简介：AbstractHypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, "tight" BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

简介：摘要：目的：甲状腺结节分类诊断过程中采用TI-RADS分类法，观察该种分类方法的应用效果。方法：将我科2018年1月--2020年10月的甲状腺结节297例患者353个结节作为观察对象，并且根据分类方法不同，将患者分成一组和二组，一组使用TI-RADS分类法，二组使用ATA标准分类。结果：（1）本次总共选择353个甲状腺结节作为研究对象，其中良性结节210个，占比59.49%；恶性结节143个，占比40.50%。（2）一组和二组甲状腺结节分类后从NPV、PPV、敏感性、特异性、准确性对照中，一组分别是94.33%、76.20%、88.66%、84.13%、89.23%，二组分别是85.26%、69.68%、77.33%、71.10%、81.01%。（x2=10.021,p=0.000），结果有差异。结论：甲状腺结节诊断过程中采用TI-RADS分类法价值较高，该种方法值得在临床上推广。

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简介：AbstractTonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review summarizes the current state of the literature and presents a management approach which attempts to maximize pain control while minimizing potential harm with combinations of medications and modification based on patient-specific factors.

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简介：AbstractWith the widespread adoption of advanced tourniquets, the mortality rate of limb wound hemorrhage has decreased significantly, and non-compressible torso hemorrhage has gradually occupied the leading position of potentially preventable death, both in military and civilian circumstances. With the emergence of novel hemostatic devices and materials, strategies for the management of non-compressible torso hemorrhage have changed significantly. This review summarizes the current treatment strategies and types of equipment for non-compressible torso hemorrhage and suggests future research directions, hoping to provide a comprehensive review for the medical personnel and researchers engaging in this field.

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简介：【摘要】目的 探讨TP-ELISA法与TRUST法同步联合检测在梅毒诊断中的效果。方法 将148例于2020年1月－2021年6月期间我院收治的梅毒患者纳入研究，所有患者均接收TP-ELISA法与TRUST法检验，并以TPPA结果进行确诊，同时评估TP-ELISA法与TRUST法同步联合检测诊断符合率。结果 在诊断符合率对比上，TP-ELISA法显著高于TRUST法，且对比有统计学意义（P〈0.05）。而二者联合应用的总符合率达到96.62%与金标准相比无统计学意义（P>0.05）。结论 TP-ELISA法与TRUST法共同应用到梅毒的诊断中，可以互补优缺，进而提升梅毒诊断准确率。

简介：AbstractThe novel coronavirus disease 2019 (COVID-19) is the third coronavirus outbreak in the last two decades. Emerging and re-emerging infections like COVID-19 pose serious challenges of the paucity of information and lack of specific cure or vaccines. This leaves utilisation of existing scientific data on related viral infections and repurposing relevant aetiologic and supportive therapies as the best control approach while novel strategies are developed and trialled. Many promising antiviral agents including lopinavir, ritonavir, remdesivir, umifenovir, darunavir, and oseltamivir have been repurposed and are currently trialled for the care for COVID-19 patients. Adjunct therapies for the management of symptoms and to provide support especially in severe and critically ill patients have also been identified. This review provides an appraisal of the current evidence for the rational use of frontline therapeutics in the management of COVID-19. It also includes updates regarding COVID-19 immunotherapy and vaccine development.

简介：AbstractLeopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.

简介：AbstractBackground:Stroke is a principal cause of mortality and disability globally. Numerous studies have contributed to the knowledge base regarding self-management interventions among chronic disease patients, but there are few such studies for patients with stroke. Therefore, it is necessary to analyze self-management interventions among stroke patients. This scoping review aimed to systematically identify and describe randomized controlled trials (RCTs) of self-management interventions for adults with stroke.Methods:A review team carried out a scoping review on stroke and self-management interventions based on the methodology of Arksey and O'Malley, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, Web of Science, CINAHL Plus Full Text, Medline Plus Full Text, and Cochrane Central Register of Controlled Trials were searched from inception to July 2020.Results:Fifty-four RCTs were included. The most popular study design is comparing a self-management intervention to usual care or waitlist control condition. Physical activity is the most common intervention topic, and interventions were mainly delivered face to face. The majority of interventions were located in inpatient and multiple settings. Interventions were conducted by various providers, with nurses the most common provider group. Symptom management was the most frequently reported outcome domain that improved.Conclusions:Self-management interventions benefit the symptom management of stroke patients a lot. The reasonable time for intervention is at least 6-12 months. Multifarious intervention topics, delivery formats, and providers are adopted mostly to meet the multiple needs of this population. Physical activity was the most popular topic currently. Studies comparing the effect of different types of self-management interventions are required in the future.

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简介：AbstractIrritable bowel syndrome (IBS) is a common functional gastrointestinal disease worldwide. Current guidelines of IBS are mostly based on the western populations and expected to vary in different communities. China has a large population and a vast literature is available on IBS. Due to linguistic variations in the literature, the studies are not widely known and their conclusions thus remain largely obscured to the western medical literature. In this article, we reviewed the published literatures on the investigations of IBS epidemiology, diagnosis, and management in the Chinese population and emphasized the different findings gleaned from the western publications. The detailed literature review will benefit understanding of and promote future study on IBS.

简介：摘要目的分析校正Tp-e间期(Tp-ec)、Tp-e/QT比值与冠状动脉左主干狭窄患者冠状动脉旁路移植术(CABG)后静脉旁路移植血管狭窄程度的关系，及对恶性心电生理事件的预测价值。方法选取首都医科大学附属北京安贞医院2018年1月至2019年8月期间就诊的169例患者，其中男113列，女59例；年龄41~79岁，平均(62.58±4.23)岁。纳入标准为CABG后5~7年，因症状复发复查冠状动脉造影，大隐静脉旁路移植血管(SVG)再狭窄>50%者。根据旁路移植血管造影狭窄程度分为A组(SVG再狭窄程度50%~70%，105例)和B组(SVG再狭窄程度>70%，64例)。患者均行常规心电图检查，测量校正QT间期(QTc)、Tp-ec和Tp-e/QT比值，随访6个月，观察恶性心电生理事件发生情况，使用受试者工作特征(ROC)曲线下面积(AUC)定量评价Tp-ec、Tp-e/QT比值对恶性心电生理事件的预测效能。结果B组QTc、Tp-ec、Tp-e/QT比值均明显大于A组，差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示，Tp-ec和Tp-e/QT比值均是旁路移植血管狭窄程度>70%的独立影响因素(P<0.05)。经Pearson相关性分析，Tp-ec和Tp-e/QT比值均与静脉旁路移植血管狭窄程度呈正相关(r分别为0.384、0.457，均P＝0.000)。169例患者中随访162例(95.86%)，发生恶性心电生理事件25例。经ROC曲线分析，Tp-ec联合Tp-e/QT比值预测冠状动脉左主干狭窄患者GABG后发生恶性心电生理事件的AUC为0.924，明显大于单一指标Tp-ec的0.698和Tp-e/QT比值的0.712，差异均有统计学意义(P<0.05)。结论Tp-ec、Tp-e/QT比值与冠状动脉左主干狭窄患者CABG后静脉旁路移植血管狭窄程度均呈正相关，两者联合预测恶性心电生理事件发生的效能较好，值得进一步研究应用。

简介：【摘要】目的：综合分析生化检验在肝硬化疾病患者诊断中的效果及对ALB（白蛋白）、TP（总蛋白）水平的影响。方法：本次研究的患者为：肝硬化疾病患者；共53例，病例的选取时间为2019年3月-2020年3月作为实验组，再选取同期我院搜集的53例健康体检人群一般资料作为对照组。采用统计学分析两组研究对象的总胆红素（TBL）水平、直接胆红素（DBL）水平、ALB水平、TP水平、碱性磷酸酶（ALP）水平、胆碱酯酶（CHE）水平、丙氨酸氨基转移酶（ALT）水平、天冬氨酸氨基转移酶（AST）水平。结果：两组研究对象的TBL水平、DBL水平、ALB水平、TP水平、ALP水平、CHE水平、ALT水平、AST水平等比较差异显著（P＜0.05）。结论：生化检验在肝硬化疾病患者诊断中的效果显著，与此同时在很大程度上影响其ALB水平、TP水平。

简介：AbstractPlacenta accreta spectrum is a complication of pregnancy, which poses a great risk on maternal health. Historically, hysterectomy was the modality of treatment of such condition, but an approach towards a more conservative management has been in the light recently. This includes several methods with varying rates of success and complications. Expectant management is effective in up to 78%-80% of the cases. The extirpative method is associated with a high risk of postpartum hemorrhage. The success of the one-step conservative procedure depends on the degree of placental invasion, and the triple-P procedure appears to be successful but requires and interdisciplinary approach. Adjuvant treatment options can be tailored according to individual cases, and these include methotrexate injection, uterine devascularization and hysteroscopic resection of retained placental tissues. Follow up after conservative management is crucial to detect complications early, and it can be done by ultrasound, Doppler examination, and trending β human chorionic gonadotropin levels. Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. In the future, more research should be directed to achieve clear guidelines regarding this topic.

简介：AbstractThe ongoing coronavirus disease 2019 (COVID-19) pandemic has put a strain on health systems globally. Although Africa is the least affected region to date, it has the weakest health systems and an exponential rise in cases as has been observed in other regions, is bound to overwhelm its health systems. Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic. The World Health Organization (WHO) recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility; however, where this is not possible due to the health system capacity, patients can be isolated in re-purposed facilities or at home. An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases, given the already limited health infrastructure and health workforce, and the risk of nosocomial transmission. Use of repurposed facilities requires additional resources, including health workers. Home isolation, on the other hand, would be a challenge given the poor housing, overcrowding, inadequate access to water and sanitation, and stigma related to infectious disease that is prevalent in many African societies. Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited. These unique cultural, social, economic and developmental differences on the continent, call for a tailored approach to COVID-19 case management strategies. This article proposes three broad case management strategies based on the transmission scenarios defined by WHO, and the criteria and package of care for each option, for consideration by policy makers and governments in African countries. Moving forward, African countries should generate local evidence to guide the development of realistic home-grown strategies, protocol and equipment for the management of COVID-19 cases on the continent.

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：AbstractPurpose:This study aimed at exploring the application of trauma time axis management in the treatment of severe trauma patients by using the Medicalsystem trauma system.Methods:We performed a retrospective cohort study involving patients with severe trauma. Patients who were admitted before the application of the Medicalsystem trauma system were divided into before system group; patients who were admitted after the application of the system were divided into after system group. Comparison was made between the two groups. For normally distributed data, means were reported along with standard deviation, and comparisons were made using the independent samples t test. Categorical data were compared using the Chi-square test. The Mann-Whitney U test was used to compare nonparametric variables.Results:There were 528 patients admitted to the study during the study period. There was no significant statistical difference in the time from the start of trauma team to arrive at the resuscitation room between the two groups. The time from arrival at hospital to endotracheal intubation, to ventilator therapy, to blood transfusion, to completion of CT scan, to completion of closed thoracic drainage, to the start of operation, as well as the length of stay in resuscitation room and hospital were significantly lower after the application of the Medicalsystem trauma system. The mortality was decreased by 8.6% in the after system group compared with that in the before system group, but there was no statistical difference.Conclusion:The Medicalsystem trauma system can optimize diagnosis and treatment process for trauma patients, and accordingly improve the treatment efficiency and shorten the treatment time. Therefore, the Medicalsystem trauma system deserves further popularization and promotion.