简介：AIM:Toanalyzethepotentialrelationshipbetweengastroesophagealrefluxdisease(GERD)andthedevelopmentofatrialfibrillation(AF).METHODS:Usingthekeywords'atrialfibrillationandgastroesophagealreflux','atrialfibrillationandesophagitis,peptic','atrialfibrillationandhernia,hiatal'thePubMed,EMBASE,CochraneLibrary,OVIDSP,WILEYdatabaseswerescreenedforrelevantpublicationsonGERDandAFinadultsbetweenJanuary1972-December2013.StudieswritteninlanguagesotherthanEnglishorFrench,studiesnotperformedinhumans,reviews,casereports,abstracts,conferencepresentations,letterstotheeditor,editorials,commentsandopinionswerenottakenintoconsideration.ArticlestreatingthesubjectofradiofrequencyablationofAFandtheconsecutivedevelopmentofGERDwerealsoexcluded.RESULTS:Twothousandonehundredsixty-onetitleswerefoundofwhich8articlesmettheinclusioncriteria.ThepresenceofAFinpatientswithGERDwasreportedtobebetween0.62%-14%,highercomparedtothosewithoutGERD.EpidemiologicaldataprovidedbytheseobservationalstudiesshowedthatpatientswithGERD,especiallythosewithmoresevereGERD-relatedsymptoms,hadanincreasedriskofdevelopingAFcomparedwiththosewithoutGERD,butacausalrelationshipbetweenGERDandAFcouldnotbeestablishedbasedonthesestudies.ThemechanismsofAFasaconsequenceofGERDremainlargelyunknown,withinflammationandvagalstimulationplayingapossibleroleinthedevelopmentofthesedisorders.TreatmentwithprotonpompinhibitorsmayimprovesymptomsrelatedtoAFandfacilitateconversiontosinusrhythm.CONCLUSION:AlthoughlinksbetweenAFandGERDexist,largerandomizedclinicalstudiesarerequiredforabetterunderstandingoftherelationshipbetweenthesetwoentities.

简介：Incomparisonwiththenormalpeoplegroup,valuesofbloodCD2+andCD4+inpa-tientswithmallgnanttumorstreatedwithradiotherapyandchemotherapyweresignificantlylowerandtheratioofCD助+andCD8+decreasedobviously（allP<0.001）;CD8+hadnoapparentchange（P>0.05）.Followingacupuncturaltreatment,valuesofCD2+,CD4+andtheratioofCD4+toCD8+increasedobviously（allP<0.001）;whilethoseofthemedicinalcontrolgrouphadnosignificantchangeaftertreatment（P>0.05）.ValuesofIgG,IgAandIgMinpatients’serumpresentedanabnormalde-creasingorincreasingtendency,andC3inminorityofpatientswereraised.ResultsindicatedthattherewasabiphasicregulatoryeffectofacupunctureonthedisturbanceofhumoralimmunityandcouldcorrectthedeviationofC3level;anditseffectwasbetterthanorsimilartothatofthemedicinecontrolgroup.Itdemonstratesthatacupuncturecanenhanceandregulate.theimmunefunctionofpa-tientstreatedwithradiotherapya

简介：AbstractBackground:Preeclampsia (PE) is a serious complication that affects maternal and perinatal outcomes. However, the mechanisms have not been fully explained. This study was designed to analyze longitudinal gut microbiota alterations in pregnant women with and without PE in the second (T2) and third trimesters (T3).Methods:In this nested case-control study, which was conducted at Nanjing Maternity and Child Health Care Hospital, fecal samples from 25 PE patients (25 fecal samples obtained in T2 and 15 fecal samples obtained in T3) and 25 matched healthy controls (25 fecal samples obtained in T2 and 22 fecal samples obtained in T3) were collected, and the microbiota were analyzed using 16S rRNA gene sequencing. The diversity and composition of the microbiota of PE cases and controls were compared.Results:No significant differences in diversity were found between the PE and control groups (P > 0.05). In the control group, from T2 to T3, the relative abundances of Proteobacteria (median [Q1, Q3]: 2.25% [1.24%, 3.30%] vs. 0.64% [0.20%, 1.20%], Z = -3.880, P < 0.05), and Tenericutes (median [Q1, Q3]: 0.12% [0.03%, 3.10%] vs. 0.03% [0.02%, 0.17%], Z= -2.369, P < 0.05) decreased significantly. In the PE group, the relative abundance of Bacteroidetes in T2 was lower than in T3 (median [Q1, Q3]: 18.16% [12.99%, 30.46%] vs. 31.09% [19.89%, 46.06%], Z= -2.417, P < 0.05). In T2, the relative abundances of mircrobiota showed no significant differences between the PE group and the control group. However, in T3, the relative abundance of Firmicutes was significantly lower in the PE group than in the control group (mean ± standard deviation: 60.62% ± 15.17% vs. 75.57% ± 11.53%, t= -3.405, P < 0.05). The relative abundances of Bacteroidetes, Proteobacteria, and Enterobacteriaceae were significantly higher in the PE group than in the control group (median [Q1, Q3]: 31.09% [19.89%, 46.06%] vs. 18.24% [12.90%, 32.04%], Z=-2.537, P < 0.05; 1.52% [1.05%, 2.61%] vs. 0.64% [0.20%, 1.20%], Z=-3.310, P < 0.05; 0.75% [0.20%, 1.00%] vs. 0.01% [0.004%, 0.023%], Z = -4.152, P < 0.05). Linear discriminant analysis combined effect size measurements analysis showed that the relative abundances of the phylum Bacteroidetes, class Bacteroidia and order Bacteroidales were increased in the PE group, while those of the phylum Firmicutes, the class Clostridia, the order Clostridiales, and the genus unidentified Lachnospiraceae were decreased in the PE group; and these differences were identified as taxonomic biomarkers of PE in T3.Conclusion:From T2 to T3, there was an obvious alteration in the gut microbiota. The gut microbiota of PE patients in T3 was significantly different from that of the control group.

简介：AIM:Todescribetheresultsof5consecutivecasesofclearlensextractioninangleclosurepatientsforthetreatmentofelevatedintraocularpressure(IOP).·METHODS:Retrospectiveobservationalcaseseries.Allangleclosurepatientswereontwoormoretopicalglaucomamedicationsandhadpriorlaseriridotomy.Eyesunderwentclearlensextractionbyphacoemu-lsificationwithintraocularlensimplantation.·RESULTS:Allfivepatientsinthiscaseseriescarriedthediagnosisofangle-closureglaucomaandhaduncontrolledIOPpriortosurgerydespitetopicalmedications.AfterclearlensextractionthreeofthecaseshadgoodIOPcontrol(IOP<22mmHg)withouttheneedfortopicalmedications.InonecasetheIOPwasbettercontrolledaftersurgery,however,topicalmedicationswererequired.ThedesiredIOPwasnotmetinonecasedespiterestartingmaximumtopicaltherapy.·CONCLUSION:Thiscaseseriessuggeststhattheremaybearolefortherapeuticclearlensextractioninselectcasesofangle-closureglaucoma.

简介：AIM:ToinvestigateFusobacteriumnucleatum（F.nucleatum）abundanceincolorectalcancer（CRC）tissuesanditsassociationwithCRCinvasivenessinChinesepatients.METHODS:Theresectedcancerandadjacentnormaltissues（10cmbeyondcancermargins）from101consecutivepatientswithCRCwerecollected.Fluorescentquantitativepolymerasechainreaction（FQ-PCR）wasappliedtodetectF.nucleatuminCRCandnormaltissues.ThedifferenceofF.nucleatumabundancebetweencancerandnormaltissuesandtherelationshipofF.nucleatumabundancewithclinicalvariableswereevaluated.Fluorescenceinsituhybridization（FISH）analysiswasperformedon22CRCtissueswiththehighestF.nucleatumabundancebyFQ-PCRtestingtoconfirmFQ-PCRresults.RESULTS:ThemedianabundanceofF.nucleatuminCRCtissues[0.242（0.178-0.276）]wassignificantlyhigherthanthatinnormalcontrols[0.050（0.023-0.067）]（P<0.001）.F.nucleatumwasover-representedin88/101（87.1%）CRCsamples.TheabundanceofF.nucleatumdeterminedby2-ΔCTwassignificantlygreaterintumorsamples[0.242（0.178,0.276）]thaninnormalcontrols[0.050（0.023,0.067）]（P<0.001）.Thefrequencyofpatientswithlymphnodemetastaseswashigherintheover-abundancegroup[52/88（59.1%）]thanintheunder-abundancegroup[0/13（0%）]（P<0.005）.NosignificantassociationofF.nucleatumwithotherclinico-pathologicalvariableswasobserved（P>0.05）.FISHanalysisalsofoundmoreF.nucleatuminCRCthaninnormaltissues(mediannumber6,25th3,75th10vs2,25th1,75th5)（P<0.01）.CONCLUSION:F.nucleatumwasenrichedinCRCtissuesandassociatedwithCRCdevelopmentandmetastasis.

简介：瞄准：在先进或变形的颜色加irinotecan+/-bevacizumab调查cape-citabine的功效和安全表面的癌症病人。方法：四十六个病人与以前未经治疗，局部地进展或变形颜色表面的癌症(mCRC)在未来的开标签的阶段II试用在2001-2006之间被招募，在德国基于社区的门诊病人诊所。病人们加bevacizumab(CAPIRI十亿电伏)加irinotecan(CAPIRI)或CAPIRI收到了标准capecitabine政体每3wk。剂量减小从在>等级2毒性的情况下的第一个周期是强制的。bevacizumab的治疗选择依据见解医生。主要端点是反应和毒性，第二等的端点包括了没有前进的幸存和全面幸存。结果：在CAPIRI组对CAPRI十亿电伏组，比男病人(47%对24%)有更多的女性，并且更多的病人与作为主要肿瘤地点(5.9%对20.7%)有S字形的冒号的更少病人一起作为主要肿瘤地点(58.8%对48.2%)有冒号。等级3/4毒性比CAPIRI十亿电伏与CAPIRI是更高的：82%对58.6%。部分反应率是29.4%和34.5%，并且肿瘤控制率分别地是70.6%和75.9%。没有完全的回答被观察。中部的没有前进的幸存分别地为CAPIRI和CAPIRI十亿电伏是11.4瞬间和12.8瞬间。为CAPIRI的中部的全面幸存是15瞬间(458d)并且为CAPIRI十亿电伏24瞬间(733d)。这些差别不是统计上不同的。在CAPIRI十亿电伏，组织，二个病人在治疗以后经历了完整的第二等的肿瘤切除术，而在CAPIRI组没有盒子经历了这个过程。结论：政体很好被容忍并且在这门诊病人设置为有效肿瘤提供了生长控制。严重胃肠的毒性和thromboembolic事件是稀罕的并且如果观察从来不是致命的。

简介：Objective:Theextremityinjurypatternafteramajorearthquakeisnotwellunderstoodbecausedataonthistypeofinjuryandmanagementarelimited.Theaimofthisstudywastoanalyzethedataoftraumapatientswithex-tremityinjuryintheearthquakeofBarnIran,registering6.6ontheRichterscale.Methods:Wereviewedmedicalrecordsof486patientsadmittedtohospitalsofTehranUniversityofMedicalSciences.Amongthem,274patientssustainedextremityinjuries.Thisgroupwascomposedof138females(50.4%)and136males(49.6%)and213cases(77.7%)wereunder40yearsofage.Results:Fracturewasthemajortypeofinjury(58.4%ofextremityinjuries).Themostcommonsitesofinjurywerelowerextremities(185patients,67.5%ofallvictims).Pelvic&ribfracturesandabdominalinjurieswerethemostfre-quentlyassociatedinjuries.ThemeanISSwas6.2±4.0,and61%ofthepatientshadISS≤7.Amputationanddeathoccurredin2.9%and2.5%ofcases,respectively.Conclusions:Specialattentionshouldbegiventodeal-ingwithorthopedicinjuriesinsimilardisastersinthefuture.

简介：AbstractThis study aimed to determine the clinical characteristics of patients diagnosed with the coronavirus disease 2019 (COVID-19). Clinical data of COVID-19 patients diagnosed between January 28, 2020 and February 23, 2020 at the Beijing You'an Hospital were summarized and analyzed. Overall, 45 (18 men and 27 women) patients were included in this study. The average age of patients was 58 years (range, 7–94 years). Furthermore, 21 patients (47%) experienced underlying chronic diseases, with another four patients (9%) having three or more chronic diseases simultaneously. The first symptoms appeared at the onset of illness onset include fever in 36 patients (80%), cough in 23 patients (51%), and expectoration in 15 patients (33%), respectively. Patients may experience hepatic and renal injury as well as abnormal myocardial enzymes in varying degrees. Senior patients (≥58) and accompanying chronic diseases were considered as independent predictors for developing a severe and critically ill population with increased mortality. Laboratory results regarding the NEU percentage, NLR, ALC, and C-reactive protein levels were considered significant in predicting clinically critical disease or for prognosis assessment and thus require further studies. COVID-19 may affect multiple organs of the human body. Glucocorticoid is considered effective in the treatment of patients diagnosed with severe COVID-19.

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简介：Objective:Toanalyzethecorrelationsamongcomorbidityandoverallsurvival(OS),biochemicalprogression-freesurvival(b-PFS)andtoxicityinelderlypatientswithlocalizedprostatecancertreatedwith125Ibrachytherapy.Methods:Elderlymen,aged≥65years,withlow-intermediateriskprostatecancer,weretreatedwithpermanent125Ibrachytherapyasmonotherapy.Comorbiditydatawereobtainedfrommedicalreportsusingage-adjustedCharlsoncomorbidityindex(a-CCI).Thepatientswerecategorizedintotwoagegroups(<75and≥75yearsold),andtwocomorbidityscoregroups(a-CCI≤3and>3).ToxicitywasscoredwithRadiationTherapyOncologyGroup(RTOG)scale.Results:FromJune2003toOctober2009,atotalof92elderlypatientsunderwentprostatebrachytherapy,including57men(62%)withlow-riskprostatecancer,and35men(38%)withintermediate-riskprostatecancer.Themedianageofpatientswas75years(range,65-87years).Forty-sevenpatients(51%)hada-CCI≤3and45patients(49%)a-CCI>3.Withamedianfollow-upperiodof56months(range,24-103months),the5-yearactuarialOSandb-PFSwere91.3%and92.4%respectively,withoutstatisticalsignificancebetweentwoCharlsonscoregroups.Toxicitywasmild.Noneofthepatientsexperiencedgastrointestinal(GI)toxicity,andonly4patiens(4%)experiencedlategenitourinary(GU)grade-3(G3)toxicity.NocorrelationbetweenacuteGUandGItoxicityandcomorbiditywasshowed(P=0.50andP=0.70,respectively).Conclusions:Ourdatasuggestthatelderlymenwithlow-intermediateriskprostatecancerandcomorbiditycanbeconsideredforaradicaltreatmentas125Ilow-doseratebrachytherapy.

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简介：摘要目的探讨角膜直径对Pentacam角膜地形图中Belin/Ambrósio增强扩张显示（BAD）系统关于角膜扩张分析结果的影响。方法回顾性系列病例研究。研究对象为2017年6月至2019年6月在陆军特色医学中心和重庆眼视光眼科医院已行角膜屈光手术或拟行角膜屈光手术但已完成术前检查的近视眼患者6 744例，其中男性3 341例，女性3 403例；年龄（23.74±5.73）岁。所有患者排除圆锥角膜，采用计算机随机法纳入单眼进行研究。患者按角膜直径进行分组，A组为角膜直径≤11.1 mm者，共630例（630只眼）；B组为角膜直径11.2~11.8 mm者，共4 063例（4 063只眼）；C组为角膜直径≥11.9 mm者，共2 051例（2 051只眼）。所有患者术前采用Pentacam角膜地形图中的BAD角膜扩张分析功能检测角膜前表面高度偏差值（Df）、后表面高度偏差值（Db）、平均厚度进展偏差值（Dp）、最薄点厚度偏差值（Dt）、Ambrósio厚度最大变化率偏差值（Da）和总偏差值（Do）等参数。术前3个组的角膜地形图指标组间比较采用单因素方差分析；各指标的正常、可疑及病理情况分布比较采用卡方检验。结果A、B、C组BAD系统相关指标结果分别为Df：0.73±1.14、0.48±1.02、0.11±0.91、Db：1.09±1.07、0.23±0.83、-0.34±0.62；Dp：1.57±0.91、1.14±0.86、0.68±0.75；Dt：-0.11±0.84、-0.02±0.82、0.03±0.78；Da：0.78±0.61、0.64±0.64、0.48±0.64；Do：1.65±0.64、1.24±0.60、0.86±0.55。3个组BAD系统相关指标Df（F=129.549）、Db（F=829.491）、Dp（F=344.373）、Dt（F=7.249）、Da（F=68.637）、Do（F=524.877）比较差异均有统计学意义（P<0.01）。3个组Df（χ²=161.8）、Db（χ²=611.75）、Dp（χ²=478.84）、Da（χ²=44.636）、Do（χ²=553.11）可疑和病理的比例分布差异均有统计学意义（P<0.01），且均是A组占比最高。结论角膜直径对BAD系统关于角膜扩张分析的结果影响显著；与大角膜者相比，小角膜者分析结果出现假阳性的比例较高。（中华眼科杂志，2020，56：761-767）

简介：Objectives:TofindoutthelevelandfunctionsofChlamydiatrachomatisheatshockprotein(C-hsp60)antibody,anti-spermantibody(ASAb),interleukin1(IL-1),interleukin6(IL-6),interleukin8(IL-8),Tumornecrosisfactoralpha(TNF-α)andγ-interferon(IFN-γ/)inpatientswithCT-relatedinfertility.Methods:CT-DNAofcervicalsecretionswasdetectedthroughpolymerasechainreaction(PCR)andmigrationinhibitingfactor(MIF)wasemployedtomeasureIgGtitreofCTMOMPantibody.WesternblotwasusedtodeterminepresenceofC-hsp60antibodyandenzyme-linkedimmunoadsorbentassay(ELISA)measuredASAbofIgGtypeinbloodserumanddeterminethecontentofIL-1,IL-6,IL-8.TNF-u,IFN-7inuterinetubefluid.Results:68patientshadpositiveCT-DNA,amongwhich57(83.8%)hadC-hsp60antibody.Amongthe172patientswithnegativeCT-DNA,64patients(37.2%)alsohadC-hsp60Antibody.Therewasasignificantdifference(P<0.01)betweeninfertilepatientsandcontrolgrouppatientsinthepresenceofASAb.InfertilepatientswithpositiveCT-DNAhadhigherlevelsofIL-1.IL-6.IL-8,TNF-u,IFN-7inuterinetubefluidcomparedtocontrolgrouppatients(P<0.01).Conclusion:Firstly,thosepatientswithnegativeCTtestingfromcervicalsecretionscannotberuledoutforCTinfectionindeeppartsofthebody(suchasoviduct,pelvickidney).DetectionofC-hsp60AntibodymayhelptodiagnosesuchcasesofCT.Secondly,CTinfectionoftheoviductcanraiselevelsofIL-1、IL-6、IL-8、TNF-α、N-γ.ThepathogenesisofinfertilitycausedbyCTinfectioninthereproductivetractmayberelatedtocytokineproductionandinflammatoryresponsesmediatedbyC-hsp60Antibody,IL-1,IL-6,IL-8,TNF-αandIFN-γ.

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简介：摘要ObjectiveTo investigate a 5-generation Chinese Han family with PRKAG2 cardiac syndrome resulting from mutations in the PRKAG2 gene encoding the AMP-activated protein kinase (AMPK) gamma 2 subunit and the treatment of myocardial hypertrophy in patients with PRKAG2 cardiac syndrome.MethodIn this study, a 5-generation Chinese Han family (n = 40) with complete atrioventricular block and asymmetric interventricular septal hypertrophy was taken as the research object, and the DNA were obtained from 30 of them (6 patients and 24 normal persons). Objective gene capture combined with high-throughput sequencing technique was used to detect the genes of family members. After the gene diagnosis was confirmed, the cardiac data of patients taking beta-blockers in this family were analyzed retrospectively with the average annual increase in thickness of interventricular septum (expressed in mm/year) as an index.ResultsA total of 6 family members were associated with PRKAG2 (c.905G>A; pR302Q) heterozygous variation. The phenotype of pedigree patients is characterized by complete atrioventricular block and asymmetric interventricular septal hypertrophy, which has high homogeneity. No syncope occurs after implantation of permanent pacemaker, but atrial flutter and atrial fibrillation occur. The 5 patients with PRKAG2 cardiac syndrome in the family took beta-blockers for a long time, and the progress of cardiac hypertrophy was significantly delayed.ConclusionsOur results suggest that the possibility of PRKAG2 mutations should be considered in patients with complete atrioventricular block and asymmetric interventricular septal hypertrophy, and that prompt implantation of pacemakers and long-term use of beta blockers may improve the prognosis of PRKAG2 cardiac syndrome patients.

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简介：AbstractBackground:Despite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for cata-strophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.Methods:The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n= 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.Results:The proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20-104], and total median costs of USD 567 (IQR: 299-1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0-9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR)= 2.8 (95% CI: 1.8-4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3-1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6-1.0), and a higher body mass index (BMI): PR= 0.97 (95% CI: 0.96-0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.Conclusions:There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.

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