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Qiangsheng He Chongfei Huang Xiwen Qin Yuanyuan Yu Di Tang Junjie Huang Zi Chong Kuo Yuyao Ling Deli Mao Bin Xia Wenjing Li Kuiqing Lu Man Yang Yulong He Wenbo Meng Jinqiu Yuan Yihang Pan 《International journal of cancer. Journal international du cancer》2023,153(5):942-949
Recent epidemiological studies suggested that proton pump inhibitor (PPI) use was associated with an increased risk of biliary tract cancer (BTC), however, confounders were not adequately controlled. Our study aimed to evaluate PPI use and subsequent risk of BTC and its subtypes in three well-established cohorts. We conducted a pooled analysis of the subjects free of cancers in UK Biobank (n = 463 643), Nurses' Health Study (NHS, n = 80 235) and NHS II (n = 95 869). Propensity score weighted Cox models were used to estimate marginal HRs of PPIs use on BTC risk, accounting for potential confounders. We documented 284 BTC cases in UK Biobank (median follow-up: 7.6 years), and 91 cases in NHS and NHS II cohorts (median follow-up: 15.8 years). In UK biobank, PPI users had a 96% higher risk of BTC compared to nonusers in crude model (HR 1.96, 95% CI 1.44-2.66), but the effect was attenuated to null after adjusting for potential confounders (HR 0.95, 95% CI 0.60-1.49). PPI use was not associated with risk of BTC in the pooled analysis of three cohorts (HR 0.93, 95% CI 0.60-1.43). We also observed no associations between PPI use with risk of intrahepatic (HR 1.00, 95% CI 0.49-2.04), extrahepatic bile duct (HR 1.09, 95% CI 0.52-2.27) and gallbladder cancers (HR 0.66, 95% CI 0.26-1.66) in UK Biobank. In summary, regular use of PPIs was not associated with the risk of BTC and its subtypes. 相似文献
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Gian Eugenio Tontini Guido Manfredi Stefania Orlando Helmut Neumann Maurizio Vecchi Elisabetta Buscarini Luca Elli 《Digestive endoscopy》2019,31(6):627-643
Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future. 相似文献
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Ramya Deepthi Vinnakota Allan S. Brett 《The American journal of the medical sciences》2019,357(2):160-163
Iron deficiency anemia is often listed among potential adverse effects of gastric acid-suppressive medications, given that gastric acidity promotes intestinal absorption of nonheme iron. Additionally, the antacid calcium carbonate can inhibit iron absorption. However, there is little direct clinical evidence that proton-pump inhibitors, histamine-2 receptor antagonists, or calcium carbonate cause iron deficiency anemia. Most case reports have had substantial limitations (e.g., minimal follow-up and presence of other causes of iron deficiency), and retrospective cohort studies have lacked sufficient patient-specific detail to make strong causal inferences. We present 2 cases—both with detailed, prospective 10-year follow-up—in which combinations of proton-pump inhibitors, histamine-2 receptor antagonists and calcium carbonate were clearly associated with development of iron deficiency anemia. Overt iron-deficiency anemia is probably uncommon in patients who use acid-modifying medications and who have no other conditions that predispose to iron deficiency. Nevertheless, clinicians should be aware of this potential complication, given widespread use of these agents. 相似文献
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目的比较双球囊与缩宫素用于促宫颈成熟并引产的临床效果。方法选取于2017年7月—2018年7月在本院分娩的足月妊娠孕妇100例为研究对象,随机平均分为观察组和对照组各50例,观察组采用双球囊引产,对照组采用缩宫素进行引产,对比2组孕妇的总产程、宫颈成熟度、引产成功率和新生儿Apgar评分、并发症发生率等。结果观察组促宫颈成熟有效率(100%)、引产成功率(96%)均高于对照组(82%,74%),差异均有统计学意义(P<0.05),治疗后新生儿Apgar评分、并发症发生率差异均无统计学意义(P>0.05);宫颈Bishop评分观察组(9.12±1.42)高于对照组(7.92±1.56),观察组总产程(8.23±2.54)h,对照组(13.45±3.77)h,差异均有统计学意义(P<0.05)。结论双球囊用于妊娠引产效果显著,能明显促进宫颈成熟、缩短产程,保障分娩的顺利进行,安全可靠,值得在临床中推广。 相似文献
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Rotary ventricular assist devices (VADs) are less sensitive to preload than the healthy heart, resulting in inadequate flow regulation in response to changes in patient cardiac demand. Starling‐like physiological controllers (SLCs) have been developed to automatically regulate VAD flow based on ventricular preload. An SLC consists of a cardiac response curve (CRC) which imposes a nonlinear relationship between VAD flow and ventricular preload, and a venous return line (VRL) which determines the return path of the controller. This study investigates the importance of a physiological VRL in SLC of dual rotary blood pumps for biventricular support. Two experiments were conducted on a physical mock circulation loop (MCL); the first compared an SLC with an angled physiological VRL (SLC‐P) against an SLC with a vertical VRL (SLC‐V). The second experiment quantified the benefit of a dynamic VRL, represented by a series of specific VRLs, which could adapt to different circulatory states including changes in pulmonary (PVR) and systemic (SVR) vascular resistance versus a fixed physiological VRL which was calculated at rest. In both sets of experiments, the transient controller responses were evaluated through reductions in preload caused by the removal of fluid from the MCL. The SLC‐P produced no overshoot or oscillations following step changes in preload, whereas SLC‐V produced 0.4 L/min (12.5%) overshoot for both left and right VADs. Additionally, the SLC‐V had increased settling time and reduced controller stability as evidenced by transient controller oscillations. The transient results comparing the specific and standard VRLs demonstrated that specific VRL rise times were improved by between 1.2 and 4.7 s ( = 3.05 s), while specific VRL settling times were improved by between 2.8 and 16.1 seconds ( = 8.38 s) over the standard VRL. This suggests only a minor improvement in controller response time from a dynamic VRL compared to the fixed VRL. These results indicate that the use of a fixed physiologically representative VRL is adequate over a wide variety of physiological conditions. 相似文献
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肖光辉 《岭南心血管病杂志》2020,26(2):188-189,209
目的探讨球囊导管取栓术治疗急性下肢动脉栓塞患者的临床疗效。方法回顾性分析祈福医院2013年1月至2018年12月应用球囊导管微创取栓术治疗的78例急性下肢动脉栓塞患者的临床资料。结果治愈60例,治愈率为89.6%,患肢血供恢复。好转7例(10.4%),肢体缺血症状明显好转。全部患者无截肢。死亡1例(2.6%)。结论球囊导管取栓术是治疗急性动脉栓塞的有效方法,患者一经确诊应尽早手术取栓,有利于提高其保肢率和降低病死率。 相似文献
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《Anaesthesia and Intensive Care Medicine》2020,21(11):548-557
Diabetes is a complex, chronic metabolic disorder affecting approximately 9.3% of the adult population with the estimated number of adults with diabetes worldwide having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Diabetes affects 10–15% of the surgical population. These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a co-ordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in manging their own diabetes and should be involved in doing so whenever possible. 相似文献
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