简介：背景：测试的HIV-1genotypic和phenotypic危险性(通用终端)优化antiretroviral选择，但是它幸存上的效果是未知的。客观：评估在通用终端和幸存之间的协会。设计：队学习。设定：10个美国HIV诊所。病人：为通过2005从1999看见的通用终端(血浆HIVRNA水平>1000copies/mL)合格的2699个感染HIV的病人。大小：人口统计的特征，临床的因素，通用终端使用，所有原因死亡，和为有幸存的通用终端的协会的粗略、调整的危险比率(HR)。结果：病人们被跟随为一3.3年中部；(34%)915有通用终端。把通用终端有的病人比那些降低死亡率(2.0对2.7死亡每100人年)。在标准考克斯模型，通用终端与改进幸存被联系(调整HR，0.69[95%CI，0.51～0.94]；P=0.017)在为临床的后续的人口统计的特征，CD4⁺房间计数，HIVRNA水平，和紧张控制以后。在亚群分析，通用终端与改进幸存被联系因为2107高度活跃的antiretroviral治疗(HAART)经历了病人(2.2对3.2死亡每为有没有通用终端的通用终端对那些的病人的100人年；调整HR，0.60[CI，0.43～0.82]；P=0.002)并且为921个三倍的antiretroviral班富有经验病人(2.1对3.1死亡每100人年；调整HR，0.61[CI0.40到0.93]；P=0.022)。边缘的结构的模型支持了在通用终端之间的协会并且在全面的队改进了幸存(调整HR，0.54；P=0.001)并且在HAART富有经验的组(调整HR，0.56；P=0.003)。限制：通用终端的使用没被使随机化。剩余惊讶可以存在。结论：通用终端的使用独立地在HAART富有经验的病人之中与改进幸存被联系。

简介：Theperitonealstromaltissuewhichprovidesarichsourceofgrowthfactorsandchemokinesisafavorableenvironmentfortumorproliferation.Thepathophysiologicalmechanismofperitonealcarcinomatosisisanindividualsequenceconsistingofgeneticandenvironmentalfactorsandremainscontroversial.Thenaturalhistoryofthediseaserevealsapoormedianprognosisofapproximately6mo;howeveraggressivesurgeryandmultimodaltreatmentoptionscanimproveoncologicoutcomes.Consideringperitonealcarcinomatosisasthoughitisalocoregionaldiseasebutnotametastaticprocess,cytoreductivesurgeryandandintraperitonealchemotherapyhasbeenacurativeoptionduringrecentyears.Cytoreductivesurgeryimpliesaseriesofvisceralresectionsandperitonectomyprocedures.Althoughtheaimofcytoreductivesurgeryistoeliminateallmacroscopicdisease,viabletumorcellsmayremainintheperitonealcavity.Atthatpoint,intraperitonealchemotherapycanextendthemacroscopicdiseaseeliminationtomicroscopicdiseaseelimination.Thesuccessfultreatmentofperitonealcarcinomatosisrequiresacomprehensivemanagementplanincludingproperpatientselection,completeresectionofallvisibledisease,perioperativeintraperitonealchemotherapyandpostoperativesystemicchemotherapy.Surgicalandoncologicoutcomesarestrictlyassociatedwithextentofthetumor,completenessofcytoreductionandpatientrelatedfactorsaswellasmultidisciplinarymanagementandexperienceofthesurgicalteam.Inthisreview,pathophysiologyandcurrentmanagementofperitonealcarcinomatosisoriginatingfromgastrointestinaltumorsarediscussedaccordingtothelatestliterature.

简介：AIM:Toevaluatetheclinicalusefulnessofendoscopicultrasonography(EUS)forthediagnosisoftheinvasiondepthofulcerativecolitis-associatedtumors.METHODS:Thestudygroupcomprised13patientswith16ulcerativecolitis(UC)-associatedtumorsforwhichthedepthofinvasionwaspreoperativelyestimatedbyEUS.Thelesionswerethenresectedendoscopicallyorbysurgicalcolectomyandwereexaminedhistopathologically.Themeanageofthesubjectswas48.2±17.1years,andthemeandurationofUCwas15.8±8.3years.Twolesionsweretreatedbyendoscopicresectionandtheother14lesionsbysurgicalcolectomy.ThedepthofinvasionofUCassociatedtumorswasestimatedbyEUSusinganultrasonicprobeandwasevaluatedonthebasisofthedeepestlayerwithnarrowingorruptureofthecolonicwall.RESULTS:ThediagnosisofUC-associatedtumorsbyEUSwascarcinomafor13lesionsanddysplasiafor3lesions.Theinvasiondepthofthecarcinomaswasintramucosalfor8lesions,submucosalfor2,themuscularispropriafor2,andsubserosalfor1.Eleven(69%)ofthe16lesionsaroseintherectum.Themacroscopicappearancewasthelaterallyspreadingtumor-non-granulartypefor4lesions,sessiletypefor4,laterallyspreadingtumor-granulartypefor3,semipedunculatedtype(Isp)for2,type1for2,andtype3for1.ThedepthofinvasionwascorrectlyestimatedbyEUSfor15lesions(94%)butwasmisdiagnosedasintramucosalfor1carcinomawithhigh-gradesubmucosalinvasion.The2lesionstreatedbyendoscopicresectionwereintramucosalcarcinomaanddysplasia,andbothwerediagnosedasintramucosallesionsbyEUS.CONCLUSION:EUSprovidesagoodestimationoftheinvasiondepthofUC-associatedtumorsandmaythusfacilitatetheselectionoftreatment.

简介：Superficialnon-ampullaryduodenalepithelialtumor(SNADET)isdefinedasasporadictumorthatisconfinedtothemucosaorsubmucosathatdoesnotarisefromVater’spapilla,anditincludesadenomaandadenocarcinoma.Recentdevelopmentsinendoscopictechnology,suchashigh-resolutionendoscopyandimage-enhancedendoscopy,mayincreasethechancesofdetectingSNADETlesions.However,becauseSNADETisrare,littleisknownaboutitspreoperativeendoscopicdiagnosis.TheuseofendoscopicresectionforSNADET,whichhasnoriskofmetastasis,isincreasing,buttheincidenceofcomplications,suchasperforation,issignificantlyhigherthaninanyotherpartofthedigestivetract.Apreoperativediagnosisisrequiredtodistinguishbetweenlesionsthatshouldbefollowedupandthosethatrequiretreatment.Retrospectivestudieshaverevealedcertainendoscopicfindingsthatsuggestmalignancy.Inrecentyears,severalnewimagingmodalitieshavebeendevelopedandexploredforrealtimediagnosisoftheselesiontypes.EstablishinganendoscopicdiagnostictooltodifferentiatebetweenadenomaandadenocarcinomainSNADETlesionsisrequiredtoselectthemostappropriatetreatment.ThisreviewdescribesthecurrentstateofknowledgeaboutpreoperativeendoscopicdiagnosisofSNADETs,suchasduodenaladenomaandduodenaladenocarcinoma.Newerendoscopictechniques,includingmagnifyingendoscopy,mayhelptoguidethesediagnostics,buttheiradditionaladvantagesremainunclear,andfurtherstudiesarerequiredtoclarifytheseissues.

简介：瞄准：在胃的很好区分的内分泌的肿瘤(GWDET)(ECL房间良性肿瘤)调查cyclin依赖的激酶禁止者p21和p27的表示。方法：p21和p27的表情从匹配GWDET的诊断标准的16个病人在内视镜的活体检视标本immunhistochemically被检验。弱或强壮的积极原子染色任何一个的百分比被注意。有年龄，性，肿瘤本地化，multifocality和伴随的长期的萎缩性胃炎，神经内分泌房间增生(NEH)，神经内分泌发育异常(NED)，肠的组织变形(IM)，Ki-67增长索引和临床的结果的免疫表情的协会也被评估。结果：所有情况与43.6%的一个吝啬的表示分数表示了p27，当31.3%案例显示出任何p21表示时。p21和p27免疫表情显著地与对方一起被相关(P<0.01)，并且表示p21组有更高的p27表示分数(68%对22%)。p21和p27表情在女人是更低的，在在某处除没有粘膜下层扩展的宫底以外，其肿瘤被定位的非衰退的粘膜和盒子。在上矛盾，p21和p27表情与粘膜下层扩展和萎缩性胃炎在男性和病人是更高的。介绍更低的p27分数的盒子有独居的肿瘤显示出既不NEH-NED也不IM。尽管有，有更低的p21表示的盒子介绍了NEH-NED伴随的多焦点的肿瘤。然而，p21的关联和p27表情都没与年龄和Ki-67表示被发现。结论：p27广泛地在GWDET被表示，当p21表示在三分之二个盒子中稀少、观察时。p21和p27表情的损失可以与不同良性肿瘤肿瘤子类型被相关；然而，更多的研究被需要在胃肠的内分泌的肿瘤估计这些未来的标记的角色。