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1.
BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II.  相似文献   
2.
目的 探讨影响原发免疫性血小板减少症(ITP)患者树突状细胞功能异常的基因,为ITP治疗寻求新方法。 方法 随机选取ITP患者(ITP组)8例和同期入院体检健康者8例正常对照组为研究对象,分离外周单个核细胞并在体外诱导分化为单核细胞源性树突状细胞(moDCs),选取ITP组和正常对照组moDCs样本各3例,使用Illumina Hiseq平台进行转录组测序,并完成生物信息学分析。其他moDCs样本分为对照组、ITP组和ITP+雷帕霉素处理组,采用Western blotting法检测哺乳动物雷帕霉素靶蛋白复合体1(mTORC1)信号通路激活情况,采用流式细胞术检测moDCs表面分子表达,采用酶联免疫吸附(ELISA)法检测moDCs细胞因子分泌能力。 结果 差异性表达分析显示,与正常对照组相比,ITP组患者moDCs中有161个基因表达上调,320个基因表达下调,差异有统计学意义(P<0.05)。利用基因本体论(GO)和京都基因与基因组百科全书(KEGG)数据库对差异基因进行功能和分子通路注释,结果表明差异基因主要集中在T细胞分化、T细胞共刺激、T细胞活化等生物学过程和T细胞受体信号通路等信号途径。基因集富集分析(GSEA)显示,ITP组患者树突状细胞中mTORC1信号通路基因表达上调。进一步验证发现,ITP组患者moDCs中磷酸化哺乳动物雷帕霉素靶蛋白(mTOR)和mTORC1活化标志物磷酸化核糖体蛋白S6激酶(S6K)相对含量升高,同时ITP组患者moDCs共刺激分子CD80、CD86和促炎因子白介素6(IL-6)、白介素12(IL-12)的表达增加,而白介素10(IL-10)、转化生长因子-β(TGF-β)表达降低。使用mTORC1抑制剂雷帕霉素可以抑制moDCs共刺激分子CD80、CD86的表达和促炎因子IL-6、IL-12的分泌,并上调IL-10的表达,而对TGF-β的分泌无明显影响。 结论 ITP患者moDCs中mTORC1信号通路高度激活,使用mTORC1抑制剂雷帕霉素可以改善moDCs的免疫调节能力。因此,mTORC1信号通路可能是调节ITP患者moDCs功能异常的新靶点。  相似文献   
3.
目的:探讨早泄的类型和年龄因素与盐酸达泊西汀临床疗效的关系。方法:选取2018年10月至2020年1月在秦皇岛市第一医院生殖医学科男科门诊治疗的96例早泄患者作为研究对象。根据早泄的类型将患者分为原发组(原发性早泄)42例、继发组(继发性早泄)54例;再根据年龄将患者分为青年组(<35岁)46例、中年组(≥35岁)50例。各组患者均于性交前1~3 h给予盐酸达泊西汀30 mg,口服;所有患者均连续治疗2个月,停药1个月后随访。观察各组患者治疗前后阴道内射精潜伏期(IELT)、早泄诊断标准量表(PEDT)评分、早泄分析表(PEP)评分、临床疗效和复发情况。结果:(1)原发组、继发组患者治疗后和随访末期IELT、PEDT评分较治疗前有显著改善,且继发组患者治疗后和随访末期的IELT显著长于原发组,PEDT评分显著低于原发组,差异均有统计学意义(P<0.05)。两组患者治疗后和随访末期的各项PEP评分与治疗前比较,均有显著改善,差异有统计学意义(P<0.05)。治疗后和随访末期,继发组患者的射精控制能力和性生活满意度评分显著高于原发组,早泄相关苦恼、早泄对伴侣关系的影响评分显著低于原发组,差异均有统计学意义(P<0.05)。(2)青年组、中年组患者治疗后和随访末期IELT、PEDT评分较治疗前有显著改善,青年组患者的IELT显著长于中年组,而PEDT评分显著低于中年组,差异均有统计学意义(P<0.05)。两组患者治疗后和随访末期的各项PEP评分与治疗前比较,均有显著改善,差异均有统计学意义(P<0.05)。治疗后,青年组患者的射精控制能力评分显著高于中年组,早泄相关苦恼及早泄对伴侣关系的影响评分显著低于中年组;随访末期,青年组患者的早泄相关苦恼及早泄对伴侣关系的影响评分显著低于中年组,差异均有统计学意义(P<0.05)。(3)原发组、继发组患者的总有效率分别为71.43%(30/42)、88.89%(48/54),复发率分别为30.95%(13/42)、9.26%(5/54),21.42%(9/42)、7.41%(4/54)组间的差异均有统计学意义(P<0.05)。青年组、中年组患者的总有效率分别为89.13%(41/46)、72.00%(36/50),组间的差异有统计学意义(P<0.05);复发率分别为17.39%(8/46)、20.00%(10/50),组间的差异无统计学意义(P>0.05)。结论:盐酸达泊西汀治疗继发性早泄的临床效果优于原发性早泄,治疗青年早泄患者的临床效果优于中年早泄患者。  相似文献   
4.
5.
目的 在健康体检人群中筛查原发性胆汁性胆管炎(PBC)的特异性抗体,即抗线粒体抗体(AMA)-M2,以了解其流行率。方法 2012年5月~2014年12月我院体检中心血清样本18515例,采用ELISA行AMA-M2定量检测,同时收集肝功能生化指标。结果 在筛查的18515名体检者中,245例(1.3%)血清AMA-M2阳性,男性97名,女性148名,男女比例约为1:1.5,46~55岁年龄段阳性比例率为28.6%;12名AMA-M2阳性者同时伴有血清ALP水平升高,符合中国PBC诊断和治疗共识的诊断标准;54例高滴度AMA-M2抗体(>150U/ml)者血清ALP为(92.8±85.6 U/L),GGT水平为(84.3±118.5 U/L,显著高于191例低滴度组【分别为(67.7±38.3U/L)和(39.1±61.8U/L),P<0.05】。结论 健康体检人群血清AMA-M2抗体阳性并不少见,筛查AMA-M2抗体有助于早期识别PBC。  相似文献   
6.
目的:研究Piezo1机械敏感性离子通道对骨细胞的调控作用。方法:应用课题组研发的流体剪切力(FSS)加载装置,使用免疫荧光探究FSS对Piezo1通道在MLO-Y4中影响的最佳强度;对Piezo1使用FSS、激动剂Yoda1或阻滞剂GsMTx4进行干预。使用Western Blot探究Cleaved Caspase-3、Bcl-2、Bax凋亡相关蛋白的表达量;使用Hoechst-33258以及流式细胞凋亡检测MLO-Y4骨细胞的凋亡比例。结果:免疫荧光染色结果表明FSS对MLO-Y4骨细胞中Piezo1的表达呈现先增加后降低的单峰趋势,其中以9 dyne/cm2加载30 min为最佳刺激条件。使用Yoda1抑制MLO-Y4细胞凋亡(P<0.05),使用GsMTx4促进MLO-Y4细胞凋亡(P<0.05)。Piezo1介导的FSS抑制MLO-Y4细胞凋亡(P<0.05)。结论:Piezo1机械敏感性离子通道介导的FSS在9 dyne/cm2条件下抑制MLO-Y4骨细胞凋亡,且FSS在该条件下可以有效逆转Piezo1阻滞剂GsMTx4在4 μmol/L作用0.5 h下促进MLO-Y4细胞凋亡作用。  相似文献   
7.
ObjectiveTo describe (1) self-care trajectories among adults with heart failure (HF) and insomnia over 1-year; (2) the extent to which trajectories varied between cognitive behavioral therapy for insomnia (CBT-I) or HF self-care intervention; and (3) the associations between self-care trajectories and clinical and demographic characteristics, sleep, symptoms and stress, and functional performance.MethodsWe conducted secondary analysis of data from a randomized controlled trial of the effects of CBT-I compared with HF self-care education among adults with stable HF and insomnia. We used the Self-Care of Heart Failure Index v6.2. The analytic approaches included t-tests, group-based trajectory modeling, ANOVA, and chi-square.ResultsWe included 175 participants (M age=63.0 (12.9) years, White, N = 100]. We found four self-care trajectories: Low self-care (N = 47, 26.8%); Moderate self-care (N = 68, 38.9%): Adequate self-care (N = 42, 24.0%); and Optimal self-care (N = 18, 10.3%). There was no difference in self-care trajectories between interventions. The low self-care group had the most severe baseline fatigue, anxiety, and perceived stress, and lowest cognitive abilities.ConclusionBoth interventions prevented declining self-care. Future research is needed to determine the most efficacious intervention to improve self-care trajectories.Practice ImplicationsHealthcare providers should provide ongoing self-care support for those with persistently low and moderate self-care.  相似文献   
8.
BackgroundPrimary hyperparathyroidism (PHP) is defined as hypercalcemia that may remain asymptomatic for years and cause lesion in skeletal system such as brown tumor (BT). Endocrine involvement in Behçet’s Disease (BD) regarding various systems can be seen.Case reportWe report an association between BD and PHP in a 45-year-old female. She had complained of inflammatory pain in the lower limb. Plain x-ray showed a lytic lesion on the upper tibia. Laboratory investigations revealed hypercalcemia (3.32 mmol/L), hypophosphatemia (0.48 mmol/L), a high parathyroid hormone (PTH) level (2278 pg/L) and a low vitamin D level (8.1 μg/L). An adenoma in the right lower parathyroid has been shown on scintigraphy, a vertebral fracture was present on lumbar spine X-ray and salt and pepper skull was shown on the lateral skull X-ray. Severe osteoporosis was present on the lumbar bone mineral density (t score ?3.3), and multiple BT were revealed on bone scan. The patient was operated on and developed Hungry Bone Syndrome (HBS) following surgery. Therefore, she received high doses of calcium with favorable outcome.ConclusionThis case is a leading report for the coexistence of BD with PHP. This case provides further evidence that BD should be considered as an autoimmune process, which may be associated with endocrine involvement including PHP. On the other hand, musculoskeletal manifestations of PHP including BT still seen in daily practice require continued vigilance on the part of the physician.  相似文献   
9.
BackgroundThe purpose of this study is to determine the comparative risk profile and clinical outcomes for patients undergoing reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) without failed prior rotator cuff repair (RCR) compared with RTSA for CTA with prior RCR.MethodsFrom 2006 to 2014, all patients who underwent RTSA by two surgeons after failed RCR with minimum 2-year follow-up were identified. Patients who underwent RTSA with failed prior RCR were matched in a 1:1 ratio to patients undergoing primary RTSA, while controlling for demographic factors, prosthesis design, and surgeon. Postoperative active forward elevation and active external rotation were recorded. Outcome measures included American Shoulder and Elbow Surgeons score, Visual Analog Scale (VAS), and Simple Shoulder Test. Perioperative complications and rates of secondary reoperation were noted, and comparative multivariate analysis was performed.ResultsOf 262 patients, 192 (73.3%) were available at minimum 2-year follow-up. The prior RCR group had a significantly higher complication rate (17.4%, n = 15) than the primary RTSA group (3.8%, n = 4) (P = .001), although no significant difference in periprosthetic infection (P = .469) or secondary revision rate (P = .136) was observed. At mean 36.3 ± 26.1-month follow-up, the prior RCR group had statistically worse American Shoulder and Elbow Surgeons score (P < .001), VAS (P = .001), Simple Shoulder Test (P < .001), and active forward elevation (P = .006). Patients with multiple failed RCR attempts (n = 38) before RTSA demonstrated no significant differences versus isolated failed RCR (n = 48; P > .05).ConclusionThis study demonstrated that patients with RTSA after prior failed RCR have significantly worse patient-reported outcomes and greater rate of perioperative complications than patients undergoing primary RTSA for CTA.  相似文献   
10.
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