BackgroundCardiac glycosides (CGs) including digitalis, digoxin and digitoxin are used in the treatment of congestive heart failure and atrial fibrillation.Pre-clinical studies have investigated the anti-neoplastic properties of CGs since 1960s. Epidemiological studies concerning the association between CGs use and cancer risk yielded inconsistent results. We have performed a systematic review and meta-analysis to summarize the effects of CGs on cancer risk and mortality.MethodsPubMed, Scopus, Cochrane library, Medline and Web of Knowledge were searched for identifying relevant studies. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects model.ResultsWe included 14 case-control studies and 15 cohort studies published between 1976 and 2016 including 13 cancer types. Twenty-four studies reported the association between CGs and cancer risk and six reported the association between CGs and mortality of cancer patients.Using CGs was associated with a higher risk of breast cancer (RR = 1.330, 95% CI: 1.247–1.419). Subgroup analysis showed that using CGs increased the risk of ER+ve breast cancer but not ER-ve. Using CGs wasn’t associated with prostate cancer risk (RR = 1.015, 95% CI: 0.868–1.87). However, CGs decreased the risk in long term users and showed a protective role in decreasing the risk of advanced stages. CGs use was associated with increased all-cause mortality (HR = 1.35, 95% CI: 1.248–1.46) but not cancer-specific mortality (HR = 1.075, 95% CI: 0.968–1.194).ConclusionThe anti-tumor activity of CGs observed in pre-clinical studies requires high concentrations which can’t be normally tolerated in humans. However, the estrogen-like activity of CGs could be responsible for increasing the risk of certain types of tumors.

(Lancet. 2018;391:1197–204) Among patients who undergo lumbar puncture, up to 35% return to the hospital with a postdural puncture headache, which is caused by continuing leakage of the cerebrospinal fluid (CSF) from the dural defect created by the spinal needle. Conventional needles are most frequently used in clinical practice by nonanesthesiologists and have a sharp slanted tip designed to cut through the dura with a distal opening for injection of drugs or collection of CSF. As these needles cut through tissues, they cause irregular lacerations that can increase the potential for CSF leakage. In contrast, atraumatic needles are blunt with a closed pencil point tip and a side port for drug injection or CSF collection. They separate and dilate dural fibers rather than cutting through the fibers; thus they have been postulated to reduce the incidence of postdural puncture headache because they limit the leakage of CSF after lumbar puncture. Although atraumatic needles are now commonly used by anesthesiologists for spinal anesthesia, they are infrequently used by other clinicians as they seem unaware of their existence. This systematic review and meta-analysis of randomized controlled trials was performed to compare atraumatic and conventional lumbar puncture needles.

Background: Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly.Materials and Methods: Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n = 45) or LS (n = 46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared.Results: Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P < 0.05). Compared with LS group, the HALS group operation time (141 ± 46 vs. 172 ± 43 min; P = 0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P = 0.026], hospital expenses (5.5 ± 1.5 vs. 6.4 ± 2.4 WanRMB; P = 0.022), and conversion rate (1/45 vs. 9/46; P = 0.015) were lower. However, there was no significant difference for hospital stay (6.4 ± 2.8 vs. 6.7 ± 3.0 d; P = 0.662) and complications (15/45 vs. 12/46; P = 0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6 ± 2.9 vs. 10.9 ± 3.5; P = 0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P = 0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P = 0.302] levels.Conclusions: HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.

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Egyptian archaeologists used different terms to express the accuracy and ingenuity of ancient Egyptian artists' work in conveying the truth they witnessed and transforming their artwork into an accurate reflection of their life. Using eight examples of writings in ancient Egyptian art clearly showed that the term portrait accurately depicted artwork in ancientEgypt and the strict religious rules that artists adhered to.