Papillary thyroid carcinoma with a high tumor mutation burden has a poor prognosis

BackgroundTumor mutation burden (TMB) as a prognostic marker for immunotherapy has shown prognostic value in many cancers. However, there is no systematic investigation on TMB in papillary thyroid carcinoma (PTC).MethodsBased on the somatic mutation data of 487 PTC patients from The Cancer Genome Atlas (TCGA), TMB was calculated, and we classified the samples into high-TMB (H-TMB) and low-TMB (L-TMB) groups. Bioinformatics methods were used to explore the characteristics and potential mechanism of TMB in PTC.ResultsHigh TMB predicts shorter progression-free survival (PFS) (P < 0.001). TMB was positively correlated with age, stage, tumor size, metastasis, the male sex and tall cell PTC. Compared to the L-TMB group, the H-TMB group presented with lower immune cell infiltration, a higher proportion of tumor-promoting immune cells (M0 macrophages, activated dendritic cells and monocytes) and a lower proportion of antitumor immune cells (M1 macrophages, CD8⁺ T cells and B cells). Additionally, the characteristics displayed by different TMB groups were not driven by critical driver mutations such as BRAF and RAS.ConclusionsPTC patients with high TMB have a worse prognosis. By stratifying PTC patients according to their TMB, advanced PTC patients who are candidates for immunotherapy could be selected.     

Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in Indian patients with retinal vein occlusion,age-related macular degeneration,and diabetic macular edema

Purpose:To evaluate the rate of compliance and the reasons for loss to follow-up in Indian patients with diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) being treated with anti-vascular endothelial growth factor (VEGF) therapy.Methods:This was a retrospective single-center study. Patients with DME, AMD, or RVO were eligible if they initiated anti-VEGF therapy between January 2013 and December 2017. Patients'' data were obtained from hospital electronic records, including the number of injections received, visits, details of follow-up, missed appointments, and reasons for loss to follow-up (>365 days).Results:A total of 648 patients were eligible for the study, of which 334 (51.54%) patients were lost to follow-up. Overall, 343 (64.96%) were males and the overall mean (SD) age was 66.40 (7.44) years. A total of 376 (58.0%) patients had a history of diabetes and 364 (56.2%) patients had a history of hypertension. Further, 127 (38.0), 112 (33.5), and 95 (28.4) had DME, AMD, and RVO, respectively and were lost to follow-up. The most commonly reported reason for loss to follow-up was “non-affordability” (n = 120; 41.1%) followed by “no improvement in vision” (n = 83; 28.4%). “No improvement in vision” (42.2%) and “non-affordability” (37.5%) were higher among patients with DME. No association was found in gender- and treatment-wise distribution of reasons for loss to follow-up.Conclusion:The results showed that around half of the patients with DME, AMD, and RVO were lost to follow-up to intravitreal anti-VEGF therapy, and the most common factors were “non-affordability” and “no improvement in vision.”     

Additional Peripheral Nerve Block to Periarticular Injection Has No Benefit for Patients Undergoing TKA: A Factorial Propensity Score–Matched Analysis Comparing Four Multimodal Analgesic Techniques

BackgroundControversy remains over what and how many analgesic techniques are required as the most effective multimodal pain regimen in total knee arthroplasty (TKA). This study aimed to evaluate the effect of additional analgesic methods combined with periarticular injection (PAI) analgesia for TKA.MethodsUsing retrospective cohort data, patients undergoing TKA with spinal anesthesia and PAI were divided into 4 groups. Group A (control) comprised 66 patients; group B (73 patients) had additional adductor canal block; group C (70 patients) obtained additional femoral nerve block, and group D (73 patients) received additional adductor canal block and intrathecal morphine. Propensity score matching was applied to compare visual analog scale (VAS) for pain intensity, cumulative morphine use (CMU), knee flexion angle, straight leg raise, length of hospital stay, and postoperative nausea and vomiting.ResultsThere was no significant difference regarding VAS and morphine use, when either group B or C was compared with group A. Group D had significantly lower VAS than groups A, B, and C during the first 24 hours after surgery and required significantly less CMU than groups A and B. However, the pain score of group D increased afterward, with significantly longer length of hospital stay than groups A and B. There was no difference in straight leg raise among the groups.ConclusionAdditional peripheral nerve block to PAI provides no benefit for patients undergoing TKA. Adjuvant intrathecal morphine could significantly reduce the VAS and CMU in the acute postoperative period; however, rebound pain with prolonged hospital stays was observed.     

复方亚甲蓝局部封闭联合中医药治疗肛周湿疹有效性和安全性的Meta分析

目的:系统评价复方亚甲蓝局部封闭联合中医药治疗肛周湿疹的有效性和安全性。方法:计算机检索中国知网(CNKI),维普中文期刊数据库(VIP),万方数字化期刊全文数据库,中国生物医学文献数据库,Embase,PubMed,Cochrane Library,收集复方亚甲蓝局部封闭联合中医药治疗肛周湿疹的临床随机对照研究,检索时限均为从建库至2019年5月。采用RevMan.5.3软件进行数据分析。结果:共纳入22个随机对照试验,共计2211例肛周湿疹患者。Meta分析显示:与常规治疗组相比,复方亚甲蓝局部封闭联合中医药治疗肛周湿疹在提高有效率、改善症状(瘙痒程度、渗出潮湿、皮损面积、皮损形态),降低症状体征总积分、减少复发率具有明显意义(P<0.05),但对于提高患者的生活质量意义不大(P=0.37>0.05);对降低不良反应发生率方面无明显意义(P=0.41>0.05),未见复方亚甲蓝局部封闭联合中药应用严重不良反应报道。结论:基于目前检索的文献及Meta分析结果,复方亚甲蓝局部封闭联合中医药治疗肛周湿疹的疗效在一定程度上优于常规疗法。但由于纳入研究的方法学质量偏低,证据质量低,临床治疗中可以借鉴应用,但仍需高质量的随机对照试验(Randomized Controlled Trial,RCT)进行验证。     

丹参川芎嗪注射液联合西药对急性缺血性脑卒中患者脑组织的保护作用及对预后的影响

目的:观察丹参川芎嗪注射液联合西药治疗对急性缺血性脑卒中患者脑组织的保护作用及对预后的影响。方法:以268例急性缺血性脑卒中患者为研究对象,按随机数字表法分为研究组和对照组各134例,2组均予西药治疗,研究组予以丹参川芎嗪注射液联合治疗,2组均随访至12周。治疗前后检测2组患者的血清炎症相关因子[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)、白细胞介素-8 (IL-8)]、血管内皮生长因子(VEGF)、神经元特异性烯醇化酶(NSE)和S-100β水平,随访评定患者治疗12周内的美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力量表(BI)评分。结果:治疗3周,2组hs-CRP、TNF-α、IL-6和IL-8水平均低于入院时(P<0.01);研究组各因子水平均低于对照组(P<0.01)。2组血清NSE和S-100β水平均较入院时降低(P<0.01),而VEGF水平较入院时升高(P<0.01)。研究组血清NSE和S-100β水平均低于对照组,VEGF水平高于对照组,差异均有统计学意义(P<0.01)。2组治疗后一时间点的NIHSS评分均低于同组治疗前一时间点(P<0.01),而2组治疗后一时间点的BI评分均高于同组治疗前一时间点水平(P<0.01)。治疗6周和12周,研究组的NIHSS评分均低于对照组(P<0.01),而BI评分均高于对照组(P<0.01)。结论:丹参川芎嗪注射液联合西药治疗可以有效减轻急性缺血性脑卒中患者的血管炎症反应程度、血管内皮细胞和脑组织的损伤程度,促进大脑神经细胞修复,提高患者卒中后的生活能力,防止卒中后肢体发生功能障碍,改善患者预后。     

High-Pressure Water Swelling Sealant Injection Injury to the Hand: a Case Report and Review of the Literature

High-pressure injection injuries (HPII) caused by water swelling sealant are rare at present. The patient generally has small-sized skin lesions, and the misleadingly benign presentation may cause delayed treatment at the early stage of management. In addition, radiographic examination may be underestimated. Subsequently, the inadequate surgical intervention may cause tissue necrosis and poor prognosis. Furthermore, the early recognition of water swelling sealant injected into tissue and emergent surgical intervention are the key to successful management for the patient with HPII caused by injecting water swelling sealant to tissue.     

Substance-use and sexual harm reduction strategies of methamphetamine-using men who have sex with men and inject drugs

Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance-use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.