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Controversies in the treatment of Crohn’s disease: The case for an accelerated step-up treatment approach

World Journal of Gastroenterology 2008年第17期14卷 2670-2677页

作者： Amandeep K Shergill Jonathan P Terdiman Veterans Affairs Medical Center Division of Gastroenterology University of California Division of Gastroenterology University of California

The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the "accelerated step-up" approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008.

关键词： Crohn's disease Top-down step-up Anti-tumor necrosis factor antibodies Immunomodulators Mucosal healing

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A Novel Family of Integrated step-up PV Micro-Inverter

A Novel Family of Integrated Step-up PV Micro-Inverter

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第37届中国控制会议

作者： Hui Li Jia Meng Mao Hu College of Communications Engineering Jilin University Changchun University of Technology College of Electrical and Electronic Engineering

A family of integrated set-up micro-inverter was proposed for the application of photovoltaic power generation system The proposed inverters have the advantages of less power devices, simpler topology and higher integration and they can achieve voltage pump and invert at the same time. These topologies are suitable for the photovoltaic AC module which has low input voltage, small size and high integration. According to the existing integrated inverters, constructing the switch-diode（SD） unit through the traditional boost or buck-boost DC/DC converters, then proposing the switch-switch（SS） unit with bi-directional flow of the energy. At last, a family of integrated sep-up micro-inverter was derived by combining the SS unit. One of the proposed topologies was given as an example and verified by simulation prototype, which indicates that the topology can achieve the functions of voltage pump and inverting.

关键词： switch unit single-stage integrated micro-inverter step-up

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一种低输入电压、低功率step-up DC-DC变换器的设计

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常州工学院学报 2011年第5期24卷 34-35,45页

作者：门秀萍安徽财经大学管理科学与工程学院安徽蚌埠233030

文章提出一种step-up DC-DC的变换器的设计方法,效率高达70%,输入电压范围低至500 mV,最小起动电压能够达到300 mV。

关键词：低输入电压 step-up DC-DC 变换器

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High-Voltage-Gain DC-DC Converter with Three-Winding Coupled Inductor

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Chinese Journal of Electrical Engineering 2019年第1期5卷 10-23页

作者： Wenjuan Liang Xuefeng Hu Hao Chen Guiyang Wu Meng Zhang Guodong Tan School of Electrical Engineering Anhui University of TechnologyMa’anshan243032 China

A novel DC-DC converter topology that uses a three-winding coupled inductor(TWCI)and a new voltagemultiplication technique is presented for achieving high voltage *** proposed converter comprises one boost unit,one passive absorption circuit,and two voltage-multiplier *** tertiary winding of the coupled inductor is connected to a capacitor and diode,and this combination acts as a secondary voltage-multiplier cell(SVMC).The SVMC,when combined with two capacitors,the secondary winding of the coupled inductor,a diode,and a switch,forms a primary voltage-multiplier cell,which can achieve a large voltage-conversion ratio that can be adjusted *** new voltage-multiplier technique can be used to decrease the number of capacitors and diodes,which improves the transformation efficiency.A prototype circuit with a nominal rating of 300 W is designed to verify the correctness of theoretical analysis.

关键词： Three-winding coupled inductor voltage multiplier output diode stress high step-up

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Real-world insights for the evolving intervention strategy for non-mild acute pancreatitis:35-year experience in a Chinese Tertiary Center

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Journal of Pancreatology 2024年第2期7卷 111-118页

作者： Xiaxiao Yan Jingya Zhou Jian Cao Qiang Xu Xianlin Han Duan Wang Shengyu Zhang Dong Wu Department of Gastroenterology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Medical Records Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China WHO Family of International Classifications Collaborating Center of China Beijing 100730China Department of Radiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Background:With the accumulation of experience and evidence,guidelines for invasive intervention for acute pancreatitis(AP)have continuously evolved,followed in Peking Union Medical College Hospital(PUMCH).We aimed to review AP case series to help understand the impact of guideline evolution on the management and prognosis of AP in real-world ***:This was a single-center study of AP patients who had received invasive interventions from 1988 to *** demographics,baseline severity,imaging findings,and the indication,timing,and specific modalities of invasive interventions were *** composite primary endpoint was death during hospitalization or major complications after *** endpoints included pancreatic fistula,incision infection,number of interventions,length of intensive care stay,length of hospitalization,and total medical ***:A total of 195 patients were *** most common indication for invasive intervention was suspected infection,followed by persistent *** step-up and delayed strategies reduced the incidence of major complications or *** 35 years,the number of patients requiring surgery has gradually declined,and more patients need only minimally invasive procedures for *** incidence of the primary outcome decreased as well as the duration of ***:The management of AP patients at PUMCH in the last 35 years has undergone therapeutic guideline changes that support the efficacy and safety of the deferred step-up strategy in real-world practice.

关键词： Acute pancreatitis Drainage Invasive intervention Necrosectomy step-up

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