简介：AbstractBackground:Early detection of gastric cancer (GC) has been the topic of major efforts in China. This study aimed to explore the risk factors associated with GC and to provide evidence for the selection of a high-risk population of GC.Methods:Based on the cancer screening cohort of the National Cancer Screening Program in Urban China, GC patients diagnosed by endoscopy and pathological examinations constituted the case group, and controls were 1:3 matched by sex and age (±5 years) individually. The variables were selected by univariable analysis of factors such as body mass index (BMI), dietary habits, lifestyle, stomach disease history, and family history of GC; and multivariable logistic regression was used to analyze the influencing factors of GC and to calculate the odds ratio (OR) of related factors and its 95% confidence interval (CI).Results:A total of 215 GC cases and 645 matched healthy controls were included in the final analysis, with a median age of 61 years for the case and control groups. Overall analysis showed that high educational level (above primary school) (OR = 0.362, 95% CI = 0.219-0.599, P < 0.001), overweight/obesity (BMI ≥24 kg/m2; OR= 0.489, 95% CI = 0.329-0.726, P < 0.001), cigarette smoking (OR = 3.069, 95% CI = 1.700-5.540, P < 0.001), alcohol consumption (OR = 1.661, 95% CI = 1.028-2.683, P = 0.038), history of stomach disease (OR = 6.917, 95% CI = 4.594-10.416, P < 0.001), and family history of GC in first-degree relatives (OR = 4.291, 95% CI = 1.661-11.084, P = 0.003) were significantly correlated with the occurrence of GC. Subgroup analyses by age and gender indicated that GC risk was still increased in the presence of a history of stomach disease. A history of chronic gastritis, gastric ulcer, or gastric polyposis was positively associated with GC, with adjusted ORs of 4.155 (95% CI = 2.711-6.368), 1.839 (95% CI = 1.028-3.288), and 2.752 (95% CI = 1.197-6.326).Conclusions:Subjects who smoke, drink, with history of stomach disease and family history of GC in first-degree relatives are the high-risk populations for GC. Therefore, attention should be paid to these subjects for GC screening.

简介：AbstractBackground:Nucleic acid test (NAT) could effectively control the spread of COVID-19 caused by large-scale sports competitions. However, quantitative analysis on the appropriate frequency of NAT is scarce, and the cost-effectiveness and necessity of high-frequency NAT remain to be fully explored and validated. This study aims to optimize the COVID-19 surveillance strategies through cost-effectiveness analysis for the Tokyo 2020 Olympic Games and the upcoming Beijing 2022 Olympic Winter Games.Methods:A total of 18 scenarios were designed regarding the NAT frequency, symptom monitoring, and strengthening close-contact control. An agent-based stochastic dynamic model was used to compare the cost-effectiveness of different NAT scenarios and optimize the surveillance strategies. The dynamics of the proposed model included the arrival and departure of agents, transmission of the disease according to Poisson processes, and quarantine of agents based on regular NATs and symptom onset. Accumulative infections, cost, and incremental cost-effectiveness ratio (ICER) were simulated in the frame of the model. ICER was used to compare the cost-effectiveness of different scenarios. Univariate sensitivity analysis was performed to test the robustness of the results.Results:In Scenario 16, where the competition-related personnel (CRP) received NAT daily and national sports delegation (NSD) with quarantined infections accepted an additional NAT daily, accumulative infection was 320.90 (90 initial infections), the total cost was (United States Dollar) USD 8 920 000, and the cost of detecting out each infection was USD 27 800. Scenario 16 would reduce the total cost by USD 22 570 000 (avoid 569.61 infections), USD 1 420 000 (avoid 47.2 infections) compared with Scenario 10 (weekly NAT, strengthened close contact control) and Scenario 7 (daily NAT, no strengthened close contact control), respectively. Sensitivity analysis showed that the result was most sensitive to the change in basic reproductive number.Conclusions:High-frequency NATs such as bidaily, daily, and twice a day were cost-effective. NAT daily for CRP with strengthening close-contact control could be prioritized in defense against COVID-19 at large-scale sports competitions. This study could assist policymakers by assessing the cost-effectiveness of NAT scenarios and provide the host country with an optimal COVID-19 surveillance strategy.

简介：AbstractBackground:Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.Methods:Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.Results:A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).Conclusions:The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

简介：S型女人,集丰胸、细腰、翘臀、纤腿于一身,成为一个魅力女人最具视觉美感的表达。如果你对夏季满怀期待,如果你也将在这一季热辣登场,不妨一起和我们开始S型美人塑造吧。

简介：贝尔面瘫（Bell’spalsy）是造成周围性面神经麻痹最常见的疾病，以19世纪英国神经学家CharlesBell命名，表现为原因不清的急性周围性面神经麻痹，又称“特发性面瘫”。流行病学调查发现贝尔面瘫的发病没有明显季节性，但夏季相对发病少；高发年龄为15～45岁，平均年龄为（32±2）岁，〈15岁和〉60岁的患者少见；患病率无明显性别差异，女性略高于男性；左右两侧的发病率无明显差异。

简介：摘要Kummell’s病是一种发病机制尚不明确的罕见疾病。临床中常常不能及时发现。随着影像学技术的提高，逐渐得到大家的认知。本文就Kummell’s病的诊疗进展作一综述。

简介：Objective:Toobservetheeffectofelectroacupuncture(EA)onMeniere'sdisease.Methods:Atotalof114cases(38malesand76females)ofMeniere'sdiseaseweretreatedwithEAofErmen(耳门TE21),Tinggong(听宫SI19),Tinghui(听会GB2),Yifeng(NFDB1风TE17),Fengchi(风池GB20)andBaihui(百会GV20).Thetreatmentwasgiven3timesaweek,9timesaltogether.Follow-upwasmadeattheendofthe3rd,6thand12thmonthsaftertreatment.Results:Follow-upin114patientsshowedthatafterEAtreatment,63cases(55.26%)werecured,30(26.31%)hadremarkableimprovementintheirsymptoms,10(8.77%)respondedwithimprovementand11(9.65%)failedinthetreatment,withatotaleffectiverateof90.35%.Conclusion:EAtreatmentwaseffectiveincontrollingMeniere'sdiseasepatients'symptomsandreducingattack.

简介：AbstractThroughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

简介：Therearemanycausesofpain.Generallyspeaking,inflammationisthemostcommoncause,followedbyinjury,ulceration,spur,chemicalstimulation,etc..Acupuncturehasitsuniqueeffectivenessoninflammationthatischaracterizedasredness,swelling,warmthandpain,includingneuritisandarthritis.

简介：Aim:Tostudypercutaneousabsorptionandmetabolismofketoprofenisopropylester(KPE)viaexcisednudemouse'sandmonkey'sskin.Methods:Excisedskinwaspreparedbysurgicalexcisionandenzymedigestion.Sideby-sidediffusioncellswereusedforinvitropermeationstudies.TheconcentrationsofKPEanditsmetaboliteinsampleswereassayedbyHPLC.Results:AllKPEpenetrationthroughwholethicknessskinandstrippedskinwasmetabolizedtoketoprofen(KP).theconcentrationofwhichinthereciiversolutionincreasedlinearlywithtime.Astothenudemouseskin.thesteady-statefluxofKPthroughwholethicknessskinwas2.5timesthatofKPEthroughthewhloethicknessskin,buttheKPandKPEremaininginthewholethicknessskinafterthefinishingofKPEpenetrationwas22.2timesincomperedwiththeKPremaininginthewholethicknessskinafterthefinshingofKPpenetration.TherateofformationofthesteadystateKPfromKPEthroughtdermiswassignificantlylowerthanthatofKPEthroughthewholethicknessskin.Inhemonkeyskin,therateofformationofthesteady-stateKPfromKPEthroughthewholethicknessskinwas0.7timesthatfromKPEthroughstrippedskin.TheKPandKPEremaininginthewholethicknessskinafterthefinishingofKPEpenetrationwas2.0timethatinthestrippedskinafterthefinishingofKPEpenetration.Therateoffornationofthesteady-stateKPfromKPEthroughdermiswaslowerthanthatfromKPEthroughthewholethicknessskinandthestrippedskin.theKPremainingindermisafterthefinsihingofKPEpenetrationwasalsosignificantlylowerthantheKPremaininginthewholethicknessskinandthestrippedskinafterthefinishingofKPEpenetration.Conclusion:KPestersareofbenefittoimporovethelocalactionofKP.andskinesterasemetabolismmainlydevelopsintheepidermis.

简介：AbstractIntroduction:Celiac disease typically presents with symptoms of malabsorption, but extraintestinal manifestations are increasingly reported. Aplastic anemia as the mode of celiac disease presentation is extremely rare in children.Case presentation:We report a 2-year-old boy who presented with loose stools, loss of appetite, and bicytopenia with severe aregenerative normocytic anemia. Investigations, including bone marrow aspirate and biopsy, revealed aplastic anemia. Screening for malabsorption showed increased plasma concentrations of anti-transglutaminase and anti-gliadin antibodies. A duodenal biopsy confirmed the histologic features of celiac disease. The child received a packed red cell transfusion and was started on a gluten-free diet, with a very good prognosis and normalization of both his blood and histological parameters. To the best of our knowledge, our report is the sixth pediatric case in the literature.Conclusion:Screening for celiac disease should be performed in children with unexplained hematological abnormalities such as aplastic anemia with or without gastrointestinal symptoms.

简介：AbstractBackground:Despite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), these patients are at risk of having a poor long-term prognosis. The aim of this study was to predict 1-year mortality in TBI patients undergoing DC using logistic regression and random tree models.Methods:This was a retrospective analysis of TBI patients undergoing DC from January 1, 2015, to April 25, 2019. Patient demographic characteristics, biochemical tests, and intraoperative factors were collected. One-year mortality prognostic models were developed using multivariate logistic regression and random tree algorithms. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were used to evaluate model performance.Results:Of the 230 patients, 70 (30.4%) died within 1 year. Older age (OR, 1.066; 95% CI, 1.045-1.087; P < 0.001), higher Glasgow Coma Score (GCS) (OR, 0.737; 95% CI, 0.660-0.824; P < 0.001), higher D-dimer (OR, 1.005; 95% CI, 1.001-1.009; P = 0.015), coagulopathy (OR, 2.965; 95% CI, 1.808-4.864; P < 0.001), hypotension (OR, 3.862; 95% CI, 2.176-6.855; P < 0.001), and completely effaced basal cisterns (OR, 3.766; 95% CI, 2.255-6.290; P < 0.001) were independent predictors of 1-year mortality. Random forest demonstrated better performance for 1-year mortality prediction, which achieved an overall accuracy of 0.810, sensitivity of 0.833, specificity of 0.800, and AUC of 0.830 on the testing data compared to the logistic regression model.Conclusions:The random forest model showed relatively good predictive performance for 1-year mortality in TBI patients undergoing DC. Further external tests are required to verify our prognostic model.

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简介：AIM:Todeterminereallifeclinicaloutcomesinpoorlyresponsiveandtreatment-naveneovascularage-relatedmaculardegeneration(nvAMD)patientsusingbimonthlyfixeddosingafliberceptregimen.METHODS:Thiswasaretrospectivestudyof165eyeswithnvAMDstartedonafliberceptatSouthamptonEyeUnitbetweenJune2013andJune2014.Patientswereeitherswitchedfromprorenata(PRN)ranibizumab/bevacizumabduetopoorresponse(107eyes),ortreatment-nave(58eyes).Patientsinitiallyreceived3-monthlyintravitrealafliberceptinjectionsfollowedby2-monthlyfixeddoses.Clinicvisitswerescheduledatmonth0,4,10and12.Meanchangeinbest-correctedvisualacuity(BCVA)andcentralretinalthickness(CRT)frombaselinewereassessedusingtheWilcoxonsignedranktest.TheproportionofpatientsmaintainingBCVA(<15lettersloss)at12mowasalsoevaluated.RESULTS:MeanBCVAchangeatmonth12was+3.29and+4.67lettersintheswitchedandnaveafliberceptgroupsrespectively(P<0.01).BCVAwasmaintainedin95.3%ofswitchedand96.6%ofnavepatients.CRTatmonth12showedadecreaseof-6.16μmintheswitchedgroupand-35.36μminthenavegroup(P<0.01).Patientspreviouslytreatedwithranibizumab/bevacizumabhadonaveragereceived7.4ranibizumab/bevacizumabinjectionsover12.6mo,attending10clinicvisits.Thefixeddosingafliberceptregimenrequiredanaverageof7.1injections(navegroup),7.5injections(switchedgroup)and4clinicvisitsperyear.CONCLUSION:Fixedbimonthlyafliberceptiseffectiveinbothtreatment-naveandpoorlyresponsivenvAMDpatients.Adoptingafixeddosingregimencanreducepatientburdenwithoutcompromisingonoutcomes.

简介：AbstractImportance:Clostridium difficile-associated diarrhea (CDAD) is a severe type of antibiotic-associated diarrhea (AAD). However, the risk factors for CDAD in children with AAD have not yet been clarified.Objective:To investigate the distribution and risk factors for CDAD among hospitalized children in Beijing Children’s Hospital.Methods:Stool samples from 197 children with AAD were tested for the C. difficile pathogenic genes (tcdA, tcdB, tcdC, tcdD, tcdE, cdtA, and cdtB) using polymerase chain reaction between January 2011 and January 2014. Children who tested positive for tcdA or tcdB were included in the CDAD group, and those remaining comprised the non-CDAD group.Results:The rate of CDAD among the 197 children with AAD was 42.6% (84/197). The age distribution was 1-15.6 years, among which the majority of children (54.8%, 46/84) were aged 1-4 years. Differences in the CDAD-positive rates among AAD children belonging to different age groups were not statistically significant. Univariate analysis revealed that the duration of antibiotic therapy, the length of hospitalization prior to diarrhea, and gastrointestinal tract operations were significant risk factors (P < 0.05). Children with CDAD underwent more antibiotic therapy and had longer periods of hospitalization prior to diarrhea onset than children in the non-CDAD group. Using multivariate regression analysis, hospitalization for ≥ 10 days prior to diarrhea was found to be an independent risk factor for CDAD.Interpretation:This study revealed that the length of hospitalization (≥ 10 days) prior to diarrhea was an independent risk factor for CDAD in children with AAD.

简介：AbstractBackground:Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.Methods:Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.Results:Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm3, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25-12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ2 = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166-13.269, P= 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548-35.974, P = 0.001) were associated with higher mortality at 8 weeks.Conclusion:This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.

简介：AIM:Toevaluatetheefficacyandsafetyofacombinedtreatmentformyopicchoroidalneovascularization(CNV)usingphotodynamictherapy(PDT)andintravitrealbevacizumabandtocompareitwithintravitrealbevacizumabmonotherapy.METHODS:Thirty-foureyeswithangiographicevidenceofmyopicCNVwererandomlydividedintotwogroups:17weretreatedwithoneintravitrealbevacizumabinjection(1.25mg)andlow-fluence-ratePDTwithinsevendaysoftheinjection(GroupA).Theother17receivedmonotherapywithbevacizumabinjections(GroupB).Clinicalevidenceofcomplications,bestcorrectedvisualacuity(BCVA)andfluoresceinleakagewereevaluated.BCVAandopticalcoherencetomography(OCT)wereevaluatedmonthly.Thetimepointsfollow-upwasestablishedat6and12mo.AllpatientswereretreatedfollowingaPRNprotocol.RESULTS:Atotalof34eyesof34patients(26womenand8men)withameanageof62.35yearswereincluded.InGroupA(17eyes)themeanBCVAincreasedfrom0.55±0.13logMARbeforethetreatmentto0.40±0.09logMARatthe12mofollow-up(P<0.01).InGroupB(17eyes)themeanBCVAincreasedfrom0.60±0.11logMARbeforethetreatmentto0.55±0.12logMARatthe12mofollow-up(P<0.01).TherewasnostatisticallysignificantdifferencebetweenthetwogroupsintermsofLogMarvisualacuity.InGroupAthemeannumberofcombinedtreatmentswas1.8±0.11perpatient;inGroupBthemeannumberofintravitrealbevacizumabinjectionswas3.1±0.08perpatient.ThenumberoftreatmentswassignificantlyfewerinGroupA(P<0.01).Nolocalorsystemicsideeffectsoccurredamonganyofthepatientstreatedinthisstudy.CONCLUSION:Thecombinationofanti-angiogenicinjectionsandPDTappearstobeasafeandeffectiveoptionformyopicCNVtreatmentandallowsforasignificantreductionofintravitrealinjections.

简介：AbstractBackground:The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.Methods:CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.Results:The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).Conclusions:TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.Trial Registration:https://www.chictr.org.cn/(No. ChiCTR2000038526).

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简介：尽管为有类型1糖尿病的个人的小岛移植被显示了产出优异的血葡萄糖控制，它为长期的控制仍然保持不适当。这是部分，由于小岛损害和压力，那能导致贝它房间损失。过量IL-1β的抑制；活动可能最小化小岛损害，因此保存工作。IL-1受体对手(IL-1Ra)，IL-1β的一个内长的禁止者；，保护小岛免受导致cytokine的坏死和apoptosis的伤害。因此，在IL-1β之间的不平衡；并且IL-1Ra可能影响到小岛的allogeneic和自体免疫的回答的功课。我们的组以前证明传播丝氨酸朊酶禁止者人alpha-1-antitrypsin(hAAT)，以及immunomodulatory活动。在现在的学习，我们寻求了决定是否胰腺的小岛hAAT的allograft保护的活动被IL-1Ra调停感应。我们的结果证明hAAT在刺激巨噬细胞在IL-1Ra表示导致了2.04褶层增加并且hAAT-pre-treated小岛接枝在IL-1Ra抄本层次展出了4.851褶层增加，它与中等煽动性的侧面被联系。出人意料地，从IL-1Ra-knockout鼠标被孤立并且在grafting前与hAAT预先对待进野类型的鼠标的小岛在大概从渗入主机房间被导出的intragraftIL-1Ra表示产出增加，当主机的hAAT处理不在时的虽然。确实，hAAT-pre-treated小岛产生了能在有教养的巨噬细胞导致IL-1Ra生产的hAAT免费的调节媒介。最后，我们证明hAAT为p65支持了不同phosphorylation和原子translocation模式，为IL-1Ra要求的一个关键抄写因素表示。