Comprehensive review into the challenges of gastrointestinal tumors in the Gulf and Levant countries

Although gastrointestinal stromal tumors(GISTs)are rare,with an incidence of 1/100000 per year,they are the most common sarcomas in the peritoneal cavity.Despite considerable progress in the diagnosis and treatment of GIST,about half of all patients are estimated to experience recurrence.With only two drugs,sunitinib and regorafenib,approved by the Food and Drug Administration,selecting treatment options after imatinib failure and coordinating multidisciplinary care remain challenging.In addition,physicians across the Middle East face some additional and unique challenges such as lack of published local data from clinical trials,national disease registries and regional scientific research,limited access to treatment,lack of standardization of care,and limited access to mutational analysis.Although global guidelines set a framework for the management of GIST,there are no standard local guidelines to guide clinical practice in a resource-limited environment.Therefore,a group of 11 experienced medical oncologists from across the Gulf and Levant region,part of the Rare Tumors Gastrointestinal Group,met over a period of one year to conduct a narrative review of the management of GIST and to describe regional challenges and gaps in patient management as an essential step to proposing local clinical practice recommendations.     

认知行为干预对乳腺癌外科手术患者认知水平、自护能力及心理状态的影响

目的 探讨认知行为干预对乳腺癌外科手术患者认知水平、自护能力及心理状态的影响.方法 选择2018年6月至2020年6月我院进行乳腺癌外科手术的50例患者作为研究对象,按照护理模式将其分为对照组和观察组,各25例.对照组给予常规护理干预,观察组在对照组的基础上采用认知行为干预.比较两组的干预效果.结果 干预后,观察组的认...     

Hemodilution and intravenous perflubron emulsion as an alternative to blood transfusion: effects on tissue oxygenation during profound hemodilution in anesthetized dogs

BACKGROUND: Intravenously administered perfluorocarbon (PFC) emulsions increase oxygen solubility in plasma. PFC might therefore temporarily replace red cells (RBCs) lost during intraoperative hemorrhage. In patients who have undergone hemodilution, the return of autologous blood may be delayed by the administration of PFC, and autologous RBCs may be saved for transfusion after surgical bleeding is stopped and PFC is cleared by the reticuloendothelial system. STUDY DESIGN AND METHODS: In 22 anesthetized, hemodiluted dogs (hemoglobin [Hb] 7 g/dL) breathing 100-percent O2, an intraoperative volume-compensated blood loss was simulated. The efficacy of three therapeutic regimens in maintaining tissue oxygenation was compared: 1) RBC group (n = 7): maintenance of a Hb > 7 g per dL by transfusion of autologous RBCs; 2) PFC group (n = 7): bolus application of a second-generation PFC emulsion (60% wt/vol perflubron) and further acute normovolemic hemodilution (ANH) to a Hb of 3 g per dL; and 3) control group (n = 7): further ANH alone to a Hb of 3 g per dL. Systemic and myocardial oxygenation status and tissue oxygenation were assessed. RESULTS: Autologous RBCs transfused to maintain a Hb of 7 g per dL preserved hemodynamics and tissue oxygenation during blood loss. In the PFC and control groups, heart rate and cardiac index increased significantly in response to further ANH. Tissue oxygenation was not different in the PFC and the RBC groups. Direct comparison of the PFC and control groups revealed better tissue oxygenation in the PFC group, as reflected by significantly higher mixed venous, coronary venous, and local tissue pO2 on liver and skeletal muscle. CONCLUSION: Bolus intravenous administration of 60- percent (wt/vol) perflubron emulsion and further hemodilution from a Hb of 7 g per dL to one of 3 g per dL were as effective as autologous RBC transfusion in maintaining tissue oxygenation during volume-compensated blood loss designed to mimic surgical bleeding.     

The metabolic syndrome is associated with carotid atherosclerosis and arterial stiffness in asymptomatic,nondiabetic postmenopausal women

The menopause transition is associated with adverse changes in cardiometabolic risk factors. We aimed to examine the association of the metabolic syndrome (MS) and its features with indices of vascular structure and function in a population of asymptomatic postmenopausal women. A total of 473 informed-consenting, nondiabetic postmenopausal women were included in the study. The MS was defined according to the Joint Definition. We evaluated the association between the presence of MS and indices of vascular structure (carotid artery intima-media thickness (IMT); atherosclerotic plaques) and function (flow-mediated dilatation (FMD); pulse wave velocity (PWV)). The mean age of women was 56.4?±?6.7 and the mean menopausal age was 7.91?±?6.31. The MS was present in 17.3% of our population. Mean values of PWV increased linearly with the accumulation of features of the MS. IMT was higher in women with the MS compared to women without the MS (0.78?±?0.12?mm vs. 0.74?±?0.11, p?=?.003). Multivariate analysis showed that the presence of the MS was independently associated with common carotid artery IMT (b?=?0.149, p?=?.001), PWV (b?=?0.114, p?=?.012) as well as central systolic and diastolic blood pressure (b?=?0.293, p?b?=?0.163, p?相似文献   

农村地区女性自评抑郁量表中文版的信度效度分析

目的:对中文版自评抑郁量表SDS的信度和效度进行评价。方法:采用中文版抑郁量表对嘉定区某农村社区501名20～74岁女性进行问卷调查,用Cronbach α系数、因子分析、Pearson相关系数和t检验等方法考察量表的信度和效度。结果:量表的总Cronbach α系数为0.784,量表各维度的Cronbach α系数在0.350~0.737之间;分半信度的Cronbach α系数分别为0.662和0.819;因子分析的分析结果和量表的理论结构基本相符,各维度得分之间的相关系数在0.057～0.322之间,除精神性-情感症状维度和精神运动性障碍的相关性外,其余维度间的相关性均有统计学意义;抑郁组和非抑郁组在各维度得分的差异均有统计学意义。结论:中文版自评抑郁量表SDS除内容效度需做部分修订外,信度和效度较好,可以应用于中国文化背景下的女性抑郁情况等心理学状况评价。     

Variation in the determination of follicular diameter: an inter-unit pilot study using an ultrasonic phantom

Ultrasound operators in assisted reproductive technology units in New South Wales, Australia cooperated in a study that was conducted to assess their ability to measure fixed objects embedded in an ultrasound phantom. The results have demonstrated a large variation ranging between 10 and 25% coefficient of variation on distances between 10 and 32 mm. As ultrasonic imaging is the only component of assisted reproductive technology not currently controlled by an external quality assurance scheme, the authors suggest there may be a need to establish a programme.      

Atopic dermatitis: correlation of peripheral blood T cell activation, eosinophilia and serum factors with clinical severity

In the first part of this study peripheral blood lymphocyte subpopulations. Iheir activation slate and various serum parameters were measured in extrinsic and intrinsic atopic dermatitis (AD) patients compared to normal individuals. Beside the characteristic eosinophilia, significantly increased numbers of CD4⁺ T cells with increased expression of IL-2 receptors (IL-2R) and HLA-DR were noted in the AD patients. In addition, extrinsic AD patients showed increased numbers of CD23⁺ B cells and decreased numbers of CD16⁺ natural killer cells. Moreover, increased serum levels of eosinophil canonic protein (ECP) and soluble 1L-2R as well as soluble factors lhat prolong survival of eosinophils in vitro could be demonstrated. In the second section of this study we determine how these blood immunological parameters relate to the clinical severity of the skin lesions of AD, by weekly analysis of 12 AD patients attending a high altitude clinic for 3 to 6 weeks. The patients were divided into two groups on the basis of treatment with topical steroids, but during the observation period a significant improvement in clinical status was observed in all AD patients independent of topical steroid therapy. A progressive decrease in eosinophil and activated T cell numbers. soluble IL-2R levels and serum eosinophil survival prolonging activity could be demonstrated, which closely correlated with the clinical severity of the AD.