Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series...Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.展开更多
Background The mental health of current medical students is predictive of their mental health as future doctors.The prevalence of anxiety,depression and burnout is high among medical students,but less is known about t...Background The mental health of current medical students is predictive of their mental health as future doctors.The prevalence of anxiety,depression and burnout is high among medical students,but less is known about the occurrence of other mental ill-health symptoms,such as eating or personality disorders,and factors contributing to mental ill-health.Aims(1)To explore the prevalence of various mental ill-health symptoms in medical students and(2)to investigate what medical school factors and students’attitudes contribute to these mental ill-health symptoms.Methods Between November 2020 and May 2021,medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time,approximately 3 months apart.Results Of the 792 participants who filled in the questionnaire at baseline,over half experienced medium to high somatic symptoms(50.8%;402)and drank alcohol at hazardous levels(62.4%;494).Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students,lower feelings of belongingness,greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health,all contributed to students’mental ill-health symptoms.Conclusions Medical students experience a high prevalence of various mental ill-health symptoms.This study suggests that medical school factors and students’attitudes towards mental ill-health are significantly associated with students’mental health.展开更多
Background:The use of inserted sham acupuncture as a placebo in randomized controlled trials(RCTs)is controversial,because it may produce specific effects that cause an underestimation of the effect of acupuncture tre...Background:The use of inserted sham acupuncture as a placebo in randomized controlled trials(RCTs)is controversial,because it may produce specific effects that cause an underestimation of the effect of acupuncture treatment.Objective:This systematic survey investigates the magnitude of insert-specific effects of sham acupuncture and whether they affect the estimation of acupuncture treatment effects.Search strategy:PubMed,Embase and Cochrane Central Register of Controlled Trials were searched to identify acupuncture RCTs from their inception until December 2022.Inclusion criteria:RCTs that evaluated the effects of acupuncture compared to sham acupuncture and no treatment.Data extraction and analysis:The total effect measured for an acupuncture treatment group in RCTs were divided into three components,including the natural history and/or regression to the mean effect(controlled for no-treatment group),the placebo effect,and the specific effect of acupuncture.The first two constituted the contextual effect of acupuncture,which is mimicked by a sham acupuncture treatment group.The proportion of acupuncture total effect size was considered to be 1.The proportion of natural history and/or regression to the mean effect(PNE)and proportional contextual effect(PCE)of included RCTs were pooled using meta-analyses with a random-effect model.The proportion of acupuncture placebo effect was the difference between PCE and PNE in RCTs with non-inserted sham acupuncture.The proportion of insert-specific effect of sham acupuncture(PIES)was obtained by subtracting the proportion of acupuncture placebo effect and PNE from PCE in RCTs with inserted sham acupuncture.The impact of PIES on the estimation of acupuncture's treatment effect was evaluated by quantifying the percentage of RCTs that the effect of outcome changed from no statistical difference to statistical difference after removing PIES in the included studies,and the impact of PIES was externally validated in other acupuncture RCTs with an inserted sham acupuncture group that were not used to calculate PIES.Results:This analysis included 32 studies with 5492 patients.The overall PNE was 0.335(95%confidence interval[CI],0.255-0.415)and the PCE of acupuncture was 0.639(95%CI,0.567-0.710)of acupuncture's total effect.The proportional contribution of the placebo effect to acupuncture's total effect was 0.191,and the PIES was 0.189.When we modeled the exclusion of the insert-specific effect of sham acupuncture,the acupuncture treatment effect changed from no difference to a significant difference in 45.45%of the included RCTs,and in 40.91%of the external validated RCTs.Conclusion:The insert-specific effect of sham acupuncture in RCTs represents 18.90%of acupuncture's total effect and significantly affects the evaluation of the acupuncture treatment effect.More than 40%of RCTs that used inserted sham acupuncture would draw different conclusions if the PIES had been controlled for.Considering the impact of the insert-specific effect of sham acupuncture,caution should be taken when using inserted sham acupuncture placebos in RCTs.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
This article reviews the evidence for efficacy and safety of Saccharomyces boulardii(S.boulardii) for various disease indications in adults based on the peerreviewed,randomized clinical trials and pre-clinical studies...This article reviews the evidence for efficacy and safety of Saccharomyces boulardii(S.boulardii) for various disease indications in adults based on the peerreviewed,randomized clinical trials and pre-clinical studies from the published medical literature(Medline,Clinical Trial websites and meeting abstracts) between 1976 and 2009.For meta-analysis,only randomized,blinded controlled trials unrestricted by language were included.Pre-clinical studies,volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis,but included in the systematic review.Of 31 randomized,placebo-controlled treatment arms in 27 trials(encompassing 5029 study patients),S.boulardii was found to be significantly efficacious and safe in 84% of those treatment arms.A meta-analysis found a significant therapeutic efficacy for S.boulardii in the prevention of antibiotic-associated diarrhea(AAD)(RR = 0.47,95% CI:0.35-0.63,P < 0.001).In adults,S.boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea.Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Heliobacter pylori treatment-related symptoms.S.boulardii shows promise for the prevention of C.difficile disease recurrences;treatment of irritable bowel syndrome,acute adult diarrhea,Crohn's disease,giardiasis,human immunodeficiency virus-related diarrhea;but more supporting evidence is recommended for these indications.The use of S.boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.展开更多
Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alte...Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics （beneficial microbes taken to improve health） may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded bials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. Pubr4ed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk （RRpooled） 0.77, 95% confidence interval （95% CI） 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 （0.69-0.88）]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.展开更多
Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all importan...Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.展开更多
Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplan...Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.展开更多
Purpose:This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale(CDS)among stroke survivors.Methods:The study was undertaken in four hospitals.We analysed dataset...Purpose:This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale(CDS)among stroke survivors.Methods:The study was undertaken in four hospitals.We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics,who were rated by nurses to determine the CDS reliability coefficients.The Cronbach'sαand Cohen's kappa coefficients were applied.Concurrent validity was conducted for the data on care dependency,which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index.A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results.Results:An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency.The reliability analysis yielded the same Cronbach'sαcoefficient of 0.98 for both the inpatient and outpatient data.A significant,moderate correlation was observed between the CDS and Barthel Index results.Conclusion:The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
The periodic outbreak of mosquito-borne diseases like dengue fever,zika fever,and yellow fever all over the world highlights the need for effective mosquito control methods targeting the biological system.Due to the l...The periodic outbreak of mosquito-borne diseases like dengue fever,zika fever,and yellow fever all over the world highlights the need for effective mosquito control methods targeting the biological system.Due to the lack of therapeutic measures,preventive treatments or vaccines against pathogens,insecticide resistance eventually lead the research focus towards novel technological applications in mosquito management.Nanomaterials with ovicidal,larvicidal,adulticidal,and repellent properties for controlling mosquito vectors are under research.A literature search was carried out for advancements in nanomaterials,insecticides,and mosquito control in PubMed/MEDLINE,Scopus,Google Scholar,ScienceDirect,and Web of Science.This paper aims to provide insights into various nanomaterials relevant to mosquito-borne diseases,in vivo and in vitro toxicity evaluation against mosquito species,mode of action,effect on non-target organisms,and ecological risks.Organic and inorganic materials that provide controlled release,target delivery,less dosage,prolonged efficacy,a reduction in the use of organic solvents and emulsifiers,and minimum pollution to the environment have already been explored.Indeed,further research on the ecological risk and economic feasibility of nanomaterials in mosquitocidal applications should be done prior to commercialization.展开更多
Background:The current World Health Organization(WHO) classification of nasopharyngeal carcinoma(NPC) con?veys little prognostic information.This study aimed to propose an NPC histopathologic classification that can p...Background:The current World Health Organization(WHO) classification of nasopharyngeal carcinoma(NPC) con?veys little prognostic information.This study aimed to propose an NPC histopathologic classification that can poten?tially be used to predict prognosis and treatment response.Methods:We initially developed a histopathologic classification based on the morphologic traits and cell differentia?tion of tumors of 2716 NPC patients who were identified at Sun Yat?sen University Cancer Center(SYSUCC)(training cohort).Then,the proposed classification was applied to 1702 patients(retrospective validation cohort) from hospitals outside SYSUCC and 1613 patients(prospective validation cohort) from SYSUCC.The efficacy of radiochemotherapy and radiotherapy modalities was compared between the proposed subtypes.We used Cox proportional hazards models to estimate hazard ratios(HRs) with 95% confidence intervals(CI) for overall survival(OS).Results:The 5?year OS rates for all NPC patients who were diagnosed with epithelial carcinoma(EC;3708 patients),mixed sarcomatoid?epithelial carcinoma(MSEC;1247 patients),sarcomatoid carcinoma(SC;823 patients),and squamous cell carcinoma(SCC;253 patients) were 79.4%,70.5%,59.6%,and 42.6%,respectively(P < 0.001).In mul?tivariate models,patients with MSEC had a shorter OS than patients with EC(HR = 1.44,95% CI = 1.27–1.62),SC(HR = 2.00,95% CI = 1.76–2.28),or SCC(HR = 4.23,95% CI = 3.34–5.38).Radiochemotherapy significantly improved survival compared with radiotherapy alone for patients with EC(HR 49–0.75),and possibly for those with SCC(HR = 0.67,95% CI = 0.56–0.80),MSEC(HR = 0.58,95% CI = 0..74–1.28).= 0.63;95% CI = 0.40–0.98),but not for patients with SC(HR = 0.97,95% CI = 0Conclusions:The proposed classification offers more information for the prediction of NPC prognosis compared with the WHO classification and might be a valuable tool to guide treatment decisions for subtypes that are associ?ated with a poor prognosis.展开更多
Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal ...Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.展开更多
A good drug or drug candidate should not only interact with its target molecule effectively and specifically,but also be absorbed into the body,distributed to the right location,metabolized into right compounds,and el...A good drug or drug candidate should not only interact with its target molecule effectively and specifically,but also be absorbed into the body,distributed to the right location,metabolized into right compounds,and eliminated out of the body in proper manner.The processes of drug getting into and out of the body involve Absorption,Distribution,Metabolism,and Excretion（ADME）,展开更多
Objective: To investigate the clinical effect of rituximab (RTX) in the management of progressive rheumatoid arthritis related interstitial lung disease (RA-ILD). Methods: A total of 10 patients with progressive RA-IL...Objective: To investigate the clinical effect of rituximab (RTX) in the management of progressive rheumatoid arthritis related interstitial lung disease (RA-ILD). Methods: A total of 10 patients with progressive RA-ILD were enrolled into this 48-week, open-label treatment study. Treatment was with RTX at 1000 mg at day 1, day 15, and again at weeks 24 and 26, with concomitant methotrexate therapy. Results: The study included 4 men and 6 women. Of 7 evaluable patients at week 48, the diffusing capacity to carbon monoxide had worsened by at least 15% in 1 patient, was stable in 4 patients, and increased by >15% of baseline value in 2 patients. The forced vital capacity declined by at least 10% in 1 patient, was stable in 4 patients, and increased by at least 10% in 2 patients. High resolution computed tomo-graphy of the chest showed improvement in 1 patient, and was unchanged in 5. Three patients were withdrawn, one who had an infusion reaction at week 0, one at week 5 who was hospitalized for congestive heart failure at week 5 and who later died at week 32 of complications following a traumatic hip fracture, and one died at week 6 of possible pneumonia. Conclusions: In this pilot study of 10 patients with RA-ILD treated with RTX, measures of lung disease remained stable in the majority of study completers. Further research is needed to clarify whether this treatment has a role in management of RA-ILD.展开更多
Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as wel...Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.展开更多
BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and...BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.展开更多
BACKGROUND Hepatitis C virus(HCV),hepatitis B virus(HBV),and human immunodeficiency virus 1(HIV-1)are the most epidemic blood-borne viruses,posing threats to human health and causing economic losses to nations for com...BACKGROUND Hepatitis C virus(HCV),hepatitis B virus(HBV),and human immunodeficiency virus 1(HIV-1)are the most epidemic blood-borne viruses,posing threats to human health and causing economic losses to nations for combating the infection transmission.The diagnostic methodologies that depend on the detection of viral nucleic acids are much more expensive,but they are more accurate than sero-logical testing.AIM To develop a rapid,cost-effective,and accurate diagnostic multiplex polymerase chain reaction(PCR)assay for simultaneous detection of HCV,HBV,and HIV-1.METHODS The design of the proposed PCR assay targets the amplification of a short conserved region featured with a distinguishable melting profile and electro-phoretic molecular weight inside each viral genome.Therefore,this diagnostic method will be appropriate for application in both conventional(combined with electrophoresis)and real-time PCR facilities.Confirmatory in silico investigations were conducted to prove the capability of the approached PCR assay to detect variants of each virus.Then,Egyptian isolates of each virus were subjected to the wet lab examination using the given diagnostic assay.RESULTS The in silico investigations confirmed that the PCR primers can match many viral variants in a multiplex PCR assay.The wet lab experiment proved the efficiency of the assay in distinguishing each viral type through high-resolution melting analysis.Compared to related published assays,the proposed assay in the current study is more sensitive and competitive with many expensive PCR assays.CONCLUSION This study provides a simple,cost-effective,and sensitive diagnostic PCR assay facilitating the detection of the most epidemic blood-borne viruses;this makes the proposed assay promising to be substitutive for the mistakable and cheap serological-based assays.展开更多
Malaria is one of the deadliest endemic diseases in Africa. The causative agent of this disease, Plasmodium, contributes to severe complications such as anemia, particularly in vulnerable groups. In Cameroon, the heal...Malaria is one of the deadliest endemic diseases in Africa. The causative agent of this disease, Plasmodium, contributes to severe complications such as anemia, particularly in vulnerable groups. In Cameroon, the health system aims to protect patients through the free distribution of long-lasting insecticide-treated mosquito nets and intermittent preventive treatment for malaria. However, access to these interventions remains limited. The objective of our study was to determine the distribution of malaria in pregnancy and its association with anemia. Methods: This was a descriptive cross-sectional study targeting pregnant women attending consultations, selected by convenience sampling, from February to May 2021 in three major health facilities in the Foumban health district of West Cameroon. Data were collected through questionnaires administered to the pregnant women, results from malaria rapid diagnostic tests (RDTs), thick drop microscopy for malaria diagnosis, and blood counts. The prevalence of malaria and anemia was estimated, as well as the association between malaria infection and the occurrence of anemia. Results: A total of 395 (91.86%) out of 430 pregnant women were enrolled in the study. The prevalence of malaria and anemia was 5.06% and 30.37%, respectively. Anemia was diagnosed in 120 women (30.37%), including 73 (60.83%) with mild anemia, 46 (38.33%) with moderate anemia, and 1 (0.83%) with severe anemia. Among women with malaria, 8 (40%) had anemia. Malaria infection was found to be associated with an increased risk of developing mild anemia (OR = 1.80 [0.66 - 4.85]) and a decreased risk of developing moderate anemia (OR = 0.74 [0.16 - 3.33]), although these associations were not statistically significant. Conclusion: A relatively low malaria prevalence was registered in the study population while anemia was more prevalent. Lack of association between malaria and anemia may be linked to low malaria prevalence.展开更多
基金Supported by Veterans’ Affairs Health Services Research & Development
文摘Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.
基金funded by the British Medical Association(BMA)Foundation(Scholarship grant).
文摘Background The mental health of current medical students is predictive of their mental health as future doctors.The prevalence of anxiety,depression and burnout is high among medical students,but less is known about the occurrence of other mental ill-health symptoms,such as eating or personality disorders,and factors contributing to mental ill-health.Aims(1)To explore the prevalence of various mental ill-health symptoms in medical students and(2)to investigate what medical school factors and students’attitudes contribute to these mental ill-health symptoms.Methods Between November 2020 and May 2021,medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time,approximately 3 months apart.Results Of the 792 participants who filled in the questionnaire at baseline,over half experienced medium to high somatic symptoms(50.8%;402)and drank alcohol at hazardous levels(62.4%;494).Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students,lower feelings of belongingness,greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health,all contributed to students’mental ill-health symptoms.Conclusions Medical students experience a high prevalence of various mental ill-health symptoms.This study suggests that medical school factors and students’attitudes towards mental ill-health are significantly associated with students’mental health.
基金the National Key R&D Program of China(No.2023YFC3503300 and No.2023YFC3503304)National Natural Science Foundation of China for Distinguished Young Scholars(No.82225049)and Youths(No.82305045)Fundamental Research Funds for the Central Public Welfare Research Institutes(No.2020YJSZX-3)。
文摘Background:The use of inserted sham acupuncture as a placebo in randomized controlled trials(RCTs)is controversial,because it may produce specific effects that cause an underestimation of the effect of acupuncture treatment.Objective:This systematic survey investigates the magnitude of insert-specific effects of sham acupuncture and whether they affect the estimation of acupuncture treatment effects.Search strategy:PubMed,Embase and Cochrane Central Register of Controlled Trials were searched to identify acupuncture RCTs from their inception until December 2022.Inclusion criteria:RCTs that evaluated the effects of acupuncture compared to sham acupuncture and no treatment.Data extraction and analysis:The total effect measured for an acupuncture treatment group in RCTs were divided into three components,including the natural history and/or regression to the mean effect(controlled for no-treatment group),the placebo effect,and the specific effect of acupuncture.The first two constituted the contextual effect of acupuncture,which is mimicked by a sham acupuncture treatment group.The proportion of acupuncture total effect size was considered to be 1.The proportion of natural history and/or regression to the mean effect(PNE)and proportional contextual effect(PCE)of included RCTs were pooled using meta-analyses with a random-effect model.The proportion of acupuncture placebo effect was the difference between PCE and PNE in RCTs with non-inserted sham acupuncture.The proportion of insert-specific effect of sham acupuncture(PIES)was obtained by subtracting the proportion of acupuncture placebo effect and PNE from PCE in RCTs with inserted sham acupuncture.The impact of PIES on the estimation of acupuncture's treatment effect was evaluated by quantifying the percentage of RCTs that the effect of outcome changed from no statistical difference to statistical difference after removing PIES in the included studies,and the impact of PIES was externally validated in other acupuncture RCTs with an inserted sham acupuncture group that were not used to calculate PIES.Results:This analysis included 32 studies with 5492 patients.The overall PNE was 0.335(95%confidence interval[CI],0.255-0.415)and the PCE of acupuncture was 0.639(95%CI,0.567-0.710)of acupuncture's total effect.The proportional contribution of the placebo effect to acupuncture's total effect was 0.191,and the PIES was 0.189.When we modeled the exclusion of the insert-specific effect of sham acupuncture,the acupuncture treatment effect changed from no difference to a significant difference in 45.45%of the included RCTs,and in 40.91%of the external validated RCTs.Conclusion:The insert-specific effect of sham acupuncture in RCTs represents 18.90%of acupuncture's total effect and significantly affects the evaluation of the acupuncture treatment effect.More than 40%of RCTs that used inserted sham acupuncture would draw different conclusions if the PIES had been controlled for.Considering the impact of the insert-specific effect of sham acupuncture,caution should be taken when using inserted sham acupuncture placebos in RCTs.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
文摘This article reviews the evidence for efficacy and safety of Saccharomyces boulardii(S.boulardii) for various disease indications in adults based on the peerreviewed,randomized clinical trials and pre-clinical studies from the published medical literature(Medline,Clinical Trial websites and meeting abstracts) between 1976 and 2009.For meta-analysis,only randomized,blinded controlled trials unrestricted by language were included.Pre-clinical studies,volunteer studies and uncontrolled studies were excluded from the review of efficacy and meta-analysis,but included in the systematic review.Of 31 randomized,placebo-controlled treatment arms in 27 trials(encompassing 5029 study patients),S.boulardii was found to be significantly efficacious and safe in 84% of those treatment arms.A meta-analysis found a significant therapeutic efficacy for S.boulardii in the prevention of antibiotic-associated diarrhea(AAD)(RR = 0.47,95% CI:0.35-0.63,P < 0.001).In adults,S.boulardii can be strongly recommended for the prevention of AAD and the traveler's diarrhea.Randomized trials also support the use of this yeast probiotic for prevention of enteral nutrition-related diarrhea and reduction of Heliobacter pylori treatment-related symptoms.S.boulardii shows promise for the prevention of C.difficile disease recurrences;treatment of irritable bowel syndrome,acute adult diarrhea,Crohn's disease,giardiasis,human immunodeficiency virus-related diarrhea;but more supporting evidence is recommended for these indications.The use of S.boulardii as a therapeutic probiotic is evidence-based for both efficacy and safety for several types of diarrhea.
基金Supported by Veterans' Affairs Health Services Research & Development fellowship, TPA 61-029 (Dr. Dublin)National Institute of Aging grant, AG028954-01A1 (Dr. Dublin)
文摘Irritable bowel syndrome （IBS） is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics （beneficial microbes taken to improve health） may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded bials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. Pubr4ed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk （RRpooled） 0.77, 95% confidence interval （95% CI） 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 （0.69-0.88）]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allow estimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.
基金This work was supported by the second batch of"Ten thousand plan"-National high-level talents special support plan(No.W02020052)National Natural Science Foundation of China(No.82072247,82204937)+1 种基金Natural Science Foundation of Beijing(No.L222150)the China Scholarship Council(No.202206557005)。
文摘Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.
文摘Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.
文摘Purpose:This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale(CDS)among stroke survivors.Methods:The study was undertaken in four hospitals.We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics,who were rated by nurses to determine the CDS reliability coefficients.The Cronbach'sαand Cohen's kappa coefficients were applied.Concurrent validity was conducted for the data on care dependency,which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index.A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results.Results:An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency.The reliability analysis yielded the same Cronbach'sαcoefficient of 0.98 for both the inpatient and outpatient data.A significant,moderate correlation was observed between the CDS and Barthel Index results.Conclusion:The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘The periodic outbreak of mosquito-borne diseases like dengue fever,zika fever,and yellow fever all over the world highlights the need for effective mosquito control methods targeting the biological system.Due to the lack of therapeutic measures,preventive treatments or vaccines against pathogens,insecticide resistance eventually lead the research focus towards novel technological applications in mosquito management.Nanomaterials with ovicidal,larvicidal,adulticidal,and repellent properties for controlling mosquito vectors are under research.A literature search was carried out for advancements in nanomaterials,insecticides,and mosquito control in PubMed/MEDLINE,Scopus,Google Scholar,ScienceDirect,and Web of Science.This paper aims to provide insights into various nanomaterials relevant to mosquito-borne diseases,in vivo and in vitro toxicity evaluation against mosquito species,mode of action,effect on non-target organisms,and ecological risks.Organic and inorganic materials that provide controlled release,target delivery,less dosage,prolonged efficacy,a reduction in the use of organic solvents and emulsifiers,and minimum pollution to the environment have already been explored.Indeed,further research on the ecological risk and economic feasibility of nanomaterials in mosquitocidal applications should be done prior to commercialization.
基金supported by grants from the National High Technology Research and Development Program of China(863 Program)(No.2012AA02A501)the Chinese State Key Basic Research Project(No.2011CB504805)the National Natural Science Foundation of China(No.81272952 and No.81472522)
文摘Background:The current World Health Organization(WHO) classification of nasopharyngeal carcinoma(NPC) con?veys little prognostic information.This study aimed to propose an NPC histopathologic classification that can poten?tially be used to predict prognosis and treatment response.Methods:We initially developed a histopathologic classification based on the morphologic traits and cell differentia?tion of tumors of 2716 NPC patients who were identified at Sun Yat?sen University Cancer Center(SYSUCC)(training cohort).Then,the proposed classification was applied to 1702 patients(retrospective validation cohort) from hospitals outside SYSUCC and 1613 patients(prospective validation cohort) from SYSUCC.The efficacy of radiochemotherapy and radiotherapy modalities was compared between the proposed subtypes.We used Cox proportional hazards models to estimate hazard ratios(HRs) with 95% confidence intervals(CI) for overall survival(OS).Results:The 5?year OS rates for all NPC patients who were diagnosed with epithelial carcinoma(EC;3708 patients),mixed sarcomatoid?epithelial carcinoma(MSEC;1247 patients),sarcomatoid carcinoma(SC;823 patients),and squamous cell carcinoma(SCC;253 patients) were 79.4%,70.5%,59.6%,and 42.6%,respectively(P < 0.001).In mul?tivariate models,patients with MSEC had a shorter OS than patients with EC(HR = 1.44,95% CI = 1.27–1.62),SC(HR = 2.00,95% CI = 1.76–2.28),or SCC(HR = 4.23,95% CI = 3.34–5.38).Radiochemotherapy significantly improved survival compared with radiotherapy alone for patients with EC(HR 49–0.75),and possibly for those with SCC(HR = 0.67,95% CI = 0.56–0.80),MSEC(HR = 0.58,95% CI = 0..74–1.28).= 0.63;95% CI = 0.40–0.98),but not for patients with SC(HR = 0.97,95% CI = 0Conclusions:The proposed classification offers more information for the prediction of NPC prognosis compared with the WHO classification and might be a valuable tool to guide treatment decisions for subtypes that are associ?ated with a poor prognosis.
文摘Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.
基金supported by the Natural Science Foundation ofChina(Nos.30873159 and 31271405)
文摘A good drug or drug candidate should not only interact with its target molecule effectively and specifically,but also be absorbed into the body,distributed to the right location,metabolized into right compounds,and eliminated out of the body in proper manner.The processes of drug getting into and out of the body involve Absorption,Distribution,Metabolism,and Excretion（ADME）,
文摘Objective: To investigate the clinical effect of rituximab (RTX) in the management of progressive rheumatoid arthritis related interstitial lung disease (RA-ILD). Methods: A total of 10 patients with progressive RA-ILD were enrolled into this 48-week, open-label treatment study. Treatment was with RTX at 1000 mg at day 1, day 15, and again at weeks 24 and 26, with concomitant methotrexate therapy. Results: The study included 4 men and 6 women. Of 7 evaluable patients at week 48, the diffusing capacity to carbon monoxide had worsened by at least 15% in 1 patient, was stable in 4 patients, and increased by >15% of baseline value in 2 patients. The forced vital capacity declined by at least 10% in 1 patient, was stable in 4 patients, and increased by at least 10% in 2 patients. High resolution computed tomo-graphy of the chest showed improvement in 1 patient, and was unchanged in 5. Three patients were withdrawn, one who had an infusion reaction at week 0, one at week 5 who was hospitalized for congestive heart failure at week 5 and who later died at week 32 of complications following a traumatic hip fracture, and one died at week 6 of possible pneumonia. Conclusions: In this pilot study of 10 patients with RA-ILD treated with RTX, measures of lung disease remained stable in the majority of study completers. Further research is needed to clarify whether this treatment has a role in management of RA-ILD.
文摘Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.
基金approved by the Institutional Review Board of the Future Medical Research Centre Ethical Committee(Approval No.TGE02100-02).
文摘BACKGROUND Esophageal variceal bleeding is a severe complication associated with liver cirrhosis and typically necessitates endoscopic hemostasis.The current standard treatment is endoscopic variceal ligation(EVL),and Western guidelines recom-mend antibiotic prophylaxis following hemostasis.However,given the impro-vements in prognosis for variceal bleeding due to advancements in the management of bleeding and treatments of liver cirrhosis and the global concerns regarding the emergence of multidrug-resistant bacteria,there is a need to reassess the use of routine antibiotic prophylaxis after hemostasis.AIM To evaluate the effectiveness of antibiotic prophylaxis in patients treated for EVL.METHODS We conducted a 13-year observational study using the Tokushukai medical database across 46 hospitals.Patients were divided into the prophylaxis group(received antibiotics on admission or the next day)and the non-prophylaxis group(did not receive antibiotics within one day of admission).The primary outcome was composed of 6-wk mortality,4-wk rebleeding,and 4-wk spontaneous bacterial peritonitis(SBP).The secondary outcomes were each individual result and in-hospital mortality.A logistic regression with inverse probability of treatment weighting was used.A subgroup analysis was conducted based on the Child-Pugh classification to determine its influence on the primary outcome measures,while sensitivity analyses for antibiotic type and duration were also performed.RESULTS Among 980 patients,790 were included(prophylaxis:232,non-prophylaxis:558).Most patients were males under the age of 65 years with a median Child-Pugh score of 8.The composite primary outcomes occurred in 11.2%of patients in the prophylaxis group and 9.5%in the non-prophylaxis group.No significant differences in outcomes were observed between the groups(adjusted odds ratio,1.11;95%confidence interval,0.61-1.99;P=0.74).Individual outcomes such as 6-wk mortality,4-wk rebleeding,4-wk onset of SBP,and in-hospital mortality were not significantly different between the groups.The primary outcome did not differ between the Child-Pugh subgroups.Similar results were observed in the sensitivity analyses.CONCLUSION No significant benefit to antibiotic prophylaxis for esophageal variceal bleeding treated with EVL was detected in this study.Global reassessment of routine antibiotic prophylaxis is imperative.
文摘BACKGROUND Hepatitis C virus(HCV),hepatitis B virus(HBV),and human immunodeficiency virus 1(HIV-1)are the most epidemic blood-borne viruses,posing threats to human health and causing economic losses to nations for combating the infection transmission.The diagnostic methodologies that depend on the detection of viral nucleic acids are much more expensive,but they are more accurate than sero-logical testing.AIM To develop a rapid,cost-effective,and accurate diagnostic multiplex polymerase chain reaction(PCR)assay for simultaneous detection of HCV,HBV,and HIV-1.METHODS The design of the proposed PCR assay targets the amplification of a short conserved region featured with a distinguishable melting profile and electro-phoretic molecular weight inside each viral genome.Therefore,this diagnostic method will be appropriate for application in both conventional(combined with electrophoresis)and real-time PCR facilities.Confirmatory in silico investigations were conducted to prove the capability of the approached PCR assay to detect variants of each virus.Then,Egyptian isolates of each virus were subjected to the wet lab examination using the given diagnostic assay.RESULTS The in silico investigations confirmed that the PCR primers can match many viral variants in a multiplex PCR assay.The wet lab experiment proved the efficiency of the assay in distinguishing each viral type through high-resolution melting analysis.Compared to related published assays,the proposed assay in the current study is more sensitive and competitive with many expensive PCR assays.CONCLUSION This study provides a simple,cost-effective,and sensitive diagnostic PCR assay facilitating the detection of the most epidemic blood-borne viruses;this makes the proposed assay promising to be substitutive for the mistakable and cheap serological-based assays.
文摘Malaria is one of the deadliest endemic diseases in Africa. The causative agent of this disease, Plasmodium, contributes to severe complications such as anemia, particularly in vulnerable groups. In Cameroon, the health system aims to protect patients through the free distribution of long-lasting insecticide-treated mosquito nets and intermittent preventive treatment for malaria. However, access to these interventions remains limited. The objective of our study was to determine the distribution of malaria in pregnancy and its association with anemia. Methods: This was a descriptive cross-sectional study targeting pregnant women attending consultations, selected by convenience sampling, from February to May 2021 in three major health facilities in the Foumban health district of West Cameroon. Data were collected through questionnaires administered to the pregnant women, results from malaria rapid diagnostic tests (RDTs), thick drop microscopy for malaria diagnosis, and blood counts. The prevalence of malaria and anemia was estimated, as well as the association between malaria infection and the occurrence of anemia. Results: A total of 395 (91.86%) out of 430 pregnant women were enrolled in the study. The prevalence of malaria and anemia was 5.06% and 30.37%, respectively. Anemia was diagnosed in 120 women (30.37%), including 73 (60.83%) with mild anemia, 46 (38.33%) with moderate anemia, and 1 (0.83%) with severe anemia. Among women with malaria, 8 (40%) had anemia. Malaria infection was found to be associated with an increased risk of developing mild anemia (OR = 1.80 [0.66 - 4.85]) and a decreased risk of developing moderate anemia (OR = 0.74 [0.16 - 3.33]), although these associations were not statistically significant. Conclusion: A relatively low malaria prevalence was registered in the study population while anemia was more prevalent. Lack of association between malaria and anemia may be linked to low malaria prevalence.
