乳腺癌新辅助化疗对前哨淋巴结活检的影响

随着近年来新辅助化疗在乳腺癌治疗领域中的应用,其在增加保乳率及肿瘤降期方面有着明显优势。乳腺癌新辅助化疗后,对前哨淋巴结的评估影响患者的后续治疗及预后,但是新辅助化疗前患者腋窝淋巴结临床状态影响患者最终治疗决策,且仍存在争议。本文对近年来国内外关于新辅助化疗后前哨淋巴结活检方面的研究进展做一综述。     

Delayed Spontaneous Bilateral Pneumothorax in a Previously Healthy Nonventilated COVID-19 Patient

BackgroundThe novel coronavirus disease 2019 (COVID-19) is a recent viral outbreak that has rapidly spread to multiple countries worldwide. Little is known about COVID-19 infection-related complications.Case ReportWe report a patient who developed spontaneous bilateral pneumothorax after a recent COVID-19 infection. To our knowledge, this is the first reported case of spontaneous bilateral pneumothorax in a patient with recent confirmed severe acute respiratory syndrome coronavirus-2 infection without any risk factors for pneumothorax and who had not received positive pressure ventilation.Why Should an Emergency Physician Be Aware of This?There may be a possible correlation between a recent COVID-19 infection and the development of spontaneous pneumothorax. The diagnosis of spontaneous pneumothorax should be considered in any patient with known or suspected recent COVID-19 infection who presents with new acute symptoms consistent with pneumothorax or sudden clinical deterioration.     

Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism

Summary. Background: The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known. Methods: We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) data to compare the 3‐month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither. Results: Of 18 028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11 647 (65%) had neither. The all‐cause mortality was 10.0% (95% confidence interval [CI] 9.5–10.4), and the PE‐related mortality was 2.6% (95% CI 2.4–2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3–5.6) than in those with surgery (1.4%; 95% CI 1.0–2.0) or those with neither (2.1%; 95% CI 1.8–2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8–2.7), with no differences being seen between patients immobilized in hospital or in the community. Conclusions: Forty‐three per cent of patients dying from PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented.     

The reflex sympathetic dystrophy syndrome associated with traumatic myelopathy: report of 5 cases

Pain is a frequent problem following recent traumatic spinal cord injury (SCI). Of specific concern in the rehabilitation setting is function-limiting hand pain which prevents optimal participation in therapy and limits independence. A treatable etiology of function-limiting hand pain in SCI is the reflex sympathetic dystrophy syndrome (RSDS). The presentation of RSDS in patients with recent SCI can be easily confused with that of dysesthetic (central origin) or radicular pain. Previous reports of RSDS associated with recent traumatic SCI have not been based on specific clinical criteria outlined in recent literature, and treatment has not been evaluated by objective outcome measures. This report describes 5 cases of RSDS associated with recent traumatic SCI that are identified by specific clinical criteria and are confirmed by a 3 phase bone scan. It is suggested that aggressive early intervention is necessary to obtain optimal functional outcome and minimize length of hospital-based rehabilitation.     

AFOREIGN SURGEON′s VIEW OF LAPAROSCOPIC SURGERY IN A DEVELOPMENT COUNTRY IN ASIA

InrecentcorrespondencewithasurgeonfriendfromChina ,IwastoldthatChinahaschangedconsid erablyinthepastdecade.Icanbelieveit.Theever presentpressuresofsocietyandpolitics,theworld widedemandsforcooperationansmutualassistance ,therecentwarsandthreatsthereof,theapparentin creasedincidenceofnaturaldisasters ,andmoststrikinglythequantumleapoftechnologyandcommunica tionovertherecentpasthaveaffectedeveryareaoflife .Onecansaywithoutequivocationthatthewholeworldhaschangeddramaticallyoverthepastdecade .Th…     

Recent onset vs. persistent pain: evidence for a distinction

Evidence for a distinction between chronic and recent onset pain on behavioural and subjective indices was reviewed. Pain behaviours and subjective indices of pain were studied in chronic and recent onset low back pain sufferers. No differences were found between chronic and acute sufferers on measures of pain behaviour, nor on subjective indices of pain. However, differences were found in the relationships between the subjective and behavioural indices of pain in these groups. Pain behaviours were found to be independent of the subjective pain experience in recent onset pain. The relationships between subjective pain experience and pain behaviour became stronger with increased pain duration. The relationships between behavioural dimensions of pain weakened with chronicity, as did the relationship between subjective pain dimensions. These findings were discussed in relation to current accounts of chronic and recent onset pain and their implications for both theory and treatment were considered.     

Correlates of Recent Suicide Attempts in a Triethnic Group of Adolescents

Purpose: To describe recent self-reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.
Methods: Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.
Results: The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic-gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.
Conclusions: Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic-gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.     

The importance of transmission time in HIV infections and an epidemiological prospective follow-up study for 1 year in the Marmara Region of Turkey

It is important to detect recent and new HIV/1 infections and to take preventative measures in order to prevent rapid disease progression in AIDS and to decrease the incidence of infection. We aimed to detect long standing or recent HIV infections by determining transmission times for the cases in which first-time HIV/1 seropositivity were detected. The serum samples of 323 cases which were found to be seropositive by ELISA and Western-blotting were included in this study. The discrimination between long-term and recent HIV/1 infection was made by determining transmission-time with the Aware BED-EIA, HIV-1 incidence test (IgG capture HIV-EIA) tests. Ninety-six healthy blood donors who did not have a positive anti-HIV test and a chronic infectious disease for at least 1 year were included in this study as a negative healthy control group. In the discrimination of long-term and recent HIV/1 infections, only in vitro ODn values were used. The cases with normalized optical density (OD) (OD(specimen)/OD(calibrator))<0.8 by commercial kit were accepted as recent HIV infection (155 days history or seroconversion less than 6 months). The cases with ODn >1.2 were accepted as long-term HIV/1 infections (more than 155 days history or more than 6 months). The cases with ODn between 0.8 and 1.2 were accepted as "additional tests needed" cases. We detected recent HIV/1 infections (<6 months) in 60 (18.5%) out of 323 cases and long-term HIV/1 infections (>6 months) in 263 (81.5%) out of 323 cases. The most frequently encountered transmission route in long-term and recent HIV/1 infections was heterosexual sexual intercourse as 54 (50%) and 257 (97%), respectively. 63.3% of newly infected patients were married females and 65.3% of recently infected patients were males. In conclusion, the detection of the high ratio of long-term HIV/1 infection cases (81.5%) compared to recent infections (18.5%) suggested to us, that the long standing cases may have some activities related with transmission of HIV/1 in the past. The detection of higher HIV/1-infections in individuals which had heterosexual sex and also in married males suggested that this situation poses a very great threat for the health of society.     

Re-experiencing old memories via hippocampus: a PET study of autobiographical memory

The time-scale of medial temporal lobe (MTL) involvement in storage and retrieval of episodic memory is keenly debated. To test competitive theories of long-term memory consolidation, the present work aimed at characterizing which cerebral regions are involved during retrieval of recent and remote strictly episodic autobiographical memory. Using positron emission tomography (PET), we examined mental retrieval of recent (0-1 year) and remote (5-10 years) autobiographical memories, controlling for the nature of the autobiographical memories (i.e., specificity, state of consciousness, vividness of mental visual imagery, emotion) retrieved during scanning by behavioral measures assessed at debriefing for each event recalled. Cognitive results showed that specificity and emotion did not change with time interval although both autonoetic consciousness and mental image quality were significantly higher for recent memories, suggesting an underlying shift in the phenomenal experience of remembering with the passage of time. The SPM analysis revealed common activations during the recollection of recent and remote memories that involved a widespread but mainly left-sided cerebral network, consistent with previous studies. Subtraction analysis demonstrated that the retrieval of recent (relative to remote) autobiographical memories principally activated the left dorsolateral prefrontal cortex whereas the retrieval of remote (relative to recent) autobiographical memories activated the inferior parietal cortex bilaterally. ROIs analysis revealed more hippocampal activity for remote memories than for recent ones and a preferentially right-sided involvement of the hippocampal responses whatever the remoteness of autobiographical memories. New insights based on higher hippocampal response to the remoteness of episodic autobiographical memories challenge the standard model and are less discrepant with the multiple trace theory.     

Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE)

BACKGROUND: Patients who have experienced a recent major bleeding episode are usually excluded from clinical studies of venous thromboembolism (VTE) treatment. Therefore, recommendations based on evidence from clinical trials may not be suitable for these patients. The Registro Informatizado de la Enfermedad TromboEmbolica (RIETE) is a multicenter, observational registry designed to gather and analyze data on VTE treatment practices and clinical outcomes in patients with acute VTE. OBJECTIVES: The aim of this analysis was to study outcomes of patients with VTE who had experienced recent major bleeding (< 30 days prior to VTE diagnosis). METHODS: Patients with objectively confirmed symptomatic acute VTE are consecutively enrolled into the RIETE registry. Patient characteristics, details of antithrombotic therapy, and clinical outcomes at 3 months were recorded. RESULTS: Of 6361 patients enrolled up to January 2004, 170 (2.7%) had experienced recent major bleeding: 69 (40.6%) gastrointestinal tract, 60 (35.3%) intracranial, 41 (24.1%) other. The incidences of major bleeding (4.1%) and recurrent pulmonary embolism (PE) (2.4%) were significantly higher in patients with recent major bleeding. Among them, patients with cancer had an increased incidence of major bleeding [odds ratio (OR) 10.0, 95% confidence interval (CI) 2.3, 50; P < 0.001] and fatal PE (OR 4.1, 95% CI 0.98, 17; P < 0.05). CONCLUSIONS: Patients with VTE and recent major bleeding prior to VTE diagnosis (2.7% of total enrolled patients) had poorer clinical outcomes compared with those who had not experienced recent major bleeding. In patients who had recent major bleeding prior to enrollment, those with cancer had a poorer clinical outcome than those without cancer.     

脊髓损伤后脑功能区重塑的功能磁共振研究进展

脊髓损伤后可引起大脑解剖结构和功能区的变化,其中功能可塑性变化对患者的预后起着重要作用.fMRI可无创、直观地显示脑区活动,目前已成为评估大脑功能变化的重要手段.本文对脊髓损伤后脑功能可塑性变化的fMRI研究进行综述.     

康复新在预防食管静脉曲张套扎术后近期再出血中的作用

目的 探讨康复新在预防食管静脉曲张套扎（EVL）术后近期再出血中的作用.方法 56例食管静脉曲张患者根据治疗方法分为对照组20例和治疗组36例.对照组患者EVL术后给予常规抑酸、抗炎、降门脉压治疗;治疗组EVL术后,在常规治疗基础上加用康复新10 mL,tid口服,疗程14 d.比较2组患者EVL术后近期再出血率及EVL术后局部溃疡愈合情况.结果 治疗组EVL术后近期再出血率（2.56％）明显低于对照组（8.89％）（P＜0.05）;套扎局部溃疡愈合情况：治疗组有效率为96.15％,对照组有效率为85.55％,治疗组疗效优于对照组（P＜0.05）.结论 食管静脉曲张EVL术后常规加服康复新能明显促进EVL术后局部溃疡的愈合,减少EVL术后近期再出血风险.     

Incorporation of economic evidence in the Dutch guideline 'cardiovascular risk management'

Rationale, aims and objectives The consideration of economic evidence in guideline development may be particularly important in health care management when different (drug) therapies show similar efficacy on clinical endpoints, such as in cardiovascular diseases. This article investigates to what extent the Dutch guideline ‘cardiovascular risk management’ (2006) considers cost‐effectiveness and budget impact according to the most recent economic evidence. Method We carried out a systematic review of economic evaluations on cholesterol‐lowering drugs and antihypertensives followed by an assessment of guideline recommendations. Results The guideline does not consider the most recent economic evidence but does consider cost‐effectiveness based on economic evaluations performed in conjunction with clinical trials. Their conclusions are largely in agreement with the most recent economic evidence. An innovative aspect in the guideline is the application of a budget impact analysis to take accessibility and affordability constraints into account when considering cost‐effectiveness. Conclusions Based on the most recent economic evidence, the guideline could be improved by more firmly formulating recommendations in favour of cost‐effective drug therapies (simvastatin, pravastatin and low‐dose diuretics) to stimulate compliance to the guideline in clinical practice.     

280例孕妇巨细胞病毒的检测分析

目的：了解孕妇人巨细胞病毒（HCMV）近期感染状况。方法：采用酶联免疫吸附试验（ELISA）对280例孕妇和50名孕前检查的健康妇女外周血进行了HCMV—IgM检测。结果：在280例孕妇中检测出HCMV—IgM阳性标本3例,阳性率为1．07％,50例健康妇女中未检测到HCMV—IgM阳性标本。结论：在孕妇中巨细胞病毒有一定近期感染率。     

Where do adolescent recent drinkers obtain and use alcohol?

Background: Alcohol use among adolescents is a serious health issue in the United States. The purpose of the study is to determine factors associated with the locations and sources of last alcoholic beverages drank by adolescent recent drinkers. Method: A secondary data analysis of the NSDUH 2012 was performed including a sample of 2,321 recent alcohol users of 12–17 years of age nationwide. Results: Findings indicate someone else’s home was the top location for recent drinkers’ last alcoholic beverage. Regarding source, recent users report obtaining their last alcoholic beverage from someone not related to them who was older than 21 years. Several differences in location and source were found based on study variables. Discussion: Several variables were found to be associated with source and location of alcohol among adolescents. Expanding existing educational and social hosting programs to adults may be an important method of reducing adolescent access to alcohol.     

Gene therapy progress and prospects: magnetic nanoparticle-based gene delivery

The recent emphasis on the development of non-viral transfection agents for gene delivery has led to new physics and chemistry-based techniques, which take advantage of charge interactions and energetic processes. One of these techniques which shows much promise for both in vitro and in vivo transfection involves the use of biocompatible magnetic nanoparticles for gene delivery. In these systems, therapeutic or reporter genes are attached to magnetic nanoparticles, which are then focused to the target site/cells via high-field/high-gradient magnets. The technique promotes rapid transfection and, as more recent work indicates, excellent overall transfection levels as well. The advantages and difficulties associated with magnetic nanoparticle-based transfection will be discussed as will the underlying physical principles, recent studies and potential future applications.     

Impact of Recent Prior Opioid Use on Rizatriptan Efficacy. A Post Hoc Pooled Analysis

Background.— Limited evidence suggests that, in individuals with migraine, prior use of opioids reduces responsiveness to treatment with subsequent acute migraine therapies. The evidence is more robust with regard to opioids as a risk factor for chronic migraine. Objectives.— To explore whether recent prior opioid use influenced treatment response, in a post hoc pooled analysis of rizatriptan clinical trials. Methods.— We included rizatriptan 10 mg and placebo data from phase 3 moderate/severe migraine studies as well as from the rizatriptan “Treat a Migraine Early” (TAME) studies. As part of the clinical assessment, medication usage for migraine and other reasons in the 30 days prior to a screening visit and up to the time of taking study drug was captured via patient's self‐report. The influence of recent prior opioid use on the endpoint of pain freedom at 2 hours was assessed via logistic regression. We further explored the influence of gender and disability on treatment response. Results.— In the moderate/severe migraine studies of 2068 individuals treated with rizatriptan, 284 (13.7%) reported recent prior use of opioids. Of those treated with placebo (1258), 12.5% recently used opioids. In the TAME studies, the proportions were lower, 3.9% and 5.3%, respectively. The pretreatment and demographic characteristics were similar across the study groups. In the moderate/severe studies, recent prior opioid use was associated with reduced 2‐hour pain freedom. Although the influence of recent prior opioid use was assessed independently of treatment, the finding was driven primarily by rizatriptan (recent prior use vs no use: 34% vs 42% for rizatriptan and 10% vs 10% for placebo; P = .013). In the TAME studies, recent prior opioid use was also predictive of reduced efficacy (recent prior use vs no use: 41% vs 59% for rizatriptan and 13% vs 32% for placebo; P = .007). Conclusion.— Recent prior opioid use was associated with lower triptan response. Because of the post hoc nature of the analysis and limitations in capturing amount of opioid used, as well as to adjust for disability levels, these findings require replication in prospective studies.     

膝关节外科与关节康复的临床研究动态

国内外膝关节外科近年发展很快 ,尤其在关节镜下修复重建手术 ,全膝人工关节置换手术 ,以及膝关节损伤和术后关节功能康复等方面 ,都取得了长足进展。本文结合近年来国际关节外科专科会议情况 ,对这些进展作一简介     

C-Reactive protein: Current status and future perspectives

This review encompasses all aspects of recent C-Reactive protein studies. Emphasis has been in the areas of (1) the physical, chemical, and potential functions of C-Reactive protein; and (2) the pass and recent procedures of C-Reactive protein analysis relative to simplicity and sensitivity. The responses of C-Reactive protein in various diseases and its future prospects are also discussed in this review.     

腹部外科近期再手术65例分析

目的探讨腹部外科近期再手术的原因、预防及处理方法。方法对我院1989年1月~2009年1月收治的腹部外科近期再手术65例的临床资料进行回顾性分析。结果本组再手术的原因为肠梗阻20例,腹腔感染14例,腹腔内出血10例,引流管并发症8例,其他原因7例,遗留病变6例。2次手术距1次手术时间最短3 h,最长1个月,65例共手术114例次,最多者4次。本组57例治愈;死亡8例,其中死于肝肾衰竭、心肌梗死各1例,因恶性肿瘤再次手术后全身衰竭死亡6例。结论腹部外科近期再手术原因复杂,早期诊断并选择再手术的时机及有效的术后综合治疗是提高再手术效果的关键。