Potential dangers in the customary methods of conducting meta-analyses. Lack of bias in the meta-analysis of recombinant versus urinary follicle stimulating hormone.

In a meta-analysis of randomized trials comparing recombinant and urinary FSH for ovarian stimulation in infertility treatment cycles, the clinical pregnancy rate per cycle started was significantly higher with recombinant FSH. Before the results of the different trials can be pooled, it is important to determine whether the results are homogeneous so that one can obtain an overall treatment estimate that is without bias. There are several methods to ascertain lack of homogeneity, including logistic regression analysis, sensitivity analysis comparing fixed-effect and random-effect models, testing based in the chi2 distribution, and graphical methods comparing event rates in experimental and treatment groups. These methods all confirmed that the treatment effect was homogeneous across all trials thereby providing assurance that the overall conclusion of the superior efficacy of recombinant FSH compared with urinary FSH is based on an unbiased analysis.     

Modulation of the neuronal circuitry subserving working memory in healthy human subjects by repetitive transcranial magnetic stimulation

We studied the effect of repetitive transcranial magnetic stimulation (rTMS) on changes in regional cerebral blood flow (rCBF) as revealed by positron emission tomography (PET) while subjects performed a 2-back verbal working memory (WM) task. rTMS to the right or left dorsolateral prefrontal cortex (DLPFC), but not to the midline frontal cortex, significantly worsened performance in the WM task while inducing significant reductions in rCBF at the stimulation site and in distant brain regions. These results for the first time demonstrate the ability of rTMS to produce temporary functional lesions in elements of a neuronal network thus changing its distributed activations and resulting in behavioral consequences.     

肩胛背神经卡压征32例的临床治疗

目的观察肩胛背神经的局部解剖、分析肩胛背神经被卡压的因素及其治疗方法。方法对30具60侧陈旧性成人尸体进行解剖学观察,观察肩胛背神经的起点、行径及与周边的关系。分析32例肩胛背神经卡压征的治疗方法及随访结果。结果肩胛背神经的起始段常和胸长神经合干,由前内侧向后外侧从中斜角肌中穿过,此处常有腱性组织包绕,与胸长神经分开走行后,发出分支至肩胛部和腋下。32例中均作保守治疗,23例24侧疗效较好。7例8侧保守治疗无效,改作手术治疗,术后随访3个月至2年,症状完全或基本解除。结论肩胛背神经卡压大部分包括于胸廓出口综合征中,但也可以单独出现。治疗以局部封闭为首选,症状严重者可考虑手术治疗。     

The Collaborative Wilms Tumour Africa Project; Baseline evaluation of Wilms tumour treatment and outcome in eight institutes in sub-Saharan Africa

AimReported survival of Wilms tumour in sub-Saharan Africa is below 50%. A published International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) consensus adapted treatment guideline is implemented as a multi-centre prospective clinical trial at eight centres in sub-Saharan Africa. A baseline evaluation has been done to help decide on priorities to improve outcome and to assess improvements over time.MethodsA retrospective chart review was performed of patients admitted with Wilms tumour in the three years (2011–2013) preceding the collaborative trial. Patient outcome at the end of treatment was documented for all patients diagnosed in 2011 and 2012. Outcome was classified as (1) alive, no evidence of disease; (2) alive with disease; (3) died during treatment and (4) incomplete treatment. Details on treatment facilities, staff and estimated cost of treatment are documented.ResultsEvery year 114–130 patients are diagnosed. The mean survival at end of treatment is 39% (69/176) ranging from 11% to 61%. Incomplete treatment is the most common cause of treatment failure with 31% (54/176), ranging from 14% to 48% between centres. Twenty-six percent (46/176) of patients died during treatment, ranging from 13% to 37%. Estimated cost of treatment for parents ranged from 100 US$ to 1100 US$ and was considered an important cause of failure to complete treatment.ConclusionOverall two year survival is estimated at 25%. Prevention of incomplete treatment is possible and will positively affect outcome. Sharing similar local challenges in this regional collaborative project helps to identify and implement feasible, sustainable and successful strategies.     

Hb Lusaka [α131(H14)Ser→Phe (α1)]: A New Variant Found in a Woman Heterozygous for Hb S [β6(A3)Glu→Val]

The present study attempts to delineate the spectrum of β‐thalassemia (thal) mutations in Tunisia by studying a large population from different parts of the country. A total of 285 unrelated subjects, 190 of whom had β‐thal major, 72 with Hb S/β‐thal, one with Hb C/β‐thal, one with Hb O‐Arab/β‐thal and 21 β‐thal carriers, were studied. The molecular defects were detected in 97.7% of the β‐thalassemic chromosomes (n?=?475). Nineteen different β‐thalassemic alleles were identified. Two mutations, namely codon 39 (C→T) and IVS‐I‐110 (G→A) accounted for 70.0% of the studied chromosomes, followed by IVS‐I‐1 (G→A) (4.5%). Five other mutations, frameshift codon (FSC) 44 (–C), codon 30 (G→C), IVS‐I‐2 (T→G), IVS‐II‐745 (C→G), and FSC 6 (–A), are not uncommon in this population, while the remaining 11 mutations, IVS‐I‐5 (G→A), ??30 (T→A), codons 25/26 (+?T), IVS‐I‐6 (T→C), FSC 5 (–CT), IVS‐II‐848 (C→A), FSC 8 (–AA), –87 (C→G), IVS‐I‐5 (G→C), IVS‐II‐1 (G→A) and IVS‐II‐849 (A→C) are quite rare; four of these have not been previously reported in the Tunisian population. Potential origin and spread of these mutations to Tunisia are also discussed.     

"全科医学+"医共体模式下新型冠状病毒肺炎疫情社区网格化防控专家建议

新型冠状病毒肺炎（COVID-19）疫情防控是当前世界范围内备受关注的公共卫生问题。我国在COVID-19疫情防控中取得了阶段性成果，其中基层医疗卫生机构及医共体内全科医生团队起到了关键作用。为更好地指导和规范我国医共体建设，发挥全科医生团队在疫情防控中的"桥梁"和网格化管理作用，进一步巩固我国COVID-19疫情防控成果，本项目组织多位相关领域专家，在归纳国内外相关文献证据、广泛征集意见、充分结合实践经验的基础上，对"全科医学+"医共体在COVID-19疫情防控中的优势和构建经验进行汇总，形成了本专家建议（第一版试行）。本专家建议的内容包括"全科医学+"医共体的内涵、组织结构、职责与分工、运行机制、工作内容、工作流程、培训与考核等，可以为各地区建设"全科医学+"医共体并发挥其在COVID-19疫情防控中的作用提供参考。     

The effect of centralization of health care services on travel time and its equality

ObjectivesTo analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access.MethodsWe used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined.ResultsInequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients.ConclusionOur findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services.