Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms

AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups. RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD(78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group(10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD. CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.

Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas

Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identified in 10%-52% of patients with IPMNs.The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN.The gastrointestinal tract is most commonly involved in secondary malignancies,with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries.Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms,gastrointestinal stromal tumors,carcinoid tumors,hepatobiliary cancers,breast cancers,prostate cancers,and lung cancers.There is no clear etiology for the development of secondary malignancies in patients with IPMN.Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients,both have reached the same conclusion:there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population.This f inding has signif icant clinical implications for both the initial evaluation and the subsequent long-term followup of patients with IPMNs.If a patient has not had recent colonoscopy,this should be performed during the evaluation of a newly diagnosed IPMN.Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease.Routine screening studies(breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.

Secondary non-resectable liver tumors:A single-center living-donor and deceased-donor liver transplantation case series

Background: During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT. Methods: Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine ( n = 18, 82%) and colorectal metastases ( n = 4, 18%);50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used;the median graft-to-recipient-weight ratios (GRWR) were 1.03%(IQR 0.86%- 1.30%) and 0.59%(IQR 0.51%- 0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17–107) in the DDLT group and 40 months (IQR 35–116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence. Results: The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively ( P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT ( P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2–2.2) vs. 3.3 (IQR 2.3–5.2) mg/dL;P = 0.02]. Conclusions: The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.

口腔专科医院非计划二次手术的回顾性分析

目的探讨口腔专科医院非计划二次手术发生的特点及影响因素。方法选取北京大学口腔医院2016—2021年所有二次手术患者信息,对非计划二次手术的病种、发生原因等进行统计分析,通过logistic回归进一步分析舌恶性肿瘤非计划二次手术的相关性因素。结果2016—2021年共发生非计划二次手术468例(1.17%),与第一次手术的间隔时间为0~20 d。构成比排在前3位的病种为颌面部恶性肿瘤、颌面部良性肿瘤、颌面部感染,导致非计划二次手术的主要原因为皮瓣血管危象、手术后血肿出血,占比为90.17%(422/468)。非计划二次手术组男性319例,女性149例,男女之比为2.14∶1,年龄53.00(36.00,62.00)岁,住院时间14.00(12.00,18.00)d,总费用为68694.91(51773.01,89850.04)元;对照组男性19932例,女性19495例,年龄31.00(18.00,53.00)岁,住院时间7.00(4.00,10.00)d,总费用为12338.96(8869.90,28650.17)元,比较差异有统计学意义(P<0.05)。非计划二次手术术式以有皮瓣为主,占比为76.07%。2016—2021年三四级手术中非计划二次手术发生率为3.62%(397/10966),高于一二级手术的0.25%(71/28929)。年龄、饮酒史、高血压、皮瓣手术是影响舌恶性肿瘤非计划二次手术的主要危险因素(P<0.05)。结论应针对口腔颌面外科专业非计划二次手术危险因素,加强围手术期和手术分级管理,以提升医疗质量。

结直肠癌肝转移患者的血浆胆汁酸谱特征及临床价值

目的分析不同转移情况结直肠癌患者血浆胆汁酸含量及胆汁酸谱分布的差异,并评估血浆胆汁酸含量比值联合肿瘤标志物对结直肠癌肝转移的诊断价值。方法纳入2021年4月至2022年1月于上海中医药大学附属曙光医院就诊的结直肠腺癌肝转移或无转移患者163例,其中无转移组82例、肝转移组81例。收集患者的临床资料,用Karnofsky功能状态(KPS)评分评估生存质量;收集患者外周血样本,检测总胆汁酸及肿瘤标志物[癌胚抗原(CEA)和糖类抗原125(CA125)]水平,用高效液相色谱-串联质谱法检测血浆中15种胆汁酸的含量。分析两组患者胆汁酸含量及胆汁酸谱分布的差异,并绘制ROC曲线分析胆汁酸含量比值联合肿瘤标志物对结直肠癌肝转移的临床诊断效能。结果两组结直肠癌患者年龄、性别、肿瘤位置、病理分化程度、KPS评分差异无统计学意义(均P>0.05)。肝转移组患者总胆汁酸、CEA、CA125均较无转移组患者升高(均P<0.001),血浆胆汁酸谱中甘氨胆酸、脱氧胆酸、牛磺脱氧胆酸、甘氨脱氧胆酸、甘氨熊脱氧胆酸、石胆酸和甘氨石胆酸含量均较无转移组患者升高(均P<0.05),血浆次级胆汁酸含量高于无转移组患者(P<0.001),次级胆汁酸与初级胆汁酸含量比值高于无转移组患者(P<0.001)。次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125诊断结直肠癌肝转移的灵敏度为71.60%,特异度为80.49%,AUC为0.820(95%CI 0.754~0.885,P<0.001)。结论结直肠癌肝转移患者血浆胆汁酸含量升高,胆汁酸谱异于无转移患者;次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125对结直肠癌肝转移有较高的诊断价值。

Prevention of metastasis to liver by using 5-FU intraperitoneal chemotherapy in nude mice inoculated with human colonic cancer cells

AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.

营养干预联合抗阻运动对脑卒中继发性肌少症患者的影响

目的探析营养干预联合抗阻运动在脑卒中继发性肌少症中的应用价值。方法采用目的抽样法,选取2022年8月至2023年2月在昆明市第二人民医院老年病科收治的50例缺血性脑卒中继发性肌少症患者作为研究对象,根据病案号个位数,按奇偶数将参与研究的对象随机分为观察组(n=25)与对照组(n=25)。两组均维持慢性病常规药物治疗。对照组采用常规饮食、传统康复锻炼,观察组在对照组基础上予以营养干预联合抗阻运动。干预前后分别测定患者血清白蛋白(albumin,ALB)、血红蛋白(hemoglobin,Hb)及维生素D(vitamin D,VD)水平;运用整体营养评定量表(patient generated-subjective global assessment,PG-SGA)及改良Barthel指数量表评定营养状况及日常生活能力。结果两组患者一般资料比较差异无统计学意义(P>0.05)。观察组患者Hb、ALB及VD分别为(128.32±14.49)g/L、(38.46±6.01)g/L、(25.89±6.71)ng/mL,高于对照组(120.07±11.32)g/L、(34.09±5.89)g/L、(21.34±7.01)ng/mL,PG-SGA评分(2.04±0.91)分低于对照组(5.05±1.16)分,差异有统计学意义(P<0.05);观察组患者日常生活能力评分高于对照组,差异有统计学意义(P<0.05)。结论营养干预联合抗阻运动可快速恢复脑卒中继发性肌少症患者营养水平,并提高其日常生活活动能力。

囊性为主成分的甲状腺鳞状细胞癌1例误诊分析

目的探讨囊性为主成分的甲状腺鳞状细胞癌(SCCT)误诊原因。方法分析1例囊性为主成分的SCCT误诊过程,并对其结局随访,结合相关文献进行讨论。结果男,67岁,发现甲状腺结节3年,颈部彩超发现甲状腺右叶囊实性包块,大小63 mm×49 mm×82 mm,因肿瘤较大且压迫气管,行右侧甲状腺腺叶切除术,术后病理报告为结节性甲状腺肿,伴囊性变及腺瘤样结构形成;遂按结节性甲状腺肿出院。术后1个月,病人颈部出现新生物,进行多项检查及多学科会诊后,取颈部新生物做病理活检,结果为原发性SCCT;第一次手术的诊断出现误诊;病人拒绝放疗并出院,随访结局为死亡,复发后生存期为2.5个月。结论原发性甲状腺鳞状细胞癌(PSCCT)是一种极具侵袭性的肿瘤,预后较差,以囊性结节为首发病例的更少见,容易误诊,需结合病史、临床检查及免疫组化等诊断。

少数民族乡镇中学开展电磁波发射与接收实验的探索

先进的物理技术及其应用实验是展现物理魅力和激发学生兴趣的重要手段,然而少数民族地区的乡镇中学由于客观原因,一些先进物理技术的实验没有条件开展或开展效果不好,就如何利用生活低成本资源,设计电磁波发射与接收实验进行了探索和研究,结果表明设计该实验能有效激发学生学习物理的兴趣,并且能增强学生的动手能力和解决问题的能力,对少数民族地区乡镇中学如何开展现代物理实验具有借鉴意义.

网红经济视角下中职电子商务直播营销教学研究

文章基于网红经济的视角,深入探讨了中职电子商务直播营销的教学策略。研究指出,为应对行业挑战,教学策略应聚焦于整合网红资源、强化内容创意与个性化、提升数据分析与精准营销能力,以及培养学生的跨界融合与创新思维。这些策略对于提高学生的实战能力和职业素养至关重要,有助于他们更好地适应直播营销领域的快速发展。通过这些教学策略,中职学校有望培养出更多具备专业技能和创新精神的直播营销人才,为行业的可持续发展注入新动力。

Laparoscopic liver resection:Experience based guidelines

Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

Liver metastasis models of human colorectal carcinoma established in nude mice by orthotopic transplantation and their biologic characteristics

AIM To establish a liver metastasis model of human colorectal carcinoma in nude mice.METHODS Orthotopic transplantation of histologically intact colorectal tissues from patients into colorectal mucosa of nude mice. Tumorgenicity, invasion, metastasis and morphological characteristics of the transplanted tumors were studied by light microscopy, electron microscopy and immunohistochemistry.RESULTS Liver metastasis models of human colon carcinoma (HCA-HMN-1) and human rectal carcinoma (HRA-HMN-2) were established after screening from 34 colorectal carcinomas. They had been passaged in vivo for 18 and 21 generations respectively. There were lymphatic, hemotogenous and implanting metastasesis. CEA secretion was maintained after transplantation. The primary and liver metastatic tumors were similar to the original human carcinoma in histopathological and ultrastructural features, DNA content and chromosomal karyotype.CONCLUSION The liver metastasis models provide useful tools for the study of mechanism of metastasis and its treatment of human colorectal cancer.INTRUDUCTIONSome models of nude mice that fresh human colorectal carcinoma tissue or cells were successfully transplanted subcuteneously have been reported at home and abroad[1,2]. But until now there has been no report on a liver metastasis model of human colorectal carcinoma established by orthotopic transplantation in nude mice in China. Based on our previous models of human liver and pancreas carcinoma by orthotopic transplantation[3,4], we established liver metastasis models of colon and rectum carcinoma with a spontaneous metastasis rate of 100%.

Treatment for liver metastases from breast cancer: Results and prognostic factors

AIM: Liver metastases from breast cancer (BCLM) are associated with poor prognosis. Cytotoxic chemotherapy can result in regression of tumor lesions and a decrease in symptoms. Available data, in the literature, also suggest a subgroup of patients may benefit from surgery, but few talked about transcatheter arterial chemoembolization (TACE). We report the results of TACE and systemic chemotherapy for patients with liver metastases from breast cancer and evaluate the prognostic factors. METHODS: Forty-eight patients with liver metastases, from proved breast primary cancer were treated with TACE or systemic chemotherapy between January 1995 and December 2000. Treatment results were assessed according to WHO criteria, along with analysis of prognostic factors for survival using Cox regression model. RESULTS: The median follow-up was 28 mo (1-72 mo). Response rates were calculated for the TACE group and chemotherapy group, being 35.7% and 7.1%, respectively. The difference was significant. The one-, two- and three-year Survival rates for the TACE group were 63.04%, 30.35%, and 13.01%, and those for the systemic chemotherapy group were 33.88%, 11.29%, and 0%. According to univariate analysis, variables significantly associated with survival were the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight. Other factors such as age, the intervals between the primary to the metastases, the maximal diameter of the liver metastases, the number of liver metastases, extrahepatic metastasis showed no prognostic significances. These factors mentioned above such as the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight were also independent factors in multivariate analysis. CONCLUSION: TACE treatment of liver metastases from breast cancer may prolong survival in certain patients. This approach offers new promise for the curative treatment of the patients with metastatic breast cancer.

Non-imaging-guided fine-needle aspiration of liver lesions:aretrospective study of 279 patients

AIM To determine the value of nonimaging-guided (direct) fine-needle aspiration cytology in diagnosing liver lesions.METHODS Detection by technetium-99m, ultrasound or computed tomographic scanning of the liver was made in 279 patients with 332 aspirations.RESULTS Based on histologic, cytologic and clinical findings, final liver diagnoses were reached in 265 patients, of whom 171 had malignant and 94 benign liver disease. Among the 171 patients with malignant liver disease, the cytologic findings indicated suspected malignancy in 8 patients, suggested definite malignancy in 130, but failed to disclose malignancy in 33 patients. In 93 of the 94 patients with benign liver disease, the cytologic findings were reported as benign, while in one patient the report of malignancy was false. The overall sensitivity, specificity, and positive and negative predictive values for cytologic results were 80.7%, 98.9%, 99.3% and 73.8%, respectively. The diagnostic accuracy of fine-needle aspiration cytology was 87.2%. The only major complication attributable to the procedure consisted of one case of pneumothorax.CONCLUSION Direct fine-needle aspiration of palpable liver mass and blind fine-needle aspiration of non-palpable liver lesions for cytodiagnosis are simple, safe, and cost-effective diagnostic method for evaluating the nature of liver lesions. The aspiration procedure including potential complications could be cut short by early finding of abnormal cells.

Present status and recent advances in living donor liver transplantation for malignant hepatic tumors

BACKGROUND: Living donor liver transplantation (LDLT) has been increasingly used to treat hepatic tumors worldwide in recent years, and is currently the most effective alternative to deceased donor liver transplantation to overcome the problem of organ shortage. LDLT has played an enormous role in treating early malignant hepatic tumors. But the indication of LDLT for malignant hepatic tumors is based on indefinite criteria. This review summarizes the recent studies in LDLT for treating malignant hepatic tumors. DATA SOURCES: A literature research of the PubMed database was conducted and research articles were reviewed. RESULTS: The current data on LDLT for malignant hepatic tumors, combined with our hospital experience, indicated that if a patient with hepatocellular carcinoma (HCC) who meets with the conventional Milan criteria cannot undergo tumor resection because of poorly preserved liver function, and a cadaveric graft is difficult to obtain within six months, LDLT may be selected. In a patient with recurrence of HCC after conventional therapies, feasibility, optimal timing, and efficacy of LDLT as a second-line treatment should be determined. CONCLUSIONS: Tumor recurrence is related to the biological behavior and staging of the tumor. New immunosuppressors which have anti-tumor effects and inhibit the immune system need to be developed. The indications of LDLT for hepatic malignant tumors should be selected meticulously.

Studies on mechanism of Sialy Lewis-X antigen in liver metastases of human colorectal carcinoma

INTRODUCTIONSialyl Lewis-X antigen ,correlated with carcinoma, is a group of carbohydrate antigen containing oligosaccharide expressed of embryonic tisue and glycoproteins on cell surface of embryonic tissue[1].The SLeX antigen located on cell surface is synthesized principally by two enzymes ,al ,3fucosyltransfrease and a2, 3sialyctransferase.In adults ,SLeX antigen is expressed principally on the surfaces of granulocytic cells and some tumor cells .

Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain

Background: Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies. The allograft shortage may be alleviated with living donation. The initial UCLouvain experience of adult living-donor liver transplantation(LDLT) is presented. Methods: A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted. The median age of 29(45.3%) females and 35(54.7%) males was 50.2 years(interquartile range, IQR 32.9–57.5). Twenty-two(34.4%) recipients had no portal hypertension. Three(4.7%) patients had a benign and 33(51.6%) a malignant tumor [19(29.7%) hepatocellular cancer, 11(17.2%) secondary cancer and one(1.6%) each hemangioendothelioma, hepatoblastoma and embryonal liver sarcoma]. Median donor and recipient follow-ups were 93 months(IQR 41–159) and 39 months(22–91), respectively. Results: Right and left hemi-livers were implanted in 39(60.9%) and 25(39.1%) cases, respectively. Median weights of right-and left-liver were 810 g(IQR 730–940) and 454 g(IQR 394–534), respectively. Graft-to-recipient weight ratios(GRWRs) were 1.17%(right, IQR 0.98%-1.4%) and 0.77%(left, 0.59%-0.95%). One-and five-year patient survivals were 85% and 71%(right) vs. 84% and 58%(left), respectively. Oneand five-year graft survivals were 74% and 61%(right) vs. 76% and 53%(left), respectively. The patient and graft survival of right and left grafts and of very small( < 0.6%), small(0.6%–0.79%) and large( ≥0.8%) GRWR were similar. Survival of very small grafts was 86% and 86% at 3-and 12-month. No donor died while five(7.8%) developed a Clavien–Dindo complication IIIa, IIIb or IV. Recipient morbidity consisted mainly of biliary and vascular complications; three(4.7%) recipients developed a small-for-size syndrome according to the Kyushu criteria. Conclusions: Adult-to-adult LDLT is a demanding procedure that widens therapeutic possibilities of many hepatobiliary diseases. The donor procedure can be done safely with low morbidity. The recipient operation carries a major morbidity indicating an important learning curve. Shifting the risk from the donor to the recipient, by moving from the larger right-liver to the smaller left-liver grafts, should be further explored as this policy makes donor hepatectomy safer and may stimulate the development of transplant oncology.

Secondary Parkinson disease caused by breast cancer during pregnancy: A case report

BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks,who presented with worsening tremors,facial stiffness and speech disfluencies,and decreased limb strength.Thorough physical examinations and auxiliary tests suggested secondary Parkinson’s disease,but the pathogenesis was unknown.During the cesarean section at the 31 weeks plus 6 d,an exploration and liver biopsy revealed a metastatic,poorly differentiated adenocarcinoma.The positron emission tomography and immunohistochemical analysis confirmed a breast ductal carcinoma of stage IV.To our knowledge,only two reports have documented the association between the breast cancer and the Parkinson disease,and neither occurred in pregnant women.CONCLUSION Our case alerts the secondary Parkinson disease as the possible presentation of breast cancer,the most common malignancy during pregnancy.

血清miR-21-3p检测联合淋巴结粗针穿刺活检对甲状腺癌颈淋巴结转移的诊断价值

目的:探讨血清miR-21-3p检测联合超声引导下淋巴结粗针穿刺活检(LCNB)对甲状腺癌颈淋巴结转移的诊断价值。方法:选取甲状腺癌伴颈淋巴结肿大(均行血清miR-21-3p检测及LCNB)病人80例,以手术病理为标准,比较血清miR-21-3p检测、超声引导下LCNB及两者联合检查对甲状腺癌伴颈淋巴结转移的诊断价值。结果:80例病人经手术病理检查,有淋巴结转移者49例,无转移者31例。血清miR-21-3p检测联合超声引导下LCNB诊断甲状腺癌伴颈淋巴结转移准确度为91.8%、灵敏度为87.6%,均高于两者独立检查准确度76.2%、84.7%和灵敏度82.3%、85.7%(P<0.05),联合检查受试者工作曲线下面积为0.9071,大于两者单独检测的0.7765、0.8292(P<0.05)。结论:相较于单独检测,血清miR-21-3p联合超声引导下LCNB诊断甲状腺癌淋巴结转移的准确度、灵敏度更好,诊断效能更高。

出院准备服务对脑卒中患者干预效果的meta分析

目的系统评价出院准备服务对脑卒中患者干预效果。方法计算机检索中国知网、万方、维普、中国生物文献数据库、PubMed、Embase、Web of Science、Cochrane Library数据库中关于出院准备服务对脑卒中患者干预效果的随机对照试验。探索时限从建库至2022年2月。采用RevMan 5.3进行meta分析。结果共纳入12篇原始文献,共有1244例研究对象。meta分析结果示,出院准备服务能够提高脑卒中患者日常生活活动能力[MD=7.86,95%CI(6.48,9.23),P<0.00001]、提高自我效能感[MD=3.85,95%CI(0.28,7.42),P=0.03]、提高出院准备度[MD=35.30,95%CI(4.43,66.17),P=0.03]以及降低二次脑卒中发生率[MD=0.27,95%CI(0.16,0.45),P<0.00001]。结论出院服务准备能够提高脑卒中患者日常生活活动能力,提高自我效能感和出院准备度以及降低二次脑卒中发生率。