BACKGROUND Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori(H.pylori).AIM To assess the efficacy and safety of high-dose dual therapy(HDDT)utilizing various highly potent a...BACKGROUND Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori(H.pylori).AIM To assess the efficacy and safety of high-dose dual therapy(HDDT)utilizing various highly potent antisecretory medications,thereby providing additional clinical guidance for H.pylori eradication.METHODS The study population comprised untreated H.pylori patients from three medical centers in central China.From February 10,2024 to March 31,2024,439 subjects were randomly allocated to either the esomeprazole-amoxicillin(EA)or esomeprazole-amoxicillin-clarithromycin-bismuth(B-quadruple)group.Subsequently,from April 1,2024 to May 10,2024,367 subjects were randomly assigned to either the vonoprazan-amoxicillin(VA)or vonoprazan-amoxicillin-clarithromycin(VAC)group.The study recorded treatment efficacy,adverse events,compliance,symptom alleviation,and associated costs.RESULTS EA-dual demonstrated non-inferiority to B-quadruple regimen in modified intention-to-treat(mITT)and perprotocol(PP)analyses(P<0.025).However,the eradication rate of EA was lower than that of the B-quadruple group[70.59%vs 83.49%,92.86%vs 98.38%,93.94%vs 98.38%,intention-to-treat(ITT),mITT,PP respectively,P<0.05].In ITT,mITT,and PP analyses,VA-dual was non-inferior to VAC treatment(84.15%vs 83.15%,96.25%vs 92.73%,96.75%vs 93.75%,P<0.025).No significant differences were observed in adverse events,compliance,and symptom relief between groups.VA exhibited the lowest cost.Antibiotic use within 2 years,poor compliance,and suburban residence were associated with reduced eradication efficacy(P<0.05).CONCLUSION The HDDT based on vonoprazan demonstrated non-inferiority to the VAC triple regimen,suggesting its potential as a recommended first-line treatment for H.pylori eradication.While B-quadruple therapy showed better eradication rate than EA therapy,the latter proved non-inferior in mITT and PP analyses.Notably,antibiotic use within the preceding two years,adherence to treatment protocols,and patient residence emerged as critical factors influencing eradication success.展开更多
This paper studies certain estimates for the lower bound of distance between unitary orbits of normal elements.We show that the distance between unitary orbits of normal elements of simple C^(*)-algebras of tracial ra...This paper studies certain estimates for the lower bound of distance between unitary orbits of normal elements.We show that the distance between unitary orbits of normal elements of simple C^(*)-algebras of tracial rank no more than k has a lower bound.Furthermore,if k≤1 and normal elements are commuting,then the lower bound will be better.Another result establishes a connection involving the spectrum distance operator Dc between a C^(*)-algebra of stable rank one C^(*)-algebra and its hereditary C^(*)-subalgebra.展开更多
The Cambrian and Lower Ordovician strata of the Bachu area in central Tarim Basin are characterized by extensively dolomitized,which have significant potential for favourable hydrocarbon reservoirs.The study herein co...The Cambrian and Lower Ordovician strata of the Bachu area in central Tarim Basin are characterized by extensively dolomitized,which have significant potential for favourable hydrocarbon reservoirs.The study herein combined petrographic,mineralogical and geochemical analyses to investigate the formation environments of these dolomite units and utilized Mg isotopic profiles to constrain the changes in the fluid flow trajectory.Positive excursions of δ^(18)O and upwardincreasing δ^(26)Mg profiles were observed in samples of the Wusonger formation(Є_(1)w),which may result from evaporation.Moreover,based on high ^(87)Sr/^(86)Sr ratios,high total REE concentrations and the occurrence of specific minerals,including quartz,barite,gypsum and pyrite,we interpret an evaporitic near-surface origin for the Є_(1)w dolomites.Samples of the Xiaoerblak Formation(Є_(1)x)are the product of seepage-reflux dolomitization,suggested by upward-decreasing δ^(26)Mg profiles and relatively lower ^(87)Sr/^(86)Sr ratios than the Є_(1)w samples.The overlapping isotope(δ^(18)O,δ^(13)C and ^(87)Sr/^(86)Sr)values between samples of the Shayilik(Є_(2)s)and Awatagh(Є_(2)a)Formation,in addition to the petrography evidence and Mg isotope variations,suggest that the formation of these dolomites were due to the shallow-burial dolomitization.The occurrence of the Xiaqiulitagh(Є_(3)ql)and Penglaiba(O_(1)p)dolomites along stylolites,together with their large crystals with opaque cores and clear rims and vertically constant δ^(26)Mg profiles,indicate that their formation may be related to pressure dissolution by mechanical compaction during deep-burial dolomitization.Therefore,the assembling of multiple petrographic,mineralogical and geochemical methods can shed light on the complicated generation processes of regional-scale dolomite within Tarim Basin or elsewhere.展开更多
The development of brain-computer interfaces(BCI)based on motor imagery(MI)has greatly improved patients’quality of life with movement disorders.The classification of upper limb MI has been widely studied and applied...The development of brain-computer interfaces(BCI)based on motor imagery(MI)has greatly improved patients’quality of life with movement disorders.The classification of upper limb MI has been widely studied and applied in many fields,including rehabilitation.However,the physiological representations of left and right lower limb movements are too close and activated deep in the cerebral cortex,making it difficult to distinguish their features.Therefore,classifying lower limbs motor imagery is more challenging.In this study,we propose a feature extraction method based on functional connectivity,which utilizes phase-locked values to construct a functional connectivity matrix as the features of the left and right legs,which can effectively avoid the problem of physiological representations of the left and right lower limbs being too close to each other during movement.In addition,considering the topology and the temporal characteristics of the electroencephalogram(EEG),we designed a temporal-spatial convolutional network(TSGCN)to capture the spatiotemporal information for classification.Experimental results show that the accuracy of the proposed method is higher than that of existing methods,achieving an average classification accuracy of 73.58%on the internal dataset.Finally,this study explains the network mechanism of left and right foot MI from the perspective of graph theoretic features and demonstrates the feasibility of decoding lower limb MI.展开更多
BACKGROUND The therapeutic role of neurodynamic mobilization in improving lower limb function in patients with mild post-traumatic knee osteoarthritis remains poorly understood.AIM To further elucidate the role of neu...BACKGROUND The therapeutic role of neurodynamic mobilization in improving lower limb function in patients with mild post-traumatic knee osteoarthritis remains poorly understood.AIM To further elucidate the role of neurodynamic mobilization in facilitating knee joint functional recovery.METHODS Thirty-two patients with post-traumatic knee osteoarthritis treated at Chonghua Hospital of Traditional Chinese Medicine(Guilin)from March 2024 to August 2025 were randomly assigned to a control group(n=16)or an intervention group(n=16).Both groups received eight weeks of conventional treatment;and the intervention group additionally underwent neurodynamic mobilization.Outcomes including pain assessed by the visual analogue scale,active range of motion,Lysholm score,stork stand test,single hop test,and Y-balance test were assessed before and after the intervention.RESULTS There were no significant differences between the two groups in baseline characteristics,including gender,age,body mass index,or surgical side(P>0.05).Two-way repeated-measures analysis of variance demonstrated significant time×group interaction effects for the visual analogue scale score(F=13.364,P<0.05),Lysholm knee score(F=20.385,P<0.05),stork stand test(F=103.756,P<0.05),and Y-balance test score(F=8.089,P<0.05).CONCLUSION Neurodynamic mobilization effectively reduces pain,improves knee function,and enhances lower limb balance in patients with mild post-traumatic knee osteoarthritis.展开更多
Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Va...Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.展开更多
This research presents a Human Lower Limb Activity Recognition(HLLAR)system that identifies specific activities and predicts the angles of the knees simultaneously,based on the EMG signals.The HLLAR systems streamline...This research presents a Human Lower Limb Activity Recognition(HLLAR)system that identifies specific activities and predicts the angles of the knees simultaneously,based on the EMG signals.The HLLAR systems streamlines the research on the lower limb activities.The HILLAR model includes Discrete Hermite Wavelets Transform-based Synchrosqueezing(DHWTS),Deep Two-Layer Multiscale Convolutional Neural Network(DTLMCNN),and Generalized Regression Neural Network(GRNN)as feature extraction,activity recognition,and knee angle prediction respectively.Electromyography signal-based automatic lower limb activity detection is crucial to rehabilitation and human movement analysis.Yet several of these methods face issues in feature extraction in complex data,overlapping signals,extraction of crucial parameters,and adaptation constraints.This research aims classify lower limb activities and predict knee joint angles from electromy-ography signals using HILLAR model.The model is validated on two datasets,comprising 26 subjects performing three classes of activities:walking,standing,and sitting.The proposed model obtained a classification accuracy of 99.95%,along with significant achievements in precision(99.93%),recall(99.91%),and F1-score(99.93%).The generalized regression neural network predicted angles of the knee joint with a root mean squared error of 1.25%.Robustness is demonstrated through consistent results in five-fold cross-validation and statistical significance testing(p-value=0.004,McNemar's test).Additionally,the proposed model showed superior performance over baseline methods by reducing error rates by 18%and decreasing processing time to 0.98 s.展开更多
The India-Asia collision resulted in the formation of Qinghai-Tibet Plateau.Lower crustal flow model was proposed to explain the mechanism of Cenozoic tectonic deformation of Qinghai-Tibet Plateau.In this study,we pro...The India-Asia collision resulted in the formation of Qinghai-Tibet Plateau.Lower crustal flow model was proposed to explain the mechanism of Cenozoic tectonic deformation of Qinghai-Tibet Plateau.In this study,we propose a new approach by combining centrifugal analog modeling with numerical simulation to simulate the tectonic uplift history of the plateau based on the lower crustal flow model,and to investigate the material migration characteristics and the influence of crustal motion velocity and ductile layer viscosity on the plateau tectonic geomorphology.The models reproduce steep-sided flat-topped geomorphic features and clockwise rotation of the material at eastern Himalayan Syntaxis,verifying the rationality of the models.The results show that the greater the crustal motion velocity and the greater the ductile layer viscosity,the steeper the terrain change;and conversely,the smaller the crustal motion velocity and the smaller the ductile layer viscosity,the gentler the terrain change.This study further indicates that the weak lower crust plays an important role in the formation of geomorphic features and material migration characteristics of Qinghai-Tibet Plateau,and provides a new insight for the study of the uplift mechanism of the Tibetan Plateau.展开更多
AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to i...AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.展开更多
AIM To evaluate toxicity and treatment outcome of highdose radiotherapy(RT) for cervical esophageal cancer(CEC).METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage Ⅰ to Ⅲ cerv...AIM To evaluate toxicity and treatment outcome of highdose radiotherapy(RT) for cervical esophageal cancer(CEC).METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage Ⅰ to Ⅲ cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local(occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed.RESULTS Grade 1, 2, and 3 esophagitis occurred in 19(30.6%), 39(62.9%), and 4 patients(6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients(25.8%) developed post-RT stenosis, of which 7 cases(43.8%) were malignant. Four patients(6.5%) developed tracheoesophageal fistula(TEF), of which 3(75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4(P = 0.001), complete circumference involvement(P < 0.0001), stenosis at diagnosis(P = 0.024), and endoscopic complete response(P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis(P = 0.003). A higher dose(≥ 60 Gy) was not associated with occurrence of postRT stenosis or TEF. With a median follow-up of 24.3(range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival(OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement(P = 0.023), stenosis at diagnosis(P < 0.0001), and occurrence of post-RT stenosis or TEF(P < 0.001) in univariate analysis, while stenosis at diagnosis(P = 0.004) and occurrence of post-RT stenosis or TEF(P = 0.023) were significant in multivariate analysis. CONCLUSION Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.展开更多
BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We sear...BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.展开更多
AIM： To evaluate the daily high-dose induction therapy with interferon-α2b （IFN-α2b） in combination with ribavirin for the treatment of patients who failed with interferon monotherapy and had a relapse, based on ...AIM： To evaluate the daily high-dose induction therapy with interferon-α2b （IFN-α2b） in combination with ribavirin for the treatment of patients who failed with interferon monotherapy and had a relapse, based on the assumption that the viral burden would decline faster, thus increasing the likelihood of higher response rates in this difficult-totreat patient group. METHODS： Seventy patients were enrolled in this study. Treatment was started with 10 NU IFN-α2b daily for 3 wk, followed by IFN-α2b 5 NU/TIW in combination with ribavirin （1 000-1 200 mg/d） for 21 wk. In case of a negative HCV RNA PCR, treatment was continued until wk 48 （IFN-α2b 3MU/TIW＋1000-1200 mg ribavirin/daily）. RESULTS： The dose of IFN-α2b or ribavirin was reduced in 16% of patients because of hematologic side effects, and treatment was discontinued in 7% of patients. An early viral response （EVR） was achieved in 60% of patients. Fifty percent of all patients achieved an end-oftreatment response （EOT） and d0% obtained a sustained viral response （SVR）. Patients with no response had a significantly lower response rate than those with a former relapse （SVR 30% vs 53%; P=0.049）. Furthermore, lower response rates were observed in patients infected with genotype la/b than in patients with non-1-genotype （SVR 28% vs7d%; P=0.001）. As a significant predictive factor for a sustained response, a rapid initial decline of HCV RNA could be identified. No patient achieving a negative HCV-RNA PCR at wk 18 or later eventually eliminated the virus. CONCLUSION： Daily high-dose induction therapy with interferon-α2b is well tolerated and effective for the treatment of non-responders and relapsers, when interferon monotherapy fails. A fast decline of viral load during the first 12 wk is strongly associated with a sustained viral response.展开更多
Objective:Methotrexate(MTX)can be safely administered to most patients but may cause severe toxicity in others.This study aimed to summarize the characteristics of high-dose methotrexate(HD-MTX)chemotherapy and to eva...Objective:Methotrexate(MTX)can be safely administered to most patients but may cause severe toxicity in others.This study aimed to summarize the characteristics of high-dose methotrexate(HD-MTX)chemotherapy and to evaluate whether the modified dose-adjustment program was able to improve the maintenance of sufficient MTX exposure levels while minimizing toxicities.Methods:We evaluated 1172 cycles of high-dose MTX chemotherapy from 294 patients who were treated according to the CCCG-ALL-2015 protocol(clinical trial number:ChiCTR-IPR-14005706)and analyzed the data of actual MTX dosage,MTX concentration,toxicity,and prognosis.We compared data between the dose-adjustment Program 1(fixed 20%reduction in dose)and the dose-adjustment Program 2(dose-individualization based on reassessment of the creatine clearance rate and the MTX concentration-monitoring point at 16 h),which were applied if the MTX clearance was delayed in the previous cycle.Results:The patients who used Program 2 had higher actual MTX infusion doses and infusion rates and were able to better maintain the MTX concentration at 44 h at the established target value than those on Program 1(P<0.001).No significant differences in toxicities were found between these two programs except that abnormal serum potassium levels and prolonged myelosuppression in intermediate-risk/high-risk patients were more frequently observed in patients using Program 2(P<0.001).No significant correlations were observed between the MTX dose,dose-adjustment programs,or MTX concentrations and relapse-free survival.Conclusion:Adjusting the MTX dose using Program 2 is more efficient for maintaining sufficient MTX exposure without significantly increasing the toxicity.展开更多
Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-ce...Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.展开更多
Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high...Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high-dose olanzapine (20 - 60 mg/day) is a possible alternative. We report two cases in which very high doses of olanzapine were administered, with significant clinical improvements above 60 mg/day. Clinical, metabolic and cardiac tolerance was good. This report highlights the usefulness of very-high-dose olanzapine in treatment-resistant schizophrenia. The main hypotheses concerning the psychopharmacological mechanisms of very-high-dose olanzapine are discussed.展开更多
Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose d...Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%;P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.展开更多
Recent studies have described the combination of both pulmonary emphysema and idiopathic interstitial lung disease (ILDs) by means of high-resolution computed axial tomography (HRCT). Definition of this syndrome was f...Recent studies have described the combination of both pulmonary emphysema and idiopathic interstitial lung disease (ILDs) by means of high-resolution computed axial tomography (HRCT). Definition of this syndrome was first named by Cottin as combined pulmonary fibrosis and emphysema (CPFE). Functional and radiological findings have showed that these patients are suffering from severe breathlessness, but whose pulmonary functional tests revealed no signs of obstruction, normal static lung volumes, and depressed DLco, most with a history of smoking [1] [2]. The radiological and endoscopic studies especially show that these patients have both areas of upper-lobe predominant emphysema and lesions compatible with fibrosis in both lung bases [3]. No prior research has reported any cases of such condition in person with no prior history of smoking as well as long-term high-dose of glucocorticoid therapy. In this case report, we discuss the presentation, diagnosis, and management of a 53-year-old non-smoker with increasing shortness of breath with a long-term high-dose of glucocorticoid therapy discovered to have an abnormal variant or presentation of CPFE. The cause of disease was attributed to a certain history of smoking in most studies;other potential risk factors have yet to be properly analyzed. This clinical report features a special case about the problem and solution surrounding this issue.展开更多
Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze...Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze changes in mortality rates and disability-adjusted life year(DALY)rates for lower respiratory infections in the elderly population(aged 70 and above)in China from 1990 to 2050.It also discusses future trends in the burden of lower respiratory infections(LRI)in China under different scenarios.Results According to GBD predictions,the burden of lower respiratory infections in the elderly aged 70 years and above in China is lower than the global average.The burden has been decreasing from 1990 to 2020,but is projected to increase from 2020 to 2050.Scenario-based predictions suggest that,under scenarios involving improvements in nutrition and vaccination,the burden of lower respiratory infections in the elderly in China is expected to be the lowest in 2050.Conclusion This study indicates that the burden of lower respiratory infections in elderly people aged 70 years and above in China remains a significant public health issue and may worsen.The government should consider strengthening the preventive measures and management strategies for respiratory infections in the elderly population.展开更多
Objective: To explore the effective mechanism of different doses of immunoglobulin combined with aspirin for children with Kawasaki disease. Methods: A total of 120 children with Kawasaki disease who visited our hospi...Objective: To explore the effective mechanism of different doses of immunoglobulin combined with aspirin for children with Kawasaki disease. Methods: A total of 120 children with Kawasaki disease who visited our hospital from May, 2019 to May, 2019 were selected. Computer 1:1 random series row group division. The study group (aspirin + high-dose immunoglobulin, n60), and the reference group (aspirin + low-dose immunoglobulin, n60). The clinical efficacy of the two groups was compared. Results: The improvement of inflammatory indicators, hospitalization indicators and clinical indicators in the investigation group were better than those in the reference group (P < 0.05). Conclusion: High-dose immunoglobulin + aspirin in the treatment of children with Kawasaki disease has a certain effect, the rehabilitation period of children is significantly shortened, and the discomfort symptoms are improved in a short time, the body inflammation is eliminated, and the normal life function of children is restored, which has a certain clinical application value.展开更多
Understanding the relationships between human activities and hydrological processes is critical for sustainable water resources management, especially under the threat of increasing climate extremes. China's Lower...Understanding the relationships between human activities and hydrological processes is critical for sustainable water resources management, especially under the threat of increasing climate extremes. China's Lower Yellow River(LYR) region is one of the world's most water-scarce and human-impacted areas, yet comprehensive information on its water resources is lacking. This study adopted a water resources system(WRS) analytical framework to investigate the water crisis facing the region. The findings reveal that over the last decade, the system's resilience has been undermined by the combined impacts of climate aridification and intensified human interference. Specifically, a delicate balance between natural groundwater depletion and irrigation replenishment has been disrupted by a series of drought events since 2012. Increased groundwater extraction during droughts, coupled with an imbalanced allocation of surface water resources, has led to a persistent decline in water storage that has continued even after the droughts have ended. To mitigate future climate risks in the LYR,we recommend implementing more adaptive strategies, such as flexible water regulation policies and combined surface-groundwater management. Lessons from the LYR have important implications for other regions facing water resource challenges.展开更多
基金Supported by the National Natural Science Foundation of China,No.82270594the National Natural Science Foundation for Youths of China,No.82103151+1 种基金the Outstanding Youth Foundation of Hunan Province,No.2022JJ20092the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University,No.YX202103.
文摘BACKGROUND Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori(H.pylori).AIM To assess the efficacy and safety of high-dose dual therapy(HDDT)utilizing various highly potent antisecretory medications,thereby providing additional clinical guidance for H.pylori eradication.METHODS The study population comprised untreated H.pylori patients from three medical centers in central China.From February 10,2024 to March 31,2024,439 subjects were randomly allocated to either the esomeprazole-amoxicillin(EA)or esomeprazole-amoxicillin-clarithromycin-bismuth(B-quadruple)group.Subsequently,from April 1,2024 to May 10,2024,367 subjects were randomly assigned to either the vonoprazan-amoxicillin(VA)or vonoprazan-amoxicillin-clarithromycin(VAC)group.The study recorded treatment efficacy,adverse events,compliance,symptom alleviation,and associated costs.RESULTS EA-dual demonstrated non-inferiority to B-quadruple regimen in modified intention-to-treat(mITT)and perprotocol(PP)analyses(P<0.025).However,the eradication rate of EA was lower than that of the B-quadruple group[70.59%vs 83.49%,92.86%vs 98.38%,93.94%vs 98.38%,intention-to-treat(ITT),mITT,PP respectively,P<0.05].In ITT,mITT,and PP analyses,VA-dual was non-inferior to VAC treatment(84.15%vs 83.15%,96.25%vs 92.73%,96.75%vs 93.75%,P<0.025).No significant differences were observed in adverse events,compliance,and symptom relief between groups.VA exhibited the lowest cost.Antibiotic use within 2 years,poor compliance,and suburban residence were associated with reduced eradication efficacy(P<0.05).CONCLUSION The HDDT based on vonoprazan demonstrated non-inferiority to the VAC triple regimen,suggesting its potential as a recommended first-line treatment for H.pylori eradication.While B-quadruple therapy showed better eradication rate than EA therapy,the latter proved non-inferior in mITT and PP analyses.Notably,antibiotic use within the preceding two years,adherence to treatment protocols,and patient residence emerged as critical factors influencing eradication success.
基金Supported by Zhejiang Provincial Natural Science Foundation of China(No.ZCLQN25A0103)。
文摘This paper studies certain estimates for the lower bound of distance between unitary orbits of normal elements.We show that the distance between unitary orbits of normal elements of simple C^(*)-algebras of tracial rank no more than k has a lower bound.Furthermore,if k≤1 and normal elements are commuting,then the lower bound will be better.Another result establishes a connection involving the spectrum distance operator Dc between a C^(*)-algebra of stable rank one C^(*)-algebra and its hereditary C^(*)-subalgebra.
基金supported by the Science&Technology Project of SINOPEC(No.P22125)the National Natural Science Foundation of China(No.41902162)。
文摘The Cambrian and Lower Ordovician strata of the Bachu area in central Tarim Basin are characterized by extensively dolomitized,which have significant potential for favourable hydrocarbon reservoirs.The study herein combined petrographic,mineralogical and geochemical analyses to investigate the formation environments of these dolomite units and utilized Mg isotopic profiles to constrain the changes in the fluid flow trajectory.Positive excursions of δ^(18)O and upwardincreasing δ^(26)Mg profiles were observed in samples of the Wusonger formation(Є_(1)w),which may result from evaporation.Moreover,based on high ^(87)Sr/^(86)Sr ratios,high total REE concentrations and the occurrence of specific minerals,including quartz,barite,gypsum and pyrite,we interpret an evaporitic near-surface origin for the Є_(1)w dolomites.Samples of the Xiaoerblak Formation(Є_(1)x)are the product of seepage-reflux dolomitization,suggested by upward-decreasing δ^(26)Mg profiles and relatively lower ^(87)Sr/^(86)Sr ratios than the Є_(1)w samples.The overlapping isotope(δ^(18)O,δ^(13)C and ^(87)Sr/^(86)Sr)values between samples of the Shayilik(Є_(2)s)and Awatagh(Є_(2)a)Formation,in addition to the petrography evidence and Mg isotope variations,suggest that the formation of these dolomites were due to the shallow-burial dolomitization.The occurrence of the Xiaqiulitagh(Є_(3)ql)and Penglaiba(O_(1)p)dolomites along stylolites,together with their large crystals with opaque cores and clear rims and vertically constant δ^(26)Mg profiles,indicate that their formation may be related to pressure dissolution by mechanical compaction during deep-burial dolomitization.Therefore,the assembling of multiple petrographic,mineralogical and geochemical methods can shed light on the complicated generation processes of regional-scale dolomite within Tarim Basin or elsewhere.
基金supported in part by the National Natural Science Foundation of China under Grant 62172368the Natural Science Foundation of Zhejiang Province under Grant LR22F020003.
文摘The development of brain-computer interfaces(BCI)based on motor imagery(MI)has greatly improved patients’quality of life with movement disorders.The classification of upper limb MI has been widely studied and applied in many fields,including rehabilitation.However,the physiological representations of left and right lower limb movements are too close and activated deep in the cerebral cortex,making it difficult to distinguish their features.Therefore,classifying lower limbs motor imagery is more challenging.In this study,we propose a feature extraction method based on functional connectivity,which utilizes phase-locked values to construct a functional connectivity matrix as the features of the left and right legs,which can effectively avoid the problem of physiological representations of the left and right lower limbs being too close to each other during movement.In addition,considering the topology and the temporal characteristics of the electroencephalogram(EEG),we designed a temporal-spatial convolutional network(TSGCN)to capture the spatiotemporal information for classification.Experimental results show that the accuracy of the proposed method is higher than that of existing methods,achieving an average classification accuracy of 73.58%on the internal dataset.Finally,this study explains the network mechanism of left and right foot MI from the perspective of graph theoretic features and demonstrates the feasibility of decoding lower limb MI.
基金Supported by the Central Guided Local Science and Technology Development Fund Project for Science and Technology Innovation Base Construction,No.Guike ZY24212046National Natural Science Foundation of China,No.U22A2092+3 种基金Guangxi Education Science“the 14th Five-Year Plan”2024 Special Project“Research on Steam Education Practice in Rehabilitation Engineering”,No.2024ZJY304the Research Basic Ability Enhancement Program for Young and Middle-aged Teachers of Guangxi,No.2025KY2255the Innovation Project of GUET Graduate Education,No.2025YCXB010Natural Science Research Project of Guilin Life and Health Career Technical College,No.2025GKKY04.
文摘BACKGROUND The therapeutic role of neurodynamic mobilization in improving lower limb function in patients with mild post-traumatic knee osteoarthritis remains poorly understood.AIM To further elucidate the role of neurodynamic mobilization in facilitating knee joint functional recovery.METHODS Thirty-two patients with post-traumatic knee osteoarthritis treated at Chonghua Hospital of Traditional Chinese Medicine(Guilin)from March 2024 to August 2025 were randomly assigned to a control group(n=16)or an intervention group(n=16).Both groups received eight weeks of conventional treatment;and the intervention group additionally underwent neurodynamic mobilization.Outcomes including pain assessed by the visual analogue scale,active range of motion,Lysholm score,stork stand test,single hop test,and Y-balance test were assessed before and after the intervention.RESULTS There were no significant differences between the two groups in baseline characteristics,including gender,age,body mass index,or surgical side(P>0.05).Two-way repeated-measures analysis of variance demonstrated significant time×group interaction effects for the visual analogue scale score(F=13.364,P<0.05),Lysholm knee score(F=20.385,P<0.05),stork stand test(F=103.756,P<0.05),and Y-balance test score(F=8.089,P<0.05).CONCLUSION Neurodynamic mobilization effectively reduces pain,improves knee function,and enhances lower limb balance in patients with mild post-traumatic knee osteoarthritis.
文摘Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.
文摘This research presents a Human Lower Limb Activity Recognition(HLLAR)system that identifies specific activities and predicts the angles of the knees simultaneously,based on the EMG signals.The HLLAR systems streamlines the research on the lower limb activities.The HILLAR model includes Discrete Hermite Wavelets Transform-based Synchrosqueezing(DHWTS),Deep Two-Layer Multiscale Convolutional Neural Network(DTLMCNN),and Generalized Regression Neural Network(GRNN)as feature extraction,activity recognition,and knee angle prediction respectively.Electromyography signal-based automatic lower limb activity detection is crucial to rehabilitation and human movement analysis.Yet several of these methods face issues in feature extraction in complex data,overlapping signals,extraction of crucial parameters,and adaptation constraints.This research aims classify lower limb activities and predict knee joint angles from electromy-ography signals using HILLAR model.The model is validated on two datasets,comprising 26 subjects performing three classes of activities:walking,standing,and sitting.The proposed model obtained a classification accuracy of 99.95%,along with significant achievements in precision(99.93%),recall(99.91%),and F1-score(99.93%).The generalized regression neural network predicted angles of the knee joint with a root mean squared error of 1.25%.Robustness is demonstrated through consistent results in five-fold cross-validation and statistical significance testing(p-value=0.004,McNemar's test).Additionally,the proposed model showed superior performance over baseline methods by reducing error rates by 18%and decreasing processing time to 0.98 s.
基金supported by Excellent Research Group Project for Multiphase Evolution in Hyper-Gravity of the National Natural Science Foundation of China(No.52588202)。
文摘The India-Asia collision resulted in the formation of Qinghai-Tibet Plateau.Lower crustal flow model was proposed to explain the mechanism of Cenozoic tectonic deformation of Qinghai-Tibet Plateau.In this study,we propose a new approach by combining centrifugal analog modeling with numerical simulation to simulate the tectonic uplift history of the plateau based on the lower crustal flow model,and to investigate the material migration characteristics and the influence of crustal motion velocity and ductile layer viscosity on the plateau tectonic geomorphology.The models reproduce steep-sided flat-topped geomorphic features and clockwise rotation of the material at eastern Himalayan Syntaxis,verifying the rationality of the models.The results show that the greater the crustal motion velocity and the greater the ductile layer viscosity,the steeper the terrain change;and conversely,the smaller the crustal motion velocity and the smaller the ductile layer viscosity,the gentler the terrain change.This study further indicates that the weak lower crust plays an important role in the formation of geomorphic features and material migration characteristics of Qinghai-Tibet Plateau,and provides a new insight for the study of the uplift mechanism of the Tibetan Plateau.
基金Supported by First Affiliated Hospital,Guangxi Medical University
文摘AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis.The primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and mortality.The meta-analysis was performed with a fixed effects model or random effects model.RESULTS:Nine eligible RCTs including 1342 patients were retrieved.The results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.2017R1D1A1B03035047the National Research Foundation of Korea Grant funded by the Korean Government,No.NRF-2017M2A2A4A03083634
文摘AIM To evaluate toxicity and treatment outcome of highdose radiotherapy(RT) for cervical esophageal cancer(CEC).METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage Ⅰ to Ⅲ cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local(occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed.RESULTS Grade 1, 2, and 3 esophagitis occurred in 19(30.6%), 39(62.9%), and 4 patients(6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients(25.8%) developed post-RT stenosis, of which 7 cases(43.8%) were malignant. Four patients(6.5%) developed tracheoesophageal fistula(TEF), of which 3(75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4(P = 0.001), complete circumference involvement(P < 0.0001), stenosis at diagnosis(P = 0.024), and endoscopic complete response(P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis(P = 0.003). A higher dose(≥ 60 Gy) was not associated with occurrence of postRT stenosis or TEF. With a median follow-up of 24.3(range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival(OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement(P = 0.023), stenosis at diagnosis(P < 0.0001), and occurrence of post-RT stenosis or TEF(P < 0.001) in univariate analysis, while stenosis at diagnosis(P = 0.004) and occurrence of post-RT stenosis or TEF(P = 0.023) were significant in multivariate analysis. CONCLUSION Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.
基金supported by grants from the National Natural Science Foundation of China (82370378 and 82070388)Taishan Scholar Program of Shandong Province (tsqn202211310)National Natural Science Foundation of Shandong Province (ZR2020MH035)。
文摘BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.
文摘AIM： To evaluate the daily high-dose induction therapy with interferon-α2b （IFN-α2b） in combination with ribavirin for the treatment of patients who failed with interferon monotherapy and had a relapse, based on the assumption that the viral burden would decline faster, thus increasing the likelihood of higher response rates in this difficult-totreat patient group. METHODS： Seventy patients were enrolled in this study. Treatment was started with 10 NU IFN-α2b daily for 3 wk, followed by IFN-α2b 5 NU/TIW in combination with ribavirin （1 000-1 200 mg/d） for 21 wk. In case of a negative HCV RNA PCR, treatment was continued until wk 48 （IFN-α2b 3MU/TIW＋1000-1200 mg ribavirin/daily）. RESULTS： The dose of IFN-α2b or ribavirin was reduced in 16% of patients because of hematologic side effects, and treatment was discontinued in 7% of patients. An early viral response （EVR） was achieved in 60% of patients. Fifty percent of all patients achieved an end-oftreatment response （EOT） and d0% obtained a sustained viral response （SVR）. Patients with no response had a significantly lower response rate than those with a former relapse （SVR 30% vs 53%; P=0.049）. Furthermore, lower response rates were observed in patients infected with genotype la/b than in patients with non-1-genotype （SVR 28% vs7d%; P=0.001）. As a significant predictive factor for a sustained response, a rapid initial decline of HCV RNA could be identified. No patient achieving a negative HCV-RNA PCR at wk 18 or later eventually eliminated the virus. CONCLUSION： Daily high-dose induction therapy with interferon-α2b is well tolerated and effective for the treatment of non-responders and relapsers, when interferon monotherapy fails. A fast decline of viral load during the first 12 wk is strongly associated with a sustained viral response.
基金supported by the National Natural Science Foundation of China(No.81700147 and No.82070172).
文摘Objective:Methotrexate(MTX)can be safely administered to most patients but may cause severe toxicity in others.This study aimed to summarize the characteristics of high-dose methotrexate(HD-MTX)chemotherapy and to evaluate whether the modified dose-adjustment program was able to improve the maintenance of sufficient MTX exposure levels while minimizing toxicities.Methods:We evaluated 1172 cycles of high-dose MTX chemotherapy from 294 patients who were treated according to the CCCG-ALL-2015 protocol(clinical trial number:ChiCTR-IPR-14005706)and analyzed the data of actual MTX dosage,MTX concentration,toxicity,and prognosis.We compared data between the dose-adjustment Program 1(fixed 20%reduction in dose)and the dose-adjustment Program 2(dose-individualization based on reassessment of the creatine clearance rate and the MTX concentration-monitoring point at 16 h),which were applied if the MTX clearance was delayed in the previous cycle.Results:The patients who used Program 2 had higher actual MTX infusion doses and infusion rates and were able to better maintain the MTX concentration at 44 h at the established target value than those on Program 1(P<0.001).No significant differences in toxicities were found between these two programs except that abnormal serum potassium levels and prolonged myelosuppression in intermediate-risk/high-risk patients were more frequently observed in patients using Program 2(P<0.001).No significant correlations were observed between the MTX dose,dose-adjustment programs,or MTX concentrations and relapse-free survival.Conclusion:Adjusting the MTX dose using Program 2 is more efficient for maintaining sufficient MTX exposure without significantly increasing the toxicity.
文摘Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.
文摘Treatment-resistant schizophrenia has an extremely negative impact on mental health and social life. If clozapine, the gold standard treatment, fails, there are very few options left. The literature suggests that high-dose olanzapine (20 - 60 mg/day) is a possible alternative. We report two cases in which very high doses of olanzapine were administered, with significant clinical improvements above 60 mg/day. Clinical, metabolic and cardiac tolerance was good. This report highlights the usefulness of very-high-dose olanzapine in treatment-resistant schizophrenia. The main hypotheses concerning the psychopharmacological mechanisms of very-high-dose olanzapine are discussed.
文摘Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%;P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.
文摘Recent studies have described the combination of both pulmonary emphysema and idiopathic interstitial lung disease (ILDs) by means of high-resolution computed axial tomography (HRCT). Definition of this syndrome was first named by Cottin as combined pulmonary fibrosis and emphysema (CPFE). Functional and radiological findings have showed that these patients are suffering from severe breathlessness, but whose pulmonary functional tests revealed no signs of obstruction, normal static lung volumes, and depressed DLco, most with a history of smoking [1] [2]. The radiological and endoscopic studies especially show that these patients have both areas of upper-lobe predominant emphysema and lesions compatible with fibrosis in both lung bases [3]. No prior research has reported any cases of such condition in person with no prior history of smoking as well as long-term high-dose of glucocorticoid therapy. In this case report, we discuss the presentation, diagnosis, and management of a 53-year-old non-smoker with increasing shortness of breath with a long-term high-dose of glucocorticoid therapy discovered to have an abnormal variant or presentation of CPFE. The cause of disease was attributed to a certain history of smoking in most studies;other potential risk factors have yet to be properly analyzed. This clinical report features a special case about the problem and solution surrounding this issue.
基金supported by the National High Level Hospital Clinical Research Funding(No.BJ-2023-066).
文摘Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze changes in mortality rates and disability-adjusted life year(DALY)rates for lower respiratory infections in the elderly population(aged 70 and above)in China from 1990 to 2050.It also discusses future trends in the burden of lower respiratory infections(LRI)in China under different scenarios.Results According to GBD predictions,the burden of lower respiratory infections in the elderly aged 70 years and above in China is lower than the global average.The burden has been decreasing from 1990 to 2020,but is projected to increase from 2020 to 2050.Scenario-based predictions suggest that,under scenarios involving improvements in nutrition and vaccination,the burden of lower respiratory infections in the elderly in China is expected to be the lowest in 2050.Conclusion This study indicates that the burden of lower respiratory infections in elderly people aged 70 years and above in China remains a significant public health issue and may worsen.The government should consider strengthening the preventive measures and management strategies for respiratory infections in the elderly population.
文摘Objective: To explore the effective mechanism of different doses of immunoglobulin combined with aspirin for children with Kawasaki disease. Methods: A total of 120 children with Kawasaki disease who visited our hospital from May, 2019 to May, 2019 were selected. Computer 1:1 random series row group division. The study group (aspirin + high-dose immunoglobulin, n60), and the reference group (aspirin + low-dose immunoglobulin, n60). The clinical efficacy of the two groups was compared. Results: The improvement of inflammatory indicators, hospitalization indicators and clinical indicators in the investigation group were better than those in the reference group (P < 0.05). Conclusion: High-dose immunoglobulin + aspirin in the treatment of children with Kawasaki disease has a certain effect, the rehabilitation period of children is significantly shortened, and the discomfort symptoms are improved in a short time, the body inflammation is eliminated, and the normal life function of children is restored, which has a certain clinical application value.
基金supported by the National Natural Science Foundation of China (Grant No. 42041007)。
文摘Understanding the relationships between human activities and hydrological processes is critical for sustainable water resources management, especially under the threat of increasing climate extremes. China's Lower Yellow River(LYR) region is one of the world's most water-scarce and human-impacted areas, yet comprehensive information on its water resources is lacking. This study adopted a water resources system(WRS) analytical framework to investigate the water crisis facing the region. The findings reveal that over the last decade, the system's resilience has been undermined by the combined impacts of climate aridification and intensified human interference. Specifically, a delicate balance between natural groundwater depletion and irrigation replenishment has been disrupted by a series of drought events since 2012. Increased groundwater extraction during droughts, coupled with an imbalanced allocation of surface water resources, has led to a persistent decline in water storage that has continued even after the droughts have ended. To mitigate future climate risks in the LYR,we recommend implementing more adaptive strategies, such as flexible water regulation policies and combined surface-groundwater management. Lessons from the LYR have important implications for other regions facing water resource challenges.
