Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period

BackgroundNational holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients.MethodsOver ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups.ResultsThere were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8–12.3%) vs.5.0% (4.2–8.9%), p = 0.324] and peritonitis rate [0.19 (0.13–0.53) vs. 0.22 (0.18–0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015).ConclusionOur study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.     

Effectiveness of moist dressings in wound healing after surgical suturing: A Bayesian network meta‐analysis of randomised controlled trials

The moist healing theory proves that a moderately moist and airtight environment is conducive to wound healing. However, different moist dressings have different functions. We aim to evaluate the effects of moist dressings on wound healing after surgical suturing and identify superior moist dressings. Randomised controlled trials investigating the application of moist dressings were retrieved from electronic databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library. Wound healing, surgical site infection (SSI), and times of dressing change were assessed. The values of the surface under the cumulative ranking (SUCRA) curve were calculated based on the Bayesian network meta‐analysis. Inconsistency tests and funnel plots were applied to analyse the consistency and publication bias. All the analysis complies with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) 2020 Checklist and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Sixteen randomised controlled trials involving 4444 patients were pooled in the network meta‐analysis. The ionic silver dressing (SUCRA, 93%) ranked first in wound healing, the metallic silver dressing (SUCRA, 75.9%) ranked first in SSI, and the hydrocolloid dressing (SUCRA, 73.9%) ranked first in times of dressing change. Inconsistency was only observed in wound healing, and no publication bias was observed in this study. The effects of moist dressings are better than gauze dressings in the process of wound healing. The ionic silver dressing is effective in wound healing, whereas the metallic silver dressing is effective in SSI prevention. The hydrocolloid dressing requires the fewest times of dressing change. More high‐quality RCTs are required to support the network meta‐analysis.     

Multiparametric MRI combined with liver volume for quantitative evaluation of liver function in patients with cirrhosis

PURPOSEWe aimed to establish a liver function evaluation model by combining multiparametric magnetic resonance imaging (MRI) with liver volume (LV) and further verify the effectiveness of the model to evaluate liver function.METHODSThis retrospective study included 101 consecutive cirrhosis patients (69 cases for modeling group and 32 cases for validation group) who underwent gadoxetic acid-enhanced MRI. Five signal intensity parameters were obtained by measuring the signal intensities of the liver, spleen, and erector spinae before and 20 minutes after gadoxetic acid disodium enhancement. The diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were obtained from intravoxel incoherent motion diffusion-weighted imaging. The LV parameters (V_liver, V_spleen, and V_liver/V_spleen) were obtained using 3-dimensional image generation software. The most effective parameter was selected from each of the 3 methods, and a multivariate regression model for liver function evaluation was established and validated.RESULTSIn the modeling group, relative enhancement (RE), D*, and V_liver/V_spleen showed significant differences among the different liver function groups (P < .001). Receiver operating characteristic analysis showed that these parameters had the highest area under the curve (AUC) values for distinguishing Child-Pugh A from Child-Pugh B and C groups (0.917, 0.929, and 0.885, respectively). The following liver function model was obtained by multivariate regression analysis: F(x) = 3.96 − 1.243 (RE) − 0.034 (D*) − 0.080 (V_liver/V_spleen) (R² = 0.811, P < .001). In the patients with cirrhosis, the F(x) of Child-Pugh A, B, and C were 1.16 ± 0.44, 1.95 ± 0.29, and 2.79 ± 0.38, respectively. In the validation group, the AUC for F(x) to distinguish Child-Pugh A from Child-Pugh B and C was 0.973.CONCLUSIONCombining multiparametric MRI with LV effectively distinguished patients with different Child-Pugh grades. This model could hence be useful as a novel radiological marker to estimate the liver function.

Main points

• Among the parameters generated by gadoxetic acid disodium-enhanced magnetic resonance imaging (MRI), intravoxel incoherent motion, and liver volume, the relative enhancement (RE), pseudo-diffusion coefficient (D*), and liver-spleen volume ratio (V_liver/V_spleen) displayed the best liver function classification performance.
• The model F(x) combining multiparametric MRI with liver volume showed an area under the curve of 0.973 in distinguishing Child-Pugh A from Child-Pugh B and C. The sensitivity and specificity were 97.6% and 90.9%, respectively.
• The model integrates the functional and morphological information of the liver. It is useful for quantitative liver function evaluation and is expected to be used for preoperative liver function evaluation.

Liver cirrhosis is a pathological stage characterized by diffuse fibrosis of the liver, formation of pseudo-lobules, and blood vessel proliferation in the liver.¹ Liver function assessment is the main factor affecting the prognosis of patients with liver cirrhosis, and the assessment of preoperative and residual liver function is extremely important for patients with liver cancer.² Moreover, liver function is unevenly distributed in the liver parenchyma and varies between different lobes and segments in cirrhosis.³ The liver morphology changes in different stages of cirrhosis. This change is partly derived from changes in the volume and number of liver parenchymal cells. However, clinical methods for assessing liver function focused on clinical symptoms, biochemical blood parameters, and lack of evaluation of liver morphology.^4-6Magnetic resonance imaging (MRI) can provide morphological and functional information about the liver. Gadoxetic acid disodium (Gd-EOB-DTPA) is a liver-targeting MRI contrast agent which can be specifically ingested by normal hepatocytes.⁷ Images of hepatobiliary phase could accurately assess liver volume (LV) which is another important clinical index for liver function.⁸ Liver function is impaired and the number of hepatocytes with normal Gd-EOB-DTPA uptake is reduced in cirrhosis. At the same time, the uptake of Gd-EOB-DTPA by hepatocytes is reduced due to the proliferation of fibrous stroma and the reduction of organic anion transporter polypeptide (OATP) expression. Consequently, the liver signal decreases during the hepatobiliary phase.⁹ During the progression of cirrhosis, the increased intrahepatic connective tissue reduces hepatic blood flow and diffusion capacity, leading to hepatocyte degeneration, inflammatory infiltration, and fibrosis. All of this leads to changes in liver tissue structure and perfusion. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can simultaneously obtain information on liver perfusion and water diffusion. The diffusion coefficient (D) value has high sensitivity and specificity in detecting liver fibrosis.¹⁰ Multiparametric imaging combining conventional techniques could enable a comprehensive examination of the liver.¹¹In view of the potential value of LV and multiparametric MRI in liver function assessment, this study aims to establish a liver function evaluation model by combining multiparametric MRI with LV and further verify the effectiveness of the model to evaluate liver function.     

应用现有国产器材进行超微量法检测红细胞比积的研究-在营养性贫血调查中的应用

关于红细胞比积（packed一Cell Volume,PCV）测定,国内通常采用Wintrobe氏（温特罗布氏,简称温氏）法。由于温氏法用血量大（约2.5ml故需静脉抽血）、操作繁杂,致使温氏法不易被接受。特别是在进行儿童贫血调查时静脉采血困难很多,因而PCV 检测不能广泛开展。     

琦云安乐片与劳拉西泮治疗广泛性焦虑症临床对照研究

目的 验证安乐片与劳拉西泮治疗广泛性焦虑症的临床疗效及副反应.方法 采用随机分组的方法,将符合CCMD-3诊断标准的60例广泛性焦虑症分为安乐片组（30例）、劳拉西泮（30例）,疗程4周,用焦虑自评量表（SAS）,Hamilton焦虑量表（HAMA）和副反应量表（TESS）评定疗效和副反应.结果 安乐片与劳拉西泮疗效相当（P＞0.05）.治疗第4周两组SAS、HAMA及HAMA因子分的减分比较有非常显著性差异（P＜0.01）,两者副反应相当,均较轻微,不影响治疗效果.结论 琦云安乐片治疗广泛性焦虑症有效,副反应轻微.     

Efficacy of short-term multidisciplinary intensive rehabilitation in patients with different Parkinson's disease motor subtypes: a prospective pilot study with 3-month follow-up

Parkinson's disease(PD) can be classified into three motor-based subtypes: postural instability/gait difficulty(PIGD), tremor dominant(TD), and indeterminate.The neuropathophysiological mechanisms of the three motor subtypes are different, which may lead to different responses to therapy.Sixty-nine patients with idiopathic Parkinson's disease(Hoehn–Yahr stage ≤ 3) were screened from 436 patients with Parkinsonism recruited through outpatient services and the internet.According to the Movement Disorder Society Unified Parkinson's Disease Rating Scale(MDS-UPDRS) TD/PIGD ratio, the patients were divided into PIGD(TD/PIGD ≤ 0.09; n = 36), TD(TD/PIGD ≥1.15; n = 19), and indeterminate(TD/PIGD = 0.90–1.15; n = 14) groups.All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment(MIRT) during hospitalization, as well as a remote home rehabilitation health education class.Compared with the scores at admission, all patients showed significant improvements in their MDS-UPDRS III score, walking ability, balance, and posture control at discharge.Moreover, the MDS-UPDRS III score improvement was greater in the PIGD group than in the TD group.The follow-up data, collected for 3 months after discharge, showed that overall symptom improvement in each group was maintained for 1–3 months.Furthermore, there were no significant differences in the duration or grade effects of symptom improvement among the three groups.These findings suggest that 2 weeks of MIRT is effective for improving motor performance in all three motor subtypes.Patients in the PIGD group had a better response after hospitalization than those in the TD group.This study was approved by the Institutional Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University of China(approval No.2018 bkky022) on May 7, 2018 and registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900020771) on January 19, 2019.     

Repeated intravitreal injections of antivascular endothelial growth factors and risk of intraocular pressure medication use

Graefe's Archive for Clinical and Experimental Ophthalmology - To determine the risk of initiating ocular hypertension and glaucoma treatment with repeated injections of antivascular...