脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊...脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。展开更多
OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus in...OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus involved three distinct stages.Initially,a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review,which was subsequently supplemented through expert interviews.In the second stage,the Delphi method was employed to assess the significance of acupoint locations,manipulations,functions,and indications.In situations where the questionnaire survey failed to yield agreement or when the experts held reservations,the nominal group approach was utilized during the expert consensus meeting.The final version of the technical standardized material was ultimately determined during an expert consensus conference.After undergoing external peer review and evaluation,the completed draft was prepared for public dissemination RESULTS:The comprehensive list identified a total of 66 specific acupoints.The location and manipulation questionnaire consisted of 156 items based on the literature database,while the function and indication questionnaire contained 116 items.Two rounds of Delphi surveys were conducted for the location and manipulation category,and another two rounds of Delphi surveys were conducted for the function and indication category.During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions,resulting in the formulation of technical guidelines for the locations,manipulations,functions,and indications of 64 paediatric Tuina acupoints.Subsequently,the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina,which was finalized after external review and feedback.CONCLUSION:This study successfully established the recognized technical standards for practitioners of paediatric Tuina,thereby standardizing clinical practices and providing a foundation setting the framework for future展开更多
Background The exact influence of the COVID-19 pandemic on sexual intercourse and usage of contraception remains largely uncharted territory.To bridge this gap in knowledge,we conducted a comprehensive,cross-sectional...Background The exact influence of the COVID-19 pandemic on sexual intercourse and usage of contraception remains largely uncharted territory.To bridge this gap in knowledge,we conducted a comprehensive,cross-sectional examination of long-term trends in the prevalence of sexual intercourse and usage of contraception among South Korean adolescents from 2006 to 2022.Methods In our research,we drew upon data encompassing 1,138,799 South Korean adolescents aged 12 to 18 years,derived from the Korean Youth Risk Behavior Web-based Survey(KYRBS)over a period spanning from 2006 to 2022.We focused on the prevalence of sexual intercourse,contraception utilization,and the underlying associated factors among this demographic.The KYRBS data was collected using a complex sampling strategy to determine the national prevalence estimates and shifts in prevalence before(2006-2019)and during(2020-2022)the COVID-19 pandemic era.Results During the pre-pandemic period,a decrease in adolescent sexual intercourse was observed(6.34%in 2006,5.53%in 2012,and 5.87%in 2019).However,in the post-pandemic period(2020-2022),there was a surge in sexual intercourse(4.55%in 2020 and 6.20%in 2022).This evident alteration in sexual intercourse trajectory between pre-and post-pandemic periods was statistically significant[βdiff,0.950;95%confidence interval(CI),0.756-1.144].Regarding contraceptive use among South Korean adolescents,there was an increase in the pre-COVID-19 pandemic phase across all demographic segments(14.61%in 2006,22.30%in 2012,and 47.69%in 2022)but a notable decline when compared with the pre-and post-pandemic periods(βdiff,-0.319;95%CI,-0.454 to-0.184).Additionally,during the study period,a decrease in sexual intercourse was observed in the pre-pandemic period(β,-0.129;95%CI,-0.148 to-0.110),followed by an increase in the post-pandemic period(β,0.821;95%CI,0.627 to 1.014).This shift is highlighted by an effect size of 0.96[weighted odds ratio(wOR);95%CI,0.92 to 1.00],indicating a substantial change in adolescent sexual behaviors展开更多
Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence...Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders.An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established,the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive.Consequently,the management of pain by traditional methods based on nociceptive deafferentation(e.g.,surgery and visceral nerve blockade)becomes difficult and often ineffective.This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis.Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source,which should be reserved for special and carefully selected cases.In this review,we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis.In addition,future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.展开更多
Objective Anaemia is associated with higher mortality among patients with non-stroke cardiovascular conditions;less is known regarding the relationship between anaemia and mortality among patients with acute ischaemic...Objective Anaemia is associated with higher mortality among patients with non-stroke cardiovascular conditions;less is known regarding the relationship between anaemia and mortality among patients with acute ischaemic stroke.Methods Medical records were abstracted for n=3965 veterans from 131 Veterans Health Administration facilities who were admitted with ischaemic stroke in fiscal year 2007.Haematocrit values within 24 hours of admission were classified as≤27%,28%-32%,33%-37%,38%-42%,43%-47% or≥48%.Multivariate logistic regression was used to examine the relationship between anaemia and in-hospital,30-day,6-month and 1-year mortality,adjusting for age,medical comorbidities,modified Acute Physiology and Chronic Health Evaluation-III and stroke severity.Impact factors were calculated to standardise comparisons between haematocrit tier and other covariates.results Among n=3750 patients included in the analysis,the haematocrit values were≤27%in 2.1%(n=78),28%-32% in 6.2%(n=234),33%-37%in 17.9%(n=670),38%-42% in 36.4%(n=1366),43%-47% in 28.2%(n=1059)and≥48% in 9.1%(n=343).Patients with haematocrit≤27%,compared with patients in the 38%-42% range,were more likely to have died across all follow-up intervals,with statistically significant adjusted ORs(aORs)ranging from 2.5 to 3.5.Patients with polycythaemia(ie,haematocrit≥48%)were at increased risk of in-hospital mortality(aOR=2.9;95%CI 1.4 to 6.0),compared with patients with mid-range admission haematocrits.Pronounced differences between patients receiving and not receiving blood transfusion limited our ability to perform a propensity analysis.Impact factors in the 1-year mortality model were 0.46(severe anaemia),0.06(cancer)and 0.018(heart disease).Conclusions Anaemia is independently associated with an increased risk of death throughout the first year post stroke;high haematocrit is associated with early poststroke mortality.Severe anaemia is associated with 1-year mortality to a greater degree than cancer or heart disease.These data cannot address the qu展开更多
It is universally accepted that the philosophy of the Tao is the essence that animates the Chinese Cosmogony. Therefore, in last decades I have tried to consolidate its scientific background, looking for solid explana...It is universally accepted that the philosophy of the Tao is the essence that animates the Chinese Cosmogony. Therefore, in last decades I have tried to consolidate its scientific background, looking for solid explanations through Exact Sciences (“Between Heaven and Earth” Scientific Basis of the Action of Shao Yin: Lightning’s Physical-Mathematical Analysis”;“Is Traditional Chinese Medicine Definitely an Exact Science?”;“Euclidean Geometry and Traditional Chinese Medicine: Diving into the Real Origin of the Five Elements”;“Solitons: A Cutting-Edge Scientific Proposal Explaining the Mechanisms of Acupuntural Action”) Currently, research on Chinese medicine leads us—with Dr. Erica Arakaki, collaborator and assistant—to verify through a profound bibliographic review the application of Fibonacci’s Golden Ratio in the constitution of T’ai Ji Tu, adding yet more substance to the hypothesis of Acupuncture and demonstrating how said Chinese Ancient Science is not only an empirical knowledge but a wisdom derived from the most ancient exact science: Geometry.展开更多
BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome...BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome predisposes patients to hypercoagulable states,including venous thromboembolism and pulmonary embolism(PE).CASE SUMMARY A 12-year-old girl with KTS was scheduled excision of verrucous hyperkeratosis in the left foot and posterior aspect of the left leg and left thigh and excision of a cutaneous hemangioma in the right buttock.After induction,the surgeon elevated the patient’s leg for sterilization,whereupon she experienced a massive PE and refractory cardiac arrest.Extracorporeal membrane oxygenation(ECMO)was performed after prolonged resuscitation,and she had a return of spontaneous circulation.After this episode,the patient was discharged without any neurologic complications.CONCLUSION The mechanism of PE,a lethal disease,involves a preexisting deep vein thrombosis that is mechanically dislodged by compression or changing positions and travels to the pulmonary artery.Therefore,patients predisposed to PE should be prescribed prophylactic anticoagulants.If the patient has unstable vital signs,resuscitation should be started immediately,and extracorporeal cardiopulmonary resuscitation should be considered in settings with existing ECMO protocols,expertise,and equipment.Awareness of PE in patients with KTS while leg raising for sterilization is critical.展开更多
Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how ca...Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Co展开更多
Alzheimer’s disease(AD)is the most common form of dementia.At the present time,however,AD still lacks effective treatments.Our recent studies showed that chronic treatment with anesthetic propofol attenuated brain ca...Alzheimer’s disease(AD)is the most common form of dementia.At the present time,however,AD still lacks effective treatments.Our recent studies showed that chronic treatment with anesthetic propofol attenuated brain caspase-3 activation and improved cognitive function in aged mice.Accumulation ofβ-amyloid protein(Aβ)is a major component of the neuropathogenesis of AD dementia and cognitive impairment.We therefore set out to determine the effects of chronic treatment with propofol on Aβlevels in brain tissues of aged mice.Propofol(50 mg/kg)was administrated to aged(18 month-old)wild-type mice once a week for 8 weeks.The brain tissues of mice were harvested one day after the final propofol treatment.The harvested brain tissues were then subjected to enzyme-linked immunosorbent assay(ELISA)and Western blot analysis.Here we report that the propofol treatment reduced Aβ(Aβ40 and Aβ42)levels in the brain tissues of the aged mice.Moreover,the propofol treatment decreased the levels ofβ-site amyloid precursor protein cleaving enzyme(the enzyme for Aβgeneration),and increased the levels of neprilysin(the enzyme for Aβdegradation)in the brain tissues of the aged mice.These results suggested that the chronic treatment with propofol might reduce brain Aβlevels potentially via decreasing brain levels ofβ-site amyloid precursor protein cleaving enzyme,thus decreasing Aβgeneration;and via increasing brain neprilysin levels,thus increasing Aβdegradation.These preliminary findings from our pilot studies have established a system and postulated a new hypothesis for future research.展开更多
OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence ...OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence using trial sequential ana-lysis(TSA).METHODS The systematic search included PubMed,EMBASE,Scopus,and Cochrane Central Register of Controlled Trials.Randomized controlled trials(RCTs)that included adult patients with IHCA,with at least one group receiving combined VSE therapy were selected.Data was extracted independently by two reviewers.The main outcome of interest was ROSC.Other out-comes included survival to hospital discharge or survival to 30 and 90 days,with good neurological outcomes.RESULTS We included a total of three RCTs(n=869).Results showed that VSE combination therapy increased ROSC(risk ra-tio=1.41;95%CI:1.25-1.59)as compared to placebo.TSA demonstrated that the existing evidence is conclusive.This was also validated by the alpha-spending adjusted relative risk(1.32[1.16,1.49],P<0.0001).Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC.Fu-ture trials of VSE therapy should evaluate survival to hospital discharge,neurological function and long-term survival.展开更多
Background:Acupuncture studies have used neuroradiology procedures to examine the role of the central nervous system (CNS) in body acupuncture, but none of these previous studies investigated CNS relationships to auri...Background:Acupuncture studies have used neuroradiology procedures to examine the role of the central nervous system (CNS) in body acupuncture, but none of these previous studies investigated CNS relationships to auriculotherapy.展开更多
文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
基金Grants from Key Research and Development Projects of the Ministry of Science and Technology Funding Support:Standards for Traditional Chinese Medicine Technology(No.2019YFC1712003)2023 First-class Discipline Construction Project of Beijing University of Chinese Medicine:Tuina。
文摘OBJECTIVE:To establish a standardized framework encompassing the precise locations,manipulations,functions and indications of specific acupoints in the field of paediatric Tuina.METHODS:The development of consensus involved three distinct stages.Initially,a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review,which was subsequently supplemented through expert interviews.In the second stage,the Delphi method was employed to assess the significance of acupoint locations,manipulations,functions,and indications.In situations where the questionnaire survey failed to yield agreement or when the experts held reservations,the nominal group approach was utilized during the expert consensus meeting.The final version of the technical standardized material was ultimately determined during an expert consensus conference.After undergoing external peer review and evaluation,the completed draft was prepared for public dissemination RESULTS:The comprehensive list identified a total of 66 specific acupoints.The location and manipulation questionnaire consisted of 156 items based on the literature database,while the function and indication questionnaire contained 116 items.Two rounds of Delphi surveys were conducted for the location and manipulation category,and another two rounds of Delphi surveys were conducted for the function and indication category.During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions,resulting in the formulation of technical guidelines for the locations,manipulations,functions,and indications of 64 paediatric Tuina acupoints.Subsequently,the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina,which was finalized after external review and feedback.CONCLUSION:This study successfully established the recognized technical standards for practitioners of paediatric Tuina,thereby standardizing clinical practices and providing a foundation setting the framework for future
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT,RS-2023-00248157).
文摘Background The exact influence of the COVID-19 pandemic on sexual intercourse and usage of contraception remains largely uncharted territory.To bridge this gap in knowledge,we conducted a comprehensive,cross-sectional examination of long-term trends in the prevalence of sexual intercourse and usage of contraception among South Korean adolescents from 2006 to 2022.Methods In our research,we drew upon data encompassing 1,138,799 South Korean adolescents aged 12 to 18 years,derived from the Korean Youth Risk Behavior Web-based Survey(KYRBS)over a period spanning from 2006 to 2022.We focused on the prevalence of sexual intercourse,contraception utilization,and the underlying associated factors among this demographic.The KYRBS data was collected using a complex sampling strategy to determine the national prevalence estimates and shifts in prevalence before(2006-2019)and during(2020-2022)the COVID-19 pandemic era.Results During the pre-pandemic period,a decrease in adolescent sexual intercourse was observed(6.34%in 2006,5.53%in 2012,and 5.87%in 2019).However,in the post-pandemic period(2020-2022),there was a surge in sexual intercourse(4.55%in 2020 and 6.20%in 2022).This evident alteration in sexual intercourse trajectory between pre-and post-pandemic periods was statistically significant[βdiff,0.950;95%confidence interval(CI),0.756-1.144].Regarding contraceptive use among South Korean adolescents,there was an increase in the pre-COVID-19 pandemic phase across all demographic segments(14.61%in 2006,22.30%in 2012,and 47.69%in 2022)but a notable decline when compared with the pre-and post-pandemic periods(βdiff,-0.319;95%CI,-0.454 to-0.184).Additionally,during the study period,a decrease in sexual intercourse was observed in the pre-pandemic period(β,-0.129;95%CI,-0.148 to-0.110),followed by an increase in the post-pandemic period(β,0.821;95%CI,0.627 to 1.014).This shift is highlighted by an effect size of 0.96[weighted odds ratio(wOR);95%CI,0.92 to 1.00],indicating a substantial change in adolescent sexual behaviors
基金Supported by Karen Elise Jensen`s Foundation and Danish Council for Strategic research,The Danish Agency for Science,Technology and Innovation
文摘Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge.Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders.An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established,the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive.Consequently,the management of pain by traditional methods based on nociceptive deafferentation(e.g.,surgery and visceral nerve blockade)becomes difficult and often ineffective.This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis.Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source,which should be reserved for special and carefully selected cases.In this review,we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis.In addition,future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity.
基金This work was supported by the Department of Veterans Affairs,VHA,Office of Quality and Performance,and Health Services Research&Development Service Quality Enhancement Research Initiative Service Directed Project 12-178 and Career Development Award 11-262,and the Department of Veterans Affairs,Health Services Research&Development,Stroke Quality Enhancement Research Initiative(QUERI)Rapid Response Project 09-184.The views expressed in this article are those of the authors and do not necessarily represent the view of the Department of Veterans Affairs.
文摘Objective Anaemia is associated with higher mortality among patients with non-stroke cardiovascular conditions;less is known regarding the relationship between anaemia and mortality among patients with acute ischaemic stroke.Methods Medical records were abstracted for n=3965 veterans from 131 Veterans Health Administration facilities who were admitted with ischaemic stroke in fiscal year 2007.Haematocrit values within 24 hours of admission were classified as≤27%,28%-32%,33%-37%,38%-42%,43%-47% or≥48%.Multivariate logistic regression was used to examine the relationship between anaemia and in-hospital,30-day,6-month and 1-year mortality,adjusting for age,medical comorbidities,modified Acute Physiology and Chronic Health Evaluation-III and stroke severity.Impact factors were calculated to standardise comparisons between haematocrit tier and other covariates.results Among n=3750 patients included in the analysis,the haematocrit values were≤27%in 2.1%(n=78),28%-32% in 6.2%(n=234),33%-37%in 17.9%(n=670),38%-42% in 36.4%(n=1366),43%-47% in 28.2%(n=1059)and≥48% in 9.1%(n=343).Patients with haematocrit≤27%,compared with patients in the 38%-42% range,were more likely to have died across all follow-up intervals,with statistically significant adjusted ORs(aORs)ranging from 2.5 to 3.5.Patients with polycythaemia(ie,haematocrit≥48%)were at increased risk of in-hospital mortality(aOR=2.9;95%CI 1.4 to 6.0),compared with patients with mid-range admission haematocrits.Pronounced differences between patients receiving and not receiving blood transfusion limited our ability to perform a propensity analysis.Impact factors in the 1-year mortality model were 0.46(severe anaemia),0.06(cancer)and 0.018(heart disease).Conclusions Anaemia is independently associated with an increased risk of death throughout the first year post stroke;high haematocrit is associated with early poststroke mortality.Severe anaemia is associated with 1-year mortality to a greater degree than cancer or heart disease.These data cannot address the qu
文摘It is universally accepted that the philosophy of the Tao is the essence that animates the Chinese Cosmogony. Therefore, in last decades I have tried to consolidate its scientific background, looking for solid explanations through Exact Sciences (“Between Heaven and Earth” Scientific Basis of the Action of Shao Yin: Lightning’s Physical-Mathematical Analysis”;“Is Traditional Chinese Medicine Definitely an Exact Science?”;“Euclidean Geometry and Traditional Chinese Medicine: Diving into the Real Origin of the Five Elements”;“Solitons: A Cutting-Edge Scientific Proposal Explaining the Mechanisms of Acupuntural Action”) Currently, research on Chinese medicine leads us—with Dr. Erica Arakaki, collaborator and assistant—to verify through a profound bibliographic review the application of Fibonacci’s Golden Ratio in the constitution of T’ai Ji Tu, adding yet more substance to the hypothesis of Acupuncture and demonstrating how said Chinese Ancient Science is not only an empirical knowledge but a wisdom derived from the most ancient exact science: Geometry.
文摘BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome predisposes patients to hypercoagulable states,including venous thromboembolism and pulmonary embolism(PE).CASE SUMMARY A 12-year-old girl with KTS was scheduled excision of verrucous hyperkeratosis in the left foot and posterior aspect of the left leg and left thigh and excision of a cutaneous hemangioma in the right buttock.After induction,the surgeon elevated the patient’s leg for sterilization,whereupon she experienced a massive PE and refractory cardiac arrest.Extracorporeal membrane oxygenation(ECMO)was performed after prolonged resuscitation,and she had a return of spontaneous circulation.After this episode,the patient was discharged without any neurologic complications.CONCLUSION The mechanism of PE,a lethal disease,involves a preexisting deep vein thrombosis that is mechanically dislodged by compression or changing positions and travels to the pulmonary artery.Therefore,patients predisposed to PE should be prescribed prophylactic anticoagulants.If the patient has unstable vital signs,resuscitation should be started immediately,and extracorporeal cardiopulmonary resuscitation should be considered in settings with existing ECMO protocols,expertise,and equipment.Awareness of PE in patients with KTS while leg raising for sterilization is critical.
基金funded by National Institutes of Health(NIH)Grant R03AG067985Foundation for Anesthesia Education and Research+1 种基金funded by the BrightFocus Foundation Alzheimer’s Disease Research Program(A2020886S)funded by NIH Grants RF1AG059867 and RF1AG064312,funded by NIH Grant R01HL140574。
文摘Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Co
基金This research was supported by R21AG038994,RO1 GM088801 and RO1AG041274 from National lnstitutes of Health,Bethesda,Maryland,Investigator-initiated Research grant from Alzheimer's Association,Chicago,llinois,and Cure Alzheimer's Fund,Wellesley,Massachusetts to Zhongcong Xie.
文摘Alzheimer’s disease(AD)is the most common form of dementia.At the present time,however,AD still lacks effective treatments.Our recent studies showed that chronic treatment with anesthetic propofol attenuated brain caspase-3 activation and improved cognitive function in aged mice.Accumulation ofβ-amyloid protein(Aβ)is a major component of the neuropathogenesis of AD dementia and cognitive impairment.We therefore set out to determine the effects of chronic treatment with propofol on Aβlevels in brain tissues of aged mice.Propofol(50 mg/kg)was administrated to aged(18 month-old)wild-type mice once a week for 8 weeks.The brain tissues of mice were harvested one day after the final propofol treatment.The harvested brain tissues were then subjected to enzyme-linked immunosorbent assay(ELISA)and Western blot analysis.Here we report that the propofol treatment reduced Aβ(Aβ40 and Aβ42)levels in the brain tissues of the aged mice.Moreover,the propofol treatment decreased the levels ofβ-site amyloid precursor protein cleaving enzyme(the enzyme for Aβgeneration),and increased the levels of neprilysin(the enzyme for Aβdegradation)in the brain tissues of the aged mice.These results suggested that the chronic treatment with propofol might reduce brain Aβlevels potentially via decreasing brain levels ofβ-site amyloid precursor protein cleaving enzyme,thus decreasing Aβgeneration;and via increasing brain neprilysin levels,thus increasing Aβdegradation.These preliminary findings from our pilot studies have established a system and postulated a new hypothesis for future research.
文摘OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence using trial sequential ana-lysis(TSA).METHODS The systematic search included PubMed,EMBASE,Scopus,and Cochrane Central Register of Controlled Trials.Randomized controlled trials(RCTs)that included adult patients with IHCA,with at least one group receiving combined VSE therapy were selected.Data was extracted independently by two reviewers.The main outcome of interest was ROSC.Other out-comes included survival to hospital discharge or survival to 30 and 90 days,with good neurological outcomes.RESULTS We included a total of three RCTs(n=869).Results showed that VSE combination therapy increased ROSC(risk ra-tio=1.41;95%CI:1.25-1.59)as compared to placebo.TSA demonstrated that the existing evidence is conclusive.This was also validated by the alpha-spending adjusted relative risk(1.32[1.16,1.49],P<0.0001).Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC.Fu-ture trials of VSE therapy should evaluate survival to hospital discharge,neurological function and long-term survival.
文摘Background:Acupuncture studies have used neuroradiology procedures to examine the role of the central nervous system (CNS) in body acupuncture, but none of these previous studies investigated CNS relationships to auriculotherapy.
