简介：BackgroundThisstudytestedthehypothesisthatmoderatealcoholintakeexertsitscardioprotectiveeffectmainlythroughanincreaseintheserumlevelofhigh-densitylipoproteincholesterol.MethodsandResultsIntheCohortofNorway(CONOR)study,149729adultparticipants,recruitedfrom1994to2003,werefollowedbylinkagetotheCauseofDeathRegistryuntil2006.Atrecruitment,questionnairedataonalcoholintakewerecollected,andtheconcentrationofhigh-densitylipoproteincholesterolinserumwasmeasured.UsingCoxregression,wefoundthattheadjustedhazardratioformenfordyingfromcoronaryheartdiseasewas0.52(95%confidenceinterval,0.39-0.69)whenconsumingalcoholmorethanonceaweekcomparedwithneverorrarely.Theratiochangedonlyslightly,to0.55(0.41-0.73),aftertheregressionmodelincludedtheserumlevelofhigh-densitycholesterol.Forwomen,thecorrespondinghazardratioswere0.62(0.32-1.23)and0.68(0.34-1.34),respectively.ConclusionsAlcoholintakeisrelatedtoareducedriskofdeathfromcoronaryheartdiseaseinthefollow-upofalarge,population-basedNorwegiancohortstudywithextensivecontrolforconfoundingfactors.Ourfindingssuggestthattheserumlevelofhigh-densitycholesterolisnotanimportantintermediatevariableinthepossiblecausalpathwaybetweenmoderatealcoholintakeandcoronaryheartdisease.

简介：Transperineal前列腺活体检视是能被用来从前列腺获得组织学的样品的一个过程。两个都改进活体检视核心样品和前列腺癌症察觉的质量，我们当前正在执行比较用18G针获得到用16G针获得的那些的前列腺活体检视样品的未来的、使随机化的试用。这初步的研究的目的是在两个组评估疼痛和复杂并发症率以便估计与一根更大的口径针执行前列腺活体检视是否是一个可行过程。经历transperineal前列腺活体检视的187个病人有希望地被评估并且把组划分了成二。第一个组(94个病人，组织A)用16G针和第二个组收到了transperineal前列腺活体检视(93个病人，组织B)与18G针经历了transperineal前列腺活体检视。麻醉在所有题目在prostatic顶与单个会阴的注射被获得。视觉类似物规模(管)和面部表情规模(FES)被用来在每个组在过程的多重步期间估计疼痛。因为它能潜在地影响病人们经历了的疼痛和复杂并发症，一张详细问询表被用来关于药使用获得信息。在过程以后的二个星期，早、迟了的复杂并发症被评估。统计分析用非参量的测试被执行。前列腺特定的抗原(PSA)和药使用在在二个组之间的基线是类似的。疼痛没在18-和16个G针组之间显著地在前列腺活体检视，与VAS和FES仪器一起被测量，期间不同，并且没有重要差别处于在这些组之间的早或迟了的复杂并发症率被发现。有16G针的Transperineal前列腺活体检视以疼痛和复杂并发症率是一个可行过程。有更大的耐心的人口的进一步的研究被要求估计这个过程是否能改进前列腺癌症察觉率。

简介：AbstractPurpose:Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated.1 All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient =-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

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简介：摘要ObjectiveTo evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle.DesignRandomized controlled trial.SettingInpatient neuro-rehabilitation clinic of a university hospital.ParticipantsStroke patients with ankle flexor spasticity.InterventionsPatients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation.Main measuresThe primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up.ResultsFifty-one participants were enrolled (active therapy n＝17, sham n＝17, control n＝17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47±0.72 to 1.41±0.62) compared to sham (from 2.19±1.05 to 2.06±1.12) and control (from 2.06±0.85 to 2.00±0.73) groups immediately after the treatment (P<0.001). Tardieu results were also in concordance (P<0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P<0.001). However, there was no difference among the groups in terms of improvement in elastography.ConclusionRadial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.

简介：Objective:Toassesstheimpactofpastlivermetastasesonthesurvivaldurationofpatientswhoareundergoingsurgeryforlungmetastases.Methods:Weconductedareviewofliteraturepublishedfrom2007to2014.ThestudieswereidentifiedbysearchingPubMed,MEDLINE,andEmbaseandweresupplementedbyamanualsearchofthereferenceslistedbytheretrievedstudies.Thefollowingsearchtermswereused:lungmetastasectomy,pulmonarymetastasectomy,lungmetastases,andlungmetastasis.Weselectedretrospectiveandprospectivestudiespublishedfrom2007to2014onpatientswithlungmetastasesfromcolorectalcancerandwereundergoingsurgerywithcurativeintent.Weexcludedreviews,studiesthatfocusedonsurgicaltechniques,patientswhoweretreatednon-surgically,analysesofspecificsubgroupsofpatients,andthosethatdidnotreportfollow-upofthepatientsundergoingsurgery.Results:Weidentified28papersthatassessedsurvivalafterlungmetastases,21ofwhichweremostlyretrospectivestudiesthatidentifiedpreviouslivermetastasestoexploretheirimpactonpatientsurvival.Inmorethanhalfofthepapersanalyzed(63.2%),patientswithahistoryofresectedlivermetastaseshadalowersurvivalratethanthosewhodidnothavesuchahistory,andthedifferencewasstatisticallysignificantineightofthesestudies.However,datawerepresenteddifferently,andauthorsreportedmeansurvivaltime,survivalrates,orhazardratios.Conclusions:Ahistoryoflivermetastasesseemstobeanegativeprognosticfactor,buttheindividualdataneedtoundergoameta-analysis.

简介：AbstractObjective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ2, Fisher's exact, and independent t tests.Results:Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps (n = 15, 44.1%) and free mucosal grafts (n = 11, 32.4%). Rigid reconstruction was uncommon (n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise (P < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis (P < 0.001), larger tumor size (P = 0.001), and operative exposure of orbital fat (P < 0.001) and extraocular muscle (P= 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short- or long-term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short-term postoperative diplopia when reconstruction was foregone (P = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well-selected by surgeons in the reported cases included in this systematic review.

简介：AbstractPurpose:By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event.Methods:The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty" , "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’ stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event.Results:This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.Conclusion:Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

简介：AbstractBackground:It remains unclear whether the outcomes of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) during off-hours are as favorable as those treated during on-hours, especially those with a first medical contact-to-device (FMC-to-device) time within 90 min. We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time ≤90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time ≤90 min from 19 chest pain centers in Beijing from January 2018 to December 2018. Patients were divided into on-hours group and off-hours group based on their arrival time. Baseline characteristics, clinical data, and key time intervals during treatment were collected from the Quality Control & Improvement Center of Cardiovascular Intervention of Beijing by the "Heart and Brain Green Channel" app.Results:Overall, the median age of the patients was 58.8 years and 19.9% (133/670) were female. Of these, 296 (44.2%) patients underwent PPCI during on-hours and 374 (55.8%) patients underwent PPCI during off-hours. Compared with the on-hours group, the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time ≤60 min (P < 0.05). During the mean follow-up period of 24 months, a total of 64 (9.6%) participants experienced a major adverse cardiovascular event (MACE), with 28 (9.1%) in the on-hours group and 36 (9.6%) in the off-hours group (P > 0.05). According to the Cox regression analyses, off-hours admission was not a predictor of 2-year MACEs (P = 0.788). Similarly, the Kaplan-Meier curves showed that the risks of a MACE, all-cause death, reinfarction, and target vessel revascularization were not significantly different between the two groups (P > 0.05).Conclusions:This real-world, multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min, off-hours admission was safe, with no difference in the risk of 2-year MACEs compared with those with on-hours admission.