Coronary stem implantation has significantly improved percutaneous coronary intervention and enabled the management of early complications of plain balloon angioplasty. However, a new complication has accompanied thes...Coronary stem implantation has significantly improved percutaneous coronary intervention and enabled the management of early complications of plain balloon angioplasty. However, a new complication has accompanied these improvements： in-stent restenosis （ISR） arising from neointimal hyperplasia. ISR after coronary angioplasty is currently one of the main limitations of this method, leading to the recurrence of exertional angina pectoris or acute coronary syndromes. The clinical incidence of ISR after bare-metal stent （BMS） implantation is approximately 20%35%. The use of drug-eluting stents （DES） has led to a further decrease in the occurrence of ISR to 5%-10%. Evidence resulting from controlled clinical studies suggests that DES and drug-eluting balloon catheters （DEB） provide the best clinical and angiographic results in the treatment of ISR. We undertook a systematic review of the pathophysiology, diagnostics and treatment options for BMS- and DES-ISR. We discuss recent randomised studies, comparing different DES or DEB used for BMS or DES-ISR treatment, as well as the use of new biovascular scafolds and the topic of scafold restenosis.展开更多
The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times,There have been remarkable local and international efforts to control the crisis,Ebola Virus Disease is the focus...The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times,There have been remarkable local and international efforts to control the crisis,Ebola Virus Disease is the focus of immense research activity,The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation,Over 28 000 people were inflicted with the condition,over 11 000 have died,Novel data has emerged regarding modes of transmission,providing rationale for recent flare-ups,Similarly,studies on survivors are elucidating the later stages of the disease recovery process,Novel techniques for diagnosis are also discussed,Finally,the current research regarding treatment and vaccine development is reviewed,particularly the implementation of r VSV-ZEBOV vaccination programs.展开更多
AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study...AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study.Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded.CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy.Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV.We evaluated the association between CMV-GID and patient characteristics(symptoms,underlying disease,medication,leukocyte counts,and antigenemia assay).All patients were checked with an human immunodeficiency virus(HIV)antibody test before endoscopic examination.White blood cell(WBC)counts were obtained from medical records within 1 wk of endoscopy.Leukopenia was defined as a total WBC count<5000 cells/mm 3 . For HIV patients,we also checked CD4+counts from medical records. RESULTS:A total of 99 patients were retrospectively selected for analysis.Of the immunocompromised patients,19 had malignant disease,18 had autoimmune disease,19 had disorders of biochemical homeostasis, three had undergone transplantation,and 45 had HIV infection.A total of 50 patients had received immunosuppressive therapy.No patients had inflammatory bowel disease.Fifty-five patients were diagnosed as having CMV-GID.Univariate analysis indicated an association between HIV infection,leukopenia,and positive antigenemia and CMV-GID(P<0.05).Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID(P<0.01).The sensitivity,specificity,positive predictive value,and negative predictive value of antigenemia for CMV-GID were 65.4%,93.6%, 91.9%,and 71.0%,respectively.In a subgroup analy-sis,patients with leukopenia displayed low sensitivity and high specificity.Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity.Accuracy barely differed between HIV-positive and-negative patients.In HIV-infected patients, CD4 count<50 cells/μL resulted in low sensitivity and high specificity.Differences in accuracy among patients were minor,regardless of CD4 count.In patients who had undergone both quantitative real-time polymerase chain reaction(PCR)and antigenemia assay,real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay;however,this difference was not statistically significant(P=0.312). CONCLUSION:If the antigenemia test is positive,endoscopic lesions are acceptable for the diagnosis of CMVGID without biopsy.The accuracy is not affected by HIV infection and leukopenia.Either PCR or the antigenemia assay are valid.展开更多
AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 20...AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 2009to December 2011 and we retrospectively assessed 15patients with Roux-en-Y HJA who had signs of biliary obstruction.In total,23 ERC procedures were performed in these patients and a single balloon videoen-teroscope(Olympus SIF Q 180)was used in all of the cases.A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope.Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of≤5.4 kPa.The technical limitations or rather the parameters of the single balloon enteroscope(working length-200 cm,diameter of the working channel-2.8 mm,absence of Albarran bridge)showed the need for special endoscopic instrumentation.RESULTS:Cannulation success was reached in diagnostic ERC in 12 of 15 patients.ERC findings were normal in 1 of 12 patients.ERC in the remaining 11 patients showed some pathological changes.One of these(cystic bile duct dilation)was subsequently resolved surgically.Endoscopic treatment was initialized in the remaining 10 patients(5 with HJA stenosis,2 with choledocholithiasis,and 3 with both).This treatment was successful in 9 of 10 patients.The endoscopic therapeutic procedures included:balloon dilatation of HJA stenosis-11 times(7 patients);choledocholitiasis extraction-five times(5 patients);biliary plastic stent placement-six times(4 patients);and removal of biliary stents placed by us-six times(4 patients).The mean time of performing a single ERC was 72 min.The longest procedure took 110 min and the shortest took34 min.This shows that it is necessary to allow for more time in individual procedures.Furthermore,these procedures require the presence of an anesthesiologist.We did not observe any complications in these 15 patients.CONCLUSION:This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy.However,it is effective,safe,and widens the possibilities of resolving biliary pathology.展开更多
We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI（rs-fMRI） with a regional homogeneity（ReHo） method. Ten medical students ...We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI（rs-fMRI） with a regional homogeneity（ReHo） method. Ten medical students participated in the study. A 1-year long doctor-patient communication skills training program was conducted. RsfMRI data were collected at baseline, one month and one year after training. There was a significant increase in the communication skills test average scores between baseline and 1-month duration of training（P〈0.001）. After one month of communication skills training, medical students had decreased ReHo in the right superior temporal gyrus compared with the baseline. After one year of communication skills training, students had increased ReHo in multiple regions and decreased ReHo in several regions（P 〈0.05, Alphasim corrected）. The change of ReHo values in the superior temporal gyrus negatively correlated with the change of communication skills scale score between one month after communication skills training and baseline（r=-0.734, P= 0.036）. The training program we used can be an effective approach of improving doctor-patient communication skills, and the training resulted in functional plasticity of the brain’s architecture toward optimizing locally functional organization.展开更多
Spondylocarpotarsal syndrome(SCT) is a rare musculoskeletal disorder characterized by short stature and vertebral, carpal, and tarsal fusions resulting from biallelic nonsense mutations in the gene encoding filamin B(...Spondylocarpotarsal syndrome(SCT) is a rare musculoskeletal disorder characterized by short stature and vertebral, carpal, and tarsal fusions resulting from biallelic nonsense mutations in the gene encoding filamin B(FLNB). Utilizing a FLNB knockout mouse,we showed that the vertebral fusions in SCT evolved from intervertebral disc(IVD) degeneration and ossification of the annulus fibrosus(AF), eventually leading to full trabecular bone formation. This resulted from alterations in the TGFβ/BMP signaling pathway that included increased canonical TGFβ and noncanonical BMP signaling. In this study, the role of FLNB in the TGFβ/BMP pathway was elucidated using in vitro, in vivo, and ex vivo treatment methodologies. The data demonstrated that FLNB interacts with inhibitory Smads 6 and 7(i-Smads) to regulate TGFβ/BMP signaling and that loss of FLNB produces increased TGFβ receptor activity and decreased Smad 1 ubiquitination. Through the use of small molecule inhibitors in an ex vivo spine model, TGFβ/BMP signaling was modulated to design a targeted treatment for SCT and disc degeneration. Inhibition of canonical and noncanonical TGFβ/BMP pathway activity restored Flnb-/-IVD morphology. These most effective improvements resulted from specific inhibition of TGFβand p38 signaling activation. FLNB acts as a bridge for TGFβ/BMP signaling crosstalk through i-Smads and is key for the critical balance in TGFβ/BMP signaling that maintains the IVD. These findings further our understanding of IVD biology and reveal new molecular targets for disc degeneration as well as congenital vertebral fusion disorders.展开更多
The 2014 Ebola outbreak in West Africa,primarily affecting Guinea.Sierra Leone,and Liberia,has exceeded all previous Ebola outbreaks in the number of cases and in international response.Although infections only occur ...The 2014 Ebola outbreak in West Africa,primarily affecting Guinea.Sierra Leone,and Liberia,has exceeded all previous Ebola outbreaks in the number of cases and in international response.Although infections only occur frequently in Western Africa,the virus has the potential to spread globally and is classified as a category A pathogen that could be misused as a bioterrorism agent.This review aims(i) to discuss the latest data to aid our current recommendations for the prevention and control of the Ebola vims infection,(ii) to review its pathophysiology as well as offering insights on the most current data available about Ebola vaccine progress and potential use.展开更多
BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchol...BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.展开更多
BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable r...BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.展开更多
In this study, the performance of Sevcik’s algorithm that calculates the fractal dimension and permutation entropy as discriminants to detect calming and insight meditation in electroencephalo-graphic (EEG) signals w...In this study, the performance of Sevcik’s algorithm that calculates the fractal dimension and permutation entropy as discriminants to detect calming and insight meditation in electroencephalo-graphic (EEG) signals was assessed. The proposed methods were applied to EEG recordings from meditators practicing insight meditation and calming meditation before as well as during both types of meditation. Analysis was conducted using statistical hypothesis testing to determine the validity of the proposed meditation-identifying techniques. For both types of meditation, there was a statistically significant reduction in the permutation entropy. This result can be explained by the increased EEG synchronization, which is repeatedly observed in the course of meditation. In contrast, the fractal dimension (FD) was significantly increased during calming meditation, but during insight meditation, no statistically significant change was detected. Increased FD during meditation can be interpreted as an increase in self-similarity of EEG signals during self-organisation of hierarchical structure oscillators in the brain. Our results indicate that fractal dimension and permutation entropy could be used as parameters to detect both types of meditation. The permutation entropy is advantageous compared with the fractal dimension because it does not require a stationary signal.展开更多
World Federation of Acupuncture-Moxibustion Societies(WFAS)Technical Benchmark of Acupuncture and Moxibustion:Cupping,developed under the leadership of Tianjin University of Traditional Chinese Medicine,was approved b...World Federation of Acupuncture-Moxibustion Societies(WFAS)Technical Benchmark of Acupuncture and Moxibustion:Cupping,developed under the leadership of Tianjin University of Traditional Chinese Medicine,was approved by WFAS.This technical benchmark was issued on October 9,2023,and implemented on December 31,2023.The main contents include the scope,normative references,terms and definitions,procedures and rules,and safety.This article focuses on the above contents,an outlook on the application,popularization,and update plan of this technical benchmark is proposed.展开更多
Objective:To ascertain the knowledge and prevention measures against dengue among selected adult population in southern Nepal.Methods:A cross sectional study was conducted in Rapti Zonal Hospital,Dang and Bharatpur Ho...Objective:To ascertain the knowledge and prevention measures against dengue among selected adult population in southern Nepal.Methods:A cross sectional study was conducted in Rapti Zonal Hospital,Dang and Bharatpur Hospital,Chitwan during August-November,2011.A total of 212 patients were interviewed regarding their knowledge and practices about dengue fever.Serum samples were collected and investigated for the presence of anti-dengue IgM antibodies by IgM-ELISA.Results:Data from 156 patients greater than 15 years were analyzed.Among them,21 samples were found to possess anti-dengue IgM antibodies by ELISA.Females,economically active people,farmers,unemployed and housewives were more frequently affected by dengue.Of the total,118(76%)were reported to know the disease dengue.Fever,headache and myalgia were the most known symptoms and house drains and kitchen garden were known as the most common breeding sites of mosquitoes.Garbage disposal,use of mosquito nets and covering water containers were the best known preventive measures.Conclusions:The overall knowledge of dengue was high,but females,old persons,unemployed and housewives had relatively little knowledge of dengue.Therefore,these groups may need special attention in future dengue education programs.Persons with knowledge of the disease more frequently reported the use of preventive measures,indicating the value of education programs as a tool in dengue prevention.展开更多
Background and purpose Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke.No prognostic tool has yet gained any widespread use.We compared the predictive value of various mod...Background and purpose Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke.No prognostic tool has yet gained any widespread use.We compared the predictive value of various models based on National Institutes of Health Stroke Scale(NIHSS)subitems,ranging from simple to more complex models,for predicting large artery occlusion(LAO)in anterior circulation stroke.Methods Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed.We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions.Using binary logistic regression,we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models.Sensitivities and specificities of the models for predicting LAO were examined.results The model with highest predictive value included all NIHSS subitems for predicting LAO(area under the curve(AUC)0.77),yielding a sensitivity and specificity of 69%and 76%,respectively.The second most predictive model(AUC 0.76)included 4-NIHSS-subitems(level of consciousness commands,gaze,facial and arm motor function)yielding a sensitivity and specificity of 67%and 75%,respectively.The simplest model included only deficits in arm motor-function(AUC 0.72)for predicting LAO,yielding a sensitivity and specificity of 67%and 72%,respectively.Conclusions Although increasingly more complex models yield a higher discriminative performance for predicting LAO,differences between models are not large.Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status,thereby assisting in triage decisions.展开更多
文摘Coronary stem implantation has significantly improved percutaneous coronary intervention and enabled the management of early complications of plain balloon angioplasty. However, a new complication has accompanied these improvements： in-stent restenosis （ISR） arising from neointimal hyperplasia. ISR after coronary angioplasty is currently one of the main limitations of this method, leading to the recurrence of exertional angina pectoris or acute coronary syndromes. The clinical incidence of ISR after bare-metal stent （BMS） implantation is approximately 20%35%. The use of drug-eluting stents （DES） has led to a further decrease in the occurrence of ISR to 5%-10%. Evidence resulting from controlled clinical studies suggests that DES and drug-eluting balloon catheters （DEB） provide the best clinical and angiographic results in the treatment of ISR. We undertook a systematic review of the pathophysiology, diagnostics and treatment options for BMS- and DES-ISR. We discuss recent randomised studies, comparing different DES or DEB used for BMS or DES-ISR treatment, as well as the use of new biovascular scafolds and the topic of scafold restenosis.
文摘The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times,There have been remarkable local and international efforts to control the crisis,Ebola Virus Disease is the focus of immense research activity,The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation,Over 28 000 people were inflicted with the condition,over 11 000 have died,Novel data has emerged regarding modes of transmission,providing rationale for recent flare-ups,Similarly,studies on survivors are elucidating the later stages of the disease recovery process,Novel techniques for diagnosis are also discussed,Finally,the current research regarding treatment and vaccine development is reviewed,particularly the implementation of r VSV-ZEBOV vaccination programs.
文摘AIM:To investigate the utility of the cytomegalovirus(CMV)antigenemia assay for the diagnosis of CMV gastrointestinal disease(GID). METHODS:One hundred and thirty immunocompromised patients were enrolled in this study.Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded.CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy.Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV.We evaluated the association between CMV-GID and patient characteristics(symptoms,underlying disease,medication,leukocyte counts,and antigenemia assay).All patients were checked with an human immunodeficiency virus(HIV)antibody test before endoscopic examination.White blood cell(WBC)counts were obtained from medical records within 1 wk of endoscopy.Leukopenia was defined as a total WBC count<5000 cells/mm 3 . For HIV patients,we also checked CD4+counts from medical records. RESULTS:A total of 99 patients were retrospectively selected for analysis.Of the immunocompromised patients,19 had malignant disease,18 had autoimmune disease,19 had disorders of biochemical homeostasis, three had undergone transplantation,and 45 had HIV infection.A total of 50 patients had received immunosuppressive therapy.No patients had inflammatory bowel disease.Fifty-five patients were diagnosed as having CMV-GID.Univariate analysis indicated an association between HIV infection,leukopenia,and positive antigenemia and CMV-GID(P<0.05).Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID(P<0.01).The sensitivity,specificity,positive predictive value,and negative predictive value of antigenemia for CMV-GID were 65.4%,93.6%, 91.9%,and 71.0%,respectively.In a subgroup analy-sis,patients with leukopenia displayed low sensitivity and high specificity.Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity.Accuracy barely differed between HIV-positive and-negative patients.In HIV-infected patients, CD4 count<50 cells/μL resulted in low sensitivity and high specificity.Differences in accuracy among patients were minor,regardless of CD4 count.In patients who had undergone both quantitative real-time polymerase chain reaction(PCR)and antigenemia assay,real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay;however,this difference was not statistically significant(P=0.312). CONCLUSION:If the antigenemia test is positive,endoscopic lesions are acceptable for the diagnosis of CMVGID without biopsy.The accuracy is not affected by HIV infection and leukopenia.Either PCR or the antigenemia assay are valid.
文摘AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 2009to December 2011 and we retrospectively assessed 15patients with Roux-en-Y HJA who had signs of biliary obstruction.In total,23 ERC procedures were performed in these patients and a single balloon videoen-teroscope(Olympus SIF Q 180)was used in all of the cases.A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope.Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of≤5.4 kPa.The technical limitations or rather the parameters of the single balloon enteroscope(working length-200 cm,diameter of the working channel-2.8 mm,absence of Albarran bridge)showed the need for special endoscopic instrumentation.RESULTS:Cannulation success was reached in diagnostic ERC in 12 of 15 patients.ERC findings were normal in 1 of 12 patients.ERC in the remaining 11 patients showed some pathological changes.One of these(cystic bile duct dilation)was subsequently resolved surgically.Endoscopic treatment was initialized in the remaining 10 patients(5 with HJA stenosis,2 with choledocholithiasis,and 3 with both).This treatment was successful in 9 of 10 patients.The endoscopic therapeutic procedures included:balloon dilatation of HJA stenosis-11 times(7 patients);choledocholitiasis extraction-five times(5 patients);biliary plastic stent placement-six times(4 patients);and removal of biliary stents placed by us-six times(4 patients).The mean time of performing a single ERC was 72 min.The longest procedure took 110 min and the shortest took34 min.This shows that it is necessary to allow for more time in individual procedures.Furthermore,these procedures require the presence of an anesthesiologist.We did not observe any complications in these 15 patients.CONCLUSION:This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy.However,it is effective,safe,and widens the possibilities of resolving biliary pathology.
文摘We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI（rs-fMRI） with a regional homogeneity（ReHo） method. Ten medical students participated in the study. A 1-year long doctor-patient communication skills training program was conducted. RsfMRI data were collected at baseline, one month and one year after training. There was a significant increase in the communication skills test average scores between baseline and 1-month duration of training（P〈0.001）. After one month of communication skills training, medical students had decreased ReHo in the right superior temporal gyrus compared with the baseline. After one year of communication skills training, students had increased ReHo in multiple regions and decreased ReHo in several regions（P 〈0.05, Alphasim corrected）. The change of ReHo values in the superior temporal gyrus negatively correlated with the change of communication skills scale score between one month after communication skills training and baseline（r=-0.734, P= 0.036）. The training program we used can be an effective approach of improving doctor-patient communication skills, and the training resulted in functional plasticity of the brain’s architecture toward optimizing locally functional organization.
基金supported by F31 AR066487(JZ)and R01 AR066124(DK)the CNSI Advanced Light Microscopy/Spectroscopy Shared Resource Facility at UCLA,supported with funding from NIH-NCRR shared resources grant(CJX1-443835-WS-29646)+4 种基金NSF Major Research Instrumentation grant(CHE-0722519)supported by the NIH/National Center for Advancing Translational Science(NCATS)UCLA CTSI Grant Number UL1TR000124by the NIH/National Institute of Arthritis Musculoskeletal and Skin(NIAMS)supported by the Ministry of Education,Youth and Sports of the Czech Republic(LTAUSA19030)the Agency for Health care Research of the Czech Republic(NV18-08-00567)。
文摘Spondylocarpotarsal syndrome(SCT) is a rare musculoskeletal disorder characterized by short stature and vertebral, carpal, and tarsal fusions resulting from biallelic nonsense mutations in the gene encoding filamin B(FLNB). Utilizing a FLNB knockout mouse,we showed that the vertebral fusions in SCT evolved from intervertebral disc(IVD) degeneration and ossification of the annulus fibrosus(AF), eventually leading to full trabecular bone formation. This resulted from alterations in the TGFβ/BMP signaling pathway that included increased canonical TGFβ and noncanonical BMP signaling. In this study, the role of FLNB in the TGFβ/BMP pathway was elucidated using in vitro, in vivo, and ex vivo treatment methodologies. The data demonstrated that FLNB interacts with inhibitory Smads 6 and 7(i-Smads) to regulate TGFβ/BMP signaling and that loss of FLNB produces increased TGFβ receptor activity and decreased Smad 1 ubiquitination. Through the use of small molecule inhibitors in an ex vivo spine model, TGFβ/BMP signaling was modulated to design a targeted treatment for SCT and disc degeneration. Inhibition of canonical and noncanonical TGFβ/BMP pathway activity restored Flnb-/-IVD morphology. These most effective improvements resulted from specific inhibition of TGFβand p38 signaling activation. FLNB acts as a bridge for TGFβ/BMP signaling crosstalk through i-Smads and is key for the critical balance in TGFβ/BMP signaling that maintains the IVD. These findings further our understanding of IVD biology and reveal new molecular targets for disc degeneration as well as congenital vertebral fusion disorders.
文摘The 2014 Ebola outbreak in West Africa,primarily affecting Guinea.Sierra Leone,and Liberia,has exceeded all previous Ebola outbreaks in the number of cases and in international response.Although infections only occur frequently in Western Africa,the virus has the potential to spread globally and is classified as a category A pathogen that could be misused as a bioterrorism agent.This review aims(i) to discuss the latest data to aid our current recommendations for the prevention and control of the Ebola vims infection,(ii) to review its pathophysiology as well as offering insights on the most current data available about Ebola vaccine progress and potential use.
基金by The publication has been supported by Ministry of Health of the Czech Republic,No.MH CZ-DRO FNBr 65269705The Czech Pneumological and Phthisiological Society(open access publication fee grant).
文摘BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.
基金Ministry of Health of the Czech Republic(University Hospital Brno,65269705),No.NU21J-09-00004.
文摘BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.
文摘In this study, the performance of Sevcik’s algorithm that calculates the fractal dimension and permutation entropy as discriminants to detect calming and insight meditation in electroencephalo-graphic (EEG) signals was assessed. The proposed methods were applied to EEG recordings from meditators practicing insight meditation and calming meditation before as well as during both types of meditation. Analysis was conducted using statistical hypothesis testing to determine the validity of the proposed meditation-identifying techniques. For both types of meditation, there was a statistically significant reduction in the permutation entropy. This result can be explained by the increased EEG synchronization, which is repeatedly observed in the course of meditation. In contrast, the fractal dimension (FD) was significantly increased during calming meditation, but during insight meditation, no statistically significant change was detected. Increased FD during meditation can be interpreted as an increase in self-similarity of EEG signals during self-organisation of hierarchical structure oscillators in the brain. Our results indicate that fractal dimension and permutation entropy could be used as parameters to detect both types of meditation. The permutation entropy is advantageous compared with the fractal dimension because it does not require a stationary signal.
基金Supported by National Key R&D Program of China:2019YFC1712200-2019YFC1712204。
文摘World Federation of Acupuncture-Moxibustion Societies(WFAS)Technical Benchmark of Acupuncture and Moxibustion:Cupping,developed under the leadership of Tianjin University of Traditional Chinese Medicine,was approved by WFAS.This technical benchmark was issued on October 9,2023,and implemented on December 31,2023.The main contents include the scope,normative references,terms and definitions,procedures and rules,and safety.This article focuses on the above contents,an outlook on the application,popularization,and update plan of this technical benchmark is proposed.
文摘Objective:To ascertain the knowledge and prevention measures against dengue among selected adult population in southern Nepal.Methods:A cross sectional study was conducted in Rapti Zonal Hospital,Dang and Bharatpur Hospital,Chitwan during August-November,2011.A total of 212 patients were interviewed regarding their knowledge and practices about dengue fever.Serum samples were collected and investigated for the presence of anti-dengue IgM antibodies by IgM-ELISA.Results:Data from 156 patients greater than 15 years were analyzed.Among them,21 samples were found to possess anti-dengue IgM antibodies by ELISA.Females,economically active people,farmers,unemployed and housewives were more frequently affected by dengue.Of the total,118(76%)were reported to know the disease dengue.Fever,headache and myalgia were the most known symptoms and house drains and kitchen garden were known as the most common breeding sites of mosquitoes.Garbage disposal,use of mosquito nets and covering water containers were the best known preventive measures.Conclusions:The overall knowledge of dengue was high,but females,old persons,unemployed and housewives had relatively little knowledge of dengue.Therefore,these groups may need special attention in future dengue education programs.Persons with knowledge of the disease more frequently reported the use of preventive measures,indicating the value of education programs as a tool in dengue prevention.
基金SITS is financed directly and indirectly by grants from Karolinska Institutet,Stockholm County Council,the Swedish Heart-Lung Foundation,the Swedish Order of St.John,Friends of Karolinska Institutet and private donors as well as from an unrestricted sponsorship from Boehringer-Ingelheim.SITS has previously received grants from the European Union Framework 7,the European Union Public Health Authority and Ferrer Internacional+3 种基金SITS is currently conducting studies supported by Boehringer-Ingelheim and EVER Pharma as well as in collaboration with Karolinska Institutet,supported by Stryker,Covidien and Phenox.RM has been supported by the project no.LQ1605 from the National Program of Sustainability II(MEYS CR)the project FNUSA-ICRC no.CZ.1.05/1.1.00/02.0123(OP VaVpI).JFS is participant in the CharitéClinical Scientist Program funded by the CharitéUniversitätsmedizin Berlin and the Berlin Institute of Health.
文摘Background and purpose Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke.No prognostic tool has yet gained any widespread use.We compared the predictive value of various models based on National Institutes of Health Stroke Scale(NIHSS)subitems,ranging from simple to more complex models,for predicting large artery occlusion(LAO)in anterior circulation stroke.Methods Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed.We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions.Using binary logistic regression,we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models.Sensitivities and specificities of the models for predicting LAO were examined.results The model with highest predictive value included all NIHSS subitems for predicting LAO(area under the curve(AUC)0.77),yielding a sensitivity and specificity of 69%and 76%,respectively.The second most predictive model(AUC 0.76)included 4-NIHSS-subitems(level of consciousness commands,gaze,facial and arm motor function)yielding a sensitivity and specificity of 67%and 75%,respectively.The simplest model included only deficits in arm motor-function(AUC 0.72)for predicting LAO,yielding a sensitivity and specificity of 67%and 72%,respectively.Conclusions Although increasingly more complex models yield a higher discriminative performance for predicting LAO,differences between models are not large.Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status,thereby assisting in triage decisions.
