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Impact of Microsurgery and Postoperative Radiotherapy on Neurological Function in Intramedullary Spinal Cord Gliomas. 髓内脊髓胶质瘤显微手术和术后放疗对神经功能的影响
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1112
Xin Li, Zhen-Jie Liu, Liang Liang, Hai-Qing Dong, Xingang Zhao

Objective: To assess the clinical efficacy of combined microsurgery and postoperative radiotherapy for the treatment of intramedullary spinal gliomas and its impact on neurological function.

Study design: An observational study. Place and Duration of the Study: Department of Neurosurgery, Baoding No.1 Central Hospital, Hebei, China, between January 2020 and 2023.

Methodology: Sixty patients diagnosed with spinal cord intramedullary gliomas were divided equally into an experimental and control group. The control group received microsurgical treatment, and the experimental group received microsurgical treatment combined with postoperative radiotherapy. The treatment effectiveness, neurological function, and follow-up results of the two groups were compared.

Results: After treatment, the clinical efficacy of the experimental group treatment was significantly better than that of the control group (p <0.05). The National Institutes of Health Stroke Scale (NIHSS) scores were significantly lower, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ-C30) scores were significantly higher in the experimental group than in the control group (p <0.05). The 1-3-year survival rate and median survival time of the experimental group were significantly higher than those of the control group (p <0.05). The incidence of complications was 3.33% in the experimental group and 6.67% in the control group, but the difference was not statistically significant (p >0.05). The postoperative recurrence rate was significantly lower in the experimental (0%) than in the control group (13.33%, p <0.05).

Conclusion: Combined microsurgery and postoperative radiotherapy was found to be more effective than microsurgery alone. It was also more conducive to the recovery of neurological function and improved the patient's quality of life.

Key words: Intramedullary spinal cord glioma, Microsurgery, Neurological function, Radiotherapy.

研究目的评估联合显微手术和术后放疗治疗髓内脊神经胶质瘤的临床疗效及其对神经功能的影响:观察性研究。研究地点和时间2020年1月至2023年,中国河北省保定市第一中心医院神经外科:将确诊为脊髓髓内胶质瘤的 60 例患者平均分为实验组和对照组。对照组接受显微外科治疗,实验组接受显微外科治疗联合术后放疗。比较两组的治疗效果、神经功能和随访结果:结果:治疗后,实验组的临床疗效明显优于对照组(P 0.05)。实验组术后复发率(0%)明显低于对照组(13.33%,P 结论:实验组术后复发率明显低于对照组(13.33%):显微手术和术后放疗联合治疗比单纯显微手术更有效。它也更有利于神经功能的恢复,并能改善患者的生活质量:髓内脊髓胶质瘤 显微外科手术 神经功能 放疗
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引用次数: 0
Inclisiran Treatment for Cardiovascular Disease Risk Reduction: A Systematic Review and Meta-Analysis. 降低心血管疾病风险的英克西兰治疗:系统回顾与元分析》。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1090
Ya-Fang Chen, Si Li, Mei-Juan Wang, Meng-Yuan Wu, Zi-Chen du, Li-Ping Wei

This study was a meta-analysis of patient data to investigate the therapeutic effects of inclisiran on LDL-C, PCSK9, and TC in patients with atherosclerosis. Authors searched the Cochrane Library, Pubmed, EMBASE, and Web of Science databases for randomised controlled trials. Data of 4,731 subjects from five randomised clinical trials were included in this analysis. Patients treated with the PCSK9 inhibitor inclisiran had significantly lower LDL-C levels than those treated with placebo or a statin (mean difference (MD) -1.477; 95% CI -1.551 to -1.403; p <0.001; I2 = 7.2%). The average level of PCSK9 was also relatively lower ((MD) -2.579; 95% CI -2.694 to -2.464; p <0.001; I2 = 36%). They exhibited significant reductions in total cholesterol protein levels ((MD) -1.477; 95% CI -1.585 to -1.369; p <0.001; I2 = 46.7%). Inclisiran reduced LDL-C and PCSK9 levels as well as TC and Apo B levels significantly in patients with atherosclerotic cardiovascular disease (ASCVD). Key Words: Inclisiran, Low-density lipoprotein cholesterol, Atherosclerosis, Adverse events, Meta-analysis.

本研究对患者数据进行了荟萃分析,以探讨 inclisiran 对动脉粥样硬化患者 LDL-C、PCSK9 和 TC 的治疗效果。作者在 Cochrane Library、Pubmed、EMBASE 和 Web of Science 数据库中检索了随机对照试验。本次分析纳入了五项随机临床试验中 4731 名受试者的数据。接受 PCSK9 抑制剂 inclisiran 治疗的患者的 LDL-C 水平明显低于接受安慰剂或他汀类药物治疗的患者(平均差 (MD) -1.477; 95% CI -1.551 to -1.403; p
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引用次数: 0
Diagnostic Accuracy of Polymerase Chain Reaction Against Giemsa Staining on Tissue Biopsy for Cutaneous Leishmaniasis. 聚合酶链式反应对皮肤利什曼病组织活检革兰氏染色的诊断准确性。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1024
Aleena Khalid, Maria Mushtaq Gill, Irfan Ali Mirza, Sakeenah Hussain Naqvi, Syed Adeel Hussain Gardezi, Rabia Sajjad

Objective: To evaluate the diagnostic accuracy of a commercial real-time polymerase chain reaction (PCR) kit targeting 18S rRNA against Giemsa-stained tissue slides in patients clinically suspected of cutaneous leishmaniasis (CL).

Study design: Cross-sectional analytical study. Place and Duration of the Study: Department of Microbiology, Armed Forces Institute of Pathology / National University of Medical Sciences, Rawalpindi, Pakistan, from July to December 2022.

Methodology: Samples of skin tissue in 98 patients suspected of CL were evaluated. These samples were subjected to Giemsa-staining for microscopy and real-time PCR. Sensitivity, specificity, and accuracy of the PCR were calculated keeping Giemsa-stained tissue slide microscopy as gold standard.

Results: Out of the 98 tissue samples, 37 were found positive for leishmaniasis on PCR while 13 were found Leishmania positive on microscopy of Giemsa-stained slides. The sensitivity, specificity, and accuracy of the PCR for the detection of Leishmania species were 100%, 71.8%, and 91.8%, respectively with 100% negative predictive value.

Conclusion: This study demonstrates that the commercial PCR is a reliable diagnostic test for the diagnosis of CL. The ease, rapidity, and reliability of the PCR make it a dependable tool in diagnostic repertoire of CL.

Key words: Giemsa stain, Leishmania spp., Polymerase chain reaction, Viasure.

目的研究设计:横断面分析研究。研究地点和时间:巴基斯坦拉瓦尔品第武装部队病理研究所/国立医科大学微生物学系,2022 年 7 月至 12 月:对 98 名疑似 CL 患者的皮肤组织样本进行评估。方法:对 98 名疑似 CL 患者的皮肤组织样本进行评估,并对这些样本进行 Giemsa 染色显微镜检查和实时 PCR 检测。以革兰染色组织切片显微镜检查为金标准,计算 PCR 的灵敏度、特异性和准确性:结果:在 98 份组织样本中,37 份在 PCR 检测中发现利什曼病阳性,13 份在革兰染色组织切片显微镜检测中发现利什曼病阳性。PCR 检测利什曼原虫的敏感性、特异性和准确性分别为 100%、71.8% 和 91.8%,阴性预测值为 100%:本研究表明,商用 PCR 是诊断 CL 的可靠检测方法。PCR的简便、快速和可靠性使其成为诊断CL的可靠工具:革兰氏染色法 利什曼原虫 聚合酶链反应 Viasure
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引用次数: 0
Impact of Teaching Methods on Clinical Reasoning in Forensic Medicine: A Quasi-Experimental Study. 教学方法对法医学临床推理的影响:一项准实验研究。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1096
Mehreen Fatima, Arshad Khan, Ramlah Naz, Muhammad Yahya Noori

Objective: To compare the effectiveness of flipped classroom and video-assisted learning techniques with didactic lectures in promoting clinical reasoning skills in Forensic Medicine.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Forensic Medicine, Dow International Medical College and Dow University of Health Sciences, Karachi, Pakistan, from May to October 2023.

Methodology: The study included 114 third-year medical students divided into three predefined tutorial groups. Over four weeks, within the Forensic Medicine respiratory module, each group was taught one topic per week using a distinct teaching strategy: Traditional lectures (TL) for the first group, flipped classroom (FC) method for the second group, and video-assisted teaching (VAT) for the third group. Students' learning achievements and clinical reasoning skills were assessed through a pre-test, post-test, and revision post-test.

Results: Pre-test scores showed no significant differences among the groups (p = 0.655). However, post-test scores differed significantly (F2:111 = 11.93, p <0.001). Tukiye's test indicated that the mean score for the FC group was significantly different from the TL group (p = 0.003) and the VAT group (p <0.001), but there was no significant difference between the TL and VAT groups (p = 0.422). The revision post-test indicated a significant decrease in mean scores across all groups, regardless of the instructional approach (p <0.001).

Conclusion: The FC approach for teaching clinical reasoning in Forensic Medicine shows promising results, effectively improving student performance and learning experience.

Key words: Flipped classroom, Video-assisted teaching, Clinical reasoning, Forensic Medicine teaching.

目的:比较翻转课堂和视频辅助学习技术与说教式授课在提高法医学临床推理能力方面的效果:比较翻转课堂和视频辅助学习技术与说教式授课在提高法医学临床推理能力方面的效果:准实验研究。研究地点和时间:研究地点和时间:巴基斯坦卡拉奇陶氏国际医学院和陶氏健康科学大学法医学系,2023 年 5 月至 10 月:研究对象包括 114 名三年级医科学生,分为三个预先确定的辅导小组。在为期四周的法医学呼吸模块中,每个小组每周使用不同的教学策略讲授一个主题:第一组采用传统授课法(TL),第二组采用翻转课堂法(FC),第三组采用视频辅助教学法(VAT)。通过前测、后测和复习后测评估学生的学习成绩和临床推理能力:结果:各组的前测成绩无明显差异(P = 0.655)。然而,后测得分却有显著差异(F2:111 = 11.93,p 结论:FC 教学法在临床推理教学中的应用效果显著:FC法医学临床推理教学法效果良好,有效提高了学生的学习成绩和学习体验:翻转课堂 视频辅助教学 临床推理 法医学教学
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引用次数: 0
Comparison of the Efficacy of Laser and Hybrid Seton Methods in the Treatment of Perianal Fistula. 激光和混合塞通法在治疗肛周瘘中的疗效比较。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1040
Ali Kemal Taskin, Mustafa Akar, Bulent Ozcetin

Objective: To compare the efficacy and postoperative complications of laser and hybrid seton methods in the treatment of perianal fistula (PF).

Study design: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkiye, from January 2021 to April 2022.

Methodology: A total of 76 patients, with 46 in the hybrid seton group and 30 in the laser group, were included in the study. Perianal fistula classification was based on preoperative magnetic resonance imaging. The Likert satisfaction scale was assessed for patient satisfaction and the Cleveland Clinic Florida Faecal Incontinence (CCF-FI) scoring system was used for incontinence. Treatment outcome was determined based on success rate and postoperative faecal incontinence.

Results: The mean age of the patients was 43 ± 13 years and 59 (78%) of them were male. Forty-seven (62%) patients had simple fistula. Acute and late complications were significantly higher in the hybrid seton group than in the laser group (p <0.001). According to the Likert satisfaction scale, the rate of unsatisfied patients was significantly higher in the laser group than in the hybrid seton group (p = 0.02). According to the CCF-FI scoring system, incontinence was significantly higher in the hybrid seton group than in the laser group (p = 0.01). Treatment failure was higher in the laser group (p = 0.03).

Conclusion: The laser method has lower intraoperative / postoperative complications, but higher treatment failure and lower patient satisfaction compared to the hybrid seton method.

Key words: Anal fistula, Fecal incontinence, Laser therapy, Outcome, Loose seton method.

研究目的比较激光和混合型套扎法治疗肛周瘘的疗效和术后并发症:描述性横断面研究。研究地点和时间:研究地点和时间:土耳其布尔萨尤克赛克-伊赫蒂萨斯培训与研究医院健康科学大学普通外科,2021年1月至2022年4月:研究共纳入 76 名患者,其中混合套管组 46 人,激光组 30 人。根据术前磁共振成像对肛周瘘进行分类。患者满意度采用李克特满意度量表,尿失禁采用克利夫兰诊所佛罗里达尿失禁(CCF-FI)评分系统。治疗结果根据成功率和术后大便失禁情况确定:患者的平均年龄为 43 ± 13 岁,其中 59 人(78%)为男性。47例(62%)患者为单纯性瘘管。混合型套管组的急性和晚期并发症明显高于激光组(P 结论:混合型套管组的术中并发症明显低于激光组:激光法的术中、术后并发症较低,但治疗失败率较高,患者满意度较低:肛瘘 大便失禁 激光治疗 效果 松套法
{"title":"Comparison of the Efficacy of Laser and Hybrid Seton Methods in the Treatment of Perianal Fistula.","authors":"Ali Kemal Taskin, Mustafa Akar, Bulent Ozcetin","doi":"10.29271/jcpsp.2024.09.1040","DOIUrl":"https://doi.org/10.29271/jcpsp.2024.09.1040","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and postoperative complications of laser and hybrid seton methods in the treatment of perianal fistula (PF).</p><p><strong>Study design: </strong>A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkiye, from January 2021 to April 2022.</p><p><strong>Methodology: </strong>A total of 76 patients, with 46 in the hybrid seton group and 30 in the laser group, were included in the study. Perianal fistula classification was based on preoperative magnetic resonance imaging. The Likert satisfaction scale was assessed for patient satisfaction and the Cleveland Clinic Florida Faecal Incontinence (CCF-FI) scoring system was used for incontinence. Treatment outcome was determined based on success rate and postoperative faecal incontinence.</p><p><strong>Results: </strong>The mean age of the patients was 43 ± 13 years and 59 (78%) of them were male. Forty-seven (62%) patients had simple fistula. Acute and late complications were significantly higher in the hybrid seton group than in the laser group (p <0.001). According to the Likert satisfaction scale, the rate of unsatisfied patients was significantly higher in the laser group than in the hybrid seton group (p = 0.02). According to the CCF-FI scoring system, incontinence was significantly higher in the hybrid seton group than in the laser group (p = 0.01). Treatment failure was higher in the laser group (p = 0.03).</p><p><strong>Conclusion: </strong>The laser method has lower intraoperative / postoperative complications, but higher treatment failure and lower patient satisfaction compared to the hybrid seton method.</p><p><strong>Key words: </strong>Anal fistula, Fecal incontinence, Laser therapy, Outcome, Loose seton method.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"34 9","pages":"1040-1045"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spontaneous Closure of Bile Leak in Abdominal Drain after Cholecystectomy: A Systematic Review. 胆囊切除术后腹腔引流管胆汁渗漏的自发闭合:系统回顾。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1084
Muhammad Tahir Ghani, Hafiz Muhammad Ijaz Ul Haq, Ibad Ur Rehman, Nain Sukh

Bile leakage in abdominal drain after cholecystectomy is reported to close spontaneously without any intervention. The aim of this systematic review was to find out the amount and source of bile leaks that can be closed spontaneously and various factors associated with this closure. A systematic search of PubMed, Google Scholar, and Cochrane under preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed. Ten studies were finally included in the review. Five studies were found from India, two from Pakistan, and one each from Mexico, Nepal, and Romania. Maximum volume of bile reported to close spontaneously was 500 ml per day and took seven days to close. Overall 66.6% cases of bile leaks were laparoscopically operated. Bile leakage in abdominal drain after cholecystectomy up to 500 ml per day closes spontaneously in a week time provided patient has no major ductal injury and peritonitis. Key Words: Bile leakage, Abdominal drain, Endoscopic retrograde cholangiopancreatography.

据报道,胆囊切除术后腹腔引流管中的胆汁渗漏可自行闭合,无需任何干预。本系统综述的目的是找出可自发闭合的胆漏的数量和来源,以及与这种闭合相关的各种因素。根据系统综述和荟萃分析首选报告项目(PRISMA)指南,对 PubMed、谷歌学术和 Cochrane 进行了系统检索。最终有 10 项研究被纳入综述。其中五项来自印度,两项来自巴基斯坦,墨西哥、尼泊尔和罗马尼亚各一项。据报道,自发闭合的最大胆汁量为每天 500 毫升,闭合时间为七天。总的来说,66.6%的胆漏病例是通过腹腔镜手术治疗的。胆囊切除术后腹腔引流管中的胆汁渗漏每天最多为500毫升,如果患者没有严重的胆管损伤和腹膜炎,一周后就会自动闭合。关键字胆汁渗漏、腹腔引流管、内镜逆行胰胆管造影。
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引用次数: 0
Frequency of Phenotypes and their Clinical and Hormonal Characteristics of Polycystic Ovarian Syndrome. 多囊卵巢综合征的表型频率及其临床和激素特征。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1107
Rehana Rahim, Heera Urooj, Hina Gul

Objective: To determine the frequency of phenotypes of polycystic ovarian syndrome (PCOS) in patients presenting with sub-fertility, and to compare the clinical and hormonal characteristics among them.

Study design: Descriptive cross-sectional study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Forest View Specialist Clinic, Peshawar, Pakistan, from August 2022 to January 2023.

Methodology: The study included 662 female patients presenting with menstrual irregularities, hyperandrogenism, and infertility to the clinic. PCOS was diagnosed on the basis of the Rotterdam criterion and clinical features and classified into different phenotypes on the basis of the National Institute of Health (NIH) panel criteria. Data were entered and analysed by IBM SPSS VERSION 23.0. The frequency of four phenotypes was calculated and phenotypes were compared for age, weight, hormonal profiles, and history of miscarriages. A p <0.05 was considered statistically significant.

Results: Frequency of PCOS in patients with infertility was 59.76%. Phenotype A was seen in 58.2%, phenotype D in 23.3%, phenotype C in 16.9%, and phenotype B in 1.7% of cases. The LH/FSH ratio was statistically significant in phenotype A as compared to other phenotypes, while other parameters were non-significant.

Conclusion: The frequency of PCOS is high in patients with infertility. Phenotype A is the most common variant and is associated with significant impairment of the LH/FSH ratio.

Key words: Polycystic ovarian syndrome, Subfertility, Phenotypes of PCOS, Hyperandrogenism, Anovulation, R-C1.

研究目的研究设计:描述性横断面研究。研究地点和时间:研究地点和时间:巴基斯坦白沙瓦市森林景观专科诊所妇产科,2022 年 8 月至 2023 年 1 月:研究对象包括 662 名因月经不调、雄激素过高和不孕症前来就诊的女性患者。多囊卵巢综合征的诊断依据是鹿特丹标准和临床特征,并根据美国国立卫生研究院(NIH)小组标准分为不同的表型。数据由 IBM SPSS VERSION 23.0 输入和分析。计算了四种表型的频率,并对表型的年龄、体重、激素水平和流产史进行了比较。A p 结果:多囊卵巢综合征在不孕症患者中的发病率为 59.76%。58.2%的患者为表型 A,23.3%为表型 D,16.9%为表型 C,1.7%为表型 B。与其他表型相比,表型 A 的 LH/FSH 比值具有显著的统计学意义,而其他参数则无显著意义:结论:多囊卵巢综合征在不孕症患者中的发病率很高。结论:多囊卵巢综合征在不孕症患者中的发病率很高,表型 A 是最常见的变异,与 LH/FSH 比值的显著降低有关:多囊卵巢综合征 亚不孕 多囊卵巢综合征表型 雄激素过多 无排卵 R-C1
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引用次数: 0
The Maximum Threshold Value for HbA1c in Diabetic Patients Undergoing Elective Total Knee Arthroplasty. 接受择期全膝关节置换术的糖尿病患者 HbA1c 的最大阈值。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1073
Dahui Shen, Shoukang Sun, Zhifang Mu, Dong Yuefu

Objective: To establish an optimal preoperative HbA1c threshold that enhances surgical outcomes and minimises postoperative complications in diabetic patients undergoing elective total knee arthroplasty (TKA).

Study design: Prospective cohort study. Place and Duration of the Study: Department of Orthopaedics, First People's Hospital of Lianyungang, China, from January 2021 to March 2024.

Methodology: A total of 152 diabetic patients scheduled for elective TKA were included. Data on preoperative HbA1c levels were collected and analysed to assess their impact on postoperative outcomes using the Oxford Knee Score (OKS). Patients were divided into groups based on HbA1c levels and compared for functional and pain recovery one year postoperatively. Statistical analyses included binary and multivariate logistic regression, with an emphasis on the minimum clinically important difference for OKS.

Results: Patients with a preoperative HbA1c below 7.35mmol/L exhibited significantly better functional and pain recovery outcomes at one-year post-TKA. The receiver operating characteristic curve (ROC) analysis confirmed the predictive power of HbA1c, with an Area Under the Curve of 0.734 for functional improvement and 0.721 for pain improvement.

Conclusion: The study identifies 7.35mmol/L as the optimal preoperative HbA1c threshold for diabetic patients undergoing elective TKA, with lower levels associated with improved functional and pain outcomes. Maintaining HbA1c below this level preoperatively can significantly enhance postoperative recovery and patient satisfaction.

Key words: Diabetes mellitus, Total knee arthroplasty, Haemoglobin A1c, Oxford knee score.

研究目的研究设计:前瞻性队列研究。研究地点和时间:研究地点和时间:中国连云港市第一人民医院骨科,2021年1月至2024年3月:方法:共纳入152名计划接受择期TKA手术的糖尿病患者。收集并分析术前 HbA1c 水平数据,使用牛津膝关节评分(OKS)评估其对术后效果的影响。根据 HbA1c 水平将患者分为几组,并比较术后一年的功能和疼痛恢复情况。统计分析包括二元和多变量逻辑回归,重点是 OKS 的最小临床重要差异:结果:术前 HbA1c 低于 7.35mmol/L 的患者在 TKA 术后一年的功能和疼痛恢复情况明显更好。接收器操作特征曲线(ROC)分析证实了 HbA1c 的预测能力,对功能改善的曲线下面积为 0.734,对疼痛改善的曲线下面积为 0.721:该研究确定 7.35mmol/L 为接受择期 TKA 手术的糖尿病患者术前 HbA1c 的最佳阈值,较低水平的 HbA1c 可改善功能和疼痛预后。术前将 HbA1c 维持在该水平以下可显著提高术后恢复和患者满意度:关键词: 糖尿病 全膝关节置换术 血红蛋白 A1c 牛津膝关节评分
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引用次数: 0
Response to Single Agent Cyclosporin in Patients with Non-Severe Aplastic Anaemia. 非严重再生障碍性贫血患者对单药环孢素的反应
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1056
Munazza Nabi Awan, Nighat Shahbaz, Irsa Hidayat, Asghar Ali Kerio, Hashim Khan, Awais Siddiq

Objective: To determine the effectiveness of cyclosporin A (CSA) monotherapy in treating patients with non-severe aplastic anaemia (NSAA).

Study design: A cross-sectional observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan, from January 2022 till December 2023.

Methodology: A total of 51 patients of NSAA, classified as aplastic anaemia not satisfying criteria for severe and very severe disease as per Modified Camitta Criteria, were included. Results were evaluated in terms of survival rate (OS) and responses. Responses were assessed as complete response (CR), partial response (PR), overall response (ORR), and no response (NR) by using standard British Committee for standard Haematology (BCSH) response criteria at 3, 6, and 12 months.

Results: Out of 51 patients, 34 (67%) were males and 17 (33%) were females. Median age at the time of diagnosis was 25 (IQR 26) years. At follow-up of 12 months, OS was 86.3%. Overall response rates to cyclosporin monotherapy at 3, 6, and 12 months were 49%, 57%, and 59%, respectively. Baseline haemoglobin was associated with responses at 6 and 12 months and a significant association was found between transfusion dependency at 3, 6, and 12 months with overall survival (p = 0.01, 0.005, and 0.04, respectively). Responses at time-defined points also had significant impact on OS (3 months Plog-rank = 0.046, 6 months Plog-rank = 0.01, and 12 months Plog-rank = 0.008).

Conclusion: Overall response rates at 3, 6, and 12 months indicate the potential of CSA as a viable treatment option, particularly in resource-constrained settings. Despite some patients experiencing treatment-related complications, CSA demonstrated a generally tolerable safety profile.

Key words: Cyclosporin A, Non-severe aplastic anaemia, Survival rate, Response rate, Complete response, Partial response.

研究目的研究设计:横断面观察研究。研究地点和时间:研究地点和时间:巴基斯坦拉瓦尔品第武装部队骨髓移植中心临床血液学部,2022 年 1 月至 2023 年 12 月:方法:共纳入 51 名非小细胞肺癌患者,根据 "改良卡米塔标准",这些患者被归类为不符合重度和极重度标准的再生障碍性贫血。结果根据生存率(OS)和反应进行评估。根据英国标准血液学委员会(BCSH)的标准,在 3 个月、6 个月和 12 个月时将反应评估为完全反应(CR)、部分反应(PR)、总体反应(ORR)和无反应(NR):在51名患者中,男性34人(67%),女性17人(33%)。确诊时的中位年龄为25岁(IQR为26岁)。随访12个月时,OS为86.3%。3、6和12个月时对环孢素单药治疗的总体反应率分别为49%、57%和59%。基线血红蛋白与6个月和12个月时的应答相关,3、6和12个月时的输血依赖性与总生存率之间存在显著关联(p=0.01、0.005和0.04)。时间定义点的反应也对OS有显著影响(3个月Plog-rank = 0.046,6个月Plog-rank = 0.01,12个月Plog-rank = 0.008):3个月、6个月和12个月的总体反应率表明,CSA有可能成为一种可行的治疗方案,尤其是在资源有限的情况下。尽管一些患者出现了与治疗相关的并发症,但CSA的安全性总体上是可以耐受的:环孢素 A 非重型再生障碍性贫血 存活率 反应率 完全反应 部分反应
{"title":"Response to Single Agent Cyclosporin in Patients with Non-Severe Aplastic Anaemia.","authors":"Munazza Nabi Awan, Nighat Shahbaz, Irsa Hidayat, Asghar Ali Kerio, Hashim Khan, Awais Siddiq","doi":"10.29271/jcpsp.2024.09.1056","DOIUrl":"10.29271/jcpsp.2024.09.1056","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effectiveness of cyclosporin A (CSA) monotherapy in treating patients with non-severe aplastic anaemia (NSAA).</p><p><strong>Study design: </strong>A cross-sectional observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan, from January 2022 till December 2023.</p><p><strong>Methodology: </strong>A total of 51 patients of NSAA, classified as aplastic anaemia not satisfying criteria for severe and very severe disease as per Modified Camitta Criteria, were included. Results were evaluated in terms of survival rate (OS) and responses. Responses were assessed as complete response (CR), partial response (PR), overall response (ORR), and no response (NR) by using standard British Committee for standard Haematology (BCSH) response criteria at 3, 6, and 12 months.</p><p><strong>Results: </strong>Out of 51 patients, 34 (67%) were males and 17 (33%) were females. Median age at the time of diagnosis was 25 (IQR 26) years. At follow-up of 12 months, OS was 86.3%. Overall response rates to cyclosporin monotherapy at 3, 6, and 12 months were 49%, 57%, and 59%, respectively. Baseline haemoglobin was associated with responses at 6 and 12 months and a significant association was found between transfusion dependency at 3, 6, and 12 months with overall survival (p = 0.01, 0.005, and 0.04, respectively). Responses at time-defined points also had significant impact on OS (3 months Plog-rank = 0.046, 6 months Plog-rank = 0.01, and 12 months Plog-rank = 0.008).</p><p><strong>Conclusion: </strong>Overall response rates at 3, 6, and 12 months indicate the potential of CSA as a viable treatment option, particularly in resource-constrained settings. Despite some patients experiencing treatment-related complications, CSA demonstrated a generally tolerable safety profile.</p><p><strong>Key words: </strong>Cyclosporin A, Non-severe aplastic anaemia, Survival rate, Response rate, Complete response, Partial response.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"34 9","pages":"1056-1060"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transparent Cap-Assisted Blunt Endoscopic Dissection of Gastric Submucosal Tumours Smaller than 2cm. 透明帽辅助钝性内镜下切除小于 2 厘米的胃黏膜下肿瘤。
Pub Date : 2024-09-01 DOI: 10.29271/jcpsp.2024.09.1046
Linyun Xue, Yaowu Cai, Junwei Xie, Pengxing Xue, Zhonghua Huang, Wei Chen

Objective: To evaluate the safety and effectiveness of transparent cap-assisted blunt dissection (TCABD) in the endoscopic resection of gastric submucosal tumours (G-SMT) smaller than 2cm, as compared with conventional electronic knife dissection.

Study design: Randomised controlled analysis. Place and Duration of the Study: Department of Gastrointestinal Surgery, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian City, Putian, China, from July 2020 to 2022.

Methodology: Fifty-eight patients having G-SMT smaller than 2cm were included. They were randomly divided into two groups; undergoing transparent cap-assisted blunt dissection (BD group) and conventional endoscopic submucosal excavation (ESE group). The pathology, lesion size in long diameter (mm), operation time, the number of clips used to close the wounds, the number of snare used to resect the tumour, hospital days, hospitalisation expense, en bloc resection rate, and the complications including perforation, postoperative bleeding, and postoperative infection were compared between the two groups.

Results: The mean long diameter in the BD group was 9.6 ± 3.6mm, while the conventional ESE group was 10.7 ± 4.5mm. As compared with the conventional ESE group, the operation time, the number of clips used to close the wounds, the number of snare used to resect the tumours, the hospital days, and the hospitalisation expense were all significantly decreased (p <0.05). The perforation rate was lower in the BD group (p <0.05).

Conclusion: TCABD was effective and safe in the endoscopic resection of G-SMT smaller than 2cm. TCABD could help to reduce the perforation rate, shorten the operation time and hospital days, and decrease the hospitalisation expense in the endoscopic resection of G-SMT.

Key words: Endoscopic submucosal excavation, Endoscopic full-thickness resection, Endoscopic resection, Submucosal tumour, Transparent cap-assisted blunt dissection.

目的评估透明帽辅助钝性剥离术(TCABD)与传统电子刀剥离术相比,在内镜下切除小于2厘米的胃黏膜下肿瘤(G-SMT)的安全性和有效性:随机对照分析。研究地点和时间:福建医科大学临床医学院胃肠外科,莆田市第一医院,中国莆田,2020年7月至2022年:纳入 58 例 G-SMT 小于 2 厘米的患者。方法:将58例小于2厘米的G-SMT患者随机分为两组,分别接受透明帽辅助钝性剥离术(BD组)和传统内镜黏膜下挖除术(ESE组)。比较两组的病理、病灶长径大小(毫米)、手术时间、缝合伤口的夹子数量、切除肿瘤的套管数量、住院天数、住院费用、全切除率以及穿孔、术后出血和术后感染等并发症:BD组的平均长径为9.6 ± 3.6毫米,而传统ESE组为10.7 ± 4.5毫米。与传统 ESE 组相比,手术时间、用于缝合伤口的夹子数量、用于切除肿瘤的卡环数量、住院天数和住院费用均显著减少(P 结论:TCABD 对肿瘤患者有效且安全:TCABD 在内镜下切除小于 2 厘米的 G-SMT 时有效且安全。TCABD有助于降低穿孔率,缩短手术时间和住院天数,减少内镜下切除 G-SMT 的住院费用:内镜下粘膜下挖出术 内镜下全层切除术 内镜下切除术 粘膜下肿瘤 透明帽辅助钝性剥离术
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引用次数: 0
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Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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