Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis

PurposeTo review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsA literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostatic artery embolization (PAE). Data on the following variables were included: International prostate symptom score (IPSS), maximum urinary flow rate, quality of life, and postvoid residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect.ResultsThere was no significant difference in outcomes between therapies for IPSS at the 3, 6, and 12-month follow ups. Although outcomes for Rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation versus PAE versus Rezum. TURP PVR was significantly better than Urolift at 3, 6, and 12 months. No significant differences in minor or major adverse events were noted.ConclusionAlthough significant differences in outcomes were limited, Aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while Aquablation has limited high quality data and has been associated with bleeding-related complications.     

Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Abstract

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).

Methods: In sum, 186 (age = 39?±?12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).

Results: Almost half (45.0%, n?=?86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β?=?0.726, p?=?.010 and β?=?0.634, p?=?.019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.

Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.     

心达康滴丸联合地尔硫卓治疗冠心病心绞痛的临床研究

目的探讨心达康滴丸联合盐酸地尔硫卓片治疗冠心病心绞痛的临床疗效。方法选择2018年7月—2019年7月在武汉市江夏区中医医院治疗的冠心病心绞痛患者94例,根据用药的差别分成对照组(47例)和治疗组(47例)。对照组口服盐酸地尔硫卓片,30mg/次,3次/d;治疗组在对照组基础上口服心达康滴丸,18粒/次,3次/d。两组患者均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者心绞痛发作次数和持续时间,临床症状积分、SAQ和GQOLI-74评分,血清C反应蛋白(CRP)、S100钙结合蛋白A12(S100A12)、白细胞介素-18(IL-18)、妊娠相关血清蛋白A(PAPP-A)、内皮素-1(ET-1)和肌钙蛋白I(CTnI)水平及心功能。结果治疗后,对照组和治疗组临床有效率分别为80.85%和97.87%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者心绞痛发作次数及持续时间都显著改善降低(P0.05),且治疗组比对照组改善更显著(P0.05)。治疗后,两组患者SAQ积分和GQOLI-74评分均明显升高,而临床症状积分明显降低(P0.05),且治疗组这些评分明显好于对照组(P0.05)。治疗后,两组患者血清CRP、S100A12、IL-18、PAPP-A、ET-1、CTnI水平均明显降低(P0.05),且治疗组明显低于对照组(P0.05)。治疗后,两组患者左心室射血分数(LVEF)和心排血量(CO)均升高,而左室收缩末期内径(LVESD)明显降低(P0.05),且治疗组LVEF、CO和LVESD比对照组改善更明显(P0.05)。结论心达康滴丸联合盐酸地尔硫卓片治疗冠心病心绞痛可明显改善患者临床症状,改善生活质量,具有一定的临床推广应用价值。     

新型冠状病毒肺炎出院患者生活质量及影响因素研究

目的:了解新型冠状病毒肺炎(COVID-19)患者出院后的生活质量及其影响因素,为优化早期干预方案,预防社区生活受限,制定相应社区康复措施提供依据。方法:选择2020年3—4月在武汉华润武钢总医院治愈出院的COVID-19患者57例,于2020年4—5月通过"问卷星"平台采用简明健康状况调查量表(SF-12V2)调查患者的生活质量;采用焦虑自评量表(SAS)调查患者的焦虑状态;采用抑郁自评量表(SDS)调查患者的抑郁状态;采用呼吸困难指数量表(mMRC)调查患者的呼吸困难程度。比较不同特征COVID-19患者生活质量的差异;分析患者生活质量与焦虑、抑郁和呼吸困难程度的相关性及其相关的影响因素。结果:共发放57份调查问卷,剔除重复及无效问卷3份,获得有效问卷54份,问卷有效率达94.74%。(1)COVID-19出院后患者生活质量情况:生理总评分和心理总评分分别为(37.02±12.32)分、(38.46±14.42)分;呼吸困难等级0~3级的分别为3例(5.56%)、45例(83.33%)、5例(9.26%)、1例(1.85%);有19例(35.19%)存在焦虑情绪(SAS≥50分)和抑郁情绪(SDS≥53分)。(2)不同特征COVID-19患者生活质量比较:不同疾病分型的患者在生理总评分方面差异有统计学意义(P<0.05)。(3)生活质量与焦虑、抑郁和呼吸困难程度的相关性分析:Pearson相关分析结果显示,SF-12V2生理总评分与焦虑程度(r=-0.34,P=0.011)和呼吸困难程度(r=-0.39,P=0.003)之间存在负相关性,SF-12V2心理总评分与焦虑程度(r=-0.46,P=0.001)和抑郁程度(r=-0.40,P=0.002)之间存在负相关性。(4)COVID-19患者生活质量的影响因素分析:多元线性回归分析显示,性别(β=8.27)、抑郁程度(β=-0.34)和疾病分型(β=-11.68)是患者SF-12V2生理总评分的重要决定因素(P<0.05);焦虑程度(β=-0.62)是患者SF-12V2心理总评分的重要决定因素(P<0.05)。结论:COVID-19出院患者存在呼吸困难、焦虑抑郁情绪和生活质量下降的问题;性别、疾病分型、抑郁程度和焦虑程度是COVID-19患者生活质量下降的重要因素。COVID-19患者(特别是女性患者和重型患者)出院后要尽早进行抑郁症和焦虑症的筛查和干预,减少患者负性情绪,鼓励患者适当参与康复训练,提高呼吸功能,从而促进生活质量提高。