Diet and nutrition against inflammatory bowel disease: Trick or treat(ment)?

Even if the relationships between nutrition and inflammatory bowel disease (IBD) remain underexplored, the current literature is providing, day by day, much more evidence on the effects of various diets in both prevention and treatment of such illnesses. Wrong dietary habits, together with other environmental factors such as pollution, breastfeeding, smoke, and/or antibiotics, are among the theoretical pathogenetic causes of IBD, whose multifactorial aetiology has been already confirmed. While some of these risk factors are potentially reversible, some others cannot be avoided, and efficient treatments become necessary to prevent IBD spread or recurrence. Furthermore, the drugs currently available for treatment of such disease provide low-to-no effect against the symptoms, making the illnesses still strongly disabling. Whether nutrition and specific diets will prove to effectively interrupt the course of IBD has still to be clarified and, in this sense, further research concerning the applications of such dietary interventions is still needed.     

26所基层民营口腔诊所医务人员手卫生现况调查

 目的 调查十堰市区基层民营口腔诊所医务人员手卫生现况。方法 2019年9—11月采用便利抽样法对十堰市区民营口腔诊所医务人员手卫生现况进行隐蔽式调查,分析并比较不同岗位类别医务人员的手卫生依从率及正确率。结果 共调查民营口腔诊所26所,设有专用洗手设施的仅17所(占65.38%),配有快速手消毒剂的12所(46.15%)。隐蔽式观察102名医务人员,观察有效手卫生时机2 183次,医务人员实际执行572次,手卫生依从率26.20%,正确率25.52%(146次)。不同岗位类别医务人员的手卫生依从率、正确率比较,差异均有统计学意义(均P＜0.001)。护士的手卫生依从率(30.80%)、正确率(31.85%)较其他岗位人员高。医务人员在接触患者体液后的依从率(76.24%)和正确率(40.26%)较其他手卫生时刻高,接触患者前后的手卫生依从率最低,仅为15.38%、24.72%。医务人员不同手卫生时刻的依从率、正确率比较,差异均有统计学意义(均P＜0.001)。结论 基层民营口腔诊所医务人员手卫生依从率和正确率均较低,急需相关部门加强对基层民营口腔诊所的手卫生管理。     

Treatment of metachronous colorectal cancer metastases in the Netherlands: A population-based study

BackgroundThis study aimed to describe the treatment of metachronous colorectal cancer metastases in a recent population-based cohort.MethodPatients with stage I-III colorectal cancer (CRC), diagnosed between January 1st and June 30th^, 2015 who were surgically treated with curative intent were selected from the Netherlands Cancer Registry. Follow-up was at least 3 years after diagnosis of the primary tumour. Treatment of metachronous metastases was categorized into local treatment, systemic treatment, and best supportive care. Overall survival was estimated using Kaplan-Meier method.ResultsOut of 5412 patients, 782 (14%) developed metachronous metastases, of whom 393 (50%) underwent local treatment (LT) with or without systemic therapy, 30% of patients underwent only systemic therapy (ST) and 19% only best supportive care (BSC). The most common metastatic site was the liver (51%) followed by lungs (33%) and peritoneum (22%). LT rates were 69%, 66%, and 44% for liver-only, lung-only and, peritoneal-only metastases respectively. Patients receiving LT and ST were significantly younger than patients receiving LT alone, while patients receiving BSC were significantly older than the other groups (p < 0.001). Patients with liver-only or lung-only metastases had a 3-year OS of 50.2% (43.3–56.7 95% CI) and 61.5% (50.7–70.6 95% CI) respectively. Patients with peritoneal-only disease had a lower 3-year OS, 18.1% (10.1–28.0 95% CI).ConclusionPatients with metastases confined to the liver and lung have the highest rates of local treatment for metachronous metastatic colorectal cancer. The number of patients who underwent local treatment is higher than reported in previous Dutch and international studies.     

醛固酮受体拮抗剂螺内酯治疗难治性高血压疗效和安全性的Meta分析

背景难治性高血压是一种特殊类型的高血压，病因复杂，治疗难度大，更易引起靶器官损害。近年研究发现，在难治性高血压患者三联常用降压药物治疗基础上添加小剂量螺内酯能有效控制血压。但这些研究规模普遍较小，其有效性与安全性尚需进一步验证。目的系统评价螺内酯治疗难治性高血压的疗效及安全性。方法计算机检索PubMed、Web of Science、The Cochrane Library、中国知网、维普网、万方数据知识服务平台，筛选螺内酯治疗难治性高血压的随机对照研究，检索时间为建库至2021-05-03。由2名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果共纳入20项研究。9项研究未报告随机化分组方法，1项研究按纳入顺序编号奇偶分配（错误的随机化方法），7项研究未描述是否采用盲法，4项研究为开放标签，3项研究描述了分配隐藏，1项研究结果数据不完整、未报告对照组治疗后的安全性指标。Meta分析结果显示，疗效方面：与安慰剂和空白对照相比，螺内酯降低诊室血压、24 h动态血压、日间血压及夜间血压的效果好（P<0.05）；与其他降压药物总体相比，螺内酯降低诊室收缩压、24 h动态血压、日间收缩压、夜间收缩压及家庭自测收缩压的效果好（P<0.05）；与肾脏去交感神经术相比，螺内酯降低日间血压及夜间收缩压的效果好（P<0.05）。安全性方面：与安慰剂相比，应用螺内酯患者的血钾及血肌酐水平高（P<0.05）；与其他降压药物总体相比，应用螺内酯患者的血钾水平升高（P<0.05）；与肾脏去交感神经术相比，应用螺内酯患者的血肌酐水平升高（P<0.05）。结论螺内酯治疗难治性高血压是相对有效及安全的，但受纳入研究数量和质量的限制，该结论尚需更多高质量研究予以证实。