Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

温针灸对功能性便秘患者临床症状及焦虑抑郁的改善作用

目的:探讨温针灸对功能性便秘(FC)患者临床症状及焦虑抑郁的改善作用。方法:选取2017年1月至2017年12月中国中医科学院广安门医院南区收治的FC患者70例作为研究对象,随机分为观察组和对照组,每组35例。对照组采用常规针刺治疗,观察组采用温针灸治疗,比较治疗前后2组患者便秘临床症状积分、首次排便时间、中医证候评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)评分。结果:观察组有效率96. 00%,对照组有效率68. 00%,差异有统计学意义(P0. 05)。治疗后2组患者的周排便次数、粪便性状积分和排便困难程度均改善,中医证候评分、SAS和SDS评分下降,较治疗前差异有统计学意义(P 0. 05)。治疗后,观察组患者的周排便次数、粪便性状积分高于对照组,中医证候评分、SDS和SAS评分、首次排便时间以及排便困难程度积分小于对照组,差异有统计学意义(P 0. 05)。结论:温针灸治疗能调节胃肠道运动、润湿肠道、显著改善便秘等临床症状,对FC患者有显著临床效果。     

A case of purulent pneumococcal pericarditis

Background

Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.

Five‐year efficacy of finasteride in 801 Japanese men with androgenetic alopecia

Finasteride is standard medical treatment for androgenetic alopecia; however, no large studies with 5 years or more of follow up have been performed in Japan. The authors followed Japanese men with androgenetic alopecia treated with finasteride for 5 years to evaluate long‐term treatment efficacy. Of 903 men treated with finasteride (1 mg/day), 801 patients were evaluated over 5 years by modified global photographic assessment. Although the proportion of improvement was high (99.4%), modified global photographic assessment scores after 5 years of treatment were lower in patients with more advanced disease as measured by the modified Norwood–Hamilton scale. After separating patients into “sufficient” and “insufficient” efficacy groups according to the modified global photographic assessment score after 5 years (scores ≥6 and <6, respectively), multivariate analysis showed that independent risk factors of insufficient efficacy were age at start of treatment of 40 years or more (P = 0.021) and classification on the modified Norwood–Hamilton scale (P < 0.001), whereas presence of stress at start of treatment was a negative predictor (P = 0.025). In conclusion, continuous finasteride treatment for 5 years improved androgenetic alopecia with sustained effect among Japanese. Younger age and less advanced disease at start of treatment were the key predictors of higher finasteride efficacy.     

Sleep quality in times of Covid-19 pandemic

BackgroundDue to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown.MethodsAll patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale.ResultsThe study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties.ConclusionsHome confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.     

Measuring hope amongst Tanzanian women who participate in microfinance: An evaluation of the Snyder hope scale

ABSTRACT

Measuring hope reliably and accurately remains an important research objective, not least in less prosperous settings where ‘holding on to hope’ may be critically important in the struggle against adverse life conditions. The State Hope Scale was designed for use in the US. Despite reported application in diverse cultures and using translations the scale has not been extensively validated outside US populations. This study contributes to a larger project exploring the measurement of hope and provides a critique of Snyder’s scale as used in a Tanzanian female population of 1021 urban microfinance participants. We evaluate the scale’s validity through assessment of the empirical distribution of scores, item response profiles, internal consistency and discriminatory ability. Participants mostly scored very high and many reached very near the maximum attainable score. Hardly any endorsed the negative half of the response scale. Several problems are discussed including poor discrimination and strong evidence of acquiescence response bias. We also found little association of the scale scores with hypothesised correlates of hope. Future improvements on the measurement of hope are recommended, especially in studies outside the narrow Western context in which the scale was devised.     

胸腔镜下心包厚壁囊肿切除术1例报告

面对来势汹汹的新型冠状病毒肺炎(COVID-19),如何能够正确、快速诊断和筛检出确诊病例显得尤为重要,国内诸多科技工作者都在积极开展相关的诊断试验研究。本文回顾了目前正在开展的十余项诊断试验的注册信息,针对其中存在的共性问题进行了讨论,重点阐述了如何使用PICOS原则构造COVID-19诊断试验的研究问题,还对金标准的设置、受试者的代表性、样本量计算和同步、独立、盲法的测定等诊断试验的设计要点进行了详细说明。旨在为广大研究者提供开展COVID-19诊断试验的设计建议,帮助研究者在顶层设计阶段减少、避免偏倚,完成高质量的临床研究,为临床诊疗提供循证医学证据。