目的:分析北京协和医院静脉药物配置中心实时干预的不合理医嘱,并探讨解决对策。方法:回顾性统计2018年我院静脉药物配置中心审方药师根据《临床药物治疗学》、药品说明书、MICROMEDEX及Up To Date等相关资料对长期医嘱和临时医嘱进行...目的:分析北京协和医院静脉药物配置中心实时干预的不合理医嘱,并探讨解决对策。方法:回顾性统计2018年我院静脉药物配置中心审方药师根据《临床药物治疗学》、药品说明书、MICROMEDEX及Up To Date等相关资料对长期医嘱和临时医嘱进行实时前置审核所发现的不合格医嘱类型与数量,计算干预率。结果:从实时审核医嘱中共发现不合理医嘱174份,主要涉及药物用法用量不适宜、录入错误、溶媒不适宜及药物浓度不适宜等,干预率达100%。结论:通过静脉药物配制中心药师对医嘱的实时审核和干预,能有效地降低和避免不合理用药的产生,促进临床合理用药。展开更多
Objective In recent years,many studies have reported that air pollution is a risk factor for type 2 diabetes mellitus(T2DM).The aim of this systematic review and meta・analysis is to summarize the evidence about the as...Objective In recent years,many studies have reported that air pollution is a risk factor for type 2 diabetes mellitus(T2DM).The aim of this systematic review and meta・analysis is to summarize the evidence about the association between exposure to air pollution andT2DM in developing countries.Methods The databases,including PubMed,EMBASE and Web of Science,were systematically searched for studies published up to 31 March 2022.Studies about the association between air pollution andT2DM prevalence or incidence in developing countries were included.The odds ratio(OR)was used as effect estimate.We synthesized the included studies in the meta-analysis.Results We included 8 cross-sectional studies and 8 cohort studies,all conducted in developing countries.Meta-analysis of 8 studies on PM_(2.5)(particulate matter ≤2.5 μm in diameter)showed that T2DM prevalence was significantly associated with PM_(2.5)exposure(OR=1.12;95%CI:1.07,1.17;P<0.001).The association between air pollutants andT2DM incidence was not estimated due to the limited relevant studies.Conclusions The exposure to PM_(2.5)would be positively associated with an increased prevalence of T2DM in developing countries.Some effective measures should be taken to reduce air pollutant exposure in people who are vulnerable to diabetes.展开更多
Objective We developed a universal lesion detector(ULDor)which showed good performance in in-lab experiments.The study aims to evaluate the performance and its ability to generalize in clinical setting via both extern...Objective We developed a universal lesion detector(ULDor)which showed good performance in in-lab experiments.The study aims to evaluate the performance and its ability to generalize in clinical setting via both external and internal validation.Methods The ULDor system consists of a convolutional neural network(CNN)trained on around 80 K lesion annotations from about 12 K CT studies in the DeepLesion dataset and 5 other public organ-specific datasets.During the validation process,the test sets include two parts:the external validation dataset which was comprised of 164 sets of non-contrasted chest and upper abdomen CT scans from a comprehensive hospital,and the internal validation dataset which was comprised of 187 sets of low-dose helical CT scans from the National Lung Screening Trial(NLST).We ran the model on the two test sets to output lesion detection.Three board-certified radiologists read the CT scans and verified the detection results of ULDor.We used positive predictive value(PPV)and sensitivity to evaluate the performance of the model in detecting space-occupying lesions at all extra-pulmonary organs visualized on CT images,including liver,kidney,pancreas,adrenal,spleen,esophagus,thyroid,lymph nodes,body wall,thoracic spine,etc.Results In the external validation,the lesion-level PPV and sensitivity of the model were 57.9%and 67.0%,respectively.On average,the model detected 2.1 findings per set,and among them,0.9 were false positives.ULDor worked well for detecting liver lesions,with a PPV of 78.9%and a sensitivity of 92.7%,followed by kidney,with a PPV of 70.0%and a sensitivity of 58.3%.In internal validation with NLST test set,ULDor obtained a PPV of 75.3%and a sensitivity of 52.0%despite the relatively high noise level of soft tissue on images.Conclusions The performance tests of ULDor with the external real-world data have shown its high effectiveness in multiple-purposed detection for lesions in certain organs.With further optimisation and iterative upgrades,ULDor may be well suited for extensive application to external data.展开更多
Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should b...Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia.展开更多
Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of th...Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of the LYMQOL was distributed with the official Wechat account"Lymphedema Channel"to lymphedema patients who were recruited from October 28^(th),2020 to February 23^(rd),2021.Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately,at enrollment,1 week later,and 1 month later.Reliability,validity,feasibility,responsiveness and average time required for completing the questionnaire were assessed.Results A total of 195 patients participated in the study.The Chinese questionnaire showed high reliability with Cronbach’sαcoefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient(ICC)of 0.848-0.884 and Cronbach’sαcoefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900.The LYMQOL showed moderate to good correlations with the EQ-5 D(0.4<r<0.6,P<0.01;for the LYMQOLARM,n=95,for the LYMQOL-LEG,n=102).Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month(P<0.05).The average time of patients to finish the questionnaire was approximately 12 minutes.Conclusions The Chinese version of the LYMQOL is easy to answer,comprehensive and appropriate in length,and has good reliability and validity.It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema.展开更多
Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to ...Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.Methods This is a multicenter cross-sectional observational study.Consecutive patients admitted to the intensive care unit(ICU)were screened for enrollment.FCU and LU were performed within the first 24 h,and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.Results Among the 992 patients included,502 were examined within 6 h of ICU admission(early phase group),and 490 were examined after 6 h of admission(later phase group).The early phase group and the later phase group had similar proportions of treatment change(48.8%vs.49.0%,χ^(2)=0.003,P=0.956).In the multivariable analysis,admission for respiratory failure was an independent variable associated with treatment change,with an odds ratio(OR)of 2.357[95%confidence interval(CI):1.284-4.326,P=0.006];the timing of examination was not associated with treatment change(OR=0.725,95%CI:0.407-1.291,P=0.275).Conclusions FCU in combination with LU,whether performed during the early phase or later phase,had a significant impact on the treatment of critically ill patients.Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.展开更多
Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai peopl...Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai people,and have provided great supports in aspects of policy,funding,and professional resource to the development of health care and medical system in Qinghai.Great progress has been made,and wellness of residents in Qinghai has been significantly improved.This article reviews the strategies and measures from central and provincial government in improving health care of Qinghai province under the leadership of the Communist Party of China.展开更多
Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis p...Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study.The clinical data including the patients’age,sex,skin lesions,HIV status,syphilis serologic test results,treatment,and follow-up results were collected.Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema.The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum.Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre,at atypical locations,or with a nonreactive nontreponemal test result,tends to be missed or misdiagnosed.展开更多
文摘目的:分析北京协和医院静脉药物配置中心实时干预的不合理医嘱,并探讨解决对策。方法:回顾性统计2018年我院静脉药物配置中心审方药师根据《临床药物治疗学》、药品说明书、MICROMEDEX及Up To Date等相关资料对长期医嘱和临时医嘱进行实时前置审核所发现的不合格医嘱类型与数量,计算干预率。结果:从实时审核医嘱中共发现不合理医嘱174份,主要涉及药物用法用量不适宜、录入错误、溶媒不适宜及药物浓度不适宜等,干预率达100%。结论:通过静脉药物配制中心药师对医嘱的实时审核和干预,能有效地降低和避免不合理用药的产生,促进临床合理用药。
文摘Objective In recent years,many studies have reported that air pollution is a risk factor for type 2 diabetes mellitus(T2DM).The aim of this systematic review and meta・analysis is to summarize the evidence about the association between exposure to air pollution andT2DM in developing countries.Methods The databases,including PubMed,EMBASE and Web of Science,were systematically searched for studies published up to 31 March 2022.Studies about the association between air pollution andT2DM prevalence or incidence in developing countries were included.The odds ratio(OR)was used as effect estimate.We synthesized the included studies in the meta-analysis.Results We included 8 cross-sectional studies and 8 cohort studies,all conducted in developing countries.Meta-analysis of 8 studies on PM_(2.5)(particulate matter ≤2.5 μm in diameter)showed that T2DM prevalence was significantly associated with PM_(2.5)exposure(OR=1.12;95%CI:1.07,1.17;P<0.001).The association between air pollutants andT2DM incidence was not estimated due to the limited relevant studies.Conclusions The exposure to PM_(2.5)would be positively associated with an increased prevalence of T2DM in developing countries.Some effective measures should be taken to reduce air pollutant exposure in people who are vulnerable to diabetes.
文摘Objective We developed a universal lesion detector(ULDor)which showed good performance in in-lab experiments.The study aims to evaluate the performance and its ability to generalize in clinical setting via both external and internal validation.Methods The ULDor system consists of a convolutional neural network(CNN)trained on around 80 K lesion annotations from about 12 K CT studies in the DeepLesion dataset and 5 other public organ-specific datasets.During the validation process,the test sets include two parts:the external validation dataset which was comprised of 164 sets of non-contrasted chest and upper abdomen CT scans from a comprehensive hospital,and the internal validation dataset which was comprised of 187 sets of low-dose helical CT scans from the National Lung Screening Trial(NLST).We ran the model on the two test sets to output lesion detection.Three board-certified radiologists read the CT scans and verified the detection results of ULDor.We used positive predictive value(PPV)and sensitivity to evaluate the performance of the model in detecting space-occupying lesions at all extra-pulmonary organs visualized on CT images,including liver,kidney,pancreas,adrenal,spleen,esophagus,thyroid,lymph nodes,body wall,thoracic spine,etc.Results In the external validation,the lesion-level PPV and sensitivity of the model were 57.9%and 67.0%,respectively.On average,the model detected 2.1 findings per set,and among them,0.9 were false positives.ULDor worked well for detecting liver lesions,with a PPV of 78.9%and a sensitivity of 92.7%,followed by kidney,with a PPV of 70.0%and a sensitivity of 58.3%.In internal validation with NLST test set,ULDor obtained a PPV of 75.3%and a sensitivity of 52.0%despite the relatively high noise level of soft tissue on images.Conclusions The performance tests of ULDor with the external real-world data have shown its high effectiveness in multiple-purposed detection for lesions in certain organs.With further optimisation and iterative upgrades,ULDor may be well suited for extensive application to external data.
基金supported by the Youth Program of National Natural Science Foundation of China(Grant No.82003309)the National Key Research and Development Program of China(Grant 2020YFB1313700)。
文摘Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia.
文摘Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of the LYMQOL was distributed with the official Wechat account"Lymphedema Channel"to lymphedema patients who were recruited from October 28^(th),2020 to February 23^(rd),2021.Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately,at enrollment,1 week later,and 1 month later.Reliability,validity,feasibility,responsiveness and average time required for completing the questionnaire were assessed.Results A total of 195 patients participated in the study.The Chinese questionnaire showed high reliability with Cronbach’sαcoefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient(ICC)of 0.848-0.884 and Cronbach’sαcoefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900.The LYMQOL showed moderate to good correlations with the EQ-5 D(0.4<r<0.6,P<0.01;for the LYMQOLARM,n=95,for the LYMQOL-LEG,n=102).Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month(P<0.05).The average time of patients to finish the questionnaire was approximately 12 minutes.Conclusions The Chinese version of the LYMQOL is easy to answer,comprehensive and appropriate in length,and has good reliability and validity.It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema.
文摘Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.Methods This is a multicenter cross-sectional observational study.Consecutive patients admitted to the intensive care unit(ICU)were screened for enrollment.FCU and LU were performed within the first 24 h,and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.Results Among the 992 patients included,502 were examined within 6 h of ICU admission(early phase group),and 490 were examined after 6 h of admission(later phase group).The early phase group and the later phase group had similar proportions of treatment change(48.8%vs.49.0%,χ^(2)=0.003,P=0.956).In the multivariable analysis,admission for respiratory failure was an independent variable associated with treatment change,with an odds ratio(OR)of 2.357[95%confidence interval(CI):1.284-4.326,P=0.006];the timing of examination was not associated with treatment change(OR=0.725,95%CI:0.407-1.291,P=0.275).Conclusions FCU in combination with LU,whether performed during the early phase or later phase,had a significant impact on the treatment of critically ill patients.Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.
文摘Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai people,and have provided great supports in aspects of policy,funding,and professional resource to the development of health care and medical system in Qinghai.Great progress has been made,and wellness of residents in Qinghai has been significantly improved.This article reviews the strategies and measures from central and provincial government in improving health care of Qinghai province under the leadership of the Communist Party of China.
基金Supported by Beijing Municipal Science and Technology Commission(Z191100006619011)Capital’s Funds for Health Improvement and Research(2020-2-4016)。
文摘Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study.The clinical data including the patients’age,sex,skin lesions,HIV status,syphilis serologic test results,treatment,and follow-up results were collected.Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema.The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum.Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre,at atypical locations,or with a nonreactive nontreponemal test result,tends to be missed or misdiagnosed.
