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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：Background:Currently,thereisasignificantlackofdataconcerninglong-termoutcomesfollowingpaediatriccochlearimplantationintermsofqualityoflife.Thereisaneedforalong-term,prospectivestudyinthisregard.Thisstudyaimsathighlightingthepreliminaryresults,oneyearpostsurgeryofafiveyearprospectivestudy.Methods:TheCochlearTMPaediatricImplantedRecipientObservationalStudy（P-IROS）isaprospective,patientoutcomesregistryforroutinelyimplantedchildren.Thestudycollectsdatausingquestionnairespost-surgeryandatregularintervalsuptofiveyears.Results:AtourCentre,159cochlearimplantsurgeryprocedureswerecarriedoutbetweenJanuary2014andDecember2014.CategoryofAuditoryPerformanceIIscoreincreasedfrom‘0’to‘3’atsixmonthsandto‘5’at12monthsforchildrenaged0—3years,althoughthiswasnotstatisticallysignificant.However,thesametrendwasstatisticallysignificantfortheage3—6yearandage6—10yearbrackets.Thequalityoflifeofthechildimprovedsignificantly.Analysisofcommunicationmoderevealedastatisticallysignificantoverallshifttotheauditory-oralmodefromtotalcommunication.Conclusion:Cochlearimplantationisalife-changingintervention.Theevidenceinsupportofwhatitcanachievesafelyisclear.However,thecostsassociatedwithitraisethequestionifitwillremainaneffectiveoptionforlifeinallchildren.TheCochlearP-IROSisanattempttoanswerthesameoverafiveyearperiod.OurstudyinNewDelhi,sofarconcludesthatcochlearimplantationinapopulationwithlimitedaccesstofundsisveryeffective,oneyearaftersurgery.

简介：AbstractPurpose:Injury continues to be an important cause of morbidity and mortality in both developed and developing countries. Globally, it is responsible for approximately 5.8 million deaths per year and 91% of these deaths occur in developing countries. Road traffic collision, suicides and homicides are the leading cause of traumatic deaths. Despite the fact that traumatic chest injury is being responsible for 10% of all trauma-related hospital admissions and 25% of trauma-related deaths across the world including in Ethiopia, only few published studies showed the burden of traumatic chest injury in Ethiopia. So, this study aims at assessing the characteristics and outcome of traumatic chest injury patients visited Tikur Anbesa Specialized Hospital (TASH) over one year period.Methods:A single center based retrospective study was done. We collected data from patients’ records to assess characteristics and outcome of traumatic chest injury at TASH over one year period. All patients diagnosed with traumatic chest injury and received treatment at the hospital from January 1 to December 31, 2016 regardless of its types and severity levels were included in the study. Patients with incomplete medical records for at least 20% of the study variables and without detailed medical history, or patients died before receiving any health care were excluded from the study. The collected data were cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21.0 for analysis. Bivariate and multivariate logistic regression models were used to examine factors associated with outcome of trau- matic chest injury patients.Results:A total of 192 chest injury patients were included in the study and about one-fourth of chest injury victims were died during treatment period in TASH. Road traffic collision (RTC) was the leading cause of morbidity and mortality among traumatic chest injury victims. Age of the victims (adjusted odds ratio (AOR) 8.9, 95% confidence interval (CI) 1.51-53.24), time elapsed between the occurrence of traumatic chest injury and admission to health care facilities (AOR 4.6, 95% CI 1.19-18.00), length of stay in hospital (AOR 0.12, 95% CI 0.02-0.58), presence of multiple extra-thoracic injury (AOR 25, 95% CI 4.18-150.02) and development of complications (AOR 23, 95% CI 10-550) were factors associated with death among traumatic chest injury patients in this study.Conclusion:RTC contributed for a considerable number of traumatic chest injuries in this study. Old age, delay in delivering the victim to health care facilities, length of stay in hospital, and development of atelectasis and pneumonia were associated with death among traumatic chest injury patients. Road safety interventions, establishment of organized pre-hospital services, and early recognition and prompt management of traumatic chest injury related complications are urgently needed to overcome the underlying problems in the study setting.

简介：BACKGROUND:Amyotrophiclateralsclerosis(ALS)isthemostcommonofallthemotorneurondiseasesandtheabsenceofabiologicmarkerhasmadebothdiagnosisandtrackingevolutionofthediseasedifficult.Electrodiagnostictestsplayafundamentalroleinquantifyingpathologicalchangesinthemotorunitpool.OBJECTIVE:Weassesseddistal-proximalMotorUnit(MU)lossandchangesusingthemethodofmotorunitnumberestimation(MUNE).DESIGN,TIMEANDSETTING:Acase-controlstudywasperformedattheDepartmentofNeuroscience,PisaUniversityMedicalSchool,ItalyfromDecember1999toNovember2009.PARTICIPANTS:Atotalof50ALSpatientswererecruited,30males:meanage(59.6±13.3)years20females:meanage(63.9±11.7)years;range(30-82)years;allpatientshadprobableordefiniteALS.Thirtyhealthyvolunteerswererecruitedfromdepartmentstaffs,including20malesand10females;meanage(57.7±13.8)yearsservedascontrols.METHODS:MUNEwasperformedforboththebicepsbrachiiandabductordigitiminimimusclesothesameside.Thetechniqueusedrelayedsubstantiallyonmanualincrementalstimulationofthemotornerve,knownastheMcComastechnique(50mssweepduration,againof2mV/DivforMwave,0.5mV/Divforeachstep;filters10-20kHz).MAINOUTCOMEMEASURES:MUNEresultsweremeasured.RESULTS:FunctioningMUnumbers,measuredbyMUNE,decreasedinthebicepsbrachiiandabductordigitiminimimusclesovertheentireone-yearfollow-upperiod(oneassessmenteverythreemonths)comparedwithbaselinedetermination,therateofMUdecreasewassimilarinbothmuscles,butsteeperdistally.CONCLUSION:MUNEisafeasiblemethodforALSpatientsbothproximallyanddistallytotrackchangesovertimeinmuscleMUsduringthedisease'sevolution.

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简介：这研究在跟随加速的transepithelial的keratoconus角膜评估了临床的结果角膜的骨胶原cross-linking(CXL)(AvedroKXL?系统，麻省沃尔瑟姆，美国)超过一年后续。光连贯断层摄影术(10月)测量的分界线的吝啬的深度是205.19???吳????????<

简介：AbstractBackground:Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.Methods:This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis.Results:Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR= 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.Conclusions:In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

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：Objective:Toinvestigatetherecurrencesites,riskfactors,andprognosisofpatientswithpersistentorrecurrentsquamouscellcarcinoma(SCC)ofthecervixwithinoneyearafterundergoingconcurrentchemoradiotherapy(CCRT).Methods:Clinicaldataof30patientswithpersistentorrecurrentSCCofthecervixwithinoneyearafterCCRTbetweenJuly2006andJuly2011wereanalyzedretrospectively.Thesedatawerecomparedwiththoseof35SCCcaseswithnosignsofrecurrenceaftercompleteremission.These35patientsweretreatedduringthesameperiod(between2006and2011)andselectedrandomly.Results:Amongthese30patients,25exhibiteddistantmetastasesofwhich14wereobservedwithin6monthsafterCCRT.Univariateanalysisshowedhigherincidenceofpelvicorpara-aorticlymphadenectasisandSCC-ag>10ng/mLinthegroupwithpersistentorrecurrentdiseasebeforetreatment(P<0.01).Multivariateanalysisbylogisticregressionrevealedthatthepre-therapeuticpelvicorpara-aorticlymphnodeenlargementandSCC-ag>10ng/mLweretheindependentriskfactors.Palliativechemotherapywasthemaintreatmentoptionforpatientswithpersistentorrecurrentdisease.The2-yearsurvivalratewas21.7%,andthemediansurvivaltimewas17months.Conclusion:PatientswithpersistentorrecurrentSCCofthecervixafterCCRTexhibitedahighrateofdistantmetastasiswithpoorprognosis.Thepre-therapeuticpelvicorpara-aorticlymphnodeenlargementandSCC-ag>10ng/mLwereidentifiedastheindependentriskfactorsforpersistentorrecurrentSCCwithin1yearafterCCRT.

简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

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.

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