Reflections on multiple strategies to reduce transfusion in cancer patients: A joint narrative

Transfusion of red blood cells, platelets and plasma is widely used in the management of anemia and coagulopathy in cancer patients undergoing surgery, chemotherapy, and radiation. The decision to transfuse should not be made lightly as exposure to transfused blood, whether from an allogeneic or even autologous source, is not without risk and the long-term effect of blood transfusion on cancer outcomes remains questionable. Recognition of anemia associated with nutritional deficiency should be promptly corrected while avoiding the use of erythropoiesis stimulating agents. Minimizing blood loss and the prompt control of bleeding, coupled with a restrictive transfusion strategy, seem to be a reasonable approach that does not appear to be associated with long-term sequelae. Limiting platelet transfusion to patients with severe hypo-proliferative thrombocytopenia, and implementation of local hemostatic measures, together with the use of fractionated coagulation factor concentrates, as an alternative to frozen plasma transfusion, may reduce the exposure of cancer patients to potentially harmful thrombogenic and pro-inflammatory cellular microparticles. This joint narrative highlights current opinions for minimizing blood usage in patients with cancer.     

Average chewing pattern improvements following Disclusion Time reduction

Objectives: Studies involving electrognathographic (EGN) recordings of chewing improvements obtained following occlusal adjustment therapy are rare, as most studies lack ‘chewing’ within the research. The objectives of this study were to determine if reducing long Disclusion Time to short Disclusion Time with the immediate complete anterior guidance development (ICAGD) coronoplasty in symptomatic subjects altered their average chewing pattern (ACP) and their muscle function.

Methods: Twenty-nine muscularly symptomatic subjects underwent simultaneous EMG and EGN recordings of right and left gum chewing, before and after the ICAGD coronoplasty. Statistical differences in the mean Disclusion Time, the mean muscle contraction cycle, and the mean ACP resultant from ICAGD underwent the Student’s paired t-test (α = 0.05).

Results: Disclusion Time reductions from ICAGD were significant (2.11–0.45 s. p = 0.0000). Post-ICAGD muscle changes were significant in the mean area (p = 0.000001), the peak amplitude (p = 0.00005), the time to peak contraction (p < 0.000004), the time to 50% peak contraction (p < 0.00001), and in the decreased number of silent periods per side (right p < 0.0000002; left p < 0.0000006). Post-ICAGD ACP changes were also significant; the terminal chewing position became closer to centric occlusion (p < 0.002), the maximum and average chewing velocities increased (p < 0.002; p < 0.00005), the opening and closing times, the cycle time, and the occlusal contact time all decreased (p < 0.004–0.0001).

Conclusion: The average chewing pattern (ACP) shape, speed, consistency, muscular coordination, and vertical opening improvements can be significantly improved in muscularly dysfunctional TMD patients within one week’s time of undergoing the ICAGD enameloplasty. Computer-measured and guided occlusal adjustments quickly and physiologically improved chewing, without requiring the patients to wear pre- or post-treatment appliances.     

正念减压改善肠易激综合征的效果

目的:探讨肠易激综合征(IBS)治疗方法。方法:对门诊就诊志愿者69例进行正念减压疗法6个月,应用症状自评量表和炎症性肠病问卷对干预前后效果评估情绪、情感状态及社会功能。结果:正念减压(MBSR)训练前后SCL-90结果比较躯体化有显著变化(t=3.753,P0.01),焦虑(t=2.219)、敌对(t=20.60)、抑郁(t=2.032)、人际关系敏感(t=3.141)及恐怖(t=2.772),变化有统计学意义(P0.05),强迫症状、偏执及精神病性变化不明显(P0.05);炎症性肠病问卷肠道症状(t=-2.085),全身症状(t=-2.542)、情感功能(t=-2.088)、社会功能(t=-3.259)及总分(t=-3.314)均有统计学意义(P0.05)。结论:MBSR训练能够改善IBS患者心身状态和社会功能,提升了幸福感。     

颧骨“L”形截骨降低术的三维有限元模型的建立与分析

目的:建立关于颧骨"L"形截骨降低术的三维有限元模型,探讨该术式在生物力学方面的特点。方法:采集高颧骨畸形患者术前头颅螺旋CT,将数据导入相应医学图像处理软件,对颧骨复合体及手术相关区域进行分体三维重建、手术模拟,应用有限元软件对模型进行网格划分,通过CT扫描灰度值的转换,对各部分材质的弹性模量、泊松比参数进行赋值,再模拟术中对颧骨、颧弓的施力,分析颧骨复合体生物力学情况。结果:建立了颧骨"L"形截骨降低术的三维有限元模型,其几何相似性、力学相似性高。运用三维有限元法生物力学分析,术中按压颧骨复合体,颧弓根部出现一个明显的应力集中,颧骨颧弓产生向内侧的形变。结论:在颧骨"L"形截骨降低术术中按压颧骨复合体,是能够在颧弓根部造成预期的青枝骨折,使颧骨产生内收、降低的形变。     

主动服务与减少医患纠纷的相关性研究

目的了解2010年1月-2012年1月两年来开展主动服务与减少医患纠纷的相关性研究。为防范医疗纠纷,构建和谐医患关系提供有价值的参考依据。方法采取分层整群随机抽样调查的方法,对1627人进行问卷调查、电话回访等方式收集信息。结果开展主动服务以来,病人的满意度明显提高,达到99.12%;医疗纠纷发生显著减少,发生率为0.24%,显著低于国家统计数字。结论主动服务能提高医患互信,有利于构建和谐医患关系,能减少医患纠纷的发生,降低医患纠纷的发生率,有力于患者康复,有力于社会稳定;有利于树立医疗行业的行业形象。     

降低手术患者麻醉诱导期低体温发生率

目的降低手术患者麻醉诱导期低体温发生率。方法QC小组活动。结果手术患者麻醉诱导期低体温发生率由活动前的43％下降到活动后的3．8％。结论降低手术患者麻醉诱导期低体温发生率,可降低患者术后并发症发生率,确保患者安全。     

降低临床用血计划差异率

目的降低临床用血计划差异率。方法QC小组活动。结果经过改进,医院年临床用血（红细胞量）计划差异率由2009年的25．35％、2010年的45．22％降至2011年的-1．56％,达到了活动目标。结论QC小组活动的开展,降低了医院临床用血计划差异率,拓宽了管理人员思路,促进了临床合理、节约用血,确保了输血安全。     

结合局部解剖手法复位治疗儿童尺桡骨下段骨折

目的探讨结合局部解剖手法复位治疗儿童尺桡骨下段骨折的疗效。方法回顾性分析我院2008年3月～2013年4月收治的156例儿童闭合性尺桡骨下段骨折,根据2011年5月前后采用不同的手法复位方式分为对照组84例和治疗组72例,对比分析两组患者的复位效果。结果治疗组和对照组总的优良率分别为93．1％,76．2％;Ⅰ型骨折的复位效果两组间差异无统计学意义（P〉0．05）,Ⅱ、Ⅲ型骨折复住效果治疗组优于对照组（P〈0．05）。结论结合局部解剖手法复位治疗儿童尺桡骨下段骨折复住效果好,临床应用价值高,可推广应用。     

The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up

Introduction

The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH.

Patients and methods

Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination.

Results

The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained.

Conclusion

Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years.     

Clinical Predictors of Risk for Atrial Fibrillation: Implications for Diagnosis and Monitoring

ObjectiveTo create a risk score using clinical factors to determine whom to screen and monitor for atrial fibrillation (AF).Patients and MethodsThe AF risk score was developed based on the summed odds ratios (ORs) for AF development of 7 accepted clinical risk factors. The AF risk score is intended to assess the risk of AF similar to how the CHA₂DS₂-VASc score assesses stroke risk. Seven validated risk factors for AF were used to develop the AF risk score: age, coronary artery disease, diabetes mellitus, sex, heart failure, hypertension, and valvular disease. The AF risk score was tested within a random population sample of the Intermountain Healthcare outpatient database. Outcomes were stratified by AF risk score for OR and Kaplan-Meier analysis.ResultsA total of 100,000 patient records with an index follow-up from January 1, 2002, through December 31, 2007, were selected and followed up for the development of AF through the time of this analysis, May 13, 2013, through September 6, 2013. Mean ± SD follow-up time was 3106±819 days. The ORs of subsequent AF diagnosis of patients with AF risk scores of 1, 2, 3, 4, and 5 or higher were 3.05, 12.9, 22.8, 34.0, and 48.0, respectively. The area under the curve statistic for the AF risk score was 0.812 (95% CI, 0.805-0.820).ConclusionWe developed a simple AF risk score made up of common clinical factors that may be useful to possibly select patients for long-term monitoring for AF detection.