Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study

Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS), and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients. This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were nondeath-censored graft, death-censored graft, and patient survival. In total, 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS, and 139 (40%) an ESP kidney. 62.5% were male, and median age was 68 years. LDK recipients had significantly better 5-year nondeath-censored graft survival compared with ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, P = 0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, P < 0.001). After 5 years, the difference remained significant (P < 0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, P = 0.480). In elderly recipients, the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.     

Locoregional therapy in de novo metastatic breast cancer: Systemic review and meta-analysis

BackgroundLocoregional therapy (LRT) in de novo metastatic disease is controversial with inconsistent results from randomized control trials (RCTs).MethodsRCTs comparing LRT and systemic therapy to standard therapy alone in de novo metastatic breast cancer were identified. Hazard ratios (HRs) and their associated 95% confidence intervals (CIs) were computed and pooled in a meta-analysis using generic inverse variance. Overall survival (OS) and time to locoregional progression data were extracted for the intention to treat (ITT) population. Data on OS for pre-specified subgroups defined by tumor subtype and by site of metastases were also extracted.ResultsAnalyses included 4 trials comprising 970 patients. LRT included standard surgery to the primary breast tumor in all studies, and adjuvant radiation per standard of care was required in 3 studies. Compared to standard treatment, LRT was not associated with improved OS in the ITT population (HR 0.97, 95% CI 0.72–1.29, p = 0.81). However, LRT was associated with improved time to locoregional progression (HR 0.36, 95% CI 0.14–0.95, p = 0.04). LRT was not associated with improved OS in any tumor subtypes, including hormone receptor positive (HR 0.96, 95% CI 0.65–1.43), triple negative (HR 1.4, 95% CI 0.50–3.91) and human epidermal growth factor receptor 2 positive disease (HR 0.93, 95% CI 0.68–1.28). Additionally, LRT did not improve OS in bone only disease (HR 0.97, 95% CI 0.58–1.62) and in visceral disease (HR = 1.02, 95% CI 0.77–1.35). Our critical appraisal has identified some methodological problems in the design and conduct of the studies included that could affect the meta-analysis result.ConclusionsLRT in de novo metastatic breast cancer is not associated with improved OS. Results are consistent among different breast cancer subgroups. However, this conclusion should be interpreted with caution in view of the limitations identified in meta-analysis.     

Damage control orthopaedics in polytraumatized patients- current concepts

The principles of fracture management in patients with multiple injuries continue to be of crucial importance. Early treatment of unstable polytraumatized patients with head, chest, abdomen or pelvic injuries, with blood loss followed by immediate fracture fixation (Early Total Care -ETC) may be associated with secondary life threatening posttraumatic systemic inflammatory response syndrome (SIRS). Development of SIRS is typically a function of the type and severity of the initial injury (the “first hit”). Immediate Fracture fixation, using reamed nails or plates, in such unstable patients with multiple injuries is subsequently defined as the “second hit” and may be associated with development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), with relatively high morbidity and mortality.The other alternative for long bone fracture fixation in unstable polytraumatized patients is based on immediate treatment of life threatening conditions related to the injuries, followed by the initial use of minimally invasive modular external frames for long bone fractures and is called Damage Control Orthopedics (DCO) and is widely accepted. In order to refine the DCO concept and to avoid an overuse of external fixation, the “Safe Definitive Surgery” (SDS) concept has been introduced, which is a dynamic synthesis of both strategies (ETC and DCO). The SDS strategy employs clinical parameters and includes repeated assessment of patients. The following paper is going to summarize historical backgrounds and recent concepts in treatment of polytraumatized patients.     

透析中运动干预对维持性血液透析患者的影响

目的 探讨维持性血液透析患者透析中运动干预的实施效果.方法 将患者随机分为观察组29例和对照组30例,对照组按常规进行透析护理,包括生命体征监测、记录治疗参数和健康教育,透析中不进行运动干预;观察组在常规护理基础上根据自制的透析中运动方案进行运动干预,其中有氧运动40 min、阻力运动20 min.比较两组干预前和干预6个月后的透析充分性、运动能力、炎症指标和生活质量.结果 干预6个月后观察组透析充分性、运动能力、炎症指标测评结果和生理健康评分显著优于对照组(P＜0.05,P＜0.01).结论 对维持性血液透析患者进行透析中运动干预,能够提高患者透析充分性,增强运动能力,改善炎症指标,提升生理健康水平.     

调畅五脏、调和营卫治疗自汗临证体会

通过分析汗与五脏、营卫的关系,探讨自汗证的病因病机,概括为五脏皆有汗,汗之本为心,汗之化为肾,汗之出为肺,汗之源为脾胃,汗之调为肝。又必以营卫调和为要,汗出方能有节。五脏功能失调、营卫失和均可致自汗。故提出“调畅五脏、调和营卫”的自汗证治则及处方用药,通过典型临床病案,进一步阐释诊疗思路及用药规律。     

肛周坏死性筋膜炎术后热毒炽盛期应用解毒消痈饮的疗效观察

[目的] 探讨解毒消痈饮治疗肛周坏死性筋膜炎术后热毒炽盛期的临床效果。[方法] 将60例肛周坏死性筋膜炎患者随机分为对照组和观察组,各30例。对照组采用术后对症支持的常规治疗+痛痒消洗剂坐浴,观察组在对照组的基础上,术后口服解毒消痈饮治疗。[结果] 观察组治疗后第3、7、14天视觉模拟评分量表（VAS）评分均低于对照组,差异具有统计学意义（P<0.05）;两组治疗14 d后白细胞（WBC）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）较治疗前显著减低,且观察组明显低于对照组（P<0.05）,而血红蛋白（Hb）较治疗前明显升高,且观察组优于对照组（P<0.05）;两组治疗14 d后坏死性筋膜炎实验室风险指数评分（LRINEC）、Fournier坏疽严重程度指数（FGSI）均较治疗前显著减低,且观察组明显低于对照组（P<0.05）;观察组治疗后第7、14天创面渗液和创面水肿情况评分均低于对照组,差异具有统计学意义（P<0.05）;观察组创面愈合时间较对照组短（P<0.05）;观察组的总有效率优于对照组（P<0.05）。[结论] 肛周坏死性筋膜炎术后热毒炽盛期应用解毒消痈饮疗效确切,能够有效缓解术后疼痛,降低炎症反应,提高血红蛋白含量,有利于评估患者术后病情及预后,减轻术后创面渗液和创面水肿,加速创面愈合。     

中医外治法在慢性萎缩性胃炎中的应用研究进展

慢性萎缩性胃炎（CAG）是消化系统常见的慢性疾病,被认为是胃癌癌前病变,严重危害人类健康。如何有效促进胃黏膜的修复、抑制腺体的萎缩、阻断癌变是临床研究的热点。目前西医尚缺乏特效的治疗手段,近年来,大量研究结果表明,中医外治法在治疗CAG方面取得了显著成果,且具有简、便、效、廉等优势,深受患者青睐。现查阅近年来包括针刺法、灸法及贴敷法等在内的常用中医外治法治疗CAG的相关文献并进行综述,以期为临床治疗该病提供参考。     

从心身同治角度针灸对乳腺癌关节痛患者生命质量改善的临床研究

目的:评价基于《黄帝内经》心身疾病病因的整体选穴与乳腺癌芳香化酶抑制剂(AI)关节痛局部配穴相结合的针灸方法,对乳腺癌康复期AI关节痛患者生命质量及局部关节症状的临床疗效。方法:选取2019年1月至2021年5月南京医科大学第一附属医院乳腺外科筛选使用唑来膦酸的乳腺癌AI患者232例作为研究对象,依据针灸意愿分为对照组(n=19)和观察组(n=16),对照组采用唑来膦酸常规镇痛,观察组在唑来膦酸的基础上采用整体及局部取穴相结合的方法针灸治疗,共治疗4周,分别评价治疗前、治疗2周、4周、8周时的乳腺癌患者生命质量量表(FACT-B)生命质量评分以及简明疼痛评估量表(BPI-SF)关节痛评分,同时评估针灸治疗的安全性。结果:治疗4周以及8周时观察组FACT-B生命质量评分较对照组高,治疗4周时观察组BPI-SF疼痛评分较对照组低,差异有统计学意义(P<0.05)。结论:采用整体配穴调和心身与局部选穴缓急止痛相结合的针灸方法对乳腺癌康复期AI患者的生命质量以及局部关节症状有较好的临床疗效。     

从发病机制概述针刺治疗血管性痴呆的研究进展

血管性痴呆是脑血管病变后所引起的认知功能障碍,是临床中较为常见的痴呆类型。其发病机制源于血管系统损害引起低脑血流灌注、氧化应激等一系列病理过程。针灸作为一种非药物疗法,在脑血管病及相关疾病中有较为广泛的临床应用,许多研究都显示了针灸对认知功能的改善作用,并涉及细胞凋亡、氧化应激、神经炎症、神经递质通路等方面的调节作用。因此,现从血管性痴呆的发病机制角度探讨针刺的治疗作用,以期为进一步揭示针灸在血管性痴呆治疗中的潜在机制提供参考。     

红芪多糖药理作用及机制的研究进展

红芪是甘肃道地药材,现代药学研究表明红芪多糖是红芪的主要活性成分,是由五碳糖、六碳糖和其衍生物糖醇或糖酸构成的植物多糖,具有免疫调节、抗氧化、抗炎、抗肿瘤、机体保护、防治糖尿病及抗骨质疏松等药理作用。通过对红芪多糖的药理作用进行综述,阐明红芪多糖药理作用可能的机制,为红芪多糖的进一步研究及临床应用提供理论依据。