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Can endoscopic submucosal dissection be safely performed in a smaller specialized clinic?

World Journal of Gastroenterology 2013年第4期19卷 528-535页

作者： Naondo Sohara Satoshi Hagiwara Riki Arai Haruhisa Iizuka Yasuhiro Onozato Satoru Kakizaki Department of Endoscopy and Endoscopic Surgery Shirakawa ClinicMaebashiGunma 371-0051Japan Department of Medicine and Molecular Science Gunma University Graduate School of MedicineMaebashiGunma 371-8511Japan

AIM:To investigate whether endoscopic submucosal dissection(ESD) can be safely performed at small clinics,such as the Shirakawa ***:One thousand forty-seven ESDs to treat gastrointestinal tumors were performed at the Shirakawa clinic from April 2006 to March *** efficacy,technical feasibility and associated complications of the procedures were *** ESD procedures were performed by five *** was induced with propofol for esophagogastorduodenal ***:One thousand forty-seven ESDs were performed to treat 64 patients with esophageal cancer(E),850 patients with gastric tumors(G:764 patients with cancer,82 patients with adenomas and four others),four patients with duodenal cancer(D) and 129 patients with colorectal tumors(C:94 patients with cancer,21 patients with adenomas and 14 others).The en bloc resection rate was 94.3%(E:96.9%,G:95.8%,D:100%,C:79.8%).The median operation time was 46 min(range:4-360 min) and the mean size of the resected specimens was 18 mm(range:2-150 mm).No mortal complications were observed in association with the ESD *** occurred in 12 cases(1.1%,E:1 case,G:9 cases,D:1 case,C:1 case) and postoperative bleeding occurred in 53 cases(5.1%,G:51 cases,D:1 case,C:1 case);however,no case required either emergency surgery or blood *** of the perforations and postperative bleedings were resolved by endoscopic clipping or *** other problematic complication observed was pneumonia,which was treated with conservative ***:ESD can be safely performed in a clinic with established therapeutic methods and medical services to address potential complications.

关键词： Endoscopic submucosal dissection Complication Perforation clinic

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Paraoxonase-1 gene in patients with chronic obstructive pulmonary disease investigation Q192R and L55M polymorphisms

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World Journal of emergency Medicine 2015年第3期6卷 201-206页

作者： ?ükrü Gürbüz Mustafa Y?ld?z Murat Kara Kür?at Kargün Mehtap Gürger Metin Ate??elik ?mer Do?an Alata? Department of emergency Medicine ?n?nü University Department of emergency Medicine F?rat University Department of Medical Genetics S?tk? Ko?man University Department of Medical Genetics F?rat University Department of emergency Medicine S?tk? Ko?man University

BACKGROUND: The effect of increased oxidative stress on the development of chronic obstructive pulmonary disease(COPD) is well known. One of the antioxidative systems against oxidative stress in human body is paraoxonase(PON) enzyme that protects low density lipoproteins(LDL) against oxidation. This study aimed to explore the polymorphisms on PON1, Q192 R, L55 M genes of patients with ***: DNAs extraction was obtained from blood samples of 50 patients diagnosed with COPD and 50 patients as a control group who were presented to emergency clinic. Genotypes were obtained with polymerase chain reaction(PCR) and AIw I and Hsp92 II restriction enzymes were used for Q192 R and L55 M polymorphisms, respectively. Analysis of data was done with the Chi-square test and Fisher's exact ***: A statistically significant difference in Q192 R polymorphism was found between the COPD patients and the control group(P=0.05). There was no statistically significant difference in L55 M polymorphisms between the patient and control groups(P>0.05). Q192 R polymorphism was significantly correlated with the PON1 gene and cigarette smoking; however other risk factors did not show any significant correlation with this polymorphism. Though L55 M polymorphism was significantly correlated with family history and tuberculosis, there was no significant correlation with other risk ***: We believe that more studies are needed to study the correlation of L55 M polymorphism with other factors.

关键词： Chronic obstructive pulmonary disease Paraoxonase Polymorphism Acute attack

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Comparison of hepatic resection and transarterial chemoembolization for solitary hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第15期21卷 4635-4643页

作者： Dong-Zhi Zhang Xiao-Dong Wei Xiao-Peng Wang emergency Department Gansu Provincial Hospital Department of General Surgery Gansu Provincial Hospital

AIM: To compare the outcomes of hepatic resection and transarterial chemoembolization(TACE) for solitary hepatocellular carcinoma(HCC) according to the Barcelona clinic Liver Cancer(BCLC) staging ***: A consecutive sample of 540 patients with solitary HCC who underwent liver resection(n = 312) or TACE(n = 128) were included in the present study. Baseline characteristics, tumor characteristics, and post-operative complications were compared between the two groups. The Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were identified using the Cox proportional hazards model(univariate and multivariate analyses).RESULTS: The TACE and liver resection groups had similar baseline demographic and clinicopathological characteristics. The TACE group showed a significantly lower rate of major complications than the liver resection group(3.9% vs 17.4%, P < 0.001). Univariate and multivariate analyses indicated that TACE did not contribute to poor overall survival compared with liver resection; however, a solitary tumor diameter of greater than 6 cm should be considered a risk factor for poor overall survival(HR = 1.328, 95%CI: 1.002-1.783, P = 0.048). The liver resection and TACE groups had comparable overall survival rates at 1 year, 3 years, and 5 years(86.2%, 62.8%, and 44.0% vs 88.3%, 59.8%, and 40.6%, respectively, P = 0.419). In cases with tumor diameters equal to or less than 6 cm, the liver resection group showed a survival benefit compared with the TACE group at 1 year, 3 years, and 5 years(P = 0.030). The 1-, 3-, and 5-year overall survival rates of HCC cases with tumor diameters ofmore than 6 cm were similar among the liver resection and TACE groups(P = 0.467).CONCLUSION: A tumor diameter of 6 cm should be the cutoff for deciding between liver resection and TACE.

关键词： Hepatocellular carcinoma Liver resection Transarterial chemoembolization Solitary

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The Utilisation of Marrow Concentrate in Canine Arthrosis—Case Report

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Journal of Pharmacy and Pharmacology 2019年第4期7卷 218-221页

作者： Busuioc Diana-Alexandra Sindilar Eusebiu-Viorel Horhogea Cristina Labusca(Simion)Luminita Drugociu Dan University of Agricultural Sciences and Veterinary Medicine Ia.iFaculty of Veterinary Medicine3 Mihail Sadoveanu AlleyIa.i 700490Romania Orthopedics and Traumatology clinic County emergency Hospital1 Independentei Boulevard70111IasiRomania

The use of bone marrow concentrate in the treatment of degenerative joint disese(DJD)in dogs represents an innovative approach,minim invasive,that already has been used with increasing success in the veterinary *** technique,adapted from human medicine for the quadruped patients is based on the principle of the autologous transplant of mesenchymal stem cells that are included in the bone marrow *** intervention involves a short anesthesia of the animal for harvesting the *** processing of the marrow is realised in strict aseptic conditions in a laboratory and the inoculation is done in the same *** results are clinically visible after 2-4 *** an enhanced effect,a part of the concentrate is grown on a flask in specific conditions in order to expand autologous bone marrow stem cells and is inoculated after a sufficient number of cells are achieved,usually 3-4 weeks.

关键词： Arthrosis marrow concentrate mesenchymal stem cells

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Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

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World Journal of clinical Cases 2024年第12期12卷 2031-2039页

作者： Tsvetelina Velikova Georgi Vasilev Russka Shumnalieva Lyubomir Chervenkov Dimitrina Georgieva Miteva Milena Gulinac Stamatios Priftis Snezhina Lazova Medical Faculty Sofia University"St.Kliment Ohridski"Sofia 1407Bulgaria clinic of Neurology and Department of emergency Medicine UMHAT"Sv.Georgi"Plovdiv 4000Bulgaria Department of Rheumatology Clinic of RheumatologyUniversity Hospital"St.Ivan Rilski"Medical University-SofiaSofia 1612Bulgaria Department of Diagnostic Imaging Medical University PlovdivPlovdiv 4000Bulgaria Department of Genetics Faculty of BiologySofia University"St.Kliment Ohridski"Sofia 1164Bulgaria Department of General and clinical Pathology Medical University of PlovdivPlovdiv 4002Bulgaria Department of Healthcare Faculty of Public Health“Prof.Tsekomir VodenicharovMDDSc”Medical University of SofiaSofia 1407Bulgaria Department of Pediatric University Hospital"N.I.Pirogov"Sofia 1606Bulgaria

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related *** this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and *** focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,*** studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological *** also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

关键词： Gluten ataxia Celiac disease Gluten enteropathy Autoantibodies Anti-gliadin antibodies Anti-bodies to tissue transglutaminase Anti-tissue transglutaminase antibodies Anti-transglutaminase 6 antibodies Anti-glycine receptor antibodies Anti-glutamine acid decarboxylase antibodies

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Time of arrival and in-hospital evaluation processes among patients with acute ischemic stroke at Yozgat City Hospital in Turkey: A retrospective study

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Journal of Acute Disease 2020年第2期9卷 56-60页

作者： Halil Onder Neurology clinic Yozgat City Hospital Yozgat Turkey

Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.

关键词： IV-tPA Acute stroke care Delay emergency ambulance Turkey

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Current treatment of ulcerative colitis

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World Journal of Gastroenterology 2011年第27期17卷 3204-3212页

作者： Johannes Meier Andreas Sturm Department of Hepatology and Gastroenterology Charité-Universittsmedizin Berlin Campus Virchow Clinic13353 BerlinGermany

Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

关键词： Ulcerative colitis Inflammatory bowel disease Medical management Diagnosis Azathioprine TNF-α blocker

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Suicidal ingestion of potassium permanganate

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World Journal of emergency Medicine 2013年第1期4卷 73-74页

作者： Esin Korkut Ayhan Saritas Yusuf Aydin Semih Korkut Hayati Kandis Davut Baltaci Gastroenterology clinic Duzce Public HospitalDuzceTurkey Department of emergency Medicine Duzce University School of MedicineDuzceTurkey Department of Internal Medicine Duzce University School of MedicineDuzceTurkey Department of Family Medicine Duzce University School of MedicineDuzceTurkey

BACKGROUND:Potassium permanganate is used clinically as an antiseptic and antifungal *** of potassium permanganate may result in damage to the upper gastrointestinal *** and ulceration of the mouth,esophagus and stomach occur due to its *** endoscopy is useful to assess the severity of damage and also to guide ***:We reported a patient presenting to the emergency department after suicidal ingestion of potassium ***:After treatment,the patient was discharged home on the 7th day after ***:Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department.

关键词： emergency endoscopy Gastric damage Suicide Potassium permanganate

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Non-alcoholic fatty liver disease:a multidisciplinary clinical practice approach—the institutional adaptation to existing clinical Practice Guidelines

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emergency and Critical Care Medicine 2022年第1期2卷 12-22页

作者： Zoran Gluvic Ratko Tomasevic Ksenija Bojovic Milan Obradovic Esma R.Isenovic University clinical-Hospital Centre Zemun-Belgrade Clinic of Internal MedicineSchool of MedicineUniversity of BelgradeBelgradeSerbia clinical Centre of Serbia Clinic of Infectious and Tropical DiseasesSchool of MedicineUniversity of BelgradeBelgradeSerbia Department of Radiobiology and Molecular Genetics “VINČA”Institute of Nuclear Sciences-National Institute of thеRepublic of SerbiaUniversity of BelgradeBelgradeSerbia

Non-alcoholic fatty liver disease(NAFLD)is among the most frequently encountered chronic liver diseases in everyday clinical *** is considered the hepatic manifestation of metabolic ***,liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD’s possible progression to non-alcoholic steatohepatitis,fibrosis,cirrhosis,and hepatocellular *** of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures,it is of great interest to recruit the patients for liver ***,as the presence of liver fibrosis determines the further clinical course,liver biopsy is expectedly reserved for those with increased fibrosis *** quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners,gastroenterologists,and *** a result,the quality of liver biopsy recruitment and patients monitoring could be significantly ***,we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients.

关键词： Diagnostics of NAFLD Fatty liver index Fibrosis score-4 Management of NAFLD Non-alcoholic fatty liver disease

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Acute interstitial pneumonia caused by interleukin-2 and interferon α-2b therapy for renal cell carcinoma： a case report and clinical study

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Chinese Medical Journal 2014年第23期127卷 4154-4156页

作者： Zhang Hanyu Xie Miaorong Department of emergency Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Interleukins and intert-erons are distinct groups of cytokines that are upregulated after viral infection in humans and have been recogmzed as having antltumor activity. For example, high-dose interleukin-2 （IL-2） has been used to treat malignant tumors, such as melanoma, in the clinic. In addition, interferon alfa-2b （IFNα-2b） has been applied extensively to treat hepatitis as well as renal cell carcinoma in the clinic.

关键词： interferon alfa-2b interleukin-2 acute interstitial pneumonia

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