9篇英文摘要详解

1、1. 文章来源： THE LANCET. Vol. 351. January 17, 1998 Department of Surgery, Gastrointestinal Unit, Norfolk and Norwich NHS Trust Hospital, Norwich NR1 3SR, UK (M Rhodes FRCS, L Sussman FRCS, L Cohen FRCS, M P Lewis FRCS) Randomised trial of laparoscopic exploration of common bile duct versus postoperativ

2、e endoscopicretrograde cholangiography for common bile duct stones 胆总管腹腔镜探查术与术后内镜逆行胆管造影治疗胆总管结石的随机比较试验 Summary 摘要 Background: The management of stones in the common bile duct in the laparoscopic era is controversial. The three major options are preoperative endoscopic retrograde cholangiography (ERCP

3、), laparoscopic exploration of the common bile duct (LECBD), or postoperative ERCP(. 注意时态) 背景：在腹腔镜时代，处理胆总管结石是有争议的。三种主要选择是：术前内镜 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 Methods: Between August, 1995, and August, 1997, 471 laparoscopic cholecystectomies were done in our department. In 427 (91%), satisf

4、actory preoperative cholangiography was obtained. In 80 (17%) of these cases there were stones in the common bile duct. 40 patients were randomised to LECBD and 40 to postoperative ERCP. If LECBD failed, patients had either open exploration of the common bile duct or postoperative ERCP. If one posto

5、perative ERCP failed, the procedure was repeated until the common bile duct was cleared of stones or an endoprosthesiswas placed to prevent stone impaction. The primary endpoints were duct-clearance rates, morbidity, operating time, and hospital stay. Analyses were by intention to treat. 方法： 1995年 8

6、 月至 1997年8 月， 471患者行腹腔镜胆囊切除术。其中 427例 (91%)获得满意的术前胆管造影结果。 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胆管造 影。若腹腔镜胆总管探查术失败，患者可行开腹探查胆总管或术后内镜逆行胆管 造影。如一次术后内镜逆行胆管造影不行，可行多次直至清除胆总管结石或者放 置内镜置管防止结石嵌顿。主要检测指标为，胆道清除率、发病率、手术时间和 住院时间。统计学采用意向性分析。 Findings: Age and sex distribution of patients was simila

7、r in the randomised groups. Duct clearance after the first intervention was 75% in both groups. By the end of treatment, duct clearance was 100% in the laparoscopic group compared with 93% in the ERCP group. Durati on of treatme nt was a media n of 90 min (range 2-310) in the laparoscopic group (inc

8、luding ERCPs for failed LECBD) compared with 105 min (range 60-255) in the postoperative ERCP group (p=0.1, 95% CI for difference -5 to 40). Hospital stay was a median of 1 day (range 1 -26) in the laparoscopic group compared with 3.5 days （ran ge 1） in the ERCP group （p=0.0001, 95% Cl 1-2）. 发现（结果）：

9、随机分组中年龄和性别分配相同。两组中首次术后胆道清除率达 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 1 05分钟（ p=0 . 1 , 95%可信区间差异 -5至 40）。腹腔镜手术组中位住院时间为 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）。 lnterpretation: LECBD is as effective as ERCP in clearing the co

10、mmon bile duct of stones. There is a non-significant trend to shorter time in the operating theatre and a significantly shorter hospital stay in patients treated by LECBD. 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， 手术时间不明显缩短， 但住院时间明显缩短。 （梁平修订） 2 文章来源：Lan cet 2005; 365: 1718-6 Pierre J Gui

11、llou, Philip Quirke, Helen Thorpe, Joanne Walker, David G Jayne, Adrian MH Smith, Richard M Heath, Julia M Brown, for the MRC CLASlCC trial group Short-term endpoints of conventional versus laparoscopic assistedsurgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised c

12、ontrolled trial 常规与腹腔镜手术治疗大肠癌患者的短期疗效（MRC CLASICC试验）：多中心 随机对照试验 Summary 摘要 Background: Laparoscopic-assistedsurgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term en dpo ints of conven tio nal versus laparoscopi

13、c assisted surgery in patie nts with colorectal can cer to predict Ion g-term outcomes. 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以预测其长期的 结果。（注意时态） Methods: Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal

14、 cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assisted （n二526） or open surgery （n二268）. Primary short-term endpoints were positivity rates of circumferential and Ion gitudi nal resecti on marg ins, proporti on of Dukes C2 tumours, and in-hospital mortality. Analysis was

15、 by intention to treat. This trial has been assigned the In ternatio nal Sta ndard Ran domised Con trolled Trial Number ISRCTN74883561. 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794名大肠 癌患者中进行了多中心随机临床实验。患者或分配实施腹腔镜手术（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（周 围转移及蔓延率）、Dukes C2期肿瘤比例和院内死亡率。统计学采用意向性分析。 本试验为

16、国际标准随机对照试验编号 ISRCTN74883561。 Findings: Six patients （two open, four laparoscopic） had no surgery, and 23 had missing surgical data （nine, 14）. 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 （29%） patients underwent conversion from laparoscopic to o

17、pen surgery. Proportion of DukesCt2umours did not differ between treatments （18 7% patients, open vs. 34 6%, laparoscopic; difference -0.3%, 95% Cl -3.9 to 3.4%, p=0.89）, and neither did in-hospital mortality （13 5% vs. 21 4%;.9%, -3.9 to 2.2%, p=0.57）. Apart from patie nts un dergoi ng laparoscopic

18、 anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups. Patients with converted treatment had raised complication rates. 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（开放手术组 9 名，腹腔镜手术组 14 名）。 253 名和 484 名患者 分别接受了开放手术和腹腔镜辅助手术。 143 名患者（ 29%

19、）由腹腔镜手术转为 开腹手术。两种治疗的Duckes C期肿瘤患者没有显著性差异（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。 lnterpretation: Laparoscopic-assisted surgery for cancer of the colon is as

20、effective as open surgery in the short term and is likely to produce similar long-term outcomes. However, impaired short-term outcomes after laparoscopic assisted anterior resection for cancer of the rectum do not yet justify its routine use. 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 能相同。然而，直肠癌前入路腹腔镜手术切除的

21、短期疗效不佳， 不适合常规进行。 (梁平修订) 3 文章来源： Circulation ( Journal of the American Heart Association ), 2007 March 12; 15;1544-1550; 2007SCI 影响因子 10.116 Caroline S. Fox, MD, MPH; Sean Coady, MA; Paul D. Sorlie, PhD; Ralph B. D Agostino, Sr, PhD; Michael J. Pencina, PhD; Ramachandran S. Vasan, MD; James B. Meigs,

22、 MD, MPH; Daniel Levy, MD; Peter J. Savage, MD The Frami ngham Heart Study弗雷明汉心脏研究所 Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus 糖尿病增加心血管疾病比例 BackgroundMarked reductions in cardiovascular disease (CVD) morbidity and mortality have occurred in the United States over the last 50 y

23、ears. We tested the hypothesis that the relative burden of CVD attributable to diabetes mellitus (DM) has in creased over the past 5 decade(.注意时态) 背景一在过去的50年里，美国心血管疾病(CVD)的发病率和死亡率明显减少。 我们推测并检验， 50 年来因糖尿病引起的心血管疾病的相对比例在增加。 time pe Methods and Results 方法和结果 Participants aged 45 to 64 years from the Fra

24、mingham Heart Study, who attended examinations in an“ early ” to 1974), were compared with those who attended examinations in a later time period (1975 to 1998). 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。 The risk of CVD events (n= 133 among those with and 1093 among t

25、hose 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. 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(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。 The age

26、- and sex-adjusted hazard ratio for DM as a CVD risk factor was 3.0 (95% CI, 2.3 to 3.9) in the earlier time period and 2.5 (95% CI, 1.9 to 3.2) in the later time period. 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) 。 The population attributable risk for D

27、M 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 ratio = 0.04), although multivariable adjustme nt resulted in atte nu atio n of these findings (P= 0.12); most of these obser

28、vations were found among men. 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% Cl, 5.9% to 11.4%)(P= 0.04)，尽管多变量调整使这些结果有所减弱(P = 0.12);这 些结果大都是在男性中发现的。 ConclusionsThe proportion of CVD attributable to DM has increased over the past 50 years in Framingham. These findings emphasiz

29、e the need for increased efforts to prevent DM and to aggressively treat and control CVD risk factors among those with DM. (注意时态) 结论 在弗雷明汉心脏研究所，50 年来由糖尿病引起的心血管疾病的比例在增 加，警示我们要加大努力去预防糖尿病，以及在糖尿病人群中大力治疗和控制心 血管疾病的危险因素。(梁平修订) 4 文章来源：CANCER RESEARCH 63, 5821 巧828, September 15, 2003 Sheila K. Singh, lan D.

30、 Clarke, Mizuhiko Terasaki, Victoria E. Bonn, Cynthia Hawkins, Jeremy Squire, and Peter B. Dirks Identification of a Cancer Stem Cell in Human Brain Tumors 人类脑肿瘤的肿瘤干细胞的识别 ABSTRACT 摘要 Most current research on human brain tumors is focused on the molecular and cellular an alysis of the bulk tumor mass

31、.大多数人类脑部肿瘤的研究都关注大肿瘤块的分 子和细胞分析。 However, there is overwhel ming evide nee in some malig nan cies that the tumor clone is heterogeneous with respect to proliferation and differentiation. 然 而，大量证据表明在某些恶性脑肿瘤中肿瘤克隆在增殖和分化上是异质性的。In human leukemia, the tumor clone is organized as a hierarchy that originates

32、from rare leukemic stem cells that possess exte nsive proliferative and selfre newal pote ntial, and are respo nsible for mai ntai ning the tumor clo ne.在人类白血病中，肿瘤克隆由源于 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较强的增殖和 自我更新的能力，能够维持肿瘤的克隆。We report here the identification and purificati on of a can cer stem cell fr

33、om huma n brain tumors of differe nt phe no types that possessesa marked capacity for proliferation, self-renewal, and differentiation. 在本文中，我们报道了对来自不同表型的人脑肿瘤的肿瘤干细胞的识别和纯化， 肿瘤干细胞具有显著的增殖、自我更新和分化能力。The in creased self-re newal capacity of the brain tumor stem cell (BTSC) was highest from the most aggre

34、ssive cli nical samples of medulloblastoma compared with low-grade gliomas. 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。The BTSC was exclusively isolated with the cell fraction expressi ng the neural stem cell surface marker CD133.脑肿瘤干细胞完全用表达神 经干细胞表面标志物CD133的细胞碎片进行分离。These CD133 cells could

35、differe ntiate in culture into tumor cells that phe no typically resembled the tumor from the patient.这些CD133细胞在培养物中可以分化为表型类似于患者肿瘤的肿瘤 细胞。 The identification of a BTSC provides a powerful tool to investigate the tumorigenic process in the central nervous system and to develop therapies targeted to th

36、e BTSC. 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 开发针对肿瘤干细胞的治疗方法，提供了一个有力的工具。 （梁平修订） 5 文章来源： Chan A T, Ogino S, Fuchs C S. Aspirin Use and Survival After Diagnosis of Colorectal Cancer J. JAMA: The Journal of the American Medical Association, 2009, 302(6): 649-658. Aspirin Use and Survival after Diagnosis of Co

37、lorectal Cancer 结肠直肠癌确诊后阿司匹林的服用与生存率 Abstract 摘要 Context 背景 Aspirin reduces risk of colorectal neoplasia in randomized trials and in hibits tumor growth and metastases in ani mal models.阿司匹林，在随机试验中能 减少结肠直肠新生肿物的危险，在动物模型试验中能抑制肿瘤的生长和转移。 However, the influence of aspirin on survival after diagnosis of co

38、lorectal cancer is unknown. 然而，在结肠直肠癌确诊后，服用阿司匹林对患者的生存率有何影响， 仍不清楚。 Objective 目的 To examine the association between aspirin use after colorectal can cer diag no sis on colorectal can cerspecific and overall survival. 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之间的联系。 Design, Setting, and Participants设计，场所和参与者 一P

39、rospective cohort study of 1279 men and women diagnosed with stage I, II, or III colorectal cancer. 前瞻性队列 研究， 1279 名诊断患有 I, II, 或 III 期结肠直肠癌的男仕和女仕。 Participants were enrolled in 2 nationwide health professional cohorts in 1980 and 1986 prior to diagnosis and followed up through June 1, 2008.诊断前，参与者在

40、 1980 年和 1986 年曾加入两个全国的健康专业人士的队列研究，随访至 2008年 6月1日。 Main Outcome Measure 主要结果的测量 Colorectal cancerrspecific and overall mortality. 结肠直肠癌 -特定死亡率与总死亡率。 Results 结果 After a median follow-up of 11.8 years, there were 193 total deaths (35%) and 81 colorectal cancerrspecific deaths (15%) among 549 participa

41、nts who regularly used aspirin after colorectal cancer diagnosis, compared with 287 total deaths (39%) and 141 colorectal cancerrspecific deaths (19%) among 730 participants who did not use aspirin. 平均随访 11.8年，诊断为结肠直肠癌后常规服用阿司匹林 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 81名 (15%)； 没有服用阿司匹林的患者 730名，总死亡人数

42、 287 名 (39%)，结肠直肠癌特定性 死亡 141 名(19%)。Compared with nonusers, participants who regularly used aspirin after diagnosis experienced a multivariate hazard ratio (HR) for colorectal cancerrspecific mortality of 0.71 (95% confidence interval CI, 0.53-0.95) and for overall mortality of 0.79 (95% CI, 0.65-0.

43、97). 与没服用者相比 , 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，结肠直肠癌-特定死亡率为0.71 (95% 可信区间 CI, 0.53-0.95)，总死亡率为 0.79 (95% 可信区间 , 0.65-0.97)。 Among 719 participants who did not use aspirin before diagnosis, aspirin use initiated after diag no sis was associated with a multivariate HR for colorectal can cerpecific mort

44、ality of 0.53 (95% CI, 0.33-0.86). 在 719名诊断前没有服用阿司匹林的参与者 中，诊断后开始服用的多变量危险度比为 0.53 (95% CI, 0.33-0.86)的结肠直肠癌 - 特定死亡率。(719名诊断前没有服用阿司匹林的参与者， 诊断后开始服用， 其多 变量危险度比为0.53 (95% Cl, 0.33-0.86)的结肠直肠癌-特定死亡率。)Among 459 participants with colorectal cancers that were accessible for immunohistochemical assessment, th

45、e effect of aspirin differed significantly according to cyclooxygenase 2 (COX-2) expression (P for interaction = .04). 459 名有免疫组化评估的结肠直肠癌 患者，阿司匹林的效果随着环氧合酶2 (COX-2)表达的不同有显著差异(交互作用 的 P 值= .04)。 Regular aspirin use after diagnosis was associated with a lower risk of colorectal cancerpecific mortality a

46、mong participants in whom primary tumors overexpressedCOX-2 (multivariate HR, 0.39; 95% Cl, 0.20-0.76), whereas aspirin use was not associated with lower risk among those with primary tumors with weak or absent expression (multivariate HR, 1.22; 95% Cl, 0.36-4.18). 在原始肿瘤过表达 COX-2 的参与者中，诊断后常规服用阿司匹林与结

47、肠直肠癌-特定死亡率的低风 险有关(多变异危险度比 , 0.39; 95%可信区间, 0.20-0.76)；反之，在原始肿瘤弱或 缺失表达的参与者中， 阿司匹林服用与低风险无关联 (多变异危险度比 , 1.22; 95% 可信区间 , 0.36-4.18)。 Conclusion 结论 Regular aspirin use after the diagnosis of colorectal cancer is associated with lower risk of colorectal cancer-specific and overall mortality, especially a

48、mong in dividuals with tumors that overexpress COX-2.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。（梁平修订） 6. 文章来源：NATURE| Vol 444|23 November 2006 Corresp onden ceto: Stephe n W. Scherer5,6Matthew E. Hurlesl Corresp ondenceand requestsfor materials should be addressedto M.E.H. (Email

49、: mehsanger.ac.uk) or S.W.S (Email: stevege net.sickkids.o n.ca). Global variation in copy number in the human genome 人类基因组拷贝数的全球性变异 Abstract 摘要 Copy nu mber variati on (CNV) of DNA seque nces is fun ctio nally sig nifica nt but has yet to be fully ascertai ned. DNA序列的拷贝数变异的功能意义重大，但是至今还未 被完全阐明清楚。 We

50、 have constructed a first-generation CNV map of the human genome through the study of 270 in dividuals from four populati ons with an cestry in Europe, Africa or Asia (the HapMap collection). DNA from these individuals was scree ned for CNV using two compleme ntary tech no logies: sin gle-nu cleotid

51、e polymorphism (SNP) genotyping arrays, and cione-based comparative genomic hybridization. 我们研究了祖先为欧洲、非洲和亚洲的 4 个种群共 270 名个体 （HapMap 图集），构建了人类基因组第一代拷贝数变异图谱。 用两个互补的技术 单核苷酸多态性（SNP）基因分型和基于克隆的比较基因组杂交方法，筛选 这些个体的拷贝数变异DNA。A total of 1,447 copy number variable regio ns （CNVRs）, which can encompass overlappin

52、g or adjacent gains or losses, covering 360 megabases （12% of the geno me） were ide ntified in these populatio ns.在这些人群中 共发现了 1,447个拷贝数变异区域（CNVRs），由重叠或相邻的获得或丢失组成， 覆盖了 360 巨碱基（占基因组的 12%）。These CNVRs contained hundreds of genes, diseaseloci, functional elements and segmental duplications. 这些拷贝数变异区域 还包

53、含成百上千的基因、致病基因座、功能元件和片段性重复。Notably, the CNVRs encompassed more nucleotide content per genome than SNPs, underscoring the importance of CNV in genetic diversity and evolution. 值得注意的是，拷贝数变异 区域比单核苷酸多态性包含更多的核苷酸， 突出显示了拷贝数变异在遗传多样性 和进化中的重要性。 The data obtained delineate linkage disequilibrium patterns for ma

54、ny CNVs, and reveal marked variation in copy number among populations. 所得 数据描绘了许多拷贝数变异的连锁不平衡模式， 也揭示了在不同种群中拷贝数的 显著变异。 We also demonstrate the utility of this resource for genetic disease studies. 我们还表明，这一资源可以利用到遗传疾病研究上。 （梁平修订） 文章来源： SCIENCE VOL 317 20 JULY 2007 Florian T. Merkle, Zaman Mirzadeh, Artu

55、ro Alvarez-Buylla* Department of Neurosurgery and Developmental and Stem Cell Biology Program, Un iversity of California, San Fran cisco, San Fra ncisco, CA 941430525, USA. Mosaic Organization of Neural Stem Cells in the Adult Brain 成年脑中神经干细胞的组织呈马赛克样分布 The in vivo potential of neural stem cells in t

56、he postnatal mouse brain is not known, but because they produce many different types of neurons, they must be either very versatile or very diverse. 出生后鼠脑中的神经干细胞的在体潜能还是未知的，但 是因为它们会产生许多不同种类的神经元，因此它们要么非常多能，要么非常多 变。 By specifically targeting stem cells and following their progeny in vivo, we showed tha

57、t postnatal stem cells in different regions produce different types of neurons, even when heterotopically grafted or grown in culture. 通过在体特异定位干细胞并 跟踪其子细胞，我们发现不同区域的出生后的干细胞会产生不同类型的神经元， 即使对干细胞进行异位移植或者培养都会有同样的结果。 This suggests that rather than being plastic and homogeneous, neural stem cells are a rest

58、ricted and diverse population of progenitors. 以上提示，神经干细胞并非是可塑性与同源性的，而是 一种有限的多变的前期细胞（先祖细胞）群落。 （梁平修订） 文章来源： Engl J Med 2004; 350:664-71. February 12, 2004. Kitt Falk Petersen, M.D., Sylvie Dufour, Ph.D. 美国康涅狄格州纽黑文， 耶鲁大学医 学院内科，等。 Impaired Mitochondrial Activity in the Insulin-Resistant Offspring of Pat

59、ients with Type 2 Diabetes 在 2 型糖尿病病人的对胰岛素抵抗的后代中存在线粒体活性受损 ABSTRACT Background: Insulin resistance appears to be the best predictor of the development of diabetes in the children of patients with type 2 diabetes, but the mechanism responsible is unknown. 背景 在 2型糖尿病病人的子女中 ,胰岛素抵抗似乎是发生糖尿病的最佳预测因素, 但引起的机制

60、尚不清楚。 Methods: We performed hyperi nsuli nemic -euglycemic clamp studies in comb in ati on with infusions of 6,6-2H2glucose in healthy, young, lean, insulin-resistant offspring of patients with type 2 diabetes and insulin-sensitive control subjects matched for age, height, weight, and physical activ