Inchoate guidelines of endoscopic resection of colloid cysts

Colloid cyst are cystic lesions in the third ventricle and could render patients asymptomatic. However, there is an inherent risk of symptomatic progression, acute decompensation, and sudden death. Therefore, there is no clear consensus as how to observe or when to treat a newly diagnosed patient with a colloid cyst. The authors’ objective is to identify the risk factors and then develop a risk stratification score to guide neurosurgeons during acute or chronic presentation. Radiological imaging characteristics have been outlined for the risk stratification as well preoperative evaluation. A baseline neuropsychological evaluation is helpful to obtain during an incidental presentation because history and neurological examination could be inconclusive in these cases. Radiological imaging with an MRI brain scan plays a vital role for the initial screening (determination of the cyst size, exact location, and the imaging characteristics) as well as for the preoperative planning. Stereotactic guidance is a high yield, followed by neuroendoscopic resection of the colloid cyst has been an established approach to resect these lesions. Modified colloid cyst risk scoring (mCCRS) system is robust and detailed for the optimal risk stratification of colloid cyst presentation. Stereotactic guided neuroendoscopic resection of the colloid cyst is a safe and efficacious approach to manage these lesions. The intended use, crucial steps involved, and the limitations of the technique have been discussed especially with a focus on the recurrence. Moreover, a comprehensive treatment algorithm has been presented.     

1例产后哺乳期腹泻患者分离单增李斯特菌的生物学特征分析

目的 分析1例单增李斯特菌所致产后哺乳期腹泻患者的临床特征、病原学、菌株的毒力基因携带及分子特征。方法 搜集病例的临床相关信息;采用选择性增菌和显色培养基分离单增李斯特菌,用VITEK- 2 COMPACT30 全自动细菌分析仪鉴定分离菌株,采用单增李斯特菌诊断血清对分离株进行血清分型,使用脉冲场凝胶电泳技术及多位点序列分型技术进行分子分型,应用PCR检测毒力基因,并用E-test方法检测分离菌株对5种抗生素的药物敏感性。结果 产后哺乳期患者食用甜瓜和冰箱冷藏的酸奶后引起不能自限的腹泻,检测结果证实病原为4b血清型、ST145序列型单增李斯特菌。分离菌株携带毒力基因plcB、act、hly、iap、prfA、inlA,对青霉素、氨苄西林、美罗培南、红霉素和复方磺胺均敏感。结论 单增李斯特菌引起的腹泻患者容易漏诊,加强孕妇等高危人群腹泻患者粪便标本中单增李斯特菌的检测,对于单增李斯特菌病病人的及时治疗,预防不良预后具有重要的公共卫生意义,尤其对这一特殊型别单增李斯特菌在我国引起的病例感染应引起重视,其可能的感染来源和致病风险值得进一步的研究。     

Patient preference for chronic obstructive pulmonary disease (COPD) treatment inhalers: a discrete choice experiment in France

Objectives: Understanding inhaler preferences may contribute to improving adherence in COPD patients and improving long-term outcomes. This study aims to identify and quantify preferences for convenience-related inhaler attributes in French moderate-to-severe COPD patients, with discrete choice experiment (DCE) methodology.

Methods: Attributes were defined from a literature search, clinician and patient interviews: shape, dose insertion, dose preparation, dose release, dose confirmation, dose counter and reusability. An online DCE was conducted in respondents with self-reported COPD stage 2–4 recruited through a panel. The study questionnaire included twelve choice scenarios per respondent and questions on patient characteristics, treatment and disease severity. Statistical analyses used a mixed logit regression model with random effects. Utility scores were estimated for four types of inhalers: Inhaler A – soft mist inhaler; Inhaler B – reusable soft mist inhaler; Inhaler C – multi-dose dry powder inhaler; and Inhaler D – single dose dry powder inhaler.

Results: The study was completed by 153 patients (50 females); respondents were 50.4?years old on average; 13 different inhaler devices were reported. The most preferred inhaler is L-shaped, has dose preparation with capsule insertion and a dose counter, and is reusable. Inhaler profiles A and B had the highest utilities (mean of 1.2533 and 0.9578 respectively) compared to inhaler C (0.6315) and D (0.2200).

Conclusions: This study showed statistically significant results that the strongest drivers of preference in French users of inhalation devices for COPD are shape, dose counter and reusability. Convenience-related characteristics are important to patients and should be taken into account by clinicians prescribing these devices.     

老年难治性胃食管反流病患者食管动力学特征和反流特点分析

目的 分析老年难治性胃食管反流病（rGERD）患者食管动力学特征和反流特点。方法 以我院2017 年2 月～2019 年12 月收治的100 例rGERD 患者为观察对象。按照年龄分为老年组（年龄≥60 岁）42 例和非老年组（年龄＜60 岁）58 例。比较两组基线资料、临床表现特征、食管动力学特征、反流特点。结果 老年组与非老年组在性别、BMI 指数、吸烟及饮酒方面比较，差异均无统计学意义（P＞0.05）。老年组胸痛、上腹部不适及慢性咳嗽发生率均高于非老年组，差异均有统计学意义（P＜0.05）。老年组LESP 及LEPP 水平均低于非老年组，差异均有统计学意义（P＜0.05）。老年组酸反流、弱酸反流、非酸反流、气体反流、气液混合反流次数均高于非老年组，差异均有统计学意义（P＜0.05）。结论 老年rGERD 患者存在明显的食管动力学异常，且该类患者的反流主要是弱酸反流、非酸反流、气体反流、气液混合反流。     

Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany

Objectives

Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.

No clear survival benefit of azacitidine for lower‐risk myelodysplastic syndromes: A retrospective study of Nagasaki

The efficacy of azacitidine (AZA) on survival of lower risk (LR) ‐ myelodysplastic syndromes (MDS) is controversial. To address this issue, we retrospectively evaluated the long‐term survival benefit of AZA for patients with LR‐MDS defined by International Prognostic Scoring System (IPSS). Using data from 489 patients with LR‐MDS in Nagasaki, hematologic responses according to International Working Group 2006 and overall survival (OS) were compared among patients that received best supportive care (BSC), immunosuppressive therapy (IST), erythropoiesis‐stimulating agents (ESA), and AZA. Patients treated with AZA showed complete remission (CR) rate at 11.3%, marrow CR at 1.9%, and any hematologic improvement at 34.0%, with transfusion independence (TI) of red blood cells in 27.3% of patients. and platelet in 20% of patients, respectively. Median OS for patients received IST, ESA, BSC, and AZA (not reached, 91 months, 58 months, and 29 months, respectively) differed significantly (P < .001). Infection‐related severe adverse events were observed in more than 20% of patients treated with AZA. Multivariate analysis showed age, sex, IPSS score at diagnosis, and transfusion dependence were significant for OS, but AZA treatment was not, which maintained even response to AZA, and IPSS risk status at AZA administration was added as factors. We could not find significant survival benefit of AZA treatment for LR‐MDS patients.     

免疫调节抗病毒中药的特性与应用

近期中国及世界各国的新型冠状病毒肺炎(COVID-19)疫情严重,目前尚无特效药。西医抗新型冠状病毒(SARS-Co V-2)药物的安全性和有效性均在考察和试验中。中国多地用中医药治疗COVID-19临床治愈率较高,且治疗经济性较好。免疫调节抗病毒中药在调节免疫力的同时具有抗病毒作用,在治疗COVID-19中应用较多。筛选2000-2020年中国知网、万方、维普和Pubmed数据库明确报道具有抗病毒和免疫调节作用的11种免疫调节抗病毒中药(甘草、广藿香、金银花、黄芩、连翘、厚朴、柴胡、板蓝根、大黄、黄芪、鱼腥草),总结了其有效成分的抗病毒和免疫调节作用、理化性质及药动学特性,以及在临床方剂和中成药中的应用,以期为中医药更好地用于COVID-19临床防治提供参考。     

肺痿、肺痹与肺间质纤维化证候认识

弥漫性肺间质疾病是一类以弥漫性肺泡炎症和肺间质纤维化为基本病理改变的疾病总称,其中特发性肺间质纤维化是一类慢性进展、预后差、病死率高的特发性间质性肺炎。结缔组织疾病亦可造成肺损伤而出现肺间质纤维化的表现,症状均以咳、痰、喘等为主。现代中医学者认为肺间质纤维化当归属于中医学的肺痹、肺痿、喘证等范畴。古代文献中对肺痿的认识基于《金匮要略》,其证候特点以肺胃气阴两虚为主,亦可见肺气虚冷;肺痹则是尊崇《内经》中"五脏痹"的理论,主要证候特点为肺气闭阻;而肺间质纤维化的现代研究则表明其证候特点多以气虚为本、瘀血为标。因此,二者分别代表了肺纤维化的不同阶段和(或)不同证候特点,即肺纤维化患者表现出气阴两虚、虚热灼肺或肺气虚冷的证候特点可参照肺痿论治,若表现为肺气闭阻之实证特点则当以肺痹论治。     

乳腺弥漫大B细胞淋巴瘤临床特点及预后分析

目的:探讨乳腺弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征及预后。方法:回顾性分析2014年5月起至2018年12月我院收治的18例乳腺DLBCL患者的临床特点及预后。结果:在18例患者中，17例为女性，中位年龄为57岁，病变主要累及右侧乳腺（11/18，61.1%）。将其分为原发性乳腺DLBCL（PB-DLBCL）和继发性乳腺DLBCL（SB-DLBCL）两大类。11例（57.6%）PB-DLBCL与7例（42.4%）SB-DLBCL相比，其具有Ann Arbor分期多为Ⅰ-Ⅱ期（P＜0.01）、B症状少（P=0.013）、相对更高的白细胞计数（P=0.041）、骨髓未累及（P=0.043）、完全缓解（CR）率高（P=0.049）等特点。生存分析发现PB-DLBCL患者5年总生存期（OS）显著长于SB-DLBCL患者（P=0.013）。本研究以非生发中心B细胞型（non-GCB）居多，生发中心型（GCB）与non-GCB型之间OS无显著差异（P=0.885）。所有获得CR患者的生存期均显著延长（P=0.008）。结论:乳腺DLBCL多见于中年女性，以右侧乳腺肿块为主要临床表现，分子分型多为non-GCB型。与SB-DLBCL患者相比，PB-DLBCL患者具有Ann Arbor分期早、B症状少、相对更高的白细胞计数、骨髓未累及、CR率高等特点，并且生存期显著延长。无论是PB-DLBCL和SB-DLBCL，还是GCB型和non-GCB型，获得CR提示预后良好。