简介：AbstractPreterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome. Many risk factors for spontaneous preterm birth (sPTB) have been identified. Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester. 17 hydroxyprogesterone caproate, vaginal progesterone, cerclage, and pessary have all been studied for prevention of sPTB. Difference in patient populations likely contributes to the conflicting study results. Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.

简介：AbstractPreterm birth (PTB) is defined as delivery before completing 37 weeks of gestation. It is the main cause of neonatal morbidity and mortality in the most countries. The inherent cervical length and strength are two main features of the cervix that determine whether or not a pregnant woman is at risk for PTB. Routine transvaginal cervical length screening was recommended for women with singleton pregnancy and history of prior spontaneous PTB, while the issue of universal cervical length screening and the screening in multiple gestations remain an object of debate. Strain sonoelastography and shear-wave sonoelastography have been used to evaluate the cervical stiffness in pregnant women, but the predictive value for PTB still requires further investigations. In this review, we will discuss the measurement methods of cervical length and cervical stiffness, and compare the value of cervical assessment by transvaginal ultrasound for predicting PTB in asymptomatic women.

简介：AbstractBackground:After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function.Methods:A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

简介：摘要A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge.

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简介：AbstractMany patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

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简介：AbstractThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) has been changing for nearly 20 years. GOLD has moved from single assessment using spirometry to a more comprehensive assessment of chronic obstructive pulmonary disease using spirometry, symptoms and exacerbation history. And subsequently, a new assessment system for chronic obstructive pulmonary disease separated spirometric grades from the old assessment system, and classified patients only according to their symptoms and history of exacerbation. The distribution, clinical characteristics, treatment, and prognosis of the new subgroups were different from the old ones. In this review, we will present a brief profile of changes made to the disease assessment method of GOLD, based on the relevant existing literature.

简介：AbstractBackground:Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis.Methods:We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.Results:Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50–1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62–1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44–1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42–0.84; P = 0.004).Conclusions:Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.

简介：AbstractObjective:To identify risk factors of saphenous vein graft (SVG) failure and to investigate the utility of anatomical SYNTAX score (SS) and SYNTAX score II (SS-II) in predicting SVG failure.Methods:A total of 598 patients who underwent angiography for clinical reasons after coronary artery bypass grafting (CABG) were included. Baseline data and factors related to SVG failure were analyzed at the patient and graft levels. Patients were divided in tertiles by anatomical SS and in three groups by SS-II revascularization recommendation, and SVG patency was analyzed across these groups.Results:Patency rates were similar in all SS-stratified and SS-II recommendation groups within 1, 5, and 10 years after CABG. At the patient level, fasting blood glucose (FBG) level <7.0 mmol/L was less common in SVG failure (68.0% vs. 76.2%). At the graft level, patients with SVG failure tended to have angiography later (4.0 years vs. 3.0 years), poorer FBG control (FBG <7.0 mmol/L: 68.2% vs. 74.7%), and more grafts anastomosed to the right coronary system (59.2% vs. 47.4%). Longer time interval after CABG was related to SVG failure both at the patient and graft levels, and odds ratio (OR)/P values (OR/P) were 1.282/0.029 and 1.384/0.016, respectively. Using independent graft and grafting to the right artery system as risk factors at the graft level, OR/Ps were 3.094/0.000 and 2.524/0.000, respectively.Conclusions:Longer time interval after CABG, independent grafts, and grafting to the right artery system are associated with SVG failure. Anatomical SS or SS-II may not be reasonable tools for predicting SVG failure.

简介：AbstractBackground:Cerebrospinal fluid (CSF) has been demonstrated as a better source of circulating tumor DNA (ctDNA) than plasma for brain tumors. However, it is unclear whether whole exome sequencing (WES) is qualified for detection of ctDNA in CSF. The aim of this study was to determine if assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma.Methods:CSFs of ten glioblastoma patients were collected pre-operatively at the Department of Neurosurgery, Sun Yat-sen University Cancer Center. ctDNA in CSF and genome DNA in the resected tumor were extracted and subjected to WES. The identified glioblastoma-associated mutations from ctDNA in CSF and genome DNA in the resected tumor were compared.Results:Due to the ctDNA in CSF was unqualified for exome sequencing for one patient, nine patients were included into the final analysis. More glioblastoma-associated mutations tended to be detected in CSF compared with the corresponding tumor tissue samples (3.56 ± 0.75 vs. 2.22 ± 0.32, P = 0.097), while the statistical significance was limited by the small sample size. The average mutation frequencies were similar in CSF and tumor tissue samples (74.1% ± 6.0% vs. 73.8% ± 6.0%, P = 0.924). The R132H mutation of isocitrate dehydrogenase 1 and the G34V mutation of H3 histone, family 3A (H3F3A) which had been reported in the pathological diagnoses were also detected from ctDNA in CSF by WES. Patients who received temozolomide chemotherapy previously or those whose tumor involved subventricular zone tended to harbor more mutations in their CSF.Conclusion:Assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma, which may provide useful information for the decision of treatment strategy.

简介：AbstractBackground:As COVID-19 makes its way around the globe, each nation must decide when and how to respond. Yet many knowledge gaps persist, and many countries lack the capacity to develop complex models to assess risk and response. This paper aimed to meet this need by developing a model that uses case reporting data as input and provides a four-tiered risk assessment output.Methods:We used publicly available, country/territory level case reporting data to determine median seeding number, mean seeding time (ST), and several measures of mean doubling time (DT) for COVID-19. We then structured our model as a coordinate plane with ST on the x-axis, DT on the y-axis, and mean ST and mean DT dividing the plane into four quadrants, each assigned a risk level. Sensitivity analysis was performed and countries/territories early in their outbreaks were assessed for risk.Results:Our main finding was that among 45 countries/territories evaluated, 87% were at high risk for their outbreaks entering a rapid growth phase epidemic. We furthermore found that the model was sensitive to changes in DT, and that these changes were consistent with what is officially known of cases reported and control strategies implemented in those countries.Conclusions:Our main finding is that the ST/DT Model can be used to produce meaningful assessments of the risk of escalation in country/territory-level COVID-19 epidemics using only case reporting data. Our model can help support timely, decisive action at the national level as leaders and other decision makers face of the serious public health threat that is COVID-19.

简介：AbstractObjective:Racial disparities have been well characterized and African American (AA) patients have 30% lower 5-year survival rates than European Americans (EAs) for head and neck squamous carcinoma (HNSCC). This poorer survival can be attributed to a myriad of different factors. The purpose of this study was to characterize AA-EA similarities and differences in sociodemographic, lifestyle, clinical, and psychosocial characteristics in HNSCC patients near the time of surgery.Methods:Setting: Single tertiary care center. Participants: Thirty-nine newly diagnosed, untreated HNSCC patients (n= 24 EAs,n= 15 AAs) who were to undergo surgery were recruited. Study Design: Cross-sectional study Sociodemographic, lifestyle factors, and disease factors (cancer site, AJCC clinical and pathologic stage, and HPV status)were assessed. Risk factors, leisure time, quality of life and social support were also assessed using validated questionnaires. Exposures: EA and AA patients were similar in the majority of sociodemographic factors assessed. AAs had a higher trend toward pathologically later stage disease compared to EAs and significantly increased time to treatment.Results:EA and AA patients were similar in the majority of sociodemographic factors assessed. AAs had a higher trend toward pathologically later stage disease compared to EAs. AAs also had significantly increased time to treatment (P= 0.05). The majority of AA patients (62%) had later stage pathologic disease. AA were less likely to complete high school or college (P= 0.01) than their EA counterparts. Additionally, AAs were more likely to report having a gap in health insurance during the past decade (37% vs. 15%).Conclusions:This preliminary study demonstrates a similar profile of demographics, clinical and psychosocial characteristics preoperatively for AAs and EAs. Key differences were AAs tending to have later pathologic stage disease, educational status, delays in treatment initiation, and gaps in health insurance.

简介：AbstractBackground:Acute myeloid leukemia (AML) is a common type of hematological malignancy in elderly people. Geriatricians have developed comprehensive geriatric assessment (CGA) methods for elderly patients; however, the tools used for CGA in AML are not uniform. Thus, we aimed to validate the instrumental activities of daily living (IADL) scales, age, comorbidities (Charlson Comorbidity Index), and albumin (IACA) index, which is a new tool for CGA, in elderly patients with AML.

简介：AbstractBackground:Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection in China with substantial morbidity and mortality. But no specific risk assessment model has been well validated in patients with HAP. The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center, retrospective study. In total, 223 patients diagnosed with HAP from 2012 to 2017 were included in this study. Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index (PSI); consciousness, urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65); Acute Physiology and Chronic Health Evaluation II (APACHE II); Sequential Organ Failure Assessment (SOFA); and Quick Sequential Organ Failure Assessment (qSOFA) scores. The discriminatory power was tested by constructing receiver operating characteristic (ROC) curves, and the areas under the curve (AUCs) were calculated.Results:The all-cause 30-day mortality rate was 18.4% (41/223). The PSI, CURB-65, SOFA, APACHE II, and qSOFA scores were significantly higher in non-survivors than in survivors (all P < 0.001). The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores (ROC AUC: APACHE II vs. CURB-65, 0.863 vs. 0.744, Z = 3.055, P= 0.002; APACHE II vs. qSOFA, 0.863 vs. 0.767, Z= 3.017, P= 0.003; SOFA vs. CURB-65, 0.856 vs. 0.744, Z= 2.589, P = 0.010; SOFA vs. qSOFA, 0.856 vs. 0.767, Z = 2.170, P = 0.030). The cut-off values we defined for the SOFA, APACHE II, and qSOFA scores were 4, 14, and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments. The qSOFA score may be a simple tool that can be used to quickly identify severe infections.

简介：AbstractBackground:Hyperuricemia and gout have become public health concerns; many important guidelines have recommended xanthine oxidase inhibitors (XOIs) as the first-line urate-lowering therapies (ULTs) to treat chronic gout with hyperuricemia. However, whether treating hyperuricemia and gout with ULTs modifies cardiovascular risks remains controversial. The aim of this study was to assess the incident risk of cardiovascular (CV) events (CVE) in hyperuricemia population, assess the cardiovascular benefit-risk of ULTs in hyperuricemia patients with or without gout in diverse cardiovascular risk sub-groups, and specify the safety of different ULTs.Methods:We searched PubMed, Embase, the Cochrane Library, Wanfang, Chongqing VIP (CQVIP, en.cqvip.com), and China National Knowledge Infrastructure Database for prospective cohort studies and randomized controlled trials (RCTs) in English and Chinese. Potential medications included XOIs, and uricosurics. RCTs were divided into sub-groups analysis based on blinding status and patients’ history of CV diseases. Risk ratios (RRs) were calculated and were reported with corresponding 95% confidence intervals (CIs) by fixed-effects or random-effects model.Results:Seven prospective cohort studies and 17 RCT studies were included. The risks of both major adverse cardiovascular events (MACE) (RR = 1.72, 95% CI 1.28-2.33) and CVE (RR = 1.35, 95% CI 1.12-1.62) were higher in the hyperuricemia population than non-hyperuricemia one. In seven RCT studies where XOIs were compared with no-treatment or placebo, the results of five low CV risk studies showed that XOIs lowered the risks of both MACE (RR = 0.35, 95% CI 0.20-0.62) and CVE (RR = 0.61, 95% CI 0.44-0.85); whereas two high CV risk studies showed that XOIs lowered the risk of CVE (RR = 0.69, 95% CI 0.54-0.88) rather than MACE (RR = 0.62, 95% CI 0.29-1.35). In nine RCT studies where the cardiovascular safety between febuxostat and allopurinol were compared, no statistical difference was found in the risk of MACE or CVE.Conclusions:The hyperuricemia population does have a higher incidence of CVE, and the results suggested that XOIs might reduce the incidence of MACE and total CVE. In addition, from the perspective of cardiovascular safety, febuxostat equaled allopurinol in our meta-analysis.

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简介：AbstractAs of March 12th Italy has the largest number of SARS-CoV-2 cases in Europe as well as outside China. The infections, first limited in Northern Italy, have eventually spread to all other regions. When controlling an emerging outbreak of an infectious disease it is essential to know the key epidemiological parameters, such as the basic reproduction number R0, i.e. the average number of secondary infections caused by one infected individual during his/her entire infectious period at the start of an outbreak. Previous work has been limited to the assessment of R0 analyzing data from the Wuhan region or Mainland China. In the present study the R0 value for SARS-CoV-2 was assessed analyzing data derived from the early phase of the outbreak in Italy. In particular, the spread of SARS-CoV-2 was analyzed in 9 cities (those with the largest number of infections) fitting the well-established SIR-model to available data in the interval between February 25–March 12, 2020. The findings of this study suggest that R0 values associated with the Italian outbreak may range from 2.43 to 3.10, confirming previous evidence in the literature reporting similar R0 values for SARS-CoV-2.

简介：AbstractBackground:Renal cell carcinoma (RCC) has the propensity to lead to venous tumor thrombus (VTT). Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications. The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava (IVC) wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings.Methods:Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy (levels I-IV) for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018. Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus.Results:Among the 110 patients, 41 underwent partial or segmental resection of IVC. There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection, including those of the Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the VTT at the RVo and IVC occlusion. For the multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus. The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion, with which we predicted invasions of the IVC wall requiring IVC resection. The probabilities of intra-operative IVC resection for patients without both independent factors, with an AP diameter of the VTT at the RVo larger than 17.0 mm, with IVC occlusion, and with both concurrent factors were 5%, 23%, 56%, and 66%, respectively.Conclusion:An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.

简介：摘要: 太阳辐射是地球表层能量的主要来源。就全球平均而言，太阳总辐射只占到达大气上界太阳辐射的45%。总辐射量随纬度升高而减小，随高度升高而增大。根据1981-2010郑州辐射站太阳辐射和日照资料、三门峡四个国家级气象观测站的日照资料，采用气候学方法、线性趋势分析等方法和太阳能资源的丰富程度、利用价值、稳定程度、日最佳利用时段等指标，对三门峡地区太阳能资源进行了计算、分析和评估。结果显示：三门峡地区近30年来相应的年均总辐射大约是4916.9 MJ·m -2·a-1，整体来看呈现逐年下降，下降速率大约是2.659 MJ·m -2·a-1/ 年;相应的年总辐射量大约是卢氏最低，则渑池最高;冬季辐射量相对较低，反之夏季辐射量相对较高，夏季总辐射量在一定程度上是冬季的2倍;月均总辐射量最少的月份是12月 ，其中最丰富的是5月份。近30年来相应的年均日照时数大约是2131小时，整体来看呈现逐年下降。渑池的年日照量大约是2298小时，居于首位，卢氏的年日照量大约是2017.5小时，居于末位;日照时数最少的季节为冬季，最多的季节为夏季多。日照总时数冬季比相应的夏季少24.64%;其中月均日照量最多的月份是5月高达219.3小时，为最多)，月均日照量最少的月份是2月低至141.7小时，为最少。三门峡相应月日照量高于6小时的的天数仅为13.8-20.9天，全年大约共有194-220.5天;其中日照相对较为丰富的月份是5月大约存在19.7天日照时数多于6小时，大致是2月份的1.35倍，从12月到次年2月份都不利于相应的太阳能利用。各县（市、区）相应的太阳能资源可进行开发利用的天数相对较多，太阳能资源呈现出相对稳定的状态，资源较为丰富，具有相对较高的利用价值。