Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Prognosis of Surgically Resectable Urinary Cancers: Systematic Review and Meta-Analysis / 中国医学科学杂志(英文版)

Objective Accumulated evidence has suggested that there is a close association between preoperative neutrophil-to-lymphocyte ratio (NLR) and prognosis of various malignant tumors. However, the relationship between NLR and surgically resectable urinary cancers remains contradictory. Therefore, we performed this systematic review and meta-analysis to explore whether preoperative NLR could predict the prognosis of surgically resectable urinary cancers. Methods After searching the Embase, PubMed/MEDLINE and Cochrane databases and screening the articles, we finally included 25 studies involving 15950 patients. Hazard ratios (s) and their 95% confidence intervals (s) were extracted to assess the association between preoperative NLR and the overall survival (OS) and cancer-specific survival (CSS) of surgically resectable urinary cancers. Results The pooled results revealed that an elevated preoperative NLR could predict a worse OS (=1.40, 95%: 1.26-1.54, <0.001) and CSS (=1.43, 95%: 1.27-1.59, <0.001) in urinary cancers. In addition, our analyses also suggested that high preoperative NLR was associated with worse prognosis in renal cell carcinoma (OS: =2.06, 95%: 1.54-2.76, =0.131; CSS: =2.46, 95%: 1.46-4.16, =0.178), upper tract urothelial carcinoma (OS: =1.91, 95%: 1.50-2.42, =0.616; CSS: =1.84, 95%: 1.41-2.39, =0.001), bladder cancer (OS: =1.09, 95%: 1.02-1.17, <0.001; CSS: =1.05, 95%: 1.01-1.09, =0.163) and prostate cancer (OS: =1.69, 95%: 1.19-2.41, =0.714). Regardless of the participants' race or the cutoff value of the preoperative NLR, the results remained valid. Conclusion Elevated preoperative NLR could predict a worse prognosis in surgically resectable urinary cancers, namely, renal cell carcinoma, bladder cancer, prostate cancer and upper tract urothelial carcinoma.

Utility of endovascular simulation to improve technical performance and stimulate interest of medical students in vascular surgery / 基础医学与临床

Objective To determine whether endovascular simulation training in medical students may increase technical proficiency,enhance interest in vascular surgery. Methods We recruited 30 medical students from Pe-king Union Medical College prospectively. We gave these students an eight-week course with a structured curricu-lum comprised of weekly simulator sessions and theoretical lessons. A test of iliac artery balloon dilatation was con-ducted in pre-and post-course. Performance was assessed. Demographics and subjective survey data,including in-terest in vascular surgery were obtained pre-and post-course from the students too. Results Parameters measured on the standardized global endovascular rating scale,including angiography skills,wire handling and interventional criteria as well as simulator-generated metrics such as fluoroscopy time and volume of contrast used significantly im-proved from pre-to post-course values for the medical students(P<0.05) All the students agreed or strongly agreed that the simulation course increased their interest in vascular surgery. Conclusions A simulation-based endovascu-lar course improves technical performance with interest in vascular surgery training of medical students. The simula-tor is quite potential in the medical students training.

Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions: Preliminary Results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions.</p><p><b>METHODS</b>This prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure.</p><p><b>RESULTS</b>There was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.</p>