Current indications for post-mastectomy radiation

It has been long established that post-mastectomy radiotherapy reduces the risk of locoregional failure. A survival advantage, however, has only recently been demonstrated. We here provide a review of the literature as regards to the current indications for post-mastectomy radiotherapy.     

Current indications for prevention and therapy of steroid-iduced osteoporosis in men and women

Steroid-induced osteoporosis is a textbook example of the secondary type of this medical condition. Glucocorticosteroids suppress bone formation by their direct and indirect effect on osteoblasts, osteoclasts and osteocytes, increasing their resorption and, eventually, leading to negative bone balance. A clinical problem arises regarding the fact that approximately 50% of patients on chronic steroid therapy undergo asymptomatic bone fractures. The treatment mode includes minimising the dose of administered steroids, encouraging an improved lifestyle and supplementation with adequate calcium and vitamin D3 doses. Bisphosphonates are a group of medical agents used both to prevent and treat steroid-induced osteoporosis, although new therapies have also become available in recent years.     

Current indications for prevention and therapy of steroid-induced osteoporosis in men and women

Steroid-induced osteoporosis is a textbook example of the secondary type of this medical condition. Glucocorticosteroids suppress bone formation by their direct and indirect effect on osteoblasts, osteoclasts and osteocytes, increasing their resorption and, eventually, leading to negative bone balance. A clinical problem arises regarding the fact that approximately 50% of patients on chronic steroid therapy undergo asymptomatic bone fractures. The treatment mode includes minimising the dose of administered steroids, encouraging an improved lifestyle and supplementation with adequate calcium and vitamin D(3) doses. Bisphosphonates are a group of medical agents used both to prevent and treat steroid-induced osteoporosis, although new therapies have also become available in recent years.     

Current indications of plasma atrial natriuretic peptide measurements in human diseases

The discovery of atrial natriuretic peptide (ANP) has modified our current understanding of the regulation of sodium metabolism. This peptide, of which the second messenger is cyclic guanosine monophosphate (cyclic GMP), is released by the atrial myocytes in response to increased atrial stretch and has for essential function to diminish the venous return to the heart. Radioimmunoassays have demonstrated that plasma ANP and cyclic GMP levels are increased in various diseases such as congestive heart failure (CHF), renal insufficiency, and, to a lesser extent, diabetes mellitus and liver cirrhosis with ascites. Plasma ANP is of prognostic value in CHF and reflects the effective central volemia in renal failure so that its assay as well as that of plasma cyclic GMP seem of interest in these diseases. Further studies are needed to assess the pathophysiological significance of ANP in diabetes mellitus and cirrhosis, and to define the indications of the treatment by enkephalinase inhibitors which increase endogenous ANP levels by lowering the catabolism of this hormone.     

慢性乙型肝炎治疗的适应症和治疗方案的最新进展

目前,对于治疗一些慢性乙型肝炎病毒(HBV)感染边缘病例的最佳方法尚存在争议.血清HBV DNA和转氨酶水平、炎性坏死的程度和肝硬变程度决定着治疗的方案.所有转氨酶升高(＞正常上限值2倍)和血清HBVDNA＞20000 IU/mL的患者都需进行治疗.肝脏活检对于制定转氨酶轻度升高和血清HBV DNA＜20000 IU/mL的病例的治疗决策非常重要.慢性HBV患者如未接受治疗则需长期随访.现有7种药物获批用于治疗慢性乙型肝炎:普通和聚乙二醇IFNα、拉米夫定、阿德福韦、恩替卡韦、替比夫定和替诺福韦.应用聚乙二醇IFNα 1年疗程后持续治疗后效应使HbeAg阳性慢性乙型肝炎患者缓解率为30%-32%.口服抗病毒药物适用于大部分患者,并被用于长期治疗.然而,病毒耐药是长期口服抗病毒药物的主要缺点.     

Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

Background:Hysterectomy, the most common gynecological operation, requires surgeons to counsel women about their operative risks. We aimed to develop and validate multivariable logistic regression models to predict major complications of laparoscopic or abdominal hysterectomy for benign conditions.Methods:We obtained routinely collected health administrative data from the English National Health Service (NHS) from 2011 to 2018. We defined major complications based on core outcomes for postoperative complications including ureteric, gastrointestinal and vascular injury, and wound complications. We specified 11 predictors a priori. We used internal–external cross-validation to evaluate discrimination and calibration across 7 NHS regions in the development cohort. We validated the final models using data from an additional NHS region.Results:We found that major complications occurred in 4.4% (3037/68 599) of laparoscopic and 4.9% (6201/125 971) of abdominal hysterectomies. Our models showed consistent discrimination in the development cohort (laparoscopic, C-statistic 0.61, 95% confidence interval [CI] 0.60 to 0.62; abdominal, C-statistic 0.67, 95% CI 0.64 to 0.70) and similar or better discrimination in the validation cohort (laparoscopic, C-statistic 0.67, 95% CI 0.65 to 0.69; abdominal, C-statistic 0.67, 95% CI 0.65 to 0.69). Adhesions were most predictive of complications in both models (laparoscopic, odds ratio [OR] 1.92, 95% CI 1.73 to 2.13; abdominal, OR 2.46, 95% CI 2.27 to 2.66). Other factors predictive of complications included adenomyosis in the laparoscopic model, and Asian ethnicity and diabetes in the abdominal model. Protective factors included age and diagnoses of menstrual disorders or benign adnexal mass in both models and diagnosis of fibroids in the abdominal model.Interpretation:Personalized risk estimates from these models, which showed moderate discrimination, can inform clinical decision-making for people with benign conditions who may require hysterectomy.

Hysterectomy is one of the most frequently performed surgical procedures. Canada has one of the highest rates of hysterectomy globally, with one-third of women undergoing this procedure before 60 years of age.¹ Minimal access approaches are favoured by both clinicians and patients,² and the proportion of hysterectomies being undertaken by a laparoscopic approach has increased substantially in many countries over the last 10 years.^3–7 The evidence-based medicine paradigm for surgical approaches to hysterectomy for benign disease advocates that the chosen surgical approach should be discussed with the patient by their surgeon and decided in light of the relative benefits and risks.² This advice is echoed by national guidelines.^8,9Most clinicians undertaking hysterectomy will intuitively identify patient characteristics that have the potential to increase the complexity and complications of surgery. A 2016 systematic review of studies that reported significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy and a 2020 population-based prospective cohort study using data from the Danish hysterectomy database have suggested that older age, race, raised body mass index (BMI), diabetes mellitus, increased uterine weight, fibroids, endometriosis and adhesions are predictors of complications in patients undergoing hysterectomy for benign indications.^10,11 However, assimilating this information to individualize and anticipate the precise risk for each patient if there are multiple factors present can be challenging. A 2020 systematic review reported that surgeons in other specialties were outperformed by risk prediction models in estimating postoperative risk and outcomes; their discriminatory ability showed greater variation (C-statistic 0.51–0.75) than other risk prediction tools.¹²Patients should be given information about potential risks before surgery to manage expectations.¹³ This is especially important when surgery is considered for benign disease because nonsurgical options are often available.Our aim was to generate prediction models that can be used in conjunction with a surgeon’s intuition to enhance preoperative patient counselling and match the advances made in the technical aspects of surgery. We sought to quantify the proportion of patients who underwent hysterectomy for benign disease and will have a major complication, and to develop and validate prognostic models to individualize this risk, using a national data set.     

国产伏立康唑治疗侵袭性真菌感染6例临床观察

目的观察国产伏立康唑治疗恶性血液病患者侵袭性真菌感染（IFI）的临床疗效和安全性。方法以国产伏立康唑治疗6例发生于恶性血液病患者的侵袭性真菌感染,观察疗效及不良反应。结果6例患者中,有效4例,其中完全反应3例,部分反应1例。1例用药第6天出现低钾血症。结论国产伏立康唑是治疗恶性血液病患者侵袭性真菌感染的安全有效的药物,     

The role of second-generation triazole antifungal agents voriconazole and posaconazole in patients with hematologic malignancies

The second-generation triazoles, voriconazole and posaconazole, have found important roles in the management of invasive fungal infections in high-risk patients. Both agents are more active against Candida albicans and the non-albicans Candida species than the first-generation triazoles. They are active against Aspergillus species, including those species less susceptible to polyenes, and against a variety of non-Aspergillus molds. In contrast to posaconazole, voriconazole has no activity against the zygomycetes, and breakthrough infections have been observed. Both are well absorbed, but considerable intra- and interpatient pharmacokinetic variability has raised the question of therapeutic drug monitoring. Both inhibit hepatic cytochrome P450 isoenzymes, which are important in the metabolism of various drugs coadministered in the management of high-risk patients. Clinical trials have demonstrated the safety and efficacy of both agents for antifungal prophylaxis and treatment in invasive candidiasis, invasive aspergillosis, and in invasive fungal infections caused by a variety of non-Aspergillus molds. Posaconazole is the only triazole approved for use in the treatment of invasive zygomycosis. Voriconazole is the accepted standard first-line therapy for invasive aspergillosis.     

Guidelines for indications for coronary revascularization in The Netherlands

In 1996 the Minister of Public Health, Welfare and Sports in The Netherlands published a 'Planning Decree Special Interventions in the Heart'. She requested from the professional organizations guidelines for the indications for interventions in the heart. A working group was formed with representatives from the Dutch professional organizations for cardiology and thoracic surgery, to address this issue for patients with coronary artery disease. The working group confirmed the need to discuss all patients who are considered for either elective or emergency revascularization during a multidisciplinary consultation in (or with) one of the specialized Dutch hospitals. During this meeting of the 'heart team', at least one interventional cardiologist and one thoracic surgeon should be present. There are three possible outcomes of the heart team's consultations for each patient: drug therapy only ('conservative management'), coronary surgery or catheter intervention. For each case, the team should indicate the expected benefit, the risk of the intervention, the urgency and the estimated waiting time. The guidelines presented in this paper address these issues for three patient categories: stable angina pectoris, unstable angina pectoris and acute myocardial infarction.     

Current pharmacologic options for patients with Alzheimer's disease

BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.     

Efficacy of voriconazole in experimental Cryptococcus neoformans infection

Voriconazole is a third generation triazole with improved activity against many fungal pathogens. We examined the efficacy of voriconazole in a murine infection model and evaluated the drug’s effect on cellular characteristics and serum polysaccharide levels. The antifungal reduced serum polysaccharide and significantly prolonged the survival of lethally infected animals.     

Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure: reevaluation of indications for parathyroidectomy

On reviewing the preoperative clinical and laboratory findings and the surgical response seen in our series of 32 patients with renal hyperparathyroidism, the indication for parathyroidectomy was reevaluated. During the 5-year period from 1975 to 1979, parathyroid resection was performed in 9 patients who had various conditions for which surgery had been thought indicated. During the following period from January 1980 to March 1985, parathyroidectomy was carried out on 23 patients all of whom had roentgenologic evidence of generalized fibrous osteitis except for two whose indication for surgery was an elevation of the serum alkaline phosphatase level more than 45 KA units. The resected parathyroid glands had increased to 1 g or more in total weight in all the 25 patients who showed distinct postoperative improvement. Laboratory evidence indicating the presence of generalized fibrous osteitis, such as subperiosteal resorption on phalanx roentgenograms and high serum alkaline phosphatase level, along with marked elevation of the plasma immunoreactive parathyroid hormone level, proved to be a good indicator for medically uncontrollable secondary hyperparathyroidism. Fracture, heterotopic calcification, pruritus or persistent hypercalcemia was not a parameter of severe hyperparathyroidism warranting parathyroid resection, unless there was concomitant evidence of fibrous osteitis. The preoperative use of the recently developed noninvasive techniques for parathyroid localization also proved to be useful in detecting the parathyroid glands large enough to fulfill the requirements for parathyroidectomy.     

Some indications for inverse DNA duplication

The Continuum Model postulates that preparations for the initiation of DNA synthesis takes place continuously, and in all phases of the cell cycle. There are no G1-specific events involved in the initiation of DNA synthesis. The statistical predictions of the Continuum Model are now presented with four basic variables: (1) the rate of initiator synthesis, (2) the time for passage through the replication-segregation sequence, (3) the amount of initiator required for initiation of DNA synthesis in a particular cell, and (4) the variation in equipartition of cells at division. Computer simulations reveal that the Continuum Model is consistent with both α-and β-curves, as well as the quartile test for β-curves. It also explains sister-sister correlations, and the correlations between cell mass at various times in the division cycle and cell interdivision times. With one additional parameter, the Continuum Model can also explain mother-daughter correlation. The Continuum Model accounts for the statistical data which has previously been used to support the Transition-Probability Model. It has a simple biochemical basis, and can explain the observed biochemical and biological observations of cell growth and division.