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991.
Borghero Y Crane CH Szklaruk J Oyarzo M Curley S Pisters PW Evans D Abdalla EK Thomas MB Das P Wistuba II Krishnan S Vauthey JN 《Annals of surgical oncology》2008,15(11):3147-3156
Background Patients with resected extrahepatic bile duct adenocarcinoma who have microscopically positive resection margins and/or pathologic
locoregional nodal involvement (R1pN1) have a high-risk of locoregional recurrence, and therefore, we advocate the use of
adjuvant chemoradiation. To evaluate the safety and effectiveness of this treatment, we compared survival and side effects
outcomes between such patients and patients with negative resection margins and pathologically negative nodes (R0pN0) who
did not receive adjuvant treatment.
Methods Between 1984 and 2005, 65 patients were treated with curative-intended resection for extrahepatic bile duct adenocarcinoma.
Patients with tumors arising in the gallbladder and periampullary region were excluded. Pathology and diagnostic images were
centrally reviewed. Overall survival and locoregional recurrence outcomes for patients with standard-risk R0pN0 (surgery alone,
or S group, n = 23) were compared with those of patients with high locoregional recurrence risk, R1 and/or pN1 (R1pN1) status who received
adjuvant chemoradiation (S-CRT group, n = 42).
Results The median follow-up for the entire group was 31 months. Patients in the S-CRT and S groups had a similar 5-year overall survival
(36% vs. 42%, P = .6) and locoregional recurrence (5-year rate: 38% vs. 37%, P = .13). In the S-CRT group, three patients (7%) experienced an acute (grade 3 or more) side effect.
Conclusions Our finding of a lack of a survival difference between the S and S-CRT groups suggests that for patients with extrahepatic
bile duct adenocarcinoma at high risk for locoregional recurrence (i.e., R1 resection or pN1 disease), adjuvant chemoradiation
provides an equivalent overall survival despite of these worse prognostic features. 相似文献
992.
OBJECTIVE: This research aims to compare the effectiveness of two methods of teaching psychopathology in reducing stigma toward mental illness. Based on previous stigma research, a first-person, narrative approach was contrasted with traditional, diagnosis-centered education. STUDY 1 METHODS: Participants consisted of 53 undergraduates at a small, public university enrolled in two introductory psychology classes. During six hours of class time focused on psychopathology, one class received the experimental pedagogy while the other served as a control, receiving traditional instruction. Stigma was assessed pre- and post-intervention using a social distance scale and vignette design. Statistical analyses compared means and change scores between the two classes. STUDY 1 RESULTS: Students in the experimental classroom showed a significant decrease in stigma following the intervention, whereas those in the control group showed no change. STUDY 2 METHODS: A follow-up study was conducted to replicate the promising effects demonstrated in Study 1. Two additional classrooms (n = 48) were both exposed to the first-person, narrative pedagogy, and their stigma monitored pre- and post- intervention. STUDY 2 RESULTS: Students reported a significant decrease in stigma following the intervention. CONCLUSIONS: Together, these studies suggest that traditional methods of teaching psychopathology do not lessen mental illness stigma, a serious concern that can potentially be reconciled by incorporating more person-centered instructional methods. Results are discussed in terms of their implications for the way psychopathology is taught throughout the mental health field, as well as the practical application of stigma interventions woven into the curriculum. 相似文献
993.
S100A6 Expression and Function in Human Osteosarcoma 总被引:2,自引:0,他引:2
Luo X Sharff KA Chen J He TC Luu HH 《Clinical orthopaedics and related research》2008,466(9):2060-2070
There is a critical need to identify markers that can accurately identify existing or predict future metastatic disease in
patients with osteosarcoma since the majority of patients present with undetectable micrometastatic disease. We previously
reported S100A6 is overexpressed in human osteosarcoma and increased expression of S100A6 by immunohistochemistry correlated
with decreased clinical metastasis. We have established 11 primary cultures from biopsies of patients with osteosarcoma and
ten of the 11 primary cultures have increased expression of S100A6 relative to normal human osteoblasts. To further explore
possible mechanisms for metastasis suppression previously reported, we used in this report siRNA-mediated knockdown of S100A6
in four commonly used human osteosarcoma lines, then examined their cell adhesion, migration, and invasion properties. Knockdown
of S100A6 expression inhibited cell adhesion and promoted cell migration and invasion in these lines. Conversely, S100A6 overexpression
enhanced cell adhesion and inhibited cell invasion. Our data demonstrate S100A6 is commonly overexpressed in human osteosarcoma.
S100A6 may inhibit osteosarcoma metastasis by promoting cell adhesion and inhibiting cell motility and invasion. Thus, S100A6
may be considered a potential marker for human osteosarcoma with prognostic value for identifying patients without metastases.
One or more of the authors (HHL, TCH) have received funding from the Orthopaedic Research and Education Foundation, the Brinson
Foundation, and the American Cancer Society (ACS-IRG).
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained. 相似文献
994.
Recent studies suggest US medical schools are not effectively addressing musculoskeletal medicine in their curricula. We examined
if there were specific areas of weakness by analyzing students’ knowledge of and confidence in examining specific anatomic
regions. A cross-sectional survey study of third- and fourth-year students at Harvard Medical School was conducted during
the 2005 to 2006 academic year. One hundred sixty-two third-year students (88% response) and 87 fourth-year students (57%
response) completed the Freedman and Bernstein cognitive mastery examination in musculoskeletal medicine and a survey eliciting
their clinical confidence in examining the shoulder, elbow, hand, back, hip, knee, and foot on a one to five Likert scale.
We specifically analyzed examination questions dealing with the upper extremity, lower extremity, back, and others, which
included more systemic conditions such as arthritis, metabolic bone diseases, and cancer. Students failed to meet the established
passing benchmark of 70% in all subgroups except for the others category. Confidence scores in performing a physical examination
and in generating a differential diagnosis indicated students felt below adequate confidence (3.0 of 5) in five of the seven
anatomic regions. Our study provides evidence that region-specific musculoskeletal medicine is a potential learning gap that
may need to be addressed in the undergraduate musculoskeletal curriculum.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. 相似文献
995.
996.
Treatment of 27 patients by electrophoresis with preparation "Polycollagenase K" was analyzed and it was shown that it gave positive results according to complex assessment by the scale developed by the authors. 相似文献
997.
Claire A. Martin PhD Myo Thant Zaw MBBS Nicola Jackson BA Dave Morris BA Pierluigi Costanzo MBBS 《Journal of cardiovascular electrophysiology》2023,34(8):1772-1775
Introduction
We present the first worldwide use of pulsed-field ablation (PFA) for ventricular tachycardia (VT) ablation via a retrograde approach.Methods
The patient had previously failed conventional ablation of an intramural circuit underneath the aortic valve. The same VT circuit was inducible during the procedure. The Farawave PFA catheter and Faradrive sheath were used to deliver PFA applications.Results
Post ablation mapping demonstrated scar homogenization. There was no evidence of coronary spasm during PFA applications and no other complications occurred. VT was non-inducible post ablation and the patient has remained free of arrhythmia at follow-up.Conclusion
PFA for VT via a retrograde approach is feasible and effective. 相似文献998.
Balrik Singh Kailey MRCP Michael Koa-Wing PhD Nilesh Sutaria PhD Tom Mott BA Afzal Sohaib PhD Norman Qureshi PhD Christine Shi MRCP Pritpal Padam MBBS James Howard PhD Prapa Kanagaratnam PhD 《Journal of cardiovascular electrophysiology》2023,34(12):2552-2562
Background
Patients with atrial fibrillation (AF) and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. Short-term anti-thrombotic drugs are used postprocedure to offset the risk of device-related thrombus, evidence for this practice is limited.Objectives
To investigate optimal postimplant antithrombotic strategy in high bleeding-risk patients.Methods
Patients with AF and high-risk for both stroke and bleeding undergoing LAAO were advised their perioperative drug therapy by a multidisciplinary physician panel. Those deemed to be at higher risk of bleeding from anti-thrombotic drugs were assigned to minimal treatment with no antithrombotics or Aspirin-alone. The remaining patients received standard care (STG) with a 12 week course of dual-antiplatelets or anticoagulation postimplant. We compared mortality, device-related thrombus, ischemic stroke, and bleeding events during the 90 days postimplant and long-term. Event-free survival was assessed using Kaplan−Meier survival analysis, with logrank testing for statistical significance.Results
Seventy-five patients underwent LAAO of whom 63 patients (84%) had a prior serious bleeding event. The 42 patients on minimal treatment were older (74.3 ± 7.7 vs. 71.2 ± 7.2) with higher HASBLED score (3.6 ± 0.9 vs. 3.3 ± 1.2) than the 33 patients having standard care. There were no device-related thrombi or strokes in either group at 90 days postprocedure; STG had more bleeding events (5/33 vs. 0/42, p = 0.01) with associated deaths (3/33 vs. 0/42, p = 0.05). During long-term follow-up (median 2.2 years), all patients transitioned onto no antithrombotic drugs (43 patients [61%]) or a single-antiplatelet (29 patients [39%]). There was no evidence of early minimal treatment adversely affecting long-term outcomes.Conclusions
Short-term anti-thrombotic drugs may not be needed after LAAO implant in patients with high bleeding risk and could be harmful. Larger, prospective studies would be warranted to test these findings. 相似文献999.
Amanda L. McKie RN B Nurs GradCert Renal MN Clin Lead Murray Turner B AppSci MBA Catherine Paterson PhD MSc BA PG Cert LTA FHEA RAN 《Journal of Renal Care》2023,49(3):170-190
Background
People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living.Objective
To conduct a meta-aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis.Design
Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov , Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta-aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta-aggregation.Results
Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta-aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient-clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs.Conclusions
This meta-aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions. 相似文献1000.
Jack M. Guralnik MD MPH PhD Peggy M. Cawthon PhD MPH Shalender Bhasin MD Roger Fielding PhD Jay Magaziner PhD MSHyg Alfonso J. Cruz-Jentoft MD Bruno Vellas MD Lindsay Clarke JD Laura Lattimer BA William Evans PhD 《Journal of the American Geriatrics Society》2023,71(5):1595-1602