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简介：Naturalproducts(NPs)arecompoundsthatarederivedfromnaturalsourcessuchasplants,animals,andmicroisms.Therapeuticshasbenefitedfromnumerousdrugclassesderivedfromnaturalproductsources.TheBiopharmaceuticsDrugpositionClassificationSystem(BDDCS)wasproposedtoserveasabasisforpredictingtheimportanceoftransportersandenzymesindeterminingdrugbioavailabilityanddisposition.Itcategorizesdrugsintooneoffourbiopharmaceuticalclassesaccordingtotheirwatersolubilityandextentofmetabolism.Thepresentpaperreviews109drugsfromnaturalproductsources:29%belongtoclass1(highsolubility,extensivemetabolism),22%toclass2(lowsolubility,extensivemetabolism),40%toclass3(highsolubility,poormetabolism),and9%toclass4(lowsolubility,poormetabolism).HereinweevaluatedthecharacteristicsofNPsintermsofBDDCSclassforall109drugsaswellsasforsubsetsofNPsdrugsderivedfromplantsourcesasantibiotics.Inthe109NPsdrugs,wepiled32drugsfromplants,50%(16)oftotalinclass1,22%(7)inclass2and28%(9)inclass3,nonefoundinclass4;Meantime,theantibioticswerefound5(16%)inclass2,22(71%)inclass3,and4(13%)inclass4;nodrugwasfoundinclass1.Basedonthisclassification,weanticipateBDDCStoserveasausefuladjunctinevaluatingthepotentialcharacteristicsofnewnaturalproducts.

简介：破坏损害被定义为avery骨头和软纸巾的严重损坏。我们在一些破裂盒子中发现了那的Butin临床的实践，软纸巾的损坏不象“destructiveinjury”一样严重显示，而弄碎破裂stillcannot表演骨头损坏的严厉。因此我们proposeda新术语“destructivefractures”在把破坏损害的定义与典型诊所盒子相结合以后。破坏破裂指谁的破裂骨状的纸巾太严重被损坏被修理，但是软纸巾，神经和静脉是严重地伤害的更少，canbe修理。从一年2001～2010，破坏破裂的75个盒子被同意进入我们的部门。根据是否与外部环境连结的破裂和破裂地点，他们被划分成6种类型：al类型，关上的骨干破坏骨折；a2类型，开的骨干破坏骨折；bl类型，关上的包含关节的破坏骨折；b2类型，开的包含关节的destructivefracture；c1类型，关上的混合破坏骨折；c2类型，开的混合破坏骨折。相应临床的治疗为破坏骨折的新分类标准是的每type.The被进行简单、实际并且thuscan被用作一个重要指南为破坏破裂做合理treatmentplans。

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简介：ＡＵＴＯＭＡＴＩＣＣＬＡＳＳＩＦＩＣＡＴＩＯＮＯＦＥＣＧＵＳＩＮＧＡＲＴＩＦＩＣＩＡＬＮＥＵＲＡＬＮＥＴＷＯＲＫＳＡＵＴＯＭＡＴＩＣＣＬＡＳＳＩＦＩＣＡＴＩＯＮＯＦＥＣＧＵＳＩＮＧＡＲＴＩＦＩＣＩＡＬＮＥＵＲＡＬＮＥＴＷＯＲＫＳＣ．Ｌ．Ｐｅｎｇ，Ｚ．...

简介：AbstractObjective:To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head & Neck surgery, and to present a simple framework by which providers can assign wound classification.Data Sources:Literature review.Conclusion:Surgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality-driven care and reimbursement, surgical wound classification may become an equally important indicator of quality.

简介：AbstractBackground:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. This study was performed to evaluate the anatomical characteristics of mallet fractures, investigate a new mallet fracture classification system using anatomical and imaging methods, and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups, and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%, 50%, 75%, and 100% of the bilateral collateral ligaments. The effect of mallet fractures on the stability of the distal interphalangeal joint was then observed. The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture, the thickness of fracture, the untreated time after injury, and the complication of distal interphalangeal joint palmar subluxation. Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion, the Ishiguro method, or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral ligaments were cut off by 25% (t= -0.415, P = 0.684) and significantly unstable when this range was ≥50% (50% transection: t= -6.363, P < 0.001; 75% transection: t= -17.036, P < 0.001; 100% transection: t = -30.977, P < 0.001, respectively). The mallet fractures were divided into Types I, II, and III (fracture involving <20%, 20%-50%, and >50% of the joint surface, respectively). Type II was further divided into Types IIa and IIb according to whether the course of injury was < or ≥2 weeks, respectively. The mean post-operative flexion of the distal interphalangeal joint was 63.4° ± 7.9°, and the mean extension lag was 6.7°± 4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint. Classification that combines the involvement of the joint surface in the fracture, the thickness of the fracture, and the untreated time after injury is reasonable and will help to choose an appropriate operational method.

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简介：AbstractPurpose:Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too.Methods:A retrospective analysis of adult patients with traumatic TTA treated in our institution between January 2012 and December 2017 was done. We only included complete TTA injuries. Children below 15 years, with open injuries, associated fractures, or partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance.Results:There were 15 patients included, 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type I: palpable soft-tissue defect without bony mass; Type II: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type III: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type IV: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type I, transosseous suture repair for Type II, and tension band wiring or steel wire sutures for Types III and IV. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up.Conclusion:Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.

简介：瞄准：评估基于万维网的技术的使用估计学习曲线并且为胃的放大多彩石印版内视镜检查法(MC)重估一个分类的一个简化版本的重制度。方法：作为部分一多集中试用，一条混合途径用CDROM被采取，与持续5s各个和“汽车跑”的MC的20部电影，触发一个本地HTML框架的文件设定通过一个因特网连接引用了到一张遥远的问询表。三endoscopists被问到有希望地并且独立地分类随机分开与至少3d选择的10部这些电影。答案集中地被存储并且与正确答案和足够的反馈回到了参加者。结果：为在3个组的分类，两内[科恩的kappa(kappa)=0.79-1.00到0.89-1.00]并且内部观察员的同意增加了从第一(中等)到第6观察(kappa=0.94)。另外，对参考的同意在最后观察增加了(0.90，1.00和1.00为观察员A，B和C，分别地)。100%的有效性被所有观察员在他们的第4观察获得。当第4(潜水艇)组被考虑的、内部观察员的协议是时，几乎完善(kappa=0.92)在第6观察。有参考的关系清楚地在他们的第6观察改善了进kappa(0.93-1.00)和敏感(75%100%)。结论：这个MC分类是由优秀intra观察员和内部观察员的同意出现，并且与参考改进同意似乎容易可解说、可学会。象在这研究使用的那个那样的一个网系统可能是有用的为内视镜或另外的图象关于定义，教育和传播基于诊断过程。

简介：关于早泄(PE)的定义，分类和流行有进行中的争论。PE的第一个基于证据的定义与终生的PE被限制到异性爱的人从事阴道交际。不幸地，有PE的抱怨的许多病人不满足这些标准。然而，这些人能作为PE子类型，也就是获得的PE，自然可变PE或象早熟一样之一被诊断射精的机能障碍。不过，这些子类型的有效性被证据还没支持了。一个普遍接受的PE定义的缺席和为数据获得的标准的缺乏导致了报导了冲突率的流行研究。20%的高流行；-30%；可能由于在如此的调查被进行的时间在定义使用的含糊的术语。尽管当为基于人口的流行研究询问了时，许多人可以抱怨PE，仅仅他们的一些将活跃地为他们的抱怨寻求治疗，尽管大多数这些病人将定义与PE适合的症状。获得的PE病人的抱怨可能是更严重的，而经历象早熟一样的病人的抱怨射精的机能障碍与PE的各种各样的形式在人之中似乎最少严重。尽管众多的治疗形式为PE的管理被建议了，仅仅抗抑郁剂和热门麻木的乳脂当前被证明了有效。当任何一个都没被规章的机构同意了治疗形式，进一步的研究不管多么必须被带为PE开发有益的治疗策略。

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简介：AIM:Todescribeanewclassificationmethodofrighthepatectomyaccordingtothedifferentspecialpositionsoftumors.METHODS:Accordingtopositions,91patientswithmalignanthepatictumorintherightliverlobeweredividedintosixgroups:tumorsintherightposteriorlobeand(or)therightcaudatelobecompressingtherightportalhilum(n=14,15.4%),tumorsintherightliverlobecompressingtheinferiorvenacavaand(or)hepaticveins(n=11,12.9%),tumorsinfiltratingdiaphragmaticmuscle(n=7,7.7%),tumorsinthehepatorenalrecess(infiltratingtherightfattyrenalcapsule,transversecolonandrightadrenalgland,n=8,8.8%),tumorsdeeplylocatednearthevertebralbody(n=3,3.3%),tumorsatothersitesintherightliverlobe(thecontrolgroup,n=48,52.75%).Thevaluesofintraoperativebloodloss(IBL),tumor'smaximcross-sectionarea(TMCSA),andtimeofhepatichilumclamping(THHC)andincidenceofpostoperativecomplicationswerecomparedbetweenfivegroupsoftumorandcontrolgroup,respectively.RESULTS:TheTHHCingroups1-4wassignificantlylongerthanthatinthecontrolgroup,theIBLingroups1-4wassignificantlyhigherthanthatinthecontrolgroup,theTMCSAingroups2-4wassignificantlylargerthanthatinthecontrolgroup,andtheratioofIBL/TMCSAingroup1wassignificantlyhigherthanthatinthecontrolgroup.Therewasnosignificantdifferenceintheindexesbetweengroup5andthecontrolgroup.CONCLUSION:ThesiteoftumoristhekeyfactorthatdeterminesIBL.

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简介：AbstractImmunoglobulin G4-related disease (IgG4-RD) is a newly recognized chronic fibro-inflammatory autoimmune disease, and its recognition has been constantly increasing worldwide over the last few years. A correct and timely recognition, as well as appropriate intervention, is crucial for the treatment of IgG4-RD. For certain subtypes of IgG4-RD, organ-specific criteria are formulated to make the diagnosis more accurate. New biomarkers have emerged in the recent years to aid the disease diagnosis, its prognosis prediction, as well as therapy response monitoring. Although recurrence is very common in IgG4-RD, glucocorticoid is still the first-line treatment for the majority of patients. The factors that affect the likelihood of disease relapse are multifaceted. The selection strategy of various steroid-sparing agents is still being explored. Besides, when patients have special sites involvement leading to severe clinical conditions, surgical operation or interventional therapy should also be considered. An update on classification, diagnosis, and management of IgG4-RD is provided in the current study to fully elucidate the recommended clinical practice of this mysterious disease.

简介：AbstractPost-traumatic osteomyelitis (PTO) is a worldwide problem in the field of orthopaedic trauma. So far, there is no ideal treatment or consensus-based gold standard for its management. This paper reviews the representative literature focusing on PTO, mainly from the following four aspects: (1) the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body, including fracture stress, different components of internal fixation devices, immune response, occurrence and development mechanisms of inflammation in PTO, as well as the occurrence and development mechanisms of PTO in skeletal system; (2) clinical classification, mainly the etiological classification, histological classification, anatomical classification and the newly proposed new classifications (a brief analysis of their scope and limitations); (3) imaging diagnosis, including non-invasive examination and invasive examination (this paper discusses their advantages and disadvantages respectively, and briefly compares the sensitivity and effectiveness of the current examinations); and (4) strategies, including antibiotic administration, surgical choices and other treatment programs. Based on the above-mentioned four aspects, we try to put forward some noteworthy sections, in order to make the existing opinions more specific.

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简介：Acutemyeloidleukemia(AML)isageneticallyheterogeneousmyeloidmalignancythatoccursmorecommonlyinadults,andhasanincreasingincidence,mostlikelyduetoincreasingage.PrecisediagnosticclassificationofAMLrequiresclinicalandpathologicinformation,thelatterincludingmorphologic,immunophenotypic,cytogeneticandmoleculargeneticanalysis.RiskstratificationinAMLrequirescytogeneticsevaluationasthemostimportantpredictor,withgeneticmutationsprovidingadditionalnecessaryinformation.AMLwithnormalcytogeneticscomprisesabout40%-50%ofallAML,andhasbeenintensivelyinvestigated.Thecurrentlyused2008WorldHealthOrganizationclassificationofhematopoieticneoplasmshasbeenproposedtobeupdatedin2016,alsotoincludeanupdateontheclassificationofAML,duetothecontinuouslyincreasingapplicationofgenomictechniquesthathaveledtomajoradvancesinourknowledgeofthepathogenesisofAML.ThepurposeofthisreviewistodescribesomeoftheserecentmajoradvancesinthediagnosticclassificationandriskstratificationofAML.