Children's Perception of Temporally Distorted Sentential Approximations of Varying Length

The purpose of this study was to investigate the abilities of second-grade and fourth-grade children to auditorially process three orders of three- and five-word sentential approximations, which had normal interstimulus intervals (ISI) and ISIs of 200 and 400 ms. Results showed that percent correct scores decreased as a function of increasing sentence length and ISI, and decreasing order of sentential approximation and grade level. The results are discussed relative to theoretical notions of short-term memory and auditory perceptual processing as well as potential clinical applications     

Adjuvant HPV vaccination for anal cancer prevention in HIV-positive men who have sex with men: The time is now

ImportanceOutcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected MSM (individuals at highest risk for anal cancer) on the basis of cost-effectiveness determined using existing evidence or whether future research is needed.MethodsWe developed a Markov (state-transition) cohort model to assess the cost-effectiveness of post-treatment adjuvant HPV vaccination of 27 years or older HIV-infected MSM. We first estimated cost-effectiveness and then performed value-of-information (VOI) analysis to determine whether future research is required by estimating the expected value of perfect information (EVPI). We also estimated expected value of partial perfect information (EVPPI) to determine what new evidences should have highest priority.ResultsWith the incremental cost-effectiveness ratio (ICER) of $71,937/QALY, “treatment plus vaccination” was the most cost-effective HSIL management strategy using the willingness-to-pay threshold of 100,000/QALY. We found that population-level EVPI for conducting future clinical research evaluating HSIL management approaches was US$12 million (range $6–$20 million). The EVPPI associated with adjuvant qHPV vaccination efficacy estimated in terms of hazards of decreasing HSIL recurrence was $0 implying that additional data from a future study evaluating efficacy of adjuvant qHPV vaccination will not change our policy conclusion that “treatment plus vaccination” was cost-effective. Both the ICER and EVPI were sensitive to HSIL treatment compliance.ConclusionPost-treatment adjuvant qHPV vaccination in HIV-infected MSM aged 27 or above is likely to be cost-effective. Use of adjuvant qHPV vaccination could be considered as a potential strategy to reduce rising anal cancer burden among these high-risk individuals.     

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.     

Non-Mass Breast Lesions on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis

The aim of this study was to analyze the features of non-mass breast lesions (NMLs) on B-mode ultrasound (US), color Doppler US, strain elastography (SE) and contrast-enhanced ultrasound (CEUS) and to develop a multimode ultrasonic method for NML differentiation. Seventy-one NMLs were included in this retrospective study. Binary logistic regression was used to identify the independent risk factors. Pathology results were used as the standard criterion. Microcalcification on US, high stiffness on SE and hyper-enhanced intensity on CEUS were identified as features correlated with malignancy. A multimode method to evaluate NMLs based on the logistic regression was developed. The sensitivity and specificity for US, US?+?Doppler, US?+?SE, US?+?CEUS and the multimode method were 100% and 29%, 92.5% and 41.9%, 97.5% and 58.1%, 90.0% and 58.1% and 95.0% and 77.4%, respectively. The accuracy of these methods was 69.0%, 70.4%, 80.2%, 76.1% and 87.3%, respectively. The multimode ultrasonic method is simple and exhibited high diagnostic performance, which might be helpful for predicting the potential malignancy of NMLs.     

我国日本血吸虫病异位损害分析

目的 分析日本血吸虫病异位损害情况,为诊疗提供参考。方法 检索《中国学术期刊网络出版总库》、《万方数据知识服务平台》2007年以来所有异位日本血吸虫病的文献报道资料,进行统计分析与总结。结果 2007 —2017年共报道异位血吸虫病211例,其中脑异位损害160例,占75.83%;肺异位损害45例,占21.33%;卵巢、输卵管、眼、脊髓、皮下、腮腺异位损害各1例。胃肠等消化道血吸虫病12例。结论 脑和肺血吸虫病异位损害发生率和误诊率最高,具有呼吸系统、神经系统症状和体征血吸虫病患者应首先排除血吸虫异位损害。血吸虫病疫区要重视异位血吸虫病诊断与治疗。异位血吸虫病预后大多良好,其病原治疗药物首选吡喹酮。     

结直肠早癌及癌前病变内镜治疗和中医论治

结直肠癌大多起源于结直肠早癌及腺瘤等癌前病变,若在发展到浸润癌之前发现并予以切除,即可取得预防或根治效果。随着内镜技术的发展,尤其是EMR/ESD技术的不断成熟,从早期诊断到治疗及预后,与传统开腹手术相比优点突出,但要严格把握其适应症,由于技术难度大,出血、穿孔等是常见并发症。EMR/ESD是经济、安全、可靠的治疗结直肠早癌及癌前病变的方法,同时中药治疗疗效肯定。