直肠癌新辅助放疗研究进展

在过去的近40年里，直肠癌的治疗方案逐渐标准化。大多数早期直肠癌患者仅通过手术即可得到充分的治疗。然而，相当比例的直肠癌患者处于局部进展期，此类患者需要行新辅助治疗。直肠癌的新辅助放射治疗已被证明能有效地降低患者术前肿瘤分期、改善患者生存以及降低直肠癌局部复发率等，随之而来的是患者放疗后出现的不同程度的放疗不良反应，但随着放射治疗规范化、放射治疗技术及设备的改进，放疗不良反应严重程度在逐渐降低。本文就新辅助放疗中的放疗方案的选择、放射治疗技术、放疗不良反应、放疗后的手术时间以及放疗后的观察与等待等问题的最新研究进展进行了系统性的综述，从而为临床直肠癌新辅助治疗提供有力依据。     

三黄消疕膏治疗寻常型银屑病血热证的临床疗效观察

目的:探讨三黄消疕膏用于治疗寻常型银屑病血热证的临床效果和安全性。方法:选取2017年12月-2018年11月就诊于我院的寻常型银屑病患者80例,根据随机数字表法,分为治疗组和对照组,对照组口服决银颗粒治疗,治疗组除口服决银颗粒外,外用三黄消疕膏于局部皮损处,治疗2周后,分别对两组患者进行皮损面积及严重程度(Psoriasis Area and Severity Index,PASI)评分、皮肤病生活质量指数(Dermatology Life Quality Index,DLQI)评分、有效率、不良反应发生率评分。结果:治疗后,两组患者PASI评分下降,差异有统计学意义(t=3.34,P<0.05);DLQI评分下降,差异有统计学意义(t=5.59,P<0.05);治疗组有效率为91%,对照组有效率为62%,差异有统计学意义(χ^2=30.09,P<0.01);两组患者治疗后不良反应发生率较低,差异无统计学意义(P>0.05)。结论:三黄消疕膏联合决银颗粒治疗寻常型银屑病血热证可取得较好的临床效果,且安全性较高,值得推广。     

光学相干断层扫描血管成像对玻璃体腔注射雷珠单抗治疗湿性年龄相关性黄斑变性的随访观察

目的 利用光学相干断层扫描血管成像(OCTA)观察雷珠单抗玻璃体腔注射3次+必要时(3+PRN)方案治疗湿性年龄相关性黄斑变性(AMD)的图像特征。方法 选取2016年9月至2017年5月经荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)检查确诊且未予治疗的湿性AMD患者8例8只眼,按照3+PRN治疗方案给予玻璃体腔注射雷珠单抗(0.5 mg/0.05 ml)治疗,采用OCTA 6 mm×6 mm范围模式扫描黄斑区视网膜,在患者治疗前,治疗后1、3、6个月进行规律的门诊随访,记录患者最小分辨角对数(logMAR)矫正视力、脉络膜新生血管(CNV)分型、CNV形态特征及变化、黄斑中心凹视网膜厚度(CRT)、黄斑区视网膜外层血流密度(ORVD)及脉络膜毛细血管层血流密度(CCVD)。结果 男性4例4只眼,女性4例4只眼,平均年龄(70.9±10.6)岁;3只眼为Ⅰ型CNV,5只眼为Ⅱ型CNV。治疗前,治疗后1、3、6个月最佳矫正视力(BCVA)分别为0.55(0.33,0.87)、0.35(0.24,0.84)、0.35(0.22,0.58)、0.26(0.10,0.58)logMAR,各组间差异均无统计学意义(P均>0.05);CRT分别为(271.88±91.95)、(204.00±45.78)、(196.00±31.14)、(219.25±71.32)μm,其中,治疗3个月与治疗前差异有统计学意义(t=2.211,P=0.044);ORVD分别为(41.38±2.77)%、(41.73±3.60)%、(42.53±1.95)%、(41.40±2.33)%,各组间差异均无统计学意义(P均>0.05);CCVD分别为(64.38±2.24)%、(64.96±1.39)%、(64.16±1.39)%、(64.63±1.86)%,各组间差异也均无统计学意义(P均>0.05)。相关性分析结果显示,BCVA与CRT(P=0.009, RR=0.457)和CCVD(P=0.001,RR=0.574)显著相关,与ORVD(P=0.093,RR=0.302)不相关。治疗前CNV形态特征,2只眼为团状,2只眼为线条样,2只眼为纠缠错乱状,1只眼为椭圆环形,1只眼为碎片样。治疗1个月,7只眼CNV形态趋于正常化,表现为CNV最大直径减小、断裂/破碎、周边毛细血管丢失、数量和密度下降、所在区域最大横截面积减小;1只眼CNV形态较前恶化,表现为CNV吻合成环、密度增加、最大血管直径增加。治疗3个月,7只眼CNV形态趋于正常化,1只眼较前无明显变化。治疗6个月,5只眼CNV趋于正常化,3只眼恶化。随访中未发现眼内感染或玻璃体内注射的其他并发症。结论 利用OCTA技术观察CNV特征能够评估湿性AMD患者接受雷珠单抗治疗的疗效,可为湿性AMD患者的治疗与随访提供指导。     

腹腔镜下直肠癌保肛术治疗直肠癌的效果观察

目的探讨腹腔镜下直肠癌保肛术治疗直肠癌的效果。方法选定2018年9月-2019年4月本院收诊的94例直肠癌患者,等距抽样法分为对照组(47例,套入式吻合保肛术)与观察组(47例,腹腔镜下直肠癌保肛术)2组,比较2组排气时间、术中出血量、手术时间、并发症发生率指标。结果观察组排气时间、术中出血量、手术时间、并发症发生率均低于对照组(P<0.05)。结论腹腔镜下直肠癌保肛术可提高直肠癌患者预后质量与治疗效果。     

Medicare's hospital readmissions reduction program and the rise in observation stays

Objective

To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use.

Data Sources and Study Setting

A nationally representative sample of fee-for-service Medicare claims, January 2009–September 2016.

Study Design

Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies.

Data Collection/Extraction Methods

We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189).

Principal Findings

Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI −0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods.

Conclusions

The increase in observation stays is likely due to other factors, including audit activity and clinical advances.     

Neural processing of social interaction: Coordinate‐based meta‐analytic evidence from human neuroimaging studies

While the action observation and mentalizing networks are considered to play complementary roles in understanding others' goals and intentions, they might be concurrently engaged when processing social interactions. We assessed this hypothesis via three activation‐likelihood‐estimation meta‐analyses of neuroimaging studies on the neural processing of: (a) social interactions, (b) individual actions by the action observation network, and (c) mental states by the mentalizing network. Conjunction analyses and direct comparisons unveiled overlapping and specific regions among the resulting maps. We report quantitative meta‐analytic evidence for a “social interaction network” including key nodes of the action observation and mentalizing networks. An action–social interaction‐mentalizing gradient of activity along the posterior temporal cortex highlighted a hierarchical processing of interactions, from visuomotor analyses decoding individual and shared intentions to in‐depth inferences on actors' intentional states. The medial prefrontal cortex, possibly in conjunction with the amygdala, might provide additional information concerning the affective valence of the interaction. This evidence suggests that the functional architecture underlying the neural processing of interactions involves the joint involvement of the action observation and mentalizing networks. These data might inform the design of rehabilitative treatments for social cognition disorders in pathological conditions, and the assessment of their outcome in randomized controlled trials.     

心理护理在ICU重症护理中的效果观察

目的探讨心理护理在ICU重症护理中的效果。方法选定本科于2017年6月-2019年8月收诊的ICU重症患者86例,等距抽样法分为对照组(43例,传统式护理)与观察组(43例,心理护理联合传统式护理)2组,比较2组ICU重症患者的护理满意率、情绪评分(SAS/SDS)指标。结果观察组ICU重症患者干预结束后的满意率高于对照组(P<0.05);观察组ICU重症患者干预结束后的SAS评分(32.52±3.26)分、SDS评分(30.09±3.45)分均低于对照组(P<0.05)。结论心理护理应用于ICU重症患者,可对其满意度、安全性进行保证。