老年患者术前心电图检查采集方法的探讨

目的探讨一种老年白内障患者术前心电图图像采集时降低图像基线偏移、防止肌电干扰更有效的方法。方法选取2020年6—10月我院东区眼科门诊,年龄60～85岁之间的老年白内障术前行心电图检查的患者600例,采用随机数字表法将患者分为研究组与对照组,每组各300例,研究组在采集图像时予以图示法干预后采集图像,对照组常规采集图像,之后对两组患者采集的图像,从ST段基线、肌电干扰、全身肌紧张情况、遵医顺从性和心电图复查率等方面进行比较。结果研究组心电图复查率为2.7%(8例),对照组为12.0%(36例),差异有统计学意义(P0.05)。结论研究组图示法干预采集心电图图像优于对照组常规采集图像,可有效提高心电图正确诊断率,减少复查降低检查费用,降低老年患者在诊疗中的风险保证医疗质量。     

A Comparison of Endodontic Treatment Factors,Operator Difficulties,and Perceived Oral Health–related Quality of Life between Elderly and Young Patients

IntroductionThe purpose of this study was to compare endodontic treatment factors, treatment difficulties, and oral health–related quality of life (OHRQOL) between elderly and young patients.MethodsA total of 150 adults, 75 elderly (≥65 years) and 75 young patients (18–64 years), were recruited. Operators enumerated difficulties associated with communication, diagnosis, rubber dam application, access cavity preparation, canal localization, working length determination, instrumentation, and obturation after root canal treatment. The number of treatment visits, maxillary first molars with a second mesiobuccal canal, and the technical quality of the root filling were registered. Patients filled out questionnaires on pain, attendance of regular dental visits, esthetics, and masticatory function and the Oral Health Impact Profile-14.ResultsSignificantly more elderly had necrotic pulp (P < .001) and needed root canal treatment on teeth with full-coverage crown/bridge abutment (P < .001). It was significantly difficult to perform access cavity preparation and localize root canals on the elderly and on teeth with a full-coverage crown/bridge abutment. In regression analysis, the elderly presented with difficulties only during canal localization (P < .05). Second mesiobuccal canals were obturated in 43.5% of the young patients and 23.1% of the elderly patients. There were no significant differences in the number of treatment visits or the technical quality of root filling between the 2 groups. There were no significant differences in pain sensation, esthetics, masticatory function, or regular dental visits between the 2 groups. Elderly patients reported a significantly better OHRQOL (P < .05). Patients experiencing pain, patients needing treatment on anteriors/premolars, and females reported a significantly poorer OHRQOL (P < .05).ConclusionsThe elderly presented with treatment difficulty during canal localization and had better OHRQOL compared with young patients.     

Fascia-iliaca compartment block vs intra-articular hip injection for preoperative pain management in intracapsular hip fractures: A blind,randomized, controlled trial

BackgroundThe aim of this study was to compare the fascia-iliaca compartment block and the intra-articular hip injection in terms of pain management and the need for additional systemic analgesia in the preoperative phase of intracapsular hip fractures.MethodsPatients >65 years old with an intracapsular hip fracture were randomized in this prospective, blind, controlled, parallel trial in a Level-I trauma center. Patients were randomly assigned to receive either the fascia-iliaca compartment block (cohort FICB) or the intra-articular hip injection (cohort IAHI) upon admission to the emergency department. The primary outcome was pain relief at 20 min, 12 h, 24 h and 48 h after the regional anesthesia, both at rest and during internal rotation of the fractured limb. The Numeric Rating Scale was used. Residual pain was managed with the same protocol in all patients. Additional analgesic drug administration during the 48 h from admission was recorded.ResultsA total of 120 patients with comparable baseline characteristics were analyzed in this study: the FICB group consisted of 70 subjects, while the IAHI group consisted of 50 subjects.Pain was significantly lower in the IAHI group during movement of the fractured limb at 20 min (p < 0.05), 12 h (p < 0.05), 24 h (p < 0.05) and 48 h (p < 0.05).In the FICB cohort 72.9% of patients needed to take oxycodone, in contrast to 28.6% of the IAHI cohort (p < 0.05). In the FICB cohort 14.09 ± 11.57 mg of oxycodone was administered, while in the IAHI cohort 4.38 ± 7.63 mg (p < 0.05). No adverse events related to either technique were recorded.ConclusionsIntra-articular hip injection provides better pre-operatory pain management in elder patients with intracapsular hip fractures compared to the fascia-iliaca compartment block. It also reduced the need for supplementary systemic analgesia.Level of EvidenceTherapeutic Level I.     

Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery

PurposeTo determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed.MethodsThis retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed.Results360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM.ConclusionLack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.     

不同分子亚型乳腺癌细胞系中RUNX3蛋白表达及定位研究

目的:检测人类Runt相关转录因子3(RUNX3)在不同分子亚型乳腺癌细胞系中的表达及其亚细胞定位情况,为进一步揭示RUNX3的失活机制和发现新的治疗靶点提供理论依据。方法:在5种乳腺癌细胞(MCF-7、T47D、SKBR-3、MDA-MB-231和BT-549)及正常乳腺上皮细胞(MCF-10A)中,通过Western blot和免疫荧光实验检测RUNX3的蛋白表达和亚细胞定位情况;采用来普霉素B(Leptomycin B)抑制RUNX3的出核,利用CCK-8法检测细胞活力的改变,EdU染色检测细胞增殖情况,Western blot和免疫荧光实验检测RUNX3的蛋白表达和亚细胞定位的改变。结果:与MCF-10A细胞相比,5种乳腺癌细胞系中RUNX3的核定位减少、胞浆定位增多。经Leptomycin B处理后,CCK-8实验结果显示5种乳腺癌细胞的活力明显减弱,EdU染色显示5种乳腺癌细胞增殖能力明显降低,Western blot和免疫荧光实验显示5种乳腺癌细胞胞浆中的RUNX3蛋白表达量明显降低、胞核中的RUNX3蛋白表达量明显增多(P0.05)。结论:不同分子亚型乳腺癌细胞中均存在RUNX3的胞浆转位失活现象,针对性地逆转RUNX3的出核过程可以明显降低肿瘤细胞的活力和增殖能力,可能成为乳腺癌潜在的治疗靶点。     

Treatment strategy for colorectal cancer with resectable synchronous liver metastases:Is any evidence-based strategy possible?

Fifteen percent to twenty-five percent of patients affected by colorectal cancer presents with liver metastases at diagnosis. In resectable cases, surgery is the only potentially curative treatment and achieves survival rates up to 50% at 5 years. Management is complex, as colorectal resection, liver resection, chemotherapy, and, in locally advanced mid/low rectal tumors, radiotherapy have to be integrated. Modern medical practice usually relies on evidence-based protocols. Levels of evidence for synchronous metastases are poor:published studies include few recent prospective series and several retrospective analyses collecting a limited number of patients across long periods of time. Data are difficult to be generalized and are mainly representative of single centre’s experience, biased by local recruitment, indications and surgical technique. In this context, surgeons have to renounce to "evidence-based medicine" and to adopt a sort of "experience-based medicine". Anyway, some suggestions are possible. Simultaneous colorectal and liver resection can be safely performed whenever minor hepatectomies are planned, while a case-by-case evaluation is mandatory in case of more complex procedures. Neoadjuvant chemotherapy is preferentially scheduled for patients with advanced metastatic tumors to assess disease biology and to control lesions. It can be safely performed with primarytumor in situ , even planning simultaneous resection at its end. Locally advanced mid/low rectal tumor represents a further indication to neoadjuvant therapies, even if treatment’s schedule is not yet standardized. In summary, several issues have to be solved, but every single HPB centre should define its proper strategy to optimize patient’s selection, disease control and safety and completeness of surgery.