The Prevalence of Incidental Simple Ovarian Cysts ≥ 3 cm Detected by Transvaginal Sonography in Early Pregnancy

ObjectiveTo determine the prevalence of simple ovarian cysts of ≥ 3 cm diameter detected by transvaginal sonography (TVS) in a population of asymptomatic women in early pregnancy.MethodsWe conducted a retrospective review of 10 830 consecutive women presenting prior to 14 weeks’ gestational age (GA) for early dating TVS. The records of all women with simple cysts ≥ 3 cm in diameter were included. The study population was divided into five groups by GA: ≤ 6 weeks; 6.1–8 weeks; 8.1–10 weeks; 10.1–12 weeks; and 12.1–14 weeks.ResultsA simple cyst ≥ 3 cm in diameter was present in 4.9% of women at ≤ 6 weeks’ gestation, in 5.1% between 6.1 and 8 weeks, in 5.3% between 8.1 and 10 weeks, in 3.2% between 10.1. and 12 weeks, and in 1.5% between 12 and 14 weeks. Overall, a simple cyst ≥ 3 cm was present in 516 women (4.8%). Prior to 10 weeks, 5.1% had simple cysts ≥ 3 cm, dropping to 2.7% after 10 weeks, a statistically significant decrease (P < 0.0001). Between 10.1 weeks and 12 weeks, the prevalence dropped to 3.2%, and then to 1.5% in the 12.1–14 week group.ConclusionThis investigation provides reference data on the prevalence of detecting simple ovarian cysts ≥ 3 cm by TVS in an asymptomatic early pregnancy population. A progressive decline in the frequency of detecting simple ovarian cysts ≥ 3 cm begins after 10 weeks’ gestational age.     

Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review

IntroductionTwo major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques.MethodsThree major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures.ResultsUsing three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32)ConclusionThe current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.     

First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients

BackgroundThis study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period.MethodsThis study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI.ResultsThe intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = −0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05).ConclusionsThe APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.     

Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

TGF-β1和CD105在胰腺癌中的表达及其临床意义

目的探讨TGF-β1和CD105在胰腺癌生长、浸润、转移过程中的作用，为对患者进行预后判断及生物治疗提供理论依据。方法应用免疫组织化学S-P法检测TGF-β1、CD105在52例胰腺癌和10例非肿瘤性胰腺组织中的表达，分析它们与胰腺癌临床病理参数及患者生存率的关系。结果TGF-β1在非肿瘤性胰腺组织、胰腺癌中的阳性表达率分别为30％和80．77％，两者间的差异具有统计学意义（P〈0．01）。TGF-β1的表达强度与胰腺癌临床分期及淋巴结有无转移呈正相关（P〈0．01）。在52例胰腺癌中，CD105标记的微血管密度（Micro Vessel Density，MVD）明显高于非肿瘤性胰腺组织（P〈0．01）。胰腺癌分化程度越低，CD105标记的MVD值越高，并且TNM分期Ⅲ、Ⅳ期MVD值显著高于Ⅰ、Ⅱ期（P〈0．01），淋巴结转移组的MVD值显著高于无淋巴结转移组（P〈0.01）。此外，生存单因素分析TGF-β1、CD105与胰腺癌的预后有关（P〈0．01）。结论TGF-β1和CD105在胰腺癌生长、浸润和转移过程中发挥了一定的作用。     

Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review

ObjectivesTo identify peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services.DesignReview of qualitative and quantitative studies.Data sourcesA comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch.Review methodsAll articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ statement.ResultsEighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers’ perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals’ negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies.ConclusionsThis review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles.