BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder...BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ') of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.展开更多
Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.展开更多
As assessment outcomes provide students with a sense of accomplishment that is boosted by the reward system,learning becomes more effective.This research aims to determine the effects of reward system prior to assessm...As assessment outcomes provide students with a sense of accomplishment that is boosted by the reward system,learning becomes more effective.This research aims to determine the effects of reward system prior to assessment in Mathematics.Quasi-experimental research design was used to examine whether there was a significant difference between the use of reward system and students’level of performance in Mathematics.Through purposive sampling,the respondents of the study involve 80 Grade 9 students belonging to two sections from Gaudencio B.Lontok Memorial Integrated School.Based on similar demographics and pre-test results,control and study group were involved as participants of the study.Data were treated and analyzed accordingly using statistical treatments such as mean and t-test for independent variables.There was a significant finding revealing the advantage of using the reward system compare to the non-reward system in increasing students’level of performance in Mathematics.It is concluded that the use of reward system is effective in improving the assessment outcomes in Mathematics.It is recommended to use reward system for persistent assessment outcomes prior to assessment,to be a reflection of the intended outcomes in Mathematics.展开更多
The CRISPR-Cas9 genome editing has many advantages over its counterparts and could ultimately assist in disease control and molecular breeding in aquaculture.Single-guide RNA(sgRNA)design is presumably the most crucia...The CRISPR-Cas9 genome editing has many advantages over its counterparts and could ultimately assist in disease control and molecular breeding in aquaculture.Single-guide RNA(sgRNA)design is presumably the most crucial task in a typical CRISPR-Cas9 experiment;an understanding of algorithms behind sgRNA design programs is thus essential for improved efficacy and specificity.We focus this review on the bioinformatics aspects in genome editing experiments and describe commonly used computational approaches and tools of sgRNA design and outcome assessment.We show an example of sgRNA design with optimal parameter settings and appropriate interpretation of results and present a brief overview of CRISPR-Cas9 applications,such as genetic improvement and sustainability in aquaculture.We discuss challenging issues,particularly in the context of computational biology,in the use of computational tools in CRISPR-based genome editing.This review provides a synthesis of bioinformatics tools used for CRISPR-Cas9 sgRNA design and outcome assessment and offers a general view of CRISPR-based applications in farmed fish,which are expected to facilitate genome editing programs and hence improve aquaculture breeding,production,and sustainability.展开更多
Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, low...Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.展开更多
BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver trans...BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with BA.It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.AIM To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for BA.METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil.Patients with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy.Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as appropriate.Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis.Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank test.RESULTS Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior portoenterostomy.Patients with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver transplantation.The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical significance.Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation,graft-to-recipient weight ratio,and use of vascular grafts.Finally,the groups did not significantly differ in terms of post-transplant survival.CONCLUSION In our study,prior portoenterostomy did not significantly affect the outcomes of liver transplantation.展开更多
Morphological analyses are key outcome assessments for nerve regeneration studies but are historically limited to tissue sections.Novel optical tissue clearing techniques enabling three-dimensional imaging of entire o...Morphological analyses are key outcome assessments for nerve regeneration studies but are historically limited to tissue sections.Novel optical tissue clearing techniques enabling three-dimensional imaging of entire organs at a subcellular resolution have revolutionized morphological studies of the brain.To extend their applicability to experimental nerve repair studies we adapted these techniques to nerves and their motor and sensory targets in rats.The solvent-based protocols rendered harvested peripheral nerves and their target organs transparent within 24 hours while preserving tissue architecture and fluorescence.The optical clearing was compatible with conventional laboratory techniques,including retrograde labeling studies,and computational image segmentation,providing fast and precise cell quantitation.Further,optically cleared organs enabled three-dimensional morphometry at an unprecedented scale including dermatome-wide innervation studies,tracing of intramuscular nerve branches or mapping of neurovascular networks.Given their wide-ranging applicability,rapid processing times,and low costs,tissue clearing techniques are likely to be a key technology for next-generation nerve repair studies.All procedures were approved by the Hospital for Sick Children’s Laboratory Animal Services Committee(49871/9)on November 9,2019.展开更多
<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS sp...<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. <strong>Methods: </strong>A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. <strong>Results: </strong>HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. <strong>Conclusion: </strong>Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.展开更多
To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RAL...To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RALRP.From July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative technique.Perioperative data,including pathological and early functional results of the patient,were collected prospectively and analyzed.Along with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly decreased.No major complication was present in any patient.Transfusion was needed in six patients;all of them were within the initial 15 cases.The positive surgical margin rate was 9.8%(5/51)in pT2 disease.The most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 weeks.Among 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 months.In this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication rate.Even during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.展开更多
BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for ...BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.METHODS This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach(cT3/4 and cN any)diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis(cTNM)staging system.We performed 1:1 propensity score matching(PSM)to reduce bias in patient selection.The histologic and prognostic effects of neoadjuvant chemotherapy were assessed.The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.RESULTS Of the 144 patients eligible for this study,36 received neoadjuvant chemotherapy,and 108 received initial surgery after diagnosis.After adjustment by PSM,36 pairs of patients were generated,and baseline characteristics,including age,sex,American Society of Anesthesiologists score,tumor location,and cTNM stage,were similar between the two groups.The R0 resection rates were 88.9%and 86.1%in the surgery-first and neoadjuvant chemotherapy groups after PSM,respectively(P=1.000).The median follow-up period was 46.4 mo.The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0%and 65.0%(P=0.235),respectively,before PSM and 50%and 64.7%(P=0.192),respectively,after PSM.Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.CONCLUSION Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma.For resectable gastric signet-ring cell carcinoma,upfront surgery should be the primary therapy.展开更多
BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission.Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019(CO...BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission.Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019(COVID-19)pandemic.Despite this,there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients.This is of paramount medicolegal importance in a high-risk patient population.AIM To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.METHODS Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited.51 patients were confirmed positive for COVID-19.Predefined outcomes were analyzed over a 30-d postoperative period.COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.RESULTS COVID-19 positive patients had more intensive care admissions(27%vs 5%,P<0.001),longer inpatient stays(median 23 d vs 9 d,P<0.001)and a higher 30-d mortality(29%vs 10%,P=0.001)than COVID-19 negative patients.Postoperative complications were evident in 74.5%of COVID-19 positive patients.35.3%of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7%developing acute respiratory distress syndrome(ARDS)and 9.8%experiencing symptomatic thromboembolic events.CONCLUSION The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery.COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications(including lower respiratory tract infection,ARDS,deep vein thrombosis and pulmonary embolism),increased requirement for intensive care admission,longer inpatient stay and higher risk of mortality.Further,clinicians must be transparent about the potential for unknown risks as research into the long-term surgical outcomes of COVID-19 positive patients continues to evolve.展开更多
BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vit...BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.展开更多
Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine(TCM)and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review.The exclud...Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine(TCM)and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review.The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets(COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps:(i) development of a comprehensive list of outcomes(including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records;(ii) merging and grouping of outcomes within domains;(iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome-set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.展开更多
The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’age group and sex.We used the Portuguese medico-legal rules for personal injury assessment,in the scope of the...The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’age group and sex.We used the Portuguese medico-legal rules for personal injury assessment,in the scope of the Civil Law in that country,which includes a three-dimensional methodology.This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old.Their final medico-legal reports all used the Portuguese methodology for personal injury assessment.Outcomes were analysed by the victims’age group(children,working-age adults,and older people)and sex.Road traffic accidents were generally serious(ISS mean 9.5),with higher severity in children and older people.The most frequent body sequelae were musculoskeletal(64.8%),which were associated with functional and situational outcomes.Temporary damage resulted in an average length of impairment of daily life of 199.6 days,171.7 days to return to work,and an average degree of quantum doloris(noneconomic damage related to physical and psychological harm)of 3.7/7.The average permanent damage was 7.3/100 points for Permanent Functional Deficit,0.43/3 for Permanent Professional Repercussion,2/7 for Permanent Aesthetic Damage,3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities.Overall,19%of people became permanently dependent(10.6%needed third-party assistance).The medico-legal methodology used,considering victims’real-life situation,allows a comprehensive assessment.There were several significant differences among the three age groups but none between sexes.These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children,older people,and severely injured victims.展开更多
The scientific literature presents a modest amount of evidence in the use of complementary and alternative medicine(CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioner...The scientific literature presents a modest amount of evidence in the use of complementary and alternative medicine(CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important. Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.展开更多
基金the grants from National Tackle Key Science and Technology Program sduring the Ninth Five-Year Plan Period, No.96-903-01-11the grants from State Administration of Traditional Chinese Medicine of People's Republic of China,No.00-01LP16
文摘BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ') of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
文摘As assessment outcomes provide students with a sense of accomplishment that is boosted by the reward system,learning becomes more effective.This research aims to determine the effects of reward system prior to assessment in Mathematics.Quasi-experimental research design was used to examine whether there was a significant difference between the use of reward system and students’level of performance in Mathematics.Through purposive sampling,the respondents of the study involve 80 Grade 9 students belonging to two sections from Gaudencio B.Lontok Memorial Integrated School.Based on similar demographics and pre-test results,control and study group were involved as participants of the study.Data were treated and analyzed accordingly using statistical treatments such as mean and t-test for independent variables.There was a significant finding revealing the advantage of using the reward system compare to the non-reward system in increasing students’level of performance in Mathematics.It is concluded that the use of reward system is effective in improving the assessment outcomes in Mathematics.It is recommended to use reward system for persistent assessment outcomes prior to assessment,to be a reflection of the intended outcomes in Mathematics.
基金This publication was made possible through funding support from the National Science Foundation(DBI-1919574)and the University of Nebraska at Omaha.
文摘The CRISPR-Cas9 genome editing has many advantages over its counterparts and could ultimately assist in disease control and molecular breeding in aquaculture.Single-guide RNA(sgRNA)design is presumably the most crucial task in a typical CRISPR-Cas9 experiment;an understanding of algorithms behind sgRNA design programs is thus essential for improved efficacy and specificity.We focus this review on the bioinformatics aspects in genome editing experiments and describe commonly used computational approaches and tools of sgRNA design and outcome assessment.We show an example of sgRNA design with optimal parameter settings and appropriate interpretation of results and present a brief overview of CRISPR-Cas9 applications,such as genetic improvement and sustainability in aquaculture.We discuss challenging issues,particularly in the context of computational biology,in the use of computational tools in CRISPR-based genome editing.This review provides a synthesis of bioinformatics tools used for CRISPR-Cas9 sgRNA design and outcome assessment and offers a general view of CRISPR-based applications in farmed fish,which are expected to facilitate genome editing programs and hence improve aquaculture breeding,production,and sustainability.
文摘Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.
文摘BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with BA.It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.AIM To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for BA.METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil.Patients with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy.Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as appropriate.Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis.Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank test.RESULTS Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior portoenterostomy.Patients with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver transplantation.The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical significance.Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation,graft-to-recipient weight ratio,and use of vascular grafts.Finally,the groups did not significantly differ in terms of post-transplant survival.CONCLUSION In our study,prior portoenterostomy did not significantly affect the outcomes of liver transplantation.
基金the German Research Foundation(DA 2255/1-1,to SCD).
文摘Morphological analyses are key outcome assessments for nerve regeneration studies but are historically limited to tissue sections.Novel optical tissue clearing techniques enabling three-dimensional imaging of entire organs at a subcellular resolution have revolutionized morphological studies of the brain.To extend their applicability to experimental nerve repair studies we adapted these techniques to nerves and their motor and sensory targets in rats.The solvent-based protocols rendered harvested peripheral nerves and their target organs transparent within 24 hours while preserving tissue architecture and fluorescence.The optical clearing was compatible with conventional laboratory techniques,including retrograde labeling studies,and computational image segmentation,providing fast and precise cell quantitation.Further,optically cleared organs enabled three-dimensional morphometry at an unprecedented scale including dermatome-wide innervation studies,tracing of intramuscular nerve branches or mapping of neurovascular networks.Given their wide-ranging applicability,rapid processing times,and low costs,tissue clearing techniques are likely to be a key technology for next-generation nerve repair studies.All procedures were approved by the Hospital for Sick Children’s Laboratory Animal Services Committee(49871/9)on November 9,2019.
文摘<strong>Background: </strong>The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. <strong>Methods: </strong>A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. <strong>Results: </strong>HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. <strong>Conclusion: </strong>Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.
基金This study was carried out without any commercial sponsorship from equipment manufacturers.
文摘To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RALRP.From July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative technique.Perioperative data,including pathological and early functional results of the patient,were collected prospectively and analyzed.Along with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly decreased.No major complication was present in any patient.Transfusion was needed in six patients;all of them were within the initial 15 cases.The positive surgical margin rate was 9.8%(5/51)in pT2 disease.The most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 weeks.Among 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 months.In this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication rate.Even during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.
基金Supported by National Natural Science Foundation of China,No.81772642Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022
文摘BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.METHODS This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach(cT3/4 and cN any)diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis(cTNM)staging system.We performed 1:1 propensity score matching(PSM)to reduce bias in patient selection.The histologic and prognostic effects of neoadjuvant chemotherapy were assessed.The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.RESULTS Of the 144 patients eligible for this study,36 received neoadjuvant chemotherapy,and 108 received initial surgery after diagnosis.After adjustment by PSM,36 pairs of patients were generated,and baseline characteristics,including age,sex,American Society of Anesthesiologists score,tumor location,and cTNM stage,were similar between the two groups.The R0 resection rates were 88.9%and 86.1%in the surgery-first and neoadjuvant chemotherapy groups after PSM,respectively(P=1.000).The median follow-up period was 46.4 mo.The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0%and 65.0%(P=0.235),respectively,before PSM and 50%and 64.7%(P=0.192),respectively,after PSM.Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.CONCLUSION Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma.For resectable gastric signet-ring cell carcinoma,upfront surgery should be the primary therapy.
文摘BACKGROUND Hip fractures are the most common reason for inpatient orthopaedic trauma admission.Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019(COVID-19)pandemic.Despite this,there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients.This is of paramount medicolegal importance in a high-risk patient population.AIM To quantify the additional perioperative risks for COVID-19 positive patients undergoing hip fracture surgery and provide clinicians with an evidence-based framework to establish an informed consent process.METHODS Two hundred and fifty nine consecutive patients undergoing surgical intervention for hip fractures in four hospitals in the United Kingdom were recruited.51 patients were confirmed positive for COVID-19.Predefined outcomes were analyzed over a 30-d postoperative period.COVID-19 positive and COVID-19 negative patients were compared after adjustment for confounding factors.RESULTS COVID-19 positive patients had more intensive care admissions(27%vs 5%,P<0.001),longer inpatient stays(median 23 d vs 9 d,P<0.001)and a higher 30-d mortality(29%vs 10%,P=0.001)than COVID-19 negative patients.Postoperative complications were evident in 74.5%of COVID-19 positive patients.35.3%of COVID-19 positive patients suffered postoperative lower respiratory tract infections with 13.7%developing acute respiratory distress syndrome(ARDS)and 9.8%experiencing symptomatic thromboembolic events.CONCLUSION The COVID-19 pandemic has created uncertainty in the medical community worldwide and poses unique challenges in providing informed consent for surgery.COVID-19 positive patients undergoing hip fracture surgery should be consented for the additional risk of postoperative complications(including lower respiratory tract infection,ARDS,deep vein thrombosis and pulmonary embolism),increased requirement for intensive care admission,longer inpatient stay and higher risk of mortality.Further,clinicians must be transparent about the potential for unknown risks as research into the long-term surgical outcomes of COVID-19 positive patients continues to evolve.
文摘BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.
基金supported by the National Natural Science Foundation of China (No. 81904051)Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine (No.CACM-2019-QNRC2-A03)the Basic Research Foundation of Beijing University of Chinese Medicine (No. 2019-JYB-JS-033)。
文摘Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine(TCM)and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review.The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets(COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps:(i) development of a comprehensive list of outcomes(including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records;(ii) merging and grouping of outcomes within domains;(iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome-set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.
文摘The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’age group and sex.We used the Portuguese medico-legal rules for personal injury assessment,in the scope of the Civil Law in that country,which includes a three-dimensional methodology.This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old.Their final medico-legal reports all used the Portuguese methodology for personal injury assessment.Outcomes were analysed by the victims’age group(children,working-age adults,and older people)and sex.Road traffic accidents were generally serious(ISS mean 9.5),with higher severity in children and older people.The most frequent body sequelae were musculoskeletal(64.8%),which were associated with functional and situational outcomes.Temporary damage resulted in an average length of impairment of daily life of 199.6 days,171.7 days to return to work,and an average degree of quantum doloris(noneconomic damage related to physical and psychological harm)of 3.7/7.The average permanent damage was 7.3/100 points for Permanent Functional Deficit,0.43/3 for Permanent Professional Repercussion,2/7 for Permanent Aesthetic Damage,3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities.Overall,19%of people became permanently dependent(10.6%needed third-party assistance).The medico-legal methodology used,considering victims’real-life situation,allows a comprehensive assessment.There were several significant differences among the three age groups but none between sexes.These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children,older people,and severely injured victims.
文摘The scientific literature presents a modest amount of evidence in the use of complementary and alternative medicine(CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important. Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.
