Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.
Objectives To assess the effectiveness and safety of any form of therapy compared with glucocorticoid for the treatment of oral lichen planus. Method The Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMbase (1966-2007), CBM (1978-2005), CNKI (1989-2007), and VIP (1989-2007) were searched for randomized controlled trials or quasi-randomized controlled trials. Quality assessment and data extraction were performed by two reviewers independently. Meta-analysis was performed for the results of homogeneous studies by RevMan 4.2.9 software.Results Finally, 14 studies involving 9 therapy methods were included. Four studies were concerned with cyclosporine.We performed a meta-analysis of 3 studies. The results showed there was no statistically significant difference in the curative effect of cyclosporine and the steroid with RR 2.94 and 95%CI 1.03 to 9.97. The results showed that the curative effect of total glucosides of paenia plus topical application of triamcinolone acetonide (RR0.21, 95%CI 0.10 to 0.44),tacrolimu (RR 0.18 and 95%CI 0.05 to 0.72), and pimecrolimus (WMD –0.50 and 95%CI –0.85 to –0.15) were better than glucocorticoid. There was a statistically significant difference between fluocinolone acetonide and retinoic acid in terms of curative effect with RR 3.20 and 95%CI 1.03 to 9.97. The curative effect of mesalazine (RR 0.42 and 95%CI 0.05 to 3.54), Mycostatin paste plus desamethasone paste (RR 1.23 and 95%CI 0.93 to 1.61), triamcinolone acetonide plus vitamin B12 ( RR 0.50 and 95%CI 0.05 to 4.94), chitin (RR 1.30 and 95%CI 0.86 to 1.96) was similar with that of glucocorticoid.Conclusion Statistical analysis showed the curative effect of total glucosides of paenia combined with triamcinoloneacetonide is better than glucocorticoid. Due to the mistakes of theincluded studies designs,,further high-quality,largescale randomized controlled trials are required to confirm the effectiveness and safety of this therapy method.
Nasopharyngeal carcinoma (NPC) is rather common in Southeast Asia and Southern China. The standard treatment for NPC is intensity-modulated radiotherapy (IMRT). A large number of the NPC survivors benefit from the IMRT, while some suffer from the late toxicities which can be life-threatening or significantly erode the patients’ quality of life and functional status, especially in the locally advanced NPC. Nowadays the late radiotherapy-related toxicities have been the most important concern for the radiotherapists and patients, who look forward to the better long-term tumor local control and overall survival. Therefore, we carried out a review about the late radiotherapy-related toxicities of the vital organs at risk after IMRT for NPC patients.
Objective To explore the influencing factors of inhalation medication compliance in Chinese asthma patients, and to provide evidence for improving the compliance of patients with inhalation therapy. Methods PubMed, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for literature on factors influencing inhalation medication compliance in Chinese asthma patients from the establishment of databases to December 2021. Meta-analysis was performed using RevMan 5.2 software. Results A total of 16 studies were included, with a sample size of 2 600 cases, 1 084 cases of good compliance with inhalation administration, 1 516 cases of poor compliance with inhalation administration, and good compliance with inhalation administration accounted for 41.69%. The literature quality evaluation scores were all ≥4 points, all of which were of medium quality and above. Meta-analysis showed that the factors affecting inhalation compliance of asthma patients included age [odds ratio (OR)=0.54, 95% confidence interval (CI) (0.32, 0.91), P=0.02], educational level [OR=0.57, 95%CI (0.36, 0.90), P=0.02], doctor-patient relationship [OR=0.42, 95%CI (0.19, 0.93), P=0.03], disease severity [OR=0.25, 95%CI (0.11, 0.58), P=0.001], degree of mastery of asthma knowledge [OR=2.51, 95%CI (1.11, 5.65), P=0.03], degree of mastery of inhalation technique [OR=8.66, 95%CI (3.20, 23.40), P<0.0001], adverse drug reaction [OR=0.23, 95%CI (0.13, 0.41), P<0.00001]. Conclusion The compliance of inhaled dosing in Chinese asthma patients needs to be improved urgently. Age, education level, doctor-patient relationship, disease severity, mastery of asthma knowledge, mastery of inhalation technology, and adverse drug reactions are the important influencing factors of inhaled medication compliance.
Ultrasound guided percutaneous interventional therapy has been widely used in clinic. Aiming at the problem of soft tissue deformation caused by probe contact force in robot-assisted ultrasound-guided therapy, a real-time non-reference ultrasound image evaluation method considering soft tissue deformation is proposed. On the basis of ultrasound image brightness and sharpness, a multi-dimensional ultrasound image evaluation index was designed, which incorporated the aggregation characteristics of the organization. In order to verify the effectiveness of the proposed method, ultrasound images of four different models were collected for experiments, including prostate phantom, phantom with cyst, pig liver tissue, and pig liver tissue with cyst. In addition, the correlation between subjective and objective evaluations was analyzed based on Spearman’s rank correlation coefficient. Experimental results showed that the average evaluation time of a single image was 68.8 milliseconds. The evaluation time could satisfy real-time applications. The proposed method realizes the effective evaluation of real-time ultrasound image quality in robot-assisted therapy, and has good consistency with the evaluation of supervisors.
ObjectiveTo investigate the effect of extranodal extension of axillary lymph nodes metastasis on the prognosis of patients with triple-negative breast cancer (TNBC). MethodsThe TNBC patients with axillary lymph node metastasis admitted to the Nanyang Central Hospital from January 2017 to January 2019 were collected. The clinicopathologic characteristics and prognosis of TNBC patients with or without extranodal extension were analyzed and compared, and the factors affecting prognosis were analyzed. ResultsA total of 216 patients were included, including 123 patients without extranodal extension and 93 patients with extranodal extension. Compared with the patients without extranodal extension, the proportions of the patients with histological grade Ⅲ, 10 or more metastatic lymph nodes, and 5 cm or greater tumor diameter were higher in the patients with extranodal extension (P<0.05). The results of multivariate analysis showed that the 10 or more metastatic lymph nodes was the risk factor affecting the overall survival (OS) and disease-free survival (DFS) of the TNBC patients (P<0.05), and the histological grade Ⅲ and lower human epidermal growth factor receptor-2 (HER-2) expression were the risk factors affecting the OS of the TNBC patients (P<0.05), as well as the extranodal extension was the risk factor affecting the DFS of the TNBC patients (P<0.05). The 5-year cumulative disease-free survival rate of the patients with extranodal extension was worse than that of the patients without extranodal extension (70.2% vs. 83.3%, χ2=6.934, P=0.008). The 5-year cumulative overall survival rate had no statistically significant difference between the them (75.3% vs. 82.1%, χ2=1.969, P=0.161). ConclusionsFrom the results of this study, the prognosis of TNBC patients with extranodal extension is worse. Especially the patients with histological grade Ⅲ, 10 or more metastatic lymph nodes, and with lower HER-2 expression should be paid attention.
Objective To systematically evaluate the efficacy and safety of iris-registration in wavefront-guided LASIK (IR+WG LASIK) versus conventional LASIK for correction of myopia accompanied with astigmatism. Methods Such databases as PubMed, EMbase, The Cochrane library (Issue 2, 2012), CBM, CNKI, VIP, and WangFang Data were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about IR+WG LASIK versus conventional LASIK for correction of myopia accompanied with astigmatism. The retrieval time was from inception to February 2012, and the language was in both Chinese and English. Two reviewers independently screened the literature, extracted the data and assessed the quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies involving 3 903 eyes were included. The results of meta-analysis showed that, compared with the conventional LASIK group, the IR+WG LASIK group had a higher ratio in patients with postoperative uncorrected visual acuity no less than 1.0 (RR=1.03, 95%CI 1.01 to 1.05, P=0.002), as well as in patients with best-corrected visual acuity gained over 1 line (RR=1.75, 95%CI 1.49 to 2.16, Plt;0.000 01); it was smaller in the postoperative high order aberration RMS (WMD=?0.16, 95%CI ?0.21 to ?0.11, Plt;0.000 01), coma-like RMS (WMD=?0.05, 95%CI ?0.11 to 0.00, P=0.07), spherical-like RMS (WMD=?0.15, 95%CI ?0.23 to ?0.07, P=0.000 2), and residual astigmatism (WMD=0.14, 95%CI 0.10 to 0.18, Plt;0.000 01); moreover, it was lower in the incidence of postoperative glare (RR=0.27, 95%CI 0.15 to 0.50, Plt;0.000 1), and it was higher in the subjective satisfaction of patients (RR=1.08, 95%CI 1.04 to 1.13, P=0.000 3). Conclusion Compared with conventional LASIK, IR+WG LASIK can more effectively reduce astigmatism, postoperative high order aberration RMS and spherical-like RMS. It can also get visual function including uncorrected visual acuity and best-corrected visual acuity, consequently increase patient’s satisfaction. But further studies are still required for its long-term effect.
Medicine bears the responsibility for human health. Technical competence, service standards, professional ethics and social accountability constitute the soul of this profession. The principles of nonmaleficence, beneficence, respect for autonomy and justice help to establish good doctor-patient relationship and regulate medical services, which has been fixed by international and domestic professional norms. Besides to ensure its truth, effectiveness and safety, medical research also should require certain rendering of subject's autonomy, minimizing risks and maintaining social justice. Some procedures have established for supporting it. Modern medical education furnishes suitable human resources for medical profession, which directly affects the accessibility and outcomes of health services. Its objectives, operations and assessments are increasingly taking shape. Faced with the current issues of healthcare equity, worsening doctor-patient relationship, scandals and ethical controversies in medical research, and the failing of medical education to fully match social needs, evidence-based medical methodology is extending to policy and social sciences for identifying and creating high-quality scientific evidence to improve the quality of decision-making.