Several indices are available to assess left ventricular (LV) function. Although ejection fraction (EF) is widely used, it has many limitations. An assessment of LV longitudinal function should be therefore provided as it precedes the impairment of EF. In this context, speckle tracking derived global longitudinal strain is the gold standard but S’ velocity of mitral annulus (by pulsed tissue Doppler) and mitral annular plane systolic excursion (by M-mode) represent more than simple surrogates. LV diastolic assessment should be oriented not to the simple classification of transmitral patterns (E/A ratio and E velocity deceleration time) but to non-invasive estimation of LV filling pressures. This can be mainly obtained from E/e’ ratio, with additional calculation of other measurements such as pulmonary flow atrial reverse velocity, systolic pulmonary arterial pressure and left atrial volume index. This comprehensive assessment could also be useful to differentiate heart failure with reduced and preserved EF in particular. 相似文献
The limited prognostic value of currently used histologic classifications of gastric cancer and their failure to account for
the complexity of the disease as revealed by more recent investigations prompted a combined reinvestigation of histologic,
molecular, and clinicopathologic patterns in 294 extensively sampled, invasive gastric cancers representing all main histotypes
and stages of the disease and followed for a median of 150 months. Among histologic parameters tested, only cellular atypia,
angio-lympho- or neuroinvasion, Ki67 proliferation index, expansile/infiltrative type growth, and T8 cell-rich high lymphoid
intra-/peritumor response (HLR) proved to be stage-independent predictors of patient survival. Among molecular tests, p53
gene exon 7 (loop 3) and 8 (loop-sheet-helix motif and S-10 band), but not p53 protein overexpression, TP53 LOH or 18qLOH,
were found to worsen prognosis. Microsatellite DNA instability was a favorable prognostic factor when coupled with HLR. Patient
survival analysis of the main histotypes and their subtypes confirmed the favorable prognosis of HLR, well-differentiated
tubular, muconodular, and low grade diffuse desmoplastic cancers, and highlighted the worse prognosis of anaplastic and infiltrative-lymphoinvasive
mucinous cancers compared to ordinary cohesive and diffuse cancers. Distinct roles of individual morphologic and molecular
factors in tumor progression of the different histotypes have been recognized. The combination of survival-predictive histotypes
and individual histologic or molecular parameters allowed us to develop a classification of all gastric cancers into three
grades of increasing malignancy which proved to be of high prognostic value. 相似文献
Autism spectrum disorders (ASD) are neurodevelopmental disorders typically diagnosed in childhood, characterized by core social dysfunction, rigid and repetitive behaviors, restricted interests, and abnormal sensorial sensitivity. ASD belong to multifactorial diseases: both genetic and environmental factors have been considered as potential risk factors for their onset. ASD are often associated with neurological conditions: the co-occurrence of epilepsy is well documented and there is also evidence of a higher prevalence of EEG abnormalities with 4–86% of individuals with ASD presenting epileptiform or not epileptiform EEG abnormalities. The presence of epilepsy in people with ASD may be determined by several structural alterations, genetic conditions, or metabolic dysfunctions, known to play a role in the emergence of both epilepsy and autism. The purpose of this article is to discuss precisely such latter cause of the autism–epilepsy association, focusing specifically on those “synaptic genes,” whose mutation predisposes to both the diseases. 相似文献
The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality.
Method
Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected.
Results
Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies.
Conclusions
Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.