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Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

World Journal of Gastroenterology 2020年第26期26卷 3712-3719页

作者： Dipesh H Vasant Alexander C Ford Gastroenterology Manchester University NHS Foundation TrustWythenshawe HospitalManchester M239LTUnited Kingdom division of Diabetes Endocrinology and GastroenterologyUniversity of ManchesterManchester M239LTUnited Kingdom Leeds Institute of Medical Research at St.James’s University of LeedsLeeds LS97TFUnited Kingdom Leeds Gastroenterology Institute Leeds Teaching Hospitals NHS TrustLeeds LS97TFUnited Kingdom

Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease(IBD).There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing,rather than clinical remission ***,the treatment of refractory“functional”gastrointestinal symptoms,often attributed as the aftermath of previous inflammation,has recently become more prominent in quiescent *** further expected advances in anti-inflammatory treatments on the horizon,the burden of such symptoms in quiescent disease,which have been relatively neglected,is set to become an even bigger *** this article,we highlight the current state of research and understanding in this field,including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms,such as irritable bowel syndrome and functional anorectal and pelvic floor disorders,in patients with quiescent *** disorders are not only highly prevalent in these patients,they are often misdiagnosed,and are difficult to treat,with very few evidence-based ***,they are associated with substantial impairment in quality-of-life,considerable morbidity,and psychological *** is therefore an urgent need for a change in emphasis towards earlier recognition,positive diagnosis,and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active *** article also highlights the need for further research to develop much needed evidence-based therapies.

关键词： Irritable bowel syndrome Inflammatory bowel disease Functional gastrointestinal disorders Faecal incontinence Pelvic floor dyssynergia

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Rising tide: The global surge of type 2 diabetes in children and adolescents demands action now

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World Journal of Diabetes 2024年第5期15卷 797-809页

作者： Joseph M Pappachan Cornelius James Fernandez Ambika P Ashraf Department of Endocrinology and Metabolism Lancashire Teaching Hospitals NHS TrustPreston PR29HTUnited Kingdom Faculty of Science Manchester Metropolitan UniversityManchester M156BHUnited Kingdom Faculty of Biology Medicine&HealthThe University of ManchesterManchester M139PLUnited Kingdom Department of Endocrinology&Metabolism Pilgrim HospitalUnited Lincolnshire Hospitals NHS TrustBoston PE219QSUnited Kingdom division of Pediatric Endocrinology and Diabetes Department of PediatricsUniversity of Alabama at BirminghamBirminghamAL 35233United States

Childhood-onset obesity has emerged as a major public healthcare challenge across the globe,fueled by an obesogenic environment and influenced by both genetic and epigenetic *** has led to an exponential rise in the incidence of type 2 diabetes mellitus in children and *** looming wave of diabetes-related complications in early adulthood is anticipated to strain the healthcare budgets in most *** there is a collective global effort to curb the devastation caused by the situation,the impact is poised to be pro-found.A multifaceted research effort,governmental legislation,and effective social action are crucial in attaining this *** article delves into the current epidemiological landscape,explores evidence concerning potential risks and consequences,delves into the pathobiology of childhood obesity,and discusses the latest evidence-based management strategies for diabesity.

关键词： Childhood obesity Diabesity Type 2 diabetes mellitus Adolescence Cardiovascular disease Pharmacotherapy

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Functional Electrical Stimulation of Peroneal Muscles on Balance in Healthy Females

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Cyborg and Bionic Systems 2021年第1期2021卷 79-86页

作者： Zoe A.Bamber Wei Sun Rhea S.Menon Patrick C.Wheeler Ian D.Swain Daniel T.P.Fong National Centre for Sport and Exercise Medicine School of SportExercise and Health SciencesLoughborough UniversityLoughboroughUK division of Orthopaedics Trauma and Sports MedicineSchool of MedicineFaculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK Shandong Sport university JinanShandongChina Department of Sport and Exercise Medicine University Hospitals of Leicester NHS TrustLeicesterUK The Faculty of Science and Technology Bournemouth UniversityPooleDorsetUK

Balance improvement could contribute to ankle stability for the prevention of ankle *** electrical stimulation(FES)is an effective way of augmenting muscle activity and improving *** study investigated the effect of FES of peroneal muscles on single-and double-leg *** healthy females(age=23:1±1:6 years,height=1:63±0:07m,and weight=63:7±9:9 kg)performed single-and double-leg standing balance tests with eyes open and closed before and after 15-minute FES intervention during treadmill running at a comfortable,self-selected *** of peroneal muscles was provided bilaterally,using an Odstock Dropped Foot *** total excursion of the centre of pressure(COP)was calculated to assess the standing balance control *** total excursion of COP in single-and double-leg stance with eyes open reduced significantly after FES intervention by 14.7%(p0:05).Limb preference did not account for balance *** significant difference in total excursion of COP was found between preferred and less preferred limbs with both visual conditions(p>0:05).FES of peroneal muscles improved standing balance control with eyes open in double-leg and single-leg stance and with eyes closed in double-leg *** improvements in balance control with FES treatment did not vary concerning limb preference.

关键词： prevention stimulation Functional

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Human umbilical cord-derived mesenchymal stem cell therapy in patients with COVID-19:a phase 1 clinical trial

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Signal Transduction and Targeted Therapy 2020年第1期5卷 1010-1016页

作者： Fanping Meng Ruonan Xu Siyu Wang Zhe Xu Chao Zhang Yuanyuan Li Tao Yang Lei Shi Junliang Fu Tianjun Jiang Lei Huang Peng Zhao Xin Yuan Xing Fan Ji-Yuan Zhang Jinwen Song Dawei Zhang Yanmei Jiao Limin Liu Chunbao Zhou Markus Maeurer Alimuddin Zumla Ming Shi Fu-Sheng Wang Department of Infectious Diseases Fifth Medical Center of Chinese PLA General HospitalNational Clinical Research Center for Infectious DiseasesBeijingChina Immunotherapy Programme Champalimaud Centre for the UnknownLisbonPortugal I Med Clinic University of MainzMainzGermany Department of Infection Division of Infection and ImmunityUniversity College LondonLondonUK National Institute for Health Research Biomedical Research Centre University College London Hospitals NHS Foundation TrustLondonUK

No effective drug treatments are available for coronavirus disease 2019(COVID-19).Host-directed therapies targeting the underlying aberrant immune responses leading to pulmonary tissue damage,death,or long-term functional disability in survivors require clinical *** performed a parallel assigned controlled,non-randomized,phase 1 clinical trial to evaluate the safety of human umbilical cord-derived mesenchymal stem cells(UC-MSCs)infusions in the treatment of patients with moderate and severe COVID-19 pulmonary *** study enrolled 18 hospitalized patients with COVID-19(n=9 for each group).The treatment group received three cycles of intravenous infusion of UC-MSCs(3×107 cells per infusion)on days 0,3,and *** groups received standard COVID-treatment *** events,duration of clinical symptoms,laboratory parameters,length of hospitalization,serial chest computed tomography(CT)images,the PaO2/FiO2 ratio,dynamics of cytokines,and IgG and IgM anti-SARS-CoV-2 antibodies were *** serious UC-MSCs infusion-associated adverse events were *** patients receiving UC-MSCs developed transient facial flushing and fever,and one patient developed transient hypoxia at 12 h post UC-MSCs *** ventilation was required in one patient in the treatment group compared with four in the control *** patients recovered and were *** data show that intravenous UC-MSCs infusion in patients with moderate and severe COVID-19 is safe and well *** 2/3 randomized,controlled,double-blinded trials with long-term follow-up are needed to evaluate the therapeutic use of UC-MSCs to reduce deaths and improve long-term treatment outcomes in patients with serious COVID-19.

关键词： patients infusion clinical

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Terlipressin and hepatorenal syndrome: What is important for nephrologists and hepatologists

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World Journal of Gastroenterology 2010年第41期16卷 5139-5147页

作者： Ahmed A Magan Atif A Khalil Mohamed H Ahmed Department of Surgery Cambridge Uni-versity Hospital NHS foundation Trust Hills Road Cambridge CB2 0QQ United Kingdom Department of Nephrology Royal Liverpool and Broadgreen University Hospitals Liverpool L7 8XP United Kingdom division of Acute Medicine James Cook University Hospital Marton Road Middlesbrough TS4 3BW United Kingdom

Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and cir-culatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cir-rhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neuro-hormonal systems. Primarily the sympathetic nervoussystem and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged ac-tivation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal per-fusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to re-verse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.

关键词： Heptorenal syndrome Terlipressin Kidney Liver

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Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres

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World Journal of Gastroenterology 2019年第39期25卷 5991-6005页

作者： Melissa Frizziero Xin Wang Bipasha Chakrabarty Alexa Childs Tu V Luong Thomas Walter Mohid S Khan Meleri Morgan Adam Christian Mona Elshafie Tahir Shah Annamaria Minicozzi Wasat Mansoor Tim Meyer Angela Lamarca Richard A Hubner Juan W Valle Mairéad G McNamara Department of Medical Oncology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of Analytics and Development The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of Pathology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom Department of Medical Oncology Royal Free London NHS Foundation TrustLondon NW3 2QGUnited Kingdom UCL Cancer Institute University College LondonLondon WC1E 6AGUnited Kingdom Department of Histopathology Royal Free London NHS Foundation TrustLondon NW3 2QGUnited Kingdom Department of Gastroenterology and Medical Oncology Edouard Herriot HospitalHospices Civils de LyonLyon 69003France Department of Gastroenterology Cardiff and Vale University Health BoardUniversity Hospital of WalesCardiff CF14 4XWUnited Kingdom Department of Cellular Pathology Cardiff and Vale University Health BoardUniversity Hospital of WalesCardiff CF14 4XWUnited Kingdom Department of Pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B15 2THUnited Kingdom Department of Hepatology University Hospitals Birmingham NHS Foundation TrustBirmingham B15 2THUnited Kingdom Department of Surgical Oncology The Christie NHS Foundation TrustManchester M20 4BXUnited Kingdom division of Cancer Sciences University of ManchesterManchester M13 9PLUnited Kingdom

BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic *** is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be *** To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of *** Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European *** data were retrospectively collected from medical *** samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of *** responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours ***-Meier analysis was applied to estimate survival *** between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 ***:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases *** distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine ***-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of *** was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal *** localised cases,median recurre

关键词： Mixed neuroendocrine non-neuroendocrine neoplasm 2017 World Health Organisation classification Mixed adeno-neuroendocrine carcinoma Gastro-enteropancreatic tract Digestive system Neuroendocrine neoplasms Survival outcomes

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Going “paperless” in an English National Health Service (nhs) breast cancer screening service: The intriduction of fully digital mammography

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Health 2014年第5期6卷 468-474页

作者： Sian Taylor-Phillips Amy Grove Sharon Hoffmeister Margot Wheaton Sarah Coult Joanne Essex Janice Hackney Sandra Di Cioccio Aileen Clarke Warwick Medical School Division of Health Sciences The University of Warwick Coventry UK Warwick Medical School Division of Health Sciences The University of Warwick Coventry UK Warwickshire Solihull & Coventry Breast Screening Unit University Hospitals Coventry and Warwickshire NHS Trust Coventry UK

Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in nhs practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in nhs practice.

关键词： Paperless Breast Screening Quality Improvement Process Improvement

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Clinical management of cerebral small vessel disease:a call for a holistic approach

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Chinese Medical Journal 2021年第2期134卷 127-142页

作者： Una Clancy Jason P.Appleton Carmen Arteaga Fergus N.Doubal Philip M.Bath Joanna M.Wardlaw Centre for Clinical Brain Sciences and UK Dementia Research InstituteUniversity of EdinburghChancellor's Building49 Little France CrescentEdinburghEH164SPUK Stroke Trials Unit Division of Clinical NeuroscienceUniversity of NottinghamNottingham NG51PBUK Stroke University Hospitals Birmingham NHS Foundation TrustMindelsohn WayEdgbastonBirmingham B152GWUK Stroke Nottingham University Hospitals NHS TrustNottingham NG51PBUK.

Cerebral small vessel disease(SVD)is a common global brain disease that causes cognitive impairment,ischemic or hemorrhagic stroke,problems with mobility,and neuropsychiatric *** brain damage,seen as focal white and deep grey matter lesions on brain magnetic resonance imaging(MRI)or computed tomography(CT),typically accumulates"covertly"and may reach an advanced state before being detected incidentally on brain scanning or causing *** have typically presented to different clinical services or been recruited into research focused on one clinical manifestation,perhaps explaining a lack of awareness,until recently,of the full range and complexity of *** this review,we discuss the varied clinical presentations,established and emerging risk factors,relationship to SVD features on MRI or CT,and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle *** core message is that effective assessment and clinical management of patients with SVD,as well as future advances in diagnosis,care,and treatment,will require a more"joined-up"’*** approach should integrate clinical expertise in stroke neurology,cognitive,and physical *** requires more clinical trials in order to improve pharmacological interventions,lifestyle and dietary modifications.A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel *** essential prerequisite to accelerating clinical trials is to improve the consistency,and standardization of clinical,cognitive and neuroimaging endpoints.

关键词： Dementia Magnetic resonance imaging Mild cognitive impairment Risk factors Small vessel disease Stroke Symptoms Treatment

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Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support?

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World Journal of Emergency Medicine 2019年第2期10卷 75-80页

作者： Robert D.Willmore Damjan Veljanoski Feray Ozdes Bethan Stephens James Mooney Seamus G.Crumley Arpan Doshi Philippa Davies Shreya Badhrinarayanan Emily Day Kristian Tattam April Wilson Nathan Crang Lorna Green Craig A.Mounsey Howell Fu Joseph Williams Michelle S.D'souza Dhanya Sebastian Liam A.Mcgiveron Matthew G.Percy James Cohen Imogen J.John Alice Lethbridge Imogen Watkins Omar Amin Mubasher A.Qamar John Gerrard Hanrahan Emily Cramond-Wong Barts Health nhs Trust Barts & the London Medical School Queen Mary University of London Norwich Medical School University of East Anglia Lancaster Medical School Lancaster University School of Medicine Dentistry and Biomedical Sciences Queen's University Belfast Faculty of Medicine University of St Andrews Faculty of Medicine Dentistry and Health University of Sheffi eld Brighton and Sussex university hospitals nhs Trust St George's university of London university of Liverpool School of Medicine university of Exeter medical school Faculty of Medicine University of Southampton Medical Sciences division University of Oxford university of Edinburgh Medical School Faculty of Medicine University of Warwick university College London Medical School Cardiff university School of Medicine College of Medical and Dental Sciences University of Birmingham College of Medical Veterinary and Life Sciences University of Glasgow Guys Kings and St Thomas School of Medicine King’s College London Faculty of Life Sciences & Medicine King's College London Faculty of Health Sciences at the university of Nottingham

BACKGROUND: Healthcare professionals have a duty to maintain basic life support(BLS) skills. This study aims to evaluate medical students' factual knowledge of BLS and the training they ***: A cross-sectional, closed-response questionnaire was distributed to the fi rst-and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent's previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions(MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identifi ed answer to the 5 MCQ'***: A total of 3,732 complete responses were received from 21 medical schools. Eighty percent(n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a signifi cant difference(P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ's compared to the fi rst-year students except in identifyingthe correct depth of compressions required during CPR(P=0.095). Overall 10.3%(95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ's on BLS: 9% of the first-year students(n=194) and 12% of the fourth-year students(n=190). On an institutional level the proportion of students answering all MCQ's correctly ranged from 2% to 54% at different universities. Eighty-one percent of students(n=3,031) wished for more BLS training in their ***: Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

关键词： Emergency Medicine Basic life support Medical education Resuscitation

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How will the latest modifications to the CG189 NICE guidelines for obesity management likely impact clinical care?

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 413-416页

作者： Thomas M.Barber Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireClifford Bridge RoadCoventryUK division of Biomedical Sciences Clinical Sciences Research LaboratoriesWarwick Medical SchoolUniversity of WarwickCoventryUK

Based on the 2019 Health Survey for England,nearly two thirds of the adult population and one third of children(aged 2-15 years)are either overweight or obese(1).In England,obesity affects 28%of adults,20%of boys and 13%of girls(1).Obesity is a chronic,often life-long disease that associates with>50 weight-related conditions,most notably type 2 diabetes mellitus(T2D),and other dysmetabolic conditions that contribute towards the metabolic syndrome and many other conditions that impact on nearly every aspect of physiology and mental functioning(2).Obesity has a huge economic burden,with government estimates indicating the current costs of obesity in the UK at£6.1 billion to the National Health Service(nhs),and£27 billion to wider society(1).Despite this,obesity remains fundamentally misunderstood and *** is reflected by woeful under-funding of management strategies for obesity(despite many of these being highly efficacious),guidelines that place time-limitations on potentially effective therapies(with possible negative outcomes that stem from subsequent weight re-gain),and a prevailing fog of obesity-related stigma that seems to pervade its way throughout society like a contagion.

关键词： Obesity compassion awareness adaptability

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