简介：AbstractThe rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

简介：Introduction,ThemembersoftheCardiovascularDivisionattheUniversityofFlorida,DepartmentofMedicinehavelongrecognizedtheneedforcardiacrehabilitationofourpatients.PriortoJuly2016,arehabilitationprogramforcardiovascularpatientsattheUniversityofFloridadidnotexist.InJuly2016weinitiatedatotalpatientrehabilitationprogramforallcardiacpatients,whethertheirdiseasewasrelatedtomyocardialischemia,myocardialinfarction,arrhythmia,orheartfailure.Whenbeginningsuchaprogramthereareseveraltopicsthatmustbeconsidered.Theseincludespaceforpatientsandequipment,aswellaspersonneltostafftheprogram.Initially,personnelshouldincludeaphysiologist,anurseandaphysician.

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简介：Inthispaperourstudiesaboutthesequentialtestingprogramforpredictingandidentificatingcarcinogens,sequentialdiscriminantmethodandcost-effectivenessanalysisaresummarized.Theanalysisofourdatabaseofcarcinogenicltyandgenotoxicityofchemicalsdemonstratestheuncertainty.ofshort-termtests(STTs)topredictcarcinogensandtheresultsofmostroutineSTTsarestatisticallydependent.WerecommendthesequentialtestingprogramcombiningSTTsandcarclnogenicityassay,theoptimalSTTbatteries,therulesofthesequentialdiscriminationandthepreferalchoicesofSTTstorspecificchemicalclass.Forillustrativepmposesthecarclnogenicitypredictionofseveralsamplechamicalsispresented.Theresultsofcost-effectivenessanalysissuggestthatthisprogramhasvastsocial-economiceffectiveness.

简介：AbstractThe demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

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简介：AbstractObjective:No ideal training system exists for pancreaticoduodenectomy (PD). We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital. The total score on the task checklist (21 parameters) for measuring technical performance during PD by self assessment and instructor assessment was compared between junior (JN) and hepatobiliary pancreatic (HBP) trainees at a university hospital. Surgical outcomes of 303 PDs (2007-2013) were also compared among JN trainees, HBP trainees, and instructors, and the present position of the trainees was investigated. This study was approved by the institutional review board of Kansai Medical University on May 26, 2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD (P <.001). The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs. Although total score curves rose to the right in the JN group, scores in the HBP group were stable, at 70 or higher, which correlated with the instructor assessment. The 90-day and 30-day mortality rates were 1.6% and 0.3%, respectively. Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees. Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system. This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

简介：Oxaliplatin,ananticancerdrugcommonlyusedtotreatcolorectalcancerandothertumors,hasanumberofserioussideeffects,mostnotablyneuropathyandototoxicity.Togaininsightsintoitsototoxicprofile,oxaliplatinwasappliedtoratcochlearorgancultures.Consistentwithitneurotoxicpropensity,oxaliplatinselectivelydamagednervefibersataverylowdose1μM.Incontrast,thedoserequiredtodamagehaircellsandspiralganglionneuronswas50foldhigher(50μM).Oxailiplatin-inducedcochlearlesionsinitial-lyincreasedwithdose,butunexpectedlydecreasedatveryhighdoses.Thisnon-lineardoseresponsecouldberelatedtodepressedoxaliplatinuptakeviaactivetransportmechanisms.Previousstudieshavedemon-stratedthataxonaldegenerationinvolvesbiologicallyactiveprocesseswhichcanbegreatlyattenuatedbynicotinamideadeninedinucleotide(NAD+).TodetermineifNAD+wouldprotectspiralganglionaxonsandthehaircellsfromoxaliplatindamage,cochlearculturesweretreatedwithoxaliplatinaloneatdosesof10μMor50μMrespectivelyascontrolsorcombinedwith20mMNAD+.Treatmentwith10μMoxaliplatinfor48hoursresultedinminordamagetoauditorynervefibers,butsparedcochlearhaircells.However,whencochlearculturesweretreatedwith10μMoxaliplatinplus20mMNAD+,mostauditorynervefiberswereintact.50μMoxaliplatindestroyedmostofspiralganglionneuronsandcochlearhaircellswithapop-toticcharacteristicsofcellfragmentations.However,50μMoxaliplatinplus20mMNAD+treatmentgreat-lyreducedneuronaldegenerationsandhaircellmissing.TheresultssuggestedthatNAD+providessignifi-cantprotectionagainstoxaliplatin-inducedneurotoxicityandototoxicity,whichmaybeduetoitsactionsofantioxidant,antiapoptosis,andenergysupply.

简介：AbstractTuberculosis (TB) is on the rise in Pakistan and there could be multiple reasons including poverty, difficulty in access to TB treatment services, non-compliance with treatment, social stigma etc. According to the TB program managers, limited treatment and testing sites for tuberculosis and lack of trained human resources play a major role in compromising TB management. A major lacuna in the TB control program is the absence of active contact tracing strategy. This is essential for a disease where positive cases are known to be able to infect a further 10-15 individuals in a year. Tackling tuberculosis in Pakistan has been beleaguered by funding challenges and other systems’ bottlenecks such as lack of skilled human resources and insufficient supply of medicines, despite the fact that disease burden is one of the highest in the world. Although it is a notifiable disease, active case finding, contact tracing and reporting is notoriously low throughout the country. Access to diagnostics and treatment facilities has been limited and stigma attached to the disease remains deeply entrenched among the communities. Researchers have shown that enhanced and active approaches to contact investigation effectively identifies additional patients with TB among household contacts at a relatively modest cost. USAID’s Integrated Health Systems Strengthening and Service Delivery Activity extended support to the Health Departments of Sindh and Khyber Pakhtunkhwa provinces. In collaboration with the two provincial TB programs, community based active contact tracing was conducted on 17,696 individuals, based on the index cases. Among the contacts traced, 243 cases were diagnosed as drug sensitive or drug resistant TB. Awareness sessions were conducted to sensitize people on the various aspects of disease and importance of getting tested. The project also supported establishing three satellite Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites for drug resistant TB treatment, enhancing the programs’diagnostic and testing capacity.

简介：Cisplatindamagescochlearhaircellsandspiralganglionneuronsthroughcelldeathsignalingpathwaysthatarenotfullyunderstood.Weusedfocusedapoptosisgenemicroarraystostudyearlychangesingeneexpres-sionincochlearculturesfromP3neonatalratstreatedwithcisplatin(0.2mM).After12hoursofcisplatintreat-ment,morethan50%ofthe96genesonthearrayshowedasignificantdecreaseinexpression,consistentwithwidespreadcelldeath.However,after3hoursofcisplatintreatment,10genesshowedsignificantincreaseinex-pressionintotalcochleartissue.Inexperimentswithsubsetsofcochleartissues,at3h,cisplatininducedincreasedexpressionof12genesinthecochlearsensoryepithelium(basilarmembrane)and11genesinthespiralganglion(tissueofRosenthal'scanal,containingthespiralganglion).Theseincludedpro-andanti-apoptoticgenesin-volvedinthep53signalingpathway,TNFreceptorfamily,NF-kappaBpathway,deathdomainfamily,deatheffec-tordomainfamily,Bcl-2family,CARDfamily,TRAFfamily,andGTPsignaltransduction.Althoughthechangesingeneexpressionshowedanoverlapbetweenbasilarmembraneandspiralganglion,otherchanges,whichmayreflecttheuniqueresponseofeachtissue,werealsoobserved.Pifithrin-αblockedcisplatin-inducedup-regulationofgenesinthep53signalingpathwaywhenassayedbybothsuperarrayandrealtimePCR.Thedataaddtoourunderstandingoftheinvolvementofp53incisplatin-inducedototoxicityandotoprotection,conferredbythep53inhibitorPifithrin-α.

简介：Brachialplexusinjuryisfrequentlyinducedbyinjuries,accidentsorbirthtrauma.Upperlimbfunctionmaybepartiallyortotallylostafterinjury,orleftpermanentlydisabled.Withthedevelopmentofvariousmedicaltechnologies,differenttypesofinterventionsareused,buttheireffectivenessiswideranging.Manyrepairmethodshavephasiccharacteristics,i.e.,repairsaredoneindifferentphases.Thisstudyexploredresearchprogressandhottopicmethodsforprotectionafterbrachialplexusinjury,byanalyzing1,797articlesconcerningtherepairofbrachialplexusinjuries,publishedbetween2004and2013andindexedbytheScienceCitationIndexdatabase.Resultsrevealedthattherearemanymethodsusedtorepairbrachialplexusinjury,andtheireffectsarevaried.Interventionmethodsincludenervetransfersurgery,electricalstimulation,celltransplantation,neurotrophicfactortherapyanddrugtreatment.Therapeuticmethodsinthisfieldchangeaccordingtothehottopicofresearch.

简介：AbstractBiosafety equipment is the key barrier enabling high containment laboratories to handle high risk agents that may cause serious and potentially lethal infections. This perspective thoroughly analyzes the development of many kinds of key biosafety technologies, and equipment for protection of laboratory workers and for high containment laboratory facilities in China. Over more than ten years of rapid development, China has had remarkable achievements in key biosafety technologies and equipment in high containment laboratories. These technologies basically meet the needs of high containment laboratories construction in China. Furthermore, according to the current global situation regarding the prevention and control of infectious diseases and the technical development level of biosafety equipment, this paper proposes targeted suggestions and notes that China still needs to increase investment in scientific research to provide further technical and equipment support enabling us to build a community with a bright future in terms of human biosafety.

简介：节日长假体重和腰围会增加的人，请通过练习双臂水平伸展动作。来紧急瘦身吧!一切先从最开始的伸展动作做起，会让锻炼的效果更好，你可以眼看着自己瘦下去。以2天为一个单元来进行锻练，应该可以很明确地感受到瘦身的效果，那就是肢体收紧了。

简介：ＡＭＩＣＲＯＣＯＭＰＵＴＥＲＰＲＯＧＲＡＭＦＯＲＣＡＬＣＵＬＡＴＩＮＧＴＨＥＣＯＮＦＩＤＥＮＣＥＩＮＴＥＲＶＡＬＳＯＦＳＵＲＶＩＶＡＬＰＲＯＢＡＢＩＬＩＴＹＩＮＭＥＤＩＣＡＬＦＯＬＬＯＷ－ＵＰＳＴＵＤＩＥＳＸｉａｎｇｙｏｎｇｂｉｎｇ项永兵；Ｇａｏｙｕ...

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简介：Objective:Tostudytheprotectiveeffectofischemicpreconditioning(Ⅰ-pre)andischemicpostconditioning(Ⅰ-post)againstischemia/reperfusion(I/R)injuryinrat'sliver.Methods:UsingratmodelofhepaticsegmentalI/Rinjury,ratsweredividedinto5groups:GroupA(shamgroup),GroupB(I/Rinjury),GroupC(Ⅰ-pregroup),GroupD(Ⅰ-postgroup)andGroupE(combinedtreatmentofⅠ-preandⅠ-post).Serumalanineaminotransferase(ALT),aspartateaminotransferase(AST),malondiaidehyde(MDA),glutathione(GSH),superoxidedismutase(SOD),glutathioneperoxidase(GSH-Px)andmyeloperoxidase(MPO)inhepatictissuesweredetermined,respectively.Inaddition,7days'survivalofGroupsB,C,DandEwereevaluated.Results:ComparedwithGroupB,GroupsC,DandEexhibitedsignificantlydecreasedALTandASTrelease,minimizedtissueinjury,suppressedvaluesofMDAandMPO,increasedactivitiesofSOD,GSH-PxandGSH(P<0.05),aswellasimprovedanimalsurvival.ThedifferencesamongGroupsC,DandEwerenotstatisticallysignificant.Conclusions:Ⅰ-pre,Ⅰ-postandcombinedtherapyofⅠ-preandⅠ-posthaveprotectiveeffectagainsthepaticI/Rinjury,whichiscorrelatedwithitsfunctionofreducingtheproductionofreactiveoxygenspecies,maintainingtheactivitiesofantioxidantsystemsandsuppressingneutrophilsrecruitment.NoadditiveeffectcanbeobtainedinGroupE.

简介：ObjectivesToevaluatethefeasibilityandsafetyofdistalprotectiondevice(PercuSurge)duringpercutaneouscoronaryintervention(PCI)inpatientswithacutecoronarysyndrome.MethodsFromOctober2004toAugust2007,40patientswithhighriskacutecoronarysyndromewhoreceivedprimarycoronaryinterventionwereincludedinthisstudy.PatientsweredividedintotwogroupsaccordingtowhetherPercuSurgewasattemptedduringPCI.Thebasicclinicalcharacteristics,angiographicresults,andfollow-updatabeforedischargewerecompared.Coronaryarteriesbloodflowthrombolysisinmyocardialinfarction(TIMI)grade,TIMImyocardialperfusion(TMP)gradeandtherateofno-reflowwereperformedinallcasesafterPCI.ResultsTherewasnosignificantdifferencebetweenthetwogroupsinbasicclinicalcharacteristicsandangiographybeforePCI(P>0.05).AllpatientsunderwentPCIsuccessfullyinbothgroups.InthePercuSurgegroup,PCIwithPercuSurgeguardwireprotectionwasperformedsuccessfullyin18patients.TherewassignificantdifferencebetweenthetwogroupsinTIMI3flowsgainedintargetvesselsafterPCI.BetterpercentageofTMPgrade3oftargetvesselswasachievedinPercuSurgegroup.Lessno-reflowwerefoundinPercuSurgegroup.TherewerelowerpeaktroponinIandserumMBisoenzymeofcreatinekinaselevels,higherleftventricularejectionfractionandsmallerleftventricularend-diastolicdimensioninthePercuSurgegroupafterPCIatthedatebeforedischarge(P<0.05).TherewasnomajoradversecardiaceventsinPercuSurgegroup,onlyonepatientdiedinthecontrolgroup.ConclusionsThisstudydemonstratesthatusingthePercuSurgeGuardwiresystemduringPCIinhighriskacutecoronarysyndromepatientstopreventno-reflowisfeasibilityandsafety.

简介：Humanheadimpactinjuriescausedbyasuddenimpactforceareverycommoninaviationlifesaving,carcrashaccident,warorsportsactivities.Yet,anintriguingexampleofnatureiswoodpeckerwhichisfreefromheadinjuryevenitdrumstrunkcontinuallyataspeedofabout6-7m/sandadecelerationofabout1000g.Woodpeckermusthavespecialcharacteristicstoattenuaterepetitiveimpactforcetosustainrapidpeckingwithoutbraininjury.Inthisstudy,theeffectofmechanicalpropertyofcranialboneonthebrainduringimpactwasinvestigatedusingthefiniteelement(FE)approach.Itwasdemonstratedthatthepressure,Von-Misesstressesandshearstressatthesamepointontheposteriorofwoodpecker'sbrainweredecreasedgreatlycomparedwithhoopoeandlark.Itwasstatedthatthehigherstrengthofwoodpecker'scranialbonemightplayanimportantroleforpreventingwoodpecker'sheadinjury.

简介：Inthispaper,weproposeamethodtoimproveanti-radiationcapabilitybycoatingheavymetalX-rayprotectionglasswithcompoundphotoniccrystallayers,basedontheuniquepropertyofphotoniccrystalthatlightcannotbepropagatedwithintherangeofbandgaps.Usingtheplanewaveexpansionmethod,wemadeatheoreticalstudyofparametersaffectingthebandgapstructuresofone-dimensionalphotoniccrystals.Basedonthefindings,wechoseappropriatematerialsandcompoundstructureofphotoniccrystalsoastogethighX-rayreflectioncoatingphotoniccrystallayers.Bythismethod,thereflectionratewithinX-raywavelengthcanreachthemaximumvalueof100%,andtheaveragevalueofover90%.Evenlow-costheavymetalX-rayprotectionglassofabsorptioncoefficientvaluecanachievethedesiredeffect.Thus,thismethodgreatlydecreasestheanti-radiationrequirementsofheavyX-rayprotectionglass.