Effect of corticosteroids on atrial fibrillation after catheter ablation: a meta-analysis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#The purpose of this meta-analysis was to explore the effect of corticosteroids on atrial fibrillation (AF) following catheter ablation.@*METHODS@#We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for published articles describing the effect of corticosteroids in preventing AF recurrence after catheter ablation. Data on study and patient were extracted. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by use of a random-effect model, and P values of <0.05 were considered significant.@*RESULTS@#Two randomized controlled trials (RCTs) and three cohort studies involving 846 patients were included in this meta-analysis. Within one month of catheter ablation, corticosteroid use was associated with a declined risk of recurrence of AF in RCT (RR 0.57, 95% CI 0.39 to 0.85, P=0.005), but without significant effect in cohort studies (RR 1.01, 95% CI 0.79 to 1.30, P=0.94). After three months of catheter ablation, corticosteroids did not have a significant effect in the prevention of late recurrence of AF in either RCT (RR 0.78, 95% CI 0.38 to 1.59, P=0.49) or cohort studies (RR 0.96, 95% CI 0.70 to 1.31, P=0.78).@*CONCLUSIONS@#Our meta-analysis suggested that periprocedural administration of corticosteroids of catheter ablation was associated with reduction of early but not late recurrence of AF.

Defining a New Tumor Dimension in Staging of Papillary Thyroid Carcinoma.

BACKGROUND: Cervical lymph node metastasis is a vital factor associated with local recurrence in papillary thyroid carcinoma (PTC). Tumor size is used in the staging of PTC because it represents the tumor load. This study compared two methods of tumor size assessment to predict tumor behavior in the relationship between size and cervical node involvement for patients with PTC. METHODS: The study enrolled 1084 patients who underwent initial thyroid surgery and had a pathologic diagnosis of PTC between 2012 and 2014 at The Second Affiliated Hospital Zhejiang University School of Medicine. Cervical lymph node metastasis (LNM) risk was analyzed according to the clinicopathologic features. For each patient with multifocal disease, two tumor size estimates were used: (1) the dominant focus size and (2) the aggregate size, calculated as the sum of the maximal diameters of all tumor foci. RESULTS: Of the 1084 patients, 294 (27.1%) had multifocal cancer lesions, and 49% of these patients had cervical LNM, compared with 38.1% who had unifocal disease (P = 0.001). The use of aggregate dimension significantly increased the tumor size and reclassified significant numbers of multifocal PTCs to a more advanced T stage. This aggregate dimension took account of all tumor foci and predicted LNM risk at a proportion identical with that for size-matched, unifocal tumors. CONCLUSION: Multifocality together with aggregate tumor size is a more accurate predictor of node status and, by inference, tumor behavior in the relationship between tumor size and cervical node involvement.

Thyroid dysfunction, either hyper or hypothyroidism, promotes gallstone formation by different mechanisms.

We have investigated comprehensively the effects of thyroid function on gallstone formation in a mouse model. Gonadectomized gallstone-susceptible male C57BL/6 mice were randomly distributed into three groups each of which received an intervention to induce hyperthyroidism, hypothyroidism, or euthyroidism. After 5 weeks of feeding a lithogenic diet of 15% (w/w) butter fat, 1% (w/w) cholesterol, and 0.5% (w/w) cholic acid, mice were killed for further experiments. The incidence of cholesterol monohydrate crystal formation was 100% in mice with hyperthyroidism, 83% in hypothyroidism, and 33% in euthyroidism, the differences being statistically significant. Among the hepatic lithogenic genes, Trß was found to be up-regulated and Rxr down-regulated in the mice with hypothyroidism. In contrast, Lxrα, Rxr, and Cyp7α1 were up-regulated and Fxr down-regulated in the mice with hyperthyroidism. In conclusion, thyroid dysfunction, either hyperthyroidism or hypothyroidism, promotes the formation of cholesterol gallstones in C57BL/6 mice. Gene expression differences suggest that thyroid hormone disturbance leads to gallstone formation in different ways. Hyperthyroidism induces cholesterol gallstone formation by regulating expression of the hepatic nuclear receptor genes such as Lxrα and Rxr, which are significant in cholesterol metabolism pathways. However, hypothyroidism induces cholesterol gallstone formation by promoting cholesterol biosynthesis.

Bombings specific triage (Bost Tool) tool and its application by healthcare professionals.

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80%) with triage tool performed better in triaging the bomb blast victims than group A (50%) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging.

Bombings specific triage (Bost Tool) tool and its application by healthcare professionals / 世界急诊医学杂志（英文）

@#BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80％) with triage tool performed better in triaging the bomb blast victims than group A (50％) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging.