Brachytherapy: An emblematic example of extreme hypofractionated regimen

In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.     

肝移植受者延续护理中应用远程随访管理系统的效果研究

目的:探讨肝移植受者延续护理中应用远程随访管理系统的效果。方法:挑选2018年6月—2019年12月医院接受治疗的60例肝移植受者,在其出院后2周以自制的远程随访管理系统对其展开居家延续护理。结果:医护小组达成了对受者术后疾病状况的远程监控,通过视频交流为病人提供706例次健康指导。所有研究对象对远程随访管理系统的接受率、掌握率、应用时间、每次视频交流时间分别为81.08%、100.00%、(10.53±2.49)d、(12.13±2.69)min。肝移植受者满意度最高的3项依次是视频交流方式、延续护理模式、指导或者咨询内容;延续护理小组满意度最高的3项依次是病情变化处理方法、视频交流方式、指导或者咨询内容。结论:通过远程随访管理,为肝移植受者开展延续护理是现实可行的,不但能使肝移植受者的术后自我管理能力得到有效提升,且受者及延续护理小组都对此系统的应用具有较高的满意度。     

Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database

ObjectiveTo examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.Patients and MethodsThis cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.ResultsA total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.ConclusionPhysicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.     

布地奈德联合阿奇霉素治疗肺炎支原体肺炎

目的探讨布地奈德联合阿奇霉素治疗肺炎支原体肺炎。方法选取我院在2018年12月—2020年5月确诊并治疗的98例支原体肺炎患儿,依据不同治疗方式分成两组,两组均接受常规治疗,对照组应用阿奇霉素,研究组联合应用布地奈德。观察两组的治疗有效率水平差异;两组的康复指标:体温恢复正常耗时、缓解咳嗽气喘耗时、啰音消失耗时水平差异。结果研究组有效率水平比对照组高(P<0.05)。研究组的康复指标:体温恢复正常耗时、缓解咳嗽气喘耗时、啰音消失耗时均优于对照组(P<0.05)。结论给予支原体肺炎患儿在常规治疗基础上联合使用阿奇霉素+布地奈德,可显著提高患儿的治疗效果,缩短患儿的康复时间。     

Retention and survival rate of etanercept in psoriasis over 15 years and patient outcomes during the COVID-19 pandemic: The real-world experience of a single center

There have been a number of investigations of the efficacy and safety of etanercept. This study was performed to obtain long-term drug survival data (ie, time to drug discontinuation) for etanercept, and the reasons for its discontinuation. The study population consisted of patients with psoriatic arthritis and psoriasis followed up by our clinic, registered in the Turkish Psoriasis Registry (PSR-TR) and treated with etanercept for at least 4 weeks between January 1, 2005, and January 31, 2020. The efficacy of etanercept was evaluated in terms of the Psoriasis Area and Severity Index (PASI) 75, PASI 90 and PASI 100 response rates at 12, 24, 36, and 48 weeks, and annually thereafter. The behaviors of the patients with respect to the use of etanercept, and the outcomes of those who continued to use it during the COVID-19 pandemic, were also investigated.     

基于心冲击信号的心率检测方法

针对现有基于心冲击描记图进行心率检测存在的抗干扰性不足问题，提出一种鲁棒的心率检测模型，首先对原始信号中受干扰的片段进行补偿重构，然后将J峰作为特征波形，通过基于J峰频段的滤波与差分增强处理放大特征，并设计改进的峰值提取算法定位心跳点，进而得到心率估计值。实验结果表明，所用模型对于不同情形下的心冲击描记图信号均表现出良好的适应性，逐拍检测平均覆盖率为98.3%，平均准确率为98.4%。心率输出结果与金标准一致性高，误差范围控制在[±]5%以内，且运算实时性好，可以为临床或家庭保健提供良好的心率检测方案。     

Dynamic functional connectivity of the EEG in relation to outcome of postanoxic coma

ObjectiveEarly EEG contains reliable information for outcome prediction of comatose patients after cardiac arrest. We introduce dynamic functional connectivity measures and estimate additional predictive values.MethodsWe performed a prospective multicenter cohort study on continuous EEG for outcome prediction of comatose patients after cardiac arrest. We calculated Link Rates (LR) and Link Durations (LD) in the α, δ, and θ band, based on similarity of instantaneous frequencies in five-minute EEG epochs, hourly, during 3 days after cardiac arrest. We studied associations of LR and LD with good (Cerebral Performance Category (CPC) 1–2) or poor outcome (CPC 3–5) with univariate analyses. With random forest classification, we established EEG-based predictive models. We used receiver operating characteristics to estimate additional values of dynamic connectivity measures for outcome prediction.ResultsOf 683 patients, 369 (54%) had poor outcome. Patients with poor outcome had significantly lower LR and longer LD, with largest differences 12 h after cardiac arrest (LR_θ 1.87 vs. 1.95 Hz and LD_α 91 vs. 82 ms). Adding these measures to a model with classical EEG features increased sensitivity for reliable prediction of poor outcome from 34% to 38% at 12 h after cardiac arrest.ConclusionPoor outcome is associated with lower dynamics of connectivity after cardiac arrest.SignificanceDynamic functional connectivity analysis may improve EEG based outcome prediction.