Living or deceased organ donors in liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis

Background

The outcomes of living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT) for HCC patients were not well defined and it was necessary to reassess.

Intrapancreatic accessory spleen: a diagnostic dilemma

Background

As intrapancreatic accessory spleen (IPAS) is rarely encountered during clinical practice, the aim of this review was to summarize the epidemiologic features, the diagnosis and treatment of IPAS.

Severe Fear of Falling Is Associated With Cognitive Decline in Older Adults: A 3-Year Prospective Study

ObjectivesFear of falling (FOF) is common in older adults. We investigated whether FOF affects development of cognitive decline over a 3-year period in community-dwelling older adults with intact cognition.DesignRetrospective, cohort, observational.Setting and participantsData for 4280 older adults with normal cognition at baseline from the Survey of Living Conditions and Welfare Needs of Korean Older Persons (2008 and 2011).MethodsHistory of falls and severity of FOF (no fear, somewhat fearful, or very fearful) were assessed at baseline (2008). We evaluated cognitive function using the Korean version of the Mini-Mental State Examination in 2008 and 2011, and defined cognitive decline as a decrease of ≥3 points over the 3-year study period. Multivariable logistic regression analysis was performed to examine the association between FOF and cognitive decline.ResultsThe prevalence of being somewhat fearful of falling was 54.6% and that of being very fearful was 9.7%. The participants who were somewhat fearful of falling had a 1.2-fold higher risk of cognitive decline; this finding lost significance in adjusted models. The participants who were very fearful of falling had a 1.45-fold higher risk of cognitive decline than those with no FOF after adjusting for confounders [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.08–1.95]. When we divided the participants according to age, sex, and baseline cognitive function, the association was significant in men (OR 2.29, 95% CI 1.24–4.25), participants age >70 years (OR 1.57, 95% CI 1.06–2.33), and those with a Mini-Mental State Examination score <30 (OR 1.45, 95% CI 1.07–1.98).Conclusions and implicationsBeing very fearful of falling increased the risk of cognitive decline in older Korean adults. Physicians should be aware of the risk of development of cognitive impairment in older individuals with FOF.     

郭蓉娟教授诊疗情志病经验总结

结合中医传统经典理论,参考相关流派及各医家的不同观点,结合多年跟师体悟,整理郭蓉娟教授发表的论文和著作,归纳总结其治疗情志病的经验和遣方用药规律。在接诊情志病患者时,导师注重审症求因,借助现代医疗手段精准定位,推行叙事医学理念与平行病历的书写。在情志病治疗方面,导师提倡心身并调,结合现代心理学方法进行语言疏导和认知重构,临证用药不拘泥于单一脏腑,将调畅全身气机贯穿治疗始终,并身体力行中西医结合,优势互补。在情志病防治方面,导师认为应未病先防,既病防变,调理脾胃为治疗之本,擅于重用生黄芪。郭蓉娟教授治疗情志病经验丰富,以治未病思想为主导,古今结合,心身并调,脾胃为本,特色鲜明,疗效显著,其经验值得进一步挖掘和传承。     

基于中医传承辅助平台探讨过建春治疗慢加急性肝衰竭用药经验

<正>慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是指在慢性肝脏疾病的基础上，由各种诱因引起以急性黄疸加深、凝血功能障碍为肝衰竭表现的综合征，属于中医“急黄”“瘟黄”等范畴^[1]。ACLF是我国最常见的肝衰竭亚型，短期死亡率高，治疗难度大，目前仍缺乏特异性的治疗手段。中西医结合治疗在改善症状、提高患者生存率等方面具有独特的疗效及优势。