Suchergebnisse

Background The treatment of paraclinoid aneurysms can be challenging due to their relationship to the cavernous sinus, carotid siphon, and optic nerve. The goal of this retrospective analysis is to compare the efficacy and safety of microsurgical versus endovascular treatments for ruptured paraclinoid aneurysms.
Methods Medical records were reviewed to collect information about patient demographics, risk factors, diagnosis (the position and size of aneurysms), Hunt and Hess grade, and surgical method and outcomes, including modified Rankin Scale (mRS) at the time of discharge and 6 months later, complications, and death.
Results In total, 15 and 6 patients were recruited into the microsurgery and endovascular groups, respectively. No difference was detected regarding age, sex, risk factors, and Hunt and Hess grade. Most patients had ophthalmic segment aneurysms (87% versus 83%; p = 1.000) and small aneurysms (< 10 mm, 67% versus 100%; p = 0.102). In the microsurgical group, five patients (33%) had large aneurysms (10–25 mm); three patients (20%) had multiple aneurysms (all p > 0.05 compared with the endovascular group). The occlusion rate at 6 months was 93% in the microsurgical group and 100% in the endovascular group (p > 0.05). No difference was found regarding mRS or the complication and mortality rates between the two groups (all p > 0.05). The occurrence of complications was not related to the location and size of aneurysms (all p > 0.05).
Conclusions Our retrospective analysis indicates that good clinical outcomes can be achieved with both microsurgical and endovascular approaches. But further prospective randomized multicenter studies are needed to provide more evidence for clinical practice.

Our planet is increasingly threatened by degradation in water quantity and quality due to climate change, population growth and development pressures. Water shortage is one of the most challenging environmental problems to humankind in the 21st century under the changing climate. Water shortages and scarcity escalate risks to food security and economic viability. For decades, water management has been dominated by supply oriented paradigm of expanding the capacity of accessible water (e. g. building dams). While large scale infrastructure projects provided effective solutions for chronic water crises in the past, they have come at expensive, irreversible and delayed ecological, economic and social costs. As more questions are raised concerning over reliance on infrastructure solutions, discussions about a sustainable future suggest a greater focus on the demand side of the equation is needed. In this paper, we use multi-recursive and runoff coefficient analysis methods to analyze the annual runoff of the mainstreams (Kuye River, Tuwei River, Wuding River and Jialu River) in the middle reaches of Yellow River. The main objective is to estimate the impacts of climate change and human activity on water resources in the study area and test the potential of water demand management to lessen the gap between supply and demand. Results show remarkable drop in the average annual runoff as a combined effect of climate change and human activity. Moreover, results show that human activities are the direct reason for the changes of river runoff, and the proportion of human activities account the biggest is Wuding river, next is Kuye river, Jialu river is smallest, these changes lead to the decrease of river runoff, and even drying up in recent years. This result highlights the importance of using WDM to diminish the increasing gap between demand and supply. Motivated by this, the paper presents a comprehensive framework for implementation WDM in the middle reaches of Yellow River. The framework includes a wide range of instruments: legislative, economic, technological and educational. The core step of the framework, collaboration among water planners, water service providers and end-users lies as an essential mechanism for achieving long term trade-offs between ecological and socio-economic water needs.

Our planet is increasingly threatened by degradation in water quantity and quality due to climate change, population growth and development pressures. Water shortage is one of the most challenging environmental problems to humankind in the 21st century under the changing climate. Water shortages and scarcity escalate risks to food security and economic viability. For decades, water management has been dominated by supply oriented paradigm of expanding the capacity of accessible water (e. g. building dams). While large scale infrastructure projects provided effective solutions for chronic water crises in the past, they have come at expensive, irreversible and delayed ecological, economic and social costs. As more questions are raised concerning over reliance on infrastructure solutions, discussions about a sustainable future suggest a greater focus on the demand side of the equation is needed. In this paper, we use multi-recursive and runoff coefficient analysis methods to analyze the annual runoff of the mainstreams (Kuye River, Tuwei River, Wuding River and Jialu River) in the middle reaches of Yellow River. The main objective is to estimate the impacts of climate change and human activity on water resources in the study area and test the potential of water demand management to lessen the gap between supply and demand. Results show remarkable drop in the average annual runoff as a combined effect of climate change and human activity. Moreover, results show that human activities are the direct reason for the changes of river runoff, and the proportion of human activities account the biggest is Wuding river, next is Kuye river, Jialu river is smallest, these changes lead to the decrease of river runoff, and even drying up in recent years. This result highlights the importance of using WDM to diminish the increasing gap between demand and supply. Motivated by this, the paper presents a comprehensive framework for implementation WDM in the middle reaches of Yellow River. The framework includes a wide range of instruments: legislative, economic, technological and educational. The core step of the framework, collaboration among water planners, water service providers and end-users lies as an essential mechanism for achieving long term trade-offs between ecological and socio-economic water needs.

Xiao-Jun Wu, Yi Zhi, Peng He, Xiao-Zhou Zhou, Ji Zheng, Zhi-Wen Chen, Zhan-Song Zhou Institute of Urinary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China Background: Platinum-based chemotherapy is the standard treatment for advanced urothelial cancer (UC) and is generally used in the first-line setting. However, the optimal salvage treatment for previously treated UC patients is unclear. We conducted a systematic review of published clinical trials of single agent versus combined chemotherapy as salvage treatment in previously treated UC patients.Methods: Trials published between 1994 and 2015 were identified by an electronic search of public databases (MEDLINE, EMBASE, Cochrane library). All relevant studies were independently identified by two authors for inclusion. Demographic data, treatment regimens, objective response rate (ORR), disease control rate (DCR), median progression-free and overall survival (PFS, OS), and grade 3/4 toxicities were extracted and analyzed using Comprehensive Meta Analysis software (Version 2.0).Results: Fifty cohorts with 1,685 patients were included for analysis: 814 patients were treated with single agent chemotherapy and 871 with combined chemotherapy. Pooled OS was significantly higher at 1 year for combined chemotherapy than for single agent (relative risk [RR] 1.52; 95% CI: 1.01–2.37; P=0.03) but not for 2-year OS (RR 1.31; 95% CI: 0.92–1.85; P=0.064). Additionally, combined chemotherapy significantly improved ORR (RR 2.25; 95% CI: 1.60–3.18; P<0.001) and DCR (RR 1.12; 95% CI: 1.01–1.25, P=0.033) compared to single agent for advanced UC patients. As for grade 3 and 4 toxicities, more frequencies of leukopenia and thrombocytopenia were observed in the combined chemotherapy than in single agent group, while equivalent frequencies of anemia, nausea, vomiting, and diarrhea were found between the two groups.Conclusion: In comparison with single agent alone, combined chemotherapy as salvage treatment for advanced UC patients significantly improved ORR, DCR, and 1-year OS, but not 2-year OS. Our findings support the need to compare combined chemotherapy with single agent alone in the salvage setting in large prospective trials due to its potential survival benefit in advanced UC patients. Keywords: advanced urothelial cancer, salvage chemotherapy, cytotoxic agents, meta-analysis, efficacy