Techniques

技术
  • 文章类型: Journal Article
    临床实践中迫切需要预防血清肿的新干预措施。动物模型是测试这些干预措施的关键工具;然而,在临床和动物模型结果之间仍然存在显著的翻译差距.本系统综述旨在评估用于血清瘤预防的动物模型的方法学特征和质量。进行荟萃分析以估计对照组的预期血清肿发生率,并确定典型干预措施的效果大小。我们系统地检索了所有描述诱导血清肿形成的动物模型的研究。方法论特征,偏见的风险,并对研究质量进行评估。血清瘤体积和发病率数据用于荟萃分析。总的来说,包括55项研究,42人符合荟萃分析的条件。大鼠(69%)是最常用的物种,在这些模型中,乳房切除术(50%)是主要的外科手术。尽管所有研究都存在很大的偏见风险,观察到报告质量每十年有改善的趋势.荟萃分析显示,典型对照组的平均血清瘤发生率为90%。平均干预措施使血清肿发生率减半(RR=0.49;CI0.35,0.70),血清肿体积显着减少(SMD=-3.31;CI-4.21,-2.41),尽管存在明显的异质性。总之,用于血清肿预防的动物模型表现出方法学缺陷和多种偏倚风险。实施足够有效的阳性和阴性对照组可以提高这些模型的内部有效性。需要更多的研究来进一步开发动物血清瘤模型。
    Novel interventions for seroma prevention are urgently needed in clinical practice. Animal models are pivotal tools for testing these interventions; however, a significant translational gap persists between clinical and animal model outcomes. This systematic review aims to assess the methodological characteristics and quality of animal models utilized for seroma prevention. A meta-analysis was performed to estimate the expected seroma incidence rate for control groups and determine the effect size of typical interventions. We systematically retrieved all studies describing animal models in which seroma formation was induced. Methodological characteristics, risks of bias, and study quality were assessed. Seroma volume and -incidence data were used for the meta-analysis. In total, 55 studies were included, with 42 eligible for meta-analysis. Rats (69%) were the most frequently used species, with mastectomy (50%) being the predominant surgical procedure in these models. Despite significant risks of bias across all studies, an improving trend in reporting quality per decade was observed. The meta-analysis revealed an average seroma incidence of 90% in typical control groups. The average intervention halved the seroma incidence (RR = 0.49; CI 0.35, 0.70) and significantly reduced seroma volume (SMD = -3.31; CI -4.21, -2.41), although notable heterogeneity was present. In conclusion, animal models for seroma prevention exhibit methodological flaws and multiple risks of bias. Implementing sufficiently powered positive and negative control groups could improve the internal validity of these models. More research is needed for further development of animal seroma models.
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  • 文章类型: Journal Article
    已知多种药物会增加有和没有潜在癫痫发作的患者的癫痫发生。矛盾的是,其中一些药物包括抗癫痫药物(ASM)和其他药物,比如精神药物,作用于中枢神经系统(CNS)。本文旨在讨论3例临床病例,这些病例突出了中枢神经系统药物继发的癫痫反应性,包括发作间癫痫样放电(IED)形式的癫痫发作性增加,而没有癫痫发作。与相关的非癫痫性运动障碍的脑电图(EEG)上的癫痫性增加,弗兰克,从头发作。我们还分析了有关中枢神经系统药物对癫痫发生的影响的相关文献。
    Multiple medications are known to increase epileptogenicity in patients with and without an underlying seizure disorder. Paradoxically, some of these medications include anti-seizure medications (ASMs) and other medications, such as psychotropics, that act on the central nervous system (CNS). This article aims to discuss 3 clinical cases that highlight the gamut of epileptogenic reactivity secondary to CNS drugs ranging from increased epileptogenicity in the form of interictal epileptiform discharges (IEDs) without seizures, increased epileptogenicity on electroencephalogram (EEG) with associated non-epileptic movement disorders, and frank, de novo seizures. We also analyze the relevant literature on the impact of CNS medications on epileptogenicity.
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  • 文章类型: Journal Article
    背景:考虑到不断发展的治疗选择和个性化的需求,血友病的治疗选择越来越具有挑战性。共享决策(SDM)方法最近引起了人们的兴趣,尽管缺乏对现有研究的综合。
    目的:进行了范围审查,以总结有关血友病中影响治疗SDM的因素的文献报道,以及可用于支持此类决策的工具或模型。
    方法:PubMed,Embase,Cochrane图书馆,搜索了截至2023年8月发表的WebofScience和灰色文献。报告了关于血友病SDM和SDM工具的促进者和障碍的原始研究,并对主题进行了分析。特点和差距。
    结果:共确定了625条记录,并选择了14项独特研究(影响治疗SDM的因素,n=7;SDM工具,n=7)。这些研究通常包括血友病患者的输入,护理人员和医疗保健从业人员(HCP)。影响SDM的因素的主题组织揭示了三个主要类别:知识,患者特征和HCP-患者相互作用。信息的可用性通常是SDM的推动者,而不良的HCP患者参与是一个常见的障碍。工具的焦点不同,其中一些促进一般治疗SDM,而另一些支持选择某些治疗类型。这些研究强调了对SDM至关重要的其他因素,例如HCP-患者感知的一致性,共享语言和针对特定亚群定制工具。
    结论:很少有研究报道血友病的治疗SDM因素和工具;可用的工具差异很大。目前尚不清楚已发布的工具是否已成功应用于临床实践。额外的研究是必要的。
    BACKGROUND: Treatment selection in haemophilia is increasingly challenging given evolving therapeutic options and the need for individualization. Shared decision-making (SDM) approaches have recently gained interest, though a synthesis of available studies is lacking.
    OBJECTIVE: A scoping review was conducted to summarize literature reporting on factors impacting treatment SDM in haemophilia and tools or models available to support such decisions.
    METHODS: PubMed, Embase, the Cochrane Library, Web of Science and grey literature were searched for studies published through August 2023. Original studies reporting on facilitators and barriers to haemophilia SDM and SDM tools were included and analyzed for themes, characteristics and gaps.
    RESULTS: A total of 625 records were identified and 14 unique studies were selected (factors influencing treatment SDM, n = 7; SDM tools, n = 7). The studies typically included input from persons with haemophilia, caregivers and healthcare practitioners (HCPs). Thematic organization of factors influencing SDM revealed three main categories: knowledge, patient characteristics and HCP-patient interactions. Availability of information was a commonly reported facilitator of SDM, while poor HCP-patient engagement was a commonly reported barrier. Tools varied in focus, with some facilitating general treatment SDM while others supported selection of certain therapy types. The studies underscored additional factors critical for SDM, such as alignment of HCP-patient perceptions, shared language and tailoring of tools to specific subpopulations.
    CONCLUSIONS: Few studies report on treatment SDM factors and tools in haemophilia; available tools vary considerably. It remains unclear whether published tools have been successfully implemented into clinical practice. Additional research is warranted.
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  • 文章类型: Journal Article
    蛋白质-蛋白质相互作用协调植物发育,并作为细胞和环境交流的关键因素。了解这些相互作用为解开复杂的蛋白质网络提供了一个门户,这将有助于更好地理解自然。表征蛋白质-蛋白质相互作用的方法已经存在了很长时间,然而,其中一些相互作用的复杂性推动了新技术的发展,这些技术提供了对潜在动力学的更好理解。在许多情况下,这些技术的应用受到可用样品的性质的限制。虽然有些方法需要体内设置,其他人仅依靠蛋白质序列通过计算机设置来研究蛋白质-蛋白质相互作用。迄今为止可用的大量技术需要一种方法来选择适当的工具来研究特定的相互作用。这里,我们根据样本要求对广泛传播的工具和新兴技术进行分类,以表征蛋白质-蛋白质相互作用,同时提供对它们可能提供的信息的见解。我们提供了常用技术的全面概述,并详细阐述了最新的发展,展示它们在植物研究中的应用。
    Protein-protein interactions orchestrate plant development and serve as crucial elements for cellular and environmental communication. Understanding these interactions offers a gateway to unravel complex protein networks that will allow a better understanding of nature. Methods for the characterization of protein-protein interactions have been around for a long time, yet the complexity of some of these interactions fuels the development of new techniques that provide a better understanding of the underlying dynamics. In many cases, the application of these techniques is limited by the nature of the available sample. While some methods require an in vivo set up, others solely depend on protein sequences to study protein-protein interactions via an in silico set up. The vast amount of techniques available to date calls for a way to select the appropriate tools for the study of specific interactions. Here, we classify widely spread tools and new emerging techniques for the characterization of protein-protein interactions based on sample requirements while providing insights into the information that they can potentially deliver. We provide a comprehensive overview of commonly used techniques and elaborate on the most recent developments, showcasing their implementation in plant research.
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  • 文章类型: Journal Article
    腹腔镜探查目前被认为是管理无法触及的腹内睾丸的金标准。在Fowler-Stephen(FS)技术中,通过分割睾丸血管来解决血管蒂短的问题,在Shehata技术(ST)中,通过牵引睾丸血管来解决。儿科外科医生在选择一种技术而不是另一种技术方面缺乏共识。该分析比较了ST分期腹腔镜睾丸固定术与经过时间测试的FS技术在管理高腹下睾丸中的报告结果。
    本系统评价和荟萃分析按照系统评价和荟萃分析指南的首选报告项目进行。仅包括随机对照试验和比较研究。比较的主要结果是睾丸萎缩的发生率,睾丸回缩/上升率,I期和II期睾丸固定术的手术时间。
    本分析基于三项随机研究,在117例符合纳入标准的患者中,共119例未降睾丸。I期FS技术的手术时间较短;然而,在II期腹腔镜睾丸固定术中,两种手术的手术时间无统计学差异.干预后睾丸萎缩的汇总分析,睾丸回缩率,和术后住院时间显示两种手术之间没有差异。
    FS和STs在干预后睾丸萎缩方面具有可比性,睾丸收缩/上升;然而,在I期腹腔镜睾丸固定术中,使用FS技术的平均手术时间明显减少。
    UNASSIGNED: Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis.
    UNASSIGNED: The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy.
    UNASSIGNED: The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures.
    UNASSIGNED: Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.
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  • 文章类型: Journal Article
    整容是一种流行的面部年轻化方法。最常见的技术是浅表肌腱膜系统(SMAS)折叠,有几个变化。然而,最佳方法尚不清楚。这篇综述分析了以前的研究,以比较SMAS整容技术,他们的结果,和并发症发生率。
    使用MEDLINE进行了系统搜索,科克伦,Embase,和谷歌学者电子数据库在2022年9月。该搜索包括2000年1月至2022年9月发表的研究,使用“整容”等关键词,“\”并发症,“和”结果。\"
    这篇综述研究了27项选定的研究,这些研究评估了6项SMAS整容技术。这些研究共涉及6086名患者,超过85%的人对手术结果感到满意。并发症的发生率因使用的技术而异,SMAS皮瓣和复合SMAS技术的并发症发生率最高(5.75%)和最低(0.05%),分别。最常见的并发症是暂时性面神经损伤(0.85%)和皮肤坏死(0.41%)。迄今为止,仅报道一例永久性面神经损伤。
    根据我们的发现,SMAS整容技术可实现较高的患者满意度,并发症发生率因技术而异。复合SMAS技术显示并发症发生率最低,而SMAS皮瓣显示最高的比率。然而,一些研究没有报告所有的并发症,这使得很难确定最佳方法。因此,未来的研究需要确定最美观、并发症风险最低的技术.
    UNASSIGNED: Facelift procedures are a popular method of facial rejuvenation. The most common technique is superficial muscular aponeurotic system (SMAS) plication, with several variations. However, the optimal approach remains unclear. This review analyzed previous studies to compare SMAS facelift techniques, their outcomes, and complication rates.
    UNASSIGNED: A systematic search was conducted using the MEDLINE, Cochrane, Embase, and Google Scholar electronic databases in September 2022. The search included studies published from January 2000 to September 2022 using keywords such as \"facelift,\" \"complications,\" and \"outcomes.\"
    UNASSIGNED: This review examined 27 selected studies that evaluated 6 SMAS facelift techniques. The studies involved 6086 patients in total, over 85% of who were satisfied with the outcome of their surgery. The complication rates varied depending on the technique used, with the SMAS flap and composite SMAS technique having the highest (5.75%) and lowest (0.05%) complication rates, respectively. The most common complications were temporary facial nerve injury (0.85%) and skin necrosis (0.41%). To date, only one case of permanent facial nerve injury has been reported.
    UNASSIGNED: On the basis of our findings, SMAS facelift techniques achieve high patient satisfaction rates, with complication rates that vary by technique. The composite SMAS technique showed the lowest complication rates, whereas the SMAS flap showed the highest rate. However, some studies have not reported all complications, making it difficult to determine the best approach. Therefore, future studies are required to identify the most aesthetically pleasing technique with the lowest complication risk.
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  • 文章类型: Journal Article
    血管内介入技术由于其最小的侵入性和较短的恢复时间,在颅内动脉瘤的治疗中得到了重视。介入的关键步骤是微导管的成形,这确保了其在动脉瘤囊内的准确放置和稳定性。这对于增强线圈放置和在卷绕过程中最小化导管反冲的风险是至关重要的。目前,微导管成形主要依赖于操作者的经验,根据目标血管的曲率和动脉瘤位置来塑造它们,利用3D旋转血管造影或CT血管造影。一些研究人员已经记录了他们使用传统成型方法的经验。此外,一些学者已经探索了辅助技术,如3D打印和计算机模拟,以促进微导管的成形。然而,微导管的成型仍然会带来挑战,特别是在复杂的解剖结构或非常小的动脉瘤的情况下,甚至有经验的操作员也可能遇到困难,文献中缺乏微导管成形技术的整体总结。在这篇文章中,我们回顾了1994年至2023年关于微导管成形技术在血管内动脉瘤栓塞术中的相关文献.我们的审查旨在全面概述研究人员在过去30年中分享的各种经验和技术,提供了整形方法的分析,对于新手和有经验的从业者来说,都是宝贵的资源,强调理解和掌握这项技术对于颅内动脉瘤血管内介入治疗成功的重要性。
    The endovascular intervention technique has gained prominence in the treatment of intracranial aneurysms due to its minimal invasiveness and shorter recovery time. A critical step of the intervention is the shaping of the microcatheter, which ensures its accurate placement and stability within the aneurysm sac. This is vital for enhancing coil placement and minimizing the risk of catheter kickback during the coiling process. Currently, microcatheter shaping is primarily reliant on the operator\'s experience, who shapes them based on the curvature of the target vessel and aneurysm location, utilizing 3D rotational angiography or CT angiography. Some researchers have documented their experiences with conventional shaping methods. Additionally, some scholars have explored auxiliary techniques such as 3D printing and computer simulations to facilitate microcatheter shaping. However, the shaping of microcatheters can still pose challenges, especially in cases with complex anatomical structures or very small aneurysms, and even experienced operators may encounter difficulties, and there has been a lack of a holistic summary of microcatheter shaping techniques in the literature. In this article, we present a review of the literature from 1994 to 2023 on microcatheter shaping techniques in endovascular aneurysm embolization. Our review aims to present a thorough overview of the various experiences and techniques shared by researchers over the last 3 decades, provides an analysis of shaping methods, and serves as an invaluable resource for both novice and experienced practitioners, highlighting the significance of understanding and mastering this technique for successful endovascular intervention in intracranial aneurysms.
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  • 文章类型: Review
    乳腺癌的发病率呈逐年上升趋势,该病已成为全球最常见的恶性肿瘤。目前,乳腺癌的主要治疗方法是手术切除。然而,转移性复发是该患者人群中癌症相关死亡的主要原因.多种因素与乳腺癌预后相关,和麻醉诱导的肿瘤微环境的变化引起了越来越多的关注。迄今为止,然而,目前尚不清楚麻醉药物对手术后的癌症结局有正面还是负面的影响.本文就不同麻醉药对乳腺癌术后预后的影响进行综述,以指导此类患者麻醉技术和药物的选择。
    The incidence of breast cancer has exhibited an annually increasing trend, and the disease has become the most common malignant tumour worldwide. Currently, the primary treatment for breast cancer is surgical resection. However, metastatic recurrence is the main cause of cancer-related death in this patient population. Various factors are associated with breast cancer prognosis, and anaesthesia-induced changes in the tumour microenvironment have attracted increasing attention. To date, however, it remains unclear whether anaesthetic drugs have a positive or negative impact on cancer outcomes after surgery. The present article reviews the effects of different anaesthetics on the postoperative prognosis of breast cancer surgery to guide the choice of anaesthetic technique(s) and agents for such patients.
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  • 文章类型: Journal Article
    背景:乳房下垂的特征是腺区和乳头乳晕复合体的下外侧下降。高度下垂可能会对女性的吸引力和自信心产生负面影响。乳房下垂有各种分类和测量技术,可用作医疗和服装行业的参考。实用而全面的分类将为上睑下垂度提供准确的标准化定义,以促进有需要的女性的矫正手术和合身内衣的发展。
    方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目,对测量乳房下垂的分类和评估技术进行了系统评价。使用改良的纽卡斯尔-渥太华量表进行观察性研究,评估偏倚风险。而修订的Cochrane随机试验偏倚风险工具(RoB2)用于评估随机研究.
    结果:在文献检索中确定的2550篇文章中,该综述包括16项观察性和2项随机研究,描述了乳房下垂的分类和评估技术。共涉及2033名受试者。所有观察性研究中有一半的纽卡斯尔-渥太华量表得分为5分以上。此外,所有随机试验记录的总体偏倚较低.
    结论:总共确定了7种乳房下垂的分类和4种测量技术。然而,大多数研究除了缺乏可靠的统计学分析外,没有明确的样本量推导.因此,需要进一步研究应用最新技术来结合以前评估技术的优势,以开发适用于所有受影响妇女的更好的分类系统。
    Breast ptosis is characterized by the inferolateral descent of the glandular area and nipple-areola complex. A high degree of ptosis may negatively impact a woman\'s attractiveness and self-confidence. There are various classifications and measurement techniques for breast ptosis used as references in the medical and garment industry. A practical and comprehensive classification will provide accurate standardized definitions of the degrees of ptosis to facilitate the development of corrective surgeries and well-fitting undergarments for women in need.
    A systematic review on the classification and assessment techniques to measure breast ptosis was carried out based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.
    Of 2550 articles identified in the literature search, 16 observational and 2 randomized studies describing the classification and assessment techniques of breast ptosis were included in the review. A total of 2033 subjects were involved. Half of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, all randomized trials recorded a low overall bias.
    A total of 7 classifications and 4 measurement techniques for breast ptosis were identified. However, most studies did not demonstrate a clear derivation of sample size beside lacking robust statistical analysis. Hence, further studies that apply the latest technology to combine the strength of previous assessment techniques are needed to develop better classification system that is applicable to all affected women.
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  • 文章类型: Journal Article
    近年来,乳腺癌护理通过各种创新来改善早期检测,取得了巨大的进步。诊断,治疗,和生存。这些创新包括成像技术的进步,微创外科技术,靶向治疗和个性化医疗,放射治疗,和多学科护理。必须认识到,在乳腺癌护理方面存在重大进步的同时,存在挑战和局限性。继续研究,倡导,和努力解决这些挑战是必要的,使这些创新对所有患者都可利用,同时仔细考虑和管理伦理,社会,和实际影响。
    Breast cancer care has seen tremendous advancements in recent years through various innovations to improve early detection, diagnosis, treatment, and survival. These innovations include advancements in imaging techniques, minimally invasive surgical techniques, targeted therapies and personalized medicine, radiation therapy, and multidisciplinary care. It is essential to recognize that challenges and limitations exist while significant advancements in breast cancer care exist. Continued research, advocacy, and efforts to address these challenges are necessary to make these innovations accessible to all patients while carefully considering and managing the ethical, social, and practical implications.
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