Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultan...Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects.One of the most concerning effects is the development of colitis.Upwards to 8% of patients have been reported to develop colitis, with 5% being severe(Grades 3-4).While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids.Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids.We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.展开更多
BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral an...BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.展开更多
Background:The medicinal material known as Os Draconis(Longgu)originates from fossilized remains of ancient mammals and is widely used in treating emotional and mental conditions.However,fossil resources are nonrenewa...Background:The medicinal material known as Os Draconis(Longgu)originates from fossilized remains of ancient mammals and is widely used in treating emotional and mental conditions.However,fossil resources are nonrenewable,and clinical demand is increasingly difficult to meet,leading to a proliferation of counterfeit products.During prolonged geological burial,static pressure from the surrounding strata severely compromises the microstructural integrity of osteons in Os Draconis,but Os Draconis still largely retains the structural features of mammalian bone.Methods:Using verified authentic Os Draconis samples over 10,000 years old as a baseline,this study summarizes the ultrastructural characteristics of genuine Os Draconis.Employing electron probe microanalysis and optical polarized light microscopy,we examined 28 batches of authentic Os Draconis and 31 batches of counterfeits to identify their ultrastructural differences.Key points for ultrastructural identification of Os Draconis were compiled,and a new identification approach was proposed based on these differences.Results:Authentic Os Draconis exhibited distinct ultrastructural markers:irregularly shaped osteons with traversing fissures,deformed/displaced Haversian canals,and secondary mineral infill(predominantly calcium carbonate).Counterfeits showed regular osteon arrangements,absent traversal fissures,and homogeneous hydroxyapatite composition.Lab-simulated samples lacked structural degradation features.EPMA confirmed calcium carbonate infill in fossilized Haversian canals,while elemental profiles differentiated lacunae types(void vs.mineral-packed).Conclusion:The study established ultrastructural criteria for authentic Os Draconis identification:osteon deformation,geological fissures penetrating bone units,and heterogenous mineral deposition.These features,unattainable in counterfeits or modern processed bones,provide a cost-effective,accurate identification method.This approach bridges gaps in TCM material standardization and supports quality control for clinical applications.展开更多
Background:Cyperi Rhizoma,derived from Cyperus rotundus L.,is a widely used medicinal herb in traditional Chinese medicine(TCM),with Shandong Province recognized as its geo-authentic habitat.However,the quality of Cyp...Background:Cyperi Rhizoma,derived from Cyperus rotundus L.,is a widely used medicinal herb in traditional Chinese medicine(TCM),with Shandong Province recognized as its geo-authentic habitat.However,the quality of Cyperi Rhizoma varies significantly across different regions,potentially influencing its therapeutic efficacy.This study investigates the influence of geographic origin on the chemical composition and overall quality of Cyperi Rhizoma.Methods:A comprehensive approach,including traditional quality assessment,GC-MS(g as c hromatography-m ass s pectrometry),RP-HPLC(r everse p hase h igh-p erformance l iquid c hromatography),and FT-IR(f ourier t ransform i nfrared s pectroscopy)techniques,was employed to analyze Cyperi Rhizoma samples from Shandong Province.These methods examined the physical appearance,chemical profile,and content variations,particularly focusing onα-cyperone.Results:Traditional quality assessments revealed noticeable differences in the external characteristics of the samples.GC-MS analysis identified a variety of unique chemical constituents,while RP-HPLC and FT-IR showed significant variations inα-cyperone content,with higher levels found in Shandong samples.Conclusion:These results demonstrate that geographic origin is a critical determinant of Cyperi Rhizoma quality,with Shandong specimens exhibiting superiorα-cyperone levels and characteristic phytochemical profiles.This validates the geo-authenticity concept in TCM and provides actionable data for developing evidence-based quality standards,suggesting that provenance should be prioritized in medicinal material selection and pharmacopeial specifications.展开更多
Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock...Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.展开更多
This study was conducted to identify the number and density of active licensed acupuncturists(LAcs),as well as the number of accredited schools in acupuncture and Oriental medicine(AOM),as of January 1,2023,in the Uni...This study was conducted to identify the number and density of active licensed acupuncturists(LAcs),as well as the number of accredited schools in acupuncture and Oriental medicine(AOM),as of January 1,2023,in the United States(U.S.).The number of active LAcs as of January 1,2023 was 34,524,potentially33,364 after removing license duplication in multiple states,among which the largest three states were California(with 7317 LAcs[21.19%of the total]),New York(5024[14.55%])and Florida(2644[7.66%]).The total number of LAcs decreased by 8.87%from 2018,and fell short of our projected number of LAcs in 2023 by 9037,or 20.75%.The overall LAc density in the U.S.Dmeasured as the number of LAcs per 100,000 populationDwas 10.36,less than in 2018.There were 56 active,accredited AOM schools which offered a total of 147 programs(121 at the level necessary for licensing[entry-level],12 for an advanced practicing degree[advanced-level],and 14 for certifications).Broken down further,offerings included 50 master's degrees in acupuncture,40 master's degrees in Oriental medicine,31 entry-level doctorate degrees(10 in acupuncture and 21 in acupuncture plus Chinese herbal medicine),and 12advanced-level doctorate degrees in AOM.The certification programs included one in East-Asian Medical Bodywork and 13 in CHM.Among these schools in 2023,institutions in the West and East Coast states comprised 67.86%(decreased from 77.42%in 2018)of the national total.California,Florida and Illinois represented 39.29%.There were 48 jurisdictions with acupuncture practice laws in place.The data suggests that the acupuncture profession in the U.S.has been significantly impacted during the coronavirus disease 2019 pandemic.展开更多
Traditional medicine has garnered significant global recognition,with an estimated 80%of the global population using it.Therefore,it is essential to fully understand the integration of traditional medicines into curre...Traditional medicine has garnered significant global recognition,with an estimated 80%of the global population using it.Therefore,it is essential to fully understand the integration of traditional medicines into current healthcare systems.This review aims to provide a comprehensive overview of the standard process to modernize traditional medicine scientifically in the context of modern biomedicine,further termed here as“scientization”.Specifically,we aim to summarize the advancements made in understanding the efficacy,effectiveness,and underlying mechanisms of herbal medicine.We also examined the transition from experience-to evidence-based medicine during acupuncture.Furthermore,we explore the development of universal safety and quality control standards.Finally,we discuss international trade and export markets for Chinese medical products.The development and integration of traditional medicine have allowed it to further improve human health,resulting in a more comprehensive health solution for the global population.展开更多
As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for u...As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.展开更多
Cultural identity in Iran is comprised of four primary elements,each of which have proven to be highly resonant in the country political history.The vexing issue of modernity,and where individuals and collectivities a...Cultural identity in Iran is comprised of four primary elements,each of which have proven to be highly resonant in the country political history.The vexing issue of modernity,and where individuals and collectivities are placed in relation to it,has been one of the most prominent of these elements of Iranian identity.A second constitutive factor has been the role of the state as a deliberate crafter of cultural,in turn directly influencing the salience,interpretation,extent,and direction of modernity,or its antithesis,in Iran.Equally defining has been the role and significance of religion,which has emerged as a marker of individual and collective,as well as political,identities.Nationalism,and its compelling impulse across Iranian society especially from the early 1900s and continuing until today,has also emerged as an integral and inseparable feature of Iranian identity.Together,these four elements―modernity,a culturally intrusive state,religion and religiosity,and nationalism―constitute fluid yet constant,sometimes complementary and sometimes competing,dimensions of Iranian identity.展开更多
Background: The differential diagnosis for intracavitary cardiac masses is limited, typically including vegetations, tumors, or thrombi. Cardiac thrombi can often mimic cardiac tumors on imaging, creating a diagnostic...Background: The differential diagnosis for intracavitary cardiac masses is limited, typically including vegetations, tumors, or thrombi. Cardiac thrombi can often mimic cardiac tumors on imaging, creating a diagnostic challenge. Primary cardiac tumors are rare and usually benign, whereas most cardiac tumors result from metastases, commonly originating from malignancies in the breast, lung, or melanoma. Aim: This report highlights the importance of distinguishing various cardiac masses based on clinical presentations, clinical courses, and radiological features. Case Presentation: We describe two cases of cardiac masses with unique and diverse clinical features. Each case posed significant diagnostic challenges due to their distinct presentations and clinical progressions. Conclusion: These cases underscore the importance of considering both benign and metastatic origins in the differential diagnosis of intracavitary cardiac masses. Accurate differentiation between thrombi and tumors is crucial for appropriate management and treatment.展开更多
Ectopic pregnancy(EP)could be defined as any embryo that got implanted in any site rather than the endometrial cavity.Lately,different types of EP were reportedly managed by high-intensity focused ultrasound(HIFU).We ...Ectopic pregnancy(EP)could be defined as any embryo that got implanted in any site rather than the endometrial cavity.Lately,different types of EP were reportedly managed by high-intensity focused ultrasound(HIFU).We aimed to pool all available data in a systematic review without meta-analysis and investigate the efficacy and safety tendencies of HIFU among different types of EP.We applied our comprehensive terms in Google Scholar,PubMed,Scopus,Ovid,and PubMed Central databases from their inception until September 23.Retrieved references were gathered using EndNote in which we omitted the duplicates and exported the record for screening.Data regarding character-istics,safety and efficacy outcomes,and baseline information of the enrolled population were extracted.The eligible case reports were assessed using a tool by Murad and colleagues,while the quality of the included cohorts was appraised using the NIH tool.We retrieved 6637 studies,which were scruti-nized by titles and abstracts.We scrutinized the full texts of 36 studies and ultimately included a total of 17 studies.All studies were conducted in China,and on different types of ectopic pregnancy including tubal,cervical,intra-mural,caesarian scar,and corneal ectopic pregnancy.The mean age of enrolled patients was 33.03 years,and we pooled a total sample of 853 patients.The follow-up period varied widely among the included studies,ranging from 1.3 months to up to 69 months.Normal menstruation recurred after a mean of 35 days,as reported by nine studies.Most of the included studies reported normalβ-HCG after around 30-40 days.Twelve studies with 757 patients reported a cumulative incidence of 179 cases of abdominal pain after HIFU.Neither of the enrolled patients reportedly complained of skin burn after HIFU.We suggested managing EP patients with HIFU,especially when seeking further conceiving.High-quality randomized controlled trials are required to draw a stronger level of evidence.展开更多
The Anthropocene as a prospective new,ongoing series/epoch must be defensible against all relevant concerns.We address the seven,still-relevant challenges posed to the Anthropocene Working Group by the Chair,Internati...The Anthropocene as a prospective new,ongoing series/epoch must be defensible against all relevant concerns.We address the seven,still-relevant challenges posed to the Anthropocene Working Group by the Chair,International Commission on Stratigraphy(ICS),in 2014.(1)Concept or reality?The Anthropocene possesses a substantial,sharply distinctive stratigraphic record recognisable through many proxy signals from the mid-20th century onwards;(2)GSSP or GSSA?The Anthropocene can be defined by a GSSP and correlated globally;(3)Past or future?The Anthropocene unquestionably represents geological time,its transformations having already moved the Earth System beyond Holocene norms towards an irreversible future trajectory;(4)Utility?The Anthropocene’s distinctive material content allows useful delineation on geological sections/maps;(5)Indelibility?Many of the Anthropocene’s transformative effects cannot be subsequently effaced or overprinted;(6)Fit within the Geological Time Scale(GTS)?The Anthropocene represents a unique,youngest,interval in Earth history and strata of profound significance;(7)What is its value?The chronostratigraphic Anthropocene has conceptual usefulness even informally,but would then lack the clarity,stability and recognition that formalization provides.Without its formalization,the GTS would no longer accurately reflect Earth history,diminishing the relevance of geological science for analysis of ongoing planetary change.展开更多
基金Supported by Med Star Georgetown University Hospital,Washington,DC,United States
文摘Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects.One of the most concerning effects is the development of colitis.Upwards to 8% of patients have been reported to develop colitis, with 5% being severe(Grades 3-4).While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids.Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids.We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.
文摘BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.
基金supported by the Scientific and Technological Innovation Project of the China Academy of Chinese Medical Sciences(CI2021A04013)the National Natural Science Foundation of China(82204610)+1 种基金the Qihang Talent Program(L2022046)the Fundamental Research Funds for the Central Public Welfare Research Institutes(ZZ15-YQ-041 and L2021029).
文摘Background:The medicinal material known as Os Draconis(Longgu)originates from fossilized remains of ancient mammals and is widely used in treating emotional and mental conditions.However,fossil resources are nonrenewable,and clinical demand is increasingly difficult to meet,leading to a proliferation of counterfeit products.During prolonged geological burial,static pressure from the surrounding strata severely compromises the microstructural integrity of osteons in Os Draconis,but Os Draconis still largely retains the structural features of mammalian bone.Methods:Using verified authentic Os Draconis samples over 10,000 years old as a baseline,this study summarizes the ultrastructural characteristics of genuine Os Draconis.Employing electron probe microanalysis and optical polarized light microscopy,we examined 28 batches of authentic Os Draconis and 31 batches of counterfeits to identify their ultrastructural differences.Key points for ultrastructural identification of Os Draconis were compiled,and a new identification approach was proposed based on these differences.Results:Authentic Os Draconis exhibited distinct ultrastructural markers:irregularly shaped osteons with traversing fissures,deformed/displaced Haversian canals,and secondary mineral infill(predominantly calcium carbonate).Counterfeits showed regular osteon arrangements,absent traversal fissures,and homogeneous hydroxyapatite composition.Lab-simulated samples lacked structural degradation features.EPMA confirmed calcium carbonate infill in fossilized Haversian canals,while elemental profiles differentiated lacunae types(void vs.mineral-packed).Conclusion:The study established ultrastructural criteria for authentic Os Draconis identification:osteon deformation,geological fissures penetrating bone units,and heterogenous mineral deposition.These features,unattainable in counterfeits or modern processed bones,provide a cost-effective,accurate identification method.This approach bridges gaps in TCM material standardization and supports quality control for clinical applications.
基金supported by the National Natural Science Foundation of China(No.82204610)Qihang Talent Program(L2022046)+1 种基金the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(CI2021A04013)Fundamental Research Funds for the Central Public Welfare Research Institutes(ZZ15-YQ-041 and L2021029).
文摘Background:Cyperi Rhizoma,derived from Cyperus rotundus L.,is a widely used medicinal herb in traditional Chinese medicine(TCM),with Shandong Province recognized as its geo-authentic habitat.However,the quality of Cyperi Rhizoma varies significantly across different regions,potentially influencing its therapeutic efficacy.This study investigates the influence of geographic origin on the chemical composition and overall quality of Cyperi Rhizoma.Methods:A comprehensive approach,including traditional quality assessment,GC-MS(g as c hromatography-m ass s pectrometry),RP-HPLC(r everse p hase h igh-p erformance l iquid c hromatography),and FT-IR(f ourier t ransform i nfrared s pectroscopy)techniques,was employed to analyze Cyperi Rhizoma samples from Shandong Province.These methods examined the physical appearance,chemical profile,and content variations,particularly focusing onα-cyperone.Results:Traditional quality assessments revealed noticeable differences in the external characteristics of the samples.GC-MS analysis identified a variety of unique chemical constituents,while RP-HPLC and FT-IR showed significant variations inα-cyperone content,with higher levels found in Shandong samples.Conclusion:These results demonstrate that geographic origin is a critical determinant of Cyperi Rhizoma quality,with Shandong specimens exhibiting superiorα-cyperone levels and characteristic phytochemical profiles.This validates the geo-authenticity concept in TCM and provides actionable data for developing evidence-based quality standards,suggesting that provenance should be prioritized in medicinal material selection and pharmacopeial specifications.
文摘Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.
文摘This study was conducted to identify the number and density of active licensed acupuncturists(LAcs),as well as the number of accredited schools in acupuncture and Oriental medicine(AOM),as of January 1,2023,in the United States(U.S.).The number of active LAcs as of January 1,2023 was 34,524,potentially33,364 after removing license duplication in multiple states,among which the largest three states were California(with 7317 LAcs[21.19%of the total]),New York(5024[14.55%])and Florida(2644[7.66%]).The total number of LAcs decreased by 8.87%from 2018,and fell short of our projected number of LAcs in 2023 by 9037,or 20.75%.The overall LAc density in the U.S.Dmeasured as the number of LAcs per 100,000 populationDwas 10.36,less than in 2018.There were 56 active,accredited AOM schools which offered a total of 147 programs(121 at the level necessary for licensing[entry-level],12 for an advanced practicing degree[advanced-level],and 14 for certifications).Broken down further,offerings included 50 master's degrees in acupuncture,40 master's degrees in Oriental medicine,31 entry-level doctorate degrees(10 in acupuncture and 21 in acupuncture plus Chinese herbal medicine),and 12advanced-level doctorate degrees in AOM.The certification programs included one in East-Asian Medical Bodywork and 13 in CHM.Among these schools in 2023,institutions in the West and East Coast states comprised 67.86%(decreased from 77.42%in 2018)of the national total.California,Florida and Illinois represented 39.29%.There were 48 jurisdictions with acupuncture practice laws in place.The data suggests that the acupuncture profession in the U.S.has been significantly impacted during the coronavirus disease 2019 pandemic.
基金supported by the National Science Foundation of China(82204610)the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(CI2021A04013)+1 种基金Qihang Talent Project of ICMM(L2022046)Fundamental Research Funds for the Central Public Welfare Research Institutes(ZZ15-YQ-041,ZXKT21029).
文摘Traditional medicine has garnered significant global recognition,with an estimated 80%of the global population using it.Therefore,it is essential to fully understand the integration of traditional medicines into current healthcare systems.This review aims to provide a comprehensive overview of the standard process to modernize traditional medicine scientifically in the context of modern biomedicine,further termed here as“scientization”.Specifically,we aim to summarize the advancements made in understanding the efficacy,effectiveness,and underlying mechanisms of herbal medicine.We also examined the transition from experience-to evidence-based medicine during acupuncture.Furthermore,we explore the development of universal safety and quality control standards.Finally,we discuss international trade and export markets for Chinese medical products.The development and integration of traditional medicine have allowed it to further improve human health,resulting in a more comprehensive health solution for the global population.
文摘As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.
文摘Cultural identity in Iran is comprised of four primary elements,each of which have proven to be highly resonant in the country political history.The vexing issue of modernity,and where individuals and collectivities are placed in relation to it,has been one of the most prominent of these elements of Iranian identity.A second constitutive factor has been the role of the state as a deliberate crafter of cultural,in turn directly influencing the salience,interpretation,extent,and direction of modernity,or its antithesis,in Iran.Equally defining has been the role and significance of religion,which has emerged as a marker of individual and collective,as well as political,identities.Nationalism,and its compelling impulse across Iranian society especially from the early 1900s and continuing until today,has also emerged as an integral and inseparable feature of Iranian identity.Together,these four elements―modernity,a culturally intrusive state,religion and religiosity,and nationalism―constitute fluid yet constant,sometimes complementary and sometimes competing,dimensions of Iranian identity.
文摘Background: The differential diagnosis for intracavitary cardiac masses is limited, typically including vegetations, tumors, or thrombi. Cardiac thrombi can often mimic cardiac tumors on imaging, creating a diagnostic challenge. Primary cardiac tumors are rare and usually benign, whereas most cardiac tumors result from metastases, commonly originating from malignancies in the breast, lung, or melanoma. Aim: This report highlights the importance of distinguishing various cardiac masses based on clinical presentations, clinical courses, and radiological features. Case Presentation: We describe two cases of cardiac masses with unique and diverse clinical features. Each case posed significant diagnostic challenges due to their distinct presentations and clinical progressions. Conclusion: These cases underscore the importance of considering both benign and metastatic origins in the differential diagnosis of intracavitary cardiac masses. Accurate differentiation between thrombi and tumors is crucial for appropriate management and treatment.
文摘Ectopic pregnancy(EP)could be defined as any embryo that got implanted in any site rather than the endometrial cavity.Lately,different types of EP were reportedly managed by high-intensity focused ultrasound(HIFU).We aimed to pool all available data in a systematic review without meta-analysis and investigate the efficacy and safety tendencies of HIFU among different types of EP.We applied our comprehensive terms in Google Scholar,PubMed,Scopus,Ovid,and PubMed Central databases from their inception until September 23.Retrieved references were gathered using EndNote in which we omitted the duplicates and exported the record for screening.Data regarding character-istics,safety and efficacy outcomes,and baseline information of the enrolled population were extracted.The eligible case reports were assessed using a tool by Murad and colleagues,while the quality of the included cohorts was appraised using the NIH tool.We retrieved 6637 studies,which were scruti-nized by titles and abstracts.We scrutinized the full texts of 36 studies and ultimately included a total of 17 studies.All studies were conducted in China,and on different types of ectopic pregnancy including tubal,cervical,intra-mural,caesarian scar,and corneal ectopic pregnancy.The mean age of enrolled patients was 33.03 years,and we pooled a total sample of 853 patients.The follow-up period varied widely among the included studies,ranging from 1.3 months to up to 69 months.Normal menstruation recurred after a mean of 35 days,as reported by nine studies.Most of the included studies reported normalβ-HCG after around 30-40 days.Twelve studies with 757 patients reported a cumulative incidence of 179 cases of abdominal pain after HIFU.Neither of the enrolled patients reportedly complained of skin burn after HIFU.We suggested managing EP patients with HIFU,especially when seeking further conceiving.High-quality randomized controlled trials are required to draw a stronger level of evidence.
文摘The Anthropocene as a prospective new,ongoing series/epoch must be defensible against all relevant concerns.We address the seven,still-relevant challenges posed to the Anthropocene Working Group by the Chair,International Commission on Stratigraphy(ICS),in 2014.(1)Concept or reality?The Anthropocene possesses a substantial,sharply distinctive stratigraphic record recognisable through many proxy signals from the mid-20th century onwards;(2)GSSP or GSSA?The Anthropocene can be defined by a GSSP and correlated globally;(3)Past or future?The Anthropocene unquestionably represents geological time,its transformations having already moved the Earth System beyond Holocene norms towards an irreversible future trajectory;(4)Utility?The Anthropocene’s distinctive material content allows useful delineation on geological sections/maps;(5)Indelibility?Many of the Anthropocene’s transformative effects cannot be subsequently effaced or overprinted;(6)Fit within the Geological Time Scale(GTS)?The Anthropocene represents a unique,youngest,interval in Earth history and strata of profound significance;(7)What is its value?The chronostratigraphic Anthropocene has conceptual usefulness even informally,but would then lack the clarity,stability and recognition that formalization provides.Without its formalization,the GTS would no longer accurately reflect Earth history,diminishing the relevance of geological science for analysis of ongoing planetary change.
