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简介：AbstractBackground:Tuberculosis (TB) prevention through the use of preventive treatment is a critical activity in the elimination of TB. In multiple settings, limited staffing has been identified as a barrier to managing preventive treatment for TB contacts. This study aims to determine how health center staffing, service type, and TB caseload affects implementation of isoniazid preventive therapy (IPT) for TB contacts in southern Lima.Methods:We conducted an ecological study in 2019 in southern Lima, Peru. Through the review of medical records, we identified contacts of TB patients who initiated IPT during 2016-2018, and who were 0-19 years old, the age group eligible for IPT according to Peruvian guidelines. We assessed bivariate associations between health center characteristics (numbers of physicians and nurses, types of services available, annual TB caseload) and IPT initiation and completion using binomial logistic regression.Results:Among 977 contacts, 69% took more than a week to start IPT and 41% did not complete IPT. For those who successfully completed IPT, 58% did not complete full medical follow-up. There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses, more comprehensive services, or higher TB caseloads. Among contacts, female sex was associated with delay in initiating IPT (P = 0.005), age 5-19 years old was associated with completion of IPT (P = 0.025) and age < 5 years old was associated with completion of clinical evaluations (P = 0.041).Conclusions:There are significant gaps in IPT implementation in health centers of southern Lima, Peru, but insufficient staffing of health centers may not be responsible. Further research is needed to identify how IPT implementation can be improved, potentially through improving staff training or monitoring and supervision.

简介：AbstractObjective:Well-defined germ-line mutations in the PTCH1 gene are associated with syndromic multiple basal cell carcinomas (BCCs). Here, we used whole exome sequencing (WES) to identify the role of patched-1 in patients with multiple, unusually large BCCs.Methods:A 72-year old patient presenting with numerous BCCs progressing to large ulcerating lesions was enrolled. WES was used to identify the pathogenic gene locus.Results:Genetic work-up by WES identified a homozygous PTCH1 nonsense mutation in the tumor tissue but not present in her blood cells or in non-lesional skin. In addition, heterozygous missense mutations were identified in three cancer-associated genes (EPHB2, RET, and GALNT12) in blood cells as well as in lesional and non-lesional skin. We also tested systemic immune therapy as a potentially beneficial approach to treat patients with numerous large BCCs on scatted areas of involvement. A rapid and sustained response to nivolumab was noted, suggesting that it is an efficacious drug for long-term therapeutic outcome.Conclusion:PTCH1, EPHB2, RET, and GALNT12 may potentially contribute to the synergistic oncogene driven malignant transformation manifesting as multiple, unusually large BCCs.

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简介：摘要Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths globally. The currently available therapy options are normobaric oxygen (NBO) and hyperbaric oxygen (HBO). While NBO lacks in efficacy, HBO is not available in all areas and countries. We present a novel method, extracorporeal hyperoxygenation therapy (EHT), for the treatment of CO poisoning that eliminates the CO by treating blood extracorporeally at elevated oxygen partial pressure. In this study, we proof the principle of the method in vitro using procine blood: Firstly, we investigated the difference in the CO elimination of a hollow fibre membrane oxygenator and a specifically designed batch oxygenator based on the bubble oxygenator principle at elevated pressures (1, 3 bar). Secondly, the batch oxygenator was redesigned and tested for a broader range of pressures (1, 3, 5, 7 bar) and temperatures (23, 30, 37 ℃). So far, the shortest measured carboxyhemoglobin half-life in the blood was 21.32 min. In conclusion, EHT has the potential to provide an easily available and effective method for the treatment of CO poisoning.

简介：Tinnitus,thephenomenonofringingorbuzzingintheearswithoutanexternalsoundsourceisoneofthemostcommonlyreportedsymptomsinotorhinolaryngologyandaffects10–15%ofthegeneralpopulation.Modelshavebeendevelopedtoaccountforneuralbasisoftinnitus,itspathogenesisanditsconsequencesonmentalhealth(deRidderetal.,2013).Inmostcasestinnitusonsetfollowsapartialhearingimpairment.Peripheralsensorydeprivationduetocochleardamages

简介：通常，组织缺氧是在松驰的阴茎的一个正常生理的条件，被常规夜的勃起在cavernosal织物的坚持的组织缺氧由于neuropraxia结果在激进的前列腺切除术以后与自发、夜的勃起的正常可勃起的function.1缺乏在男人打断，它导致cavernosal的apoptosis和退化光滑的肌肉纤维。因此，克服组织缺氧被相信在neuropraxia期间起一个关键作用。真空的使用在阴茎康复的可勃起的设备(VED)据说是有效的并且可以阻止阴茎长度的损失。在VED使用以后的肉体的血被增加并且由动脉、静脉的血组成，由颜色Dopplersonography和血气体分析揭示了。类似的现象在否定压力创伤治疗(NPWT)被观察。然而，NPWT比VED，和hypoperfused采用一个更低的否定压力地区，响应邻近创伤边的否定压力增加，被观察。尽管如此，询问考虑理想的低于大气层的压力层次，行动的模式，和VED的治疗学的持续时间仍然保持未答复。而且，一个hypoperfused地区或PO2坡度是否在VED期间出现在阴茎，仍然保持不清楚治疗。在阴茎康复优化一个临床的VED协议，关于VED的机制的进一步的研究，在阴茎的不同部分的特别即时的PO2大小，应该被执行。

简介：BackgroundClinicalapplicationofimplantablecardioverterdefibrillator(ICD)cansignificantlyreducetheincidenceofsuddencardiacdeath(SCD).However,ICDcannotpreventventriculartachycardia(VT)orventricularfibrillation(VF).PreviousstudiesindicatedthatICDcombinedwithreasonableanti-arrhythmicdrugtherapycanimproveanti-arrhythmiceffect.EMIAT,CAMIAandOPTICtrialsreportedthatcombinedtreatmentofAmiodaroneandβreceptorblockerswassuperiortotheirtreatmentalone.Therefore,itisnecessarytogiveanti-arrhythmictreatmentafterICDimplantation.MethodsTotally180ICDimplantationrecipientsenrolledinourhospitalfromJan2011toMarch2014.Amongthem,39recipientsweretreatedwithAmiodarone(GroupA),89recipientsweretreatedwithβblocker(GroupB),and52recipientsweretreatedwithAmiodaronecombinedwithβblocker(GroupC)afterICDimplantation.Patientswerefollowedupfor3to40monthsbymonitoringtheheartrate,LVEFValueandrapidventriculararrhythmiasevents.ResultsTherewerenosignificantdifferencesonheartratebeforeandafterICDimplantationamongthethreegroups(P=1.28,P=0.85),butthechangeofheartratewasstatisticallyhigher(P=0.04)inGroupBcomparedwithGroupAandGroupC.TherewerenostatisticalsignificanceinLVEFvaluebeforeICDimplantationandafterICDimplantationandthechangeofLVEFvalue(P=0.56,P=0.50,P=0.99).TheoccurrencerateofrapidventriculararrhythmiasinGroupA(10.26%)andGroupB(10.11%)wassignificantlyhigher(P=0.04)thaninGroupC(1.92%).whichwaeslightlyincreasedbyAmiodaroneinGroupAandGroupC.Therewere2casesofthyroiddysfunctioninGroupA,1caseinGroupCandnocaseinGroupB.Nopulmonaryinterstitialfibrosiscaseswerefoundinthisstudy.ConclusionsCombinedtreatmentwithAmiodaroneandβreceptorblockerscouldsignificantlyreducerapidventriculararrhythmiaswhencomparedwithtreatmentofAmiodaroneorβblockeralone.

简介：Thisreviewaimsatevaluatingtheexistingevidenceregardingpostreperfusionsyndrome,providingadescriptionofthepathophysiologicmechanismsinvolvedandpossiblemanagementandpreventivestrategies.APubMedsearchwasconductedusingtheMeSHdatabase,＂Reperfusion＂AND＂livertransplantation＂werethecombinedMeSHheadings;EMBASEandtheCochranelibrarywerealsosearchedusingthesameterms.52relevantstudiesandoneongoingtrialwerefound.Theconceptofpostreperfusionsyndromehasevolvedthroughyearstoamultisystemicdisorder.Theimplicationsofthemainorgan,recipientandprocedurerelatedfactorsinthegenesisofthiscomplexsyndromearediscussedinthetextasthenovelpharmacologicandtechnicalapproachestoreduceitsincidence.Howevertheavailableevidenceaboutriskfactors,physiopathologyandpreventivemeasuresisstillconfusing,thepresenceoftwomaindefinitionsandthenumerosityofpossibleconfoundingfactorsgreatlycomplicatestheinterpretationofthestudies.

简介：BACKGROUND:ResearchesindicatethatpatientswithWilsondisease(WD)haveabnormalskeletalmetabolism,whichisinducedbyvariousfactors.OBJECTIVE:ToprobeintothechangingcharacteristicsofabnormalskeletalmetabolisminWDpatientsandobservetheeffectofdecoppertherapy.DESIGN:Case-contrastandself-controlstudy.SETTING:DepartmentofNeurology,AffiliatedHospitalofNeurologicalInstitute,AnhuiCollegeofTraditionalChineseMedicine.PARTICIPANTS:Atotalof35patientswithWDincluding21malesand14femalesagedfrom10to42yearswiththemeanageof(20±8)yearswereselectedfromDepartmentofNeurology,AffiliatedHospitalofNeurologicalInstitute,AnhuiCollegeofTraditionalChineseMedicinefromSeptember2000toFebruary2001.Allthepatientswereincompliancewiththediagnosticcriteria:historyoffamilyheredity;conesymptomsinvitro,physicalsignorliversymptoms;positiveKayser-Fleischerring;serumcopperprotein＜200mg/LorAcopperoxidase＜0.2;urinecopper＞1.6μmol/24hours;livercopper＞250μg/g(dryweight).Thecontrolgroupwasselectedfrom25casesofhealthindividualsincluding13malesand12femalesagedfrom16to35yearswiththemeanageof(22±6)years.Allpatientswhoparticipatedinthestudywereinformedfirstandconsented.METHODS:Patientsintreatmentgroupweretreatedwithvenousinjectionof1.0gsodiumdimercaptosulfonate,onceadayfortotally6successivedays.Andthen,patientsrestedfor2days.Thisprocedurementionedabovewasregardedasacourse,andthetreatmentlastedfor4-8courses.Beforeandafterinjectionofsodiumdimercaptosulfonate,serumcalcitonin(CT),osteocalcin(BGP),parathyroidhormone(PTH)and1,25-(OH)2VitD3weremeasuredwithradio-immunitymethod:blood,urinecalcium,phosphorumandurinecreatinineweremeasuredwithbiochemicalanalyzer;urinedihydropyrimidinedehydrogenase(DPD)wasdetectedwithenzyme-immunitymethod;bonemineraldensity(BMD)wascheckedattheonethirdfromdistalendofulnaandradiuswithsingle

简介：目的：观察耳穴贴压治疗海洛因依赖的疗效。方法：耳穴贴压配合西药美沙酮治疗海洛因依赖60例，并与美沙酮治疗60例作对照，临床戒毒观察10d。结果与结论：结果表明，耳穴贴压配合西药美沙酮戒毒疗效明显优于对照组美沙酮的戒毒疗效（P〈0．01），其复吸率也低（P〈0．01）。认为耳穴贴压配合西药美沙酮戒毒是目前比较理想的戒毒治疗方法。

简介：挑治百会、大椎、陶道、身柱、神道、灵台、肺俞和三阴交穴，并取肺、胃、内分泌、皮质下、耳神门、面颊为主穴行耳穴贴压，治疗痤疮34例，4个疗程后33例有效，1例无效。

简介：AbstractCOVID-19 is known for its magical infectivity, fast transmission and high death toll based on the large number of infected people. From the perspective of the clinical manifestation, autopsy examination and pathophysiology, the essence of COVID-19 should be viewed as a sepsis induced by viral infection, and has the essential characteristics as sepsis induced by other pathogens. Therefore, in addition to etiological and supportive treatment, immunomodulatory therapy is also appropriate to severe COVID-19. Although there is still a lack of consensus on immunotherapy for sepsis so far, relatively rich experiences have been accumulated in the past decades, which will help us in the treatment of severe COVID-19. This article will elaborate immunotherapy of sepsis, though it may not be consistent.

简介：Risingworldwidecancerincidenceandresistancetocurrentanti-cancerdrugsnecessitatetheneedfornewpharmaceuticalcompoundsanddrugdeliverysystem.Malfunctionoftheimmunesystem,particularlyinthetumormicroenvironment,causestumorgrowthandenhancestumorprogression.Thus,cancerimmunotherapycanbeanappropriateapproachtoprovokethesystemicimmunesystemtocombattumorexpansion.Texosomes,whichareendogenousnanovesiclesreleasedbyalltumorcells,contributetocell-cellcommunicationandmodifythephenotypicfeaturesofrecipientcellsduetothetexosomes'abilitytotransportbiologicalcomponents.Forthisreason,texosome-baseddeliverysystemcanbeavaluablestrategyfortherapeuticpurposes.Toimprovethepharmaceuticalbehaviorofthissystemandtofacilitateitsuseinmedicalapplications,biotechnologyapproachesandmimetictechniqueshavebeenutilized.Inthisreview,wepresentthedevelopmenthistoryoftexosome-baseddeliverysystemsanddiscusstheadvantagesanddisadvantagesofeachsystem.

简介：Immunecheckpointinhibitorsareincreasinglydrawingmuchattentioninthetherapeuticdevelopmentforcancertreatment.However,manycancerpatientsdonotrespondtotreatmentswithimmunecheckpointinhibitors,partlybecauseofthelackoftumor-infiltratingeffectorTcells.CancervaccinesmayprimepatientsfortreatmentswithimmunecheckpointinhibitorsbyinducingeffectorT-cellinfiltrationintothetumorsandimmunecheckpointsignals.Thecombinationofcancervaccineandanimmunecheckpointinhibitormayfunctionsynergisticallytoinducemoreeffectiveantitumorimmuneresponses,andclinicaltrialstotestthecombinationarecurrentlyongoing.

简介：Lungcanceristhemostfrequentlydiagnosedcancerandaleadingcauseofcancermortalityworldwide,withadenocarcinomabeingthemostcommonhistologicalsubtype.Deeperunderstandingofthepathobiologyofnon-smallcelllungcancer(NSCLC)hasledtothedevelopmentofsmallmoleculesthattargetgeneticmutationsknowntoplaycriticalrolesinprogressiontometastaticdiseaseandtoinfluenceresponsetotargetedtherapies.Theprinciplegoalofprecisionmedicineistodefinethosepatientpopulationsmostlikelytorespondtotargetedtherapies.However,thecancergenomelandscapeiscomposedofrelativelyfew"mountains"[representingthemostcommonlymutatedgeneslikeKRAS,epidermalgrowthfactor(EGFR),andanaplasticlymphomakinase(ALK)]andavastnumberof"hills"(representinglowfrequencybutpotentiallyactionablemutations).Low-frequencylesionsthataffectadruggablegeneproductallowarelativelysmallpopulationofcancerpatientsfortargetedtherapytobeselected.

简介：点刺耳穴目1和目2,并挤压出血,治疗85例麦粒肿患者,经过5次治疗,治愈63例,好转17例,无效5例,总有效率94.1%.

简介：Objective:Toobservethetherapeuticeffectofhydro-acupuncturetherapyfortreatmentofvertigoinducedbyvertebroarterytypecervicalspondylopathyandtostudyitsactionmechanisms.Methods:Atotalof54casesofvertebroarterytypecervicalspondylopathypatientswereobservedinthepresentstudy.Fengfu(GV16)andJiaji(EX-B2)neartheregeneratedcervicalvertebralbodywereusedforinjectionofLigustrazineinjectio,1mLeveryacupoint,onceeveryotherday,with7sessionsbeingatherapeuticcourse.Beforeandaftertreatment,cerebralbloodflowvolumewasdeterminedusingaDopplervelocimeter.Results:After2weeks'treatment,ofthe54cases,28(51.9%)hadtheirvertigodisappeared,13(24.1%)hadremarkableimprovement,10(18.5%)hadimprovementand3(5.5%)failedinthetreatment,withaneffectiverateof94.5%.Aftertreatment,thepeakandmeanvaluesofthebloodflowvelocityofthebilateralvertebralarteriesandthebasilararteryincreasedsignificantlyincomparisonwithpre-treatment(P＜0.01).Conclusion:Hydro-acupuncturetherapyhasanobvioustherapeuticeffectforrelievingvertebroarterytypevertigoandamelioratingcerebralbloodsupply.

简介：各种各样的研究证明了那变换血管收缩素的酶(王牌)基因插入/删除(标志)多型性可以在前进起一个作用结束舞台在有IgA肾炎(IgAN)的病人的肾的失败(ESRF)。在这使随机化的控制试用，病人们被跟随在上面5年决定他们的长期的肾的结果到ACEI/ATRA治疗并且如果他们的王牌基因侧面能在决定他们的反应到治疗起一个作用，查明。有IgAN的七十五个病人被获得。37在为62的ACEI/ATRA治疗上??H

简介：为了在长期的绿内障patients.METHODSA评估有中央角膜的subbasal神经纤维层的眼睛的表面变化和它的关联，没有任何眼睛的问题，眼睛的表面评估的未来的比较学习为至少6mo和25个正常题目的50只眼睛在使用二的25个病人或更多的antiglaucoma药的50只眼睛被执行作为控制。评估的学习参数包括了视觉尖酸，intraocular压力，眼睛的表面评估参数[荧光黄分散时间(FTBUT)，我测试的Schirmers，眼睛的表面染色分数和眼睛的表面疾病索引分数(OSDI)]，中央角膜的感觉(CochetBonnettaesthesiometer)，由在绿内障盒子和控制组中的共焦的microscopy.RESULTSThe平均数值的中央subbasal神经纤维层密度(SBNFLD)分别地如下：OSDI分数(35.89祣潴楫敮????????????木????€???€乔????偉?‰??????????倨???‵？？