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简介：AbstractCoronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.

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简介：AbstractBackground:At the end of 2019, a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus (2019-nCoV). The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear, and warrants further investigation.Methods:The present study will be conducted as an open-labeled, randomized, controlled trial. We will enrol 48 subjects from Chongqing Public Health Medical Center. Each eligible subject will be assigned to an intervention group (methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days) or a control group (no glucocorticoid use) randomly, at a 1:1 ratio. Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points. We will use the clinical improvement rate as our primary endpoint. Secondary endpoints include the timing of clinical improvement after intervention, duration of mechanical ventilation, duration of hospitalization, overall incidence of adverse events, as well as rate of adverse events at each visit, and mortality at 2 and 4 weeks.Discussion:The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades. Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past. However, there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease, or indeed in other types of severe respiratory disease. In this study, we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019.Trial registration:ClinicalTrials.gov, ChiCTR2000029386, http://www.chictr.org.cn/showproj.aspx?proj=48777.

简介：Objective:Toevaluatetheefficacyandfeasibilityofscreeningprocedureforuppergastrointestinalcancerinbothhigh-riskandnon-high-riskareasinChina.Setting:Sevencities/counties,representingthreeeconomical-geographicalregions(Eastern,CentralandWestern)inChina,wereselectedasscreeningcenters:threeinhigh-riskareasandfourinnon-high-riskareas.Participants:Villages/communitiesinthesesevencentersregardedasclusterswererandomlyassignedtoeitherinterventiongroup(screeningbyendoscopicexamination)orcontrolgroup(withnormalcommunitycare)ina1:1ratiostratifiedbyeachcenter.Eligibleparticipantsarelocalresidentsaged40–69yearsintheselectedvillages/communitieswithnohistoryofcancerorendoscopicexaminationinthelatest3yearswhoarementallyandphysicallycompetent.Thosewhoarenotwillingtotakeendoscopicexaminationorareunwillingtosigntheconsentformareexcludedfromthestudy.Totally140,000participantswillbeenrolled.Interventions:Inhigh-riskareasofuppergastrointestinalcancer,allsubjectsinscreeninggroupwillbescreenedbyendoscopy.Innon-high-riskareas,30%ofthesubjectsinscreeninggroup,identifiedthroughasurvey,willbescreenedbyendoscopy.Primaryandsecondaryoutcomemeasures:Theprimaryoutcomeisthemortalitycausedbyuppergastrointestinalcancer.Thesecondaryoutcomesincludedetectionrate,incidencerate,survivalrate,andclinicalstagedistribution.Additionaldataonqualityoflifeandcost-effectivenesswillalsobecollectedtoanswerimportantquestionsregardingscreeningeffects.Conclusions:ScreeningstrategyevaluatedinthoseareaswithpositivefindingsmaybepromotednationallyandappliedtothemajorityofChinesepeople.Ontheotherhand,negativefindingswillprovidescientificevidenceforabandoningatestandshiftingresourceselsewhere.Trialregistration:ThestudyhasbeenregisteredwiththeProtocolRegistrationSysteminChineseClinicalTrialRegistry.

简介：AbstractBackground:Transcranial alternating current stimulation (tACS) offers a new approach for adult patients with major depressive disorder (MDD). The study is to evaluate the efficacy and safety of tACS treating MDD.Methods:This is an 8-week, double-blind, randomized, placebo-controlled study. Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), following a 4-week observation period (week 8). The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale (HDRS-17) score ≤7 at week 8. Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17, the proportion of participants having improvement in the clinical global impression-improvement, the change in HDRS-17 score (range, 0–52, with higher scores indicating more depression) over the study, and variations of brain imaging and neurocognition from baseline to week 4. Safety will be assessed by vital signs at weeks 4 and 8, and adverse events will be collected during the entire study.Discussion:The tACS applied in this trial may have treatment effects on MDD with minimal side effects.Trial registration:Chinese Clinical Trial Registry, ChiCTR1800016479; http://www.chictr.org.cn/showproj.aspx?proj=22048.

简介：AbstractEnhanced recovery after surgery (ERAS) protocols have been developed in numerous surgical specialties as a means of systematically improving patient recovery, functional outcomes, cost savings, and resource utilization. Such multidisciplinary initiatives seek to minimize variability in several aspects of perioperative patient care, helping to reduce inpatient length of hospital stay, complications, and the overall resource and financial burden of surgical care. Head and neck oncology patients stand to benefit from the implementation of comprehensive ERAS protocols, as these patients have complex medical needs that may dramatically impact multiple aspects of their recovery, including breathing, eating, nutrition, pain, speech, swallowing, and communication. Implementing ERAS protocols for head and neck cancer patients may present unique challenges, and require significant interdisciplinary coordination and collaboration. We therefore sought to provide a comprehensive guide to the planning and institution of such ERAS systems at institutions undertaking care of head and neck cancer patients. Key elements to consider in the implementation of successful ERAS protocols for this population include organizing a team consisting of frontline leaders such as nursing staff, medical specialists, and associated health professionals; designing interventions based on systematically evaluated, high-quality literature; and instituting a clear methodology for regularly updating protocols and auditing the success or potential limitations of a given intervention. Potential obstacles to the success of ERAS interventions for head and neck cancer patients include challenges in systematically tracking progress of the protocol, as well as resource limitations in a given health system.

简介：AIMtotestthefeasibilityandperformanceofanoveluppergastrointestinal(GI)capsuleendoscopeusinganurse-ledprotocol.METHODSWeconductedaprospectivecohortanalysisofpatientswhodeclinedgastroscopy(oesophagogastroduodenoscopy,OGD)butwhoconsentedtoupperGIcapsuleendoscopy.PatientsswallowedtheupperGIcapsulefollowingingestionof1literofwater(containingsimethicone).AseriesofpositionalchangeswereusedtoexploittheeffectsofwaterflowandmovetheupperGIcapsulefromonegravity-dependentareatoanotherusinganurse-ledprotocol.Capsuletransittime,videoreadingtime,mucosalvisualisation,pathologydetectionandpatienttolerancewasevaluated.RESULTSFiftypatientswereincludedinthestudy.Themeancapsuletransittimesintheoesophagusandstomachwere28sand68minrespectively.Visualisationofthefollowingmajoranatomicallandmarkswasachieved(graded1-5:Poortoexcellent):Oesophagus,4.8(±0.5);gastro-oesophagealjunction(GOJ),4.8(±0.8);cardia,4.8(±0.8);fundus,3.8(±1.2);body,4.5(±1);antrum,4.5(±1);pylorus,4.7(±0.8);duodenalbulb,4.7(±0.7);secondpartoftheduodenum(D2),4.7(±1).TheupperGIcapsulereachedD2in64%ofpatients.Themeanvideoreadingtimewas48minwithstandardplaybackmodeand20minusingQuickview(p=0.0001).NopathologywasmissedusingQuickview.Proceduraltolerancewasexcellent.NocomplicationswereseenwiththeupperGIcapsule.CONCLUSIONTheupperGIcapsuleachievedexcellentviewsoftheupperGItract.FuturestudiesshouldcomparethediagnosticaccuracybetweenupperGIcapsuleandOGD.

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简介：AbstractBackground:Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.Methods:A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.Results:A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).Conclusions:Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.Trial Registration:ChiCTR.org.cn, ChiCTR-ONRC-14005096

简介：Dearcolleague,Astheeditor-in-chief,IwouldliketodeclarethegoodnewsthatCancerBiology&Medicine(CBM)hasbeenindexedinScienceCitationIndexExpanded(SCIE)andwillgetanimpactfactorsoon.AstheofficialjournaloftheChineseAnti-CancerAssociation(CACA)whichpossessesmorethan40,000members,CBMholdsalargeaudiencebothinChinaandabroad.Thejournalmainlyfocusesontranslationalcancerresearch,dedicatingtonarrowing

简介：Acupunctureiswidelyusedtotreatfunctionaldyspepsiawithsatisfactoryoutcomes.CombinationoftheHeandMuacupointsiscommonlyusedandhasasynergisticeffectonfunctionaldyspepsia;however,itsunderlyingmechanismsremainunclear.Therefore,arandomizedcontrolledparallelclinicaltrialiscurrentlyunderwayatChengduUniversityofTraditionalChineseMedicine,China.ThistrialisdesignedtoexploretheefficacyofandcentralresponsestotheHe-Mupointcombinationinpatientswithfunctionaldyspepsiausingfunctionalmagneticresonanceimaging.Atotalof105patientswithfunctionaldyspepsiawillbeallocatedinto3groups:thelow-Hepointgroup(puncturingatZusanli(ST36)),Mupointgroup(puncturingatZhongwan(CV12)),andHe-Mupointcombinationgroup(puncturingatST36andCV12).Everyparticipantwillreceive20sessionsofmanualacupuncturefor4weeks.Theneedleswillbeinsertedperpendicularlytoadepthof1to2cun.Theangleofrotationandtwistingwillrangefrom90to180degrees,whileliftingandthrustingwillrangefrom0.3to0.5cm.Thevariousmanipulationswillbeperformed60to90timesperminute.Theneedleswillremaininplacefor30minutes,duringwhichmanipulationwillbeappliedevery10minutes.Magneticresonanceimagingwillbeperformedbeforeandafter20sessionsofacupuncture.TheprimaryoutcomeissymptomimprovementaccordingtotheChineseversionoftheNepeanDyspepsiaIndex.SecondaryoutcomesincludetheLeedsdyspepsiaquestionnaire,Self-RatingAnxietyScale,Self-RatingDepressionScale,BeckAnxietyInventory,BeckDepressionInventory,andvisualanaloguescalescoresbeforeandafter10and20sessionsofacupuncture.Needlesensationandadverseeventswillbeusedtoassessthetherapeuticeffects.ThisstudywillpromotemorewidespreadawarenessofthebenefitsofacupointcombinationintheclinicalsettingandprovideafurtherexplanationoftheneuromechanismbywhichacupunctureattheHe-Mupointcombinationforfunctio

简介：AbstractBackground:An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China.Methods:Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS).Results:A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (-0.1, 95% CI - 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019-March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (-0.3, 95% CI - 1.4 to 0.9, P = 0.653).Conclusions:Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.

简介：Abducensnervepalsy(ANP)iscommonlyseeninpatientswithdiabetesmellitus.ThevalidityofacupunctureasatraditionalChinesemedicinemethodinperipheralnerverepairiswellestablished.However,itsefficacyinrandomizedcontrolledtrialsremainsunclear.Herein,wedesignedaprotocolforaprospective,single-center,randomizedcontrolledtrialtoinvestigatetheeffectofintraorbitalelectroacupunctureondiabeticANP.Weplantorecruit60patientswithdiabeticANP,andrandomlydividethemintotreatmentandcontrolgroups.Patientsinbothgroupswillcontinuetheirglucose-loweringtherapy.Aneuralnutritiondrugwillbegiventobothgroupsforsixweeks.Thetreatmentgroupwillalsoreceiveintraorbitalelectroacupuncturetherapy.Wewillassessefficacyoftreatment,eyeballmovement,diplopiadeviationandthelevelsoffastingblood-glucoseandglycosylatedhemoglobinbeforetreatmentat2,4,and6weeksaftertreatment.Theefficacyandrecurrencewillbeinvestigatedduringfollow-up(1monthafterintervention).ThisprotocolwasregisteredatChineseClinicalTrialRegistryon16January2015(ChiCTR-IPR-15005836).ThisstudywasapprovedbytheEthicsCommitteeofFirstAffiliatedHospitalofHarbinMedicalUniversityofChina(approvalnumber:201452).AllprotocolswillbeinaccordancewithDeclarationofHelsinki,formulatedbytheWorldMedicalAssociation.Writteninformedconsentwillbeprovidedbyparticipants.WeenvisagethattheresultsofthisclinicaltrialwillprovideevidenceforpromotingclinicaluseofthisnewtherapyformanagementofANP.

简介：AbstractBackground:Depression is a common mental illness in childhood and adolescence, with an incidence of 4%-5%; it can lead to impairments in learning and social functioning. Transcutaneous auricular vagus nerve stimulation (taVNS) is a commonly used method of auricular acupuncture point stimulation, which is regarded as an effective treatment for adults with depression. The aim of this study was to investigate the efficacy and mechanism of taVNS for adolescents with mild to moderate depression.Methods:This randomized controlled clinical trial will include 120 patients aged 12-16 years, all of whom are diagnosed with mild to moderate depression. Patients will be randomly assigned to a taVNS group and a drug control group (sertraline hydrochloride) at a ratio of 1:1. Patients will be evaluated using the 17-item Hamilton Depression Scale, Hamilton Anxiety Rating Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Pittsburgh Sleep Quality Index scores at baseline, as well as at the 2nd, 4th, 6th, 8th, and 12th weeks. To investigate the underlying neural mechanisms of taVNS treatment from the perspective of the default mode network, multimodal magnetic resonance imaging (MRI; i.e., structural MRI [sMRI], resting state MRI [rsMRI], and pseudocontinuous arterial spin-labeled [pcASL] MRI) will be used to compare cerebral images among groups. MRI data will also be collected from 40 healthy volunteers to assess whether the participants exhibit normal development of structural and functional components.Discussion:Depression is the most common mental disorder in adolescence. Drug treatment can improve depression symptoms; however, the side effects of drug treatments are often severe. This study proposes a simple physiotherapy that aims to treat adolescents with mild to moderate depression. The mechanism of taVNS in the treatment of depression will also be investigated. The results of this study will provide evidence to guide the application of taVNS in adolescents with depression.

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简介：AbstractObjective:To evaluate the efficacy of progestin-primed ovarian stimulation (PPOS) protocol in infertile women with high basal follicle-stimulating hormone (FSH) levels ≥15 IU/L.Methods:Patients with high basal FSH levels ≥15 IU/L with autologous oocytes from September 2016 to March 2019 were reviewed. Either medroxyprogesterone acetate 4 mg/d or clomiphene citrate (CC) 50 mg/d was administered daily from day 3 to the trigger day. When serum FSH levels decreased to ≤15.0 IU/L, a low dose of human menopausal gonadotropin (hMG) 75/150 IU/d was administered to promote late follicular development.Results:Two hundred and twenty women were retrospectively analyzed in this study. Among them, 139 patients were administered with PPOS protocol as the study group, and 81 patients were administered with CC protocol as the control group. The numbers of received oocytes and viable embryos were higher in the study group than those in the control group (1.5 ± 1.2 vs. 1.2 ± 0.8 and 0.8 ± 0.8 vs. 0.5 ± 0.6, respectively, P < 0.05). However, hMG duration and dosage were significantly higher in the study group than those in the control group (4.2 ± 2.7 d vs. 1.1 ± 2.3 d and 609.1 ± 424.5 IU vs. 140.7 ± 231.3 IU, respectively, P < 0.01). Incidence of luteinizing hormone surge and cycle cancellation rate were lower in the study group than those in the control group with statistical difference (2.88% vs. 16.05% and 36.50% vs. 50.63%, respectively, P < 0.05).Conclusions:PPOS protocol can effectively downregulate the endogenous FSH levels. Compared with CC protocol, treatment with PPOS protocol in patients with high basal FSH levels ≥15 IU/L could receive more oocytes and more viable embryos.

简介：AbstractObjective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome. The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index (BMI) undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), compared to the long protocol (LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching (PSM). Patients were divided into two groups: modified ultra-LP (MULP) (n = 1,960) and LP (n = 1,960).Results:In the MULP group, live birth rate (52.65% vs. 46.79%, P < 0.001, odds ratio [OR]: 1.784, 95% confidence interval [CI]: 1.563-2.036), clinical pregnancy rate (62.50% vs. 57.91%, P = 0.003, OR: 1.211, 95% CI: 1.066-1.377), and implantation rate (53.24% vs. 49.65%, P = 0.004, OR: 1.155, 95% CI: 1.048-1.272) were statistically significantly higher than those of the LP group. Moreover, the cycle cancellation rates (12.70% vs. 15.15%, P = 0.027, OR: 0.815, 95% CI: 0.68-0.977), abortion rates (12% vs. 14.8%, P = 0.046, OR: 0.785, 95% CI: 0.619-0.996), and ectopic pregnancy rates (1.06% vs. 2.11%, P = 0.04, OR: 0.497, 95% CI: 0.252-0.98) were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment, providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.