1、这是老师上课划出的重点这是由于课代表水平有限,所以自己又划了一些感觉重要的地方这是找不到对应的中/英文或者在该段落中重复出现整理的不好的地方请亲们自行修改,感谢亲们的支持,欢迎亲们请我吃饭,祝亲们英语都考个好成绩!1.Randomised trial of laparoscopic exploration of common bile duct1versus2postoperative endoscopic retrograde cholangiography for3 common bile duct stones.Background:The management 1of stones i
2、n the common bile duct in the laparoscopic era2 is controversial3. The three major options4 are preoperative5 endoscopic retrograde cholangiography (ERCP), laparoscopic exploration of the common bile duct (LECBD), or postoperative ERCP. Methods:Between August, 1995, and August, 1997, 471 laparoscopi
3、c cholecystectomies were done in our department. In 427 (91%), satisfactory1 preoperative cholangiography was obtained2. In 80 (17%) of these cases there were stones in the common bile duct. 40 patients were randomised to3 LECBD and 40 to postoperative ERCP. If LECBD failed, patients had4 either5 op
4、en exploration of the common bile duct or5 postoperative ERCP. If one postoperative ERCP failed6, the procedure was repeated7until the common bile duct was cleared of stones8 or an endoprosthesis was placed9to prevent stone impaction10. The primary endpoints11 were duct-clearance rates, morbidity12,
5、 operating time, and hospital stay. Analyses were by intention to treat.Findings:Age and sex distribution of patients was similar in the randomised groups. Duct clearance after the first intervention1 was 75% in both groups. By the end of treatment, duct clearance was 100% in the laparoscopic group
6、compared with2 93% in the ERCP group. Duration of treatment was a median of 90 min (range 25310) in the laparoscopic group (including ERCPs for3 failed LECBD) compared with2 105 min (range 60255) in the postoperative ERCP group (p=0.1, 95% CI for difference -5 to 40). Hospital stay3 was a median of
7、1 day (range 126) in the laparoscopic group compared with2 3.5 days (range 111) in the ERCP group (p=0.0001, 95% CI 12). Interpretation:LECBD is as effective as ERCP in clearing the common bile duct of stones. There is a non-significant trend1 to shorter time in the operating theatre2 and a signific
8、antly3 shorter hospital stay in patients treated by LECBD.1.胆总管1腹腔镜探查术与术后内镜逆行胆管造影治疗3胆总管结石的随机比较2试验。背景:在腹腔镜时代2,处理1胆总管结石是有争议的3。三种主要选择4是:术前5内镜逆行胆管造影(ERCP),腹腔镜胆总管探查术(LECBD),或术后内镜逆行胆管造影。(注意时态)方法:1995年8月至1997年8月,471患者行腹腔镜胆囊切除术。其中427例(91%)获得2满意的1术前胆管造影结果。80例(17%)存在胆总管结石。40名患者随机进行3了腹腔镜胆总管探查术,40名患者随机进行了术后内镜逆行
9、胆管造影。若腹腔镜胆总管探查术失败,患者可行4开腹探查胆总管或5术后内镜逆行胆管造影。如一次术后内镜逆行胆管造影不行6,可行多次7直至清除胆总管结石8或者放置内镜置管9防止结石嵌顿10。主要检测指标11为,胆道清除率、发病率12、手术时间和住院时间。统计学采用意向性分析。发现(结果):随机分组中年龄和性别分配相同。两组中首次术后1胆道清除率达75%。治疗结束时,腹腔镜组胆道清除率达到100%,ERCP组也达到了93%。腹腔镜组中位治疗时间(包括腹腔镜胆总管探查术失败后行内镜逆行胆管造影)为90分钟(范围25-310),而术后胆管造影组为105分钟(p=0.1,95%可信区间差异-5至40)。腹
10、腔镜手术组中位住院时间3为1天(范围1-26),胆管造影组为3.5天(p=0.0001,95%可信区间差异1-2)。解释(结论):在清除胆总管结石方面,腹腔镜胆总管探查术和内镜逆行胆管造影效果相同。腹腔镜胆总管探查术,手术时间不明显1缩短,但住院时间明显3缩短。(2:手术室)2.Short-term endpoints1 of conventional2 versus laparoscopic assisted surgery in patients with3 colorectal cancer: multicentre,randomised controlled trial.Backgro
11、und:Laparoscopic assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials1 to support its use. We compared short-term endpoints2 of conventional versus laparoscopic assisted surgery in patients with colorectal cancer to predict long-term outcomes
12、3.Methods:Between July, 1996, and July, 2002, we undertook1 a multicentre, randomised clinical trial2 in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive3 laparoscopic-assisted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rat
13、es4 of circumferential and longitudinal resection margins, proportion of Dukes C2 tumours, and in-hospital mortality5. Analysis was by intention to treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN74883561.Findings: Six patients (two open, four
14、laparoscopic) had no surgery, and 23 had missing surgical data 1(nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively2. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of DukesC2 tumours did not differ between
15、treatments (18 7% patients, open vs. 34 6%, laparoscopic; difference 0.3%, 95% CI 3.9 to 3.4%, p=0.89), and neither did3 in-hospital mortality (13 5% vs. 21 4%; 0.9%, 3.9 to 2.2%, p=0.57). Apart from4 patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection
16、margins were similar between treatment groups. Patients with converted treatment had raised complication rates5.Interpretation:Laparoscopic assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to1 produce similar long-term outcomes. However, impair
17、ed short-term outcomes2 after laparoscopic assisted anterior resection for cancer of the rectum do not yet justify3 its routine use4.2.常规2与腹腔镜手术治疗3大肠癌患者的短期疗效1(MRC CLASICC试验):多中心随机对照试验。背景:腹腔镜辅助大肠癌手术已经被广泛应用,但缺乏大规模随机试验1的数据支持。我们比较常规与腹腔镜辅助手术治疗大肠癌患者的短期效果2以预测其长期的结果3。(注意时态)方法:1996年7月至2002年7月,我们在来自英国27个医疗中心的
18、794名大肠癌患者中进行1了多中心随机临床实验2。患者或分配实施3腹腔镜手术(n=526)或分配实施开放手术(n=268)。主要短期疗效指标为,周围及纵向切除的阳性率4(周围转移及蔓延率)、Dukes C2期肿瘤比例和院内死亡率5。统计学采用意向性分析。本试验为国际标准随机对照试验编号ISRCTN74883561。结果:六名患者(开放手术组2名,腹腔镜手术组4名)没有进行手术,23名患者手术数据丢失1(开放手术组9名,腹腔镜手术组14名)。253名和484名患者分别2接受了开放手术和腹腔镜辅助手术。143名患者(29%)由腹腔镜手术转为开腹手术。两种治疗的Duckes C2期肿瘤患者没有显著性
19、差异(18例7%开腹,34例6%腹腔镜,差异-0.3%,95%可信区间-3.9至3.4%,p=0.89),两种治疗的住院死亡率也没有3显著性差异(13例5%开腹,21例4%腹腔镜,差异-0.9%,95%可信区间-3.9至2.2%,p=0.57)。除了4接受前入路腹腔镜切除直肠的病例,两种治疗组的切除阳性率基本相同。转换治疗方法的患者并发症发生率较高5。解释:腹腔镜辅助手术治疗大肠癌在短期内与开腹手术效果相同,长期效果也可能1相同。然而,直肠癌前入路腹腔镜手术切除的短期疗效不佳2,不适合3常规进行4。3.Increasing Cardiovascular Disease Burden Due t
20、o Diabetes Mellitus.Background:Marked reductions1 in cardiovascular disease (CVD) morbidity and mortality have occurred in the United States over the last 50 years. We tested the hypothesis2 that the relative burden of CVD attributable to diabetes mellitus (DM) has increased over the past 5 decades.
21、 Methods and Results:Participants aged 45 to 64 years from the Framingham Heart Study, who attended examinations in an “early” time period (1952 to 1974), were compared with those who attended examinations in a later time period (1975 to 1998). The risk of CVD events (n133 among those with and 1093
22、among those without DM) attributable to DM in the 2 time periods was assessed with Cox proportional hazards models; population attributable risk of DM as a CVD risk factor was calculated for each time period. The age- and sex-adjusted hazard ratio for DM as a CVD risk factor was 3.0 (95% CI, 2.3 to
23、3.9) in the earlier time period and 2.5 (95% CI, 1.9 to 3.2) in the later time period. The population attributable risk for DM as a CVD risk factor increased from 5.4% (95% CI, 3.8% to 6.9%) in the earlier time period to 8.7% (95% CI, 5.9% to 11.4%) in the later time period (P for attributable risk
24、ratio0.04), although multivariable adjustment1 resulted in attenuation2 of these findings (P0.12); most of these observations were found among men.Conclusions:The proportion of1 CVD attributable to DM has increased over the past 50 years in Framingham. These findings emphasize2 the need for increase
25、d efforts to3 prevent DM and to aggressively treat4 and control CVD risk factors among those with DM. 3.糖尿病增加心血管疾病比例背景:在过去的50年里,美国心血管疾病(CVD)的发病率和死亡率明显减少1。我们推测并检验2,50年来因糖尿病引起的心血管疾病的相对比例在增加。(注意时态)方法和结果:参与者都来自弗雷明汉心脏研究所,年龄在45至64岁之间,比较早期(1952年至1974年)受检者与后期(1975年至1998年)受检者。用考克斯比例风险模型来评估两个时期由糖尿病引起的心血管事件的风险
26、(糖尿病者中133例和无糖尿病者中1093例);计算每一时期的作为心血管疾病危险因素的糖尿病的人口危险因素。作为心血管疾病危险因素的糖尿病的年龄和性别调整风险比率在早期是3.0 (95% CI, 2.3 to 3.9),在后期是2.5 (95% CI, 1.9 to 3.2)。作为心血管疾病危险因素的糖尿病人口危险因素从早期的5.4% (95% CI, 3.8% to 6.9%)增加到后期的8.7% (95% CI, 5.9% to 11.4%)(P0.04),尽管多变量调整1使这些结果有所减弱2(P0.12);这些结果大都是在男性中发现的。结论:在弗雷明汉心脏研究所,50年来由糖尿病引起的心
27、血管疾病的比例1在增加,警示2我们要加大努力3去预防糖尿病,以及在糖尿病人群中大力治疗4和控制心血管疾病的危险因素。(注意时态)4.Identification of a Cancer Stem Cell in Human Brain Tumors.Most current research on human brain tumors is focused on1 the molecular and cellular analysis of the bulk tumor mass2.However, there is overwhelming evidence1 in some maligna
28、ncies that the tumor clone is heterogeneous with respect to2 proliferation and differentiation.In human leukemia, the tumor clone is organized as a hierarchy that originates from1 rare leukemic stem cells that possess2 extensive proliferative and selfrenewal potential3, and are responsible for maint
29、aining the tumor clone. We report here the identification and purification1 of a cancer stem cell from human brain tumors of different phenotypes2 that possesses a marked capacity for proliferation, self-renewal, and differentiation.The increased self-renewal capacity of the brain tumor stem cell (B
30、TSC) was highest from the most aggressive clinical samples of medulloblastoma compared with low-grade gliomas.The BTSC was exclusively1 isolated2 with the cell fraction3 expressing the neural stem cell surface marker CD133.These CD133 cells could differentiate in culture1 into tumor cells that pheno
31、typically2 resembled3 the tumor from the patient.The identification of a BTSC provides1 a powerful tool to investigate the tumorigenic process in the central nervous system and to develop therapies targeted to2 the BTSC.4.人类脑肿瘤的肿瘤干细胞的识别大多数人类脑部肿瘤的研究都关注1大肿瘤块2的分子和细胞分析。然而,大量证据1表明在某些恶性脑肿瘤中肿瘤克隆在增殖和分化上2是异质
32、性的。在人类白血病中,肿瘤克隆由源于1罕见的白血病干细胞的不同层次的细胞完成,因为肿瘤干细胞具有2较强的增殖和自我更新的能力3,能够维持肿瘤的克隆。在本文中,我们报道了对来自不同表型2人脑肿瘤的肿瘤干细胞的识别和纯化1,肿瘤干细胞具有显著的增殖、自我更新和分化能力。与低级别的胶质瘤相比,来自恶性化程度最高的髓母细胞瘤的临床样本,其脑肿瘤干细胞的自我更新的能力最高。脑肿瘤干细胞完全1用表达神经干细胞表面标志物CD133的细胞碎片3进行分离2。这些CD133细胞在培养物1中可以分化为表型2类似于3患者肿瘤的肿瘤细胞。肿瘤干细胞的识别(分离)为研究中枢神经系统的肿瘤发生过程,为开发针对2肿瘤干细胞的
33、治疗方法,提供1了一个有力的工具。5.Aspirin Use and Survival after Diagnosis of Colorectal Cancer.Context:Aspirin reduces risk of colorectal neoplasia in randomized trials and inhibits tumor growth1 and metastases2 in animal models. However, the influence of aspirin on survival3 after diagnosis of colorectal cancer
34、is unknown.Objective:To examine the association1 between aspirin use after colorectal cancer diagnosis on colorectal cancerspecific and overall survival2.Design, Setting, and Participants:Prospective cohort study of 1279 men and women diagnosed with1 stage I, II, or III colorectal cancer. Participan
35、ts were enrolled in2 2 nationwide health professional cohorts in 1980 and 1986 prior to diagnosis3 and followed up through4 June 1, 2008. Main Outcome Measure:Colorectal cancerspecific and overall mortality.Results:After a median1 follow-up of 11.8 years, there were 193 total deaths (35%) and 81 col
36、orectal cancerspecific deaths (15%) among 549 participants who regularly used2 aspirin after colorectal cancer diagnosis, compared with 287 total deaths (39%) and 141 colorectal cancerspecific deaths (19%) among 730 participants who did not use aspirin. Compared with nonusers3, participants who regu
37、larly used aspirin after diagnosis experienced4 a multivariate hazard ratio (HR) for4 colorectal cancerspecific mortality of 0.71 and for overall mortality of 0.79. Among 719 participants who did not use aspirin before diagnosis, aspirin use initiated5 after diagnosis was associated with6 a multivar
38、iate HR for colorectal cancerspecific mortality of 0.53. Among 459 participants with colorectal cancers that were accessible7 for immunohistochemical assessment8, the effect of aspirin differed significantly9 according to10 cyclooxygenase 2 (COX-2) expression11 (P for interaction = .04). Regular asp
39、irin use after diagnosis was associated with12 a lower risk of colorectal cancerspecific mortality among participants in whom primary tumors overexpressed COX-2, whereas13 aspirin use was not associated with14 lower risk among those with primary tumors with weak or absent expression15 (multivariate
40、HR, 1.22; 95% CI, 0.36-4.18).Conclusion:Regular aspirin use after the diagnosis of colorectal cancer is associated with lower risk of colorectal cancerspecific and overall mortality, especially among individuals with tumors that overexpress COX-2.5.结肠直肠癌确诊后阿司匹林的服用与生存率背景:阿司匹林,在随机试验中能减少结肠直肠新生肿物的危险,在动物
41、模型试验中能抑制肿瘤的生长1和转移2。然而,在结肠直肠癌确诊后,服用阿司匹林对患者的生存率3有何影响,仍不清楚。目的:确定结肠直肠癌确诊后服用阿司匹林与该疾病的特定生存率以及总生存率2之间的联系1。设计、场所和参与者:前瞻性队列研究,1279名诊断患有1I, II, 或 III期结肠直肠癌的男仕和女仕。诊断前3,参与者在1980年和1986年曾加入2两个全国的健康专业人士的队列研究,随访至42008年6月1日。主要结果的测量:结肠直肠癌-特定死亡率与总死亡率。结果:平均1随访11.8年,诊断为结肠直肠癌后常规服用2阿司匹林的患者549名,其中总死亡人数193名(35%),结肠直肠癌特定性死亡8
42、1名 (15%);没有服用阿司匹林的患者730名,总死亡人数287名 (39%),结肠直肠癌特定性死亡141名 (19%)。与没服用者相比3, 确诊后常规服用阿司匹林的参与者,其多变量危险度比(HR)为4,结肠直肠癌-特定死亡率为0.71,总死亡率为0.79。719名诊断前没有服用阿司匹林的参与者,诊断后开始5服用,其多变量危险度比为60.53 (95% CI, 0.33-0.86)的结肠直肠癌-特定死亡率。459名有7免疫组化评估8的结肠直肠癌患者,阿司匹林的效果随着10环氧合酶2 (COX-2)表达11的不同有显著差异9(交互作用的P值= .04)。在原始肿瘤过表达COX-2的参与者中,诊
43、断后常规服用阿司匹林与结肠直肠癌-特定死亡率的低风险有关12;反之13,在原始肿瘤弱或缺失表达15的参与者中,阿司匹林服用与低风险无关联14(多变异危险度比, 1.22; 95%可信区间, 0.36-4.18)。结论:诊断为结肠直肠癌后常规服用阿司匹林与结肠直肠癌-特定死亡率和总死亡率的低风险有关,特别是在肿瘤过表达COX-2的患者中。6.Global variation in copy number in the human genome.Copy number variation (CNV) of DNA sequences is functionally significant1 but
44、 has yet2 to be fully ascertained3. We have constructed1 a first-generation CNV map2 of the human genome through the study3 of 270 individuals from four populations4 with ancestry in Europe, Africa or Asia (the HapMap collection). DNA from these individuals was screened5 for CNV using two complement
45、ary technologies6: single-nucleotide polymorphism (SNP) genotyping arrays, and clone-based comparative genomic hybridization. A total of 1447 copy number variable regions (CNVRs), which can encompass1 overlapping2 or adjacent gains or losses3, covering 360 megabases (12% of the genome) were identifi
46、ed in4 these populations. These CNVRs contained hundreds of genes, disease loci, functional elements and segmental duplications.Notably1, the CNVRs encompassed2 more nucleotide content per genome than SNPs, underscoring the importance of CNV in genetic diversity and evolution. The data obtained1 del
47、ineate2 linkage disequilibrium patterns for many CNVs, and reveal3 marked variation4 in copy number among populations. We also demonstrate1 the utility2 of this resource for genetic disease studies. 7.Mosaic Organization of Neural Stem Cells in the Adult BrainThe in vivo potential1 of neural stem ce
48、lls in the postnatal2 mouse brain is not known, but because they produce many different types of neurons, they must be either very versatile3 or very diverse4. By specifically targeting5 stem cells and following their progeny6 in vivo, we showed that postnatal stem cells in different regions produce different types of neurons, even when heterotopically7 grafted8 or grown in culture9.This suggests that