动态血压变异性与主观认知下降进展的相关性CSCD

Objective To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD). Methods In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD‑Q9 questionnaire was used to self‑evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow‑up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow‑up and were included in this study. According to the MoCA score at the end of follow‑up (<26 or ≥26), the patients were divided into progression group (39 cases) and non‑progression group (44 cases). The difference of MoCA score between baseline and last follow‑up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD‑Q9 score in the progression group were tested by multiple linear regression analysis. Results The 4‑year progression rate of SCD patients was 46.99% (39/ 83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD‑Q9 score and MoCA score between the progressive group and the non‑progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non‑progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P= 0.016]. There was no significant difference in 24 h DCV between the two groups (P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference (r=-0.368, P= 0.021). Conclusion There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value. © 2023 Chinese Journal of Health Management. All rights reserved.     

Incidence,characteristics, management and outcome of patients with follicular lymphoma with tumor epidural compression,a study on 22 cases

PurposeFollicular lymphoma (FL) is one of the most common lymphoma. Occasionally, FL is associated with tumoral epidural compression and management of these patients remain poorly codified. This study aims to report incidence, clinical characteristics, management and outcomes of patients with FL and tumoral epidural compression.Material and methodsObservational, retrospective cohort study of adult patients with FL and epidural tumor compression, treated in a French Institute over the last 20 years (2000–2021).ResultsBetween 2000 and 2021, 1382 patients with FL were followed by the haematological department. Of them, 22 (1.6%) patients (16 men and 6 women) had follicular lymphoma with epidural tumor compression. At epidural tumor compression occurrence, 8/22 (36%) patients had a neurological clinical deficit (motor, sensory or sphincter function) and 14/22 (64%) had tumor pain. All patients were treated with immuno-chemotherapy; the main regimen being used was R-CHOP plus high dose IV methotrexate in 16/22 (73%) patients. Radiotherapy for tumor epidural compression was performed in 19/22 (86%) patients. With a median follow-up of 60 months (range = [1–216]), 5 year local tumor relapse free survival was achieved in 65% (95% CI 47–90%) of patients. The median PFS was of 36 months (95% CI 24–NA) and 5 years OS estimate was 79% (95% CI 62–100%). Two patients developed a relapse at a second epidural site.ConclusionFL with tumoral epidural compression reached 1.6% of all FL patients. Management based on immuno-chemotherapy with radiotherapy appeared to produce comparable outcomes with the general FL population.     

The Natural History of Advanced Chronic Liver Disease Defined by Transient Elastography

1. Download : Download high-res image (185KB)
2. Download : Download full-size image

     

Progresión en glaucoma. Guía de práctica clínica

ObjectiveTo provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence.MethodsAfter defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology.ResultsRecommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented.ConclusionsDespite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.     

Factores clínicos e histológicos predictores de reclasificación en pacientes incluidos en programa de vigilancia activa de cáncer de próstata

Introduction and ObjectiveActive surveillance (AS) has been established as a therapeutic strategy in patients with low-risk prostate cancer. Demographic and anatomopathological factors that increase the probability of reclassifying patients have been identified.Materials and MethodsLaboratory and histopathological data were collected from 116 patients included on AS since 2014. Univariate analysis was performed with Chi-square, t-student and Kendall's Tau, multivariate analysis according to logistic regression and Kaplan-Meier curves were calculated.ResultsOf the 116 patients in AS, the median age at diagnosis was 66 years and the median follow-up was 13 months (2-72). Of these, 61 (52.6%) are still on surveillance, while 55 (47.4%) have left the program, mostly due to histological progression (52 patients (45.2%)); radical prostatectomy was performed in 27 (49.1%). Prostate volume (PV) ≤ 60cc and the number of positive cylinders > 1 in diagnostic biopsy (p = 0.05) were associated with higher reclassification rate in univariate analysis (p < 0.05). Multivariate analysis showed that these two variables significantly correlated with higher reclassification rate (PV 60 cc: OR 4.39, p = 0.04; > 1 positive cylinder at diagnostic biopsy: OR 2.48, p = 0.03).ConclusionsIt has been shown that initial ultrasound volume and the number of positive cylinders in the diagnostic biopsy are independent risk factors for reclassification. Initial PSA, laterality of the affected cylinders and PSA density were not predictive factors of progression in our series.     

乳腺癌化疗相关性肝损伤的研究进展

【摘要】 乳腺癌是目前世界上女性最常见的恶性肿瘤之一。化疗作为乳腺癌患者全身治疗的重要组成部分常引发患者肝功能损伤。肝损伤反过来又会影响乳腺癌的治疗与预后。本文就乳腺癌化疗相关性肝损伤的发生机制、诊断、危险因素及防治原则进行综述，对预测其发生、指导其防治具有重要意义。