基于生物钟节律探讨前列腺癌的 发病机理及择时治疗策略

生物钟节律观与中医“天人一体”观相契合，生物钟节律紊乱可影响人体的生理病理状态，通过调节生物钟节律可达到提高治疗效果的目的。生物钟节律系统包括中枢生物钟节律系统与外周生物节律系统两大系统，分别在疾病发生发展中发挥不同的作用。与之相应，择时疗法是根据人体气血阴阳节律变化而选择相应药物治疗以达到最佳的疗效的一种时间医学治疗方法。临床上许多前列腺癌患者的发病与生物钟节律紊乱密切相关，通过调整生物钟节律具有预防和改善前列腺癌预后的积极作用。因此，本文将以现代生物钟节律的生理及病理机理为切入点，探讨不同生物钟节律系统紊乱在促前列腺癌中医主证形成过程中的发生机理，进而探讨择时治疗策略在不同类型前列腺癌治疗中运用的可行性，以期对前列腺癌的防治及预后产生一定的影响。     

Effects of immediate or early oral feeding on acute pancreatitis: A systematic review and meta-analysis

BackgroundThe timing of oral refeeding can affect length of stay (LOS) and recovery of acute pancreatitis (AP). However, the optimal timing for oral refeeding is still controversial for AP. This meta-analysis investigated the effects of immediate or early versus delayed oral feeding on mild and moderate AP, regardless of improvement in clinical signs or laboratory indicators.MethodsThis systematic review and meta-analysis of randomized controlled trials (RCTs) based on data from Embase, Cochrane Library, PubMed, Web of science, and CBM before August 2021. Two researchers independently used Stata16 to extract and analyse study data. Random effect model was performed for meta-analysis to calculate the risk ratio (RR) and standardized mean difference (SMD).Results8 RCTs were selected, including 748 patients with mild to moderate AP. Patients in IOR (Immediate or early Oral Refeeding) group had less costs [SMD -0.83, 95%CI (?1.17, ?0.5), P < 0.001] and shorter LOS [SMD -1.01, 95%CI (?1.17, ?0.85), P < 0.001] than the DOR (Delayed Oral Refeeding) group patients. However, there was no difference in mortality [RR 0.54, 95%CI (0.11, 2.62), P = 0.44], pain relapse rate [RR 0.58, 95%CI (0.25, 1.35), P = 0.27], feeding intolerance rate [RR 0.61, 95%CI (0.28, 1.3), P = 0.2], AP progression rate [RR 0.21, 95%CI (0.04, 1.07), P = 0.06] and overall complications rate [RR 0.41, 95%CI (0.17, 1.01), P = 0.05] between the IOR and DOR groups.ConclusionsLimited data suggest that IOR could reduce LOS and costs without increasing adverse events in mild to moderate AP.     

Impact of vaccination delay on deaths averted by pneumococcal conjugate vaccine: Modeled effects in 8 country scenarios

Delay in vaccination from schedule has been frequently documented and varies by vaccine, dose, and setting. Vaccination delay may result in the failure to prevent deaths that would have been averted by on-schedule vaccination.We constructed a model to assess the impact of delay in vaccination with pneumococcal conjugate vaccine (PCV) on under-five mortality. The model accounted for the week of age-specific risk of pneumococcal mortality, direct effect of vaccination, and herd protection. For each model run, a cohort of children were exposed to the risk of mortality and protective effect of PCV for each week of age from birth to age five. The model was run with and without vaccination delay and difference in number of deaths averted was calculated. We applied the model to eight country-specific vaccination scenarios, reflecting variations in observed vaccination delay, PCV coverage, herd effect, mortality risk, and vaccination schedule. As PCV is currently being scaled up in India, we additionally evaluated the impact of vaccination delay in India under various delay scenarios and coverage levels.We found deaths averted by PCV with and without delay to be comparable in all of the country scenarios when accounting for herd protection. In India, the greatest relative difference in deaths averted was observed at low coverage levels and greatest absolute difference was observed around 60% vaccination coverage. Under moderate delay scenarios, vaccination delay had modest impact on deaths averted by PCV in India across levels of coverage or vaccination schedule. Without accounting for herd protection, vaccination delay resulted in much greater failure to avert deaths.Our model suggests that realistic vaccination delay has a minimal impact on the number of deaths averted by PCV when accounting for herd effect. High population coverage can largely over-ride the deleterious effect of vaccination delay through herd protection.     

小细胞肺癌脑转移发生时间与预后分析

目的 探讨小细胞肺癌(SCLC)脑转移发生时间与预后的关系。 方法 回顾分析2007-2015年收治的首发远处转移部位为脑的局限期SCLC患者 131例,依据中位无脑转移生存期(BMFS)将病例分为A、B两组,其中BMFS≤10个月为A组(61例),BMFS>10个月为B组(70例)。Kaplan-Meier法计算生存率,Logrank法比较组间差异,Cox模型多因素预后分析。 结果 131例SCLC患者中位总生存期及1、2、3年生存率分别为22.5个月及87.3%、44.7%、20.8%;全组中位脑转移后生存期及1、2年生存率分别为9.3个月及39.3%、14.8%。由于A、B组脑转移后中位生存期相近(分别为8.6、9.3个月,P=0.695),进而对未行预防性脑照射的A、B两组患者进行分析,其脑转移后生存期也相近(P=0.240~0.731)。 结论 SCLC脑转移发生时间与总生存相关,而与脑转移后生存无关,因此着重预防和减少脑转移的发生可能是提高SCLC患者生存的重要手段。     

Intrauterine insemination: simultaneous with or 36 h after HCG? A randomized clinical trial

Research questionDoes intrauterine insemination (IUI) carried out simultaneously with HCG triggering (‘simultaneous IUI’) increase the ongoing pregnancy rate compared with IUI 32–36 h after HCG triggering (‘regular IUI’)?Study designAn open-label randomized clinical trial was conducted in seven Dutch fertility clinics. One hundred and sixty-six couples were randomized to receive simultaneous IUI and 208 couples to receive regular IUI. Treatment was allocated using a computer-based randomization algorithm using sealed opaque envelopes. Data were analysed according to the intention-to-treat principle. Couples with unexplained or mild-to-moderate male factor subfertility were eligible. Exclusion criteria were female age 42 years or older, female body mass index 35 kg/m² or over, double-sided tubal pathology or severe male factor subfertility.Mild ovarian stimulation was carried out by subcutaneous FSH self-administration. ‘Simultaneous IUI’ was carried out at the point of HCG triggering for ovulation. ‘Regular IUI’ was carried out 32–36 h after HCG triggering.ResultsThe cumulative ongoing pregnancy rate after a maximum of four cycles was 26.2% for simultaneous IUI (43 ongoing pregnancies) and 33.7% for regular IUI (70 ongoing pregnancies) (RR 0.78 95% CI 0.57 to 1.07). Ongoing pregnancy rates per cycle in the simultaneous IUI group were 6.8%, 10.5%, 9.5% and 7.4% for the first, second, third and fourth IUI cycle. In the regular IUI group, ongoing pregnancy rates were 8.3%, 16.4%, 13.5% and 9.0% for the first, second, third and fourth IUI cycle.ConclusionsThis multicentre randomized controlled trial did not demonstrate that IUI carried out at the point of HCG triggering increases pregnancy rates compared with IUI carried out around the time of ovulation.     

Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet

Background

In our experience, for all surgeries in the hand, the optimal epinephrine effect from local anesthesia—producing maximal vasoconstriction and visualization—is achieved by waiting significantly longer than the traditionally quoted 7 min from the time of injection.

Methods

In this prospective comparative study, healthy patients undergoing unilateral carpal tunnel surgery waited either 7 min or roughly 30 min, between the time of injection of 1 % lidocaine with 1:100,000 epinephrine and the time of incision. A standardized incision was made through dermis and into the subcutaneous tissue followed by exactly 60 s of measuring the quantity of blood loss using sterile micropipettes.

Results

There was a statistically significant reduction in the mean quantity of bleeding in the group that waited roughly 30 min after injection and before incision compared to the group that waited only 7 min (95 % confidence intervals of 0.06 + −0.03 ml/cm of incision, compared to 0.17 + −0.08 ml/cm, respectively) (P = 0.03).

Conclusions

Waiting roughly 30 min after injection of local anesthesia with epinephrine as oppose to the traditionally taught 7 min, achieves an optimal epinephrine effect and vasoconstriction. In the hand, this will result in roughly a threefold reduction in bleeding—making wide awake local anesthesia without tourniquet (WALANT) possible. This knowledge has allowed our team to expand the hand procedures that we can offer using WALANT. The benefits of WALANT hand surgery include reduced cost and waste, improved patient safety, and the ability to perform active intraoperative movement examinations.     

Timing of first restorations in permanent teeth: a new system for oral health determination

Objectives: A system of oral health determination in which times between eruption of teeth and first restorations because of caries is measured is applied in a retrospective analysis of oral health data relating to rural health centres in Finland.

Method: The retrospective analysis was carried out using data relating to three health centres in different parts of Finland. The times between eruption and the placement of the first restorations in subjects up to 18 years of age were investigated.

Results: Between 10% and 25% of all permanent molar teeth were filled in the year of tooth emergence —the ‘immediate posteruptive step’. A steadily increasing restoration placement rate—the ‘ascending growth phase’—was observed after the ‘posteruptive step’. The restoration rate was found to plateau 5–8 years after eruption—the ‘retardation phase’.

Conclusions: Restoration increment curves with longitudinal measurements are believed to be a sensitive indication of oral health at both individual and population levels.