Acupuncture Points ; Acupuncture Therapy ; Aged ; Humans ; Male ; Thrombocythemia, Essential ; therapy

Objective:To assess rapid on-line evaluation (ROLE) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic masses.Methods:Data of patients with solid pancreatic masses who underwent EUS-FNA in Peking University First Hospital from October 2017 to October 2019 were retrospectively analyzed. Patients were divided into the ROLE group and the control group. The number of FNA passes in ROLE group was decided by the cytopathologist based on the number of pancreatic tissue cells or heteromorphic cells obtained, while that in the control group was decided by the endoscopy physician according to the visual observation of tissue strips. The cytological and histological diagnosis of EUS-FNA specimen were made by another cytopathologist. The gold standard for final diagnosis was based on the histological diagnosis of surgically resected specimens. For patients who did not undergo surgical treatment, the final diagnosis was made based on the clinical course, imaging, tumor markers and feedback on treatment. The diagnostic yield, the accuracy, the sensitivity, the specificity, FNA passes, puncture time and adverse events were compared between the two groups.Results:A total of 87 patients were enrolled, 51 in the ROLE group and 36 in the control group. The diagnostic yield of the ROLE group was higher than that of the control group without significant difference [98.0% (50/51) VS 86.1%(31/36), P=0.078]. The number of FNA passes in the ROLE group was significantly less than that in the control group (median 2 VS 3, P<0.001). No significant difference in mean FNA puncture time was found between the ROLE group and the control group (19.4 min VS 18.5 min, P=0.089). There were no significant differences between the two groups with regard to the diagnostic yield, the sensitivity, the specificity, the positive predictive value, the negative predictive value or the incidence of adverse events. Conclusion:ROLE of EUS-FNA for pancreatic solid tumor may improve tissue acquisition for puncture, reduce the number of FNA passes, and may not significantly increase the procedure time and risk of puncture.

富含半胱氨酸的酸性分泌蛋白（SPARC）；巨噬细胞；肿瘤；微环境 肿瘤微环境对肿瘤的发生、发展具有重要的调节作用。富含半胱氨酸的酸性分泌蛋白（cysteine-rich acidic secreted protein ，SPARC）和巨噬细胞作为肿瘤微环境重要基质成分，不仅对肿瘤细胞有直接的调节作用，两者的相互作用也可以影响肿 瘤的各种生物学行为变化。SPARC通过维持细胞外基质紧密结构，减少巨噬细胞等免疫细胞向肿瘤区域的浸润，或通过减少巨 噬细胞向M2功能表型方向转换，抑制肿瘤进展；另一方面， M2型巨噬细胞可以通过吞噬SPARC，从而消除SPARC对肿瘤的抑制 作用。此外，巨噬细胞还可通过自身分泌的SPARC抑制肿瘤增殖和迁移等生物学行为。本文将就SPARC维持细胞外基质紧密 结构，减少巨噬细胞等免疫细胞向肿瘤区域的浸润；抑制巨噬细胞向M2功能表型方向转换，从而发挥抑瘤作用； M2可以通过吞 噬SPARC，消除SPARC对肿瘤的抑制作用;巨噬细胞来源SPARC决定细胞外基质沉积，抑制肿瘤迁移和增殖；SPARC与巨噬细 胞相互作用在肿瘤免疫治疗的应用5个方面进行综述，为巨噬细胞来源SPARC对肿瘤不同生物学行为的调节的作用深入研究提 供借鉴。

OBJECTIVETo compare the effects of need-in-row combined with herb-partition moxibustion,need-in-row and conventional acupuncture for superior gluteal nerve entrapment syndrome.

METHODSTotally 105 patients were randomly assigned into a combination group,a need-in-row group and an acupuncture group,35 cases in each one. In the combination group and needle-in-row group,needle-in-row therapy was used at the pain tendon region of the pathological waist-hip part,and TDP was combined. Also,herb-partition moxibustion was applied at the same part after needle-in-row in the combined group. In the acupuncture group,conventional acupuncture was implemented at Weizhong(BL 40),Yanglingquan(GB 34),Zhibian(BL 54),Huantiao(GB 30),Sanyinjiao(SP 6) and Jiaji of L-L(EX-B 2),and TDP was applied. All the treatment was given once a day for four weeks. The changes of pain scores were compared after treatment.

RESULTSThe pain scores decreased obviously after treatment in all the groups(all<0.05). The scores of the combination group and the needle-in-row group declined more apparently than that of the acupuncture group(both<0.05). The score of the combination group reduced more obviously than that of the needle-in-low group(<0.05). The markedly effective rates of the combination group and the needle-in-row group were 88.6%(31/35) and 68.6%(24/35),which were higher than 40.0%(14/35) of the acupuncture group(both<0.05),and the markedly effective rate of the combination group was better than that of the needle-in-row group(<0.05).

CONCLUSIONSNeed-in-row combined with herb-partition moxibustion show definite effect for superior gluteal nerve entrapment syndrome,and it is better than those of simple needle-in-row therapy and conventional acupuncture.

BACKGROUND: Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS: Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS: A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P  <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P  <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001). CONCLUSIONS In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.
Humans ; Administration, Oral ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; Patient Discharge ; Patients ; Registries ; Risk Factors ; Stroke/drug therapy*