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简介：AbstractFetal growth restriction (FGR) is the condition in which a fetus does not reach its intrinsic growth potential and in which the shortterm and long-term risks of severe complications are increased. FGR is a frequent complication of pregnancy with a complex etiology and limited management options, other than timely delivery. The most common pathophysiological mechanism is placental insufficiency, due to many underlying causes such as maternal vascular malperfusion, fetal vascular malperfusion and villitis.Identifying truly growth restricted fetuses remains challenging. To date, FGR is often defined by a cut-off of the estimated fetal weight below a certain percentile on a population-based standard. However, small fetal size as a single marker does not discriminate adequately between fetuses or newborns that are constitutionally small but healthy and fetuses or newborns that are growth restricted and thus at risk for adverse outcomes. In 2016, the consensus definition of FGR was internationally accepted to better pinpoint the FGR population.In this review we will discuss the contemporary diagnosis and management issues. Different diagnostic markers are considered, like Doppler measurements, estimated fetal growth, interval growth, fetal movements, biomarkers, and placental markers.

简介：AbstractAmbulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.

简介：AbstractSevere asthma is "asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming 'uncontrolled’ or which remains 'uncontrolled’ despite this therapy." The state of control was defined by symptoms, exacerbations and the degree of airflow obstruction. Therefore, for the diagnosis of severe asthma, it is important to have evidence for a diagnosis of asthma with an assessment of its severity, followed by a review of comorbidities, risk factors, triggers and an assessment of whether treatment is commensurate with severity, whether the prescribed treatments have been adhered to and whether inhaled therapy has been properly administered. Phenotyping of severe asthma has been introduced with the definition of a severe eosinophilic asthma phenotype characterized by recurrent exacerbations despite being on high dose ICS and sometimes oral corticosteroids, with a high blood eosinophil count and a raised level of nitric oxide in exhaled breath. This phenotype has been associated with a Type-2 (T2) inflammatory profile with expression of interleukin (IL)-4, IL-5, and IL-13. Molecular phenotyping has also revealed non-T2 inflammatory phenotypes such as Type-1 or Type-17 driven phenotypes. Antibody treatments targeted at the T2 targets such as anti-IL5, anti-IL5Rα, and anti-IL4Rα antibodies are now available for treating severe eosinophilic asthma, in addition to anti-immunoglobulin E antibody for severe allergic asthma. No targeted treatments are currently available for non-T2 inflammatory phenotypes. Long-term azithromycin and bronchial thermoplasty may be considered. The future lies with molecular phenotyping of the airway inflammatory process to refine asthma endotypes for precision medicine.

简介：AbstractOver the past few decades, understanding of the pathogenesis of rheumatoid arthritis (RA) has improved substantially. Insights into the cellular and molecular mechanisms involved in RA have enabled the discovery of new therapeutic targets and led to the development of biologics and targeted synthetic disease-modifying antirheumatic drugs. In parallel with the improvement in therapies, the evolution of strategies in the management of RA has also contributed considerably to better outcomes in patients. Major changes include the development of disease activity measures, formulation of the treat-to-target principles as well as increased attention to comorbidities. The presence of comorbidities such as cardiovascular diseases may increase the mortality of RA patients, affect their treatment strategies and result in worse outcomes. Therefore, prevention and management of certain high-risk comorbidities have become increasingly important in the long-term treatment of RA. In this study, we summarized new insights into the pathogenesis and management of rheumatoid arthritis and associated comorbidities, with a special focus on the 2021 update of the American College of Rheumatology (ACR) guideline for RA and key reports presented at the 2021 ACR convergence.

简介：Earlydiagnosisandtreatmentisthekeytoimprovingtheprognosisofgastriccancer.Thepastdecadeshavewitnessedtherapidadvancesinthediagnosisandmanagementofearlygastriccancer(EGC):endoscopyhasplayedanincreasinglyimportantrole,whereaslaparoscopictechniqueshavealsobeenintroducedforEGCtreatment.InChina,the

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简介：Therelationshipbetweentacitknowledgeandinformalnetworkshasnotbeenfullyexplored.Tacitknowledgecannotbewellmanageddirectly,becauseitisdeeplyembeddedinindividualactionsandexperiences.Thisstudyproposesanapproachtomanaginginformalnetworksasanewmiddlewaytofacilitatethesharingandtransferringoftacitknowledge,owingtothefactthattacitknowledgeismostlysharedandtransferredthroughinformalnetworks.Tosupporttheideaoftheapproach,anempiricalcasestudyofapplyingtheapproachtomanagementofalargescientificprojectisalsoincluded.Ourfindingssuggestthatinformalnetworksplayessentialrolesformanagementoftacitknowledge,andthusgoodmanagementofinformalnetworkscanleadtoefficientsharingandtransferringoftacitknowledge.

简介：<正>Since1980s,participatoryapproach,asatoolandmajortechnology,hasbeenreceivedbymanycountriesandinternationalorgans,andhasbeenusedextensivelyintheprojectsofsurvey,povertyrelief,resourcedevelopmentandresourceprotection.Indeed,thesedevelopmentactions,supportedby

简介：TherevisedAtlantaclassificationofacutepancreatitiswasadoptedbyinternationalconsensus,andisbasedonactuallocalandsystemicdeterminantsofdiseaseseverity.Thelocaldeterminantispancreaticnecrosis(sterileorinfected),andthesystemicdeterminantisorganfailure.Localcomplicationsofpancreatitiscanincludeacuteperi-pancreaticfluidcollection,acutenecroticcollection,pseudocystformation,andwalledoffnecrosis.Interventionalendoscopicultrasound(EUS)hasbeenincreasingutilizedinmanagingtheselocalcomplications.AfterperformingaPubMedsearch,theauthorsmanuallyappliedpre-definedinclusioncriteriaorafiltertoidentifypublicationsrelevanttoEUSandpancreaticcollections(PFCs).Theauthorsthenreviewedtheutility,efficacy,andrisksassociatedwithusingtherapeuticEUSandinvolvedEUSdevicesintreatingPFCs.Duetothedevelopmentandregulatoryapprovalofimprovedandnovelendoscopicdevicesspecificallydesignedfortransmuraldrainageoffluidandnecroticdebris(accessandpatencydevices),theauthorspredictcontinuingevolutioninthemanagementofPFCs.WebelievethatEUSwillbecomeanindispensablepartofproceduresusedtodiagnosePFCsandperformimage-guidedinterventions.AfterdrainingaPFC,theamountoftissuenecrosisisthemostimportantpredictorofasuccessfuloutcome.Hence,itseemslogicaltoclassifythesecollectionsbasedontheirpercentageofnecroticcomponentordebrispresentwhenviewedbyimagingmethodsorEUS.Finally,theauthorsproposeanalgorithmformanagingfluidcollectionsbasedontheirsize,location,associatedsymptoms,internalechogenicpatterns,andcontent.

简介：Conflictisanimportantcomponentofhumansocietyandanecessaryforsocialdevelopment,owingtothedifferenceofsocialeconomy,historicalculturalbackgroundandregionalenvironment,variousconflictsandcontradictionswillbegeneratedunavoidably.Insolvingtheseconflictsandcontradic

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