Patient Selection for Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Cancer: Consensus on Decision Making Among International Experts

BackgroundColorectal cancer (CRC) treatment for patients with peritoneal metastases is complex. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has continued to be debated. The aim of the present study was to assess the consensus among international experts for decision-making regarding the use of CRS and HIPEC for patients with CRC.Materials and MethodsOf 15 experts invited, 12 had provided their decision algorithms for CRS and HIPEC for patients with, or at high risk of, peritoneal metastases from CRC. Using the objective consensus method, the results were transformed into decision trees to provide information on the consensus and discordance.ResultsOnly 1 scenario was found for which the consensus on performing HIPEC had reached 100%. The scenario was the treatment of young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of < 16 in the presence of certain risk factors. Five major decision criteria were identified: age, PCI, completeness of cytoreduction, extent of extraperitoneal metastases (EoMs), and, in the case of unverified EoMs, additional risk factors. Consensus was found regarding refraining from using HIPEC for older patients with a high PCI. The consensus further increased when addressing incomplete cytoreduction and an extensive extent of EoMs.ConclusionA definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance; however, owing to the heterogeneity of each individual situation, the impracticality of presenting the information through decision trees, and the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice could not be achieved.     

Manejo y seguimiento radiológico del paciente post-COVID-19

Most of the patients who overcome the SARS-CoV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate / severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.     

膝痹宁对膝骨关节炎模型大鼠滑膜纤维化的影响

目的观察膝痹宁对膝骨关节炎(KOA)模型大鼠滑膜纤维化的影响。方法大鼠分为空白组、KOA组、膝痹宁组;KOA组、膝痹宁组造模。分别在膝痹宁灌胃治疗的第1、14、28、42、56天测量各组大鼠的膝关节横径;第56天处死大鼠提取滑膜组织,解剖学观察滑膜组织形态;天狼星红染色评估滑膜组织胶原沉积情况;WB和PCR检测纤维化标记物生长转化因子-β(TGF-β)、Ⅰ型胶原α1链(COL1α1)、金属蛋白酶抑制剂1(TIMP1)的蛋白和基因表达。结果膝痹宁用药14天,28天时,膝关节横径变化并不显著,但膝痹宁用药42天,56天时,膝关节横径则较KOA模型明显减小,差异具有统计学意义(P<0.05);用药56天后对大鼠进行膝关节解剖学观察,KOA大鼠滑膜组织较正常大鼠有一定程度的增厚、充血、欠规则;而上述表现在膝痹宁大鼠有所减轻;天狼星红染色显示膝痹宁用药大鼠滑膜组织胶原沉积较少;纤维化标记指标物TGF-β、COL1α1、TIMP1的基因和蛋白表达在膝痹宁组均较KOA组降低,差异具有统计学意义(P<0.05)。结论膝痹宁对能有效减轻KOA滑膜纤维化,以“温经活血”立法的中药复方对组织纤维化具有良性干预效应。     

Bilateral total deafness after preparation of wild boar meat

IntroductionStreptococcus suis is responsible for a zoonosis for which Suidae (pigs and wild boars) constitute the reservoir, mainly in Asia, with a much lower prevalence in Europe. The predominant clinical manifestation is meningitis, possibly resulting in deafness.Case reportWe report the case of a woman hospitalised for meningitis complicated by labyrinthitis, occurring several hours after preparing a meal composed of wild boar meat. Despite the presence of intracochlear fibrosis, the patient was managed by sequential bilateral cochlear implants.DiscussionThe discussion presents a review of the international literature and describes the mechanisms responsible for hearing loss related to this rare zoonosis.     

实时剪切波弹性成像在拉米夫定治疗乙肝纤维化过程中的疗效评估作用

目的探讨实时剪切波弹性成像在评估拉米夫定治疗乙肝纤维化临床疗效中的作用。方法选取2017年1月～2018年1月我院收治的80例乙肝纤维化患者,根据随机数字法分为对照组和观察组,每组40例。对照组采用常规治疗,观察组在对照组的基础上给予拉米夫定进行治疗,治疗6个月。比较两组治疗前后肝功能、肝纤维化指标,利用实时剪切波弹性成像评估两组治疗前后肝脏弹性模量值及肝穿刺活检情况,并进行比较。结果两组治疗后AST、ALT、TBIL水平均明显低于治疗前,差异有统计学意义(P0.05);观察组治疗后AST、ALT、TBIL水平均明显低于对照组,差异有统计学意义(P0.05);两组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于对照组,差异有统计学意义(P0.05);与治疗前相比,两组治疗后肝穿刺活检结果均有好转,尤其是汇管区、肝小叶内炎症及肝纤维化改善明显。结论实时剪切波弹性成像作为肝脏硬度定量检测的无创性技术,可用于拉米夫定治疗乙肝纤维化临床疗效评估的重要方法。     

Non alcoholic fatty liver disease and risk of incident diabetes in subjects who are not obese

Background and aims

It is not known whether non alcoholic fatty liver disease (NAFLD) is a risk factor for diabetes in non obese, non centrally-obese subjects. Our aim was to investigate relationships between fatty liver, insulin resistance and a biomarker score for liver fibrosis with incident diabetes at follow up, in subjects who were neither obese nor centrally-obese.