Outcomes of Endovascular Aortic Aneurysm Repair in Kidney Transplant Recipients: Results From a National Quality Initiative

Contrast‐induced nephropathy after endovascular aortic aneurysm repair (EVAR) in kidney transplant recipients (KTRs) can have devastating consequences. The Vascular Quality Initiative (VQI) database was queried to select all KTRs who underwent EVAR between January 2003 and December 2014. Our primary outcome was renal dysfunction, defined as acute kidney injury (AKI; elevation of serum creatinine >0.5 mg/dL from baseline) or new postoperative hemodialysis requirement. Within the EVAR VQI dataset, 40 patients were KTRs (40 of 17 213, or 0.2%). Renal dysfunction occurred in five of 40 patients in the KTR group in comparison to 779 of 17 173 patients in the nontransplanted group (12.5% versus 4.5%, p < 0.01). Emergent EVAR was required in 2 (5%) patients, one of whom required dialysis after surgery and subsequently died. One‐year survival after EVAR was similar in the two groups (92.9% versus 93.1%, p = 0.73). KTRs who developed renal dysfunction had significantly lower preoperative estimated glomerular filtration rates (eGFRs) (29.5 versus 54.7, p = 0.007) and a significantly higher iodine:eGFR ratio (0.78 versus 0.39, p = 0.02) despite receiving a similar volume of contrast (70.0 versus 68.8, p = 0.97). Renal dysfunction is 3 times more frequent in KTRs treated with EVAR, though overall survival did not differ between the groups. Decreased preoperative eGFR and a higher iodine:eGFR ratio are associated with postoperative renal dysfunction.     

Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case–Control Study

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case–control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09–90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08–10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04–339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63–456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.     

Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: A systematic review

The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle–Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.     

多模式健康宣教在小儿骨科住院患儿中的应用

目的探讨多模式健康宣教在小儿骨科住院患儿中的运用及其效果评价。方法选择2013年1月至2014年12月于我科住院治疗的1081例患儿为研究对象,将2014年1月至12月住院治疗的652例患儿纳入多模式组,采用多模式健康宣教方法;2013年1月至12月住院治疗的429例患儿纳入对照组,采用常规健康宣教方法。出院时和出院后分别对患儿及其家属实施健康宣教满意度调查,比较两组患儿的满意度。结果两组患儿出院时的健康宣教满意度分别为93.49%（对照组）、99.16%（多模式组）,出院后随访时的健康宣教满意度分别为93.14%（对照组）、98.29%（多模式组）,组间差异均有统计学意义（χ2=24.352,P=0.000;χ2=4.909,P=0.027）。结论在小儿骨科住院患儿中应用多模式健康宣教方法可以提高患儿及家长的满意度及知晓率,便于护士操作执行,值得推广。     

The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

Objective: Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design: Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting: A total of 23 countries. Subjects: General practitioners and patients. Main outcome measures: Diabetes-related avoidable hospitalizations. Results: Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions: Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations.

• Key points

• Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization.

• Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications.

• Continuity of care was associated with lower rates of diabetes-related hospitalization.

• Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.

     

Consideration of treatment fidelity to improve manual therapy research

Objectives: The purpose of this paper was to define treatment fidelity, review its use in health care research and suggest how it may be utilized in manual therapy research to improve the reliability and validity of the literature.

Results: We offer an outline and a table of how manual therapy research may benefit from the concept of treatment fidelity.

Discussion: While treatment fidelity is a newer concept, and has not been integrated into Physical Therapy or Manual Therapy research, when utilized, it can have positive effects on the reliability and validity of the techniques we evaluate.     

微课在中医诊断学教学中的运用和评价

中医学是源于我国的传统医学,中医诊断学是中医学专业课程体系中的主干课程,它不仅涵盖了中医诊断的基本理论和知识,而且还涉及到基本的临床操作技能。中医诊断学是我校的国家级精品课程,我校所有本科专业均开设了该课程。该课程知识点多、信息量大、内容零散、包含许多中医术语,传统灌输式授课法容易给学生带来枯燥乏味、抽象繁杂的感觉,从而降低学生的学习兴趣和效率,制约教学质量的提升。为增强学生的应用实践能力,提高学生的中医临床分析思维能力,本教研团队一直致力于改革和探索新型的中医诊断学教学方法,已经实践过的教学方法有PBL 教学法[1]、慕课、网络资源共享课[2-3]、数字化实验实训课程等[4]。     

磷酸化蛋白质组学富集策略进展及其在疾病研究中的应用

蛋白质磷酸化是生物体内重要的翻译后修饰,几乎参与调节着细胞增殖、信号转导、新陈代谢、肿瘤发生等过程在内的所有生命活动。对磷酸化蛋白质组的全面分析可以帮助人们深入了解磷酸化蛋白在生命过程中的作用,协助发现生物标志物,辅助疾病的诊疗。然而,磷酸化蛋白丰度低、信号被非磷酸化肽段所掩盖等问题限制了磷酸化蛋白质组学的发展。因此,亟需开发高效的富集策略,如设计新型纳米材料,合并多种分析方法等,以提高检测灵敏度、富集特异性,增大富集容量。本文回顾了近年来磷酸化蛋白质组学研究策略中的富集策略进展及其在疾病研究中的应用。     

基于循证医学角度的天灸临床及基础研究思路探讨

本文从循证医学的角度出发,结合目前的研究现状,就天灸的辨证论治、天灸治疗方案的确立、三伏针与三伏灸临床应用的异同、天灸与穴位敷贴的疗效比较、天灸疗法的疾病谱研究、三伏天灸与三九天灸的区别与联系等问题进行探讨。