Effects of Tai Chi exercise on improving walking function and posture control in elderly patients with knee osteoarthritis: A systematic review and meta-analysis

Objective:It remains unclear whether Tai Chi is effective for walking function and posture control improvements in aged populations with knee osteoarthritis. The aim of this study was to systematically evaluate the effects of Tai Chi on improving walking function and posture control in elderly patients with knee osteoarthritis by updating the latest trial evidence.Methods:Web of Science, PubMed/Medline, Embase, Scopus, PEDro, and Cochrane library were searched up to October 1, 2020 to identify RCTs evaluating Tai Chi for improving walking function and posture control in older adults with knee osteoarthritis. The primary outcomes were walking function and posture control. Meta-analysis was performed with RevMan Version 5.3 software.Results:A total of 603 participants with knee osteoarthritis in the 11 trials were included. The results of meta-analysis showed that: The Tai Chi group was associated with better performance in 6-minute walk test (6 MWT), time up and go test (TUG) and “Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index” Physical Function Score than the control group ([MD: 46.67, 95% CI 36.91–56.43, P < .001]), ([MD: −0.89, 95% CI −1.16 to −0.61, P < .001]), ([MD: −11.28, 95% CI −13.33 to −9.24, P < .001]).Conclusion:This meta-analysis provided evidence from 11 RCTs that Tai Chi could be an excellent physical training strategy for improving walking function and posture control in older adults with knee osteoarthritis. Assuming that Tai Chi is at least effective and safe in most areas, it can be used as an adjuvant and reliable physical training strategy for walking function upgrading and balance control improvements for older patients with knee osteoarthritis.     

Paraaortic dissection in “total mesopancreas excision” and “mesopancreas-first resection” pancreaticoduodenectomies for pancreatic cancer: Useless,optional, or necessary?A systematic review

The mesopancreas does not have well-defined boundaries but is continuous and connected through its components with the paraaortic area. The mesopancreatic resection margin has been indicated as the primary site for R1 resection after PD in pancreatic head cancer and total mesopancreas excision has been proposed to achieve adequate retropancreatic margin clearance and to minimize the likelihood of R1 resection. However, the anatomy of the mesopancreas requires extended dissection of the paraaortic area to maximize posterior clearance. The artery-first surgical approach has been developed to increase local radicality at the mesopancreatic resection margin. During PD, the artery-first approach begins with dissection of the connective tissues around the SMA. However, the concept of the mesopancreas as a boundless structure that includes circumferential tissues around the SMA, SMV, and paraaortic tissue highlights the need to shift from artery-first PD to mesopancreas-first PD to reduce the risk of R1 resection. From this perspective the “artery-first” approach, which allows for the avoidance of R2 resection risk, should be integrated into the “mesopancreas-first” approach to improve the R0 resection rate.In total mesopancreas excision and mesopancreas-first pancreaticoduodenectomies, the inclusion of the paraaortic area and circumferential area around the SMA in the resection field is necessary to control the tumour spread along the mesopancreatic resection margin rather than to control or stage the spread in the nodal basin.     

Intrauterine Device Initiation After Gonococcal and Chlamydial Infections: A Practice Workflow Initiative

Unplanned pregnancy remains an issue in the United States. The intrauterine device (IUD) is a solution. The IUD is safe for most women and is recommended for adolescents. Misconceptions exist about IUDs and sexually transmitted infections caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Accepted guidelines ensure the management of these sexually transmitted infections and subsequent, safe initiation of the IUD. The use of best practice alerts preserves the health care team’s adherence to clinical guidelines. This IUD provision initiative creates a workflow for the interprofessional team to ensure the safe initiation of an IUD to clients with a gonococcal or chlamydial infection.     

案例教学法、PBL教学法在实习教学中的应用

目的研究分析案例教学、PBL教学法在实习教学中的应用效果。方法选取2019年2月—2020年1月,共80名实习生在本院肿瘤内科实习,遵循计算机随机分组法将实习生分为甲组、乙组,每组40例实习生。甲组实习过程中实施传统教学法+PBL教学法,乙组实习过程中实施案例教学+PBL教学法,在两组实习生实习完毕后,采集相关数据并进行比较分析。分别实施传统教学法+PBL教学法、案例教学+PBL教学法,并进行比较分析。结果乙组笔试成绩、临床操作成绩、教学效果优于甲组(P<0.05)。结论在肿瘤内科实习生教学过程中采用案例教学法联合PBL教学法,可有效提高实习生的自主学习能力,可促使实习生主动参与学习,深入研究分析,深入理解所学知识,可有效提高实习生的理论、实践能力。     

Global,regional, and national survey on the burden and quality of care of pancreatic cancer: a systematic analysis for the Global Burden of Disease study 1990–2017

BackgroundPancreatic cancer (PC) is among the most lethal cancers worldwide, and the quality of care provided to PC patients is a vital public health concern. We aimed to investigate the quality of care of PC globally and to report its current burden.MethodsThe Quality of Care Index (QCI) was achieved by performing a Principal Component Analysis utilizing the results of the GBD study 2017. The QCI was defined as a range between 0 and 100, in which higher QCIs show higher quality of care. Possible gender- and age-related inequalities in terms of QCI were explored based on WHO world regions and the sociodemographic index (SDI).ResultsIn 2017, Japan had the highest QCI among all countries (QCI = 99/100), followed by Australia (QCI = 83/100) and the United States (QCI = 76/100). In Japan and Australia, males and females had almost the same QCIs in 2017, while in the United States, females had lower QCIs than males. In contrast to these high-QCI nations, African countries had the lowest QCIs in 2017. Besides, QCI increased by SDI, and high-SDI regions had the highest QCIs. Regarding patients’ age, elderly cases had higher QCIs than younger patients globally and in high-SDI regions.ConclusionThis study provides clinicians and health authorities with a wider vision around the quality of care of PC worldwide and highlights the existing disparities. This could help them investigate possible effective strategies to improve the quality of care in regions with lower QCIs and higher gender- and age-related inequities.     

Diagnostic échographique d’un souffle cardiaque systolique au sein d’une population de 280 jeunes militaires français. Implications en médecine d’expertise militaire

Clinically discovering a systolic murmur is frequent among the young military population. When this murmur does not sound benign, a transthoracic echocardiography (TTE) is made to detect any cardiopathy, which could cause sudden cardiac death. The aim of this study was to evaluate the interest of systematic TTE in the assessment of any cardiac systolic murmur (CSM) among militaries.MethodsWe ran a retrospective monocentric study in the “Clermont-Tonnerre” military hospital in Brest. We included all patients sent for TEE, aged 15 to 30 years old, from the 1st January 2010 until the 31st July 2013.ResultsTwo hundred and eighty TTES assessing CSM were performed. We found 28/280 (10%) echocardiographic abnormalities: 13 were bicuspid aortic valves (4.6%), 6 were ventricular septal defects (2.15%), 3 were atrial septal defects (1.07%), 4 were mild mitral regurgitations (1.43%), one mild pulmonary stenosis (0.35%) and one aortic stenosis (0.35%). No hypertrophic cardiomyopathy was found. Concerning military expertise, 11 (3.92%) patients among these 28 with abnormal TEE were considered unfit for work or “fit for work with limitations”.ConclusionAssessing a cardiac systolic murmur with TEE lead to the diagnosis of a cardiomyopathy in 10% of the case. This study enhances the importance of systematic TEE when a CSM is detected in the young military, in order to determine if those soldiers can still fulfill their military duty.     

Yam storage protein dioscorins modulate cytokine gene expression in BALB/c and C57BL/6 lymphocytes

This study aimed to evaluate the effects of dioscorins isolated from 2 yam species, Dioscorea alata (Da-dioscorins) and Dioscorea japonica (Dj-dioscorins), on mouse immune activities. Results from cytokine array indicated that Dj-dioscorins increased the production of tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-3, IL-6, IL-10, IL-12p40, IL-13, monocyte chemoattractant protein (MCP)-1, regulated on activation, normal T cell expressed and secreted (RANTES), and granulocyte colony-stimulating factor (GCSF) in the spleen cells of BALB/c mice. In RAW264.7 macrophage, Da-dioscorins upregulated the expression of TNF-α, IL-1β, IL-6, IL-10, RANTES, MCP-1, and GCSF genes to a greater extent than Dj-dioscorins did. TNF-α, IL-1β, IL-6, IL-10, and RANTES gene expression was higher in spleen cells than in bone marrow and thymus cells in Da-dioscorin- or Dj-dioscorin-treated BALB/c and C57BL/6. Overall, our results suggest that dioscorins exert distinct immunomodulatory effects on mouse immune cells, and that different mouse strains respond differently to dioscorins.     

护理专业大学生的复原力状况

目的:研究护理专业大学生复原力的情况,分析影响其复原力的因素,进而有针对性地对大学生进行必要的心理干预及预防,为有效开展大学生心理健康教育提供参考和依据。方法:在广东药学院大一~大四护理专业本科生中,随机抽取358名进行问卷调查,采用由刘兰兰编制的大学生复原力量表,并用SPSS 19.0做统计分析。结果:1护理本科生在性别方面总体复原力有显著差异,女生的总体复原力水平高于男生(F=5.001,P0.05);2在社会交往方面,不同年级存在显著差异,四年级的复原力水平最高(F=7.687,P0.05);在家庭支持方面,不同性别间的差异有统计学意义(t=2.251,P0.05);独生子女与非独生子女间的差异有统计学意义(t=2.203,P0.05)。在朋友支持方面,不同性别间的差异有统计学意义(t=3.629,P0.05);独生子女与非独生子女间的差异有统计学意义(t=1.990,P0.05)。在自我掌控方面,不同年级间的差异有统计学意义(F=3.045,P0.05);不同性别间的差异有统计学意义(t=2.105,P0.05)。结论:护理专业女生比男生的总体复原力水平高。社会交往、家庭支持、朋友支持、自我掌控等维度影响大学生复原力水平。