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1.
BackgroundA bleeding episode may herald cancer in the general population. Oral anticoagulants (OACs), the mainstay treatment for atrial fibrillation (AF), are known to increase the risk of bleeding, and may thus promote an earlier diagnosis of cancer. Data regarding the association of bleeding episodes with cancer in patients with AF on OACs are scarce.MethodsIn this systematic review and meta-analysis, we searched electronic databases (Medline, Scopus, and Central) and gray literature sources for studies of patients with nonvalvular AF under any OAC, from inception until 14 October 2020. The primary outcome was the association of bleeding occurrences with the detection of cancer. A subgroup analysis was performed according to OAC type [NOAC (non-vitamin K oral anticoagulant) versus VKA (vitamin K antagonist)].ResultsOverall, 4 studies were included, accounting for a total of 144,362 patients with AF receiving OAC. During follow-up, 816 (0.57%) cases of cancer were confirmed. The presence of a bleeding event, either major or minor, was associated with a higher risk for cancer detection (odds ratio [OR] 8.79, 95% confidence interval [CI] 4.98-15.51, and I2 85%). Heterogeneity was explained after studies were stratified by the type of OAC (NOACs: OR 6.12, 95% CI 4.47-8.37, I2 0%, VKAs: OR 15.16, 95% CI 12.61-18.23, and I2 0%).ConclusionThe detection of a bleeding event could be an alerting sign of cancer in patients with AF on OACs, particularly in patients receiving VKAs.Registration number (DOI)available in https://doi.org/10.17605/OSF.IO/3948R, DOI: 10.17605/OSF.IO/3948R.  相似文献   
2.
目的观察揿针耳穴贴压在体外受精-胚胎移植(IVF-ET)经阴道超声穿刺取卵术中的镇痛效果及不良反应,探讨其可能的镇痛机理。方法将2020年1月至2021年2月收治的210例行IVF-ET经阴道超声穿刺取卵术的患者按治疗方法分为3组:揿针组、耳穴压豆组、药物对照组,每组70例。揿针组和耳穴压豆组选穴均为双侧子宫、盆腔、神门、交感、皮质下、内分泌,分别予揿针和耳豆贴压,药物对照组选吲哚美辛0.1 g纳肛,比较3组患者取卵术中及术后1 h的疼痛分级指数(PRI)、现有疼痛强度(PPI)、目测类比定级法(VAS),术中及术后不良反应发生率、取卵手术时间及获卵数。结果3组的取卵时间、获卵数差异无统计学意义(P>0.05)。揿针组、耳穴压豆组及药物对照组的术中及术后1 h PRI、VAS、PPI评分呈增高趋势,差异有统计学意义(P<0.05)。揿针组(8.57%)、耳穴压豆组(10.00%)总不良反应发生率低于药物对照组(34.29%),差异有统计学意义(P<0.01)。结论揿针在IVF-ET经阴道取卵术中镇痛效果好,术中及术后不良反应发生率低,且效果优于耳穴压豆。  相似文献   
3.
本文内容来源于2022年7月22日由上海市医师协会、上海市医师协会全科医师分会主办的"第二届海上全科医师论坛",主要包括《基层医疗在整合医疗中的作用》《创建全科医学科为国家临床重点专科》《上海市基层卫生发展趋势》《拥抱变化,更好更强》四部分。其中,《基层医疗在整合医疗中的作用》从整合程度、整合层面、整合方向3个维度阐释了"整合医疗"的概念与内涵,并就整合医疗在制度、管理、支付、服务模式、技术应用5个层面的实现路径做了详细介绍;在分析基层医疗和整合医疗共性特征的基础上,阐释基层医疗在上述5个层面对整合医疗的助推作用。《创建全科医学科为国家临床重点专科》从全科医学科在卫生保健改革、满足居民卫生服务需求中的重要作用出发,阐述了创建全科医学科为国家临床重点专科的必要性,认为创建临床重点专科需做到:提高全科医学科学术地位,推进全科医学人才建设,提升全科医学科区域协同能力,形成全方位全周期健康照护专科特色,加快全科医学科研创新发展。《上海市基层卫生发展趋势》肯定了基层卫生对城市健康发展的贡献,提出在"大健康"的背景下进一步的重点工作为推进健康老龄化和实现出生人口提升计划;上海基层卫生的发展趋势在于创新,而基层卫生高质量发展工作的创新需要由全科医生作为推动者和牵头者,创造出新的健康服务模式。《拥抱变化,更好更强》,认为当前社区卫生服务的"薄弱"之处,并非发展之初的硬件或人员配置不足,而是体现在全科学科建设方面。全科医学领域工作者应主动面对和接纳当前国家健康战略的变化、健康需求的变化、医学模式的变化、自身发展/管理的变化,开展主动健康,应对多病共存,加强全-专结合,关注需方角度的服务评价,以助力全科医学学科建设。  相似文献   
4.
Several attempts have been made to understand when and how the two hemispheres of the brain work together to encode and retrieve information during memory tasks, but it remains unclear whether they are equally capable of encoding and retrieval, particularly when the stimuli do not evoke a leftward processing asymmetry. Using a divided visual field paradigm, we presented nonverbal visual stimuli to one visual field/hemisphere at encoding, and at retrieval presented the stimuli either to the same or opposite visual field/hemisphere. Recognition responses were faster and more accurate when the stimuli were initially presented at encoding and retrieval to the same hemisphere (Experiment 1), even when delay intervals between study and test were short (Experiment 2). Taken together, these findings suggest that recognition decisions for stimuli initially presented to a single hemisphere occur more quickly at shorter lags, perhaps due to a stronger memory representation in the original hemisphere of input compared to the indirectly activated hemisphere. Our results are significant because they demonstrate that each hemisphere of the brain can function to encode and retrieve memory representations equally well, as long as the stimuli contain no linguistic information.  相似文献   
5.
BackgroundClinical concern exists regarding fretting corrosion and material loss from taper junctions in orthopedic devices, with previous research focusing on the modular components from total hip arthroplasty. Comparatively little has been published regarding the fretting corrosion and material loss in modular knee devices. The purpose of this study is to evaluate fretting corrosion damage and quantify material loss for conical total knee arthroplasty taper interfaces.MethodsStem tapers of 166 retrieved modular knee devices were evaluated for fretting corrosion using a semiquantitative scoring method. High precision profilometry was then used to determine volumetric material loss and maximum wear depth for a subset of 37 components (implanted for 0.25-18.76 years). Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to characterize the observed damage.ResultsMild to severe fretting corrosion was observed on the majority of tapers, with 23% receiving a maximum visually determined damage score of 4. The median rate of volumetric material loss was 0.11 mm3/y (range 0.00-0.76) for femoral components (both cone and bore taper surfaces combined) and 0.01 mm3 (range 0.00-8.10) for tibial components. Greater rates of material loss were associated with mixed metal pairings. There was a strong correlation between visual fretting corrosion score and calculated material loss (ρ = 0.68, P < .001). Scanning electron microscopy revealed varying degrees of scratching, wear, fretting corrosion, and instances of cracking with morphology not consistent with fretting corrosion, wear, or fatigue.ConclusionAlthough visual evidence of fretting corrosion damage was prevalent and correlated with taper material loss, the measured volumetric material loss was low compared with prior reports from total hip arthroplasty.  相似文献   
6.
We report a 7‐year‐old male patient who developed severe atrioventricular block after transcatheter closure of the atrial septal defect with an Occlutech Figulla® Flex II ASD occluder (FSO). He had a small aortic rim and the defect measuring 22.3 mm by balloon sizing. When a 24 mm FSO was deployed, he developed Wenckebach second‐degree heart block; however, it recovered to sinus rhythm. Hence, the device was implanted. The rhythm deteriorated to a fixed 2:1 heart block within 7 hr. He underwent surgical retrieval of the device and closure of the defect. Intraoperative findings demonstrated the right atrium disk compressing the triangle of Koch, resulting in a small hematoma. The rhythm recovered completely by 7 days after the surgery. Care must be taken when a relatively large device is deployed in a patient with small rims as even “soft and flexible” device like the FSO can injure the endocardium.  相似文献   
7.
《Vaccine》2019,37(43):6310-6316
BackgroundSerotype 3 pneumococcal disease has not substantially declined at the population level after the routine introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into pediatric immunization programs across the globe. This epidemiological finding has generated debate regarding the effectiveness of PCV13 against serotype 3 disease. Evaluating PCV13 effectiveness against serotype 3 is especially critical in adults, where serotype 3 makes up an important amount of remaining pneumococcal disease.MethodsWe performed a systematic review of the published literature to assess the direct effectiveness of PCV13 against serotype 3 community-acquired pneumonia (CAP) among adults. We then estimated overall vaccine effectiveness (VE) using a pooled analysis of the individual-level, raw data.ResultsTwo published studies met inclusion criteria. One was a randomized controlled trial conducted in the Netherlands and published in 2014. The other was a recently-published case-control study conducted in Louisville, Kentucky that used a test-negative design (TND). We also identified a third TND study conducted in Argentina that was recently presented as a conference abstract but is not yet published. All three studies were conducted in adults aged ≥65 years. PCV13 VE against serotype 3 hospitalized CAP was 52.5% (95%CI: 6.2–75.9%) from the pooled analysis of individual-level data from all three studies. Results were similar if the unpublished estimate was excluded (serotype 3 VE = 53.6% [95%CI: 6.7–76.9%]). No heterogeneity was observed.ConclusionsCurrently-available evidence, although limited to three studies, suggests that PCV13 provides direct protection against serotype 3 hospitalized CAP in adults aged ≥65 years.  相似文献   
8.
9.
PurposeAnimal experiments have shown that the loss of occlusal support causes impairments in spatial cognition. Many reports have focused on the memory encoding process, and only few studies have investigated the effect on memory retrieval. This study aimed to examine the effects of both the loss and reconstruction of occlusal support on the memory retrieval process and on the number of hippocampal pyramidal cells.MethodsThe experimental animals were divided into a molarless group, in which molars were extracted, a denture-wearing molarless group with experimental dentures inserted after molar extraction, and a control group. Radial maze trials were performed for 20 consecutive days (acquisition phase). The rats were tested on long-term memory retention following the acquisition phase in eight trials every five days, and in an additional trial 20 days later (probe phase).ResultsThe denture-wearing molarless group showed higher levels of spatial learning and memory than the molarless group. There were no significant differences in memory retrieval during the probe phase between the denture-wearing molarless and the control group. The molarless group showed significantly worse spatial learning and memory and had fewer neurons in the hippocampus than the control group.ConclusionsOur results suggest that the loss of occlusal support decreases the number of pyramidal cells in the hippocampus and impairs memory decoding and retrieval. However, this effect is suppressed by the reconstruction of occlusal support.  相似文献   
10.
BackgroundApproximately 7% of breast cancers are diagnosed in women under 40. Question of subsequent fertility has become fundamental. We aimed to evaluate the rate of fertility preservation (FP) by oocyte retrieval (OR) after ovarian stimulation in patients of childbearing age, managed for breast cancer with adjuvant chemotherapy in France, reuse rate of frozen gametes and live births rate (LBR) after treatment.MethodsWe included 15,774 women between 18 and 40 years old, managed by surgery and adjuvant chemotherapy for breast cancer, between January 2011 and December 2020 from a French health registry. Patients with OR after breast surgery and before chemotherapy were considered as FP group; those with no OR as no FP group. To compare LBR with French population independently of age, we calculated Standardized Incidence Rates (SIR) of live births using indirect standardization method.ResultsFP rate increased gradually since 2011, reaching 17% in 2019. A decrease in use was observed in 2020 (13,9%). Among patients with at least 2 years of follow-up, gamete reuse rate was 5,6%. Births after cancer were mostly from spontaneous pregnancies. Among patients with at least 3 years of follow-up, LBR was 19,6% in FP group, 3,9% in second group. SIR of live births was of 1,05 (95% CI = 0.91–1.19) and 0.33 (95% CI = 0.30–0.36) in FP and no FP group respectively.ConclusionOncofertility activity increased until 2019 in France, reaching 17%. Gamete reuse rate was low. Births resulted mainly from spontaneous pregnancies. SIR of live births was lower in no FP group.  相似文献   
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