经导管缘对缘技术（MitraClip）治疗二尖瓣反流——亚太心脏病学会（APSC）专家共识

经导管二尖瓣缘对缘修复技术(代表产品:MitraClip),是一种经导管介入途径治疗二尖瓣反流(MR)的技术,西方循证医学证据已证实MitraClip是一种有效且安全的MR介入治疗技术。但是,在亚太地区患者群体中应用该类技术及产品的随机对照试验数据仍然有限。因此,亚太心脏病学会(APSC)召集专家组,通过详细回顾现有亚太地区MitraClip文献及临床治疗证据,制定共识建议,以更好地指导亚太地区的临床医师使用MitraClip治疗MR。本专家组讨论并制定的声明包括MitraClip在各种疾病中的应用,如:退行性MR,功能性MR和其他少见的指征,例如:急性MR,动力性MR,肥厚型梗阻性心肌病和三尖瓣反流。共识声明中的每一项条目都由专家成员投票表决,只有当80%专家表决"同意"或"中立"时才予通过。经过投票表决后,共有10项共识决议被认可,以指导心脏专科医师对准备使用MitraClip进行治疗的患者进行评估与管理。     

Consensus of the Brazilian Society of Infectious Diseases and Brazilian Society of Clinical Oncology on the management and treatment of Kaposi's sarcoma

Kaposi's sarcoma is a multifocal vascular lesion of low-grade potential that is most often present in mucocutaneous sites and usually also affects lymph nodes and visceral organs. The condition may manifest through purplish lesions, flat or raised with an irregular shape, gastrointestinal bleeding due to lesions located in the digestive system, and dyspnea and hemoptysis associated with pulmonary lesions. In the early 1980s, the appearance of several cases of Kaposi's sarcoma in homosexual men was the first alarm about a newly identified epidemic, acquired immunodeficiency syndrome. In 1994, it was finally demonstrated that the presence of a herpes virus associated with Kaposi's sarcoma called HHV-8 or Kaposi's sarcoma herpes virus and its genetic sequence was rapidly deciphered. The prevalence of this virus is very high (about 50%) in some African populations, but stands between 2% and 8% for the entire world population. Kaposi's sarcoma only develops when the immune system is depressed, as in acquired immunodeficiency syndrome, which appears to be associated with a specific variant of the Kaposi's sarcoma herpes virus.There are no treatment guidelines for Kaposi's sarcoma established in Brazil, and thus the Brazilian Society of Clinical Oncology and the Brazilian Society of Infectious Diseases developed the treatment consensus presented here.     

Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine

This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.     

The Japan Esophageal Society Consensus Meeting 2010

The consensus meeting was held at the 64th Annual Meeting of the Japan Esophageal Society (JES) in 2010. The majority of the 150 participants were surgeons with a license as a specialist in esophageal surgery or as a certified esophagologist authorized by the JES working in a university hospital or cancer center. Using the answer pad system, each participant chose one answer among three to five answers to a total of 32 questions. Concerning the Japanese Classification of Esophageal Cancer, the majority supported dividing T4 into T4a and T4b, to classify the N category based on a combination of the spread and the number of lymph nodes with metastasis, and to maintain the anatomical staging and the same staging systems for squamous cell carcinoma and adenocarcinoma. Concerning perioperative management, the majority supported no intubation or overnight intubation for respiratory support, the early start of tube feeding within POD 1–3, and the start of peroral intake on around POD 7 after esophagography. Concerning treatment strategy, the majority supported endoscopic treatment for T1a-EP/LPM cancer and esophagectomy for T1b-SM2/SM3 cancer. There was no consensus on the treatment for T1a-MM/T1b-SM1 cancer. They supported neoadjuvant CT followed by esophagectomy for stage II–III cancer, and they supported dCRT as necessary with salvage surgery for cT4 cancer. The JES Consensus Meeting 2010 clarified the motion for the next revision of the Japanese Classification and also determined the policy for the treatment strategy in practice for esophageal cancers.     

Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences

The goal of this Consensus Statement is to help primary care practitioners achieve adequate vitamin D intake from all sources in their older patients, with the goal of reducing falls and fall‐related injuries. The workgroup graded the quality of evidence and assigned an evidence level using established criteria. Based on the evidence for fall and fracture reduction in the clinical trials of older community‐dwelling and institutionalized persons and metaanalyses, the workgroup concluded that a serum 25 hydroxyvitamin D (25(OH)D) concentration of 30 ng/mL (75 nmol/L) should be a minimum goal to achieve in older adults, particularly in frail adults, who are at higher risk of falls, injuries, and fractures. The workgroup concluded that the goal—to reduce fall injuries related to low vitamin D status—could be achieved safely and would not require practitioners to measure serum 25(OH)D concentrations in older adults in the absence of underlying conditions that increase the risk of hypercalcemia (e.g., advanced renal disease, certain malignancies, sarcoidosis).     

对心脏磁共振学会及欧洲心脏病学会磁共振工作组心肌T1 mapping和细胞外容积量化共识的解读

随着影像学技术的发展,我们已经可以在活体水平下测量细胞外间隙,这项技术在心血管疾病的诊断治疗和预后判断方面有重大意义,在2013年10月心脏磁共振学会及欧洲心脏病学会磁共振工作组对T1 mapping及细胞外容积定量测量提出共识,旨在指导磁共振成像基于细胞外间隙评估的临床实践与科学研究,现分析点评该共识的主要内容,希望能进一步在国内推广该技术的应用。     

Mechanical circulatory support device database of the International Society for Heart and Lung Transplantation

Over the last 2 decades, mechanical circulatory support devices have been developed at a rapid pace with the goal of supporting patients with advanced heart failure as a bridge to cardiac transplantation, a bridge to recovery, and an alternative to transplantation, also called chronic or destination therapy. The current generation of devices provides a differentiated spectrum of circulatory support. The major limitations are infection, coagulopathies, and device dysfunction. The Scientific Council on Mechanical Circulatory Support of the International Society for Heart and Lung Transplantation has established an international database (http://www.ishlt.org/regist_mcsd_main.htm) to generate critical data to advance knowledge about effectiveness of mechanical circulatory support device therapy for one of the most difficult and costly contemporary medical problems, the malignant syndrome of advanced heart failure.     

对特发性身材矮小儿童诊断和治疗的共识声明生长激素研究学会、Lawson wilkins儿科内分泌学会及欧洲儿科内分泌学会专题研讨会纪要

身材矮小是小儿内分泌科和其他儿科医生最常遇到的主诉之一,其中有相当数量病因不明,称为特发性身材矮小(ISS).     

Management of hepatitis B: Consensus of the Japan Society of Hepatology 2009

Recently, much progress has been made in the field of hepatitis B, such as natural history of the disease in relation to the amount of hepatitis B virus (HBV) DNA, genotypes of HBV influencing the natural course and treatment effects, mutations of HBV influencing the severity of the disease and development of hepatocellular carcinoma, and antiviral treatment such as nucleos(t)ide analogues and pegylated interferon. To make the consensus for the diagnosis, management and treatment of hepatitis B, a meeting was held during 45th annual meeting of Japan Society of Hepatology (JSH) in June 2009. In the meeting, recommendations and informative statements were discussed on the following subjects: (i) natural history of HBV infection; (ii) clinical implication of HBV genotypes; (iii) HBV mutations and their potential impact on pathogenesis of HBV infection; (iv) indications for antiviral treatment of chronic hepatitis B; (v) nucleos(t)ide analogues for chronic hepatitis B; and (vi) interferon therapy for chronic hepatitis B. The presenters reviewed the data on these subjects and proposed the consensus statements and recommendations. These statements were discussed among the organizers and presenters, and were approved by the participants of the meeting. In the current report, the relevant data were reviewed and the 12 consensus statements and nine recommendations on chronic hepatitis B were described.