Carcinoid of the Rectum Risk Stratification (CaRRS): A Strategy for Preoperative Outcome Assessment

Background Predicting rectal carcinoid behavior exclusively on the basis of tumor size is imprecise. We sought to identify factors associated with outcome and incorporate them into a preoperative risk stratification scheme. Methods Seventy patients with rectal carcinoid evaluated at our institution were identified. Demographic, clinical, and histopathologic data were collected and correlated with recurrence and survival. Results The mean age of our cohort was 53.6 years. Fifty-seven percent of patients were women. The mean tumor size was 1.3 cm (range, .1–5 cm). Twenty-five percent of patients had deeply invasive tumors (into the muscularis propria or deeper); an equal percentage had tumors with lymphovascular invasion (LVI) or an increased mitotic rate (two or more mitoses per 50 high-power fields). Eleven patients (17%) had distant metastases at presentation. Sixty-one patients were followed for a median of 22 months (range, 2–308 months), during which seven patients developed recurrence and seven died of disease (including two of seven whose disease recurred). Poor outcome was associated with large tumor size, deep invasion, presence of LVI, and increased mitotic rate. These factors were incorporated into a Carcinoid of the Rectum Risk Stratification (CaRRS) score. CaRRS predicted recurrence-free and disease-specific survival better than any single factor alone. Conclusions Poor prognostic features of rectal carcinoids include large size, deep invasion, LVI, and increased mitotic rate. The CaRRS score incorporates these features and accurately predicts outcome. Because the CaRRS score is based on values available by preoperative biopsy, it can identify patients with favorable prognosis and those with poor prognosis who may benefit from additional staging or surveillance.     

Undertaking Procedure-Based Assessment is Feasible in Clinical Practice

INTRODUCTION

With the development of a new curriculum, workplace based assessments such as procedure-based assessment (PBA) are becoming increasingly common within surgical training. However, there have been concerns about the impact of these assessments on clinical practice. This study assessed the time taken to complete PBA forms to determine whether it is feasible in clinical practice.

MATERIALS AND METHODS

PBAs for three colorectal procedures (anterior resection, right hemicolectomy and anal fistula) were undertaken by various trainers and trainees. A pilot study was performed to identify potential reasons for incomplete forms and procedural modifications subsequently applied in the main study. Times taken to complete the consenting and operative components of the forms were recorded.

RESULTS

Incomplete forms in the pilot were mainly attributable to time constraints. In the main study, all assessments were completed within 30 min. Assessment times increased with complexity of the procedure. Median times for completing the consenting and operative components in anterior resection were 13 min (range, 8–15 min) and 15 min (range, 10–18 min), respectively.

CONCLUSIONS

PBAs are feasible in clinical practice and are valued by trainees as a means of enabling focused feedback and targeted training. Commitment from trainers and trainees will be required but, with adequate planning, the assessment tool is effective with minimal impact on clinical practice.     

超声心动图诊断胎儿法洛四联症的价值

  目的  分析超声心动图诊断胎儿法洛四联症（TOF）的价值。  方法  选取2017年1月至2019年6月在云南省第二人民医院超声科接受胎儿超声心动图检查的558例孕妇作为研究对象，以引产后病理解剖及产后超声心动图随访结果为金标准，计算产前超声心动图诊断灵敏度、特异度、准确率，并对TOF的声像特征进行分析。  结果  共有558例孕妇接受超声心动图检查，经过引产后病理解剖及产后超声心动图随访结果证实共25例TOF胎儿。产前超声心动图检出TOF胎儿共26例，伴肺动脉狭窄的典型TOF20例，伴室间隔缺损的肺动脉闭锁3例，伴肺动脉瓣缺如的TOF2例，误诊2例，漏诊1例。产前超声心动图诊断灵敏度、特异度、准确率、误诊率、漏诊率分别约96%（24/25）、99.62%（531/533）、99.46%（555/558）、0.38%（2/533）、4%（1/25）。以室间隔缺损，主动脉骑跨，肺动脉狭窄、闭锁、肺动脉瓣缺如声像特征为主。  结论  胎儿产前超声心动图是诊断TOF最有重要价值的影像学方法，对评估胎儿预后有重要的临床指导意义。     

蒙药达日布-8治疗高脂血症动脉粥样硬化的研究进展

蒙药达日布-8是蒙医临床治疗高脂血症动脉粥样硬化的验方。目前,临床研究和实验研究都已证明达日布-8确有降低血脂、抗氧化及保护血管内皮等作用。并且具有疗效好、不良反应小等优势。高脂血症是“三高症”之一,具有患病率高、危害性大等特点,也是引起动脉粥样硬化的重要危险因素之一。而动脉粥样硬化是多种心血管疾病的主要病理变化,对人的生命健康极具有危害性。     

History of eating disorders in female patients with obsessive-compulsive disorder

The prevalence of eating disorders was assessed in a case note study of 105 female patients with obsessive-compulsive disorder (OCD). A previous history of anorexia nervosa was found in 12 (11%). Patients with a previous history of eating disorders (OCD-AN) had an earlier onset of OC symptoms than other patients. Among OCD-AN patients, the anorexia nervosa and obsessive-compulsive disorders had a similar age of onset. The comorbidity of the two syndromes among females may point to common vulnerability factors. Patients with early onset OCD may be at increased risk of developing eating disorders. The assessment of OCD in young female patients should include a careful check for evidence of eating disorders. © 1993 by John Wiley & Sons, Inc.     

Use of Flipped Classroom and Screen-Based Simulation for Interdisciplinary Critical Care Fellow Teaching of Electroencephalogram Interpretation

Neurocritical Care -     

Theoretical considerations for oocyte cryopreservation by freezing

Attempts to cryopreserve oocytes by freezing have, to date, been based mostly on empirical approaches rather than on basic principles, and perhaps in part for this reason have not been very successful. Theoretical considerations suggest some fairly 'heretical' conclusions. The concentrations of permeating cryoprotectants employed in past studies have probably been inadequate, and the choice of propylene glycol (PG) as a protective agent is questionable. The use of non-penetrating agents, such as sucrose to preshrink oocytes prior to freezing and which, therefore, exacerbate osmotic stress during freezing, may be inappropriate, yet may protect in part by reducing the concentration of PG during freezing. The methods used to add and remove cryoprotectant may be suboptimal, and may be based on an inadequate understanding of the cryobiological constraints for oocyte survival. Given these concerns, it is not surprising that fully satisfactory results have been elusive, but there is every reason to believe that greater success is possible using a more theoretically appropriate approach.     

早期应用醒脑开窍针法结合康复训练治疗高血压脑出血术后病入疗效观察

目的：观察早期醒脑开窍针法结合康复治疗对高血压脑出血术后病人的临床疗效。方法：将42例高血压脑出血术后患者随机分为治疗组及对照组,治疗组在常规药物治疗基础上,术后314天加醒脑开窍针法及康复治疗,对照组术后单纯予常规药物治疗。评定治疗前后神经功能缺损评分,进行临床疗效评定。比较治疗前后Glasgow昏迷评分（GCS）、简化Fugl-Meyer肢体运动功能评分（FMA）及日常生活活动能力评分（ADL）改良Barthel指数（MBI）等,进行功能评价。结果：早期采用醒脑开窍针法结合康复治疗能明显改善患者的临床疗效及神经功能,临床疗效治疗组总有效率为90.48%,对照组总有效率为52.39%,经统计学处理（P〈0.05）,两组间差异有显著性意义。治疗后治疗组GCS、FMA、BI均有明显改善,与对照组比较,有明显差异（P〈0.05）。结论：早期采用醒脑开窍针法结合康复治疗高血压脑出血术后病人,疗效更好。