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World Journal of Gastrointestinal Oncology 2017年第11期9卷 444-451页

作者： Katharina Endhardt Bruno Markl Andreas Probst Tina Schaller Daniela Aust Institute of Pathology Klinikum Augsburg Department of Gastroenterology Klinikum Augsburg Institute of Pathology Universitatsklinikum Dresden

AIM To test the validity of tumour thickness measurement in distinguishing between the different infiltration depths, especially when the duplication of muscularis mucosae cannot be demarcated clearly. METHODS We re-evaluated 100 completely embedded Barrett's adenocarcinomas regarding m-classification, maximum tumour thickness, and muscularis mucosae duplication. For validation, smoothelin staining was performed on a subset of cases. RESULTS The m1-, m2-and m3-classified adenocarcinomasshowed a significant lower tumour thickness compared to the m4-and sm1-classified lesions(P < 0.001). Smoothelin staining determined a clear muscularis mucosae duplication in 64% of the tested samples and enabled the differentiation of the two layers in diffuse and merged splits. CONCLUSION Tumour thickness in early oesophageal adenocarcinoma significantly correlates with the depth of infiltration and demonstrates its worth as an accurate p T classification in non-polypoid lesions. We created a new algorithm, which combines histomorphology with morphometric analyses. It is noteworthy that it facilitates the assessment of mucosal vs submucosal infiltration depth. The smoothelin staining strengthened our results of the tumour thickness evaluation and can be used in cases of doubt.

关键词： Smoothelin Endoscopic submucosal dissection Muscularis mucosae Barrett's carcinoma

Circulating cytokeratin-positive cells and tumor budding in colorectal cancer

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World Journal of Clinical Oncology 2016年第6期7卷 433-440页

作者： Bruno M?rkl Narjes Wilhelms Matthias Anthuber Gerhard Schenkirsch Günter Schlimok Daniel Oruzio Institute of Pathology Klinikum Augsburg Department of Visceral Surgery Klinikum Augsburg Clinical and Population-Based Cancer Registry augsburg Hematology and Oncology Diakonissen-krankenhaus Augsburg Onkologische Praxis MVZ

AIM To investigate whether circulating cytokeratin-positive(CK^+) cells in the mesenteric blood of resected colorectal specimens are prognostic and correlate with tumor *** Fifty-six colorectal specimens were collected between 9/2007 and 7/*** from the mesenteric vein was drawn immediately after receiving the fresh and unfixed specimens in the pathology *** separation of the mononuclear cells by Ficoll-Hypaquedensity-gradient centrifugation,cytological smears were immunocytochemically stained for *** budding was evaluated on slides stained for *** identification of ≥ 30 buds/1.3 mm2 was defined as high grade *** CK^+ cells and clusters were identified in 29(48%) and 14(25%) of the samples,*** cells were identified in one of three non-malignant *** were found exclusively in malignant *** occurrence of CK^+ cells or clusters was not associated with any of the evaluated clinicopathological factors,including surgical technique and tumor ***,the occurrence of CK^+ cells or clusters had no influence on the cancerspecific survival [75 mo(CI:61;88) vs 83 mo(CI:72;95) and 80 mo(CI:63;98) vs 79 mo(CI:69;89),respectively].CONCLUSION CK^+ cells and showed neither prognostic significance nor an association with tumor *** is very likely that CK18-staining is not specific enough to identify the relevant cells.

关键词： Colorectal cancer Circulating cells Tumor budding Peripheral blood Survival

Colorectal mucosal histamine release by mucosa oxygenation in comparison with other established clinical tests in patients with gastrointestinally mediated allergy

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World Journal of Gastroenterology 2006年第29期12卷 4699-4705页

作者： M Raithel M Weidenhiller R Abel HW Baenkler EG Hahn Functional Tissue Diagnostics Gastroenterology Department of Medicine ⅠUniversity Erlangen-NurembergGermany medicine clinics ⅲ klinikum augsburg Germany Clinical Immunology and Allergology Department of medicine Ⅲ University Erlangen-NurembergGermany

瞄准：评估的这研究作为一个新诊断过程响应挑战积极的使失明的食物和否定食物抗原渲染表面的粘膜组织安版本。方法：受不了胃肠地调停的过敏症由使失明的口头的挑衅证实了的 19 个病人在他们的病历，皮肤刺测试，浆液 IgE 察觉和颜色... 详细信息

瞄准：评估的这研究作为一个新诊断过程响应挑战积极的使失明的食物和否定食物抗原渲染表面的粘膜组织安版本。方法：受不了胃肠地调停的过敏症由使失明的口头的挑衅证实了的 19 个病人在他们的病历，皮肤刺测试，浆液 IgE 察觉和颜色的根据上被调查由前 vivo 粘膜氧化的表面的粘膜组织安版本。未经触动的织物粒子为 30 min 与不同食物抗原在一种氧化文化被孵化 / 刺激。与反人的免疫球蛋白 E 并且没有任何刺激质问的标本分别地用作积极、否定的控制。粘膜组织安版本(全部的活体检视组织安内容的 %) 被认为成功(积极) ，从响应抗原的活体检视的组织安版本的率什么时候到达了多于两次自发的版本的。组织安测量被放射性免疫测定执行。结果：从全部的活体检视组织安内容的表面的粘膜被发现是 3.2 的颜色(0.1%-25.8%) 的自发的组织安版本的 median (范围) 。食物抗原由口头的挑衅容忍了没得到桅杆房间去粒 3.4 (0.4%-20.7% ， P = 0.4 ) 当 anti-IgE 和原因的食物变应原导致了 5.4 的一个重要组织安版本时(1.1%-25.6% ， P = 0.04 ) 并且 8.1 (1.5%-57.9% ， P = 0.008 ) 分别地。19 个病人(63.1%) 中的 12 个显示出积极颜色根据对一样的抗原(s) 作出回应的使失明的口头的挑战的表面的粘膜组织安版本，当功能的组织安版本的特性容忍了精确地认出时，食品被发现是 78.6% 。与历史(30.8% 和 57.1%) 的使失明的食物挑战测试，敏感和特性的结果比较，皮肤试验(47.4% 和 78.6%) 或抗原特定的浆液 IgE 决心(57.9% 和 50%) 被发现具有在胃肠地调停的过敏症的更低的诊断精确性。结论：颜色的反应的功能的测试在在有胃肠地调停的过敏症的病人的遗传因子的刺激具有更高诊断的功效的反之上的表面的粘膜。

关键词：结肠黏膜组胺氧化作用过敏反应

Stage migration vs immunology: The lymph node count story in colon cancer

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World Journal of Gastroenterology 2015年第43期21卷 12218-12233页

作者： Bruno Markl Institute of Pathology Klinikum Augsburg86156 AugsburgGermany

Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases,the number of harvested lymph nodes itself has prognostic relevance in stage Ⅱ/Ⅲ cancers. A stage migration effect caused by missed lymph node metastases has been postulated as most likely explanation for that. In order to avoid false negative node staging reporting of at least 12 lymph nodes is recommended. However,this threshold is met only in a minority of cases in daily practice. Due to quality initiatives the situation has improved in the past. This,however,had no influence on staging in several studies. While the numbers of evaluated lymph nodes increased continuously during the last decades the rate of node positive cases remained relatively constant. This fact together with other indications raised doubts that understaging is indeed the correct explanation for the prognostic impact of lymph node harvest. Several authors assume that immune response could play a major role in this context influencing both the lymph node detectability and the tumor's behavior. Further studies addressing this issue are need. Based on the findings the recommendations concerning minimal lymph node numbers and adjuvant chemotherapy should be reconsidered.

关键词： Colon cancer Lymph node harvest Stage migration Understaging Will Rogers Immune response

Endoscopic hemostasis state of the art-Nonvaricealbleeding

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World Journal of Gastrointestinal Endoscopy 2016年第4期8卷 205-211页

作者： Stefan Karl Goelder Juliane Brueckner Helmut Messmann Department of Internal medicineⅢ Klinikum Augsburg86159 AugsburgGermany

New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-thescope(TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scopeclip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons.

关键词： Gastrointestinal bleeding Endoscopictreatment Intestinal hemorrhage Endoscopic clips Topical hemostatic substances

Lobar lung transplantation from deceased donors: A systematic review

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World Journal of Transplantation 2017年第1期7卷 70-80页

作者： Michael Eberlein Robert M Reed Mayy Chahla Servet Bolukbas Amy Blevins Dirk Van Raemdonck Alessia Stanzi Ilhan Inci Silvana Marasco Norihisa Shigemura Clemens Aigner Tobias Deuse Division of Pulmonary Critical Care and Occupational Medicine University of Iowa Hospitals and Clinics Department of medicine University of Iowa Hospitals and Clinics University of Iowa Hospitals and Clinics Division of Pulmonary and Critical Care medicine University of Maryland Department of Thoracic Surgery Helios Klinikum Wuppertal - University Hospital Witten/Herdecke Hardin Library for the Health Sciences University of Iowa Hospitals and Clinics Department of Thoracic Surgery and Lung Transplant Unit University Hospitals Leuven Department of Thoracic Surgery Zurich University Hospital Cardiothoracic Surgery Unit The Alfred Hospital Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Department of Thoracic Surgery Medical University of Vienna Department of Thoracic Surgery and Surgical Endoscopy Ruhrlandklinik University Clinic Essen Tueschener Weg Department of Cardiovascular Surgery University Heart Center Hamburg

AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.

关键词： Lobar lung transplantation from deceased donors Cadaveric lobar lung transplantation Lung size matching Primary graft dysfunction Survival

血管造影及经皮经腔血管成形术(PTA)的工作人员射线照射量

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放射学实践 1993年第2期8卷 83-87页

作者： L.Bogner H.Czempiel H.Gfirtner H.Gohlke H.-J.Lssl W.Maier M.Schtzl Th.Schmidt M.Wucherer 张在沛 Stadtisches Krankenhaus Schwabing Institut fur Medizinische Physik und StrahlenschutzKolner Platz 18000 Munchen 81 klinikum Passau Medizinische Physik Bischof-Pilgrim-Str. 18390 Passau Elisabeth-Krankenhaus GmbH Radiologische Abteilung Medizinische Physik und Strahlenschutz Schulgasse 208440 Straubing Arztliche Stelle bei der Bayerischen Landesarztekammer Elsenheimerstr.378000 Munchen 21 Zentralklinikum augsburg Radiologisches Zentrum 8900 Augsburg 1 klinikum Groβhadern der Ludwig-Maximilians-Universitat Munchen Klinik und Poliklinik fur Radiologie Marchioninistr. 158000 Munchen 70 Radiologlsches Zentrum der Stadt Narnberg.Abteilung Fur Medizinische Physik.Flurstr.17.8500 Nurnberg 1 宜昌医学专科学校

从事诊断工作的人员职业性射线照射必须引起我们注意,以便采取一切必要的防护措施。若采取相应的预防措施,照射就不会超过临界剂量。

关键词：血管造影血管成形放射损伤医生

电视卒中联网医院和卒中研究中心组织纤溶酶原激活剂治疗情况的比较:巴伐利亚/德国卒中综合护理电视医疗试验计划

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世界核心医学期刊文摘(神经病学分册) 2006年第12期 46-46页

作者： Audebert H.J. Kukla C. Vatankhah B. 郭俊 Dr.Department of Neurology Stàdtisches Klinikum München GmbHKlinikum HarlachingSanatoriumsplatz 281545 MunchenGermany

BACKGROUND AND PURPOSE-Systemic thrombolysis is the only therapy proven to be effective for ischemic *** may help to extend its ***,concerns remain whether management and safety of tissue plasminogen activator(tPA)administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke ***-During the second year of the ongoing Telemedical Pilot Project for Integrative Stroke Care,all systemic thrombolyses in stroke patients of the 12 regional clinics and the 2 stroke centers were recorded ***'demographics,stroke severity(National Institutes of Health Stroke Scale),frequency of administration,time management,protocol violations,and safety were included in the ***-In 2004,115 of 4727 stroke or transient ischemic attack patients(2.4%)in the community hospitals and 110 of 1889 patients in the stroke centers(5.8%)received systemic *** latencies were shorter in the regional hospitals despite longer *** to needle times were shorter in the stroke *** blood pressure was controlled more strictly in community hospitals,symptomatic intracerebral hemorrhage rate(7.8%)was higher(P=0.14)than in stroke centers(2.7%)but still within the range of the National Institute of Neurological Disorders and Stroke ***-hospital mortality rate was low in community hospitals(3.5%)and in stroke centers(4.5%).CONCLUSIONS-Although with a lower rate of systemic thrombolysis,there was no evidence of lower treatment quality in the remote *** increasing numbers of tPA administration and growing training effects,the telestroke concept promises better coverage of systemic thrombolysis in nonurban areas.

关键词：综合护理组织纤溶酶原激活剂卒中中心卒中中风医疗电视电信试验计划

Advance Planning in the Context of a Psychiatric Acute Care Hospital:Acceptance of a Trialogical Pilot Project

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Psychology Research 2018年第7期8卷 299-307页

作者： Daniela Blank Ruth Weizel Markus Witzmann Kbo-Isar-Amper klinikum HaarGermany Kliniken des Bezirks Oberbayern-Kommunalunternehmen MunichGermany Kliniken des Bezirks Oberbayern-Kommunalunternehmen MunichGermany University of Applied Sciences MunichGermany

A joint crisis plan is a written consensus-orientated agreement between mental health service users and *** instrument is used to regulate a potential future hospital *** the clinics of Upper Bavaria(kbo-Kliniken des Bezirks Oberbayern)representatives of the clinics,the organized relatives and those affected developed the pilot project“Joint Crisis Plan”in a trialogical *** pilot project was evaluated between 2015 and *** qualitative study looked at the experiences with the implementation of the instrument medical treatment agreement in different local *** doing so it considered the complex effects of“advance directives”on various levels such as the subjective importance and meaning as experienced by the patients,the effects on face-to-face interactions between patients and the medical staff,and the effects on institutional *** it considered the local influence—such as medical cultures or economic and institutional conditions—on the implementation process and the use of this *** results showed that patients need numerous competences to complete a joint crisis *** the instrument affects self-efficacy and self-images of the patients and the relation between the patients and the clinical staff in a positive *** if the joint crisis plan is insufficiently implemented,the instrument generates rather a mortification of the self.

关键词： psychiatric advance directives joint crisis plan concept of self grounded theory