肝癌I号方随证加减结合经肝动脉化疗栓塞治疗对原发性肝癌疗效和患者预后影响的临床研究（附60例报告）

目的：观察评价肝癌I号方随证加减结合肝动脉化疗栓塞（TACE）治疗对原发性肝癌（PLC）的疗效和患者预后的影响。方法：取2010~2012年收治的PLC患者60例,分为治疗组及对照组。进行TACE治疗后,治疗组用肝癌I号方加减辨证施治,对照组用西医对症治疗。分别于治疗前、治疗后观察T淋巴细胞亚群及NK细胞、瘤体变化、生活质量评分、生存率等指标。结果：治疗组CD3＋、CD4＋、CD4＋/CD8＋、NK升高率均明显高于对照组,对照组CD3＋、CD4＋/CD8＋均明显高于治疗组。瘤体大小比较显示治疗组显效率明显高于对照组,但两组总有效率对比无明显差异。治疗组生活质量提高率明显高于对照组;治疗组生活质量下降率明显低于对照组;生活质量稳定者两组之间相比无明显差异。1~5年生存时间治疗组明显高于对照组。结论：服用肝癌I号方结合TACE治疗可明显提升部分PLC患者的免疫功能、延缓瘤体增大、提高生活质量、延长带瘤生存时间,从而改善预后。     

Current Data Do Not Support Routine Use of Patient-Specific Instrumentation in Total Knee Arthroplasty

The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty (TKA) with regard to coronal and sagittal alignment, operative time, intraoperative blood loss, and cost. A systematic query in search of relevant studies was performed, and the data published in these studies were extracted and aggregated. In regard to coronal alignment, PSI demonstrated improved accuracy in femorotibial angle (FTA) (P = 0.0003), while standard instrumentation demonstrated improved accuracy in hip-knee-ankle angle (HKA) (P = 0.02). Importantly, there were no differences between treatment groups in the percentages of FTA or HKA outliers (>3 degrees from target alignment) (P = 0.7). Sagittal alignment, operative time, intraoperative blood loss, and cost were also similar between groups (P > 0.1 for all comparisons).     

Predictive Risk Factors for 30-day Readmissions Following Primary Total Joint Arthroplasty and Modification of Patient Management

The Centers for Medicare and Medicaid have begun to publically publish statistics on readmissions following primary total hip (THA) and total knee arthroplasty (TKA). Our study retrospectively assesses 30-day readmissions rates following THA and TKA, performed by a single surgeon at a tertiary care medical center between 2007 and 2012. Results of a univariate analysis and logistic regression model indicated female gender, high ASA class, and increased operative time to be significantly associated with higher rates of readmission (OR 4.646, OR 1.257, and OR 5.323, respectively). Readmissions most often occurred within the first week of patient discharge. Surgical complications and gastrointestinal discomfort were the most common causes for readmission. Using readmission risk we can stratify patients into tiered critical care pathways to reduce readmissions.     

A Nomogram to Predict Major Complications After Hip and Knee Arthroplasty

We aimed to develop a nomogram for risk stratification of major postoperative complications in hip and knee arthroplasty based on preoperative and intraoperative variables, and assessed whether this tool would have better predictive performance compared to the Surgical Apgar Score (SAS). Logistic regression analysis was performed to develop a nomogram. Discrimination and calibration were assessed. Net reclassification improvement (NRI) was used to compare to the SAS. All variables were found to be statistically significant predictors of post-operative complications except race and lowest heart rate. The concordance index was 0.76 with good calibration. Compared to the SAS, the NRI was 71.5% overall. We developed a clinical prediction tool, the Morbidity and Mortality Acute Predictor for arthroplasty (arthro-MAP) that might be useful for postoperative risk stratification.     

Primary cilia mediate sonic hedgehog signaling to regulate neuronal‐like differentiation of bone mesenchymal stem cells for resveratrol induction in vitro

Mesenchymal stem cells (MSCs) can differentiate into neuronal‐like cell types under specific conditions. The classical antioxidant inducers such as β‐mercaptoethanol (BME), butylated hydroxyanisol (BHA), and dimethylsulfoxide (DMSO) are limited in clinical because of toxicity. Resveratrol, a safer, natural antioxidant, can stimulate osteoblastic differentiation of MSCs. However, its effect of inducing MSCs to differentiate into neuronal‐like cells is less well studied, and its differentiated mechanisms are not well understood. Sonic hedgehog (Shh) signaling, mediated by the primary cilia, is crucial for embryonic development and tissue differentiation, but relatively little is known about the role of Shh signaling and primary cilia in neuronal‐like differentiation of MSCs. Here we show that primary cilia, harboring patched 1 (Ptc1), are present in growth‐arrested MSCs and that smoothened (Smo) and Gli1 are present in cytoplasm of MSCs, which are important components of the Shh signaling pathway. After resveratrol induction, MSCs acquire neuronal‐like cell morphologies and phenotypes, Smo translocates to the primary cilia, Gli1 enters the nucleus, and expressions of Smo and Gli1 proteins increase, which can be inhibited by cyclopamine, a Smo antagonist. Meanwhile, Smo agonist (SAG) attains similar effects compared with the resveratrol group. These data indicate that resveratrol can induce MSCs to differentiate into neuronal‐like cells and activate Shh signaling pathway in the primary cilia. Moreover, the primary cilia and Shh signaling are essential for resveratrol inducing neuronal‐like differentiation of MSCs. Our finding is important for understanding the neuronal‐like differentiation mechanism of MSCs for resveratrol and promoting its clinical therapeutic utility. © 2014 Wiley Periodicals, Inc.     

Incentives and Disincentives for the Treatment of Depression and Anxiety: A Scoping Review

Objective:

There is widespread support for primary care to help address growing mental health care demands. Incentives and disincentives are widely used in the design of health care systems to help steer toward desired goals. The absence of a conceptual model to help understand the range of factors that influence the provision of primary mental health care inspired a scoping review of the literature. Understanding the incentives that promote and the disincentives that deter treatment for depression and anxiety in the primary care context will help to achieve goals of greater access to mental health care.

Method:

A review of the literature was conducted to answer the question, how are incentives and disincentives conceptualized in studies investigating the treatment of common mental disorders in primary care? A comprehensive search of MEDLINE, PsycINFO, CINAHL, and Google Scholar was undertaken using Arksey and O’Malley’s 5-stage methodological framework for scoping reviews.

Results:

We identified 27 studies. A range of incentives and disincentives influence the success of primary mental health care initiatives to treat depression and anxiety. Six types of incentives and disincentives can encourage or discourage treatment of depression and anxiety in primary care: attitudes and beliefs, training and core competencies, leadership, organizational, financial, and systemic.

Conclusions:

Understanding that there are 6 different types of incentives that influence treatment for anxiety and depression in primary care may help service planners who are trying to promote improved mental health care.     

Factors influencing defensive medicine-based decision-making in primary care: A scoping review

Rationale, Aims and Objectives

Medical decision-making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient−doctor relationship. Aim of this review was to identify factors of defensive medicine-based decision-making in primary care.

Methods

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed.

Results

From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross-sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour.

Conclusions

Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under- and postgraduate training.