Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non–small cell lung cancer: A propensity-matched analysis

Objective

Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non–small cell lung cancer has not been extensively studied.

CT与MRI对脑梗死后出血性转变的诊断价值

目的探讨CT与MRI在脑梗死后出血性转变(HT)中的诊断价值。方法对2011-01—2014-04我院收治的45例HT患者的临床资料进行回顾性分析,对CT与MRI的检查结果进行对比。结果45例患者中,脑内血肿34例(75.6%),脑梗死病灶内片状、斑点状或条状出血11例(24.4%)。其中大面积脑梗死继发出血24例(53.3%),中等面积继发出血15例(33.3%),小面积脑梗死继发出血6例(13.3%);CT检出HT 10例(22.2%),MRI检出45例(100%),差异有统计学意义(P0.05);在对不同部位的HT检查中,CT检出幕上出血9例(20.0%),幕下出血1例(2.2%);MRI检出幕上出血39例(86.7%),幕下出血6例(13.3%)。MRI对幕上及幕下出血的检出率均优于CT(P0.05)。结论在HT的诊断中,MRI比CT更加准确和敏感,在判断出血时间、指导临床治疗以及预后判断中具有重要意义。     

Yakima Valley Farm Workers Clinic oral health transformation project

The Yakima Valley Farm Workers Clinic (YVFWC) is one of the largest community health centers in the country with clinics throughout south-central Washington and northern Oregon. Its dental program consists of 14 dental clinics providing general and specialty services to the low-income populations it serves. Modeling itself after the YVFWC medical managed care program; the Dental program recently added value-based metrics to its dental practice after Oregon offered a value-based dental reimbursement plan in 2019. This is the first-step YVFWC's dental program that has taken to prepare for value-based reimbursement and transform its dental practice in order to reduce the disease burden in its patient population. The purpose of this article is to describe the processes YVFWC undertook to prepare itself for the new reimbursement model, which included the development of metrics, a metric validation process, a clinical dashboard, and a method for improving metrics. It also outlines its medical/dental integration improvement brought about by embedding hygienists into the medical primary care teams.     

甲状腺手术患者围术期优质护理干预效果探讨

目的观察分析在甲状腺手术患者护理中予以围术期优质护理干预的应用价值。方法此研究从本院甲状腺手术患者中选取样本,总例数为80例,研究时间始于2017年4月,止于2019年4月,依据护理方案的异同对患者进行分组,试验组予以围术期优质护理干预,对照组予以常规性护理干预,对比两组护理结果。结果研究可得,试验组护理满意率相对较高,组间数据对比得知与对照组相比统计值合理(P<0.05)。研究可得,试验组并发症发生率相对较低,组建数据对比得知与对照组相比统计值合理(P<0.05);研究可得,试验组预后生活质量相对较高,组建数据对比得知与对照组相比统计值合理(P<0.05)。结论此研究得知,在甲状腺手术患者护理中予以围术期优质护理干预,能提高患者护理效果,降低其并发症发生情况,并进一步改善患者预后效果。     

中期18F-FDG PET-CT两种图像判读法在弥漫性大B细胞淋巴瘤预后评估中的应用

目的:探讨中期正电子发射型计算机断层显像(positron emission tomography-computed tomography,PET-CT)Deauville五分法(Deauville five-point scale,5-PS)与最大标准摄取值缩减率(maximum standard uptake value variation,△SUVmax)两种图像判读法在弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者预后评估中的应用价值。方法:回顾性分析2012年10月至2018年6月重庆医科大学附属第一医院收治的94例DLBCL患者资料。采用Kaplan-Meier法及Cox比例风险回归模型进行生存资料分析,计算并采用χ2检验比较5-PS和△SUVmax对DLBCL患者预后预测的能力。结果:5-PS和△SUVmax分别以4分、86%进行分组。5-PS<4分组、△SUVmax≥86%组的患者无进展生存期(progression free survival,PFS)和总生存期(overall survival,OS)均优于5-PS≥4分组、△SUVmax<86%组的患者(P<0.05)。△SUVmax与5-PS对患者PFS和OS均有影响,较高的阴性预测值(89.4%,93.6%;76.1%,85.9%),较低的阳性预测值(48.9%,31.9%;47.8%,34.8%),并且△SUVmax对于患者的敏感性优于5-PS(82.1%,83.3%vs.39.3%,44.4%)。单因素分析中国际预后指数(international prognostic index,IPI)(P=0.007)、△SUVmax(P<0.001)、5-PS(P=0.014)及基线全身肿瘤代谢体积(total metabolic tumor volume,TMTV)(P=0.001)与PFS相关,△SUVmax(P=0.014)、5-PS(P=0.033)、TMTV(P=0.004)与OS相关;多因素分析显示TMTV是OS的独立预测因子(P=0.005),△SUVmax和TMTV是PFS的独立预测因子(P=0.002,P=0.020),并且△SUVmax<86%且高水平TMTV患者较低TMTV患者的PFS明显缩短(P=0.001)。结论:5-PS和△SUVmax均能初步评估DLBCL患者预后,但△SUVmax具有更高的预测价值,并且联合基线TMTV可以对DLBCL患者进行再次危险度分层。     

Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

There were few studies assessed the postoperative sarcopenia in patients with cancers. The objective of present study was to assess whether postoperative development of sarcopenia could predict a poor prognosis in patients with adenocarcinoma of esophagogastric junction, (AEG) and upper gastric cancer (UGC).

Prognostic tools for hypertrophic scar formation based on fundamental differences in systemic immunity

Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP‐1, IL‐8, IL‐18 and IL‐23 levels have a strong correlation with HS (P < .010‐0.004; AUC = 0.790‐0.883). Notably, combinations of two or three cytokines (TNF‐a, MCP‐1 and IL‐23; AUC: 0.942, Nagelkerke R²: 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice.