Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

浅谈骨肿瘤诊治中的底线

老实说，我本人专门从事骨肿瘤工作才10年，尚不够写述评的资格，但既然“降大任”于我，我愿结合本期刊出的几篇论文，谈谈自己对骨肿瘤治疗的一些思考。首先介绍一个背景：由于诸多原因，现在我们通常所提及的骨肿瘤专业，不仅是包括累及骨组织的肿瘤，还包括累及四肢、骨盆、甚至脊柱的软组织肿瘤。约定俗成，有些场合下笼统称“骨肿瘤”。     

基于影像学危险因素评价化疗对于减少中高危腹膜后神经母细胞瘤手术并发症的作用研究CSCD

目的基于影像学危险因素(image-defined risk factor,IDRF)概念,探讨化疗对于减少中高危腹膜后神经母细胞瘤手术并发症的作用。方法回顾性分析2016年6月至2017年6月在首都医科大学附属北京儿童医院行规范化疗后完整切除肿瘤的中高危腹膜后神经母细胞瘤患儿临床及影像学资料。采用国际神经母细胞瘤危险度分级协作组(International Neuroblastoma Risk Group,INRG)标准定义IDRF。记录化疗前及化疗后(手术前)每例患儿的IDRF情况并进行比较。采用Spearman相关系数法分析化疗后(手术前)IDRF数目与并发症项数之间的相关性,P<0.05为差异有统计学意义。结果本研究共纳入神经母细胞瘤患儿53例,其中男22例,女31例;起病月龄4~148个月,平均月龄(39.60±28.70)个月。化疗前IDRF数目范围为0~11项(中位数4项),化疗后(手术前)IDRF数目范围0~11项(中位数3项),化疗前后IDRF的数目变化差异有统计学意义(P<0.05);37例出现并发症,共计74项,各例项数范围0~4项(中位数1项)。各例手术并发症项数与化疗后(手术前)各例IDRF数目存在较强的相关性(r=0.687,P<0.05)。结论化疗能够有效减少中高危腹膜后神经母细胞瘤的IDRF,降低手术风险。IDRF对于手术风险的评估具有重要价值。     

International Impact of COVID-19 on the Diagnosis of Heart Disease

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.ObjectivesThe study sought to assess COVID-19’s impact on global cardiovascular diagnostic procedural volumes and safety practices.MethodsThe International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.ResultsSurveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.ConclusionsCOVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted.     

直肠癌患者术后化疗联合CIK免疫治疗的临床疗效

目的:探讨直肠癌患者术后行化疗联合细胞因子诱导杀伤细胞(CIK)治疗的临床疗效。方法:回顾性分析2011年6月—2013年5月45例术后行FOLFOX4方案化疗联合CIK治疗的直肠癌患者(CIK+化疗组)临床资料,以同期术后仅接受相同方案的45例直肠癌患者(单纯化疗组)为对照,比较两组患者的生存质量、近期疗效、生存率以及不良反应,并分析直肠癌患者预后的影响因素。结果:与单纯化疗组比较,CIK+化疗组患者的生存质量改善率明显升高(82.2%vs.33.3%,P0.05);总有效率无统计学差异(31.1%vs.22.2%,P0.05),但疾病控制率明显增加(77.8%vs.51.1%,P0.05);1、2年总生存率无统计学差异(100.0%vs.97.8%;93.3%vs.80%,均P0.05),但1、2年无进展生存率明显升高(86.7%vs.62.2%;62.2%vs.40%,均P0.05);总不良反应发生率无统计学差异(46.7%vs.53.3%,P0.05)。单因素分析显示,直肠癌术后患者的预后与肿瘤的分化程度、淋巴结转移、病理分期及手术方式有关(均P0.05);多因素分析显示,肿瘤的分化程度和病理分期是影响直肠癌患者术后生存的独立因素(均P0.05)。结论:直肠癌患者术后行化疗联合CIK免疫治疗可明显改善生活质量,提高总体疗效,延长无进展生存时间;肿瘤的分化程度和病理分期是影响直肠癌患者术后生存的独立因素。     

局部切除胰体尾联合血管切除重建治疗晚期胰腺癌的疗效分析

目的:探讨局部切除胰体尾联合血管切除重建手术治疗晚期胰腺癌的效果。方法:将2010年—2012年收治的58例胰腺体部及体尾部晚期胰腺癌患者分为观察组和对照组,观察组患者采用局部切除胰体尾联合血管切除重建手术治疗后配合化疗,对照组仅接受化疗,比较两组患者的临床治疗效果与生存情况并分析预后因素。结果:两组患者的一般资料具有可比性;与对照组比较,观察组的客观有效率(44.9%vs.6.9%)、疾病控制率(82.8%vs.55.2%)明显升高(均P0.05);半年生存率(79.3%vs.48.3%)、1年生存率(55.2%vs.17.2%)、平均生存时间(17.6个月vs.10.3个月)、总生存率和无进展生存率均明显增加(均P0.05);两组患者的不良反应发生率差异无统计学差异(P0.05);单因素分析结果显示,肿瘤分期、有无淋巴/血管转移是胰腺癌患者无进展生存的影响因素(均P0.05)。结论:对于可以采取手术治疗的晚期胰腺癌患者而言,采用局部切除胰体尾联合血管切除重建手术疗效良好,可推荐应用。     

严重胰腺外伤的早期处理

目的:探讨严重胰腺外伤的早期处理方法。方法:回顾性分析2006年1月—2015年4月收治的24例胰腺外伤的患者的临床资料。结果:全组24例患者中,I级损伤5例及II级损伤6例均行胰腺坏死组织清除加局部引流术;III级损伤6例均行胰腺体尾部切除术;IV级损伤7例,2例行胰十二指肠切除术,4例行胰腺空肠Roux-en-Y吻合术,1例行局部的清创引流术。全组治愈23例(95.8%),死亡1例(感染性休克),有并发症者15例(62.5%,24例次),其中胰瘘9例,创伤性胰腺炎3例,胰腺假性囊肿2例,感染2例,胆瘘1例,失血性休克1例。结论:应根据损伤程度不断调整治疗方案,选择合理的手术方式和手术时机,胰周的通畅引流和灌洗是严重胰腺外伤治疗成功保证。     

YouTube is a poor-quality source for patient information on the rehabilitation following total shoulder arthroplasty

BackgroundDespite the ubiquity of health information on YouTube, the quality of the information as it pertains to total shoulder arthroplasty (TSA) rehabilitation is unknown. The purpose of this study is to investigate the quality of information available on YouTube as it pertains to rehabilitation following TSA, including anatomic and reverse TSA.MethodsUtilizing predefined search terms, 480 videos regarding rehabilitation following TSA were screened for study inclusion. A total of 143 videos were included in the final analysis. Of these, 99 (69.2%) videos were on rehabilitation of anatomical TSA and 44 (30.8%) videos reported on rehabilitation after reverse TSA. Each video was reviewed using 3 scoring systems: (1) Journal of the American Medical Association (JAMA) benchmark criteria, (2) Global Quality Score (GQS), and (3) DISCERN instrument.ResultsYouTube videos regarding TSA are of suboptimal educational quality with a mean JAMA score of 2.5 ± 0.7, mean GQS of 2.7 ± 0.9, and mean DISCERN score of 33.2 ± 5.5 overall. Upon evaluation of video metrics based on classification it was found that educational nonphysician videos had significantly more likes than all other categories (P = .01). Educational physician videos were found to be significantly longer than all other categories (educational physician: 10.0 ± 14.8 minutes, educational nonphysician: 6.2 ± 3.2 minutes, personal testimony: 3.5 ± 2.6 minutes, commercial: 5.8 ± 5.4 minutes; P < .01) and had significantly higher JAMA (P < .01), GQS (P < .01), and DISCERN (P < .01).ConclusionYouTube videos are a poor source of educational information for patients regarding TSA rehabilitation. Educational videos prepared by nonphysicians accrued more likes than other video categories. Although educational videos by physicians provided statistically higher quality educational content as noted by JAMA, GQS, and DISCREN scores, the average scores across all author categories were classified as low (JAMA), moderate to poor (GQS), or poor (DISCERN) quality educational content. Additionally, our findings suggest that physician educational videos that are shorter in duration are more likely to be well received and watched to completion by viewers compared to longer videos. Patients should be provided trusted resources to learn more about TSAs.     

Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial

Objective

this randomized single blind clinical study aimed to evaluate the efficacy of auriculotherapy with and without a protocol for reducing stress levels among nursing staff.

Method

a total of 175 nursing professionals with medium and high scores according to Vasconcelos'' Stress Symptoms List were divided into 3 groups: Control (58), Group with protocol (58), Group with no protocol (59). They were assessed at the baseline, after 12 sessions, and at the follow-up (30 days).

Results

in the analysis of variance, statistically significant differences between the Control and Intervention groups were found in the two evaluations (p<0.05) with greater size of effect indices (Cohen) for the No protocol group. The Yang Liver 1 and 2, Kidney, Brain Stem and Shen Men were the points most used.

Conclusion

individualized auriculotherapy, with no protocol, could expand the scope of the technique for stress reduction compared with auriculotherapy with a protocol. NCT: 01420835     

三阴性乳腺癌的新辅助化疗：附31 例报告

目的：探讨三阴性乳腺癌（TNBC）新辅助化疗的疗效。 方法：回顾性分析2009年1月―2013年1月收治的63例I~III期TNBC患者临床资料,其中31例术前行新辅助化疗（新辅助化疗组）,32例行直接手术后辅助化疗（术后辅助化疗组）,新辅助化疗与术后的辅助化疗均采用蒽环类为主序贯紫杉类方案。分析新辅助化疗组患者术前获益情况,并比较两组患者术后复发转移与生存率情况。 结果：新辅助化疗组31例患者术前总获益率为100%,其中完全缓解达61.29%（19/31）;3年内发生局部复发和远处转移者新辅助化疗组13例（41.94%）,术后辅助化疗组22例（68.75%）,两组差异有统计学意义（χ2=4.585,P<0.05）。新辅助化疗组和术后辅助化疗组的3年无病生存率分别为48.38%、25.00%;5年总生存率分别为38.71%、9.78%,新辅助化疗组两者均明显优于术后辅助化疗组（χ2=4.870,P=0.027;χ2=7.469,P=0.006）。 结论：蒽环类为主序贯紫杉类方案的新辅助化疗能使TNBC患者明显获益,且远期疗效优于术后辅助化疗。