SARS-CoV-2对生育的影响

近年严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome corona virus 2,SARS-CoV-2）大流行对人类健康造成了威胁。研究表明,SARS-CoV-2对人类生育能力有潜在影响,对男性生育力的影响远大于女性。目前研究表明接种疫苗可能不会对人类的生育能力存在不利影响。感染SARS-CoV-2会不会发生性传播、垂直传播及母婴传播,从而对下一代产生影响,目前暂不清楚。尚需要从生殖医学科、传染病学科角度探讨SARS-CoV-2及其疫苗对生育的影响,并讨论可能存在的性传播、垂直传播和母婴传播,以提高对SARS-CoV-2及其疫苗的认识。     

2021年ACOG关于产后阶梯式多模式药物镇痛的建议及要点解读

产后疼痛是困扰产妇的常见问题,如治疗不当可能会导致阿片类药物滥用、产后抑郁和疼痛长期存在等不良后果。因此,美国妇产科医师学会（American College of Obstetricians and Gynecologists,ACOG）于2021年9月提出了针对产后疼痛的临床共识,专门对产后疼痛的一般管理、阴道分娩、剖宫产术后、母乳喂养时及出院后疼痛的处置给出了治疗建议与指导,强调了阶梯式多模式药物镇痛方法与个体化用药原则。推荐临床用药可遵循“非阿片类镇痛药（如对乙酰氨基酚和非甾体抗炎药）—弱阿片类药物—强阿片类药物（必要时）”阶梯式给药原则,并可合理联合用药。对此进行简要介绍与要点解读。     

施普瑞对冠心病患者胰岛素敏感性的影响

目的观察施普瑞对冠心病患者胰岛素敏感性的影响.方法40例血压正常、非糖尿病的冠心病患者,施普瑞治疗前及1.2g/d治疗10周后,分别检测空腹血糖、空腹血浆胰岛素、血胆固醇、甘油三酯、高密度脂蛋白-胆固醇,计算胰岛素敏感指数,并以38例性别、年龄、体重指数相当的正常人为对照组.结果2组空腹血糖差异无显著性(P＞0.05),冠心病组空腹血浆胰岛素显著升高,胰岛素敏感性指数显著降低(P＜0.01),施普瑞治疗10周后,空腹血浆胰岛素水平明显下降(P＜0.01),胰岛素敏感性指数显著增高(P＜0.05),血脂代谢明显改善.结论施普瑞在纠正冠心病患者血脂代谢异常的同时,对其胰岛素敏感性也有明显的改善.     

伤病比在医院维权中的运用

为了保证民法的公平原则,避免医疗纠纷赔偿案件审理中忽视患者本身病情所致的不良后果的情况,对损伤与疾病对患者预后的影响进行了研究.介绍了伤病比的来源,论述了伤病比在医疗纠纷处理中的适用 范围,伤病比的级别与医院承担的赔偿额度.指出应增强伤病比意识,促进医与法的完美结合.     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3

Introduction and objectivesThe goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging.Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival.We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR.Material and methodsIn our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS.In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions.ResultsThe following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001.ConclusionsThe most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.     

A simple scoring system to estimate perioperative mortality following liver resection for primary liver malignancy—the Hepatectomy Risk Score (HeRS)

BackgroundSelection of the optimal treatment modality for primary liver cancers remains complex, balancing patient condition, liver function, and extent of disease. In individuals with preserved liver function, liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality. The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease (MELD) and extent of resection to guide risk assessment for liver resections.MethodsThe 2005–2015 NSQIP database was queried for patients undergoing liver resection for primary liver malignancy. We first developed a model that incorporated the extent of resection (1 point for major hepatectomy) and a MELD-Na score category of low (MELD-Na =6, 1 point), medium (MELD-Na =7–10, 2 points) or high (MELD-Na >10, 3 points) with a score range of 1–4, called the Hepatic Resection Risk Score (HeRS). We tested the predictive value of this model on the dataset using logistic regression. We next developed an optimal multivariable model using backwards sequential selection of variables under logistic regression. We performed K-fold cross validation on both models. Receiver operating characteristics were plotted and the optimal sensitivity and specificity for each model were calculated to obtain positive and negative predictive values.ResultsA total of 4,510 patients were included. HeRS was associated with increased odds of 30-day mortality [HeRS =2: OR =3.23 (1.16–8.99), P=0.025; HeRS =3: OR =6.54 (2.39–17.90), P<0.001; HeRS =4: OR =13.69 (4.90–38.22), P<0.001]. The AUC for this model was 0.66. The AUC for the optimal multivariable model was higher at 0.76. Under K-fold cross validation, the positive predictive value (PPV) and negative predictive value (NPV) of these two models were similar at PPV =6.4% and NPV =97.7% for the HeRS only model and PPV =8.4% and NPV =98.1% for the optimal multivariable model.ConclusionsThe HeRS offers a simple heuristic for estimating 30-day mortality after resection of primary liver malignancy. More complicated models offer better performance but at the expense of being more difficult to integrate into clinical practice.     

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach

ObjectiveTo assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach.MethodsA scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 “overall” indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 “equity-related” indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach.ResultsOverall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, “D”) than that for equity-related indicators (average score of 17%, “F”). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients’ immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors.ConclusionOne year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several “best practices” in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00496-6.