Systematic analysis of early phase clinical studies for patients with breast cancer: Inclusion of patients with brain metastasis

PurposeThis systematic review aims to better define the limitations and patterns with which patients with MBC and CNS metastasis are enrolled into early phase developmental therapeutics trials.MethodsIn June 2016, PubMed search was conducted using the following keywords: “Breast cancer”. Drug-development phase 1, phase 2 or phase 1/2 trials for patients with MBC were included. Multiple-histology trials and trials without an efficacy endpoint were excluded.ResultsIn total, 1474 studies were included; Inclusion criteria for 423 (29%) allowed for CNS metastasis, 770 (52%) either excluded or did not document eligibility of patients with CNS disease. Trials accruing patients with HER2-positive MBC and including targeted therapies had higher odds of allowing for patients with CNS disease (adjusted OR 1.56, 95% CI 1.08–2.2.6; p = 0.019 and 1.49, 95% 1.08–2.06; p = 0.014, respectively). There were also higher odds of accrual of patients with CNS involvement into clinical trials over time (odds ratio = 1.10, 95% CI 1.07–1.12; p < 0.0001).ConclusionMost published early phase clinical trials either did not clearly document or did not allow for accrual of patients with CNS disease. Early phase trials with targeted agents or enrolling HER2+ MBC had higher odds of permitting CNS metastases.     

Routine Screening for CKD Should Be Done in Asymptomatic Adults … Selectively

CKD is an important public health problem associated with substantial morbidity, impaired quality of life, shortened life expectancy, and excessive health care costs. Given its long preclinical latency, screening of asymptomatic individuals for CKD has been considered as a potentially useful means of early detection, with a goal of reducing CKD progression and its complications. A recent clinical practice guideline from the American College of Physicians that recommended against screening for CKD in asymptomatic adults without risk factors has reignited debate regarding CKD screening. Despite the lack of randomized controlled trial evidence showing benefits of CKD screening, even among individuals at increased risk for CKD, such as those with diabetes or hypertension or who are of certain high-risk racial or ethnic groups, a thoughtful and selective approach to CKD screening seems to be cost-effective and clinically valuable. CKD screening is recommended by several nephrology professional societies and appropriate in at-risk asymptomatic individuals with the intent of identifying and managing CKD, diagnosing the etiology of CKD, limiting or preventing CKD progression and its associated cardiovascular disease risk, and minimizing risk of AKI, inappropriate drug dosing, and nephrotoxic injury.     

Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician's Perspective

This paper presents some previously proposed neurobiological mechanisms on how acupuncture may work in some clinical applications from a clinician's perspective. For the treatment of musculoskeletal conditions, the proposed mechanisms included microinjury, increased local blood flow, facilitated healing, and analgesia. Acupuncture may trigger a somatic autonomic reflex, thereby affecting the gastric and cardiovascular functions. Acupuncture may also change the levels of neurotransmitters such as serotonin and dopamine, thereby affecting the emotional state and craving. This mechanism may form the basis for the treatment of smoking cessation. By affecting other pain-modulating neurotransmitters such as met-enkephalin and substance P along the nociceptive pathway, acupuncture may relieve headache. Acupuncture may affect the hypothalamus pituitary axis and reduce the release of the luteinizing hormone in the treatment of polycystic ovary syndrome. In addition, two other approaches to the acupuncture mechanism, the fascia connective tissue network and the primo vascular system, are briefly reviewed. Finally, the idea of true versus sham acupuncture points, which are commonly used in clinical trials, is examined because the difference between true and sham points does not exist in the neurobiological model.     

Perceived stigma reductions following participation in mental health services integrated within community-based HIV primary care

HIV stigma remains a significant challenge for individuals living with HIV disease that can adversely affect overall well-being and patterns of HIV health service engagement. Finding ways to effectively address stigma concerns is, therefore, an important consideration in the clinical management of HIV disease. This study examined changes in perceived stigma in a sample of 48 adults living with HIV disease as an outcome of their participation in a mental health services program integrated with community-based HIV primary care. Participants completed a self-report instrument that provided a multidimensional measure of perceived HIV stigma, including distancing, blaming, and discrimination dimensions. This scale was administered at the baseline mental health service visit and then re-administered at the three-month follow-up point. Study results showed reductions in self-reported perceived HIV stigma over time for the distancing (t = 4.01, p = 0.000, d = 0.43), blaming (t = 2.79, p = 0.008, d = 0.35), and discrimination (t = 2.90, p = 0.006, d = 0.42) dimensions of stigma. These findings suggest that participation in HIV mental health services may have a favorable impact on perceived HIV stigma. Implications of these findings are discussed, including possible mechanisms that might explain the observed results as well as suggested directions for future research in this area. Randomized controlled trials would represent an important next step to investigate the extent to which HIV mental health services can reduce levels of perceived HIV stigma.     

3D打印技术联合CBL教学法在骨科教学中的价值

目的对骨科临床教学中应用3D打印技术联合CBL教学法的临床实际应用价值进行研究分析。方法择取2018年4月—2019年4月间在我院骨科的实习生共80例作为研究对象,采用随机数字表法,将所有实习生分为观察组(40人)、对照组(40人);对照组应用常规教具联合CBL教学法,观察组应用3D打印技术联合CBL教学法,对比两组实习生的教学效果以及对教学活动的满意度。结果在理论知识以及临床操作方面,观察组实习同学成绩高于对照组(P<0.05);在对教学满意度方面,观察组实习同学高于对照组(P<0.05)。结论在骨科临床教学中,应用3D打印技术联合CBL教学法具有显著临床教学效果,学生的理论知识以及临床操作成绩更为优异,对教学满意度更高。     

慢性精神分裂症患者合并肺部感染临床资料分析

目的：探讨慢性精神分裂症患者合并肺部感染的临床特征。方法对162例慢性精神分裂症合并肺部感染患者的临床资料进行回顾性分析。结果162例肺部感染者，其中节段性肺炎124例，慢性肺部感染38例。急性肺炎以中青年，精神病病程＜3 a居多，感染部位以右肺中叶和左肺舌叶为主，对症治疗后均痊愈；慢性感染以中老年多见，精神病病程＞3a，感染部位以两肺下叶、肺底及脊柱两旁慢性感染为主，对症治疗后痊愈率为71．1％，临床症状消失率为28．9％。结论精神分裂症患者合并肺部感染率较高，临床症状不典型，应制定有效的预防和控制对策，减少感染的发生。     

杭州地区蜘蛛咬伤临床特征分析

目的 分析杭州地区蜘蛛咬伤病例的临床特征。方法 回顾性分析2020年4月～2021年11月因蜘蛛咬伤收治我科住院患者71例，对患者人群特征、临床表现、实验室检查结果、诊疗情况、转归进行分析、总结。结果 被咬伤人群主要为中青年，每年5~9月为发病高峰期，咬伤部位主要在双下肢，71例患者中58例患者仅有局部症状，13例患者除了局部症状还伴有全身毒性反应发症。 结论：杭州地区蜘蛛毒性较小，伤人后主要以局部症状为主，合理的局部和全身治疗均能得到痊愈。