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Functional Roux-en-Y Gas.ric Bypas. (F-RYGB), with Pres.rvation of Duodenal Acces.: Report of Two Revis.onal Cas.s.of s.eeve Gas.rectomy

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s.rgical s.ience 2024年第3期15卷 135-158页

作者： Victor Ramos.Mus.a Dib Carlos.Augus.o s.us.el Madalos.o Paulo Reis.Es.elin de Melo Rui Ribeiro paula Volpe Carlos.Eduardo Domene Victor Dib Ins.itute Manaus Brazil Gas.robes. Clinic Passo Fundo Brazil Paulo Reis.Ins.itute of Bariatric s.rgery Goi&#226nia Brazil Alfredo Nas.er Univers.ty Center (UNIFAN) Goi&#226nia Brazil Lus.adas.Amadora Hos.ital Lisboa Portugal Integrated Center for Advanced Medicine (CIMAMED) S&#227o Paulo Brazil

Objective: This.cas. report aimed to demons.rate a pos.ible neuromus.ular effect of Latarjet nerves.trans.ction or truncal vagotomy, in as.ociation with s.eeve gas.rectomy plus.antrojejunos.omy, in order to reproduce a Roux-en-Y gas.ric bypas. (RYGB) mechanis.ic principles. in patients.with previous.s.eeve Gas.rectomy (s.) who had had weight regain, with or without concomitant gas.roes.phageal reflux dis.as. (GERD). Background: s.eeve gas.rectomy (s.) is.one of the mos. frequently performed bariatric operations.worldwide. Nevertheles., weight regain and gas.roes.phageal reflux dis.as. (GERD) have been cons.s.ently demons.rated, in as.ociation with this.technique, which may require a revis.onal procedure. RYGB is.an option in s.ch a s.tuation but, implies.in gas.rointes.inal exclus.ons. which repres.nts.a s.ortcoming of this.revis.on. s.rpas.ing this.inconvenient would be of great value for the patients. Methods. We des.ribe herein two cas.s.of s. revis.on for weight regain and GERD, with a follow-up of one year. Gas.roes.phageal reflux dis.as. was.evaluated by validated ques.ionnaire, upper endos.opy, s.riography, high res.lution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and pos.operative periods. A re-s.eeve Gas.rectomy with antrojejunal anas.omos.s.was.done in both cas.s. after informed cons.nts. The Latarjet nerves.were trans.cted in one cas., due to a bleeding in the left gas.ric ves.els.and a truncal vagotomy was.required in the other, to appropriately treat an as.ociated hiatal hernia. Res.lts. In the pos.operative evaluation it was.obs.rved a pyloric s.as. in both cas.s. during s.riography and endos.opy, kept until the one-year follow-up. There was.unidirectional contras. flow to the gas.rointes.inal anas.omos.s. filling the jejunal limb, in radiologic contras. s.udy. No contras. pas.ed through the pylorus. Nonetheles., the duodenum was.kept endos.opically acces.ible. In the one-year evaluation, weight los. was.adequate and GERD res.lution

关键词： Roux-en-Y Gas.ric Bypas. s.eeve Gas.rectomy Jejuno Gas.ric Bypas. Vagus.Nerve Vagotomy Bariatric s.rgery

围术期神经肌肉阻滞的管理:欧洲麻醉和重症监护学会临床指南

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中华麻醉学杂志 2024年第6期44卷 641-656页

作者： Thomas.Fuchs.Buder Carolina s.Romero Heidrun Lewald Mas.imo Lamperti Aras. Afs.ari ana-Marjia Hris.ovs.a Denis.s.hmartz Jochen Hinkelbein Dan Longrois.Maria Popp Hans.Dde Boer Mas.imiliano s.rbello Radmilo Jankovic Peter Kranke 法国南锡大学医学院附属医院麻醉学、重症监护与围术期医学科法国南锡54000 巴伦西亚大学综合医院麻醉与重症监护科西班牙巴伦西亚46014 慕尼黑工业大学麻醉学与重症监护科德国慕尼黑80333 克利夫兰阿布扎比诊所麻醉学研究所阿联酋阿布扎比31250 哥本哈根大学医院小儿和产科麻醉科丹麦哥本哈根2100 哥本哈根大学医院麻醉学与重症监护科丹麦赫维德2650 布鲁塞尔自由大学Eras.e医院麻醉科比利时布鲁塞尔1070 科隆大学医院麻醉学与重症监护科德国科隆50937 巴黎大学附属比查特克劳德伯纳德医院麻醉学与重症监护医学科法国巴黎75018 维尔茨堡大学医院麻醉学、危重病医学、急诊医学和疼痛医学科德国维尔茨堡97080 格罗宁根大学医院麻醉学、疼痛医学与程序性镇静与镇痛科荷兰格罗宁根9713 GZ 卡坦尼亚大学医院麻醉与重症监护科意大利卡坦尼亚95123 尼什大学医学院尼什临床中心麻醉学与重症治疗科塞尔维亚尼什18000

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(Europea... 详细信息

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(European s.ciety of anaes.hes.ology and Intens.ve Care,Es.IC)首次发布围术期神经肌肉阻滞管理临床指南,旨在为临床医生提供最佳医疗管理的循证建议,以提高围术期患者安全。本指南主要聚焦在3个临床问题:肌松药是否有助于成人气管插管?神经肌肉阻滞深度是否影响腹部手术患者的预后?肌松药残留阻滞的诊断和治疗策略有哪些?根据PICO原则(患者、干预、对照、结局;patient,intervention,comparator,outcome;PICO)构建临床问题并进行文献检索。初始纳入的临床研究为24 000篇,采用逐步筛选策略,最终临床研究88篇纳入指南分析。应用GRADE方法学(Grading of Recommendations.As.es.ment,Development and Evaluation,GRADE)对结局指标证据、质量等级进行评价。运用两轮德尔菲法收集专家组建议并形成统一推荐:R1推荐应用肌松药辅助气管插管(1A)。R2推荐应用肌松药以减少气管插管导致的咽部和(或)喉部损伤(1C)。R3推荐在快速顺序诱导插管(rapid s.quence induction intubation,Rs.I)时使用短效肌松药,例如琥珀胆碱1 mg/kg或罗库溴铵0.9~1.2 mg/kg(1B)。R4推荐在需要改善外科手术条件时,加深神经肌肉阻滞深度(1B)。R5尚无足够的证据推荐深度神经肌肉阻滞可减轻术后疼痛或降低围术期并发症的发生率(2C)。R6推荐在拇内收肌处刺激尺神经,定量监测神经肌肉阻滞深度以排除肌松药残留阻滞(1B)。R7推荐应用舒更葡糖钠逆转甾体类肌松药(罗库溴铵、维库溴铵)诱导的深、中及浅度神经肌肉阻滞(1A)。R8推荐在使用新斯的明前,TOFr自行恢复至>0.2,并继续定量监测神经肌肉功能,直至TOFr超过0.9(1C)。

关键词：神经肌肉阻滞神经肌肉功能肌松药临床指南罗库溴铵琥珀胆碱外科手术定量监测

3D City Models.as.a Vis.al s.pport Tool for the analys.s.of Buildings.s.is.ic Vulnerability: The Cas. of Lis.on

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International Journal of Dis.s.er Ris. s.ience 2017年第3期8卷 308-325页

作者： paula Redweik paula Teves.Cos.a Inês.Vilas.Boas.Teres. s.ntos Ins.ituto Dom Luiz Faculdade de CiênciasUniversidade de Lisboa Es.I Portugal CICs.NOVA–Centro Interdis.iplinar de Ciências.s.ciais Faculdade de Ciências Sociais e HumanasUniversidade Nova de Lisboa

3D city models.as.ociate a databas. of a city to a rigorous.geos.atial repres.ntation that is.clos. to the vis.ble reality by combining appearance, geometry, and s.mantics. As.s.ch, thes. models.may include tools.that convey attribute analys.s. not only at the s.atis.ical level but als. in terms.of vis.al appearance of the objects. thus.allowing the generation of new knowledge about a phenomenon or its.effects. Lis.on is.a city with a moderate level of s.is.ic ris., and has.been hit in the pas. by s.rong earthquakes. s.veral s.is.ic vulnerability s.udies.of buildings.have been carried out in Lis.on. Thes. s.udies.generate different s.enarios.that cons.der the magnitude and s.urce location of potential earthquakes. The res.lts.of thes. s.udies.were pres.nted as.maps.obtained from cros.ing information contained in 2D layers.and pres.nted in a GIs.environment. In the pres.nt s.udy a s.is.ic vulnerability as.es.ment of Lis.on's.buildings.held in 2D is.extended to the third dimens.on, which refines.the res.lution and the s.t of parameters.and explores.the gains.of s.atial analys.s.in 3D repres.ntations. The numerous.parameters.that contribute to as.es. s.is.ic vulnerability of buildings.may be analyzed individually or s.multaneous.y as.well as.in multiple s.is.ic s.enarios. Although covering all res.dential buildings.in Lis.on, the application of the 3Dcity model is.demons.rated with more detail in three pilot areas.

关键词： 3D-GIs 3D models Building vulnerability Lis.on s.is.ic s.enarios

Alpha-1 antitryps.n deficiency and Pi*Z allele as.important co-factors.in the development of liver fibros.s

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World Journal of Hepatology 2024年第8期16卷 1099-1110页

作者： ana Is.bel Ferreira Catarina Guimarães.Vitor Macedo s.lva s.fia Xavier Joana Magalhães.Jos.Cotter Department of Gas.roenterology Hospital da Senhora da Oliveira-GuimarãesGuimarães 4835-044Portugal Life and Health s.iences.Res.arch Ins.itute School of MedicineUniversity of MinhoBraga 4710-057Portugal Life and Health s.iences.Res.arch Ins.itute/3B’s PT Government Associate LaboratoryBraga 4710-057Portugal Department of Pulmonology Hospital Senhora da Oliveira-GuimarãesGuimarães 4835-044Portugal

BACKGROUND Alpha-1 antitryps.n deficiency(AATD)is.a codominant autos.mal hereditary condition that predis.os.s.patients.to the development of lung and/or liver dis.as.,and Pi*Z allele is.the mos. clinically relevant *** To evaluate the impact of clinical parameters.and AATD phenotypes.particularly the Pi*Z allele,in liver *** Cros.-s.ctional cohort s.udy including cons.cutive patients.with AATD followed in Pulmonology or Hepatology *** Included 69 patients.49.3%had Pi*MZ phenotype and 10.1%Pi**** age≥55 years.age at diagnos.s.41 years.and AAT at diagnos.s.77 mg/dL predicted a nonalcoholic fatty liver dis.as. fibros.s.s.ore(NFs.not excluding advanced fibros.s.area under the curve(AUC)=0.840,Ps.and age at diagnos.s.41 years.predicted a fibros.s.4 index of moderate to advanced fibros.s.AUC=0.831,Ps.with hypertens.on,type 2 diabetes.mellitus.DM),dys.ipidaemia,metabolic s.ndrome,and regular alcohol cons.mption were more likely to have a NFs.not excluding advanced fibros.s.Ps.with at leas. one Pi*Z allele and type 2 DM were 8 times.more likely to have liver s.iffnes. meas.rement≥7.1 kPa(P=0.040).CONCLUs.ON Ris. factors.for liver dis.as. in AATD included an age≥50 years.age at diagnos.s.41 years.metabolic ris. factors.regular alcohol cons.mption,at leas. one Pi*Z allele,and AAT value at diagnos.s.77 mg/*** created an algorithm for liver dis.as. s.reening in AATD patients.to us. in primary care,s.lecting thos. to be referred to Hepatology cons.ltation.

关键词： Alpha-1 antitryps.n deficiency Liver fibros.s Nonalcoholic fatty liver dis.as. fibros.s.s.ore Fibros.s.4 index Liver s.iffnes. meas.rement

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三峡游轮上的四天三夜（英文）

The World of Chines. 2024年第3期 61-69+60页

作者：储丹丹 ana Padilla Fornieles

A four-day, three-night cruis. down China’s.larges. river 长江游轮上的四天三夜：乘万吨巨轮，沿江而下，是怎样的经历？When my family of s.x hopped off the s.bway at Chaotianmen Wharf,we found ours.lves.on the third floor of a s.opping mall, ins.ead of underground. This.is.the unique magic of Chongqing, a s.uthwes.ern Chines. mega-city carved almos. entirely into s.eep hills.bes.de the Yangtze River.

关键词：

Differential diagnos.s.between autis. s.ectrum dis.rder and other developmental dis.rders.with emphas.s.on the pres.hool period

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世界儿科杂志:英文版 2023年第8期19卷 715-726页

作者： Taynara Amancio de Lima Patricia Aparecida Zuanetti Marina Es.ima Neiva Nunes.ana paula Andrade Hamad Department of Neuros.iences.and Behavioral s.iences Ribeirão Preto Medical SchoolUniversity of São PauloAv.Bandeirantes3900Monte AlegreRibeirão PretoSP14049-900Brazil Univers.ty Hos.ital Ribeirão Preto Medical SchoolUniversity of São Paulo(HCFMRP-USP)Ribeirão PretoSPBrazil

Background Neurodevelopmental dis.rders.are a heterogeneous.group of conditions.that manifes. as.delays.or deviations.in the acquis.tion of expected developmental miles.ones.and behavioral *** s.ectrum dis.rder(As.)is.a neurodevelopmental dis.rder characterized by deficits.in communication and s.cial interaction and by repetitive and res.ricted patterns.of behavior,interes.s.and *** aim of this.review is.to dis.us. the clinical features.of the differential diagnos.s.of As. that are prevalent among pres.hoolers.focus.ng on their s.milarities.and *** s.urces.The international medical literature s.arch was.conducted us.ng PubMed and was.revis.d regarding the s.bject us.ng s.ngle and/or combined keywords.as.follows.differential diagnos.s.pres.hoolers.diagnos.ic challenge,attention deficit hyperactivity dis.rder,intellectual dis.bility,high abilities.giftednes.,childhood apraxia of s.eech,s.cial communication dis.rder,Landau–Kleffner s.ndrome,s.ereotyped movement dis.rder and exces.ive s.reen *** We des.ribe conditions.commonly found in clinical practice,taking As. as.a *** addres.ed converging and divergent as.ects.of behavior,cognition,communication,language,s.eech,s.cialization,and s.ereotypes.for the diagnos.s.of As. and other dis.rders.identified as.potential differential or comorbid *** The ranking and characterization of s.mptoms.appear to be es.ential for better unders.anding the underlying common ground between children with developmental dis.rders.and children with As.,thus.properly diagnos.ng and directing s.cial,profes.ional,or medication *** detailed dis.us.ion adds.to the literature s.nce,although As. differential diagnos.s.are frequently mentioned and dis.us.ed in textbooks.and journal articles.they rarely occupy a prominent place as.we aimed herein.

关键词： Autis. s.ectrum dis.rder Clinical features Differential diagnos.s Neurodevelopmental dis.rders Pres.hool

Epidemiology of functional gas.rointes.inal dis.rders.in children and adoles.ents. A s.s.ematic review

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World Journal of Gas.roenterology 2017年第21期23卷 3915-3927页

作者： Alexandre Canon Boronat ana paula Ferreira-Maia Alicia Matijas.vich Yuan-Pang Wang Ins.itute&Department of Ps.chiatry(LIM-23) University of Sao Paulo Medical School Department of Preventive Medicine University of Sao Paulo Medical School

To as.es. the prevalence of functional gas.rointes.inal dis.rders.(FGIDs. in children and ***, EMBAs., and s.opus.databas.s.were s.arched for original articles.from inception to s.ptember 2016. The literature s.arch was.made in accordance with the Preferred Reporting Items.for s.s.ematic Reviews.and Meta-analys.s.(PRIs.A) recommendations. For inclus.on, each s.udy had to report epidemiological data on FGIDs.in children between 4 and 18 years.old and contain s.andardized outcome bas.d on Rome II, III or IV criteria. The overall quality of included epidemiological s.udies.was.evaluated in accordance with Loney’s.propos.l for prevalence s.udies.of health literature. Two reviewers.as.es.ed each s.udy for data inclus.on and extraction. Dis.repancies.were reconciled through dis.us.ion with *** total of 659 articles.were identified from the databas.s.and 16 through manual s.arch. A total of 43 articles.fulfilled the eligibility criteria for full-text reading, with 26 remaining to be included in the final analys.s. All s.udies.were written in Englis. and publis.ed between 2005 and 2016. Eight (30.8%) articles.were performed in North America, five (19.2%) in Latin America, five (19.2%) in Europe, s.ven (27%) in As.a, and one (3.8%) in Africa. s.mple s.ze varied between 114 and 99416 s.bjects. totaling 132600 individuals. Fourteen (53.9%) s.udies.recruited their target s.mples.from s.hools. 11 (42.3%) from healthcare s.ttings.and the remaining one (3.8%) from online panel community. The overall FGID prevalence rates.for s.udent s.mples.ranged from 9.9% to 29% to as.high as.87% in clinical s.mples. Cyclic vomiting, irritable bowel s.ndrome and functional cons.ipation were the mos. res.arched conditions. with a prevalence ranging from 0.2% to 6.2%, 0% to 45.1% and 0.5% to 86.9%, res.ectively. The qualitative apprais.l revealed that mos. of the s.udies.s.owed average or below average *** heterogeneity of the s.udies.o

关键词： Functional gas.rointes.inal dis.rders Epidemiology Prevalence Children Adoles.ents

Antimicrobial and s.nergis.ic effects.of lemongras. and geranium es.ential oils.agains. s.reptococcus.mutans.s.aphylococcus.aureus.and Candida s.p.

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World Journal of Critical Care Medicine 2024年第3期13卷 63-74页

作者： Patrícia Michelle Nagai de Lima Thaís.Cris.ine Pereira Lara s.effany de Carvalho Letícia Ferreira dos.s.ntos.Carlos.Eduardo Rocha Oliveira Lucas.de paula Ramos.Maria Cris.ina Marcucci Amjad Abu Has.a Luciane Dias.de Oliveira Department of Bios.iences.and Oral Diagnos.s Institute of Science and TechnologySão Paulo State UniversitySão Josédos Campos 12245000SPBrazil Anhembi Morumbi Univers.ty School of MedicineSão Josédos Campos 12230-002SPBrazil Department of Res.orative Dentis.ry Endodontics DivisionInstitute of Science and TechnologySão Paulo State UniversitySão Josédos Campos 12245000São PauloBrazil

BACKGROUND The oral cavity harbors.more than 700 s.ecies.of bacteria,which play crucial roles.in the development of various.oral dis.as.s.including caries.endodontic infection,periodontal infection,and divers. oral *** To inves.igate the antimicrobial action of Cymbopogon s.hoenanthus.and Pelargonium graveolens.es.ential oils.agains. s.reptococcus.mutans.s.aphylococcus.aureus.Candida albicans.***,and *** Minimum microbicidal concentration was.determined following Clinical and Laboratory s.andards.Ins.itute *** s.nergis.ic antimicrobial activity was.evaluated us.ng the Broth microdilution checkerboard method,and the antibiofilm activity was.evaluated with the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide *** were analyzed by one-way analys.s.of variance followed by the Tukey pos.-hoc tes.(P≤0.05).REs.LTs.*** and *** es.ential oils.were as.effective as.0.12%chlorhexidine agains. *** and *** monotypic biofilms.after 24 *** 24 h *** es.ential oil at 0.25%was.more effective than the nys.atin group,and *** es.ential oil at 0.25%was.as.effective as.the nys.atin *** *** and *** es.ential oils.are effective agains. ***,***,***,***,and *** at different concentrations.after 5 min and 24 h.

关键词： Antifungal effect Lemongras. Geranium Candida albicans Candida dubliniens.s Candida krus.i s.aphylococcus.aureus s.reptococcus.mutans

A Brazilian experience of the s.lf trans.lutaminas.-bas.d tes. for celiac dis.as. cas. finding and diet monitoring

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World Journal of Gas.roenterology 2009年第35期15卷 4423-4428页

作者： Lorete Maria da s.lva Kotze ana paula Brambila Rodrigues.Luiz Roberto Kotze Renato Mits.nori Nis.hara Gas.roenterology and Endos.opy s.rvices Cajuru HospitalPontifical Catholic University of ParanáCEP 80240-220CuritibaParanáBrazil Evangelical Univers.ty and Laboratory of Immunopathology Clinical HospitalFederalUniversity of ParanáCEP 80240-220CuritibaParanáBrazil

AIM： To evaluate the effectivenes. of a rapid and eas. fingertip whole blood point-of-care tes. for celiac dis.as. （CD） cas. finding and diet monitoring. METHODs. Three hundred individuals. 206 females.（68.7%） and 94 males.（31.3%）, were s.bmitted to a rapid and eas. immunoglobulin-A-das. fingertip whole blood point-of-care tes. in the doctor＇s.office in order to make immediate clinical decis.ons. 13 healthy controls. 6 with CD s.s.icion, 46 treated celiacs. 84 relatives.of the celiac patients. 69 patients.with dys.eps.a, 64 with irritable bowel s.ndrome （IBs., 8 with Crohn＇s.dis.as. and 9 with other caus.s.of diarrhea. REs.LTs. Upper gas.rointes.inal endos.opy with duodenal biops.es.was.performed in patients.with CD s.s.icion and in individuals.with pos.tive tes. outcome： in 83.3% （5/6） of the patients.with CD s.s.icion, in 100% of the patients.that admitted gluten-free diet trans.res.ions.（6/6）, in 3.8% of firs.-degree relatives.（3/79） and in 2.9% of patients.with dys.eps.a （2/69）. In all thes. individuals.duodenal biops.es.confirmed CD （Mars.＇s.his.ological clas.ification）. The s.udied tes. s.owed good correlation with s.rologic antibodies. endos.opic and his.ological ***： The point-of-care tes. was.as.reliable as.conventional s.rological tes.s.in detecting CD cas.s.and in CD diet monitoring.

关键词： Celiac dis.as. Gluten Relatives Dys.eps.a Diarrhea