Tratamiento endovascular de aneurismas con anatomía aórtica compleja / Endovascular treatment of aneurysms with complex aortic anatomy

RESUMEN Introducción: la anatomía arterial es la principal limitante para el abordaje aórtico endovascular estándar. Presentamos nuestra experiencia para la reparación endovascular de aneurismas aórticos complejos. Material y métodos: estudio observacional retrospectivo en pacientes con aneurismas complejos (yuxta/pararrenales y toracoabdominales) tratados en forma consecutiva mediante: endoprótesis fenestradas (FEVAR), ramificadas (BEVAR), con EndoAnchors (ESAR), o en chimenea (ChEVAR). La decisión de la técnica fue determinada con base en la anatomía arterial. Resultados: se evaluaron los últimos 50 procedimientos (6 mujeres; edad promedio 71,3 años; diámetro 69,6mm; 3 pacientes con aneurismas complicados), de los cuales 22 recibieron FEVAR (2,8 fenestraciones / paciente), 11 BEVAR, 11 ESAR y 6 ChEVAR (1,8 chimeneas /paciente). La tasa de éxito técnico fue del 100% (ausencia de endoleak I o III con permeabilidad adecuada de los vasos viscerales). A 30 días 3 pacientes fallecieron (6%). Durante el seguimiento, 5 pacientes presentaron oclusión de la arteria renal, repermeabilizada en 4. Cuatro pacientes desarrollaron un endoleak tipo IA (3 ESAR secundarios y un ChEVAR), un paciente un endoleak IC y un cuarto uno IIIB (22%, 3 de los 11 ESAR, ninguno de los FEVAR industriales). En el análisis de supervivencia, la supervivencia global fue del 88,6% al año, y libre de reoperación del 86,5%. Conclusiones: se trata de la primera publicación en nuestro medio que muestra un enfoque global del paciente con un aneurisma de aorta complejo, de acuerdo con sus características anatómicas. Estas tecnologías ya desempeñan un papel primario en el tratamiento de estos pacientes.

ABSTRACT Background: Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms. Material and Methods: This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy. Results: The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation. Conclusions: This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.

A Long-Term Follow-up Study for the Treatment of Snoring after Using Patterned Non-Ablative Erbium: YAG 2,940 nm Laser

Abstract Introduction Laser uvulopalatoplasty is an established operation for the treatment of snoring with good results on a short-term basis, while long-term follow-up studies, in addition to their scarcity, had conflicting results regarding recurrence, the change of snoring quality, and complications. Objective To assess the long-term follow-up results of using nonablative 2,940 nm Erbium: YAG for the treatment of snoring regarding outcomes and recurrence. Methods This 2-year follow-up study was conducted on 76 patients operated upon by non-ablative 2940 nm Erbium: yttrium-aluminum-garnet (YAG) using a PS01 patterned headpiece. Subjective evaluation of the treatment was performed relying on a smartphone application to record snoring in addition to a questionnaire specially designed to report recurrence and change in the quality of snoring reported by a patient's spouse. The objective evaluation was done by computed tomography (CT) imaging of the soft palate. The patients were evaluated preoperatively, 6 weeks postoperatively and after a 2-year follow-up period. Results Six week after the procedure, there was a significant improvement in 52 patients (68.4%). Out of the 52 patients, only 43 completed the 2-year follow-up; however, 15 of them complained of recurrence. Nevertheless, the patients who suffered from recurrence showed subjective improvement in snoring quality. Conclusions The nonablative mode of Erbium: YAG 2,940 nm laser proved to be efficient in soft palate tightening for the management of snoring. However, there was recurrence in 34.8% of the patients who presented objective and subjective improvement of the complaints, 6 weeks postoperatively and after a 2-year follow-up period.

Factors affecting penile appearance and erectile function for postoperative hypospadias patients in adulthood: a long-term follow-up observational study / 现代泌尿外科杂志

【Objective】 To investigate the penile appearance, sexual function, psychological status and related influencing factors of adult patients who underwent hypospadias repair surgery in their minors, so as to provide reference for the diagnosis, treatment and prognosis of hypospadias. 【Methods】 This study included 50 adult hypospadias patients who underwent urethroplasty in our hospital during May 2005 and Aug. 2018. The present appearance, sexual function and psychological status were evaluated. The correlation and consistency between hypospadias objective scoring evaluation (HOSE) and pediatric penile perception score (PPPS) were analyzed. Factors affecting the results were determined with univariate and multivariate regression analysis. 【Results】 The satisfaction rate of HOSE was significantly correlated with the urethral length and complications (P=0.024, P=0.033). The satisfaction rate of PPPS was significantly correlated with the number of urethral operations and postoperative complications (P=0.041, P=0.023). There was a weak correlation between HOSE and PPPS (r=0.291, P=0.040), but almost no consistency (Kappa=0.2, P=0.107). Sixty percent of the patients paid attention to the ventral appearance of penis, whose dissatisfaction rate of PPPS was higher than those who did not pay attention to the ventral appearance of the penis (19/30 vs. 6/20, P=0.021). Patients with multiple operations (>1), postoperative complications or unsatisfactory penile appearance were more likely to have inferiority complex (52.6% vs. 22.6%, P=0.029; 59.1% vs.14.3%, P=0.001;61.5% vs. 24.3%, P=0.015). Multivariate regression analysis showed that dissatisfaction with the appearance of the penis was an independent risk factor for patients’ perception of their own physical defects. Among the patients who believed that they had physical defects, the percentage of patients with grade IV penile erectile hardness was significantly lower than that of those who denied they had physical defects (9/17 vs. 27/33, P=0.047). 【Conclusion】 The undesirable postoperative penis appearance is likely to have a negative impact on patients’ long-term psychological state, which might further damage the sexual function in adulthood. Surgeons should pay attention to the penile appearance during the conduction of hypospadias repair.

What is the best method for long?term survival analysis?

In the Cox proportional hazards regression model, which is the most commonly used model in survival analysis, the effects of independent variables on survival may not be constant over time and proportionality cannot be achieved, especially when long-term follow-up is required. When this occurs, it would be better to use alternative methods that are more powerful for the evaluation of various effective independent variables, such as milestone survival analysis, restricted mean survival time analysis (RMST), area under the survival curve (AUSC) method, parametric accelerated failure time (AFT), machine learning, nomograms, and offset variable in logistic regression. The aim

Más allá de la cura: la necesidad de implementar un sistema de seguimiento a largo plazo para los supervivientes de cáncer infantil en Colombia / Beyond the cure: the need to implement a long-term follow-up system for childhood cancer survivors in Colombia

Resumen Con el advenimiento de tratamientos multidisciplinarios y de alta calidad, la supervivencia global a cinco años por cáncer en la población pediátrica ha mejorado considerablemente, llegando a ser hasta de 80% en países de altos ingresos. En Colombia también ha habido un aumento progresivo de la supervivencia global a 5 años, particularmente para las neoplasias hematológicas. En consecuencia, el número de supervivientes de cáncer infantil ha aumentado de forma importante en los últimos años y junto con ellos la aparición de eventos adversos tardíos relacionados con mayor morbilidad y riesgo de muerte prematura en la edad adulta. Aunque se han venido implementando estrategias de seguimiento a supervivientes de cáncer infantil en países de altos ingresos, en Colombia se han realizado pocos esfuerzos para la implementación de estas estrategias. De hecho, la práctica común en la mayoría de los centros de tratamiento consiste en dar de alta al niño que cumple 5 años de seguimiento oncológico, sin instrucciones precisas para dicho seguimiento. El objetivo del presente trabajo es argumentar sobre la necesidad de diseñar e implementar estrategias de seguimiento para supervivientes de cáncer infantil en el contexto colombiano.

Abstract With the advent of high-quality multidisciplinary treatments, the overall 5-year cancer survival in the pediatric population has improved considerably, reaching up to 80% in high-income countries. In Colombia, there has also been a progressive increase in overall 5-year survival, particularly for hematologic malignancies. Consequently, the number of childhood cancer survivors has increased significantly in recent years and, together with them, the occurrence of late adverse events related to increased morbidity and risk of premature death in adulthood. Although follow-up strategies have been implemented for childhood cancer survivors in high-income countries, few efforts have been made in Colombia to implement these strategies. In fact, the common practice in most treatment centers is to discharge children who have had 5 years of cancer follow-up, without precise instructions for long-term follow-up. This paper aims to argue about the need to design and implement follow-up strategies for survivors of childhood cancer in the Colombian context.

Clinical profile and course on follow-up of newborns of SARS-CoV-2 positive mothers

Objective@#This study aims to determine the clinical profile and course on follow-up of newborns delivered to a SARS-CoV-2 positive mother from two private tertiary hospitals. @*Methodology@#This is a retrospective, cross-sectional study. A chart review of all neonates delivered to SARS-CoV-2 positive mothers was conducted. Subsequent interview was done to determine their clinical course and neurologic status at 3-, 6-, 9-, 12-, and 15-month-old. Data collected was presented as frequencies, percentages, or proportions. @*Results@#Out of the 67 newborns born to SARS-CoV-2 positive mothers, three neonates tested positive for SARS-CoV-2. All three were delivered to mothers with mild symptoms, were full term, with good APGAR score and appropriate for gestational age. One was eventually intubated and managed as COVID-19 confirmed critical. Among the SARS-CoV-2 negative newborns, majority had an unremarkable neonatal outcome. Thirty-six neonates were available for follow-up: 1 expired due to aspiration pneumonia at 2 months of age, 4 were readmitted for pneumonia, UTI, acute gastroenteritis, and cow’s milk allergy. Twenty-one had infection at one point prior to this study follow-up but were all mild not requiring admission. Two had abnormal head size, while 2 had developmental delay, these 4 infants with neurological findings on follow-up were all RT-PCR negative at birth. @*Conclusion@#Maternal COVID-19 infection does not necessarily result to a neonatal infection. For those neonate swith mild symptoms, SARS-CoV-2 causality could not be established. On follow-up, there were a few who developed significant problems that have long-term implications in the overall growth and development of the child.

Congenital elbow luxation grade I treated by radial head ostectomy in an English Bulldog / Luxação congênita de cotovelo grau I tratada por ostectomia da cabeça do rádio em um Bulldog Inglês

O objetivo deste relato foi o de apresentar o acompanhamento tardio de um caso de luxação congênita de cabeça de rádio (LCCR) em um Buldog Inglês jovem, tratada por ostectomia da cabeça radial (OCR). A LCCR é uma condição incomum nos cães, mas é a forma mais comum de luxação de cotovelo nos mesmos (grau I). Um Bulldog Inglês, macho, 6 meses, 14 quilos, foi atendido com suspeita de luxação do cotovelo. Exame físico revelou uma proeminência na superfície lateral do cotovelo direito, além de claudicação grau I e dor leve. Amplitude de movimento apresentava-se normal. Radiografias e tomografia prévias confirmaram LCCR. Optou-se pela OCR ao invés de técnicas corretivas, devido à idade do animal à época do procedimento e à dificuldade no reposicionamento do rádio na articulação. Após 3 anos e meio de pós-operatório, foram realizados novos exames clínicos e radiográficos. O paciente não apresentava dor, apresentava bom apoio do membro e boa amplitude de movimento, permitindo bom movimento do cotovelo. Houve um novo crescimento parcial do segmento proximal da cabeça do rádio ocasionando melhor readequamento do mesmo na articulação. Sinais leves de degeneração articular estavam presentes. A OCR se mostrou efetiva neste caso, provando ser uma boa técnica a ser utilizada nos casos de LCCR quando tratamento conservativo ou técnicas de redução já não podem ser mais utilizados.

The aim of this study is to report a long term follow up of a congenital luxation of the radial head (CLRH) case of a young Bulldog treated by radio head ostectomy (RHO). CLRH is an uncommon condition in dogs, but it is the most commom form of elbow dislocation (grade I). An English Bulldog, male, 6 months, 14 kilograms, was suspected of elbow dislocation. Physical examination revealed a lateral proeminence on the lateral surface of the right elbow, as well as grade I lameness and mild pain. Range of motion was normal. Previous radiographs and tomography confirmed CLHR. RHO was chosen instead of corrective techniques, due to the age of the animal at the time of the procedure and the difficulty in repositioning the radial head in the joint. Three and a half years after surgery, new clinical and radiographic examaminations were performed. The patient had no pain, good limb support and good range of motion, allowing good elbow movement. There was a partial regrowth of the proximal segment of the radial head causing better readjustment of it in the joint. Mild signs of joint degeneration were present. RHO proved to be effective in this case, proving to be a good technique to be used in cases of CLRH when conservative treatment or reduction techniques can no longer be used.

Congenital elbow luxation grade I treated by radial head ostectomy in an English Bulldog / Luxação congênita de cotovelo grau I tratada por ostectomia da cabeça do rádio em um Bulldog Inglês

The aim of this study is to report a long term follow up of a congenital luxation of the radial head (CLRH) case of a young Bulldog treated by radio head ostectomy (RHO). CLRH is an uncommon condition in dogs, but it is the most commom form of elbow dislocation (grade I). An English Bulldog, male, 6 months, 14 kilograms, was suspected of elbow dislocation. Physical examination revealed a lateral proeminence on the lateral surface of the right elbow, as well as grade I lameness and mild pain. Range of motion was normal. Previous radiographs and tomography confirmed CLHR. RHO was chosen instead of corrective techniques, due to the age of the animal at the time of the procedure and the difficulty in repositioning the radial head in the joint. Three and a half years after surgery, new clinical and radiographic examaminations were performed. The patient had no pain, good limb support and good range of motion, allowing good elbow movement. There was a partial regrowth of the proximal segment of the radial head causing better readjustment of it in the joint. Mild signs of joint degeneration were present. RHO proved to be effective in this case, proving to be a good technique to be used in cases of CLRH when conservative treatment or reduction techniques can no longer be used.

O objetivo deste relato foi o de apresentar o acompanhamento tardio de um caso de luxação congênita de cabeça de rádio (LCCR) em um Buldog Inglês jovem, tratada por ostectomia da cabeça radial (OCR). A LCCR é uma condição incomum nos cães, mas é a forma mais comum de luxação de cotovelo nos mesmos (grau I). Um Bulldog Inglês, macho, 6 meses, 14 quilos, foi atendido com suspeita de luxação do cotovelo. Exame físico revelou uma proeminência na superfície lateral do cotovelo direito, além de claudicação grau I e dor leve. Amplitude de movimento apresentava-se normal. Radiografias e tomografia prévias confirmaram LCCR. Optou-se pela OCR ao invés de técnicas corretivas, devido à idade do animal à época do procedimento e à dificuldade no reposicionamento do rádio na articulação. Após 3 anos e meio de pós-operatório, foram realizados novos exames clínicos e radiográficos. O paciente não apresentava dor, apresentava bom apoio do membro e boa amplitude de movimento, permitindo bom movimento do cotovelo. Houve um novo crescimento parcial do segmento proximal da cabeça do rádio ocasionando melhor readequamento do mesmo na articulação. Sinais leves de degeneração articular estavam presentes. A OCR se mostrou efetiva neste caso, provando ser uma boa técnica a ser utilizada nos casos de LCCR quando tratamento conservativo ou técnicas de redução já não podem ser mais utilizados.

Comparison of long-term outcomes in different managements of diverticular neck in percutaneous nephrolithotomy for diverticular calculi / 北京大学学报(医学版)

OBJECTIVE@#To compare the short-term effects and long-term outcomes of incisional procedure and dilatation procedure to manage diverticular neck in percutaneous nephrolithotomy for diverticular stones.@*METHODS@#Clinical data of 61 patients with diverticular stones who underwent percutaneous nephrolithotomy from June 2009 to January 2019 were retrospectively collected and analyzed, which was as follous: (1) basic information: age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) classifications and preoperative symptoms.(2)stone characteristic and procedure-related data: location and size of stone, skinned renal access length and procedure time.(3)perioperative clinical data: hemoglobin drop, Clavien's classification and stone-free rate. Long-term follow-ups were performed for more than 5 years after the patients were discharged.@*RESULTS@#Fifty-three patients were included based on the inclusion and exclusion criteria, and were divided into the dilation group (n=37) and the incision group (n=16) by the treatment methods of diverticular neck. There were 24 male patients (45.3%) and 29 female patients (54.7%), with a mean age of 39.96±12.88 years. Stones were mainly located in the upper pole (n=32, 60.38%) and posterior area (n=41, 77.4%), with a predominance of single stone (n=36, 67.9%). There was no statistically significant difference in demographic data and stone characteristics between the two groups except for age and stone burden. Forty-five patients (84.9%) reached stone-free status after surgeries, and 44 patients (83.0%) postoperative symptoms improved. Twelve patients were lost to the follow-ups, and 41 cases were followed up for an average of 77 months. One recurrence occurred 1 year after surgery. Fifteen patients underwent operations within the past 5 years and the overall 5-year recurrence rate for the remaining 26 patients was 34.6%. There was no statistically significant difference in the incidence of perioperative complications, postoperative stone-free rate and recurrence rate between the two groups, and the recurrence rate was significantly higher 5 years postoperatively than 1 year postoperatively. The proportion of the patients who remained lithotripsy-free and residual stone status decreased significantly.@*CONCLUSION@#Both incisional and dilatation procedures in percutaneous nephrolithotomy to manage diverticular neck could bring the satisfactory postoperative stone free rate. The recurrence rate was about 30% to 40% 5 years after surgery.

Multifocal eosinophilic granuloma of the jaws with long-term follow-up: a case report / 华西口腔医学杂志

Eosinophilic granuloma, a rare disease, has various clinical manifestations and no specific X-rays features and is thus easily misdiagnosed. This paper reports a case of multifocal eosinophilic granuloma of jaw with long-term follow-up. The patient initially presented with periodontal tissue destruction.The diagnosis, treatment and prognosis of multifocal eosinophilic granuloma of jaw were discussed in combination with the literature to alert this disease in clinical practice.

Characteristics and Challenges of Physical Fitness, Activities, and Social Participation of Childhood Cancer Survivors / The Japanese Journal of Rehabilitation Medicine

Objective：We conducted a new physical fitness test and assessed activity and social participation in pediatric cancer survivors who participated in our hospital events and examined its characteristics and issues.Subjects：A total of 30 children aged 5 years or older (median age 9 years, 17 boys, 13 girls) were enrolled in the study. They were chosen from a pool of 44 pediatric cancer survivors who participated in our hospital's long-term follow-up events from August 2018 to August 2019.Methods：Medical records and evaluations performed at the events were examined retrospectively. Survey items included sex, diagnosis, age at evaluation and onset, years since discharge, physical and cognitive functions, new physical fitness test results, and ability to perform basic physical activity.Results：Regardless of the number of years since discharge from the hospital, physical fitness tended to be lower than the national average for both sexes and all ages, with a particular decline in endurance. Twenty-six of the 30 subjects (87%) were able to attend school all day and go out for a day. In addition, 11 (37%) participated in physical activities other than physical education and club activities.Conclusions：Childhood cancer survivors may have a long-term, persistent decline in physical fitness, even if they are able to participate in academic, leisure, and social activities, such as exercise lessons. It is beneficial to provide continuous support for physical fitness during hospitalization and throughout life, as well as to accomplish activities and social participation in accordance with growth.

Characteristics and Challenges of Physical Fitness, Activities, and Social Participation of Childhood Cancer Survivors / The Japanese Journal of Rehabilitation Medicine

Objective：We conducted a new physical fitness test and assessed activity and social participation in pediatric cancer survivors who participated in our hospital events and examined its characteristics and issues.Subjects：A total of 30 children aged 5 years or older (median age 9 years, 17 boys, 13 girls) were enrolled in the study. They were chosen from a pool of 44 pediatric cancer survivors who participated in our hospital's long-term follow-up events from August 2018 to August 2019.Methods：Medical records and evaluations performed at the events were examined retrospectively. Survey items included sex, diagnosis, age at evaluation and onset, years since discharge, physical and cognitive functions, new physical fitness test results, and ability to perform basic physical activity.Results：Regardless of the number of years since discharge from the hospital, physical fitness tended to be lower than the national average for both sexes and all ages, with a particular decline in endurance. Twenty-six of the 30 subjects (87%) were able to attend school all day and go out for a day. In addition, 11 (37%) participated in physical activities other than physical education and club activities.Conclusions：Childhood cancer survivors may have a long-term, persistent decline in physical fitness, even if they are able to participate in academic, leisure, and social activities, such as exercise lessons. It is beneficial to provide continuous support for physical fitness during hospitalization and throughout life, as well as to accomplish activities and social participation in accordance with growth.

Full-cycle management of endodontic microsurgery / 口腔疾病防治

@#Contemporary endodontic microsurgery has emerged as a significant treatment modality in the retention of teeth with persistent apical periodontitis. This article proposes the concept of the full-cycle clinical management of endodontic microsurgery based on the condition of the patient and tooth, attempting to develop a comprehensive strategy for the examination, treatment and follow-up to save natural teeth. Full-cycle clinical management included preoperative consideration of the general condition and surgical site and selection of cases for endodontic microsurgery; intraoperative application of techniques such as lasers, "bone window" technique and targeted endodontic microsurgery to make the surgical approaches more varied and the operation minimally invasive; postoperative outcome assessment according to the history, clinical and radiographic examination; and analysis of the short- and long-term outcomes.

Long-term results of suppressing thyroid-stimulating hormone during radiotherapy to prevent primary hypothyroidism in medulloblastoma/PNET and Hodgkin lymphoma: a prospective cohort study / 医学前沿

Primary hypothyroidism commonly occurs after radiotherapy (RT), and coincides with increased circulating thyroid-stimulating hormone (TSH) levels.We tested therefore the protective effect of suppressing TSH with L-thyroxine during RT for medulloblastoma/PNET and Hodgkin lymphoma (HL) in a prospective cohort study. From1998 to 2001, a total of 37 euthyroid children with medulloblastoma/PNET plus 14 with HL, scheduled for craniospinal irradiation and mediastinum/neck radiotherapy, respectively, underwent thyroid ultrasound and free triiodothyronine (FT3), free thyroxine (FT4), and TSH evaluation at the beginning and end of craniospinal iiradiation. From 14 days before and up to the end of radiotherapy, patients were administered L-thyroxine checking every 3 days TSH to ensure a value < 0.3 μIU/mL. During follow-up, blood tests and ultrasound were repeated; primary hypothyroidism was considered an increased TSH level greater than normal range. Twenty-two/37 patients with medulloblastoma/PNET and all the 14 patients with HL were alive after a median 231 months from radiotherapy with 7/22 and 8/14 having correctly reached TSH levels < 0.3 μIU/mL and well matched for other variables. Twenty years on, hypothyroidism-free survival rates differed significantly, being 60% ± 15% and 15.6% ± 8.2% in TSH-suppressed vs. not-TSH suppressed patients, respectively (P = 0.001). These findings suggest that hypothyroidism could be durably prevented in two populations at risk of late RT sequelae, but it should be confirmed in a larger cohort.

Supervivencia de la cirugía coronaria de múltiples vasos en el seguimiento hasta 20 años / Long-term survival of multi-vessel coronary surgery bypass grafting up to 20 years of follow-up

RESUMEN Introducción: Los resultados del seguimiento a largo plazo constituyen uno de los mejores parámetros para evaluar la calidad de una intervención médica. Objetivos: Analizar la supervivencia global y la supervivencia libre de eventos cardiovasculares a 20 años de la cirugía coronaria en un hospital de comunidad con historia clínica electrónica de larga data. Métodos: Se estudiaron en forma retrospectiva los resultados alejados de las cirugías coronarias aisladas efectuadas en pacientes con enfermedad de múltiples vasos o tronco de coronaria izquierda entre 1999 y 2003 en un hospital de comunidad. El seguimiento hasta 20 años se realizó a través de la historia clínica electrónica. Resultados: Se logró un tiempo de seguimiento medio de 125 meses (rango: 6-268) en 254 pacientes de los 272 operados en ese período (93,4%). El número promedio de puentes fue 3,3 (desvío estándar: 0,97); en 97,6% se usó al menos una arteria mamaria y 59,4% recibieron un puente con arteria radial. Se obtuvo un seguimiento de 2646 pacientes-años, con un riesgo anual de muerte por toda causa de 2,5%. La supervivencia global al seguimiento medio fue de 0,806 (error estándar, EE: 0,03), y la supervivencia libre de eventos cardiovasculares fue de 0,826 (EE: 0,03). Conclusiones: El registro electrónico completo de los afiliados a un hospital de comunidad operados hace más de 15 años permitió analizar la supervivencia global y libre de eventos a largo plazo. Estos resultados servirán como estándar al momento de elegir entre la cirugía y la angioplastia de múltiples vasos.

ABSTRACT Background: The outcomes of long-term follow-up constitute one of the best parameters to assess the quality of a medical intervention. Objectives: To analyze the overall and the free-of-cardiovascular events 20-year survival after coronary surgery in a community hospital with a long-standing electronic medical records. Methods: The results of coronary surgeries in patients with multi-vessel or trunk disease operated between 1999 and 2003 in a community hospital were retrospectively studied. The follow-up up to 20 years was carried out through the electronic medical record. Results: Of 272 patients operated, a mean follow-up of 125 months (range 6-268) was achieved in 254 (93.4%). The average number of bypasses was 3.3 (standard deviation 0.97); in 97.6%, at least one internal mammary artery was used and 59.4% received a radial artery graft. A follow-up of 2646 patient-years was obtained with an annual risk of death from all causes of 2.5%. The overall survival at the mean follow-up time was 0.806 (standard error (SE) 0.03), and the cardiovascular event-free survival 0.826 (SE 0.03). Conclusions: The complete electronic registration of affiliates to a community hospital operated more than 15 years ago allowed us to analyze the overall survival and the freedom of long-term events. These results will serve as a standard when choosing between surgery and multi-vessel angioplasty.

Long-term analysis of safety and efficacy of standard percutaneous nephrolithotomy in patients with solitary kidneys / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones.@*METHODS@#The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function.@*RESULTS@#In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%.@*CONCLUSION@#This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.

Immediate and late follow-up effects of class III early correction in cleft lip and palate patients treated with maxillary protraction / Efeitos imediatos e a longo prazo da correção precoce da classe III em pacientes com fissura lábio palatal tratados com protração maxilar

Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient's age was determined by Pearson's chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.

Resumo Introdução Não há consenso sobre os efeitos imediatos e tardios da protração maxilar em pacientes com fissura lábio palatal. Objetivo avaliar a estabilidade do tratamento precoce da Classe III em pacientes com fissura labiopalatina por meio da expansão e protração maxilar. Material e método A amostra consistiu de 28 pacientes com fissura lábio palatal com (média de idade pré tratamento de 6.7±1.8) com fissura lábio palatal transforame unilateral, tratados com disjuntor maxilar e com máscara facial de Petit. Por meio de análise em telerradiografias laterais as grandezas angulares (SNA, SNB, ANB, SN.GoGn, FMA, Ângulo Z) e lineares (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) foram avaliadas, com o software Dolphin®, nos tempos: inicial (T0), após o tratamento (T1) e acompanhamento de 2 a 6 anos (T2). Os dados foram submetidos à ANOVA e teste Tukey-Kramer. A correlação entre as grandezas cefalométricas e a idade do paciente foi determinada pelo teste de Pearson. Todas as análises foram realizadas com nível de significância de 5%. Resultado SNA, ANB e AO-BO aumentaram significativamente (p<0,05) e após o período de acompanhamento voltaram a ser semelhantes às iniciais (p>0,05). O overjet aumentou significativamente após o tratamento e mesmo tendo diminuído com o tempo, ainda se apresentava maior quando comparado ao momento inicial (p<0,05). O ângulo Z apresentou melhora com o tratamento e se manteve estável no período de acompanhamento (p<0,05). Conclusão após o tratamento (disjunção associada à protração maxilar) houve melhora do padrão esquelético. No período de acompanhamento, verificou-se que essas melhoras voltaram a medidas próximas das iniciais. Houve melhora no padrão dentário e no perfil facial que se manteve no período de controle.

Modeling the Long-term Antibody Response and Duration of Immune Protection Induced by an Inactivated, Preservative-free Hepatitis A Vaccine (Healive) in Children / 生物医学与环境科学（英文）

Objective@#Long-term seroprotection the hepatitis A vaccine is essential for the prevention of disease from the hepatitis A virus (HAV). Due to documented difficulties during decade-long follow-ups after receiving vaccines, statistical-modeling approaches have been applied to predict the duration of immune protection.@*Methods@#Based on five-year follow-up data from a randomized positive-controlled trial among Chinese children (1-8 years old) following a 0, 6 months vaccination schedule, a power-law model accounting for the kinetics of B-cell turnover, as well as a modified power-law model considering a memory-B-cell subpopulation, were fitted to predict the long-term immune responses induced by HAV vaccination (Healive or Havrix). Anti-HAV levels of each individual and seroconversion rates up to 30 years after vaccination were predicted.@*Results@#A total of 375 participants who completed the two-dose vaccination were included in the analysis. Both models predicted that, over a life-long period, participants vaccinated with Healive would have close but slightly higher antibody titers than those of participants vaccinated with Havrix. Additionally, consistent with previous studies, more than 90% of participants were predicted to maintain seroconversion for at least 30 years. Moreover, the modified power-law model predicted that the antibody titers would reach a plateau level after nearly 15 years post-vaccination.@*Conclusions@#Based on the results of our modeling, Healive may adequately induce long-term immune responses following a 0, 6 months vaccination schedule in children induction of memory B cells to provide stable and durable immune protection.

Chimeric antigen receptor T-cell therapy: a promising treatment modality for relapsed/refractory mantle cell lymphoma / 医学前沿

Mantle cell lymphoma (MCL) is a distinct histological type of B-cell lymphoma with a poor prognosis. Several agents, such as proteasome inhibitors, immunomodulatory drugs, and inhibitors of B cell lymphoma-2 and Bruton's tyrosine kinase have shown efficacy for relapsed or refractory (r/r) MCL but often have short-term responses. Chimeric antigen receptor (CAR) T-cell therapy has emerged as a novel treatment modality for r/r non-Hodgkin's lymphoma. However, long-term safety and tolerability associated with CAR T-cell therapy are not defined well, especially in MCL. In this report, we described a 70-year-old patient with r/r MCL with 48-month duration of follow-up who achieved long-term remission after CAR T-cell therapy. CAR T-cell-related toxicities were also mild and tolerated well even in this elderly patient. This report suggested that CAR T-cell therapy is a promising treatment modality for patients with MCL, who are generally elderly and have comorbid conditions.

Registro prospectivo de tratamiento antitrombótico en coronarios agudos (EPICOR) / Prospective Registry of Antithrombotic Therapy in Acute Coronary Syndromes (EPICOR)

RESUMEN Objetivo: Presentar los resultados a dos años de seguimiento de la cohorte argentina del estudio EPICOR, un registro internacional, multicéntrico, observacional, prospectivo, diseñado para determinar los patrones de utilización de la terapia antitrombótica en pacientes con síndrome coronario agudo en el contexto de la práctica clínica habitual. Material y métodos: Se enrolaron 438 pacientes consecutivos con infarto de miocardio con supradesnivel del segmento ST (STEMI, 41%) o SCA sin supradesnivel del segmento ST (NSTE-ACS, 59%), externados vivos de centros hospitalarios públicos, privados y de comunidad. La media de edad fue 62 años, el 76% eran varones, el 71% hipertensos, el 64% fumadores, el 19% diabéticos y el 40% tenían antecedentes de patología cardiovascular previa. Resultados: La mortalidad global fue del 4,8% al año y del 7,3% a los 2 años. El uso de doble antiagregación plaquetaria fue del 80% al año y del 53% a los 2 años (p < 0,0001), sin diferencias entre aquellos con supradesnivel del ST o sin este. La incidencia de eventos isquémicos y hemorrágicos mayores a los 2 años fue del 15,3% y del 1,8%, respectivamente. Conclusiones: Se observó un elevado porcentaje de persistencia de la doble antiagregación plaquetaria a los 2 años, más allá del año recomendado por las guías, con baja incidencia de hemorragias mayores, lo que sugiere una selección clínica de riesgo-beneficio.

ABSTRACT Objectives: To present the two-year follow-up resultis of the EPICOR study Argentine cohort, a prospective, international, observational, multicenter registry designed to determine the use of antithrombotic therapy patterns in the routine clinical practice of patientis with acute coronary syndrome (ACS). Methods: The study enrolled a total of 438 consecutive patientis with ST-segment elevation myocardial infarction (STEMI, 41%) or non-ST-segment elevation ACS (NSTE ACS, 59%) discharged alive from public, private, and community hospitals. Mean age was 62 years, 76% of patientis were male, 71% hypertensive, 64% smokers, 19% diabetic and 40% had history of previous cardiovascular disease. Resultis: Overall mortality was 4.8% at 1 year and 7.3% at 2 years. Use of dual antiplatelet therapy was 80% at one year and 53% at 2 years (p<0.0001), with no differences between those with or without ST-segment elevation. The 2-year incidence of ischemic and major bleeding eventis was 15.3% and 1.8%, respectively Conclusions: Beyond the one-year administration recommended by the guidelines, a high percentage of persistent dual antiplatelet therapy was observed at 2 years, with a low incidence of major bleeding eventis, suggesting a clinical risk-benefit selection.