Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certif...Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.展开更多
Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in ...Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.展开更多
AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the  ...AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.展开更多
Background:Low cardiorespiratory fitness is an independent predictor of all-cause and cardiovascular mortality,and interventions that increase fitness reduce risk.Water-walking decreases musculoskeletal impact and ris...Background:Low cardiorespiratory fitness is an independent predictor of all-cause and cardiovascular mortality,and interventions that increase fitness reduce risk.Water-walking decreases musculoskeletal impact and risk of falls in older individuals,but it is unclear whether water-walking improves aerobic fitness in the same way as weight-dependent land-walking.This randomized controlled trial involved 3 intervention groups—a no-exercise control group(CG),a land-walking(LW)group,and a water-walking(WW)group—to investigate the comparative impacts of LWandWWto CG on fitness.Methods:Both exercise groups attended individually tailored,center-based,intensity-matched 3×weekly sessions for 24 weeks,which progressed to 150 min of exercise per week.This was followed by a 24-week no-intervention period.Maximal graded exercise tests were performed on a treadmill at Weeks 0,24,and 48.Results:Maximal oxygen uptake increased from Week 0 to Week 24 in both exercise groups(0.57±0.62 mL/kg/min,0.03±0.04 L/min for LW;0.93±0.75 mL/kg/min,0.06±0.06 L/min for WW,mean±SE)compared to the CG(-1.75±0.78 mL/kg/min,-0.16±0.05 L/min)(group×time,p<0.05).Time to exhaustion increased significantly following LW only(123.4±25.5 s),which was significantly greater(p=0.001)than the CG(24.3±18.5 s).By Week 48,the training-induced adaptations in the exercise groups returned to near baseline levels.Conclusion:Our study supports current physical-activity recommendations that 150 min/week of moderate-intensity exercise produces improvements in fitness in previously sedentary older individuals.Also,LW andWW elicit similar improvements in fitness if conducted at the same relative intensities.Exercise-na?ve older individuals can benefit from the lower impact forces and decreased risk of falls associated withWWwithout compromising improvements in cardiorespiratory fitness.展开更多
Diagnostic overshadowing refers to a phenomenon commonly characterised by a person with pre-existing or recently diagnosed mental illness receiving inadequate attention for symptoms of physical illness,which are then ...Diagnostic overshadowing refers to a phenomenon commonly characterised by a person with pre-existing or recently diagnosed mental illness receiving inadequate attention for symptoms of physical illness,which are then misattributed as manifestations of the mental illness.There are potentially several underlying reasons for this,including diagnostic challenges in establishing a medical cause for the presenting symptoms,likely lack of expertise in medicine,stigma directed towards mental illness,a protean or polymorphic presentation not immediately relating to an established nosology,lack of a reliable evidence base in the area leading to an inability to correlate with established medical diagnoses as well as biases towards treating surface-level symp-toms instead of identifying the underlying causes.展开更多
INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were fo...INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were four to five times more likely to be affected by this condi-tion,with a mean age of onset between 41 and 48 years2,though rare occasional paediatric presentations were also reported.展开更多
In a pivotal phase 3 randomized con trolled trial, Hussain et al. tested thehypothesis that, with respect to survival, intermittent androgen deprivation therapy （ADT） is noninferior to continuous in men with newly d...In a pivotal phase 3 randomized con trolled trial, Hussain et al. tested thehypothesis that, with respect to survival, intermittent androgen deprivation therapy （ADT） is noninferior to continuous in men with newly diagnosed metastatic prostate cancer. While the trial findings were statis tically inconclusive, the study suggests, but does not prove, that intermittent may do more harm than good, although findings are not definitive. While outcomes of ongoing trials are awaited, the trial by Hussain et al., in conjunction with an ear lier trial in men with nonmetastatic pro state cancer by Crook et al., does provide important new guidance regarding the choice of ADT in men with androgensensitive prostate cancer. ADT is one of the most effective palliat ive therapies for patients with metastatic prostate cancer, but not without drawbacks. While not as toxic as chemotherapy, ADT carries a significant risk of morbidity, including sexual dysfunction, fatigue, ane mia, accelerated bone loss and fractures, sarcopenia, increased risk of diabetes, and possibly, of cardiovascular events.1＇2 In addition, despite an initial response rate of more than 90%, most patients develop res istance to ADT, resulting in a median sur vival of 2.53 years. Predinical data suggest that continuous use of ADT may accelerate the emergence of resistance to this therapy, and that reexposure of prostate cancer stem cells to androgens can reinduce dif ferentiation and increase their apoptotic potential.3 These ADTassociated shortcom ings, in addition to treatment expense, havespurred the development of strategies to min imize the exposure to ADT, including the use of intermittent ADT. While several smaller randomized controlled clinical trials have compared the use of intermittent with con tinuous ADT, no definitive information is available for patients with metastatic prostate cancer. To fill this evidence gap, a large mul tinational randomized controlled trial led by Hussain et al.4 was designed in 1993, and out comes have been published recently in the New England Journal of Medicine. In a coprimary end point, the authors tested the hypotheses that （i） intermittent ADT is not inferior to continuous ADT with respect to survival in men with metastatic, hormone sensitive prostate cancer; and （ii） compared to continuous therapy, intermittent ADT improves quality of life. The primary finding from the study was inconclusive, that is, intermittent ADT was not proven to be as good as continuous ADT, and there was instead a trend to inferiority. While intermit tent ADT was associated with better erectile function and mental health, this benefit did not persist beyond 3 months. Due to the inconclusive finding of this noninferiority trial its findings may be difficult to interpret and apply to clinical practice. Therefore, we explore this trial in more detail. The study by Hussain et al.4 enrolled 3040 men from the Unite States, Canada and UK who had newly diagnosed prostate cancer with lymph node, visceral or bone metastases and a prostatespecific antigen （PSA） 〉 5 ng ml 1. Men received a 7month induction course with a luteinizing hormone releasing hormone agonist and antiandrogen （goser elin and bicalutamide, or equivalent） to select androgendependent disease, defined by a PSA G〈 4 ng ml 1 at induction end. One thou sand five hundred and thirtyfive men fulfilled this criterion and were then rando mized but not blinded to intermittent orcontinuous ADT, stratified by performance status, prior hormone therapy and extent of disease. Men assigned to continuous therapy continued, whereas men assigned to intermit tent therapy discontinued ADT at completion of the 7-month induction course. The展开更多
Introduction: Sexual behaviour among gay and other men who have sex with men (GMSM) is influenced by the shared understanding of HIV/STI risk and peer norms regarding sexual behaviour. However, there is little researc...Introduction: Sexual behaviour among gay and other men who have sex with men (GMSM) is influenced by the shared understanding of HIV/STI risk and peer norms regarding sexual behaviour. However, there is little research evidence to support this relationship. The unique geographic spread of Australian communities, the history of Australian HIV epidemic and the different patterns in risky sexual practices and HIV diagnoses across Australia present an opportunity to explore the role of social norms and GMSM behaviours in shaping different patterns of HIV epidemics. We describe the protocol of the study of contemporary norms in networks and communities of GMSM (CONNECT) which investigates gay community behavioural norms and practices. Methods: CONNECT is aimed to 1) identify the patterns of connections between individuals in GMSM communities and assess how they shape HIV-related behaviours;2) describe the relationship between social norms and sexual practices;and 3) compare the norms and patterns of behaviour in geographically and epidemiologically distinct GMSM populations in three Australian states New South Wales, Victoria and Western Australia, in order to identify local community norms and barriers to effective HIV prevention. This quantitative cross-sectional study uses respondent-driven sampling (RDS) for recruitment. Results: Analyses will be carried out on individual and community level and will investigate the relationship between community-level behavioural norms and associated practices of individuals. Conclusion: CONNECT is anticipated to inform HIV prevention services to better target and increase the effectiveness of the current health promotion for GMSM in the context of increasing HIV/STI incidence.展开更多
Sweeping across the continents,the unprecedented Coronavirus crisis has transformed the images of health professionals in the world's eyes.Covered in personal protective equipment(PPE),faces barely recognized,thes...Sweeping across the continents,the unprecedented Coronavirus crisis has transformed the images of health professionals in the world's eyes.Covered in personal protective equipment(PPE),faces barely recognized,these are the warriors who fight on the frontline for the health of the global community,and we,as part of the global community,in turn want to ensure that they too are well,both physically and mentally.展开更多
Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the dia...Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the diagnostic performances of artificial intelligence(AI)-assisted tools for HPV-related HSILs.We followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines and systematically searched PubMed,Embase,Web of Science,IEEE,and the Cochrane Library for eligible studies published between 2000 and January 2024.Studies on AI-assisted colposcopy used to facilitate the diagnosis of cervical or anal HSILs and cancers were included.The revised Quality Assessment of Diagnostic Studies 2 and AI checklists were used to assess the risk of bias.With random-effect models,meta-analyses were performed on performance indicators,including accuracy,sensitivity,specificity,and area under the receiver-operating characteristic curves(AUC).Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity.Twenty-five studies,comprising 21 studies focused on cervical cancer and 4 on anal cancer,were included in the meta-analysis.When differentiating from individuals with<cervical intraepithelial neoplasia grade 2(CIN2)/low-grade squamous intraepithelial lesion(LSIL)−(lesion grade<CIN2 or≤LSIL),the AI-assisted diagnostic tools identified individuals with CIN2+/HSIL+(lesion grade≥CIN2 or≥HSIL)at a pooled accuracy of 0.84(95%confidence interval[CI]:0.81-0.88),sensitivity of 0.87(0.81-0.93),specificity of 0.85(0.81-0.89),and AUC of 0.94(0.91-0.96).For anal cancer,the AI-assisted diagnostic tools differentiated individuals with anal intraepithelial neoplasia grade 2(AIN2)+/HSIL+(≥AIN2 or≥HSIL)from those with<AIN2/LSIL−(lesion grade<AIN2 or≤LSIL)at a pooled accuracy of 0.90(95%CI:0.88-0.93),sensitivity of 0.94(0.87-0.99),specificity of 0.88(0.71-0.98),and AUC of 0.97(0.95-0.98).All meta-analysis results demonstrated high heterogeneity(I^(2)>90%),but the meta-regression analysis did not reveal any significant contributing sources of heterogeneity.Based on this systematic review and meta-analysis of existing literature,we concluded that AI-assisted diagnostic tools have demonstrated promising predictive performance in diagnosing HPV-related cervical and anal precancerous lesions and cancers.展开更多
Background The World Health Organization(WHO)targets a 65%reduction in hepatitis B-related deaths by 2030 compared to 2015 to eliminate viral hepatitis as a major public health threat.It is unknown whether and how Chi...Background The World Health Organization(WHO)targets a 65%reduction in hepatitis B-related deaths by 2030 compared to 2015 to eliminate viral hepatitis as a major public health threat.It is unknown whether and how China can achieve this target despite significant intervention achievements.We aimed to predict the hepatitis B-related deaths in China and identify key developments needed to achieve the target.Methods An age-and time-dependent dynamic hepatitis B virus(HBV)transmission compartmental model was developed to predict the trend of hepatitis B-related deaths under base-case and subsequent scenarios from 2015 to 2040.In base-case scenario,we assumed the diagnosis and treatment(D&T)rate would reach 72%in 2030,as proposed by WHO.Subsequent scenarios were set based on the results of base-case and one-way sensitivity analysis.Results Compared with 2015,hepatitis B-related deaths would be reduced by 23.89%in 2030 and 51.79%in 2040,respectively,and the WHO's impact target of 65%reduction would not be achieved until 2038 at the earliest under base-case scenario.HBV clearance rate and current treatment effectiveness were the most sensitive parameters that significantly influenced the decline of hepatitis B-related deaths from 2015 to 2040.In the subsequent scenario,when D&T rate improving to 90%by 2030,with the current treatment effectiveness and HBV clearance rate being optimized from 2016,the WHO's impact target would be achieved in 2038.Increasing the clearance rate further from 2%to 2.8%during 2016–2030 linearly,the impact target would be achieved on time.Conclusions It is difficult for China to achieve the WHO's impact target of 65%reduction in hepatitis B-related deaths by 2030 even we assumed the D&T rate would reach 72%in 2030 and beyond.A comprehensive scale-up of available strategies,especially innovative drugs and technologies will ensure that China achieves the target on schedule.展开更多
Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Desi...Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.展开更多
Objective:To evaluate the effect and safety of foot baths with Tangbi Waixi Decoction(TW)in treating patients with diabetic peripheral neuropathy(DPN).Methods:It is a multicenter double-blinded randomized controlled t...Objective:To evaluate the effect and safety of foot baths with Tangbi Waixi Decoction(TW)in treating patients with diabetic peripheral neuropathy(DPN).Methods:It is a multicenter double-blinded randomized controlled trial.Participants with DPN were recruited between November 18,2016 and May 30,2018 from 8 hospitals in China.All patients received basic treatments for glycemic management.Patients received foot baths with TW herbal granules either 66.9 g(intervention group)or 6.69 g(control group)for 30 min once a day for 2 weeks and followed by a 2-week rest,as a therapeutic course.If the Toronto Clinical Scoring System total score(TCSS-TS)6 points,the patients received a total of 3 therapeutic courses(for 12 weeks)and were followed up for 12 weeks.The primary outcome was change in TCSS-TS score at 12 and 24 weeks.Secondary outcomes included changes in bilateral motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median and common peroneal nerve.Safety was also assessed.Results:Totally 632 patients were enrolled,and 317 and 315 were randomized to the intervention and control groups,respectively.After the 12-week intervention,patients in both groups showed significant declines in TCSSTS scores,and significant increases in MNCV and SNCV of the median and common peroneal nerves compared with pre-treatment(P<0.05).The reduction of TCSS-TS score at 12 weeks and the increase of SNCV of median nerve at 24 weeks in the control group were greater than those in the intervention group(P<0.05).The number of adverse events did not differ significantly between groups(P>0.05),and no serious adverse event was related with treatment.Conclusion:Treatment of TW foot baths was safe and significantly benefitted patients with DPN.A low dose of TW appeared to be more effective than a high dose.(Registry No.Chi CTR-IOR-16009331)展开更多
Objective: Neurosyphilis is challenging to diagnose, especially in patients with human immunodeficiency virus (HIV)/syphilis co-infection. The aim of this study was to profile the clinical features of neurosyphilis an...Objective: Neurosyphilis is challenging to diagnose, especially in patients with human immunodeficiency virus (HIV)/syphilis co-infection. The aim of this study was to profile the clinical features of neurosyphilis and evaluate the correlation between neurosyphilis and clinical or laboratory factors among patients with HIV/syphilis co-infection.Methods: We retrospectively analyzed the data of 479 HIV/syphilis co-infected patients examined between August 2009 and September 2018. A multivariate logistic regression model was used to identify factors correlated with neurosyphilis.Results: The overall prevalence of neurosyphilis was 21.7%. The prevalence of neurosyphilis differed among patients with primary (11.1%), secondary (20.1%), and latent syphilis (29.1%). The prevalences of neurosyphilis in patients with serological non-response and serofast patients were 26.1% and 6.3%, respectively, while 12.5% of patients with serological relapse had neurosyphilis. Patients with secondary and latent syphilis had serum rapid plasma reagin (RPR) titers (per unit) of 1.44-fold [95% confidence interval (CI): 1.08-1.93,P= 0.014] and 2.73-fold (95%CI: 1.49-5.00,P= 0.001), respectively, which increased the risk of confirmed neurosyphilis. Among patients with latent syphilis, a serum RPR titer of ≥1:32 and peripheral blood CD4 cell count of ≤350/mL were significantly associated with neurosyphilis, with adjusted odds ratios of 9.45 (95%CI: 1.86-48.03,P= 0.007) and 3.75 (95%CI: 1.11-12.66,P= 0.033), respectively.Conclusion: A serum RPR titer of ≥1:32 and a peripheral blood CD4 cell count of ≤350/mL have predictive value in screening for neurosyphilis among HIV-positive patients with latent syphilis.展开更多
A new coronavirus disease(COVID-19)with infection by a novel coronavirus named severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has spread globally since December 2019.By 22th September 2020,more than 200 co...A new coronavirus disease(COVID-19)with infection by a novel coronavirus named severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has spread globally since December 2019.By 22th September 2020,more than 200 countries worldwide have reported about 30 million confirmed cases and more than 950,000 deaths.1 China has reported a total of 85,307(including 2,758 imported)cases and 4,634 deaths.展开更多
Mass testing is an intervention strategy for COVID-19 control in the general population regardless of the presentation of symptoms.It involves collecting nasal or pharyngeal swabs for DNA testing,often using the polym...Mass testing is an intervention strategy for COVID-19 control in the general population regardless of the presentation of symptoms.It involves collecting nasal or pharyngeal swabs for DNA testing,often using the polymerase chain reaction method.Countries that have used mass testing consider it to be a viable strategy to control the COVID-19 pandemic as the strategy can potentially identify and isolate asymptomatic cases in the early stages of infection and reduce the risk of virus transmission.Since the reopening of Wuhan,China,in early April 2020,China has conducted mass testings in three megacities with populations of over 10 million,including Beijing and Qingdao1 at the beginning of their local outbreaks,and Wuhan immediately after the reopening.展开更多
文摘Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.
文摘Hepatic hydrothorax(HH)is an uncommon yet severe manifestation of portal hypertension which develops in 5%-10%of patients with liver cirrhosis.It typically presents as a unilateral,right-sided pleural effusion and in the context of end-stage liver disease and concomitant ascites.The most widely accepted explanatory model for HH accumulation is the formation of small diaphragmatic defects(pleuroperitoneal connections)facilitating migration of ascitic fluid from the peritoneal cavity directly to the pleural cavity.Medical management involves sodium restriction and diuretic therapy,with thoracentesis also offering symptomatic relief.In cases of refractory HH,a transjugular intrahepatic portosystemic shunt is considered either as definitive treatment or as a bridge to liver transplantation,which remains the only curative treatment option.HH refractory to medical therapy presents a challenging clinical dilemma,particularly in those who are ineligible for liver transplantation.In this mini-review,we aim to highlight the pathophysiology,clinical presentation,diagnosis and management of HH.Additionally,we discuss and appraise novel therapeutic options and offer future directions.
文摘AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
基金supported by the National Health and Medical Research Council(NHMRC)of Australia(1045204)supported by an NHMRC Principal Research Fellowship(APP1080914)supported by a National Heart Foundation of Australia Future Leader Fellowship(ID 101895)。
文摘Background:Low cardiorespiratory fitness is an independent predictor of all-cause and cardiovascular mortality,and interventions that increase fitness reduce risk.Water-walking decreases musculoskeletal impact and risk of falls in older individuals,but it is unclear whether water-walking improves aerobic fitness in the same way as weight-dependent land-walking.This randomized controlled trial involved 3 intervention groups—a no-exercise control group(CG),a land-walking(LW)group,and a water-walking(WW)group—to investigate the comparative impacts of LWandWWto CG on fitness.Methods:Both exercise groups attended individually tailored,center-based,intensity-matched 3×weekly sessions for 24 weeks,which progressed to 150 min of exercise per week.This was followed by a 24-week no-intervention period.Maximal graded exercise tests were performed on a treadmill at Weeks 0,24,and 48.Results:Maximal oxygen uptake increased from Week 0 to Week 24 in both exercise groups(0.57±0.62 mL/kg/min,0.03±0.04 L/min for LW;0.93±0.75 mL/kg/min,0.06±0.06 L/min for WW,mean±SE)compared to the CG(-1.75±0.78 mL/kg/min,-0.16±0.05 L/min)(group×time,p<0.05).Time to exhaustion increased significantly following LW only(123.4±25.5 s),which was significantly greater(p=0.001)than the CG(24.3±18.5 s).By Week 48,the training-induced adaptations in the exercise groups returned to near baseline levels.Conclusion:Our study supports current physical-activity recommendations that 150 min/week of moderate-intensity exercise produces improvements in fitness in previously sedentary older individuals.Also,LW andWW elicit similar improvements in fitness if conducted at the same relative intensities.Exercise-na?ve older individuals can benefit from the lower impact forces and decreased risk of falls associated withWWwithout compromising improvements in cardiorespiratory fitness.
基金funded by the National Health and Medical Research Council of Australia,Targeted Call for Research 1046692supported by NHMRC Career Development Fellowship(APP1061998)+2 种基金supported by an NHMRC Fellowshipsupported by an NHMRC Early Career Fellowship(APP1035887)supported by an Early Career Fellowship from the Society of Mental Health Research
文摘Diagnostic overshadowing refers to a phenomenon commonly characterised by a person with pre-existing or recently diagnosed mental illness receiving inadequate attention for symptoms of physical illness,which are then misattributed as manifestations of the mental illness.There are potentially several underlying reasons for this,including diagnostic challenges in establishing a medical cause for the presenting symptoms,likely lack of expertise in medicine,stigma directed towards mental illness,a protean or polymorphic presentation not immediately relating to an established nosology,lack of a reliable evidence base in the area leading to an inability to correlate with established medical diagnoses as well as biases towards treating surface-level symp-toms instead of identifying the underlying causes.
文摘INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were four to five times more likely to be affected by this condi-tion,with a mean age of onset between 41 and 48 years2,though rare occasional paediatric presentations were also reported.
文摘In a pivotal phase 3 randomized con trolled trial, Hussain et al. tested thehypothesis that, with respect to survival, intermittent androgen deprivation therapy （ADT） is noninferior to continuous in men with newly diagnosed metastatic prostate cancer. While the trial findings were statis tically inconclusive, the study suggests, but does not prove, that intermittent may do more harm than good, although findings are not definitive. While outcomes of ongoing trials are awaited, the trial by Hussain et al., in conjunction with an ear lier trial in men with nonmetastatic pro state cancer by Crook et al., does provide important new guidance regarding the choice of ADT in men with androgensensitive prostate cancer. ADT is one of the most effective palliat ive therapies for patients with metastatic prostate cancer, but not without drawbacks. While not as toxic as chemotherapy, ADT carries a significant risk of morbidity, including sexual dysfunction, fatigue, ane mia, accelerated bone loss and fractures, sarcopenia, increased risk of diabetes, and possibly, of cardiovascular events.1＇2 In addition, despite an initial response rate of more than 90%, most patients develop res istance to ADT, resulting in a median sur vival of 2.53 years. Predinical data suggest that continuous use of ADT may accelerate the emergence of resistance to this therapy, and that reexposure of prostate cancer stem cells to androgens can reinduce dif ferentiation and increase their apoptotic potential.3 These ADTassociated shortcom ings, in addition to treatment expense, havespurred the development of strategies to min imize the exposure to ADT, including the use of intermittent ADT. While several smaller randomized controlled clinical trials have compared the use of intermittent with con tinuous ADT, no definitive information is available for patients with metastatic prostate cancer. To fill this evidence gap, a large mul tinational randomized controlled trial led by Hussain et al.4 was designed in 1993, and out comes have been published recently in the New England Journal of Medicine. In a coprimary end point, the authors tested the hypotheses that （i） intermittent ADT is not inferior to continuous ADT with respect to survival in men with metastatic, hormone sensitive prostate cancer; and （ii） compared to continuous therapy, intermittent ADT improves quality of life. The primary finding from the study was inconclusive, that is, intermittent ADT was not proven to be as good as continuous ADT, and there was instead a trend to inferiority. While intermit tent ADT was associated with better erectile function and mental health, this benefit did not persist beyond 3 months. Due to the inconclusive finding of this noninferiority trial its findings may be difficult to interpret and apply to clinical practice. Therefore, we explore this trial in more detail. The study by Hussain et al.4 enrolled 3040 men from the Unite States, Canada and UK who had newly diagnosed prostate cancer with lymph node, visceral or bone metastases and a prostatespecific antigen （PSA） 〉 5 ng ml 1. Men received a 7month induction course with a luteinizing hormone releasing hormone agonist and antiandrogen （goser elin and bicalutamide, or equivalent） to select androgendependent disease, defined by a PSA G〈 4 ng ml 1 at induction end. One thou sand five hundred and thirtyfive men fulfilled this criterion and were then rando mized but not blinded to intermittent orcontinuous ADT, stratified by performance status, prior hormone therapy and extent of disease. Men assigned to continuous therapy continued, whereas men assigned to intermit tent therapy discontinued ADT at completion of the 7-month induction course. The
文摘Introduction: Sexual behaviour among gay and other men who have sex with men (GMSM) is influenced by the shared understanding of HIV/STI risk and peer norms regarding sexual behaviour. However, there is little research evidence to support this relationship. The unique geographic spread of Australian communities, the history of Australian HIV epidemic and the different patterns in risky sexual practices and HIV diagnoses across Australia present an opportunity to explore the role of social norms and GMSM behaviours in shaping different patterns of HIV epidemics. We describe the protocol of the study of contemporary norms in networks and communities of GMSM (CONNECT) which investigates gay community behavioural norms and practices. Methods: CONNECT is aimed to 1) identify the patterns of connections between individuals in GMSM communities and assess how they shape HIV-related behaviours;2) describe the relationship between social norms and sexual practices;and 3) compare the norms and patterns of behaviour in geographically and epidemiologically distinct GMSM populations in three Australian states New South Wales, Victoria and Western Australia, in order to identify local community norms and barriers to effective HIV prevention. This quantitative cross-sectional study uses respondent-driven sampling (RDS) for recruitment. Results: Analyses will be carried out on individual and community level and will investigate the relationship between community-level behavioural norms and associated practices of individuals. Conclusion: CONNECT is anticipated to inform HIV prevention services to better target and increase the effectiveness of the current health promotion for GMSM in the context of increasing HIV/STI incidence.
文摘Sweeping across the continents,the unprecedented Coronavirus crisis has transformed the images of health professionals in the world's eyes.Covered in personal protective equipment(PPE),faces barely recognized,these are the warriors who fight on the frontline for the health of the global community,and we,as part of the global community,in turn want to ensure that they too are well,both physically and mentally.
文摘Detection of high-grade squamous intraepithelial lesions(HSILs)is key for the prevention of human papillomavirus(HPV)-related cancers.In this study,we aimed to identify and consolidate the existing evidence on the diagnostic performances of artificial intelligence(AI)-assisted tools for HPV-related HSILs.We followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines and systematically searched PubMed,Embase,Web of Science,IEEE,and the Cochrane Library for eligible studies published between 2000 and January 2024.Studies on AI-assisted colposcopy used to facilitate the diagnosis of cervical or anal HSILs and cancers were included.The revised Quality Assessment of Diagnostic Studies 2 and AI checklists were used to assess the risk of bias.With random-effect models,meta-analyses were performed on performance indicators,including accuracy,sensitivity,specificity,and area under the receiver-operating characteristic curves(AUC).Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity.Twenty-five studies,comprising 21 studies focused on cervical cancer and 4 on anal cancer,were included in the meta-analysis.When differentiating from individuals with<cervical intraepithelial neoplasia grade 2(CIN2)/low-grade squamous intraepithelial lesion(LSIL)−(lesion grade<CIN2 or≤LSIL),the AI-assisted diagnostic tools identified individuals with CIN2+/HSIL+(lesion grade≥CIN2 or≥HSIL)at a pooled accuracy of 0.84(95%confidence interval[CI]:0.81-0.88),sensitivity of 0.87(0.81-0.93),specificity of 0.85(0.81-0.89),and AUC of 0.94(0.91-0.96).For anal cancer,the AI-assisted diagnostic tools differentiated individuals with anal intraepithelial neoplasia grade 2(AIN2)+/HSIL+(≥AIN2 or≥HSIL)from those with<AIN2/LSIL−(lesion grade<AIN2 or≤LSIL)at a pooled accuracy of 0.90(95%CI:0.88-0.93),sensitivity of 0.94(0.87-0.99),specificity of 0.88(0.71-0.98),and AUC of 0.97(0.95-0.98).All meta-analysis results demonstrated high heterogeneity(I^(2)>90%),but the meta-regression analysis did not reveal any significant contributing sources of heterogeneity.Based on this systematic review and meta-analysis of existing literature,we concluded that AI-assisted diagnostic tools have demonstrated promising predictive performance in diagnosing HPV-related cervical and anal precancerous lesions and cancers.
基金supported by the National Science and Technology Key Project of the Ministry of Science and Technology of the People’s Republic of China(No.2018ZX10721202).
文摘Background The World Health Organization(WHO)targets a 65%reduction in hepatitis B-related deaths by 2030 compared to 2015 to eliminate viral hepatitis as a major public health threat.It is unknown whether and how China can achieve this target despite significant intervention achievements.We aimed to predict the hepatitis B-related deaths in China and identify key developments needed to achieve the target.Methods An age-and time-dependent dynamic hepatitis B virus(HBV)transmission compartmental model was developed to predict the trend of hepatitis B-related deaths under base-case and subsequent scenarios from 2015 to 2040.In base-case scenario,we assumed the diagnosis and treatment(D&T)rate would reach 72%in 2030,as proposed by WHO.Subsequent scenarios were set based on the results of base-case and one-way sensitivity analysis.Results Compared with 2015,hepatitis B-related deaths would be reduced by 23.89%in 2030 and 51.79%in 2040,respectively,and the WHO's impact target of 65%reduction would not be achieved until 2038 at the earliest under base-case scenario.HBV clearance rate and current treatment effectiveness were the most sensitive parameters that significantly influenced the decline of hepatitis B-related deaths from 2015 to 2040.In the subsequent scenario,when D&T rate improving to 90%by 2030,with the current treatment effectiveness and HBV clearance rate being optimized from 2016,the WHO's impact target would be achieved in 2038.Increasing the clearance rate further from 2%to 2.8%during 2016–2030 linearly,the impact target would be achieved on time.Conclusions It is difficult for China to achieve the WHO's impact target of 65%reduction in hepatitis B-related deaths by 2030 even we assumed the D&T rate would reach 72%in 2030 and beyond.A comprehensive scale-up of available strategies,especially innovative drugs and technologies will ensure that China achieves the target on schedule.
基金funded by the Australian Government Medical Research Future Fund(MRFF),Grant number 2015947.
文摘Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.
基金Supported by the National Science and Technology Support Program(No.2015BAI04B09)。
文摘Objective:To evaluate the effect and safety of foot baths with Tangbi Waixi Decoction(TW)in treating patients with diabetic peripheral neuropathy(DPN).Methods:It is a multicenter double-blinded randomized controlled trial.Participants with DPN were recruited between November 18,2016 and May 30,2018 from 8 hospitals in China.All patients received basic treatments for glycemic management.Patients received foot baths with TW herbal granules either 66.9 g(intervention group)or 6.69 g(control group)for 30 min once a day for 2 weeks and followed by a 2-week rest,as a therapeutic course.If the Toronto Clinical Scoring System total score(TCSS-TS)6 points,the patients received a total of 3 therapeutic courses(for 12 weeks)and were followed up for 12 weeks.The primary outcome was change in TCSS-TS score at 12 and 24 weeks.Secondary outcomes included changes in bilateral motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median and common peroneal nerve.Safety was also assessed.Results:Totally 632 patients were enrolled,and 317 and 315 were randomized to the intervention and control groups,respectively.After the 12-week intervention,patients in both groups showed significant declines in TCSSTS scores,and significant increases in MNCV and SNCV of the median and common peroneal nerves compared with pre-treatment(P<0.05).The reduction of TCSS-TS score at 12 weeks and the increase of SNCV of median nerve at 24 weeks in the control group were greater than those in the intervention group(P<0.05).The number of adverse events did not differ significantly between groups(P>0.05),and no serious adverse event was related with treatment.Conclusion:Treatment of TW foot baths was safe and significantly benefitted patients with DPN.A low dose of TW appeared to be more effective than a high dose.(Registry No.Chi CTR-IOR-16009331)
基金This work was supported by grants from the National Natural Science Foundation of China(Nos.81301374 and 82072322)Shanghai Municipal Commission of Health and Family Planning(No.20184Y0225)+1 种基金Shanghai Committee of Science and Technology(Nos.YDZX20193100002868 and 17DZ2293300)National Megaprojecton on Key Infectious Diseases(No.2017ZX10202102-001-007).
文摘Objective: Neurosyphilis is challenging to diagnose, especially in patients with human immunodeficiency virus (HIV)/syphilis co-infection. The aim of this study was to profile the clinical features of neurosyphilis and evaluate the correlation between neurosyphilis and clinical or laboratory factors among patients with HIV/syphilis co-infection.Methods: We retrospectively analyzed the data of 479 HIV/syphilis co-infected patients examined between August 2009 and September 2018. A multivariate logistic regression model was used to identify factors correlated with neurosyphilis.Results: The overall prevalence of neurosyphilis was 21.7%. The prevalence of neurosyphilis differed among patients with primary (11.1%), secondary (20.1%), and latent syphilis (29.1%). The prevalences of neurosyphilis in patients with serological non-response and serofast patients were 26.1% and 6.3%, respectively, while 12.5% of patients with serological relapse had neurosyphilis. Patients with secondary and latent syphilis had serum rapid plasma reagin (RPR) titers (per unit) of 1.44-fold [95% confidence interval (CI): 1.08-1.93,P= 0.014] and 2.73-fold (95%CI: 1.49-5.00,P= 0.001), respectively, which increased the risk of confirmed neurosyphilis. Among patients with latent syphilis, a serum RPR titer of ≥1:32 and peripheral blood CD4 cell count of ≤350/mL were significantly associated with neurosyphilis, with adjusted odds ratios of 9.45 (95%CI: 1.86-48.03,P= 0.007) and 3.75 (95%CI: 1.11-12.66,P= 0.033), respectively.Conclusion: A serum RPR titer of ≥1:32 and a peripheral blood CD4 cell count of ≤350/mL have predictive value in screening for neurosyphilis among HIV-positive patients with latent syphilis.
基金supported by the National Natural Science Foundation of China(81950410639[L.Z.],11801435[M.S.],11631012[Y.X.],81673275[Z.P.],91846302[Z.P.])Outstanding Young Scholars Support Program(3111500001[L.Z.])+9 种基金Xi'an Jiaotong University Basic Research and Profession Grant(xtr022019003[L.Z.],xzy032020032[L.Z.])Xi'an Jiaotong University Young Scholar Support Grant(YX6J004[L.Z.])the Bill&Melinda Gates Foundation(20200344[L.Z.])China Postdoctoral Science Foundation(2018M631134,2020T130095ZX)the Fundamental Research Funds for the Central Universities(xjh012019055,xzy032020026)Natural Science Basic Research Program of Shaanxi Province(2019JQ-187)Xi'an Special Science and Technology Projects on Prevention and Treatment of Novel Coronavirus Penumonia Emergency(20200005YX005)Zhejiang University special scientific research fund for COVID-19 prevention and control(2020XGZX056)the National S&T Major Project Foundation of China(2018ZX10715002-004,2018ZX10713001-001)the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD).
文摘A new coronavirus disease(COVID-19)with infection by a novel coronavirus named severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has spread globally since December 2019.By 22th September 2020,more than 200 countries worldwide have reported about 30 million confirmed cases and more than 950,000 deaths.1 China has reported a total of 85,307(including 2,758 imported)cases and 4,634 deaths.
基金This work was supported by the National Natural Science Foundation of China(11801435 to M.S.,8191101420 to L.Z.,11631012 to Y.X.)the China Postdoctoral Science Foundation(2018M631134,2020T130095ZX)+7 种基金the Fundamental Research Funds for the Central Universities(xjh012019055,xzy032020026)the Natural Science Basic Research Program of Shaanxi Province(2019JQ-187)the Bill&Melinda Gates FoundationOutstanding Young Scholars Funding(3111500001to L.Z.)Xi’an Jiaotong University Basic Research and Profession Grant(xtr022019003 and xzy032020032 to L.Z.),and Xi’an Jiaotong University Young Talent Support Grant(YX6J004 to L.Z.)Xi’an Special Science and Technology Projects on Prevention and Treatment of Novel Coronavirus Penumonia Emergency(20200005YX005)Science Foundation for COVID-19 of Xi’an Jiaotong University Health Science Center and Qinnong Bank(2008124)Zhejiang University special scientific research fund for COVID-19 prevention and control(2020XGZX056).
文摘Mass testing is an intervention strategy for COVID-19 control in the general population regardless of the presentation of symptoms.It involves collecting nasal or pharyngeal swabs for DNA testing,often using the polymerase chain reaction method.Countries that have used mass testing consider it to be a viable strategy to control the COVID-19 pandemic as the strategy can potentially identify and isolate asymptomatic cases in the early stages of infection and reduce the risk of virus transmission.Since the reopening of Wuhan,China,in early April 2020,China has conducted mass testings in three megacities with populations of over 10 million,including Beijing and Qingdao1 at the beginning of their local outbreaks,and Wuhan immediately after the reopening.
