BACKGROUND & AIMS: :It is clear that the optimal clinical outcomes in bladder cancer patients requiring radical cystectomy are related to standard histopathologic variables of tumor grade, stage and lymph node status. However, other less well defined variables are also critical to the successful outcomes of these patients. Patients with muscle invasive bladder cancer and treating physicians should avoid unnecessary and significant treatment delays. In addition, hospital and surgeon-volume/experience are thought to be factors that may too be important components that relate to the clinical outcomes of patients following surgery. Lastly, there is a growing body of literature to support the concept of an appropriate lymphadenectomy at the time of surgery, for both node-positive and node-negative bladder cancer patients. It is becoming more obvious that there are multiple variables involved in the clinical success and outcomes of patients with bladder cancer following radical cystectomy. As treating physicians and surgeons we must be aware of these components to ensure the best outcomes for our patients.

背景与目标： ：很明显，需要根治性膀胱切除术的膀胱癌患者的最佳临床结局与肿瘤分级，分期和淋巴结状态的标准组织病理学变量有关。但是，其他定义欠佳的变量对于这些患者的成功结局也至关重要。患有肌肉浸润性膀胱癌的患者和主治医师应避免不必要和显着的治疗延迟。另外，医院和外科医生的体格/经验被认为是可能也是与手术后患者的临床结果相关的重要组成部分的因素。最后，越来越多的文献支持针对淋巴结阳性和淋巴结阴性的膀胱癌患者在手术时进行适当的淋巴结清扫术的概念。越来越明显的是，根治性膀胱切除术后膀胱癌患者的临床成功和结局涉及多个变量。作为主治医师和外科医生，我们必须意识到这些因素，以确保为我们的患者提供最佳的治疗效果。

BACKGROUND & AIMS: BACKGROUND:A detailed appreciation of left atrial/pulmonary vein (LA/PV) anatomy may be important in improving the safety and success of catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVES:The aim of this nonrandomized study was to determine the impact of computerized tomography (CT) image integration into a 3-dimensional (3D) mapping system on the clinical outcome of patients undergoing CA for AF. METHODS:Ninety-four patients (age: 56 +/- 10 years) with AF (paroxysmal 46, persistent 48) underwent wide encirclement of ipsilateral PV pairs using irrigated radiofrequency ablation with the endpoint of electrical isolation. Ablation was guided by 3D mapping alone (electroanatomic 24, noncontact 23) in 47 (3DM group) patients and by CT image integration (Cartomerge) in 47 (CT group). In persistent AF, a combination of linear ablation and targeted ablation of complex fractionated electrograms was also performed. RESULTS:Successful PV electrical isolation did not differ between the two groups. A significant reduction in fluoroscopy times was demonstrated in the CT group (49 +/- 27 minutes vs 3DM group 62 +/- 26 minutes, P = 0.03). Arrhythmia recurrence was reduced in the CT group (32% vs 51% in the 3DM group, P < 0.01). In 30 symptomatic patients (12 CT and 18 3DM), repeat procedures for AF (13 in 3DM and 5 CT, P < or = 0.10) and AT (5 in 3DM and 7 CT, P = NS) were performed. Overall success on 7-day monitor off antiarrhythmic drugs was achieved in 60% in the 3DM group when compared with 83% in the CT group (P < 0.05) at a follow-up of 25 +/- 5 weeks. CONCLUSION:CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.

背景与目标： 背景：详细了解左心房/肺静脉（LA / PV）解剖结构对于提高房颤（AF）导管消融（CA）的安全性和成功率可能很重要。
目的：这项非随机研究的目的是确定将计算机断层扫描（CT）图像集成到3维（3D）制图系统中对接受CA房颤的患者的临床结局的影响。
方法：94例房颤（阵发性46岁，持续性48岁）（年龄56 /-10岁）患者接受了射频消融，并采用电隔离终点，对同侧PV对进行了大包围。 47例（3DM组）患者仅通过3D映射（电解剖学24，非接触式23）进行消融，47例（CT组）通过CT图像积分（Cartomerge）进行消融。在持续性房颤中，还执行了复杂的电描记图的线性消融和靶向消融的组合。
结果：两组之间成功的PV电气隔离没有差异。在CT组中，荧光检查时间显着减少（49 /-27分钟，而3DM组62 /-26分钟，P = 0.03）。 CT组心律失常复发率降低（3DM组为32％，而51％为P <0.01）。在30例有症状的患者中（12 CT和18 3DM），重复进行AF（3DM和5 CT中的13，P <或= 0.10）和AT（3DM和7 CT中的5，P = NS）的重复手术。在25 /-5周的随访中，3DM组60％的抗心律失常药物获得了总体成功，而CT组为83％（P <0.05）。
结论：CT整合引导的房颤CA与减少的透视时间，心律失常的复发和窦性心律的恢复增加有关。改善复杂的LA几何图形的可视化可能会提高CA用于AF的安全性和成功率。

BACKGROUND & AIMS: The selective promotion of clinical services which have proven effectiveness is a movement that is gaining momentum within healthcare. Outcome evaluation in treatment services for alcohol dependency is given as an example of the methodological issues associated with the establishment of clinical efficacy. It is argued that the adoption of clear protocols for assessment, treatment and outcome are a prerequisite of the process. There are costs associated with in-house follow-up studies but the benefits of feedback are evident for patients and for staff providing their care. Although exposing service providers (and commissioners) to the possibility of negative feedback, outcome evaluation in the treatment of alcohol dependency should be an integral part of provision. The principle of systematic assessment of efficacy applies to healthcare provision generally and should include management, teaching, purchasing and policymaking.

背景与目标： 选择性推广已证明有效的临床服务是一项在医疗保健领域正获得发展的运动。酒精依赖治疗服务的结果评估是与建立临床疗效相关的方法论问题的一个例子。有人认为，采用明确的评估，治疗和结果方案是该过程的先决条件。内部跟踪研究会产生一定的成本，但是反馈的好处对于患者和提供护理的工作人员来说是显而易见的。尽管使服务提供者（和专员）面临负面反馈的可能性，但治疗酒精依赖的结果评估应成为规定的组成部分。对效力进行系统评估的原则通常适用于医疗保健服务，应包括管理，教学，购买和决策。

BACKGROUND & AIMS: PURPOSE:To determine the clinical importance and relative value of reinterpreting brain CT imaging studies by subspecialty experts regarding changes in clinical management. METHODS:Computerized records were queried at two institutions during the years 2002-2003 for both primary interpretation by board-certified nonneuroradiologists and secondary interpretation by three neuroradiologists. A total of 1,081 cases were reviewed. Each case was initially interpreted as an emergent or urgent study. The reinterpreted studies were scored as concordant or discordant by the subspecialty experts. The discordant studies were then categorized as a "major discordance" if there was a change in clinical management, or as a "minor discordance" if there was no impact or change in clinical management. RESULTS:Of the 1,081 studies reviewed, 14 studies were identified as discordant (1.3%). Of those discordant studies, four were categorized as major discrepancies necessitating a change in clinical management (0.4 %). Ten were categorized as minor discrepancies (0.9%). There were no permanent adverse outcomes with respect to morbidity and mortality as a result of any discrepancy. CONCLUSION:The vast majority of interpreted head CT cases read by board-certified general radiologists do not result in discordant interpretations as verified by subspecialty experts. Discordant interpretations did not result in changes in clinical management in most cases. Double reading of head CTs by subspecialty experts appears to be an inefficient method of substantially improving imaging health quality outcomes.

背景与目标： 目的：确定亚专业专家对临床管理变化进行重新解释脑CT成像研究的临床重要性和相对价值。
方法：在2002年至2003年期间，在两家机构中查询了计算机记录，以获取由董事会认证的非神经放射科医生进行的主要解释，以及由三位神经放射科医生进行的次要解释。总共审查了1,081例。最初，每个案例都被解释为紧急研究。重新解释的研究被专业专家评定为一致或不一致。如果临床管理发生变化，则将不一致的研究分类为“重大不一致”，如果临床管理没有影响或发生变化，则将其分类为“轻微不一致”。
结果：在所审查的1,081项研究中，有14项研究被确定为不一致（1.3％）。在这些不一致的研究中，有四项被归类为需要改变临床管理的主要差异（0.4％）。十个分类为轻微差异（0.9％）。任何差异都不会在发病率和死亡率方面带来永久性的不良后果。
结论：经董事会认证的一般放射科医生阅读的绝大多数解释性头部CT病例，经专科专家验证，并不会导致不一致的解释。在大多数情况下，不一致的解释并不会导致临床管理的改变。专科专家对头颅CT进行双重读取似乎是一种实质上改善影像健康质量结果的无效方法。

BACKGROUND & AIMS: BACKGROUND:Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. METHODS:We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database. RESULTS:The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study. CONCLUSIONS:This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.

背景与目标： 背景：几例病例报告引起了人们对与全脑低灌注相关的沙滩椅位置肩部手术安全性的严重关注。我们总结了我们在11年中共15014例肩关节镜检查的经验。我们的主要目的是评估术中或术后立即发生的神经系统事件的发生率，其次是与其他围手术期并发症相关。
方法：我们在2001年4月至2011年11月的11年期间，通过在线不确定的部门质量改善和患者安全数据库，搜索了在沙滩椅位置进行的关节镜肩部手术相关的不良结局，以及医院系统数据库和全州数据库。将其与此类案件的总数进行比较，可从我们的部门账单数据库中获得该数目。
结果：不良反应总发生率为0.37％。围手术期未发生提示急性脑缺血或出血的神经系统异常。据报道，缺血性中风继发于术后24小时，出现了一种新的神经功能缺损。发现的最常见并发症是计划外恢复治疗（0.067％），局麻药全身毒性（0.053％）和需要计划外插管的气道损害（0.033％）。在研究过程中，并发症很少见，发生率也没有变化。
结论：这项回顾性研究表明，当在沙滩椅位置进行手术并结合区域麻醉，丙泊酚镇静和通过自然呼吸道自发呼吸时，很少发生术中或术后中风。

BACKGROUND & AIMS: PURPOSE:To evaluate the indications and outcomes of amniotic membrane transplantation (AMT) performed within the first 2 weeks of presentation in the management of patients with acute Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS:A retrospective chart review from January 1998 to May 2011 identified 128 SJS/TEN patients admitted to Loyola University Medical Center Burn intensive care unit. The degree of initial ocular surface inflammation was graded as mild, moderate, or severe within the first 2 weeks of admission. Patients were managed either medically or with amniotic membrane (AM). Outcomes were graded as good [best-corrected visual acuity (BCVA)>20/40], fair (BCVA 20/40 to 20/200 or with ocular surface discomfort, requiring contact lens or reconstructive surgeries), or poor (BCVA<20/200). RESULTS:Of the 182 eyes (91 patients) with documented inpatient eye examinations, 108 eyes (59.4%) had mild or no initial ocular involvement, 37 eyes (20.3%) had moderate, and 37 eyes (20.3%) had severe inflammation. Of the 29 patients (58 eyes) with greater than 1 month of follow-up, 17 patients (33 eyes) were treated with medical management and 13 patients (25 eyes) were treated with early AM. One of the 23 eyes with moderate or severe presentation treated with early AMT (4.3%) resulted in a poor outcome within 3 months compared with 8 of 23 eyes (34.8%) that were medically managed (P=0.022). CONCLUSIONS:We present the first case-control study of the use of AM in the management of acute SJS/TEN. Early use of AMT prevents severe vision loss in SJS/TEN patients with initial moderate or severe ocular surface inflammation.

背景与目标： 目的：评估在急性史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死溶解症（TEN）患者治疗的前两周内进行羊膜移植（AMT）的适应症和结果。
方法：回顾性调查1998年1月至2011年5月的病历，确定了128名SJS / TEN患者，他们被洛约拉大学医学中心烧伤重症监护室收治。在入院的前两周内，初期眼表炎症的程度分为轻度，中度或重度。患者接受药物治疗或羊膜（AM）治疗。结果分为好[最佳矫正视力（BCVA）> 20/40]，一般（BCVA 20/40至20/200或眼表不适，需要隐形眼镜或重建手术）或较差（BCVA <20） / 200）。
结果：在有住院眼科检查的182眼（91例患者）中，有108眼（59.4％）有轻度或无初次眼部受累，有37眼（20.3％）为中度，有37眼（20.3％）有严重的炎症。在随访时间超过1个月的29例患者（58眼）中，有17例患者（33眼）接受了药物治疗，有13例患者（25眼）接受了早期AM治疗。接受早期AMT治疗的23眼中度或重度表现之一（4.3％）在3个月内导致不良结局，相比之下，接受药物治疗的23眼中有8眼（34.8％）（P = 0.022）。
结论：我们提出了在急性SJS / TEN治疗中使用AM的首例病例对照研究。早期使用AMT可防止SJS / TEN患有初期中度或严重眼表炎症的患者严重视力下降。

BACKGROUND & AIMS: INTRODUCTION:The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS:In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION:Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER:Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.

背景与目标： 简介：烧伤护理的目标是“结果的质量必须值得生存之苦”。需要更多的研究来了解如何最好地为烧伤患者提供护理以实现该目标。烧伤和照顾者患者失去独立性，功能以及收入损失，在个人和社会层面都造成了沉重的负担。为了提高临床护理领域的知识水平，正在做很多工作。然而，很少有研究探讨社会心理结果。本文描述了一项研究背景和方法，该方法在澳大利亚严重烧伤后心理社会结局队列研究中实施。
方法和分析：在这项队列研究中，由医院工作人员确定了230名年龄在18岁或以上，被纳入一个州范围内烧伤中心的烧伤中心的参与者的目标样本。基线调查数据在受伤后28天内亲自或通过电话收集，参与者在烧伤后3、6和12个月进行电话访谈。受伤和烧伤的治疗信息是从医疗记录中收集的。使用“感知社会支持的多维量表”将社会支持作为预测变量进行衡量。通过生活质量（SF-12，EQ-5D，BSHS-B），抑郁症（PHQ-9），创伤后应激障碍（PCL-C，PAS），社区整合等领域的标准化措施收集结果数据（CIQ-R）和质量调整寿命年（EQ-5D）。额外的调查问题可衡量受伤后12个月的生活满意度，重返工作岗位和使用公共服务的情况。数据分析方法将包括方差分析，Pearson相关性和分层多元回归分析。
道德与传播：医院和昆士兰大学人类研究伦理委员会已批准该协议。该研究的结果将在国家和国际会议，同行评审期刊和博士学位论文中进行传播。
试验注册号：澳大利亚新西兰临床试验注册（ACTRN12616000828426）。追溯注册于2016年6月23日;结果。

BACKGROUND & AIMS: OBJECTIVES:We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment. METHODS:We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up. RESULTS:Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 ("usually understandable") in the salvage group and 100 ("always understandable") in the previously untreated group. CONCLUSIONS:Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.

背景与目标： 目的：我们评估了先前未经治疗的声门上癌患者经口激光显微外科手术（TLM）的功能和肿瘤学结果，与基于放射治疗的抢救病例的结果相比。
方法：我们在一家单一的三级学术机构中进行了一项回顾性病例对照研究。功能结局通过事先照射进行分层，并在基线，手术后不到1周和最后一次随访时进行评估。
结果：5例接受过TLM的患者先前未接受过治疗，而5例接受过放射线的患者则接受了TLM进行局部衰竭治疗。没有患者需要气管切开术。 TLM作为主要疗法后没有局部复发，而且这些患者均不需要放疗。一名抢救患者出现局部复发。抢救性TLM病例的进食管依赖性持续时间（p = 0.049）和慢性误吸率（术后1个月以上； p = 0.048）显着高于先前未治疗的病例。挽救组的PSS-HN语音可理解性中位数为75（“通常可理解”），以前未治疗的组为100（“始终可理解”）。
结论：先前未治疗的患者的局部控制和功能均优于抢救患者。我们的发现为TLM作为选定的声门上癌的主要治疗手段提供了支持，但也暗示了先前未治疗和挽救病例的功能恢复潜力。

BACKGROUND & AIMS: :We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.

背景与目标： ：我们对12年来中度至复杂性先天性心脏病或肺动脉高压妇女的妊娠进行了回顾性队列研究，得出65例妇女的107例队列。自发性阴道，手术阴道和剖腹产分别有84％，89％和95％提供神经镇痛或麻醉作用。剖腹产率为43％，而同期我们机构的平均分娩率为27％（p = 0.02），而手术阴道分娩率为38％，而机构分娩率为10.5％（p <0.01）。在所有分娩中有28％使用了侵入式监测。有1例孕产妇死亡和2例新生儿死亡。这项研究为患有先天性心脏病的妇女提供了详细的麻醉和围产期治疗方法，该病患者中大量缺乏循证医学实践和数据。我们观察到神经麻醉技术占优势，剖腹产和手术分娩率增加，孕产妇和新生儿预后良好。需要进行多中心研究和登记，以进一步比较麻醉和产科管理策略，并描述不良后果的危险因素。

BACKGROUND & AIMS: OBJECTIVE:To identify early clinical factors that are correlated with death or severe disability in paediatric patients who have sustained an injury by hanging or strangulation. METHODS:A retrospective review of all patient records from January 1, 1997, to September 30, 2007, was conducted. Patient records were identified by International Classification of Diseases and Related Health Problems, Tenth Revision, Canada diagnostic codes for asphyxia, strangulation, hypoxic-ischemic encephalopathy, hanging, hypoxemia, hypoxia or anoxia. RESULTS:A total of 109 records were identified. Of these, 41 met the inclusion criteria for the study. Of 19 (46%) children who were pulse-less and received cardiopulmonary resuscitation, 16 died and the survivors were severely disabled. Of the 22 (54%) children who were found with a pulse, 18 made a full recovery. CONCLUSIONS:Children who are pulseless at discovery for hanging injuries are at high risk of death or severe disability. Early clinical and neurophysiological indicators should be applied systematically to best guide clinicians and parents in their decision making.

背景与目标： 目的：确定与因悬挂或绞死而受伤的小儿患者的死亡或严重残疾有关的早期临床因素。
方法：对1997年1月1日至2007年9月30日的所有患者记录进行回顾性回顾。通过国际疾病分类和相关健康问题分类（第十次修订版，加拿大）对窒息，窒息，缺氧缺血性脑病，悬挂，低氧血症，缺氧或缺氧的诊断代码确定了患者的记录。
结果：共鉴定到109条记录。其中有41个符合研究的纳入标准。在无脉搏并接受心肺复苏的19名儿童中（46％），有16人死亡，幸存者严重残疾。在发现有脉搏的22名儿童中（54％），其中18名完全康复。
结论：发现悬吊伤害而无脉搏的儿童极有可能导致死亡或严重残疾。应系统地应用早期临床和神经生理指标，以最好地指导临床医生和父母进行决策。

BACKGROUND & AIMS: :We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.

背景与目标： ：我们进行了首次荟萃分析，比较了胰腺假性囊肿的内镜超声引导引流术（EUD）和常规透壁引流术（CTD）的技术成功率和临床结果。我们搜索了PubMed，Embase，Scopus和Cochrane库，以确定相关的前瞻性试验。比较了技术成功率，短期（4-6周）成功率和长期（6个月时）症状的成功率以及假性囊肿的放射学分辨率，并发症发生率和死亡率。检索了两项合格的随机对照试验和两项前瞻性研究，其中包括229例患者。 EUD的技术成功率显着高于CTD [风险比（RR）= 12.38，95％置信区间（CI）：1.39-110.22]。当CTD由于假性囊肿的非膨隆性而失败时，便与EUD进行了交叉（n = 18），在所有这些情况下均成功进行了交叉。所有患有门静脉高压症和出血倾向的患者均应接受EUD治疗，以避免严重的并发症。就短期成功率（RR = 1.03，95％CI：0.95-1.11）或长期成功率（RR = 0.98，95％CI：0.76-1.25）而言，EUD并不优于CTD。两组的总并发症相似（RR = 0.98，95％CI：0.52-1.86）。最常见的并发症是出血和感染。 CTD后有两人因出血死亡。仅当在特定的临床情况下选择了适当的引流方式时，这两种方法的短期和长期治疗成功率才具有可比性。对于隆起的假性囊肿，可以选择EUD或CTD，而EUD是不隆起的假性囊肿，门脉高压或凝血病的治疗选择。

BACKGROUND & AIMS: OBJECTIVE:Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long-term functional outcomes and quality of life (QoL) are unclear. METHODS:In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre. RESULTS:In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow-up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re-resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients. CONCLUSIONS:Surgery for pediatric-onset CD is risky even under expert care. Disease relapses and bowel re-resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.

背景与目标： 目的：患有克罗恩病的小儿患者中，有20％至30％在10年内接受手术。尽管疾病复发和再次手术很普遍，但长期功能结局和生活质量（QoL）尚不清楚。
方法：2010年，我们回顾了1985年至2008年间两家主要三级医院的所有CD患儿在小儿时期进行过肠切除的小儿CD的医院记录，并寄出了有关健康结局和QoL的问卷。我们比较了患者和从人口登记中心随机选择的一组配对对照的生活质量。
结果：总共有36名儿童接受了肠切除术，中位值是10年前，并且至少接受了2年的随访。 94％（初次切除后中位数为1.8年）发生了需要药物或手术治疗的疾病激活（在内窥镜检查中验证）。 77％的患者至少发生了1例手术并发症，而54％的患者接受了再次切除。患者报告白天大便次数中位数为3次，晚上为零，其中33％完全为大洲。总体而言，有96％的人对手术的结果完全满意或中度满意。患者和对照组之间的QoL相当，但是因学校缺勤或缺勤而降低了患者的QoL。
结论：即使在专家的护理下，小儿发作性CD的手术也是有风险的。在初次手术后的头十年，疾病复发和肠切除很常见。但是，从长期来看，肠功能是可以接受的，患者与同伴之间的QoL相当。

BACKGROUND & AIMS: BACKGROUND:Severity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. METHODS:All adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. RESULTS:A total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P < 0.0001) and 1.45 (P < 0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. CONCLUSIONS:REMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.

背景与目标： 背景：疾病评分的高低有助于预测死亡率。但是，尚无标准的评分系统在金黄色葡萄球菌菌血症（SAB）患者中得到验证。在预测SAB发作的结果时，比较了修改后的快速急诊医学评分（REMS），CURB-65（精神错乱，尿素，呼吸频率，血压和65岁）和Charlson合并症加权指数（CWIC）。
方法：对2008年7月15日至2009年12月31日期间所有成人SAB住院患者进行前瞻性评估。应用了3种评分系统：REMS，CURB-65和CWIC。终点归因于总死亡率。
结果：在研究期间，共对241名SAB患者进行了回顾。全因死亡率为22.8％，归因死亡率为14.1％。死亡患者的CURB-65平均得分和REMS均高于活着的患者，而CWIC得分的差异并不显着。在控制了CWIC之后，基于CURB-65得分或REMS的两个逻辑回归模型显示，两个得分都是死亡率的独立预测因子，CURB-65的优势比为3.38（P <0.0001）和1.45（P <0.0001）。和REMS分别。接收器工作特性分析显示，临界点3.0（CURB-65）和6.0（REMS）提供了最高的灵敏度和特异性。对于CURB-65和REMS，全因死亡率的曲线下面积分别为0.832和0.806，归因死亡率分别为0.845和0.819。
结论：REMS和CURB-65得分优于CWIC作为SAB死亡率的预测指标，可能有效地预测菌血症发作时疾病的严重程度。

BACKGROUND & AIMS: OBJECTIVE:The aim was to investigate birth characteristics, obstetric and neonatal outcomes of the first childbirth in women with Marfan syndrome by use of Swedish national registers since pregnancy-related outcomes in women with Marfan syndrome have only been sparsely investigated. STUDY DESIGN:In this national population-based cohort study and matched case-control study of Swedish women born 1973-1993, women with Marfan syndrome (n=273) were compared to women without the condition (n=1 017 265). The study population was followed until 2013. A total of 364 553 mother-firstborn-offspring pairs were analyzed. Sixty-one women with Marfan syndrome became mothers. Women with Marfan syndrome were also compared to 543 healthy controls. RESULTS:Women with Marfan syndrome were more often born preterm (p<0.001), small-for-gestational age (p<0.001), and delivered by cesarean section (p=0.001). Women with Marfan syndrome had no increased risk of giving birth by cesarean section (p=0.079). No increased neonatal risks in their children were found. Women with Marfan syndrome were less likely to give birth than those without (p<0.001). There were no maternal deaths. CONCLUSIONS:Women with Marfan syndrome were more likely to be born preterm, SGA and by cesarean section. These increased risks of preterm birth and SGA babies were not found in connection with their own first childbirth. Pregnancies with known fetal Marfan syndrome have to be carefully monitored. The results are important for obstetricians giving preconception counseling and treating women with Marfan syndrome. Further studies are needed to evaluate risks during pregnancy and long-term effects of pregnancy on the cardiovascular status of women with Marfan syndrome.

背景与目标： 目的：由于仅对马凡氏综合征妇女的妊娠相关结局进行了稀疏调查，因此目的是通过瑞典国家登记簿调查马凡氏综合征妇女的首次生育的​​出生特征，产科和新生儿结局。
研究设计：在这项基于全国人群的队列研究和匹配的病例对照研究中，对1973年至1993年出生的瑞典妇女进行了比较，将患有马凡氏综合症（n = 273）的妇女与未患此病的妇女（n = 1 017 265）进行了比较。研究人群一直追踪到2013年。共分析了364 553对母亲-第一胎-后代。六十一名患有马凡氏综合症的妇女成为母亲。还比较了患有马凡氏综合症的女性和543名健康对照者。
结果：马凡氏综合征的妇女更早产（p <0.001），小胎龄（p <0.001），并通过剖宫产分娩（p = 0.001）。患有马凡氏综合症的妇女通过剖宫产术分娩的风险没有增加（p = 0.079）。没有发现孩子的新生儿患病风险增加。患有马凡氏综合症的妇女比没有马芬综合症的妇女分娩的可能性更低（p <0.001）。没有孕产妇死亡。
结论：马凡氏综合征的女性更可能早产，SGA和剖宫产。未发现早产和SGA婴儿的这些增加的风险与他们的初生有关。患有已知胎儿马凡氏综合征的孕妇必须进行仔细监测。这些结果对于产科医生进行孕前咨询和治疗患有马凡氏综合症的妇女非常重要。需要进一步的研究来评估妊娠期间的风险以及妊娠对马凡氏综合症女性心血管状况的长期影响。

BACKGROUND & AIMS: :In 2015, there will be an estimated 11.3 million cancer survivors. With an increasing population of cancer survivors, it is imperative to understand the treatment options available and outcomes for chemotherapy-related cardiomyopathy. Anthracycline-based chemotherapy causes heart failure in approximately 5% of patients. Orthotopic heart transplantation (OHT) is an option for cancer survivors in complete remission who develop end-stage heart failure. We examined retrospective OHT data collected from the United Network of Organ Sharing from 1987 to 2011. The primary aim was to characterize the survival in patients with either the primary diagnosis of "dilated cardiomyopathy: Adriamycin" (DCA) versus "all other" causes of cardiomyopathy. The secondary aim was to define the differences in the primary cause of death and to describe the temporal relationship of DCA OHT. The United Network of Organ Sharing database identified 453 OHTs for the diagnosis of DCA and 51,312 OHTs for all other causes of cardiomyopathy. The DCA group was significantly younger with a greater percentage of women. After adjusting for age, gender, and history of malignancy, the 10-year survival curves showed that patients with DCA have an improved survival compared to those with all other causes of cardiomyopathy (hazard ratio 1.28, p = 0.026). No difference was found in the primary cause of death between the 2 groups. A statistically significant increasing temporal trend was seen in the number of OHTs for the diagnosis DCA. In conclusion, patients who undergo OHT for DCA have favorable 10-year survival, making OHT a good therapeutic option for end-stage heart failure due to anthracyclines. Additionally, no increased risk of cancer-related deaths was found in the DCA group, demonstrating that recurrent malignancy does not affect long-term survival. The temporal trends demonstrated that DCA remains a significant problem for cancer survivors.

背景与目标： ：2015年，估计将有1,130万癌症幸存者。随着癌症幸存者人数的增加，必须了解可用的治疗方案和化疗相关性心肌病的预后。基于蒽环类的化学疗法在大约5％的患者中引起心力衰竭。原位心脏移植（OHT）是完全缓解并发展为晚期心力衰竭的癌症幸存者的一种选择。我们检查了从1987年至2011年从器官共享联合网络收集的回顾性OHT数据。主要目的是鉴定患有“扩张型心肌病：阿霉素”（DCA）与“其他所有”原因的原发性诊断的患者的生存情况。心肌病。第二个目的是确定主要死亡原因的差异，并描述DCA OHT的时间关系。器官共享网络联合会确定了用于诊断DCA的453个OHT，以及所有其他引起心肌病的原因的51,312个OHT。 DCA组明显年轻，女性比例更高。在对年龄，性别和恶性肿瘤病史进行调整后，10年生存曲线显示DCA患者的生存率比所有其他原因的心肌病患者高（危险比1.28，p = 0.026）。两组之间的主要死亡原因均未发现差异。诊断DCA的OHT数量出现了统计上显着增加的时间趋势。总之，接受OHT进行DCA治疗的患者具有良好的10年生存期，这使OHT成为治疗因蒽环类药物所致晚期心力衰竭的良好治疗选择。此外，在DCA组中未发现与癌症相关的死亡风险增加，表明复发性恶性肿瘤不会影响长期生存。时间趋势表明，DCA对于癌症幸存者仍然是一个重大问题。