BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially l...BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially locally,still inhibits the treatment efficacy.The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC.However,there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.PDAC.METHODS Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study.All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure.Baseline characteristics,surgical data,and postoperative morbidities were recorded.All of the patients were followed up,and the date and location of tumor recurrence,and death were recorded.The Kaplan-Meier method and log-rank test were used for the survival analysis.RESULTS There were 93 patients included in the study and 37 underwent the TRIANGLE technique.Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group[440(410-480)min vs 320(265-427)min](P=0.001).Intraoperative blood loss[700(500-1200)mL vs 500(300-800)mL](P=0.009)and blood transfusion[975(0-1250)mL vs 400(0-800)mL](P=0.009)were higher in the PDTRIANGLE group.There was a higher incidence of surgical site infection(43.2%vs 12.5%)(P=0.001)and postoperative diarrhea(54.1%vs 12.5%)(P=0.001)in the PDTRIANGLE group.The rates of R0 resection and local recurrence,overall survival,and disease-free survival did not differ significantly between the two groups.CONCLUSION The TRIANGLE technique is safe,with acceptable postoperative morbidities compared with standardized PD,but it does not improve prognosis for patients with resectable PDAC.展开更多
Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraum...Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. In this sense, TKA surgery, which seeks to replace the damaged joint with prosthetic components, has proven to be highly effective in relieving pain, improving joint function, and, ultimately, significantly increasing patients’ quality of life. The present study describes the TKA and revision knee arthroplasty (RKA) rates and, identifies the associated co morbidities in the Colombian context. Methods: A retrospective cohort study was carried out. It describes demographic and clinical characteristics between two groups of patients, TKA or RKA, and its association with mortality at 30 days, 90 days, or one year after the intervention. Results: The incidence rate of the population undergoing TKA was approximately 11.71 cases per 100,000 inhabitants. Furthermore, the incidence rate for revision knee arthroplasty (RKA) procedures in the same period was around 0.96 per 100,000 inhabitants. In both groups at 30 days postoperatively, a total mortality rate of 0.09%was recorded. When the follow-up was extended to 90 days, it increased to 0.15%;at one year postoperatively, it rose to 0.88%. Conclusion: Mortality after surgery was low in Colombia in 2019. Although RKA is a beneficial procedure, in certain circumstances, it was noted that it carries a higher risk compared to primary TKA. Our results emphasize the importance of careful evaluation of co morbidities and risk factors in patients undergoing these surgical procedures. The application of quality-of-life questionnaires should be considered in future studies on effectiveness and mortality for TKA and RKA in our country.展开更多
Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has...Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has demonstrated that unnecessary laboratory tests did not change the management plan.[3]These actions led to ED overcrowding,causing consequences to patient outcomes.展开更多
To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identi...To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identify and respond to youth mental health needs more rapidly”.1 Increased rates of suicidal behaviour,depression and anxiety symptoms and substance use.展开更多
Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developi...Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developing countries,as well as infectious causes,like Tuberculosis(TB)in developing countries,contribute to significant disease burden.The literature points towards the coexistence of psychiatric disorders with respiratory disorders responsible for poorer outcomes.Despite the extensive burden of respiratory disorders and the presence of concurrent psychiatric disorders,studies focusing on their prevalence are limited in India.Methods:A cross-sectional psychiatric screening was carried out on sequential patients attending the tertiary respiratory unit over eight months.Those screened positive were interviewed in detail for psychiatric diagnosis and challenges in the management were discussed.Psychiatric diagnosis,pulmonary TB and medical comorbidity were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20.Results:Psychiatric morbidity was present in 100 out of 350 patients(28.57%).Tuberculosis was the most common diagnosis(46%)in subjects attending the respiratory clinic services while common mental disorders like depression,anxiety,and insomnia were the most common psychiatric concern(88%)in this study.Conclusion:Psychiatric disorders and medical morbidities are common in patients with respiratory disorders.Multiple factors determine the treatment adherence in both respiratory and psychiatric disorders.Screening for psychiatric disorders with the help of a consultation-liaison psychiatrist in respiratory units is recommended.Future studies should focus on developing dedicated psychiatry services to enhance overall outcomes in patients with respiratory disorders.展开更多
Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they po...Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they possess a broad dividing potential.When the standard treatment proves ineffective,stem cells are typically utilized as a final option.Infections and childhood malignancies are among the significant causes of mortality in the pediatric population.Stem cell therapy has shown a decrease in morbidity and mortality when used in patients with favorable conditions like young age and lack of comorbidities.This review discusses how stem cells are prepared and used in treating pediatric diseases like X-linked agammaglobulinemia,diabetes mellitus,aplastic anemia,infections,and leukemia.Technological advancement has played a significant role in producing more specific stem cells using genetic modification methods like clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9,which produce stem cells that target a particular cell type,e.g.,myocytes and hematopoietic cells,further increasing the effectiveness of the therapy.We address the obstacles faced when conducting research related to stem cells,including ethical and legal issues,which hinder the use of this therapy in some fields.We also indicate recommendations for increasing the efficacy of stem cell therapy in the pediatric population.展开更多
The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 ...The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.展开更多
AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional...AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.展开更多
Liver transplantation has evolved tremendously from an experimental surgery to being gold standard treatment for patients with liver failure and liver malignancies over the past 5 decades.In the meantime,due to a shor...Liver transplantation has evolved tremendously from an experimental surgery to being gold standard treatment for patients with liver failure and liver malignancies over the past 5 decades.In the meantime,due to a shortage of donated organs,living donor liver transplantation has emerged to be a safe alternative,particularly in the Asian countries.While most donor hepatectomies were performed in an open manner,selected centers explored using minimally invasive techniques to perform the surgery.展开更多
Summary What is already known about this topic?Pneumoconiosis,recognized as one of the most detrimental occupational diseases in China,exhibits a multimorbidity profile due to a plethora of comorbidities and complicat...Summary What is already known about this topic?Pneumoconiosis,recognized as one of the most detrimental occupational diseases in China,exhibits a multimorbidity profile due to a plethora of comorbidities and complications.These factors significantly influence the treatment outcomes,progression,prognosis,and overall quality of life of the afflicted patients.展开更多
Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to ...Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been reported.Liao et al.found that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more complex.However,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from VVS.Therefore,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.展开更多
To the Editor:Psoriasis is often associated with comorbidities such as cardiovascular diseases,obesity,and metabolic syndrome(MS).However,the prevalence of abovementioned diseases in Chinese patients with plaque psori...To the Editor:Psoriasis is often associated with comorbidities such as cardiovascular diseases,obesity,and metabolic syndrome(MS).However,the prevalence of abovementioned diseases in Chinese patients with plaque psoriasis is still unknown.Recently,biologics such as tumor necrosis alpha inhibitors,interleukin-17A inhibitors have been successfully used in the treatment of plaque psoriasis.However,the effects of biological treatment on comorbidities associated with metabolism are still controversial.Study on the relationship between the comorbidities associated with metabolism and plaque psoriasis and the effects of biologics are necessary.展开更多
Prurigo nodularis(PN),as a subtype of chronic prurigo(CPG),is characterized by nodular lesions and severe pruritus,which signicantly affect patients’quality of life.[1]It has been observed that patients with PN often...Prurigo nodularis(PN),as a subtype of chronic prurigo(CPG),is characterized by nodular lesions and severe pruritus,which signicantly affect patients’quality of life.[1]It has been observed that patients with PN often have comorbidities,including physical and mental diseases.[2]However,information on comorbidities in Chinese PN patients is lacking.This study aims toll this gap by using a representative patient population to provide comprehensive data on comorbidities in Chinese patients with PN.展开更多
To the Editor:Chronic obstructive pulmonary disease(COPD)is a common disease among the elderly,affecting over one-third of the elderly population worldwide.The progressive decline in lung function characteristic of CO...To the Editor:Chronic obstructive pulmonary disease(COPD)is a common disease among the elderly,affecting over one-third of the elderly population worldwide.The progressive decline in lung function characteristic of COPD significantly impacts the quality of life and employability of affected individuals,resulting in a substantial direct and indirect socioeconomic burden.COPD frequently has comorbidities involving other organ systems.Virtually all elderly COPD patients present with one or more comorbid conditions,collectively exacerbating health and economic burdens.While viral and bacterial infections remain the most common triggers for COPD exacerbations(ECOPD).展开更多
Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,pati...Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,patients with pre-existing underlying comorbidities,such as chronic obstructive pulmonary disease,cardiovascular disease,diabetes and obesity,are more likely to have severe disease compared to healthy adults[2].An inconsistency is seen in current fndings on the association with comorbidities and pediatric COVID-19 severity.An important limitation in currently available studies is limited data:severe disease is rare in children compared to adults,and most studies describe COVID-19 severity merely by reporting intensive care unit(ICU)admission or mortality rates instead of detailed data on clinical presentation and outcomes.展开更多
Objective To evaluate the status and influencing factors of psychiatric comorbidities of patients with epilepsy(PWEs)in Hubei province during the outbreak of COVID-19.Methods From February 23,2020 to March 5,2020,a ne...Objective To evaluate the status and influencing factors of psychiatric comorbidities of patients with epilepsy(PWEs)in Hubei province during the outbreak of COVID-19.Methods From February 23,2020 to March 5,2020,a network questionnaire survey(including demographic characteristics,seizures,Generalized Anxiety Disorder Scale-7 score,Patient Health Questionnaire-9 score,Insomnia Severity Index score)was conducted a-mong 570 PWEs who visited the Epilepsy Center of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology during April 1,2019 and January 20,2020.展开更多
AIM:To describe the demographics,clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India.METHODS:This was a retrospective longitudinal hospital-based study of 1...AIM:To describe the demographics,clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India.METHODS:This was a retrospective longitudinal hospital-based study of 1382 children aged≤12y included in the National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS(NIMBUS)Study.Data on patient demographics,treatment approach,and best-corrected visual acuity(BCVA)changes were reviewed.RESULTS:The mean age of the study cohort was 4.54±2.46y,with males constituting the majority(55.4%).The cause of amblyopia was refractive error in 73.2%,strabismus in 7.3%,and anisometropia in 6.8%of eyes.The majority of therapies comprised glasses(74.4%),followed by occlusion+glasses(10.3%),occlusion alone(7.3%),and surgery+patching+glasses(5.1%).The mean occlusion time was 2.46±1.14h.After a median follow-up of 10.00(6-85)mo,the mean BCVA significantly improved from 0.85±0.41 to 0.55±0.42 logMAR.Subgroup analysis revealed BCVA gain for all etiologies,including refractive errors(P<0.001),strabismus(P<0.001),cataract(P<0.001),and ptosis(P<0.001).Additionally,eyes with refractive errors showed significantly better BCVA than eyes with cataracts(P<0.001),strabismus(P<0.001)and marginally better BCVA than eyes with ptosis(P<0.05),both at the baseline and final visit.CONCLUSION:Refractive errors are the commonest cause of amblyopia,followed by strabismus and anisometropia.Timely detection,optimal therapy,and periodic follow-up are crucial in bettering visual acuity regardless of the cause.展开更多
Cancer is one of the most important health problems that deeply affects all humanity and will have groundbreaking consequences in human history with its elimination.Gastrointestinal cancers,including colon and rectum,...Cancer is one of the most important health problems that deeply affects all humanity and will have groundbreaking consequences in human history with its elimination.Gastrointestinal cancers,including colon and rectum,stomach,liver,pancreatic,and esophageal,account for 26%of the global cancer incidence and 35%of cancer-related deaths.Unfortunately,it is estimated that today’s high incidence and mortality rates will increase by 58%and 73%by 2040,respectively.Although the treatment process includes novel options such as immunotherapy in addition to classical options with a multidisciplinary approach,surgical treatment under general anesthesia remains the leading option.Considering a long-lasting cancer process,it is quite surprising that a very short-term anesthetic adminis-tration can have various effects on cancer cell behavior.Various anesthetic approaches such as regional blocks used in pain management,the use of ane-sthetic adjuvants such asβ-adrenoceptor antagonists,nonsteroidal anti-inflam-matory drugs,and intravenous lidocaine,and the choice of anesthetic drugs seem to have potential effects on long-term cancer outcomes.Propofol is an intravenous anesthetic drug that is used for both induction and maintenance of general anesthesia.Many in vitro and clinical studies examining the effects of propofol comparatively with other anesthetic agents on tumor recurrence and metastasis revealed possible effects on tumor cell signaling,the immune response,and the modulation of the neuroendocrine stress response.However,the evidence from all these in vitro and clinical studies is different,complicated,and inconsistent.The general effects of propofol on the behavioral patterns,growth,and metastasis of gastrointestinal tumor cells,as well as the clinical features and consequences resulting from these effects,constitute the subject of this review.展开更多
Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respir...Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).展开更多
BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postopera...BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.展开更多
基金Supported by the National Natural Science Foundation of China,No.31971518.
文摘BACKGROUND Radical surgery combined with systemic chemotherapy offers the possibility of long-term survival or even cure for patients with pancreatic ductal adenocar-cinoma(PDAC),although tumor recurrence,especially locally,still inhibits the treatment efficacy.The TRIANGLE technique was introduced as an extended dissection procedure to improve the R0 resection rate of borderline resectable or locally advanced PDAC.However,there was a lack of studies concerning postoperative complications and long-term outcomes of this procedure on patients with resectable PDAC.PDAC.METHODS Patients with resectable PDAC eligible for PD from our hospital between June 2018 and December 2021 were enrolled in this retrospective cohort study.All the patients were divided into PDstandard and PDTRIANGLE groups according to the surgical procedure.Baseline characteristics,surgical data,and postoperative morbidities were recorded.All of the patients were followed up,and the date and location of tumor recurrence,and death were recorded.The Kaplan-Meier method and log-rank test were used for the survival analysis.RESULTS There were 93 patients included in the study and 37 underwent the TRIANGLE technique.Duration of operation was longer in the PDTRIANGLE group compared with the PDstandard group[440(410-480)min vs 320(265-427)min](P=0.001).Intraoperative blood loss[700(500-1200)mL vs 500(300-800)mL](P=0.009)and blood transfusion[975(0-1250)mL vs 400(0-800)mL](P=0.009)were higher in the PDTRIANGLE group.There was a higher incidence of surgical site infection(43.2%vs 12.5%)(P=0.001)and postoperative diarrhea(54.1%vs 12.5%)(P=0.001)in the PDTRIANGLE group.The rates of R0 resection and local recurrence,overall survival,and disease-free survival did not differ significantly between the two groups.CONCLUSION The TRIANGLE technique is safe,with acceptable postoperative morbidities compared with standardized PD,but it does not improve prognosis for patients with resectable PDAC.
文摘Introduction: Total knee arthroplasty (TKA) has been established as a transformative solution in the treatment of advanced degenerative diseases of the knee, such as osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. In this sense, TKA surgery, which seeks to replace the damaged joint with prosthetic components, has proven to be highly effective in relieving pain, improving joint function, and, ultimately, significantly increasing patients’ quality of life. The present study describes the TKA and revision knee arthroplasty (RKA) rates and, identifies the associated co morbidities in the Colombian context. Methods: A retrospective cohort study was carried out. It describes demographic and clinical characteristics between two groups of patients, TKA or RKA, and its association with mortality at 30 days, 90 days, or one year after the intervention. Results: The incidence rate of the population undergoing TKA was approximately 11.71 cases per 100,000 inhabitants. Furthermore, the incidence rate for revision knee arthroplasty (RKA) procedures in the same period was around 0.96 per 100,000 inhabitants. In both groups at 30 days postoperatively, a total mortality rate of 0.09%was recorded. When the follow-up was extended to 90 days, it increased to 0.15%;at one year postoperatively, it rose to 0.88%. Conclusion: Mortality after surgery was low in Colombia in 2019. Although RKA is a beneficial procedure, in certain circumstances, it was noted that it carries a higher risk compared to primary TKA. Our results emphasize the importance of careful evaluation of co morbidities and risk factors in patients undergoing these surgical procedures. The application of quality-of-life questionnaires should be considered in future studies on effectiveness and mortality for TKA and RKA in our country.
文摘Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has demonstrated that unnecessary laboratory tests did not change the management plan.[3]These actions led to ED overcrowding,causing consequences to patient outcomes.
基金The funder or sponsor had no role in the study design,analysis,data interpretation or preparation of the manuscript.The effort was supported in part by NIDA(K12 DA041449,KYX)the APA Psychiatric Research Fellowship funded by NIDA(KYX).BYL was an APA/APA Foundation Public Psychiatry Fellow at the time of acceptance.The contents of this publication are solely the responsibility of the author and do not necessarily represent the official views of the Department of Health and Human Service,APA or APA Foundation.Mention of trade names,commercial practices or organisations does not imply endorsement by the US Government.ASK receives research funding from Alto Neuroscience,Liva Nova,Curemark and Beam Diagnostics.
文摘To the editor:Two recent advisories from the US surgeon general have underscored the unprecedented public health crisis in youth mental health and emphasised the need for“timely data collection and research to identify and respond to youth mental health needs more rapidly”.1 Increased rates of suicidal behaviour,depression and anxiety symptoms and substance use.
文摘Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developing countries,as well as infectious causes,like Tuberculosis(TB)in developing countries,contribute to significant disease burden.The literature points towards the coexistence of psychiatric disorders with respiratory disorders responsible for poorer outcomes.Despite the extensive burden of respiratory disorders and the presence of concurrent psychiatric disorders,studies focusing on their prevalence are limited in India.Methods:A cross-sectional psychiatric screening was carried out on sequential patients attending the tertiary respiratory unit over eight months.Those screened positive were interviewed in detail for psychiatric diagnosis and challenges in the management were discussed.Psychiatric diagnosis,pulmonary TB and medical comorbidity were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20.Results:Psychiatric morbidity was present in 100 out of 350 patients(28.57%).Tuberculosis was the most common diagnosis(46%)in subjects attending the respiratory clinic services while common mental disorders like depression,anxiety,and insomnia were the most common psychiatric concern(88%)in this study.Conclusion:Psychiatric disorders and medical morbidities are common in patients with respiratory disorders.Multiple factors determine the treatment adherence in both respiratory and psychiatric disorders.Screening for psychiatric disorders with the help of a consultation-liaison psychiatrist in respiratory units is recommended.Future studies should focus on developing dedicated psychiatry services to enhance overall outcomes in patients with respiratory disorders.
文摘Stem cells are pluripotent cells that can divide and differentiate,forming many different types of cells.Stem cells can be obtained from various sources,with embryonic stem cells being the most advantageous as they possess a broad dividing potential.When the standard treatment proves ineffective,stem cells are typically utilized as a final option.Infections and childhood malignancies are among the significant causes of mortality in the pediatric population.Stem cell therapy has shown a decrease in morbidity and mortality when used in patients with favorable conditions like young age and lack of comorbidities.This review discusses how stem cells are prepared and used in treating pediatric diseases like X-linked agammaglobulinemia,diabetes mellitus,aplastic anemia,infections,and leukemia.Technological advancement has played a significant role in producing more specific stem cells using genetic modification methods like clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9,which produce stem cells that target a particular cell type,e.g.,myocytes and hematopoietic cells,further increasing the effectiveness of the therapy.We address the obstacles faced when conducting research related to stem cells,including ethical and legal issues,which hinder the use of this therapy in some fields.We also indicate recommendations for increasing the efficacy of stem cell therapy in the pediatric population.
文摘The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.
基金Supported by Vision International Eye Missions-USA,“One Drop for All”,Italy,and Private Donors in the Netherlands.
文摘AIM:To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies.METHODS:A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W.Kenya,amongst a seminomadic tribe(Maasai).Students in Grades 1-8 were included.Visual acuity was measured using the Snellen“tumbling E”chart at 6 m.Children with symptoms of refractive error underwent non-cycloplegic refraction.RESULTS:A total of 2036 children(1084 males)between the ages of 4-20y were examined.Conjunctival actinic changes were present in 22%(442/2036).Nine cases were seen with a potential squamous carcinoma.No overt classical ocular signs of vitamin A deficiency were noted,although 181(8.9%)children complained of nyctalopia.Three hundred thirty-six(16.5%)children had a visual acuity worse than 6/12 in either eye,were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error.Refractive data led to an estimate of hyperopia of+1.00 D or more in 3.9%and of myopia of-0.50 D or more in either eye in 3.0%of the study population.CONCLUSION:Solar exposure-and dust-related conjunctival pathology is common.As this may develop into potentially sight-or even life-threatening conditions,it warrants further study,and preventive strategies may be needed.Complaints of nyctalopia were common and could suggest vitamin A deficiency.The prevalence of refractive errors is low in this rural African population.
文摘Liver transplantation has evolved tremendously from an experimental surgery to being gold standard treatment for patients with liver failure and liver malignancies over the past 5 decades.In the meantime,due to a shortage of donated organs,living donor liver transplantation has emerged to be a safe alternative,particularly in the Asian countries.While most donor hepatectomies were performed in an open manner,selected centers explored using minimally invasive techniques to perform the surgery.
基金National Key Research&Development Program of China(No.2021 YFC2500700).
文摘Summary What is already known about this topic?Pneumoconiosis,recognized as one of the most detrimental occupational diseases in China,exhibits a multimorbidity profile due to a plethora of comorbidities and complications.These factors significantly influence the treatment outcomes,progression,prognosis,and overall quality of life of the afflicted patients.
基金supported by the Peking University Clinical Scientist Program(BMU2019LCKXJ001)the Fundamental Research Funds for the Central Universities,China.Clinical Medicine Plus X-Young Scholars Project(PKU2022LCXQ028)the Fundamental Research Funds for the Central Universities,China.Multi-center Study Project,Peking University First Hospital,China.
文摘Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been reported.Liao et al.found that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more complex.However,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from VVS.Therefore,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.
文摘To the Editor:Psoriasis is often associated with comorbidities such as cardiovascular diseases,obesity,and metabolic syndrome(MS).However,the prevalence of abovementioned diseases in Chinese patients with plaque psoriasis is still unknown.Recently,biologics such as tumor necrosis alpha inhibitors,interleukin-17A inhibitors have been successfully used in the treatment of plaque psoriasis.However,the effects of biological treatment on comorbidities associated with metabolism are still controversial.Study on the relationship between the comorbidities associated with metabolism and plaque psoriasis and the effects of biologics are necessary.
基金National Natural Science Foundation of China(No.81972930)Shenzhen Natural Sciences Foundation(No.JCYJ20210324105411030)+2 种基金Scientific Research Foundation of Peking University Shenzhen Hospital(No.KYQD2021016)Shenzhen Key Medical Discipline Construction Fund(No.SZXK040)Guangdong Basic and Applied Basic Research Foundation(No.2021A1515111009)
文摘Prurigo nodularis(PN),as a subtype of chronic prurigo(CPG),is characterized by nodular lesions and severe pruritus,which signicantly affect patients’quality of life.[1]It has been observed that patients with PN often have comorbidities,including physical and mental diseases.[2]However,information on comorbidities in Chinese PN patients is lacking.This study aims toll this gap by using a representative patient population to provide comprehensive data on comorbidities in Chinese patients with PN.
基金supported by grants from National Key R&D Program of China(Nos.2020YFC2009000 and 2020YFC2009001)Scientific Research Project of Shanghai Science and Technology Commission(Nos.22Y11901200 and 21140902500)+3 种基金Scientific Research Project of Shanghai Municipal Health Commission(Nos.2022XD030 and 202140036)Shanghai Municipal Key Clinical Specialty(No.shslczdzk02801)Investigator-initiated clinical trials Foundation of Huadong Hospital(Nos.HDLC2022018,ZDXK2216,ZDZB2226,and JYRC202209)Shanghai Health System Young Talent Fund Project Hengjie-Special Support Program(No.2022-020)
文摘To the Editor:Chronic obstructive pulmonary disease(COPD)is a common disease among the elderly,affecting over one-third of the elderly population worldwide.The progressive decline in lung function characteristic of COPD significantly impacts the quality of life and employability of affected individuals,resulting in a substantial direct and indirect socioeconomic burden.COPD frequently has comorbidities involving other organ systems.Virtually all elderly COPD patients present with one or more comorbid conditions,collectively exacerbating health and economic burdens.While viral and bacterial infections remain the most common triggers for COPD exacerbations(ECOPD).
文摘Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,patients with pre-existing underlying comorbidities,such as chronic obstructive pulmonary disease,cardiovascular disease,diabetes and obesity,are more likely to have severe disease compared to healthy adults[2].An inconsistency is seen in current fndings on the association with comorbidities and pediatric COVID-19 severity.An important limitation in currently available studies is limited data:severe disease is rare in children compared to adults,and most studies describe COVID-19 severity merely by reporting intensive care unit(ICU)admission or mortality rates instead of detailed data on clinical presentation and outcomes.
文摘Objective To evaluate the status and influencing factors of psychiatric comorbidities of patients with epilepsy(PWEs)in Hubei province during the outbreak of COVID-19.Methods From February 23,2020 to March 5,2020,a network questionnaire survey(including demographic characteristics,seizures,Generalized Anxiety Disorder Scale-7 score,Patient Health Questionnaire-9 score,Insomnia Severity Index score)was conducted a-mong 570 PWEs who visited the Epilepsy Center of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology during April 1,2019 and January 20,2020.
文摘AIM:To describe the demographics,clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India.METHODS:This was a retrospective longitudinal hospital-based study of 1382 children aged≤12y included in the National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS(NIMBUS)Study.Data on patient demographics,treatment approach,and best-corrected visual acuity(BCVA)changes were reviewed.RESULTS:The mean age of the study cohort was 4.54±2.46y,with males constituting the majority(55.4%).The cause of amblyopia was refractive error in 73.2%,strabismus in 7.3%,and anisometropia in 6.8%of eyes.The majority of therapies comprised glasses(74.4%),followed by occlusion+glasses(10.3%),occlusion alone(7.3%),and surgery+patching+glasses(5.1%).The mean occlusion time was 2.46±1.14h.After a median follow-up of 10.00(6-85)mo,the mean BCVA significantly improved from 0.85±0.41 to 0.55±0.42 logMAR.Subgroup analysis revealed BCVA gain for all etiologies,including refractive errors(P<0.001),strabismus(P<0.001),cataract(P<0.001),and ptosis(P<0.001).Additionally,eyes with refractive errors showed significantly better BCVA than eyes with cataracts(P<0.001),strabismus(P<0.001)and marginally better BCVA than eyes with ptosis(P<0.05),both at the baseline and final visit.CONCLUSION:Refractive errors are the commonest cause of amblyopia,followed by strabismus and anisometropia.Timely detection,optimal therapy,and periodic follow-up are crucial in bettering visual acuity regardless of the cause.
文摘Cancer is one of the most important health problems that deeply affects all humanity and will have groundbreaking consequences in human history with its elimination.Gastrointestinal cancers,including colon and rectum,stomach,liver,pancreatic,and esophageal,account for 26%of the global cancer incidence and 35%of cancer-related deaths.Unfortunately,it is estimated that today’s high incidence and mortality rates will increase by 58%and 73%by 2040,respectively.Although the treatment process includes novel options such as immunotherapy in addition to classical options with a multidisciplinary approach,surgical treatment under general anesthesia remains the leading option.Considering a long-lasting cancer process,it is quite surprising that a very short-term anesthetic adminis-tration can have various effects on cancer cell behavior.Various anesthetic approaches such as regional blocks used in pain management,the use of ane-sthetic adjuvants such asβ-adrenoceptor antagonists,nonsteroidal anti-inflam-matory drugs,and intravenous lidocaine,and the choice of anesthetic drugs seem to have potential effects on long-term cancer outcomes.Propofol is an intravenous anesthetic drug that is used for both induction and maintenance of general anesthesia.Many in vitro and clinical studies examining the effects of propofol comparatively with other anesthetic agents on tumor recurrence and metastasis revealed possible effects on tumor cell signaling,the immune response,and the modulation of the neuroendocrine stress response.However,the evidence from all these in vitro and clinical studies is different,complicated,and inconsistent.The general effects of propofol on the behavioral patterns,growth,and metastasis of gastrointestinal tumor cells,as well as the clinical features and consequences resulting from these effects,constitute the subject of this review.
基金supported by a Grant-inAid for Scientific Research(KAKENHI)from the Japan Society for the Promotion of Science(grant no.22J23183)。
文摘Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).
文摘BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.
