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.
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.
Science is a system of knowledge that reflects the essential connections and laws of the objective world. Classification of disciplines is a subsystem of science, which involves the development of human cognition which evolved from the scientific category to the department of higher education, and then formation of a complex management system. Nowadays with the rapid development of science and technology which triggering numerous complex social problems, an increasing trend of scientific integration calls for multidisciplinary and interdisciplinary research and education. In the 1990s, evidence-based medicine was emerged in the self-doubting of medical science, and extended to other fields of medicine, health policy and social sciences, forming an interdisciplinary evidence-based science system. Evidence-based science is an embodiment of scientific integration, and also the carrier and mechanism of cross-disciplinary convergence. It attempts to break through barriers of disciplines and management, and promotes interdisciplinary research, during which it has encountered many difficulties due to limitations of traditional disciplines. Evidence-based science does not provide an intrusion or transformation of thinking paradigm into other disciplines, but rather an equal dialogue to promote broader discipline collaboration and a new round of self-improvement, so as to constantly explore novel methods and theories to solve emerging problems, achieve continuous improvement, and pursue excellence.
ObjectiveTo develop Knowledge attitude behavior and practice (KABP) health education path table, and to explore its application in health education of physician-nurse collaboration for children with epilepsy, and provide practical reference for health education of children with epilepsy.MethodsA convenient sampling method was used to select 94 family units of children with epilepsy and their main caregivers from the Department of Neurology in Hunan Children’s Hospital from September 2018 to March 2019. Divided into observation group and control group, 47 cases in each group. In the control group, the health care education was carried out by the conventional method of medical personnel’s one-way input of knowledge. The observation group conducted health education through interactive participation in the path of the health education path of KABP on the basis of regular health education. Then compared the effect of the health education between the two groups.ResultsAfter the intervention, the quality of life scores of the observation group were significantly higher than the control group (P<0.01). The relevant knowledge scores of main caregivers at 1 and 3 months after discharge were significant higher than those in the control group (P=0.008, P=0.001). The medication compliance scores of children with epilepsy at 1 and 3 months after discharge were significant higher than those in the control group (P=0.010, P=0.006).ConclusionsThe KABP health education pathway can improve the knowledge level of caregivers, as well as the medication compliance and quality of life of children with epilepsy.
Objective To analyze the causal relationship between cerebrospinal fluid (CSF) metabolites and tic disorder (TD) based on two-sample Mendelian randomization (MR). Methods CSF metabolites data from humans were downloaded from genome-wide association study databases, and CSF metabolites were selected as exposure factors. single nucleotide polymorphisms (SNPs) strongly associated with the exposure factors and independent of each other were selected as instrumental variables. The TD dataset from the Finngen database was downloaded, including 365 cases of TD and 411 816 controls. Analysis was conducted using inverse variance weighting, MR-Egger, weighted median, weighted mode, and simple mode. Sensitivity analysis was conducted using leave-one-out, and multiple-effects testing was conducted using MR-Egger and MR-PRESSO. Heterogeneity was detected using Cochran’s Q. Results A total of 9 CSF metabolites were found to have a causal relationship with the occurrence and development of TD (P<0.05), with a total of 394 SNPs included in the analysis. Inverse variance weighting results showed that N-acetylneuraminic acid [odds ratio (OR)=2.715, 95% confidence interval (CI) (1.102, 6.961), P=0.030], γ-glutamylglutamine [OR=1.402, 95%CI (1.053, 1.868), P=0.021], lysine [OR=2.816, 95%CI (1.084, 7.319), P=0.034] could increase the risk of TD. Cysteinylglycine disulfide [OR=0.437, 95%CI (0.216, 0.885), P=0.021], propionylcarnitine [OR=0.762, 95%CI (0.616, 0.941), P=0.012], pantothenate [OR=0.706, 95%CI (0.523, 0.952), P=0.023], gulareic acid [OR=0.758, 95%CI (0.579, 0.992), P=0.044], and cysteine-glycine [OR=0.799, 95%CI (0.684, 0.934), P=0.005] could reduce the risk of TD. The results of leave-one-out sensitivity analysis were stable, and no horizontal pleiotropy or heterogeneity was observed. Conclusions N-acetylneuraminic acid, γ-glutamylglutamine, and lysine can increase the risk of TD, but cysteinylglycine disulfide, propionylcarnitine, pantothenate, gulagic acid and cysteine-glycine can reduce the risk of TD. However, the mechanism of their effects on TD still needs to be further explored.
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.
ObjectiveTo evaluate the effectiveness of levetiracetam (LEV) added on to usual care, in treating children refractory partial seizure epilepsy.MethodsWe searched the Cochrane library, EMBASE and PubMed between January 1998-January 2017, We systematically searched CNKI database and Wanfang data, Chinese biology medline and the manual retrieval related magazines.RevMan 5.3 statistical software for Meta analysis.ResultsAccording to the enrollment criteria, fourtrials were included involving 498 participants according to the intent-to-treat, 268 for LEV, and 230 for placebo groups.We assessed the following outcomes: 50% or greater seizure reduction, seizure freedom, adverse effects, proportion of dropouts and quality of life. There was no evidence of statistical heterogeneity between trials.We assessed outcomes by using a meta-analysis to calculate odds ratio (OR) with 95% confidence intervals (95% CI). For the 50% or greater reduction in focal seizure frequency outcome, the OR was significantly in favour of LEV [OR=2.94, 95% CI(1.99, 4.34)].Participants were significantly more likely in LEV groups than placebo groups to get seizure free[OR=5.31, 95% CI(2.49, 11.32)]. There was no significance between LEV groups and placebo groupsin the rate of Treatment withdrawal[OR=0.76, 95% CI(1.32, 1.82)]. Somnolence[OR=2.57, 95% CI(1.36, 4.86)]and changes in behaviour [OR=2.54, 95% CI(1.56, 4.14)] were significantly associated with LEV. Other adverse effects were not significantly associated with LEV in children.ConclusionThe existing evidence suggests that LEV add in treatment of children refractory epilepsy have definite curative effect, LEV long-term treatment effect is stable, good security, retention rate is higher, can be used in clinical further promotion.
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.
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.
