首页 > 最新文献

Visceral Medicine最新文献

英文 中文
Removable Transduodenal Bypass: Development of a New Endoscopic Concept. 可移动经十二指肠旁路:内镜新概念的发展
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-01 Epub Date: 2023-07-14 DOI: 10.1159/000531682
Alida Finze, Mirko Otto, Georg Kähler

Introduction: Obesity and obesity-related disease such as diabetes mellitus type 2 are a permanently rising concern worldwide. Current effective therapeutic options mostly include medication and surgery, but there is a lack of effective treatment options between medication and surgery. Previously, devices such as EndoBarrier® have been placed on the market. However, high complication rates, especially liver abscesses, were seen in patients after implantation of the device. Nevertheless, duodenal lining seems to be an effective therapy for type 2 diabetes in obese patients and can lead to weight loss.

Methods: A new removable transduodenal bypass was developed and tested on a porcine model. In this course, the device evolved in its mechanism and handling. The device is designed to avoid typical complications seen in previous duodenal liners.

Results: After further development of the device, implantation and use were feasible and safe in the porcine model. Autopsies showed that the device stayed in place and remained intact.

Discussion: The new removable transduodenal bypass aims to be a removable therapeutic option for diabetes mellitus type 2 and obesity, replacing previous duodenal lining devices. Use and handling of the device, however, are yet to be tested in the human model in the future.

引言:肥胖和与肥胖相关的疾病,如2型糖尿病,是全世界日益关注的问题。目前有效的治疗方案主要包括药物和手术,但在药物和手术之间缺乏有效的治疗选择。以前,EndoBarrier®等设备已投放市场。然而,植入该装置后,患者的并发症发生率很高,尤其是肝脓肿。尽管如此,十二指肠内衬似乎是治疗肥胖患者2型糖尿病的有效方法,并可导致体重减轻。方法:研制了一种新型可拆卸的经十二指肠旁路移植术,并在猪模型上进行了试验。在这一过程中,该设备在其机制和操作方面进行了改进。该装置的设计是为了避免以前十二指肠衬垫中出现的典型并发症。结果:经过进一步的开发,该装置在猪模型中的植入和使用是可行和安全的。尸检显示,该装置保持原位,完好无损。讨论:新的可移除经十二指肠搭桥术旨在取代以前的十二指肠内衬装置,成为2型糖尿病和肥胖症的可移除治疗选择。然而,该设备的使用和操作仍有待于未来在人体模型中进行测试。
{"title":"Removable Transduodenal Bypass: Development of a New Endoscopic Concept.","authors":"Alida Finze, Mirko Otto, Georg Kähler","doi":"10.1159/000531682","DOIUrl":"10.1159/000531682","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity and obesity-related disease such as diabetes mellitus type 2 are a permanently rising concern worldwide. Current effective therapeutic options mostly include medication and surgery, but there is a lack of effective treatment options between medication and surgery. Previously, devices such as EndoBarrier<sup>®</sup> have been placed on the market. However, high complication rates, especially liver abscesses, were seen in patients after implantation of the device. Nevertheless, duodenal lining seems to be an effective therapy for type 2 diabetes in obese patients and can lead to weight loss.</p><p><strong>Methods: </strong>A new removable transduodenal bypass was developed and tested on a porcine model. In this course, the device evolved in its mechanism and handling. The device is designed to avoid typical complications seen in previous duodenal liners.</p><p><strong>Results: </strong>After further development of the device, implantation and use were feasible and safe in the porcine model. Autopsies showed that the device stayed in place and remained intact.</p><p><strong>Discussion: </strong>The new removable transduodenal bypass aims to be a removable therapeutic option for diabetes mellitus type 2 and obesity, replacing previous duodenal lining devices. Use and handling of the device, however, are yet to be tested in the human model in the future.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"87-92"},"PeriodicalIF":1.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45567309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fluorescent Imaging in Visceral Surgery: Current Opportunities and Future Perspectives. 内脏手术中的荧光成像:当前机遇与未来展望》。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-06-01 Epub Date: 2023-06-12 DOI: 10.1159/000530362
Philipp H von Kroge, Anna Duprée

Background: Fluorescent imaging using indocyanine green (FI-ICG) has become quite popular in the past century, giving the surgeon various pre- and intraoperative approaches in visceral surgery. Nevertheless, several aspects and pitfalls of using the technology need to be addressed.

Summary: This article focused on the applications of FI-ICG in esophageal and colorectal surgery as this is where the clinical relevance is most important. Important benchmark studies were summarized to explain the background. In addition, dosage, the timing of application, and future perspectives - especially quantification methods - were the article's content.

Key message: There are currently encouraging data on the use of FI-ICG, particularly concerning perfusion assessment to reduce anastomotic leakage, although its use is mainly subjective. The optimal dosage remains unclear; for perfusion evaluation, it should be around 0.1 mg/kg body weight. Moreover, the quantification of FI-ICG opens new possibilities, so that reference values may be available in the future. However, in addition to perfusion measurement, the detection of additional hepatic lesions such as liver metastases or lesions of peritoneal carcinomatosis is also possible. A standardization of FI-ICG and further studies are needed to fully utilize FI-ICG.

背景:使用吲哚菁绿(FI-ICG)的荧光成像技术在上个世纪已相当流行,它为外科医生提供了内脏手术的各种术前和术中方法。摘要:本文重点讨论了吲哚菁绿荧光成像技术在食道和结直肠手术中的应用,因为这两种手术的临床意义最为重要。对重要的基准研究进行了总结,以解释其背景。此外,用量、应用时机和未来展望--尤其是量化方法--也是文章的内容:目前,关于使用 FI-ICG 的数据令人鼓舞,特别是关于减少吻合口漏的灌注评估,尽管其使用主要是主观的。最佳剂量仍不明确;对于灌注评估,剂量应在 0.1 毫克/千克体重左右。此外,FI-ICG 的定量为将来提供参考值提供了新的可能性。不过,除了灌注测量外,还可以检测其他肝脏病变,如肝转移或腹膜癌变病变。要充分利用 FI-ICG 还需要标准化和进一步的研究。
{"title":"Fluorescent Imaging in Visceral Surgery: Current Opportunities and Future Perspectives.","authors":"Philipp H von Kroge, Anna Duprée","doi":"10.1159/000530362","DOIUrl":"10.1159/000530362","url":null,"abstract":"<p><strong>Background: </strong>Fluorescent imaging using indocyanine green (FI-ICG) has become quite popular in the past century, giving the surgeon various pre- and intraoperative approaches in visceral surgery. Nevertheless, several aspects and pitfalls of using the technology need to be addressed.</p><p><strong>Summary: </strong>This article focused on the applications of FI-ICG in esophageal and colorectal surgery as this is where the clinical relevance is most important. Important benchmark studies were summarized to explain the background. In addition, dosage, the timing of application, and future perspectives - especially quantification methods - were the article's content.</p><p><strong>Key message: </strong>There are currently encouraging data on the use of FI-ICG, particularly concerning perfusion assessment to reduce anastomotic leakage, although its use is mainly subjective. The optimal dosage remains unclear; for perfusion evaluation, it should be around 0.1 mg/kg body weight. Moreover, the quantification of FI-ICG opens new possibilities, so that reference values may be available in the future. However, in addition to perfusion measurement, the detection of additional hepatic lesions such as liver metastases or lesions of peritoneal carcinomatosis is also possible. A standardization of FI-ICG and further studies are needed to fully utilize FI-ICG.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"39-45"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current and Emerging Targeted Therapies for Ulcerative Colitis. 溃疡性结肠炎的现有和新兴靶向疗法。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-06-01 Epub Date: 2023-06-12 DOI: 10.1159/000530983
Robert Pietschner, Timo Rath, Markus F Neurath, Raja Atreya

Background: Ulcerative colitis is one of the main entities of inflammatory bowel diseases. The clinical course of this immune-mediated disorder is marked by unpredictable exacerbations and asymptomatic remission, causing lifelong morbidity. Optimized anti-inflammatory treatment is a prerequisite to not only restore the quality of life of the affected patients but also halt progressive bowel damage and reduce the risk for colitis-associated neoplasia. Advances in understanding the underlying immunopathogenesis of ulcerative colitis have led to the advent of targeted therapies that selectively inhibit crucial molecular structures or signaling pathways that perpetuate the inflammatory reaction.

Summary: We will delineate the mode of action and summarize efficacy and safety data of current and emerging targeted therapies in ulcerative colitis, which encompasses representatives of the drug classes of antibodies, small molecules, and oligonucleotides. These substances have already been approved for induction and maintenance treatment or are being tested in late-stage clinical trials in moderately-to-severely active ulcerative colitis patients. These advanced therapies have enabled us to define and achieve novel therapeutic outcomes, such as clinical and endoscopic remission, histological remission, mucosal healing, and recently, also barrier healing as an emerging outcome measure.

Key messages: Established and emerging targeted therapies and monitoring modalities broaden our therapeutic armamentarium and have enabled us to define novel therapeutic outcomes that have the potential to modify the individual disease course of patients with ulcerative colitis.

背景:溃疡性结肠炎是炎症性肠病的主要类型之一。这种免疫介导疾病的临床过程以不可预测的加重和无症状缓解为特征,导致终生发病。优化抗炎治疗是一个先决条件,不仅能恢复患者的生活质量,还能阻止进行性肠道损伤,降低结肠炎相关肿瘤的风险。对溃疡性结肠炎潜在免疫发病机制的认识取得了进展,从而导致了靶向疗法的出现,这些疗法可选择性地抑制使炎症反应持续存在的关键分子结构或信号通路。摘要:我们将介绍目前和新兴的溃疡性结肠炎靶向疗法的作用模式,并总结其疗效和安全性数据。这些药物已被批准用于诱导和维持治疗,或正在中度至重度活动性溃疡性结肠炎患者的后期临床试验中进行测试。这些先进的疗法使我们能够确定并实现新的治疗结果,如临床和内镜缓解、组织学缓解、粘膜愈合,最近还将屏障愈合作为一种新的结果衡量标准:已有的和新兴的靶向疗法和监测模式拓宽了我们的治疗手段,使我们能够确定新的治疗结果,从而有可能改变溃疡性结肠炎患者的个体病程。
{"title":"Current and Emerging Targeted Therapies for Ulcerative Colitis.","authors":"Robert Pietschner, Timo Rath, Markus F Neurath, Raja Atreya","doi":"10.1159/000530983","DOIUrl":"10.1159/000530983","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis is one of the main entities of inflammatory bowel diseases. The clinical course of this immune-mediated disorder is marked by unpredictable exacerbations and asymptomatic remission, causing lifelong morbidity. Optimized anti-inflammatory treatment is a prerequisite to not only restore the quality of life of the affected patients but also halt progressive bowel damage and reduce the risk for colitis-associated neoplasia. Advances in understanding the underlying immunopathogenesis of ulcerative colitis have led to the advent of targeted therapies that selectively inhibit crucial molecular structures or signaling pathways that perpetuate the inflammatory reaction.</p><p><strong>Summary: </strong>We will delineate the mode of action and summarize efficacy and safety data of current and emerging targeted therapies in ulcerative colitis, which encompasses representatives of the drug classes of antibodies, small molecules, and oligonucleotides. These substances have already been approved for induction and maintenance treatment or are being tested in late-stage clinical trials in moderately-to-severely active ulcerative colitis patients. These advanced therapies have enabled us to define and achieve novel therapeutic outcomes, such as clinical and endoscopic remission, histological remission, mucosal healing, and recently, also barrier healing as an emerging outcome measure.</p><p><strong>Key messages: </strong>Established and emerging targeted therapies and monitoring modalities broaden our therapeutic armamentarium and have enabled us to define novel therapeutic outcomes that have the potential to modify the individual disease course of patients with ulcerative colitis.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"46-53"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
C. perfringens Blood Stream Infection due to Nontransmural Ischemia of the Esophagus, Stomach, and Left Colon: Case Report. 食管、胃和左结肠非横纹肌缺血导致的C. perfringens血流感染:病例报告。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-06-01 Epub Date: 2023-06-12 DOI: 10.1159/000530031
Johannes Reiner, Katharina Reichenbach, Imad Kamaleddine, Daniel Mokosch, Felix Streckenbach, Beate Brinkmann, Annette Pertschy, Maria Witte, Clemens Schafmayer, Marc-André Weber, Georg Lamprecht

We report the case of a 74-year-old female with abdominal pain, tarry stools, and tachycardia. Previous history included diabetes mellitus with micro- and macroangiopathy. Imaging revealed portal gas, left sided colitis, and emphysematous gastritis, besides severe atherosclerosis with subtotal celiac trunk occlusion and moderate stenosis of the inferior mesenteric artery. Upper endoscopy revealed findings consistent with focal necrotizing gastritis at the greater curvature and acute esophageal necrosis. Blood cultures immediately grew Clostridium perfringens. The patient was treated with broad spectrum antibiotics and was discharged after 21 days in the hospital. This case demonstrates the rare coincident occurrence of nontransmural ischemia of the left colon, the esophagus, and the stomach as a result of low-flow circulatory compromise, which then precipitated C. perfringens associated emphysematous gastritis and blood stream infection.

我们报告了一例 74 岁女性的病例,她患有腹痛、柏油样便和心动过速。既往病史包括糖尿病并发微血管和大血管病变。影像学检查发现门脉积气、左侧结肠炎和气肿性胃炎,此外还有严重的动脉粥样硬化,腹腔干次全闭塞和肠系膜下动脉中度狭窄。上内镜检查发现,大弯处有局灶性坏死性胃炎,食管急性坏死。血液培养立即培养出产气荚膜梭菌。患者接受了广谱抗生素治疗,住院 21 天后出院。该病例表明,由于低流量循环受损,左结肠、食管和胃同时发生非横纹肌缺血,进而诱发与产气荚膜梭菌相关的气肿性胃炎和血流感染,这种情况十分罕见。
{"title":"<i>C. perfringens</i> Blood Stream Infection due to Nontransmural Ischemia of the Esophagus, Stomach, and Left Colon: Case Report.","authors":"Johannes Reiner, Katharina Reichenbach, Imad Kamaleddine, Daniel Mokosch, Felix Streckenbach, Beate Brinkmann, Annette Pertschy, Maria Witte, Clemens Schafmayer, Marc-André Weber, Georg Lamprecht","doi":"10.1159/000530031","DOIUrl":"10.1159/000530031","url":null,"abstract":"<p><p>We report the case of a 74-year-old female with abdominal pain, tarry stools, and tachycardia. Previous history included diabetes mellitus with micro- and macroangiopathy. Imaging revealed portal gas, left sided colitis, and emphysematous gastritis, besides severe atherosclerosis with subtotal celiac trunk occlusion and moderate stenosis of the inferior mesenteric artery. Upper endoscopy revealed findings consistent with focal necrotizing gastritis at the greater curvature and acute esophageal necrosis. Blood cultures immediately grew <i>Clostridium perfringens</i>. The patient was treated with broad spectrum antibiotics and was discharged after 21 days in the hospital. This case demonstrates the rare coincident occurrence of nontransmural ischemia of the left colon, the esophagus, and the stomach as a result of low-flow circulatory compromise, which then precipitated <i>C. perfringens</i> associated emphysematous gastritis and blood stream infection.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 2","pages":"54-57"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9966029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Front & Back Matter 正面和背面
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-06-01 DOI: 10.1159/000531605
U. Denzer, T. Hackert
{"title":"Front & Back Matter","authors":"U. Denzer, T. Hackert","doi":"10.1159/000531605","DOIUrl":"https://doi.org/10.1159/000531605","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46957976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Society Bulletins 社会公告
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-06-01 DOI: 10.1159/000531095
Darmkrebsmonat März, Matthias P. Ebert, Vorstandsmitglied der Dgvs
In der Normalbevölkerung steigt das Darmkrebsrisiko ab dem 50. Lebensjahr. Daher erhalten gesetzlich Versicherte in diesem Alter regelmäßig Einladungen zur Darmkrebsvorsorge. Für Menschen, bei denen bereits Darmkrebsfälle in der Familie bekannt sind, wären regelmäßige Vorsorgeuntersuchungen bereits ab dem 30. Lebensjahr sinnvoll und kosteneffektiv. Das zeigen die Ergebnisse der im vergangenen Jahr veröffentlichten FARKOR-Studie. Im Rahmen der Studie wurden Menschen mit familiärer Darmkrebs-Vorbelastung zu einem Darmkrebs-Screening eingeladen. Das Ergebnis: Jede achte Untersuchung brachte Darmkrebs-Vorstufen zutage. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) begrüßt daher die Empfehlung des Gemeinsamen Bundesausschusses (G-BA), das familiäre Darmkrebsscreening in die Krebsfrüherkennungsrichtlinie aufzunehmen und fordert eine Umsetzung noch in diesem Jahr. Das Kürzel FARKOR steht für das Projekt „Vorsorge bei familiärem Risiko für das kolorektale Karzinom“ – eine Studie, die auf Initiative der Felix Burda Stiftung als bayrisches Modellprojekt durch den Innovationsausschuss des G-BA seit 2017 gefördert wurde und deren Auswertung nun vorliegt. „Die Studie belegt klar den Nutzen einer früheren Darmkrebsvorsorge bei Menschen mit familiärer Vorbelastung“, sagt Professor Dr. med. Frank Kolligs, Chefarzt der Inneren Medizin und Gastroenterologie am Helios Klinikum Berlin-Buch, der die Task Force Darmkrebs der DGVS leitet. Als familiär DGVS fordert zum Darmkrebsmonat März
在普通人口中,从50岁起罹患肠癌的可能性就会增加。o .因此,该年龄成为法定受益人的人经常受到肠道癌的邀请。30岁开始进行定期体检。生命科学,请。这表明去年发表的法拉克研究的结果。在这项研究中,有家庭结肠癌先天症状的人被邀请来进行肠癌筛选。结果,每8次检查就发现了肠癌的尖端。因此,德国肠胃病、肠胃病和代谢病协会(DGVS)欢迎联合联邦委员会(gba)关于为癌症筛查制定相关标准的建议,并呼吁在今年予以执行。可,FARKOR最近代表“偶发车祸家庭风险预防”项目——该研究自2017年以来一直由g集团创新委员会赞助并获得成果——由费利克斯·布尔达基金会(Felix Burda狮子座基金会)发起。这项研究很明显证明了以前的肠道癌对有家庭病史的人有好处。”嘿,我想我会参加这场盛大的聚会
{"title":"Society Bulletins","authors":"Darmkrebsmonat März, Matthias P. Ebert, Vorstandsmitglied der Dgvs","doi":"10.1159/000531095","DOIUrl":"https://doi.org/10.1159/000531095","url":null,"abstract":"In der Normalbevölkerung steigt das Darmkrebsrisiko ab dem 50. Lebensjahr. Daher erhalten gesetzlich Versicherte in diesem Alter regelmäßig Einladungen zur Darmkrebsvorsorge. Für Menschen, bei denen bereits Darmkrebsfälle in der Familie bekannt sind, wären regelmäßige Vorsorgeuntersuchungen bereits ab dem 30. Lebensjahr sinnvoll und kosteneffektiv. Das zeigen die Ergebnisse der im vergangenen Jahr veröffentlichten FARKOR-Studie. Im Rahmen der Studie wurden Menschen mit familiärer Darmkrebs-Vorbelastung zu einem Darmkrebs-Screening eingeladen. Das Ergebnis: Jede achte Untersuchung brachte Darmkrebs-Vorstufen zutage. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) begrüßt daher die Empfehlung des Gemeinsamen Bundesausschusses (G-BA), das familiäre Darmkrebsscreening in die Krebsfrüherkennungsrichtlinie aufzunehmen und fordert eine Umsetzung noch in diesem Jahr. Das Kürzel FARKOR steht für das Projekt „Vorsorge bei familiärem Risiko für das kolorektale Karzinom“ – eine Studie, die auf Initiative der Felix Burda Stiftung als bayrisches Modellprojekt durch den Innovationsausschuss des G-BA seit 2017 gefördert wurde und deren Auswertung nun vorliegt. „Die Studie belegt klar den Nutzen einer früheren Darmkrebsvorsorge bei Menschen mit familiärer Vorbelastung“, sagt Professor Dr. med. Frank Kolligs, Chefarzt der Inneren Medizin und Gastroenterologie am Helios Klinikum Berlin-Buch, der die Task Force Darmkrebs der DGVS leitet. Als familiär DGVS fordert zum Darmkrebsmonat März","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"62 - 70"},"PeriodicalIF":1.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41870458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Society Bulletins 社会公告
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-28 DOI: 10.1159/000530032
biliären Karzinomen
Das Leitlinienprogramm Onkologie hat seine S3-Leitlinie zum Hepatozellulären Karzinom (HCC) und zu biliären Karzinomen aktualisiert. Die überarbeitete Fassung enthält unter anderem neue Empfehlungen zur Zweitlinientherapie bei biliären Karzinomen und zu seltenen Erkrankungen als Risikofaktoren für HCC. Die S3Leitlinie entstand unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und unter Mitwirkung von 36 Fachgesellschaften und Organisationen. Ziel ist es, evidenzbasierte Behandlungsmöglichkeiten aufzuzeigen und die Therapie von Patient*innen mit hepatobiliären Tumoren zu verbessern.
肿瘤学指南计划更新了其关于肝细胞癌(HCC)和胆管癌的S3指南。修订版包括关于胆管癌二线治疗和作为HCC危险因素的罕见病的新建议。S3Guideline是在德国胃肠病、消化和代谢疾病学会(DGVS)的领导下制定的,有36个专业学会和组织参与。目的是确定循证治疗方案,并改进肝胆肿瘤患者的治疗。
{"title":"Society Bulletins","authors":"biliären Karzinomen","doi":"10.1159/000530032","DOIUrl":"https://doi.org/10.1159/000530032","url":null,"abstract":"Das Leitlinienprogramm Onkologie hat seine S3-Leitlinie zum Hepatozellulären Karzinom (HCC) und zu biliären Karzinomen aktualisiert. Die überarbeitete Fassung enthält unter anderem neue Empfehlungen zur Zweitlinientherapie bei biliären Karzinomen und zu seltenen Erkrankungen als Risikofaktoren für HCC. Die S3Leitlinie entstand unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und unter Mitwirkung von 36 Fachgesellschaften und Organisationen. Ziel ist es, evidenzbasierte Behandlungsmöglichkeiten aufzuzeigen und die Therapie von Patient*innen mit hepatobiliären Tumoren zu verbessern.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"30 - 38"},"PeriodicalIF":1.9,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46783337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature. 治疗食管切除术后食管-肺瘘的内窥镜真空疗法:病例报告和文献综述。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-01 Epub Date: 2023-02-23 DOI: 10.1159/000529725
Imad Kamaleddine, Magdalena Popova, Ahmad Alwali, Clemens Schafmayer

An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.

后天性食管-呼吸道瘘是食管和呼吸系统之间的异常连接。它通常是由恶性肿瘤和感染引起的,或者是手术或放射治疗后的并发症。根据解剖层次可分为食管-气管瘘、食管-支气管瘘,以及最罕见的食管-肺瘘(EPF)。我们介绍了一例食管癌 Ivor-Lewis 手术后吻合口漏(AL)加重的 EPF 病例。我们使用 Eso-Sponge® 系统(B. Braun Melsungen AG,德国梅尔松根)进行了内窥镜真空治疗(EVT)。在接下来的治疗过程中,患者在口服流质食物后再次出现剧烈咳嗽,因此被怀疑患有 EPF。在内窥镜检查中,将亚甲蓝染料注入食管旁腔,并通过同时进行的支气管镜检查证实亚甲蓝染料存在于呼吸道中,从而证实了这一怀疑。此外,口腔造影剂计算机断层扫描显示右肺下叶存在造影剂。对这一并发症采取了EVT和抗生素的保守治疗。营养通过现有的空肠造口输入。两个瘘管和食道旁腔完全愈合,口服营养得以维持,患者康复出院。这种罕见的危及生命的并发症可以采取保守治疗。其治疗方法具有挑战性和争议性,缺乏普遍共识。
{"title":"Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature.","authors":"Imad Kamaleddine, Magdalena Popova, Ahmad Alwali, Clemens Schafmayer","doi":"10.1159/000529725","DOIUrl":"10.1159/000529725","url":null,"abstract":"<p><p>An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"18-24"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9399576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic and Therapeutic Management of Early Colorectal Cancer. 早期结直肠癌的诊断和治疗管理。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-01 Epub Date: 2022-11-30 DOI: 10.1159/000526633
Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz

Background: Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a "high-risk" situation, there is a risk for lymph node metastasis of up to 23%.

Summary: The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.

Key messages: Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a "high-risk" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a "low-risk" constellation (G1/G2; L0, size <3 cm) and an R0 resection.

背景:早期结直肠癌(eCRC)是指未跨越结肠或直肠粘膜下层的癌症,包括原位癌(pTis)、pT1a 和 pT1b。早期癌的预后因风险状况而异。区分低风险和高风险至关重要。低风险组包括 R0 切除、分化良好(G1)或中度(G2)、无淋巴管侵犯(L0)、无血管侵犯(V0)且肿瘤大小≤3 厘米的肿瘤。在这种情况下,估计发生淋巴结转移的风险约为 1%或以下。高风险组包括未完全切除(Rx)、差(G3)或未分化(G4)癌和/或淋巴及血管侵犯(L1)且肿瘤大小≥3 厘米的肿瘤。在 "高危 "情况下,淋巴结转移的风险高达 23%。小结:eCRC 的发病率正在上升,在结肠镜检查的所有内镜下切除病灶中的发病率为 10%。为了进行正确的组织学评估,所有疑似病灶都应完全切除。如果是直肠内的 pT1 病变,则应进行盆腔磁共振成像,以评估可疑淋巴结。eCRC 的治疗方法以组织学评估为基础,从内窥镜切除到根治性肿瘤手术不等。需要在肿瘤委员会上与患者仔细讨论各种治疗策略的优缺点和相关风险:早期结直肠癌的治疗方案取决于组织学评估。分化较差的癌、工藤≥SM2 级病变和 Haggitt 4 级病变始终代表着 "高风险 "情况。还应提及的是,在直肠癌中,对于 "低风险 "的 pT1 癌(G1/G2;L0,大小
{"title":"Diagnostic and Therapeutic Management of Early Colorectal Cancer.","authors":"Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz","doi":"10.1159/000526633","DOIUrl":"10.1159/000526633","url":null,"abstract":"<p><strong>Background: </strong>Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a \"high-risk\" situation, there is a risk for lymph node metastasis of up to 23%.</p><p><strong>Summary: </strong>The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.</p><p><strong>Key messages: </strong>Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a \"high-risk\" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a \"low-risk\" constellation (G1/G2; L0, size <3 cm) and an R0 resection.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"10-16"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10230821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9571889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current Surgical Concepts in Lynch Syndrome and Familial Adenomatous Polyposis. 林奇综合征和家族性腺瘤性息肉病的当前手术概念。
IF 1.9 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-01 Epub Date: 2023-03-28 DOI: 10.1159/000530030
Karoline Horisberger, Carolina Mann, Hauke Lang

Background: Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).

Summary: LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.

Key message: Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.

背景:约有 5% 的结直肠癌 (CRC) 与遗传性癌症综合征有关。这些综合征的自然病史与散发性癌症不同,而且由于其发生间变性癌的风险增加,手术方法也有所不同。本综述重点介绍目前对遗传性 CRC 综合征手术治疗的建议,以及导致这些建议的证据:摘要:林奇综合征没有共同的表型,是由错配修复基因(MLH1、MSH2、MSH6 或 PMS2)之一的单个种系变异引起的。由于每种基因都与不同的罹患晚期癌症的风险有关,因此现在的指南在推荐肿瘤学干预措施时会区分不同的基因。典型和减弱的 FAP 是由 APC 基因的种系突变引起的,具有特征性的表型。虽然表型与基因型之间存在相关性,但手术指征主要基于临床表现而非特定基因突变:目前,对这两种疾病的建议倾向于相反的方向:虽然某些形式的 FAP 可能需要较小范围的手术,但对某些 LS 患者来说,对远期癌风险的更深入了解会导致更大范围的手术。
{"title":"Current Surgical Concepts in Lynch Syndrome and Familial Adenomatous Polyposis.","authors":"Karoline Horisberger, Carolina Mann, Hauke Lang","doi":"10.1159/000530030","DOIUrl":"10.1159/000530030","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).</p><p><strong>Summary: </strong>LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.</p><p><strong>Key message: </strong>Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 1","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10051043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9297024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Visceral Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1