MedNexus
2016年 · 第02卷第01期
MedNexus
非传染性疾病（NCD，以下简称慢病）占我国各种原因总死亡率的80%，已成为持续存在的全球性挑战。然而，在慢性病防控需要加大资源投入的同时，更需要的是对不发达的传统医疗服务体系进行彻底改革，避免投入的资源出现更大的浪费和损失。转化医学不仅适用于B2B（Bench to Bedside）生物医学技术。更重要的是，顶层设计的变革和转型不断推动现有医疗技术的创新。这些创新已经转变为有效的慢性病预防策略，以促进更好的总体健康。
Neoadjuvant therapy has become the standard of care for locally advanced mid-low rectal cancer. Pathological complete response (pCR) can be achieved in 12%-38% of patients. Patients with pCR have the most favorable long-term outcomes. Intensifying neoadjuvant therapy and extending the interval between termination of neoadjuvant treatment and surgery may increase the pCR rate. Growing evidence has raised the issue of whether local excision or observation rather than radical surgery is an alternative for patients who achieve a clinical complete response after neoadjuvant therapy. Herein, we highlight many of the advances and resultant controversies that are likely to dominate the research agenda for pCR of rectal cancer in the modern era.
Granulomatous lobular mastitis is an unusual breast benign inflammatory disorder with unknown aetiology. It is generally emerged with the clinical symptoms of breast mass, abscess, inflammation and mammary duct fistula. The diagnosis is made by histopathology with a chronic non-necrotizing granulomatous inflammation in lobules of the breast tissue as the microscopic feature. Therapy of granulomatous lobular mastitis consists of surgical, medication treatment or combination of both, but now researches suggest that observational management is an acceptable treatment.
Atherosclerosis, the major cause of cardiovascular diseases, has been a leading contributor to morbidity and mortality in the United States and it has been on the rise globally. Endothelial cell-cell junctions are critical for vascular integrity and maintenance of vascular function. Endothelial cell junctions dysfunction is the onset step of future coronary events and coronary artery disease.
在临床实践中，医生经常根据专家的指南或建议使用某些策略。这是因为在循证医学时代，临床医生更愿意做出“循证”决策。降脂治疗领域也是如此。术语“降脂治疗”不仅仅是指血脂谱中具有异常值的项目，个体化管理在患者的总体评估中更为重要。由此，很容易得出结论，医生需要一个相对权威的评估体系来确定患者是否需要降脂治疗，以及治疗的强度、治疗的血脂指标、治疗的预期靶点。本文对上述问题进行了简要评述。
血脂异常，特别是低密度脂蛋白胆固醇（LDL-C）水平升高，是斑块型动脉粥样硬化性心血管疾病（ASCVD）发生和发展的先决条件。LDL颗粒穿过血管内皮并滞留在血管壁内。LDL随后在细胞外基质分子的作用下发生氧化修饰，随后在巨噬细胞吞噬作用后形成泡沫细胞。随后，出现局部生物学反应，主要是非特异性炎症，这进一步促进LDL滞留和动脉粥样硬化病变进展。
Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE), while the ultimate predictive value of a high uric acid (UA) level on LATH/LASEC remained obscure.
We searched the PubMed and Cochrane clinical trials databases up to July 2015. Following screening the 369 initially identified studies, we analyzed six observational studies with 2381 patients.
The meta-analysis of these studies showed that an elevated serum UA level was associated with a higher likelihood of LATH/LASEC (OR = 1.59, 95%CI 1.13-2.23, P = 0.008), while significant differences exist among individual trials (P < 0.00001 and I2 = 85%). Sensitivity analysis failed to find any heterogeneity.
An elevated UA level was associated with a higher risk of detecting a left atrial abnormality represented by LATH/LASEC.
To evaluate the maintenance effect of probiotics versus that of aminosalicylates on ulcerative colitis.
MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the Chinese Biomedical Database were searched in English or Chinese. Data extracted were selected with strict criteria.
In six randomized controlled trials (RCTs), a total of 721 participants were enrolled and the maintenance effect of probiotics (n = 364) versus that of aminosalicylates (n = 357) on ulcerative colitis was investigated. No significant difference was observed between probiotics and aminosalicylate groups (relative risk (RR) = 1.08; 95% confidence interval (CI): 0.91-1.28; P = 0.40). Three RCTs compared the incidence of adverse events with probiotics versus those with aminosalicylates. No significant difference was observed in the incidence of adverse events between the two groups (RR = 1.20; 95% CI: 0.92-1.56; P = 0.17).
Probiotics and aminosalicylates both showed a maintenance effect on ulcerative colitis. However, more well-designed RCTs are required.
The aim of our study was to determine if there is any advantage of three-dimensional helical computed tomography (3D-HCT) over intravenous urogram (IVU) for the retrograde flexible ureteronephroscopy in the treatment of lower pole calyx stones.
From June 2012 to January 2014, a total of 52 cases of lower pole renal stones underwent retrograde intrarenal surgery (RIRS) in our center. All patients underwent a preoperative IVU and three-dimensional helical computed tomography urography (3D-CTU) program to define the collecting system anatomy, manly concerning the following lower pole features; infundibulopelvic angle (IPA), infundibular length (IL), and infundibular width (IW). The examinations were performed in the same center of reference with a standardized method and with 3D-HCT Siemens Somaton Plus equipment. The measurements were performed by the same researcher, using a ruler and a square.
Based on clinical threshold difference of the anatomic factors on an IVU image to compare the difference between an IVU image and a 3D-CT image of 52 patients, the IPA was <30° when measured on intravenous pyelography (IVP) for 21 patients. We found that with the IPA of <30° measured with IVP only 19% (4/21) were correctly classified in the same size category using 3D-HCT, whereas 81% (17/21) were upgraded to 40-50° on 3D-CT. This difference was significant between IVP and 3D-HCT.
3D-HCT has advantages over IVU when analyzing the morphometric and the morphological features of kidney lower pole spatial anatomy for the retrograde flexible ureteronephroscopy in the treatment of lower pole calyx stones.
To investigate the correlation between serum Omentin-1 levels and the presence of osteoporosis in older men.
Serum Omentin-1, bone turnover biochemical markers, and bone mineral density (BMD) were determined in 45 older men with osteoporosis or 45 older men without osteoporosis (65-70 years old).
Omentin-1 levels were increased in older men with osteoporosis, and the differences remained significant after controlling for fat mass. Omentin-1 was negatively correlated with BMD. In a multiple linear stepwise regression analysis, Omentin-1, lean mass, but not fat mass, were independent predictors of BMD for the combined group. Significant negative correlations between Omentin-1 and bone-specific alkaline phosphatase (BAP) and bone cross-linked N-telopeptides of type Ⅰ collagen (NTX) were found. Omentin-1 was also independently associated with BMD and bone turnover markers in older men with osteoporosis and control groups that were considered separately.
Omentin-1 is an independent predictor of BMD in older men with osteoporosis, and it is negatively correlated with bone turnover biochemical markers. It is suggested that Omentin-1 may exert a negative effect on bone mass through the regulation of the osteoblast differentiation in the older men with osteoporosis.
Previous studies have revealed inconsistent results regarding the association between occult hepatitis B virus (HBV) infection and chronic kidney disease (CKD). Therefore, we conducted a prospective cohort study to evaluate the association between occult HBV infection and CKD.
A total of 4329 adults, aged 46.2 ± 13.7 years, without CKD at baseline were enrolled while undergoing physical examinations. Occult HBV infection was defined as seropositivity for antibody to HBV core antigen. CKD was defined as decreased estimated glomerular filtration rate (eGFR < 60 ml·min-1·1.73 m-2) or presence of proteinuria ≥1+, assessed using a repeated dipstick method. eGFR was computed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
The prevalence of occult HBV infection was 8.1% (352/4329). During 5 years of follow-up, 165 patients (3.8%) developed CKD. Univariate Logistic regression analysis showed that occult HBV infection was positively associated with decreased eGFR, with an odds ratio (OR) of 2.15 (95% confidence interval (CI): 1.05-4.11). In contrast, occult HBV infection was not associated with either proteinuria or CKD (P > 0.05). After adjustment for potential confounders in the multivariate Logistic regression analysis, age, hypertension, diabetes, and the highest quartile of uric acid were associated with CKD, with ORs of 1.04 (95% CI: 1.02-1.05), 2.1 (95% CI: 1.46-3.01), 2.02 (95% CI: 1.36-2.99), and 1.86 (95% CI: 1.17-2.95), respectively. However, occult HBV infection was not associated with CKD, with an OR of 1.12 (95% CI: 0.65-1.95).
This study did not find an association between occult HBV infection and CKD. However, high-risk patients infected with HBV should still be targeted for monitoring for the development of CKD.
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