简介：

简介：

简介：ＡＣＬＩＮＩＣＡＬＲＥＰＯＲＴＯＦＲＥＦＲＡＣＴＯＴＹＣＡＲＣＩＮＯＭＡＯＦＯＶＡＲＹＡＮＤＦＡＬＬＯＰＩＡＮＴＵＢＥＴＲＥＡＴＥＤＷＩＴＨＴＡＸＯＬＣａｉＳｈｕｍｏ蔡树模；ＴａｎｇＪｉｅ汤洁；ＦａｎＪｉａｎｘｕａｎ范建玄；ＷｅｎｇＺｈｏｎｇｙｉｎｇ...

简介：AbstractTransparency Ecosystem for Research and Journals in Medicine (TERM) working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline. These recommendations from editors and reviewers included 10 components of essential requirements: systematic review of existing relevant guidelines, guideline registration, guideline protocol, stakeholders, conflicts of interest, clinical questions, systematic reviews, recommendation consensus, guideline reporting and external review. TERM working group abbreviates them as PAGE (essential requirements for Publishing clinical prActice GuidelinEs), and recommends guideline authors, editors, and peer reviewers to use them for high-quality guidelines.

简介：AbstractBackground:Postoperative pneumonia (POP) is one of the most common infections following heart valve surgery (HVS) and is associated with a significant increase in morbidity, mortality, and health care costs. This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study. Patients were randomly assigned to the derivation and validation sets at 1:1 ratio. A prediction model was developed with multivariable logistic regression analysis in the derivation set. Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients (8.2%). Multivariable analysis identified ten significant predictors for POP in the derivation set, including older age, smoking history, chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, poor cardiac function, heart surgery history, longer cardiopulmonary bypass, blood transfusion, and concomitant coronary and/or aortic surgery. A 22-point risk score based on the multivariable model was then generated, demonstrating good discrimination (C-statistic: 0.81), and calibration (Hosmer-Lemeshow χ2 = 8.234, P = 0.312). The prediction rule also showed adequate discriminative power (C-statistic: 0.83) and calibration (Hosmer-Lemeshow χ2 = 5.606, P = 0.691) in the validation set. Three risk intervals were defined as low-, medium-, and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS, which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org, ChiCTR1900028127; http://www.chictr.org.cn/showproj.aspx?proj=46932

简介：AbstractFibroblast growth factor 21 (FGF21) is a fasting or stress inducible metabolic hormone produced mainly in the liver. It plays important roles in regulating both glucose and lipid homeostasis via interacting with a heterodimeric receptor complex comprising FGF receptor 1 (FGFR1) and β-klotho (KLB). For the past decade, great effort has been made on developing FGF21 derivatives or specific FGF21 receptor agonists into therapeutic agents for various metabolic disorders including type 2 diabetes (T2D), obesity, and more importantly, nonalcoholic fatty liver disease (NAFLD). Here we have reviewed FGF21 gene and protein structures, its expression pattern, cellular signaling cascades that mediate FGF21 production and function. We have then summarized the six clinical trials utilizing four FGF21 analogues. Finally, two recent literatures on the development of GLP-1 and FGF21 dual agonists were presented briefly.

简介：Staphylococcusepidermidisisoneoftheleadingpathogensofnosocomialinfections.Twenty-eightstrainsofbiofilm-negativeStaphylococcusepidermidis,ofwhichthirteenstrainsconsideredastheclinicalstrainswereisolatedfromcatheters,bloodandurineofpatientsinHuashanHospital(Shang-hai,China)andfifteenstrainsconsideredascommensalstrainswereisolatedfromtheskinofhealthystudentswhohadnocontactwithhospitalsinrecenthalfyear,wereinvestigatedfortheadherencetohumanumbilicalveinendothelialcelllineECV304andhumancervicaladenocareinomacelllineHela,respectively.Ourresultsshowedthattheclinicalstrainsweremuchmoreadhesivetobothcellsthancommensalones.Theendothelialadherencemaybeavirulencefactorassociatedwiththisbacterialpathogenesis.

简介：客观：为了改进痊愈，与由craniocerebral损害复杂的腹的内脏的损害病人评价。方法：由craniocerebral损害复杂的腹的内脏的损害的176个盒子的临床的数据回顾地被分析。结果：在这个系列，44个盒子死了，死亡是25.0%。死亡的主要原因是与吃惊相结合的腹的内脏的损害和严重craniocerebral损害。结论：在早舞台由精确诊断改进痊愈率是必要的。腹的帕拉穿刺术和CT应该即时并且动态地被执行。优先级应该被给life-threateninginjuries的治疗。

简介：ToexploretherelationbetweenserumbilinabinandeoronaryheartdiseaseMethodsComparethelevelofserumbilinabinamongpatientswitheoronaryheartdisease,patientswithotherdiseaseandnormalpersons.ResultsThelevelofserumbilinabinofpatientswithcoronaryheartdiseaseishigherthanthatofnormalpersons.ConclusionThereductionofdensityofserumbihrubinisoneoftheindependentriskfactorsofcoronaryheartdisease.

简介：AbstractAllergic contact dermatitis is a common clinical allergic disease. The patch test is the gold standard for finding and clarifying contact allergens. With the deepening understanding of the epidemiology, pathogenesis, and clinical manifestations of contact dermatitis, as well as the increased requirements for the standardized application of patch tests, the relevant consensus needs to be continuously updated. This consensus is updated on the basis of the version issued in 2015. In this revised version, it refines the selection of clinical indications, improves the judgment and interpretation of results, adds delayed detection and patient education, and so on, which aims to further standardize clinical applications and improve the value of patch test.

简介：AbstractBackground:The 2019 novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyze the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were retrospectively collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens.Results:None of the 137 patients (61 males, 76 females, aged 20-83 years, median age 57 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their conditions. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.

简介：

简介：目的：研究针刺对中风偏瘫痉挛状态的影响。方法：采用修改的Ashworth痉挛评定级、Brunnstrom分级、Barthel日常生活能力（ActivitiesofDailyLiving，ADL）指数分别评定痉挛程度、运动功能水平、日常生活能力，观察头针、体针联合应用对中风后偏瘫患者痉挛状态的影响。结果：头针、体针联合应用对痉挛状态的改善，对运动功能水平及日常生活能力的影响均优于单纯体针治疗（P〈0．01）。结论：头针、体针联合应用在改善痉挛状态方面有独特的优势，可提高患者的运动功能水平及日常生活能力。

简介：

简介：Peripheralfacialparalysisisacommondiseasewithmanifestationoffacialparalysis.Theauthor'sclinicalobservationon50casesoffacialparalysistreatedmainlywithacupunctureshowedaneffectiverateof98%,andtheremarkableeffectivenesswasreportedasfollows.50casesofoutpatientswhichconsistedof14malesand36femaleswereobserved.Theoldestwas61yearsandtheyoungest24years,withanaverageageof36years.33caseshadfacialparalysisontherightsideandother17casesontheleftside.Theshortestdurationwasonedayandthelongest19months.Treatmentwasdoneonceeveryotherdayandacoursecomprisedoftentreatments.Mainacupoints:Chengqi(ST1),Sibai(ST2),Juliao(ST3),Dicang(ST4),Jiache(ST6),Xiaguan(ST7),Sizhukong(TE23),andHegu(LI4),etc.werealladoptedineverytreatement.ComplementaryacupointswereYingxiang(Li20),Cuanzhou(BL2),Yangbai(GB14),andChengjiang(CV24).Methods:Gauge28filiformneedles(1cunatlength)wereused.Intheneedlingprocess,manipulationsofevenreinforcingandreducingincombinationwithlifting-thrustingandtwirling-rotatingwereabopted.Theneedlingsensationwasmadetoincreaseonlywithinthepatient'sbearablethresholdandtheneedleswerewithdrawnimmediatelyfollowingmanipulatingtheneedlesforawhile(about3min).Shallowinsertionofacupunctureneedleswascarriedoutthroughoutthewholetreatmentprocess.Criteriaofthetherapeuticeffect:Cure:Theclinicalsynptomsdisappearedompletelyaftertreatment(facialmusclewasnormal).Effective:Somesymptomswereimprovedbutfacialexpressionwasstillslay.Noeffect:Symptomsremainedthesameafterthetherapy.Results:80%ofthe50cases,namely27caseswithleftfacialparalysisand13caseswithrightsidefacialparalysis,werecured.7cases(14%)showedsignificantimprovement,2cases(4%)effectiveness,and1case(2%)noeffect,thusthetotaleffectiveratewas98%.Conclusion:Patientswithshorterdurationofdisease(withinamonth)hadhigherrecoveringratethanthos

简介：

简介：

简介：Toinvestigatetherelationshipbetweenthechronotropicincompetenceandangiographicseverityofcoronaryarterydisease,andtheclinicalvalueofinappropriatechronotropicresponsesinexercise.MethodsCoronaryangiographywasperformedin130patientssuspectedordiagnosedascoronaryheartdisease(CHD),andangiographicseverityofcoronaryarterydiseasewasquantitatedbyDukescoreandGensiniscore.Thepatientsweredividedinto4groups:non-CHDgroup(39cases),CHDgroupwithonlyonecoronaryarteryinvolved(CHD1,30cases),CHDgroupwithtwocoronaryarteriesinvolved(CHD2,31cases)andCHDgroupwiththreecoronaryarteriesinvolved(CHD3group,30cases).Amonthbeforecoronaryangiography,symptom-limitedbicycleergometorexercisehadbeenaccomplished,thechronotropicresponsehadbeenmeasuredandexpressedasratioofheartratereserve(HRR)andthemaximalage-predictedheartrateachieved(rHR).ResultsAnalysisofvarianceshowedthatrHRandHRRweremuchsignificantlylower(allP<0.01)inCHD2group(rHR0.793±0.078,HRR0.626±0.110)andCHD3group(rHR0.775±0.065,HRR0.586±0.125)thanthatinnon-CHDgroup(rHR0.888±0.062,HRR0.798±0.105)andCHD1group(rHR0.857±0.084,HRR0.735±0.146).rHRwassimilarbothbetweennon-CHDgroupandCHD1group(P>0.05)andbetweenCHD2groupandCHD3group(P>0.05).HRRhasnodifferencebetweenCHD2groupandCHD3group(P>0.05),butwassignificantlydifferentbetweennon-CHDgroupandCHD1group(P<0.05).TherewasasignificantlynegativecorrelationbetweenrHR,HRRandDukescore(r=-0.554,-0.578,respectively,allP<0.01),Gensiniscore(r=-0.453,-0.467,respectively,allP<0.01).CHDproportionreached75%inpatientswhohadpositiverHR(orHRR)andnon-STdepression.Diagnosticvalue[sensitivity0.868(P<0.01),0.846(P<0.01),specificity0.462,0.462,accuracy0.746(P<0.05),0.731,positivepredictivevalue0.790,0.786,negativepredictivevalue0.600,0.563,respectively]ofrHR<85%orHRR<72%whichwereusedasan

简介：AbstractCerebral small vessel disease (SVD) is a common global brain disease that causes cognitive impairment, ischemic or hemorrhagic stroke, problems with mobility, and neuropsychiatric symptoms. The brain damage, seen as focal white and deep grey matter lesions on brain magnetic resonance imaging (MRI) or computed tomography (CT), typically accumulates "covertly" and may reach an advanced state before being detected incidentally on brain scanning or causing symptoms. Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation, perhaps explaining a lack of awareness, until recently, of the full range and complexity of SVD.In this review, we discuss the varied clinical presentations, established and emerging risk factors, relationship to SVD features on MRI or CT, and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle interventions. The core message is that effective assessment and clinical management of patients with SVD, as well as future advances in diagnosis, care, and treatment, will require a more "joined-up" ’ approach. This approach should integrate clinical expertise in stroke neurology, cognitive, and physical dysfunctions. It requires more clinical trials in order to improve pharmacological interventions, lifestyle and dietary modifications. A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions. An essential prerequisite to accelerating clinical trials is to improve the consistency, and standardization of clinical, cognitive and neuroimaging endpoints.

简介：