Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific hea...Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific health conditions(e.g.,diabetes or sepsis)for statistical analyses.However,there has been substantial variation in the algorithm development and validation,leading to frequently suboptimal performance and posing a significant threat to the validity of study findings.Unfortunately,these issues are often overlooked.Methods:We systematically developed guidance for the development,validation,and evaluation of algorithms designed to identify health status(DEVELOP-RCD).Our initial efforts involved conducting both a narrative review and a systematic review of published studies on the concepts and methodological issues related to algorithm development,validation,and evaluation.Subsequently,we conducted an empirical study on an algorithm for identifying sepsis.Based on these findings,we formulated specific workflow and recommendations for algorithm development,validation,and evaluation within the guidance.Finally,the guidance underwent independent review by a panel of 20 external experts who then convened a consensus meeting to finalize it.Results:A standardized workflow for algorithm development,validation,and evaluation was established.Guided by specific health status considerations,the workflow comprises four integrated steps:assessing an existing algorithm’s suitability for the target health status;developing a new algorithm using recommended methods;validating the algorithm using prescribed performance measures;and evaluating the impact of the algorithm on study results.Additionally,13 good practice recommendations were formulated with detailed explanations.Furthermore,a practical study on sepsis identification was included to demonstrate the application of this guidance.Conclusions:The establishment of guidance is intended to aid researchers and clinicians in the appropriate and accurate development and application of algorithms for identifying health status from RCD.This guidance has the potential to enhance the credibility of findings from observational studies involving RCD.展开更多
OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi met...OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi method).METHODS:Our study was consistent with T/CACM 1336-2020.We searched the monographs and references published in the past 40 years(1983-2022),and established the diagnostic criteria pool of waterdampness syndrome and dampness-turbidity syndrome in Traditional Chinese Medicine(TCM)based on literature by using frequency statistics and correlation analysis.Expert investigation(interview method and two rounds of Delphi method)was used to form the diagnostic criteria of water-dampness syndrome and dampnessturbidity syndrome of idiopathic membranous nephropathy.Clinical diagnostic test research was carried out,and compared with“Diagnostic Criteria for dampness syndrome”(T/CACM 1454-2023)to evaluate the authenticity,reliability and clinical application value of the standard.RESULTS:A total of 122 relevant guides,standards,monographs and documents were included through searching books and Chinese databases.Four experts were interviewed and two rounds of delphi method(75 experts nationwide)were carried out.The experts'opinions are relatively concentrated and the differences are small.Based on the weight of each index,the diagnostic criteria indexes of water-dampness syndrome and dampness-turbidity syndrome were selected.After discussion by the core group members,the diagnostic model of"necessary symptoms and optional symptoms"was established,and the final diagnostic criteria of waterdampness syndrome and dampness-turbidity syndrome were established.One hundred and ninety-one inpatients and outpatients of Guangdong Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were included in Diagnostic test study.There was no statistical difference in gender,age and course of disease(P>0.05).The sensitivity and specificity of the trial standard were 90.34%and 73.33%respectively,while the sensitivity and specificity of T/CACM 1454-2023 were 99.43%and 6.67%,respectively.CONCLUSIONS:The consensus-based diagnostic criteria for IMN can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our IMN criteria.展开更多
To evaluate the subchronic and chronic toxicity of Fuyanxiao capsules,Sprague-Dawley(SD)rats were used in toxicity studies.In the subchronic toxicity study,50 female rats were randomly divided into a high-dose group(5...To evaluate the subchronic and chronic toxicity of Fuyanxiao capsules,Sprague-Dawley(SD)rats were used in toxicity studies.In the subchronic toxicity study,50 female rats were randomly divided into a high-dose group(5.4g/kg/day)and a control group,with 15 rats in each,and medium(2.7g/kg/day)and low(1.35g/kg/day)dose groups,with 10 rats in each.The test substance was administered orally(mixed with feed,twice daily)for 90 consecutive days.In the chronic toxicity study,40 female rats were randomly divided into high,medium,and low dose groups and a control group,with 10 rats in each.The test substance was administered orally in the same manner for 180 consecutive days.Clinical signs,body weight,and food consumption were observed and recorded daily.At the end of the terminal phase(the first 10 rats from each group,1 day after the last dose)and the recovery phase(the last 5 rats from the control group and the high-dose group,observed for an additional 28 days after the last dose),blood and urine samples,as well as organs,were collected.Organ coefficients were calculated,and various hematological and urinary indicators were detected,followed by pathological analysis.The results showed that there were no significant differences in body weight,food consumption,or organ coefficients between any of the dose groups and the control group in both subchronic and chronic toxicity studies(P>0.05).Histopathological examination revealed no lesions,suggesting no tissue or organ damage in any of the dose groups.The rats exhibited good mental status,and hematological and urinary physiological indicators were within normal ranges,indicating stable liver and kidney function,hematopoietic system of the bone marrow,and internal environment in all dose groups.Therefore,Fuyanxiao capsule has no obvious subchronic or chronic toxicity in SD rats,and it is safe and reliable to use at reasonable dosage in clinical practice.展开更多
BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the t...BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the treatment of both conditions.It mitigates diarrhoea by restoring mucosal integrity and enhancing enterocyte brush border enzyme activity.In ARI,zinc boosts immune function,promotes epithelial regeneration,and inhibits the replication of respiratory viruses.AIM To assess the effectiveness of prophylactic intermittent zinc supplementation in preventing acute diarrhoea and ARI in infants.METHODS This open-label,randomized controlled trial with a 1:1 allocation ratio was conducted over 15 months(October 2022 to December 2023)at a tertiary care hospital in Eastern India.A total of 320 infants attending the outpatient department for routine vaccinations were enrolled and randomly assigned to intervention and control groups.The intervention group received zinc drops for two weeks,with the regimen repeated one month later and again at six months during subsequent vaccination visits.The control group received no placebo or alternative treatment.Outcomes were assessed after the final follow-up at nine months.RESULTS The mean annual incidence of ARI and diarrhoea was significantly lower in the zinc group than in the control group[ARI:0.25±0.61 vs 0.92±1.22;mean difference=-0.67(95%CI:-0.88 to-0.45),P<0.001,Cohen’s d=-0.69]and[diarrhoea:1.04±1.30 vs 2.07±2.09;mean difference=-1.03(95%CI:-1.42 to-0.65),P<0.001,Cohen's d=-0.59],respectively.Additionally,the zinc group showed significantly greater gains in length[10±0.6 cm vs 8.6±0.4 cm;mean difference=1.4(95%CI:1.3-1.5),P<0.001,Cohen’s d=2.74]and weight[3150±108 g vs 2818±76 g;mean difference=332(95%CI:310-352),P<0.001,Cohen's d=3.56].CONCLUSION Prophylactic intermittent zinc supplementation administered alongside routine immunization substantially reduces the incidence of ARI and diarrhoea in infants and promotes improved growth.This affordable strategy holds promise for reducing infant morbidity and mortality without increasing healthcare burdens.展开更多
Objective:To compare the nursing effects of routine care and specialized nursing intervention on patients with dysphagia during acute stroke.Methods:A total of 188 patients with acute stroke and dysphagia who received...Objective:To compare the nursing effects of routine care and specialized nursing intervention on patients with dysphagia during acute stroke.Methods:A total of 188 patients with acute stroke and dysphagia who received treatment at our hospital from May 2022 to December 2024 were selected as study subjects.The patients were randomly divided into a control group and an observation group,with 94 patients in each group.The control group received routine nursing intervention,while the observation group received specialized nursing intervention.The general information,swallowing function,quality of life,and nursing satisfaction were compared between the two groups.Results:There was no statistically significant difference in general information between the two groups(P>0.05).The SAS score of the observation group after nursing was significantly lower than that of the control group(t=19.463,P=0.000<0.001).After intervention,the number of patients with lung infection in the observation group was significantly lower than that in the control group(χ2=7.309,P=0.007<0.01).The overall quality of life score of the observation group was significantly better than that of the control group after intervention(P<0.001).The nursing satisfaction of the observation group was significantly higher than that of the control group(χ^(2)=15.865,P=0.000<0.001).Conclusion:Compared with routine care,specialized nursing intervention can effectively improve the swallowing function of patients with dysphagia during acute stroke,enhance their quality of life,and increase nursing satisfaction.展开更多
Every day,people follow a routine.What is your morning routine?Maybe you wake up at six or seven.You wash your face and brush your hair.You dress for school or work.Maybe you eat breakfast at home.
Objective:To explore the accuracy and stability of the results of peripheral blood routine tests at different time points after anticoagulation and standing,providing a scientific basis for actual clinical work.Method...Objective:To explore the accuracy and stability of the results of peripheral blood routine tests at different time points after anticoagulation and standing,providing a scientific basis for actual clinical work.Methods:In this study,30 patients who visited the hospital in October 2023 were randomly selected and divided into two groups(15 cases in each group).The same collection method was used for routine blood tests.The tests were performed after anticoagulation and standing for 5 minutes,1 hour,and 5 minutes,2 hours respectively,and the routine blood test indicators at different time points were compared.Results:After comparison,there were no significant differences in the results of routine blood tests at 5 minutes after mixing,anticoagulating,and standing peripheral blood and those at 1 hour and 2 hours(P>0.05).Conclusion:The results of peripheral blood after mixing,anticoagulating,and standing for 5 minutes are stable compared with those after standing for 1 hour and 2 hours.In actual work,the pre-test turnaround time can be appropriately extended.展开更多
Objective:To study the application effect of bundle nursing strategy in the maintenance of difficult blood vessels for long-term hemodialysis patients.Methods:A prospective study was conducted on 40 long-term hemodial...Objective:To study the application effect of bundle nursing strategy in the maintenance of difficult blood vessels for long-term hemodialysis patients.Methods:A prospective study was conducted on 40 long-term hemodialysis patients admitted from January 2024 to January 2025.The patients were randomly divided into a control group(20 cases)and an observation group(20 cases)using computer random sampling.The control group received routine nursing for difficult blood vessels,while the observation group received a bundle nursing strategy for difficult blood vessels.The self-care ability,complication rate,and nursing satisfaction were compared between the two groups.Results:After nursing,the self-care ability score of the observation group was higher than that of the control group(P<0.05).The complication rate in the observation group was lower than that in the control group(P<0.05).The nursing satisfaction in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the bundle nursing strategy in the maintenance of difficult blood vessels for long-term hemodialysis patients is beneficial for improving self-care ability,reducing complications,and increasing patient satisfaction with nursing services.展开更多
Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 wer...Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 were selected as the study subjects and divided into two groups by lottery method.The control group(55 cases)received routine care,while the observation group(56 cases)received a combination of routine care and progressive effect nutritional care.Results:After 4 weeks of care,the observation group demonstrated higher treatment adherence(P<0.05),better quality of life(P<0.05),and improved nutritional status(P<0.05)compared to the control group.Conclusion:Progressive effect nutritional care can significantly enhance treatment adherence,quality of life,and nutritional status in uremia patients undergoing dialysis.展开更多
好题精选阅读下面短文,从短文后的选项中选出可以填入空白处的最佳选项。选项中有两项为多余选项。I hear the word“uncertainty”everywhere.Job security,future development and even health advice seem to change daily.1 Fortuna...好题精选阅读下面短文,从短文后的选项中选出可以填入空白处的最佳选项。选项中有两项为多余选项。I hear the word“uncertainty”everywhere.Job security,future development and even health advice seem to change daily.1 Fortunately,research shows that an effective way to resist the anxiety that comes with uncertainty is to focus on our daily routines.展开更多
This study investigates the variability in cancer diagnosis across different tissues and organs, with a focus on the role of diagnostic methods such as Hematoxylin and Eosin (H&E) staining and immunohistochemistry...This study investigates the variability in cancer diagnosis across different tissues and organs, with a focus on the role of diagnostic methods such as Hematoxylin and Eosin (H&E) staining and immunohistochemistry (IHC). The predominance of female breast cancer (30%) aligns with global trends, underscoring the need for robust diagnostic protocols, particularly in developing regions. Other prevalent cancers, including skin, stomach, and cervix uteri, reflect a mix of environmental, genetic, and infectious factors. The underrepresentation of gallbladder and thyroid cancers (<1%) suggests potential underdiagnosis or lower prevalence. Age distribution data indicate peak cancer incidence in individuals aged 31 - 45 years, with gender-specific cancers like breast and cervical cancer predominantly affecting females (63.4%). The analysis also highlights significant diagnostic gaps, as 61.2% of cases did not undergo IHC testing due to resource constraints, leading to potential biases in cancer prevalence and diagnostic accuracy. The study emphasizes the complementary role of IHC in confirming ambiguous H&E findings, with strong alignment observed when both methods were used. However, the absence of IHC in many cases limits the robustness of conclusions, suggesting the need for increased access to IHC testing. The findings advocate for integrating IHC into routine diagnostics, expanding diagnostic capabilities, and improving sample sizes to ensure more reliable and comprehensive cancer data.展开更多
Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-t...Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.展开更多
There are many things that make me change in the past three years.Most of them make me better.One of the most important changes is I am healthier and stronger because of my exercise.As I ate junk food and seldom exerc...There are many things that make me change in the past three years.Most of them make me better.One of the most important changes is I am healthier and stronger because of my exercise.As I ate junk food and seldom exercised,I used to be fat.So I made a decision to do exercise for two hours once a week.展开更多
Dear Editor,Evidence-based medicine guides modern clinical practice.Quantitative evidence synthesis facilitates clinical decision-making after comprehensive interviews between clinicians and patients.Individualised co...Dear Editor,Evidence-based medicine guides modern clinical practice.Quantitative evidence synthesis facilitates clinical decision-making after comprehensive interviews between clinicians and patients.Individualised concern is always critical,not only for the diversity of patients’values and preferences,but also for questioning whether the treatment response of the individual is in line with the population.Precision medicine aims to choose the right treatment for each person.展开更多
Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) represents a significant advancement in the imaging of prostate cancer (PCa), yet its application in low- and intermedi...Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) represents a significant advancement in the imaging of prostate cancer (PCa), yet its application in low- and intermediate-risk cases continues to be a topic of active discussion. This article delves into the nuanced role of PSMA PET/CT, critically analyzing its strengths and limitations in these specific risk categories. For patients with low-risk PCa, PSMA PET/CT demonstrates limited effectiveness in routine staging due to its minimal tracer uptake in low-grade tumors. However, its ability to differentiate between low- and high-grade tumors suggests a promising role in active surveillance, offering a potential noninvasive method for monitoring disease progression and aiding in treatment decision-making. In the intermediate-risk PCa setting, the high specificity of PSMA PET/CT in nodal staging makes it a valuable asset for precise surgical and radiation therapy planning. The article underscores the necessity for further research to fully realize the potential of PSMA PET/CT in PCa management, particularly in developing more personalized treatment approaches in these clinical scenarios.展开更多
The prevalence of patients with coronary heart disease(CHD)and diabetes mellitus is notably high,posing sig-nificant residual cardiovascular risks even after routine interventions such as antihypertensive,lipid-loweri...The prevalence of patients with coronary heart disease(CHD)and diabetes mellitus is notably high,posing sig-nificant residual cardiovascular risks even after routine interventions such as antihypertensive,lipid-lowering,and antithrombot-ic treatments.Recent studies have demonstrated that certain glucose-lowering medications confer cardiovascular benefits for pa-tients with type 2 diabetes.However,a survey indicates that cardiologists may not be fully acquainted with the optimal screen-ing timing,indicators,and diagnostic criteria for type 2 diabetes,and there is insufficient awareness and a low rate of prescrip-tion of novel glucose-lowering medications with proven cardiovascular efficacy,such as glucagon-like peptide-1 receptor agon-ists(GLP-1 RAs)and sodium-glucose co-transporter-2 inhibitors(SGLT-2i).In this context,based on domestic and international guidelines or consensus and the latest evidence-based evidence,this consensus aims to standardize the glycemic management for patients with acute coronary syndrome,chronic coronary syndrome,and perioperative management for percutaneous coronary intervention.It highlights the key points of screening and diagnosis of type 2 diabetes,and the comprehensive management of cardiovascular risk in patients with CHD.The consensus elaborates on the principles and algorithms of glycemic management for CHD patients,without involving acute complications of diabetes,clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits,and promotes the standardized use of these medications in cardiovascular and other related spe-cialty fields.Additionally,it addresses the glucose-lowering treatment to comprehensively reduce cardiovascular risks.展开更多
Objective: To explore the promoting function of TCM nursing in the rehabilitation of hemiplegia patients with stroke. Methods: 78 stroke hemiplegic patients admitted from April 2022 to April 2024 were randomly divided...Objective: To explore the promoting function of TCM nursing in the rehabilitation of hemiplegia patients with stroke. Methods: 78 stroke hemiplegic patients admitted from April 2022 to April 2024 were randomly divided into a control group of 38 cases who received routine care, and an experimental group of 40 cases who received routine nursing basis plus traditional Chinese medicine nursing;the nursing effects of the two groups of patients were compared. Results: After 12 days of nursing care, the experimental group showed better psychological status [SAS score (21.71 ± 3.21), SDS score (22.18 ± 2.31)], limb motor function, daily living ability, and neurological function [NIHSS score (12.23 ± 2.21)] than the control group, with significant differences in data (P Conclusion: Traditional Chinese medicine nursing for stroke hemiplegia patients is more conducive to promoting rehabilitation than routine nursing.展开更多
Methicillin-resistant Staphylococcus aureus(MRSA)is a common pathogen causing acquired infections.Antibiotics are routinely employed for bacterial infection treatment.Excessive antibiotic use for bacterial infections ...Methicillin-resistant Staphylococcus aureus(MRSA)is a common pathogen causing acquired infections.Antibiotics are routinely employed for bacterial infection treatment.Excessive antibiotic use for bacterial infections heightens resistance,and MRSA resistance is being prevalent[1].MRSA exhibits substantial resistance to conventional antibiotics,which is associated with its biofilm-forming capability.The bacterial biofilm serves as a barrier,restricting nutrient access and slowing internal metabolism,increasing antibiotic resistance.The bacterial biofilm forms a defensive layer,resisting antibiotic penetration while preventing nutrient entry,inducing a slow bacterial metabolism,and increasing bacterial resistance[2].Consequently,biofilm formation and the emergence of resistance to conventional antibiotics have become substantial challenges in the field of infectious diseases.The development of agents to remove biofilm barriers is urgently required because biofilms are extremely hazardous.展开更多
Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the ca...Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the care team,including vital sign checks,medication delivery,and blood draws for laboratory investigations,are routinely done in many hospitals.Frequent interruptions by staff and noise by other patients have been cited as barriers to restorative sleep in the hospital.展开更多
Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Metho...Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.展开更多
基金supported by the National Natural Science Foundation of China(82225049,72104155)the Sichuan Provincial Central Government Guides Local Science and Technology Development Special Project(2022ZYD0127)the 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYGD23004).
文摘Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific health conditions(e.g.,diabetes or sepsis)for statistical analyses.However,there has been substantial variation in the algorithm development and validation,leading to frequently suboptimal performance and posing a significant threat to the validity of study findings.Unfortunately,these issues are often overlooked.Methods:We systematically developed guidance for the development,validation,and evaluation of algorithms designed to identify health status(DEVELOP-RCD).Our initial efforts involved conducting both a narrative review and a systematic review of published studies on the concepts and methodological issues related to algorithm development,validation,and evaluation.Subsequently,we conducted an empirical study on an algorithm for identifying sepsis.Based on these findings,we formulated specific workflow and recommendations for algorithm development,validation,and evaluation within the guidance.Finally,the guidance underwent independent review by a panel of 20 external experts who then convened a consensus meeting to finalize it.Results:A standardized workflow for algorithm development,validation,and evaluation was established.Guided by specific health status considerations,the workflow comprises four integrated steps:assessing an existing algorithm’s suitability for the target health status;developing a new algorithm using recommended methods;validating the algorithm using prescribed performance measures;and evaluating the impact of the algorithm on study results.Additionally,13 good practice recommendations were formulated with detailed explanations.Furthermore,a practical study on sepsis identification was included to demonstrate the application of this guidance.Conclusions:The establishment of guidance is intended to aid researchers and clinicians in the appropriate and accurate development and application of algorithms for identifying health status from RCD.This guidance has the potential to enhance the credibility of findings from observational studies involving RCD.
基金the Special Project of State Key Laboratory of Dampness Syndrome of Chinese Medicine:Study on Criteria for Diagnosis of Dampness Syndrome of Idiopathic Membranous Nephropathy,Cohort Study on Pathogenesis and Material Basis of Dampness Syndrome of Idiopathic Membranous Nephropathy,Randomized Controlled Clinical Study of Sanqi Qushi Granule in Treatment of Membranous Nephropathy(No.SZ2021ZZ02,SZ2021ZZ09 and SZ2021ZZ36)the 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund:Guangdong-Hong Kong-Macao Joint Lab(No.2020B1212030006)+2 种基金the Natural Science Foundation of Guangdong Province:Study on the Mechanism of Sanqi Qushi Prescription Delaying Podocellular Senescence in Membranous Nephropathy based on Cyclic Guanosine Monophosphate-Adenosine Monophosphate Synthase-Stimulator of Interferon Genes-Nuclear Factor Kappa-B Signaling Pathway(No.2022A1515011628)the Guangzhou Science and Technology Plan Project:to Explore the Mechanism of Treating Membranous Nephropathy from the Perspective of Regulating Amino Acid Metabolism Disorder(No.2023A03J0746)Special Funding for Scientific and Technological Research on Traditional Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine:a Multimodular Machine Learning Prediction Model based on Pathological Image-transcriptomics and Traditional Chinese Medicine Syndromes was Used to Investigate the Prognostic Correlation of Long non-coding RNA Molecules in Nephropathy and the Intervention Mechanism of Sanqi Qushi Formula,to Investigate the Pathogenesis and Microbiological Mechanism of Dampness Syndrome of Membranous Nephropathy based on the Microecological Changes of Tongue Coating(No.YN2023MB02,YN2023MB10)。
文摘OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi method).METHODS:Our study was consistent with T/CACM 1336-2020.We searched the monographs and references published in the past 40 years(1983-2022),and established the diagnostic criteria pool of waterdampness syndrome and dampness-turbidity syndrome in Traditional Chinese Medicine(TCM)based on literature by using frequency statistics and correlation analysis.Expert investigation(interview method and two rounds of Delphi method)was used to form the diagnostic criteria of water-dampness syndrome and dampnessturbidity syndrome of idiopathic membranous nephropathy.Clinical diagnostic test research was carried out,and compared with“Diagnostic Criteria for dampness syndrome”(T/CACM 1454-2023)to evaluate the authenticity,reliability and clinical application value of the standard.RESULTS:A total of 122 relevant guides,standards,monographs and documents were included through searching books and Chinese databases.Four experts were interviewed and two rounds of delphi method(75 experts nationwide)were carried out.The experts'opinions are relatively concentrated and the differences are small.Based on the weight of each index,the diagnostic criteria indexes of water-dampness syndrome and dampness-turbidity syndrome were selected.After discussion by the core group members,the diagnostic model of"necessary symptoms and optional symptoms"was established,and the final diagnostic criteria of waterdampness syndrome and dampness-turbidity syndrome were established.One hundred and ninety-one inpatients and outpatients of Guangdong Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were included in Diagnostic test study.There was no statistical difference in gender,age and course of disease(P>0.05).The sensitivity and specificity of the trial standard were 90.34%and 73.33%respectively,while the sensitivity and specificity of T/CACM 1454-2023 were 99.43%and 6.67%,respectively.CONCLUSIONS:The consensus-based diagnostic criteria for IMN can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our IMN criteria.
文摘To evaluate the subchronic and chronic toxicity of Fuyanxiao capsules,Sprague-Dawley(SD)rats were used in toxicity studies.In the subchronic toxicity study,50 female rats were randomly divided into a high-dose group(5.4g/kg/day)and a control group,with 15 rats in each,and medium(2.7g/kg/day)and low(1.35g/kg/day)dose groups,with 10 rats in each.The test substance was administered orally(mixed with feed,twice daily)for 90 consecutive days.In the chronic toxicity study,40 female rats were randomly divided into high,medium,and low dose groups and a control group,with 10 rats in each.The test substance was administered orally in the same manner for 180 consecutive days.Clinical signs,body weight,and food consumption were observed and recorded daily.At the end of the terminal phase(the first 10 rats from each group,1 day after the last dose)and the recovery phase(the last 5 rats from the control group and the high-dose group,observed for an additional 28 days after the last dose),blood and urine samples,as well as organs,were collected.Organ coefficients were calculated,and various hematological and urinary indicators were detected,followed by pathological analysis.The results showed that there were no significant differences in body weight,food consumption,or organ coefficients between any of the dose groups and the control group in both subchronic and chronic toxicity studies(P>0.05).Histopathological examination revealed no lesions,suggesting no tissue or organ damage in any of the dose groups.The rats exhibited good mental status,and hematological and urinary physiological indicators were within normal ranges,indicating stable liver and kidney function,hematopoietic system of the bone marrow,and internal environment in all dose groups.Therefore,Fuyanxiao capsule has no obvious subchronic or chronic toxicity in SD rats,and it is safe and reliable to use at reasonable dosage in clinical practice.
文摘BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the treatment of both conditions.It mitigates diarrhoea by restoring mucosal integrity and enhancing enterocyte brush border enzyme activity.In ARI,zinc boosts immune function,promotes epithelial regeneration,and inhibits the replication of respiratory viruses.AIM To assess the effectiveness of prophylactic intermittent zinc supplementation in preventing acute diarrhoea and ARI in infants.METHODS This open-label,randomized controlled trial with a 1:1 allocation ratio was conducted over 15 months(October 2022 to December 2023)at a tertiary care hospital in Eastern India.A total of 320 infants attending the outpatient department for routine vaccinations were enrolled and randomly assigned to intervention and control groups.The intervention group received zinc drops for two weeks,with the regimen repeated one month later and again at six months during subsequent vaccination visits.The control group received no placebo or alternative treatment.Outcomes were assessed after the final follow-up at nine months.RESULTS The mean annual incidence of ARI and diarrhoea was significantly lower in the zinc group than in the control group[ARI:0.25±0.61 vs 0.92±1.22;mean difference=-0.67(95%CI:-0.88 to-0.45),P<0.001,Cohen’s d=-0.69]and[diarrhoea:1.04±1.30 vs 2.07±2.09;mean difference=-1.03(95%CI:-1.42 to-0.65),P<0.001,Cohen's d=-0.59],respectively.Additionally,the zinc group showed significantly greater gains in length[10±0.6 cm vs 8.6±0.4 cm;mean difference=1.4(95%CI:1.3-1.5),P<0.001,Cohen’s d=2.74]and weight[3150±108 g vs 2818±76 g;mean difference=332(95%CI:310-352),P<0.001,Cohen's d=3.56].CONCLUSION Prophylactic intermittent zinc supplementation administered alongside routine immunization substantially reduces the incidence of ARI and diarrhoea in infants and promotes improved growth.This affordable strategy holds promise for reducing infant morbidity and mortality without increasing healthcare burdens.
文摘Objective:To compare the nursing effects of routine care and specialized nursing intervention on patients with dysphagia during acute stroke.Methods:A total of 188 patients with acute stroke and dysphagia who received treatment at our hospital from May 2022 to December 2024 were selected as study subjects.The patients were randomly divided into a control group and an observation group,with 94 patients in each group.The control group received routine nursing intervention,while the observation group received specialized nursing intervention.The general information,swallowing function,quality of life,and nursing satisfaction were compared between the two groups.Results:There was no statistically significant difference in general information between the two groups(P>0.05).The SAS score of the observation group after nursing was significantly lower than that of the control group(t=19.463,P=0.000<0.001).After intervention,the number of patients with lung infection in the observation group was significantly lower than that in the control group(χ2=7.309,P=0.007<0.01).The overall quality of life score of the observation group was significantly better than that of the control group after intervention(P<0.001).The nursing satisfaction of the observation group was significantly higher than that of the control group(χ^(2)=15.865,P=0.000<0.001).Conclusion:Compared with routine care,specialized nursing intervention can effectively improve the swallowing function of patients with dysphagia during acute stroke,enhance their quality of life,and increase nursing satisfaction.
文摘Every day,people follow a routine.What is your morning routine?Maybe you wake up at six or seven.You wash your face and brush your hair.You dress for school or work.Maybe you eat breakfast at home.
基金Project of Guangdong Provincial Medical Science and Technology Research Fund(A2022011)Major Science and Technology Project of Shenzhen Nanshan District Health System(NSZD2023067)Sub-project of Education(Health)Science and Technology Project of Nanshan District Technology Research and Development and Creative Design Project in Shenzhen(NS2022002)。
文摘Objective:To explore the accuracy and stability of the results of peripheral blood routine tests at different time points after anticoagulation and standing,providing a scientific basis for actual clinical work.Methods:In this study,30 patients who visited the hospital in October 2023 were randomly selected and divided into two groups(15 cases in each group).The same collection method was used for routine blood tests.The tests were performed after anticoagulation and standing for 5 minutes,1 hour,and 5 minutes,2 hours respectively,and the routine blood test indicators at different time points were compared.Results:After comparison,there were no significant differences in the results of routine blood tests at 5 minutes after mixing,anticoagulating,and standing peripheral blood and those at 1 hour and 2 hours(P>0.05).Conclusion:The results of peripheral blood after mixing,anticoagulating,and standing for 5 minutes are stable compared with those after standing for 1 hour and 2 hours.In actual work,the pre-test turnaround time can be appropriately extended.
文摘Objective:To study the application effect of bundle nursing strategy in the maintenance of difficult blood vessels for long-term hemodialysis patients.Methods:A prospective study was conducted on 40 long-term hemodialysis patients admitted from January 2024 to January 2025.The patients were randomly divided into a control group(20 cases)and an observation group(20 cases)using computer random sampling.The control group received routine nursing for difficult blood vessels,while the observation group received a bundle nursing strategy for difficult blood vessels.The self-care ability,complication rate,and nursing satisfaction were compared between the two groups.Results:After nursing,the self-care ability score of the observation group was higher than that of the control group(P<0.05).The complication rate in the observation group was lower than that in the control group(P<0.05).The nursing satisfaction in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the bundle nursing strategy in the maintenance of difficult blood vessels for long-term hemodialysis patients is beneficial for improving self-care ability,reducing complications,and increasing patient satisfaction with nursing services.
文摘Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 were selected as the study subjects and divided into two groups by lottery method.The control group(55 cases)received routine care,while the observation group(56 cases)received a combination of routine care and progressive effect nutritional care.Results:After 4 weeks of care,the observation group demonstrated higher treatment adherence(P<0.05),better quality of life(P<0.05),and improved nutritional status(P<0.05)compared to the control group.Conclusion:Progressive effect nutritional care can significantly enhance treatment adherence,quality of life,and nutritional status in uremia patients undergoing dialysis.
文摘好题精选阅读下面短文,从短文后的选项中选出可以填入空白处的最佳选项。选项中有两项为多余选项。I hear the word“uncertainty”everywhere.Job security,future development and even health advice seem to change daily.1 Fortunately,research shows that an effective way to resist the anxiety that comes with uncertainty is to focus on our daily routines.
文摘This study investigates the variability in cancer diagnosis across different tissues and organs, with a focus on the role of diagnostic methods such as Hematoxylin and Eosin (H&E) staining and immunohistochemistry (IHC). The predominance of female breast cancer (30%) aligns with global trends, underscoring the need for robust diagnostic protocols, particularly in developing regions. Other prevalent cancers, including skin, stomach, and cervix uteri, reflect a mix of environmental, genetic, and infectious factors. The underrepresentation of gallbladder and thyroid cancers (<1%) suggests potential underdiagnosis or lower prevalence. Age distribution data indicate peak cancer incidence in individuals aged 31 - 45 years, with gender-specific cancers like breast and cervical cancer predominantly affecting females (63.4%). The analysis also highlights significant diagnostic gaps, as 61.2% of cases did not undergo IHC testing due to resource constraints, leading to potential biases in cancer prevalence and diagnostic accuracy. The study emphasizes the complementary role of IHC in confirming ambiguous H&E findings, with strong alignment observed when both methods were used. However, the absence of IHC in many cases limits the robustness of conclusions, suggesting the need for increased access to IHC testing. The findings advocate for integrating IHC into routine diagnostics, expanding diagnostic capabilities, and improving sample sizes to ensure more reliable and comprehensive cancer data.
基金funded,in part,by the National Natural Science Fund (NSFC,China) under award number 81900382supported,in part,by the Yang talents Program of Beijing (QML20200302)Beijing Municipal Natural Science Foundation (7222072).
文摘Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.
文摘There are many things that make me change in the past three years.Most of them make me better.One of the most important changes is I am healthier and stronger because of my exercise.As I ate junk food and seldom exercised,I used to be fat.So I made a decision to do exercise for two hours once a week.
文摘Dear Editor,Evidence-based medicine guides modern clinical practice.Quantitative evidence synthesis facilitates clinical decision-making after comprehensive interviews between clinicians and patients.Individualised concern is always critical,not only for the diversity of patients’values and preferences,but also for questioning whether the treatment response of the individual is in line with the population.Precision medicine aims to choose the right treatment for each person.
文摘Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) represents a significant advancement in the imaging of prostate cancer (PCa), yet its application in low- and intermediate-risk cases continues to be a topic of active discussion. This article delves into the nuanced role of PSMA PET/CT, critically analyzing its strengths and limitations in these specific risk categories. For patients with low-risk PCa, PSMA PET/CT demonstrates limited effectiveness in routine staging due to its minimal tracer uptake in low-grade tumors. However, its ability to differentiate between low- and high-grade tumors suggests a promising role in active surveillance, offering a potential noninvasive method for monitoring disease progression and aiding in treatment decision-making. In the intermediate-risk PCa setting, the high specificity of PSMA PET/CT in nodal staging makes it a valuable asset for precise surgical and radiation therapy planning. The article underscores the necessity for further research to fully realize the potential of PSMA PET/CT in PCa management, particularly in developing more personalized treatment approaches in these clinical scenarios.
文摘The prevalence of patients with coronary heart disease(CHD)and diabetes mellitus is notably high,posing sig-nificant residual cardiovascular risks even after routine interventions such as antihypertensive,lipid-lowering,and antithrombot-ic treatments.Recent studies have demonstrated that certain glucose-lowering medications confer cardiovascular benefits for pa-tients with type 2 diabetes.However,a survey indicates that cardiologists may not be fully acquainted with the optimal screen-ing timing,indicators,and diagnostic criteria for type 2 diabetes,and there is insufficient awareness and a low rate of prescrip-tion of novel glucose-lowering medications with proven cardiovascular efficacy,such as glucagon-like peptide-1 receptor agon-ists(GLP-1 RAs)and sodium-glucose co-transporter-2 inhibitors(SGLT-2i).In this context,based on domestic and international guidelines or consensus and the latest evidence-based evidence,this consensus aims to standardize the glycemic management for patients with acute coronary syndrome,chronic coronary syndrome,and perioperative management for percutaneous coronary intervention.It highlights the key points of screening and diagnosis of type 2 diabetes,and the comprehensive management of cardiovascular risk in patients with CHD.The consensus elaborates on the principles and algorithms of glycemic management for CHD patients,without involving acute complications of diabetes,clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits,and promotes the standardized use of these medications in cardiovascular and other related spe-cialty fields.Additionally,it addresses the glucose-lowering treatment to comprehensively reduce cardiovascular risks.
文摘Objective: To explore the promoting function of TCM nursing in the rehabilitation of hemiplegia patients with stroke. Methods: 78 stroke hemiplegic patients admitted from April 2022 to April 2024 were randomly divided into a control group of 38 cases who received routine care, and an experimental group of 40 cases who received routine nursing basis plus traditional Chinese medicine nursing;the nursing effects of the two groups of patients were compared. Results: After 12 days of nursing care, the experimental group showed better psychological status [SAS score (21.71 ± 3.21), SDS score (22.18 ± 2.31)], limb motor function, daily living ability, and neurological function [NIHSS score (12.23 ± 2.21)] than the control group, with significant differences in data (P Conclusion: Traditional Chinese medicine nursing for stroke hemiplegia patients is more conducive to promoting rehabilitation than routine nursing.
基金supported by the National Natural Science Foundation of China(No.82060806)the Guangxi Natural Science Foundation Project(No.2023GXNSFAA026461)+2 种基金the Interdisciplinary innovation research team for key technologies of traditional Chinese medicine,emerging biological materials,and intelligent equipment development(GZKJ2303)Graduate education innovation project of Guangxi University of Chinese Medicine(YCSZ2022008)the college student innovation and entrepreneurship training program of Guangxi University of Chinese Medicine(S202310600107,202310600241,S20221060053).
文摘Methicillin-resistant Staphylococcus aureus(MRSA)is a common pathogen causing acquired infections.Antibiotics are routinely employed for bacterial infection treatment.Excessive antibiotic use for bacterial infections heightens resistance,and MRSA resistance is being prevalent[1].MRSA exhibits substantial resistance to conventional antibiotics,which is associated with its biofilm-forming capability.The bacterial biofilm serves as a barrier,restricting nutrient access and slowing internal metabolism,increasing antibiotic resistance.The bacterial biofilm forms a defensive layer,resisting antibiotic penetration while preventing nutrient entry,inducing a slow bacterial metabolism,and increasing bacterial resistance[2].Consequently,biofilm formation and the emergence of resistance to conventional antibiotics have become substantial challenges in the field of infectious diseases.The development of agents to remove biofilm barriers is urgently required because biofilms are extremely hazardous.
基金supported by a Clinical Research Award from the Fonds de recherche du Québec.
文摘Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the care team,including vital sign checks,medication delivery,and blood draws for laboratory investigations,are routinely done in many hospitals.Frequent interruptions by staff and noise by other patients have been cited as barriers to restorative sleep in the hospital.
文摘Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.
