential methods to study the flooding induced uplift for abandoned mines.This paper gives an overview about di...Numerical simulation approaches have been widely applied to study mining induced subsidence,and they are potential methods to study the flooding induced uplift for abandoned mines.This paper gives an overview about different numerical approaches to simulate uplift induced by flooding abandoned underground mines,including three different hydraulic conditions,considering both unconfined and confined water conditions.Four basic simulation schemes using 1-dimensional rock column models verified by analytical solutions demonstrate these procedures.The results reveal that flooding induced uplift is mainly related to the pore pressure in the mine goaf.The parameter study documents that height and stiffness of the mine goaf have the strongest influence on maximum surface uplift.展开更多
Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cereb...Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate outcomes were soug ht: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whites (NHWs) were seen for ischemic stroke (66% ) or TIA (34% ). Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED ), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.展开更多
Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been establ...Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.展开更多
Background Carotid endarterectomy(CEA)results in fewer perioperative strokes,but more myocardial infarctions(MI)than carotid artery stenting(CAS).We explored a combined modelling approach that stratifies patients by b...Background Carotid endarterectomy(CEA)results in fewer perioperative strokes,but more myocardial infarctions(MI)than carotid artery stenting(CAS).We explored a combined modelling approach that stratifies patients by baseline stroke and MI.Methods Baseline registry-based risk models for perioperative stroke and MI were identified via literature search.We then selected treatment risk models in the Carotid Revascularisation Stenting versus Endarterectomy(CREST)trial by serially adding covariates(baseline risk,treatment(CEA vs CAS),treatment-risk interaction and age-treatment interaction terms).Treatment risk models were externally validated using data from the Society for Vascular Surgery(SVS)Vascular Quality Initiative(VQI)CEA and carotid stenting registries and treatment models were recalibrated to the SVS-VQI population.Predicted net benefit was estimated by summing the predicted stroke and MI risk differences with CEA versus CAS.Results Perioperative treatment models had moderate predictiveness(c-statistic 0.69 for stroke and 0.68 for MI)and reasonable calibration across the risk spectrum for both stroke and MI within CREST.On external validation in SVS-VQI,predictiveness was substantially reduced(c-statistic 0.61 for stroke and 0.54 for MI)and models substantially overpredicted risk.Most patients(86.7%)were predicted to have net benefit from CEA in CREST(97.0%of symptomatic patients vs 75%of asymptomatic patients).Discussion A combined modelling approach that separates risk elements has potential to inform optimal treatment.However,our current approach is not ready for clinical application.These data support guidelines that suggest that CEA should be the preferred revascularisation modality in most patients with symptomatic carotid stenosis.展开更多
AIM:To compare the microRNA (miR) profiles in the primary tumor of patients with recurrent and non-recurrent gastric cancer.METHODS:The study group included 45 patients who underwent curative gastrectomies from 1995 t...AIM:To compare the microRNA (miR) profiles in the primary tumor of patients with recurrent and non-recurrent gastric cancer.METHODS:The study group included 45 patients who underwent curative gastrectomies from 1995 to 2005 without adjuvant or neoadjuvant therapy and for whom adequate tumor content was available.Total RNA was extracted from formalin-fixed paraffin-embedded tumor samples,preserving the small RNA fraction.Initial profiling using miR microarrays was performed to identify potential biomarkers of recurrence after resection.The expression of the differential miRs was later verified by quantitative real-time polymerase chain reaction (qRT-PCR).Findings were compared between patients who had a recurrence within 36 mo of surgery (bad-prognosis group,n=14,31%) and those who did not (good-prognosis group,n=31,69%).RESULTS:Three miRs,miR-451,miR-199a-3p and miR-195 were found to be differentially expressed in tumors from patients with good prognosis vs patients with bad prognosis (P<0.0002,0.0027 and 0.0046 respectively).High expression of each miR was associated with poorer prognosis for both recurrence and survival.Using miR-451,the positive predictive value for non-recurrence was 100% (13/13).The expression of the differential miRs was verified by qRT-PCR,showing high correlation to the microarray data and similar separation into prognosis groups.CONCLUSION:This study identified three miRs,miR-451,miR-199a-3p and miR-195 to be predictive of recurrence of gastric cancer.Of these,miR-451 had the strongest prognostic impact.展开更多
文摘骨折相关性感染（fracture related infection,FRI）是创伤骨科一种常见的严重并发症.迄今为止,尚无明确定义,因此很难对该并发症带来的影响进行准确评估和对现有的研究展开比较.为解决这一难题,在AO基金会的支持下,我们成立了一个由科学家和医学专家组成的专家组,旨在对FRI定义达成的共识.
基金Supported by National Institute of Neurological Disorders and Stroke No.P30 NS047101Neurosciences Microscopy Shared Facility,UCSD from the G Harold and Leila Y Mathers Charitable Foundation No.CSD018NIH center grant No.DK080506
文摘AIM: To determine the expression of membrane-bound mucins and glycan side chain sialic acids in Helicobacter pylori (H. pylori)-associated, non-steroidal inflammatory drug (NSAID)-associated and idiopathic-gastric ulcers.
基金Beilinson Hospital Gastroenterology Department Trust Fund
文摘AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 92 patients with H. pylori-associated (n = 30), NSAID-associated (n = 18), combined H. pylori and NSAID-associated gastric ulcers (n = 24), and patients with idiopathic gastric ulcers (n = 20). Immunohistochemistry for T-cell CD4/CD8, andfor mucin 5AC (MUC5AC) and mucin 6 (MUC6), was performed on sections of the mucosa from the ulcer margin. Inflammation score was assessed according to the Sydney system. RESULTS: MUC5AC was expressed on the surface epithelium (98.9%) and neck glands (98.9%) with minimal expression in the deep glands (6.5%). MUC6 was strongly expressed in the deep glands (97.8%), variable in the neck glands (19.6%) and absent in the surface epithelium (0%). The pattern of mucin expression in idiopathic ulcer margins was not different from the expression in ulcers associated with H. pylori, NSAIDs, or combined H. pylori and NSAIDs. CD4/CD8 ratio was higher in H. pylori-positive patients (P = 0.009). Idiopathic ulcers are associated with hospitalized patients and have higher bleeding and mortality rates. CONCLUSION: Idiopathic ulcers have a unique clinical profile. Gastric mucin expression in idiopathic gastric ulcers is unchanged compared with H. pylori and/or NSAID-associated ulcers.
文摘AIM： To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy. METHODS： An open label multicenter study was carried out in 39 patients with active ulcerative colitis （CAI 6-8） despite continuous use of steroids （a minimum total dose of 400 mg prednisone within the last 4 wk）. Patients received a total of five aphereses using a granulocyte adsorptive technique （Adacolumn, Otsuka Pharmaceutical Europe, UK）. Assessments at wk 6 and during follow-up until 4 mo comprised clinical （CAI） and endoscopic （EI） activity index, histology, quality of life （IBDQ）, and laboratory tests. RESULTS： Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 （37.1%） patients achieved clinical remission and 10/35 （28.6%） patients had endoscopic remission （CAI〈4, EI〈4）. Quality of life （IBDQ） increased significantly （24 points, P〈0.01） at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia. CONCLUSION： In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/ monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.
文摘ROS1 oncogenic fusion is reported to be 1%</span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> - </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">2% of non-small cell lung cancers (NSCLCs) of the adenocarcinoma subgroup. Meanwhile, there are no records of squamous cell cancer patients with tumors harboring ROS1 fusions. The Foundation Medicine database indicates a frequency of ROS1 rearrangements is 0.2% among squamous NSCLC. Crizotinib is known to be very effective in these patients</span><b><span style="font-family:Verdana;">.</span></b></span></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Here we present a non-smoker patient who had pure squamous NSCLC that was treated by combinational immunotherapy under a clinical trial and progressed after 2 cycles. Surprisingly, comprehensive genomic profiling detected a rare oncogenic EZR-ROS1 fusion, and the patient was treated by crizotinib with a significant response within 6 weeks. To date, the patient has been on therapy for 42 months</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and has achieved</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">a complete metabolic response.
基金This work was partly funded by the European Union’s Horizon 2020 Research and Innovation Programme under Agreement No.952147(Invictus)as well as the German Federal Ministry of Education and Research(BMBF)through the Research Program MoDL under Contract No.01 IS 20044.
文摘Accurate and temporally consistent modeling of human bodies is essential for a wide range of applications,including character animation,understanding human social behavior,and AR/VR interfaces.Capturing human motion accurately from a monocular image sequence remains challenging;modeling quality is strongly influenced by temporal consistency of the captured body motion.Our work presents an elegant solution to integrating temporal constraints during fitting.This increases both temporal consistency and robustness during optimization.In detail,we derive parameters of a sequence of body models,representing shape and motion of a person.We optimize these parameters over the complete image sequence,fitting a single consistent body shape while imposing temporal consistency on the body motion,assuming body joint trajectories to be linear over short time.Our approach enables the derivation of realistic 3D body models from image sequences,including jaw pose,facial expression,and articulated hands.Our experiments show that our approach accurately estimates body shape and motion,even for challenging movements and poses.Further,we apply it to the particular application of sign language analysis,where accurate and temporally consistent motion modelling is essential,and show that the approach is well-suited to this kind of application.
基金The first author would like to thank the China Scholarship Council(CSC No.201806430001)for the financial support for his study in Germany.The authors are grateful to the anonymous reviewer for the recommendations to improve the paper。
文摘Numerical simulation approaches have been widely applied to study mining induced subsidence,and they are potential methods to study the flooding induced uplift for abandoned mines.This paper gives an overview about different numerical approaches to simulate uplift induced by flooding abandoned underground mines,including three different hydraulic conditions,considering both unconfined and confined water conditions.Four basic simulation schemes using 1-dimensional rock column models verified by analytical solutions demonstrate these procedures.The results reveal that flooding induced uplift is mainly related to the pore pressure in the mine goaf.The parameter study documents that height and stiffness of the mine goaf have the strongest influence on maximum surface uplift.
文摘Objective: To identify demographic and clinical variables of emergency depart ment (ED) practices in a community-based acute stroke study. Methods: By both active and passive surveillance, the authors identified cerebrovascular disease cases in Nueces County, TX, as part of the Brain Attack Surveillance in Corpus C hristi (BASIC) Project, a population-based stroke surveillance study, between January 1, 2000, and December 31, 2002. With use of multivariable logistic regre ssion, variables independently associated with three separate outcomes were soug ht: hospital admission, brain imaging in the ED, and neurologist consultation in the ED. Prespecified variables included age, sex, ethnicity, insurance status, NIH Stroke Scale score, type of stroke (ischemic stroke or TIA), vascular risk factors, and symptom presentation varia bles. Percentage use of recombinant tissue plasminogen activator (rt-PA) was c alculated. Results: A total of 941 Mexican Americans (MAs) and 855 non-Hispani c whites (NHWs) were seen for ischemic stroke (66% ) or TIA (34% ). Only 8% of patients received an inperson neurology consultation in the ED, and 12% did not receive any head imaging. TIA was negatively associated with neurology cons ultations compared with completed stroke (odds ratio [OR] 0.35 [95% CI 0.21 to 0.57]). TIA (OR 0.14 [0.10 to 0.19]) and sensory symptoms (OR 0.59 [0.44 to 0.8 1]) were also negatively associated with hospital admission. MAs (OR 0.58 [0.35 to 0.98]) were less likely to have neurology consultations in the ED than NHWs. Only 1.7% of patients were treated with rt-PA. Conclusions: Neurologists are seldom involved with acute cerebrovascular care in the emergency department (ED ), especially in patients with TIA. Greater neurologist involvement may improve acute stroke diagnosis and treatment efforts in the ED.
基金partially supported by the National Heart,Lung,and Blood Institute of the National Institutes of Health(https://www.nhlbi.nih.gov/)under Award Number R01HL157991sponsored by the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium,Inc.
文摘Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.
基金This work was funded by the National Institute of Health(NINDS,K08 NS082597).
文摘Background Carotid endarterectomy(CEA)results in fewer perioperative strokes,but more myocardial infarctions(MI)than carotid artery stenting(CAS).We explored a combined modelling approach that stratifies patients by baseline stroke and MI.Methods Baseline registry-based risk models for perioperative stroke and MI were identified via literature search.We then selected treatment risk models in the Carotid Revascularisation Stenting versus Endarterectomy(CREST)trial by serially adding covariates(baseline risk,treatment(CEA vs CAS),treatment-risk interaction and age-treatment interaction terms).Treatment risk models were externally validated using data from the Society for Vascular Surgery(SVS)Vascular Quality Initiative(VQI)CEA and carotid stenting registries and treatment models were recalibrated to the SVS-VQI population.Predicted net benefit was estimated by summing the predicted stroke and MI risk differences with CEA versus CAS.Results Perioperative treatment models had moderate predictiveness(c-statistic 0.69 for stroke and 0.68 for MI)and reasonable calibration across the risk spectrum for both stroke and MI within CREST.On external validation in SVS-VQI,predictiveness was substantially reduced(c-statistic 0.61 for stroke and 0.54 for MI)and models substantially overpredicted risk.Most patients(86.7%)were predicted to have net benefit from CEA in CREST(97.0%of symptomatic patients vs 75%of asymptomatic patients).Discussion A combined modelling approach that separates risk elements has potential to inform optimal treatment.However,our current approach is not ready for clinical application.These data support guidelines that suggest that CEA should be the preferred revascularisation modality in most patients with symptomatic carotid stenosis.
文摘AIM:To compare the microRNA (miR) profiles in the primary tumor of patients with recurrent and non-recurrent gastric cancer.METHODS:The study group included 45 patients who underwent curative gastrectomies from 1995 to 2005 without adjuvant or neoadjuvant therapy and for whom adequate tumor content was available.Total RNA was extracted from formalin-fixed paraffin-embedded tumor samples,preserving the small RNA fraction.Initial profiling using miR microarrays was performed to identify potential biomarkers of recurrence after resection.The expression of the differential miRs was later verified by quantitative real-time polymerase chain reaction (qRT-PCR).Findings were compared between patients who had a recurrence within 36 mo of surgery (bad-prognosis group,n=14,31%) and those who did not (good-prognosis group,n=31,69%).RESULTS:Three miRs,miR-451,miR-199a-3p and miR-195 were found to be differentially expressed in tumors from patients with good prognosis vs patients with bad prognosis (P<0.0002,0.0027 and 0.0046 respectively).High expression of each miR was associated with poorer prognosis for both recurrence and survival.Using miR-451,the positive predictive value for non-recurrence was 100% (13/13).The expression of the differential miRs was verified by qRT-PCR,showing high correlation to the microarray data and similar separation into prognosis groups.CONCLUSION:This study identified three miRs,miR-451,miR-199a-3p and miR-195 to be predictive of recurrence of gastric cancer.Of these,miR-451 had the strongest prognostic impact.
