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61.
Jan F.M. Verbeek Chris H. Bangma Charlotte F. Kweldam Theodorus H. van der Kwast Intan P. Kümmerlin Geert J.L.H. van Leenders Monique J. Roobol 《Urologic oncology》2019,37(2):138-144
Introduction
The use of risk calculators predicting clinically significant prostate cancer (csCaP) on biopsy reduces unnecessary biopsies and overdiagnosis of indolent disease compared to a Prostate Specific Antigen (PSA) strategy. Updating these tools using more specific outcome measures and contemporary predictors could potentially lead to further reductions. Our objective was to assess clinical impact of the 4 kallikrein (4K) score, the Rotterdam Prostate Cancer Risk Calculator (RPCRC), and the combination of both for predicting csCaP based on the latest International Society of Urological Pathology grading system and cribriform growth pattern.Materials and methods
Our prospective cohort consisted of 2,872 men from the first screening round in the European Randomized Study of Screening for Prostate Cancer Rotterdam; biopsy indication PSA ≥ 3.0. The predictive performance of the 4Kscore, RPCRC, and the combination of RPCRC with 4Kscore were assessed with area under the receiver operator characteristic curve (AUC) and calibration plots. Decision curve analysis was used to evaluate the reduction of unnecessary biopsy and indolent CaP.Results
The csCaP was present in 242 (8%) men, and indolent CaP in 578 (20%). The 4Kscore and RPCRC had similar high AUCs (0.88 vs. 0.87; P?=?0.41). The 4Kscore-RPCRC combination improved AUC to 0.89 compared to 4Kscore (P < 0.01) and RPCRC (P < 0.01). The RPCRC and 4Kscore reduced the number of Bx with 42 and 44, respectively, per 100 men at risk compared to a ≥PSA 3.0 strategy without increasing missed csCaP. The RPCRC-4Kscore combination resulted in a slight additional net reduction of 3.3 biopsies per 100 men.Conclusions
The RPCRC and 4Kscore had similar reductions of unnecessary biopsies and overdiagnosis of indolent disease. Combination of both models slightly reduced unnecessary biopsies further. Gain in net benefit must, however, be weighed against additional costs and availability of tests. 相似文献62.
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目的 分析重症监护病房(ICU)感染病原菌分布及其耐药趋势,为ICU有效预防与控制医院感染提供依据。方法 采用回顾性研究方法,收集我院2013-2017年综合ICU送检的25057份临床标本分离的病原菌进行细菌种类鉴定和药敏试验。结果 分离病原菌6938株,其中革兰阴性菌5513株(79.46%),革兰阳性菌710株(10.23%),真菌715株(10.31%),排名前4位分别为鲍曼不动杆菌(31.65%)、肺炎克雷伯菌(15.90%)、铜绿假单胞菌(11.46%)和大肠埃希菌(6.31%)。真菌随着时间变化呈现下降后升高趋势,鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌呈现升高后下降趋势,而肺炎克雷伯菌呈现下降后升高趋势。分离出多重耐药菌1387株,前3位分别为鲍曼不动杆菌(84.21%)、肺炎克雷伯菌(8.22%)和铜绿假单胞菌(4.83%)。5年间多重耐药鲍曼不动杆菌分布率均显著高于肺炎克雷伯菌和铜绿假单胞菌(P=0),且在2016年检出率达最高,2013和2017年检出率最低;多重耐药肺炎克雷伯菌在2017年检出率达最高,2013年检出率最低;多重耐药铜绿假单胞菌5年间差异无统计学意义(P>0.05)。结论 我院病原菌以革兰阴性菌为主,不同年份病原菌及其耐药性变化有所不同,应定期监测病原菌及其耐药性变迁,正确合理使用抗菌药物。 相似文献
66.
Sílvia Aguiar Rosa Pedro Silva Cunha Ana Lousinha Bruno Valente Ana Sofia Delgado Ricardo Pimenta Manuel Brás Madalena Coutinho Cruz Guilherme Portugal André Viveiros Monteiro Mário Oliveira Rui Cruz Ferreira 《Revista portuguesa de cardiologia》2019,38(1):11-16
Introduction
Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs.Methods
In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail.Results
A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported.Conclusion
Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice. 相似文献67.
目的 观察对住院医师规范化培训部分学员使用Mini-CEX进行临床教学的效果。方法选取我院2015级住培学员40名,随机分为对照组和实验组,每组20人。2015年10月至2018年4月,对照组采用传统教学;实验组在传统教学基础上结合Mini-CEX活动,实验组每人在每个轮转科室至少进行2次Mini-CEX。毕业时应用改良的Mini-CEX评分量表、病例答辩和OSCE三种考核方法对两组学员进行测评。针对实施过Mini-CEX的教师和学员分别发放问卷,进行满意度调查。采用SPSS 18.0对数据进行统计分析,组间比较采用独立样本t检验,组内前后比较采用配对样本t检验。结果 Mini-CEX测评显示,两组学员各项临床能力毕业成绩均高于入学成绩,实验组学员毕业成绩优于对照组,实验组学员成绩提高分数大于对照组提高分数,差异均有统计学意义(P<0.05)。病例答辩显示,实验组学员平均成绩为(81.16±3.75)分,优于对照组的(70.13±3.88)分,差异有统计学意义(t= -9.140,P=0.000)。OSCE考核显示,实验组平均总分为(96.300±4.681),优于对照组的(91.775±3.227)分,差异有统计学意义(t=-3.559,P=0.001)。共发放调查问卷80份,其中教师40份、学员40份,结果显示教师满意率达95.0%、学员满意率达92.5%。结论 Mini-CEX应用于住院医师规范化培训临床带教中,有利于提高学员的临床思维、医患沟通和人文关怀能力。 相似文献
68.
目的:探讨评价消风散合黄连解毒汤治疗湿疹效果及价值。方法:选择2017年5—12月治疗湿疹的患者54例作为对象,随机数字表分为对照组(27例)和观察组(27例)。对照组给予常规盐酸西替利嗪片治疗的方法,观察组采用消风散合黄连解毒汤治疗,15 d后对两组治疗方法的患者血清白细胞介素(Interleukin,IL)-4、γ-干扰素(γ-Interferon,IFN-γ)水平和临床治疗效果进行评估,比较两组湿疹患者体内的血清IL-4、IFN-γ含量以及患者治愈、显效、好转、无效以及总有效率的情况。结果:治疗前后两组患者IL-4、IFN-γ差异无统计学意义(P>0.05)。经15 d治疗后,观察组血清IL-4、IFN-γ水平相较于对照组有明显改善,差异有统计学意义(P<0.05),观察组患者总有效率高于对照组,临床治疗效果显著优于对照组(P<0.05)。结论:将消风散合黄连解毒汤治疗用于湿疹,相较于盐酸西替利嗪片治疗,患者血清水平更佳,临床疗效更好,值得推广应用。 相似文献
69.
《Clinical lung cancer》2020,21(5):e464-e473
BackgroundIn advanced epidermal growth factor receptor (EGFR)-mutated non–small-cell lung cancer (NSCLC) patients whose disease has progressed during treatment with first- and second-generation tyrosine kinase inhibitors (TKIs), liquid biopsy (LB) is routinely used to evaluate the presence of EGFR T790M as an acquired resistance mechanism. The objective of this study was to assess a real-life picture of EGFR T790M detection in LB.Materials and MethodsLiquid biopsies performed between June 2016 and October 2018 for advanced EGFR-mutated NSCLC at disease progression during treatment with first- and second-generation TKIs were retrospectively evaluated in 5 Italian centers. Circulating tumor DNA was extracted from plasma and tested with different commercial kits. The detection rate in LBs and the patients’ characteristics were correlated.ResultsWe enrolled 120 consecutive patients. The overall T790M detection rate observed using LB was 25.8%. Fifty-four of 89 (60.7%) patients with negative LB results underwent tissue rebiopsy, and 56% were positive for T790M. The overall rate of T790M positivity in the study cohort was 49.2%. LB performed before formal tumor progression according to Response Evaluation Criteria In Solid Tumors criteria was negative for T790M in all patients (n = 21; P = .012). T790M positivity was statistically significantly higher in cases of disease progression at extrathoracic metastatic sites (P = .008) and, specifically, in the case of worsening bone disease (P = .003).ConclusionOur study shows that the detection of T790M-positive patients whose disease progressed during treatment with first- and second-generation TKIs in real life was according to the literature. However, this result was obtained with a specific clinical course (repeat LBs and tissue rebiopsy), thus implying the necessity for multidisciplinary management. 相似文献
70.