Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance a...Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is characterized by a high cardiac output, increased total blood volume and splanchnic vasodilatation, resulting in increased mesenteric blood flow. Pharmacological manipulation of cirrhotic portal hypertension targets both the splanchnic and hepatic vascular beds. Drugs such as angiotensin converting enzyme inhibitors and angiotensin Ⅱ type receptor 1 blockers, which target the components of the classical renin angiotensin system(RAS), are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and vasoactivity of contractile cells and thereby improve portal hypertension. However, these drugs have been shown to produce significant offtarget effects such as systemic hypotension and renal failure. Therefore, the current pharmacological mainstay in clinical practice to prevent variceal bleeding and improving patient survival by reducing portal pressure is non-selective-blockers(NSBBs). These NSBBs work by reducing cardiac output and splanchnic vasodilatation but most patients do not achieve an optimal therapeutic response and a significant proportion of patients are unable to tolerate these drugs.Although statins, used alone or in combination with NSBBs, have been shown to improve portal pressure and overall mortality in cirrhotic patients, further randomized clinical trials are warranted involving larger patient populations with clear clinical end points. On the other hand, recent findings from studies that have investigated the potential use of the blockers of the components of the alternate RAS provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilatation in portal hypertension. This review outlines the mechanisms related to the pat展开更多
AIM:To study the relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China, which is a unique Littoral high-risk area of esophageal carcinoma in China. The poor commu...AIM:To study the relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China, which is a unique Littoral high-risk area of esophageal carcinoma in China. The poor communication and transportation in the past has made Chaoshan a relatively closed area and kept its culture and custure of old China thousand years ago. METHODS: Data on age, sex, ABO blood type and X-ray or pathological diagnose of the patients with carcinoma of esophagus or cardia were collected from the Tumor Hospital. First Affiliated Hospital, Second Affiliated Hospital of Shantou University Medical College; and the Central Hospital of Shantou and the Central Hospital of Jieyang. A total of 6685 patients with esophageal carcinoma (EC) and 2955 patients with cardiac cancer (CC) in Chaoshan district were retrospectively assessed for their association with ABO blood groups. RESULTS: The distribution of ABO blood groups in patients with EC or CC was similar to the normal local population in Chaoshan. However, blood group B in male patients with CC and in the patients with carcinoma in the upper third esophagus was 2.3% and 4.7% higher than the corresponding controls. The relative risk B O was 1.1415 (P【0.05) and 1.2696 (P【0.05), respectively. No relationship was found between ABO blood groups and tumor differentiation. CONCLUSION: ABO blood group B is associated with the incidence of CC in male individuals and carcinoma in the upper third esophagus. The distribution of ABO blood groups varies in the different geographical and ethnic groups. As a result, proper controls are very important for such studies.展开更多
目的通过系统评价对股骨粗隆间骨折髓内与髓外固定围手术期失血特点进行分析,以期了解股骨粗隆间骨折患者围手术期失血的特点,为临床围手术期处理提供必要的数据支撑,提高广大临床医师对股骨粗隆间骨折围手术期失血的重视。方法通过计...目的通过系统评价对股骨粗隆间骨折髓内与髓外固定围手术期失血特点进行分析,以期了解股骨粗隆间骨折患者围手术期失血的特点,为临床围手术期处理提供必要的数据支撑,提高广大临床医师对股骨粗隆间骨折围手术期失血的重视。方法通过计算机检索Medline、Pub Med、Embase、Cochrane图书馆、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库,并配合手工检索关于股骨粗隆间骨折髓内与髓外固定失血特点的随机对照研究(RCTs)、临床病例对照实验(CCTs)。检索时间均为建库至2014年10月,纳入符合标准的文献,比较两组不同内固定方式的显性失血量、隐性失血量、总失血量,同种内固定方式的显性失血量与隐性失血量。提取相关数据输入Rev Man 5.2软件进行统计学分析。结果共4篇文献符合纳入标准,纳入文献的方法学质量评价采用修订后的Jadad量表。系统评价结果显示:髓外固定显性失血量与隐性失血量比较差异有统计学意义(MD=-216.78,95%CI[-322.64,-110.91],<0.001);髓内固定显性失血量与隐性失血量的比较差异有统计学意义(MD=-448.51,95%CI[-651.13,-245.88],<0.001);髓内与髓外固定显性失血量的比较差异有统计学意义(MD=144.08,95%CI[34.94,253.22],=0.01);髓内与髓外固定隐性失血量的比较差异有统计学意义(MD=-128.41,95%CI[-190.74,-66.08],<0.001);髓内与髓外固定总失血量的比较差异无统计学意义(MD=28.06,95%CI[-88.68,144.81],=0.64)。结论据本系统评价结果:无论是髓内固定还是髓外固定,其隐性失血量均多于显性失血量;髓内固定与髓外固定均具有巨大的隐性失血量,但二者相比,髓内固定的隐性失血量要多于髓外固定,因此我们应该更加关注髓内固定的隐性失血;髓内固定与髓外固定的总失血量基本一致,对于降低围手术期风险、减少术后并发症、促进术后患者的功能恢复具有重要的意义�展开更多
基金Supported by National Health and Medical Research Council (NHMRC) of Australia Project Grants,No. APP1124125。
文摘Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is characterized by a high cardiac output, increased total blood volume and splanchnic vasodilatation, resulting in increased mesenteric blood flow. Pharmacological manipulation of cirrhotic portal hypertension targets both the splanchnic and hepatic vascular beds. Drugs such as angiotensin converting enzyme inhibitors and angiotensin Ⅱ type receptor 1 blockers, which target the components of the classical renin angiotensin system(RAS), are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and vasoactivity of contractile cells and thereby improve portal hypertension. However, these drugs have been shown to produce significant offtarget effects such as systemic hypotension and renal failure. Therefore, the current pharmacological mainstay in clinical practice to prevent variceal bleeding and improving patient survival by reducing portal pressure is non-selective-blockers(NSBBs). These NSBBs work by reducing cardiac output and splanchnic vasodilatation but most patients do not achieve an optimal therapeutic response and a significant proportion of patients are unable to tolerate these drugs.Although statins, used alone or in combination with NSBBs, have been shown to improve portal pressure and overall mortality in cirrhotic patients, further randomized clinical trials are warranted involving larger patient populations with clear clinical end points. On the other hand, recent findings from studies that have investigated the potential use of the blockers of the components of the alternate RAS provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilatation in portal hypertension. This review outlines the mechanisms related to the pat
基金Supported ty the Key Teacher Fund,Ministry of Education of China and Sir Li Ka-Ching Foundation.
文摘AIM:To study the relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China, which is a unique Littoral high-risk area of esophageal carcinoma in China. The poor communication and transportation in the past has made Chaoshan a relatively closed area and kept its culture and custure of old China thousand years ago. METHODS: Data on age, sex, ABO blood type and X-ray or pathological diagnose of the patients with carcinoma of esophagus or cardia were collected from the Tumor Hospital. First Affiliated Hospital, Second Affiliated Hospital of Shantou University Medical College; and the Central Hospital of Shantou and the Central Hospital of Jieyang. A total of 6685 patients with esophageal carcinoma (EC) and 2955 patients with cardiac cancer (CC) in Chaoshan district were retrospectively assessed for their association with ABO blood groups. RESULTS: The distribution of ABO blood groups in patients with EC or CC was similar to the normal local population in Chaoshan. However, blood group B in male patients with CC and in the patients with carcinoma in the upper third esophagus was 2.3% and 4.7% higher than the corresponding controls. The relative risk B O was 1.1415 (P【0.05) and 1.2696 (P【0.05), respectively. No relationship was found between ABO blood groups and tumor differentiation. CONCLUSION: ABO blood group B is associated with the incidence of CC in male individuals and carcinoma in the upper third esophagus. The distribution of ABO blood groups varies in the different geographical and ethnic groups. As a result, proper controls are very important for such studies.
文摘目的通过系统评价对股骨粗隆间骨折髓内与髓外固定围手术期失血特点进行分析,以期了解股骨粗隆间骨折患者围手术期失血的特点,为临床围手术期处理提供必要的数据支撑,提高广大临床医师对股骨粗隆间骨折围手术期失血的重视。方法通过计算机检索Medline、Pub Med、Embase、Cochrane图书馆、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库,并配合手工检索关于股骨粗隆间骨折髓内与髓外固定失血特点的随机对照研究(RCTs)、临床病例对照实验(CCTs)。检索时间均为建库至2014年10月,纳入符合标准的文献,比较两组不同内固定方式的显性失血量、隐性失血量、总失血量,同种内固定方式的显性失血量与隐性失血量。提取相关数据输入Rev Man 5.2软件进行统计学分析。结果共4篇文献符合纳入标准,纳入文献的方法学质量评价采用修订后的Jadad量表。系统评价结果显示:髓外固定显性失血量与隐性失血量比较差异有统计学意义(MD=-216.78,95%CI[-322.64,-110.91],<0.001);髓内固定显性失血量与隐性失血量的比较差异有统计学意义(MD=-448.51,95%CI[-651.13,-245.88],<0.001);髓内与髓外固定显性失血量的比较差异有统计学意义(MD=144.08,95%CI[34.94,253.22],=0.01);髓内与髓外固定隐性失血量的比较差异有统计学意义(MD=-128.41,95%CI[-190.74,-66.08],<0.001);髓内与髓外固定总失血量的比较差异无统计学意义(MD=28.06,95%CI[-88.68,144.81],=0.64)。结论据本系统评价结果:无论是髓内固定还是髓外固定,其隐性失血量均多于显性失血量;髓内固定与髓外固定均具有巨大的隐性失血量,但二者相比,髓内固定的隐性失血量要多于髓外固定,因此我们应该更加关注髓内固定的隐性失血;髓内固定与髓外固定的总失血量基本一致,对于降低围手术期风险、减少术后并发症、促进术后患者的功能恢复具有重要的意义�
