Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance

Background & AimsThe Charlson Comorbidity Index (CACI) has been suggested as a tool to determine comorbidity burden and guide management for patients with mucinous pancreatic cysts (Intrapapillary Mucinous Neoplasms and Mucinous Cystic Neoplasms), but has not been studied well among “low-risk” mucinous pancreatic cysts i.e. without worrisome features (WF) and high-risk stigmata (HRS). This study sought to determine the comorbidity burden among surveillance population of low-risk pancreatic cysts and provide their follow-up mortality outcomes.MethodsA single center study retrospectively reviewed a prospective pancreatic cyst database and included individuals with low-risk cysts undergoing serial imaging during 2016. Electronic medical records were reviewed to determine their baseline age-adjusted CACI (age-CACI). After 4 years, their progression to WF, disease specific (pancreatic malignancy-related, DSM), extra-pancreatic (EPM), and overall mortalities (OM) were determined using Kaplan-Meir Survival Analysis.Results502 individuals underwent prospective surveillance. The study included 440 individuals with low-risk suspected or presumed mucinous cysts and excluded 50 and 12 individuals with WF and HRS respectively. Over a median follow-up of 56 months, 12 WF progressions, 2 DSMs, 42 EPMs, and 44 OMs were observed. Baseline age-CACI had good predictive capacity for 4-year EPM (Area-Under Curve: 0.87; p< .0001). The median age-CACI of 4 enabled cohort stratification into Low (age-CACI <4) and High CACI (age-CACI ≥4) groups. A significantly higher OM (p< .001) was observed among the High CACI group as compared to the Low CACI group.ConclusionThrough real-time application of CACI to patient outcomes, our analysis supports incorporation of this comorbidity assessment tool in making shared surveillance decisions among low-risk pancreatic cyst population.     

Efficacy of rituximab in an aggressive form of multicentric Castleman disease associated with immune phenomena

Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disorder for which the best therapeutic option is not yet well established. Immune-related disorders are rare complications of MCD. We report on an MCD case in a 23-year-old patient with extensive abdominal involvement and associated immune hemolytic anemia and Raynaud phenomenon. He was negative for human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8). After 8 courses of the anti-CD20 monoclonal antibody (rituximab), the patient achieved complete remission. Interestingly, Raynaud phenomenon disappeared under treatment and no new hemolytic events occurred. Anti-CD20 antibody treatment could be an attractive therapeutic approach for MCD, mainly when immune-related disorders are associated.     

Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study

Background  Evidence-based medicine (EBM) is increasingly taught in medical schools, but few curricula have been evaluated using validated instruments. Objective  To evaluate a longitudinal medical school EBM curriculum using a validated instrument. Design, Participants, Measurements  We evaluated EBM attitudes and knowledge of 32 medical students as they progressed through an EBM curriculum. The first part was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second part integrated EBM assignments with third-year clinical rotations. The validated 15-item Berlin Questionnaire was administered before the course, after the short course, and at the end of the third year. Results  EBM knowledge scores increased from baseline by 2.8 points at the end of the second year portion of the course (p = .0001), and by 3.7 points at the end of the third year (p < .0001). Self-rated EBM knowledge increased from baseline by 0.8 and 1.1 points, respectively (p = .0006 and p < .0001, respectively). EBM was felt to be of high importance for medical education and clinical practice at all time points, peaking after the short course. Conclusions  A longitudinal medical school EBM curriculum was associated with increased EBM knowledge. This knowledge increase was sustained throughout the curriculum. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Refractory autoimmune thrombocytopenic purpura: responses to treatment with a recombinant antibody to lymphocyte membrane antigen CD20 (rituximab)

"Refractory" autoimmune thrombocytopenia represents a life-threatening condition, having failed to respond to a variety of therapeutic measures. We report a series of cases, all failing splenectomy and multiple therapeutic programs, including, in two patients, marrow transplant. Five of the six cases reported responded to a recombinant antibody to the lymphocyte membrane antigen CD20 (rituximab), an agent commonly employed in the treatment of non-Hodgkin's lymphoma. Our experiences over a period of 4 years are documented. The results support the use of this product, rituximab, in the treatment of patients with autoimmune thrombocytopenia who have not attained a hemostatically effective platelet count following splenectomy and require a continuing therapeutic management program.     

Helping journalists get it right

News reports are the way that most people, including many physicians and scientists, first learn about new developments in medicine. Because these reports can raise awareness, influence behavior, and confer credibility, physicians should share responsibility with the media for accurate reporting. Physicians can work with reporters to avoid sensationalizing tentative findings, overstating benefits, and making inappropriate generalizations. This article includes pragmatic suggestions for crafting effective news releases and explaining numerical data. It details "rules of the road" for interviews. Working collaboratively with news reporters to improve the quality of medical stories in the lay press benefits patients and physicians alike.     

医疗设备固定资产分类及信息化管理方法

本文分析了医疗设备固定资产分类管理的现状,介绍了常用的分类方法及优缺点,提出了基于医疗设备原理和功能分类的管理方法,指出了固定资产信息化管理的发展趋势。     

Pharmacotherapeutic options for treating brain metastases in non-small cell lung cancer

Introduction: Central nervous system (CNS) metastases represent an important cause of morbidity and mortality in non-small cell lung cancer (NSCLC) patients. Local approaches of neurosurgery (usually for single brain lesions), whole brain radiotherapy, and stereotactic radiosurgery are often withheld for the treatment of NSCLC-derived brain metastases (BMs). However, systemic treatment is consistently emerging as an option for patients with asymptomatic BMs, which could allow for delaying cranial radiotherapy at symptomatic/radiological progression.

Areas covered: Chemotherapy, monoclonal antibodies, tyrosine-kinase inhibitors (TKIs) for molecularly selected NSCLCs, such as epidermal growth factor receptor (EGFR)-mutant and anaplastic lymphoma kinase (ALK)-rearranged diseases, and immune checkpoint inhibitors are all systemic treatments that have shown activity against NSCLC-derived CNS metastases. Among these, EGFR- and ALK-TKIs will be discussed more in detail owing to their superior efficacy in this context.

Expert opinion: Up-front systemic treatment should be considered for patients with asymptomatic, multiple BMs, as recently acknowledged by the European Society of Medical Oncology guidelines. Nevertheless, it must be emphasized that the best treatment strategy for NSCLC-derived BMs has to be defined within a multidisciplinary team.     

High-fidelity simulation is associated with good discriminability in emergency medicine residents’ in-training examinations

In-training examinations (ITEs), arranged during residency training, evaluate the residents’ performances periodically. There is limited literature focusing on the effectiveness of resident ITEs in the format of simulation-based examinations, as compared to traditional oral or written tests. Our primary objective is to investigate the effectiveness and discriminative ability of high-fidelity simulation compared with other measurement formats in emergency medicine (EM) residency training program.This is a retrospective cohort study. During the 5-year study period, 8 ITEs were administered to 68 EM residents, and 253 ITE measurements were collected. Different ITE scores were calculated and presented as mean and standard deviation. The ITEs were categorized into written, oral, or high-fidelity simulation test forms. Discrimination of ITE scores between different training years of residency was examined using a one-way analysis of variance test.The high-fidelity simulation scores correlated to the progression of EM training, and residents in their fourth training year (R4) had the highest scores consistently, followed by R3, R2, and then R1. The oral test scores had similar results but not as consistent as the high-fidelity simulation tests. The written test scores distribution failed to discriminate the residents’ seniority. The high-fidelity simulation test had the best discriminative ability and better correlation between different EM residency training years comparing to other forms.High-fidelity simulation tests had the good discriminative ability and were well correlated to the EM training year. We suggest high-fidelity simulation should be a part of ITE in training programs associated with critical or emergency patient cares.