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中华临床营养杂志 1993年第3期11卷 36-36页

作者： douglas W.wilnore M.D. 陈亭苑 Deparment of surgery Briphan and Women’s HospitalBospitalBostonMassUSA

谷氨酰胺是体内最丰富的氨基酸,但在多数肠内和肠外营养的配方中阙如。在与创伤、感染或手术有关的分解状态下,骨骼肌蛋白分解,并约有1/3的氨基酸氮转归为谷氨酰胺。大部分谷氨酰胺通过血流输送到胃肠道。在胃肠道谷氨酰胺是提供能源的... 详细信息

谷氨酰胺是体内最丰富的氨基酸,但在多数肠内和肠外营养的配方中阙如。在与创伤、感染或手术有关的分解状态下,骨骼肌蛋白分解,并约有1/3的氨基酸氮转归为谷氨酰胺。大部分谷氨酰胺通过血流输送到胃肠道。在胃肠道谷氨酰胺是提供能源的主要物质。

关键词：肠外营养氨基酸氮胃肠道功能 enteral 骨骼肌蛋白 DNA glutamine 肝脂肪变性 atrophy 危重病人

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吸入麻醉药的制动效应是否需要一种新的解释

麻醉与镇痛 2010年第3期6卷 61-78页

作者： Edmond I Eger II, MD douglas E. Raines, MD Steven L. Sharer, MD Hugh C. Hemmings, Jr., MD, PhD James M. Sonner, MD 张益(译) 喻田(校) Department of Anesthesia and Perioperative Care University of California San Francisco California Department of Anesthesia and Critical Care Massachusetts General Hospital and Harvard Medical School Boston Massachusetts Department of Anesthesia Columbia University New York City New York Departments of Anesthesiology and Pharmacology Weill Cornell Medical College New York City New York 不详

吸入麻醉药使人或动物对伤害性刺激不产生体动反应的具体机制，目前的研究仍然众说纷纭。一些研究发现，如吸入麻醉药之间的相加作用，提示各种麻醉药可能通过作用于一些共同的位点产生制动作用。然而，近20年来的研究却并未真正发现一... 详细信息

吸入麻醉药使人或动物对伤害性刺激不产生体动反应的具体机制，目前的研究仍然众说纷纭。一些研究发现，如吸入麻醉药之间的相加作用，提示各种麻醉药可能通过作用于一些共同的位点产生制动作用。然而，近20年来的研究却并未真正发现一种配体或是电压门控通道能单独介导这种制动作用。很多猜测的靶点，如阿片受体、5-HT3受体、GABA。受体、谷氨酸受体，以及钾和钙通道等，有的在制动效应的机制中仅起很小的作用，有的则完全没有作用。此外，多种配体门控通道或多种电压门控通道的联合效应也达不到这样的效果。少数较可信的靶点（如钠通道）值得进一步研究，但仍存在非特异性机制的可能。

关键词：吸入麻醉药制动作用 5-HT3受体电压门控阿片受体伤害性刺激谷氨酸受体特异性机制

改进实效型试验的报告质量：CONSORT声明的扩充（2）

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英国医学杂志中文版 2009年第3期12卷 174-179页

作者： Merrick Zwarenstein Shaun Treweek Joel J Gagnier douglas G Altman Sean Tunis Brian Haynes Andrew D Oxman David Moher 汪谋岳(译) Health Services Sciences Surmybrook Hospital Toronto Ontario Canada Insdtute for Clinical Evaluative Sciences Toronto Department of Health Policy Management and Evaluation University of Tomato Toronto Division of International Health (IHCAR) Karolinska Institute Stockholm Sweden Clinical and Population Sciences and Education University of Dundee Dundee Norwegian centre for Services Oslo Norway Faculty of Medicine University of Tomato centre for Statistics in Medicine University of Oxford Oxford Center for Medical Technology Policy Baltimore MD USA Division of General Internal Medicine Johns Hopkins School of Medicine Baltimore MD Center for Healthcare Policy Stanford University School of Medicine Palo Alto CA USA Department of Medicine McMastor University Faculty of Health Sciences Hamilton ON Canada Clinical Epidemiology Program Ottawa Health research institute Ottawa Canada Department of Epidemiology and Community Medicine Faculty of Medicine University of Ottawa Ottawa 中华医学杂志英文版编辑部

实效型试验旨在为临床实践决策提供依据，但报告得不好会降低其实用性。CONSORT和Practihc小组描述了对CONSORT指南的修改，帮助读者评估研究结果的适用性。

关键词： CONSORT声明报告质量试验临床实践适用性

Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention

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World Journal of Gastrointestinal Endoscopy 2016年第11期8卷 425-432页

作者： douglas S Fishman Bruno P Chumpitazi Isaac Raijman Cynthia Man-Wai Tsai E O’Brian Smith Mark V Mazziotti Mark A Gilger Section of Pediatric Gastroenterology Hepatology and Nutrition Baylor College of Medicine Texas Children’s Hospital Houston TX 77030 United States Digestive Associates of Houston Houston TX 77098 United States Department of Surgery Section of Pediatric Surgery Baylor College of Medicine Houston TX 77030 United States Department of Surgery Section of Pediatric Surgery Baylor College of MedicineHouston TX 77030 United States Department of Pediatrics Baylor College of Medicine Children’s Hospital of San Antonio San Antonio TX 78207 United States

AIM:To assess pediatric patients for *** applied current adult guidelines to identify predictivefactors in ***:A single-center retrospective analysis was performed at a tertiary children's *** evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected *** were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected ***:CBDS were identified in 84% at the time of *** ultrasound identified CBDS in 36% of *** bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to *** aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,***:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.

关键词： Endoscopic retrograde cholangiography Pediatric Endoscopy Choledocholithiasis Children Gallstones Abdominal ultrasound

改进实效型试验的报告质量：CONSORT声明的扩充（1）

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英国医学杂志中文版 2009年第2期12卷 108-111页

作者： Merrick Zwarenstein Shaun Treweek Joel J Gagnier douglas G Altman Sean Tunis Brian Haynes Andrew D Oxman David Moher 汪谋岳(译) Health Services Sciences Sunnybrook Hospital Toronto Ontario Canada Institute for Clinical Evaluative Sciences Toronto Depamnent of Health Policy Management and Evaluation University of Toronto Toronto Division of International Health (IHCAR) Karolinska Institute Stockholm Sweden Clinical and Population Sciences and Education University of Dundee Dundee Norwegian Knowledge centre for the Health Services Oslo Norway Faculty of Medicine University of Toronto centre for Statistics in Medicine University of Oxford Oxford Center for Medical Technology Policy Baltimore MD USA Division of General Internal Medicine Johns Hopkins School of Medicine Baltimore MD Center for Heahhcare Policy Stanford University School of Medicine Palo Alto CA USA Department of Clinical Epidemiology and Biostatistics and Department of Medicine McMaster University Faculty of Health Sciences Hamilton ON Canada Clinical Epidemiology Program Ottawa Health Research Institute Ottawa Canada Department of Epidemiology and Community Medicine Faculty of Medicine University of Ottawa Ottawa 中华医学杂志英文版编辑部

关键词： CONSORT声明报告质量试验临床实践适用性

晚期卵巢癌、输卵管癌及原发性腹膜癌腹腔镜肿瘤细胞减灭术的安全性及有效性研究

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中国微创外科杂志 2012年第2期12卷 97-100页

作者：李萌熊光武 Farr R.Nezhat Shaghayegh M.DeNoble Connie S.Liu Jennifer E.Cho douglas N.Brown Linus Chuang Herbert Gretz Prakash Saharia 北京大学第三医院妇产科北京100191 Columbia University Department of Obstetrics and Gynecology Division of Gynecologic Oncology and Minimally Invasive SurgeryDepartment of Obstetrics and GynecologySt.Luke's-Roosevelt Medical Center Department of Obstetrics and Gynecology New York University Langone Medical Center Division of Gynecologic Oncology Department of ObstetricsGynecologyand Reproductive ScienceThe Mount Sinai Medical Center Department of General Surgery Winthrop University Hospital

目的总结晚期卵巢癌、输卵管癌和腹膜癌患者行腹腔镜初次或间歇性肿瘤细胞减灭术的临床经验。方法回顾分析接受腹腔镜肿瘤细胞减灭术的晚期卵巢癌(FIGOⅡc期以上)、输卵管癌和原发性腹膜癌患者临床资料。结果 32名患者接受腹腔镜评估手... 详细信息

目的总结晚期卵巢癌、输卵管癌和腹膜癌患者行腹腔镜初次或间歇性肿瘤细胞减灭术的临床经验。方法回顾分析接受腹腔镜肿瘤细胞减灭术的晚期卵巢癌(FIGOⅡc期以上)、输卵管癌和原发性腹膜癌患者临床资料。结果 32名患者接受腹腔镜评估手术。17例接受全腹腔镜肿瘤细胞减灭术,其中88.2%为满意的肿瘤细胞减灭术;11例腹腔镜评估后转开腹肿瘤细胞减灭术,其中72.7%为满意的肿瘤细胞减灭术;4例仅进行活检和(或)姑息手术。腹腔镜组平均随访时间19.7月9,例无瘤生存6,例带瘤生存2,例因肿瘤死亡。开腹组平均随访时间25.8月,3例无瘤生存,5例带瘤生存,3例因肿瘤死亡。腹腔镜组术中失血量较少,术后住院时间较短(P=0.008和P=0.03),但手术时间及并发症发生率与开腹组相比无统计学差异。中位复发时间,腹腔镜组为31.7月,开腹组为21.5个月(P=0.3)。结论对于经过精心挑选的晚期卵巢癌、输卵管癌和原发性腹膜癌病例,采用腹腔镜进行诊断、分期和肿瘤细胞减灭术,在技术上是可行的。

关键词：腹腔镜手术卵巢癌肿瘤细胞减灭术

Endoscopic cryotherapy:Indications,techniques,and outcomes involving the gastrointestinal tract

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World Journal of Gastrointestinal Endoscopy 2022年第1期14卷 17-28页

作者： Amaninder Dhaliwal Syed M Saghir Harmeet S Mashiana Annie Braseth Banreet S Dhindsa Daryl Ramai Pushpak Taunk Rene Gomez-Esquivel Aamir Dam Jason Klapman douglas G Adler Division of Gastroenterology and Advanced Endoscopy McLeod Regional Medical CenterFlorenceSC 29501United States Division of Gastroenterology Creighton University School of MedicineOmahaNE 68124United States Division of Gastroenterology and Hepatology University of Nebraska Medical CenterOmahaNE 68198-2000United States Division of Gastroenterology University of IowaIowa CityIA 52242-1009United States Division of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Division of Gastroenterology USF HealthTampaFL 33612United States Division of Gastroenterology and Hepatology Moffitt Cancer CenterTampaFL 33612United States Gastrointestinal Tumor Program Moffitt Cancer CenterTampaFL 33612United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCenter HealthDenverCO 80210United States

Endoscopic cryotherapy is a technique utilized for the ablation of target tissue within the gastrointestinal tract.A cryotherapy system utilizes the endoscopic application of cryogen such as liquid nitrogen,carbon dioxide or liquid nitrous *** leads to disruption of cell membranes,apoptosis,and thrombosis of local blood vessels within the target *** trials utilizing cryotherapy for Barrett’s esophagus(BE)with variable dysplasia,gastric antral vascular ectasia(GAVE),esophageal carcinoma,radiation proctitis,and metastatic esophageal carcinomas have shown safety and *** recently,liquid nitrogen cryotherapy(cryodilation)was shown to be safe and effective for the treatment of a benign esophageal stricture which was refractory to dilations,steroid injections,and ***,liquid nitrogen cryotherapy is associated with less post procedure pain as compared to radiofrequency ablation in BE with comparable ablation *** patients with GAVE,cryotherapy was found to be less tedious as compared to argon plasma *** events from cryotherapy most commonly include chest pain,esophageal strictures,and *** perforations did occur as well,but less *** summary,endoscopic cryotherapy is a promising and growing field,which was first demonstrated in BE,but the use now spans for several other disease *** randomized controlled trials are needed before its role can be established for these different diseases.

关键词： Cryotherapy Gastric antral vascular ectasia Barrett’s esophagus Esophageal cancer Palliative therapy

吸入麻醉药在大鼠最小肺泡有效浓度上无协同作用

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麻醉与镇痛 2010年第1期6卷 1-8页

作者： Edmond I Eger II Michael Tang Mark Liao Michael J. Laster Ken Solt Pamela Flood Andrew lenkins douglas Raines Jan F. Hendrickx Steven L. Shafer Tanifuji Yasumasa James M. Sonner 杨静(译) 米卫东(校) Department of Anesthesia and Perioperative Care University of California San Frandsco California Deparmlent of Anesthesia and Critical Care Massachusetts General Hospital Boston Massachusetts Department of Anaesthesia Harvard Medical School Boston Massachusetts Department of Anesthesiology Columbia University New York City New York Department of Anesthesiology Emory University Manta Georgia Department of Anesthesia Stanford University Stanford California Department of Biopharrnaceutical Science UCSF San Francisco California Tokyo Japan Department of Anesthesiology Jekei University School of Medicine Tokyo Japan 不详

背景本研究假设对特定受体或通道具有不同作用强度[一种在最小肺泡麻醉药浓度（MAC）时作用弱，另一种则作用较强]的两个吸入麻醉药联合使用时可产生协同作用.这种非单纯相加的相互作用方式将支持麻醉药是通过多位点作用而产生麻醉效应... 详细信息

背景本研究假设对特定受体或通道具有不同作用强度[一种在最小肺泡麻醉药浓度（MAC）时作用弱，另一种则作用较强]的两个吸入麻醉药联合使用时可产生协同作用.这种非单纯相加的相互作用方式将支持麻醉药是通过多位点作用而产生麻醉效应的论点。方法根据药物作用强度差别（一个作用弱，一个作用强），我们研究了11组相加为1MAC的麻醉药物对某特定受体或通道的作用.此处“作用强度差别”是指两种麻醉药在体外对特定受体或通道的增强或阻断作用，按MAC计算，作用较强者至少是较弱者的两倍（或更多）。这些特定受体包括：TREK-1和TASK-3钾通道；γ-氨基丁酸A（GABAA）、甘氡酸、N-甲基-D-天门冬氡酸和乙酰胆碱受体。我们还研究了环丙烷-苯酚组合，因为N-甲基-D-天门冬氨酸受体阻滞剂MK-801对这两种药物MAC的影响明显不同。此外，纳入研究的还有4对包含氧化亚氯的组合，因为有报道氧化亚氮与异氟烷联合应用可产生亚相加作用（拮抗作用）。结果除氧化亚氮和异氟烷组合产生了拮抗作用之外，其余所有组合的作用强度均在所预计两者之和10％的范围以内．结论本研究结果支持“吸入麻醉药是作用于单一位点而抑制伤害刺激所致体动反应”的观点。

关键词：吸入麻醉药肺泡有效浓度 N-甲基-D-天门冬氨酸受体阻滞剂协同作用乙酰胆碱受体 γ-氨基丁酸天门冬氡酸大鼠

颈动脉粥样硬化疾病的处理美国血管外科学会临床实践指南

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国际脑血管病杂志 2008年第12期16卷 881-887页

作者： Robert W. Hobson, Ⅱ William C. Mackey Enrico Ascher M. Hassan Murad Keith D. Calligaro Anthony J. Comerota Victor M. Montori Mark K. Eskandari douglas W. Massop Ruth L. Bush Brajesh K. Lal Bruce A. Perler 刘德志(译) 徐格林(译) 刘新峰(译) University of Medicine and Dentistry of New Jersey Newark New England Medical Center Boston Maimonides Medical Center Brooklyn Mayo Clinic Rochester University of Pennsylvania school of Medicine Philadelphia Jobst Vascular Center Toledo Mayo Clinic College of Medicine Rochester Northwestern University Feinberg School of Medicine Chicago The Iowa Clinic Des Moines University of Medicine and Dentistry of New Jersey Newark Texas A & M University Health Science Center College Station Johns Hopkins hospital Baltimore 南京军区南京总医院神经内科 210002

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为G... 详细信息

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为GRADEⅡ级）和证据的质量（高、中、低和极低）进行了分级。对于轻度颈动脉狭窄患者（有症状患者狭窄程度〈50％和无症状患者狭窄程度〈60％），推荐进行最佳的内科治疗而非血管重建术（I级推荐，高质量证据）。对于有症状中到重度狭窄患者（狭窄程度≥50％），推荐行颈动脉内膜切除术（CEA）＋最佳的内科治疗（I级推荐，高质量证据）。对于围手术期风险高的有症状巾到重度狭窄患者（狭窄程度≥50％），建议采用颈动脉支架置入术作为其替代治疗手段（Ⅱ级推荐，低质量证据）。对于中到重度狭窄的无症状患者（狭窄程度≥60％），只要围手术期风险较低，就推荐行CEA＋内科治疗（I级推荐，高质量证据）。对于中到重度狭窄的尢症状患者（狭窄稗度≥60％），不推荐行颈动脉支架置入术（I级推荐，低质量证据）。颈动脉狭窄≥80％但存在CEA高危解剖学风险的患者可能是一个例外。

关键词：临床实践指南动脉粥样硬化疾病血管外科学会美国颈动脉支架置入术颈动脉狭窄颈动脉内膜切除术