简介：ObjectivesToexaminepatientdelay(PD)inseekingtreatmentamongpatientswithST-elevationmyocardialinfarction(STEMI)andtoidentifyfactorsinfluencingPD.MethodspatientswithSTEMIweredividedintotwogroupsbasedonPD:ShortPDgroup(PD≤60minutesafteronsetofsymptoms)andlongPDgroup(>60minutesaftersymptomonset).Aquestionnairedevelopedtoassessdemographiccharacteristics,clinicalfactorsandpsychologicalfactors.Patientswereinterviewedwithin72hoursofadmissionto2hospitals.Results329consecutiveconfirmedSTEMIpatients(Meanage61years;72.5%men)withamedianPDof90minandapre-hospitaldelaytime170minwerestudied,PDwaslessthan1hoursin47.4%ofpatients,whilemorethan1hoursin52.6%,Inunivariateanalyses,patientswithshortPDwerewitnessonset,progresscourseofsymptom,severepain,deathanxiety,knowingAMIasadeadlydiseaseanditspresentation,takingthesymptomseriously.PatientswithlongerPDwereage≥65year,nocturnalonset,experiencedtheirsymptomsathome,gradualonset,’waitedtoseewhethersymptomsdisappeared’,’worriedabouttroublingothers’,’tookpainmedication’andpreinfarctionangina.Astepwisemultipleregressionanalysisfurthersuggestedthatthefollowinginde-pendentcontributorstoalatedecisiontoseekmedicalhelp(relativerisk,95%confidenceinterval):takingpainmedication(15.97;1.70～149.8),wantingtowaitandsee(6.46;1.92～21.74),notwantingtobotheranybody(6.42;2.87～14.34),preinfarctangina(2.73;1.20～6.19),age≥65years(2.51;1.15～5.48),gradualonset(2.40;1.05～5.44),severepain(0.38,0.17～0.85),witnessonset(0.27,0.10～0.70),takingsymptomsseriously(0.019;0.08～0.46).ConclusionsAge≥65years,gradualonset,witnessonset,severepain,preinfarctangina,emotionalresponsesandcopingstrategiesaretheindependentfactorsassociatedwithpatientdelayordecisiontimeinpatientswithAMI.Emotionalresponsesandcopin

简介：Objective:Thisstudyaimstoinvestigatethetruth-tellingstatusandtherelevantfactorsofesophagealsquamouscellcarcinoma(ESCC)patientsinHenan,China.Methods:Across-sectionalstudyfromApriltoJune2015usingquestionnaireswasgivento301familymembersofhospitalizedESCCpatientsbasedinthreeaffiliatedhospitalsofZhengzhouUniversity(i.e.,TheFirstHospital,TheSecondHospital,andTumorHospital)andAnyangTumorHospital.Results:Amongthe41.9%(126/301)hospitalizedESCCpatientswhoknewoftheirtruediagnoses,only4.0%patientswereinformedbytheircorrespondingresponsibledoctors,39.7%bytheirfamilymembers,and56.3%bythemselves.UnivariateanalysesshowedthatdisclosureofconfirmedESCCdiagnosistopatientswascorrelatedwithgender,familyhistoryofcancer(FHC),educationlevel,vocation,hospitaladministrativelevel,andattitudesoffamilymembers(P<0.05).Furthermore,multivariateanalysisindicatedthatattitudeoffamilymemberswasthemostimportantandanindependentfactorfordiagnosisdisclosure.ThosepatientswithanegativeFHC,under-education,manualoccupation,advancedstages,andhospitalizedinmunicipalhospitalsexhibitedalowrateoftruthtelling.Conclusions:TruthtellingforESCCpatientsinHenanisnotprevalentandmaybeimprovedthroughconsultationwithfamilymembers,particularlyforpatientswithanegativeFHC,pooreducation,manualoccupation,andadvancedstages.

简介：OBJECT:Optimummanagementforelderlypatientswithnewlydiagnosedglioblastoma(GBM)inthetemozolomide(TMZ)eraisnotwelldefined.Theobjectofthisstudywastoclarifyoutcomesinthispopulation.METHODS:Theauthorsretrospectivelyreviewed105consecutivecasesinvolvingelderlypatients(age≥65years)withnewlydiagnosedGBMwhoweretreatedattheMayoClinicbetween2003and2008.RESULTS:Thepatients'medianagewas74years(range66-87years),andthemedianKarnofskyPerformanceStatus(KPS)scorewas80(range40-90).Halfofthepatientsunderwentbiopsyandhalfunderwentresection.Patientswithdeep-seatedlesions(19patients[18%])ormultifocallesions(34patients[32%])weremorelikelytohavebiopsythanresection(p=0.0001and0.0009,respectively).Newpersistentneurologicaldeficitsdevelopedin7patients(6.7%).Postoperativehemorrhageoccurredin6patients(5.7%),allofwhomunderwentbiopsy.Completefollow-updataregardingadjuvanttreatmentwasavailablein84patients.Forty-one(49%)weretreatedwithchemotherapy(mostlyTMZ)andradiationtherapy(RT),and23(27%)withRTalone.Nineteen(23%)receivedonlypalliativecareaftersurgery(morecommonwithbiopsy,p=0.03).Chemotherapycomplicationsoccurredin28.6%(Grade3or4hematologicalcomplicationsin11.9%).Themedianvaluesforprogression-freesurvival(PFS)andoverallsurvival(OS)were3.5and5.5months.Inamultivariateanalysis,youngerage(p=0.03,riskratio[RR]0.34,95%CI0.13-0.89),singlelesion(p=0.02,RR0.51,95%CI0.30-0.89),resection(p=0.04,RR0.54,95%CI0.31-0.94),andadjuvanttreatment(p=0.0001,RR0.24,95%CI0.11-0.49)wereassociatedwithbetterOS.OnlyadjuvanttreatmentwassignificantlyassociatedwithprolongedPFS(p=0.0007,RR0.27,95%CI0.13-0.57).Withcombinedtherapywithresection,RT,andchemotherapy,themedianPFSandOSwere8and12.5months,respectively.CONCLUSIONS:TheprognosisforGBMworsenswithincreasingageinelderlypatients.Withimportantrisks,resectionandadjuvanttreatmen

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简介：Atotalof116patientswithseverecraniocerebralinjurywerehospitalizedinourdepartmentfromFebruary1998toFebruary2001.Amongthem,92patientssufferedfromintracranialhematomadiagnosedbyCTscanandprovedbyoperations.

简介：Toevaluatetheeffectofatrovastatintherapyonborderlinevulnerablelesionsinpatientswithacutecoronarysyndrome(ACS).MethodsPatientswithACSunderwentcoronaryangiography(CAG)andintravascularultrasound(IVUS)investigation.Patientswithculpritvulnerableborderlinelesionswereenrolled.Nocoronaryinter-ventionwasperformedontheselesions.Allthepatientsreceivedatrovastatintherapyfor12monthsandunderwentclin-icalfollow-upalongwithIVUSfollow-up.Crosssectionarea(CSA)ofthetargetedlesion,CSAofthereferencearter-ies(extraelasticmembrane),minimallumenCSA,andplaqueareaweremeasuredatbaselineandfollow-ups.Ad-verseeventsincludedrecurrentangina,recurrentmyocardialinfarction,revascularizationanddeath.ResultsNoad-verseeventswasreportedduringfollow-upperiod.Comparedwithbaselinedata,thelevelofApoBdecreasedsignifi-cantlyattheendofthestudy(0.589±0.136g/Lvs0.681±0.132g/L,P=0.03).Boththepercentdiametersteno-sisandthepercentareastenosisdetectedbyCAGdisplayedminimalchange((62.50±10.21)%vs(54.79±12.35)%,P=0.48and(58.61±8.36)%vs(48.18+10.56)%,P=0.78).DetectedbyIVUS,theminimallu-minalCSAofthetargetedlesionincreasedsignificantly(6.32±2.42mm2vs5.63±2.51mm2,P<0.01),theplaqueareaandCSAstenosisdecreased(7.70±2.19mm2vs8.17±2.55mm2,P<0.05and56.94±8.47%vs61.4±110.34%,P<0.01).Atotalof25softplaques(50%)transformedintofibrousplaque.ConclusionsAtro-vastatintherapystabilizesborderlinevulnerableplaqueandreversesatherosclerosisprogressioninpatientswithACS.

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简介：Background:Althoughcurrentresearchsupportstheuseofactivevideogames(AVGs)inrehabilitation,theevidencehasyettobesystematicallyreviewedorsynthesized.Thecurrentprojectsystematicallyreviewedliterature,summarizedfindings,andevaluatedtheeffectivenessofAVGsasatherapeutictoolinimprovingphysical,psychological,andcognitiverehabilitativeoutcomesamongolderadultswithchronicdiseases.Methods:Sevendatabases(AcademicSearchComplete,Communication&MassMediaComplete,ERIC,PsycINFO,PubMed,SPORTDiscus,andMedline)weresearchedforstudiesthatevaluatedtheeffectivenessofAVG-basedrehabilitationamongolderpatients.Theinitialsearchyielded946articles;afterevaluatingagainstinclusioncriteriaandremovingduplicates,19studiesofAVG-basedrehabilitationremained.Results:Moststudieswerequasi-experimentalindesign,withphysicalfunctioningtheprimaryoutcomeinvestigatedwithregardtotheuseofAVGsinrehabilitation.Overall,9studiesfoundsignificantimprovementsforallstudyoutcomes,whereas9studiesweremixed,withsignificantimprovementsonseveralstudyoutcomesbutnoeffectsobservedonotheroutcomesafterAVG-basedtreatments.OnestudyfailedtofindanybenefitsofAVG-basedrehabilitation.Conclusion:FindingsindicateAVGshavepotentialinrehabilitationforolderpatients,withseveralrandomizedclinicaltrialsreportingpositiveeffectsonrehabilitativeoutcomes.However,existingevidenceisinsufficienttosupporttheadvantagesofAVGsoverstandardtherapy.Giventhelimitednumberofstudiesandconcernswithstudydesignquality,moreresearchiswarrantedtomakemoredefinitiveconclusionsregardingtheabilityofAVGstoimproverehabilitativeoutcomesinolderpatients.

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简介：AbstractAdenotonsillectomy is one of the most common surgical procedures performed by otolaryngologists. It is vital that surgeons are aware of the risks in performing this surgery especially during the COVID-19 pandemic and in children with hematologic disorders. In this review we describe common hematologic disorders often noted in pediatric patients undergoing this procedure, as well as proper screening and management of these patients. In addition, we also address the impact of the COVID-19 pandemic and some measures to help mitigate the risks of this procedure during this time.

简介：AbstractBackground:Hypertension is considered an important risk factor for the coronavirus disease 2019 (COVID-19). The commonly anti-hypertensive drugs are the renin-angiotensin-aldosterone system (RAAS) inhibitors, calcium channel blockers (CCBs), and beta-blockers. The association between commonly used anti-hypertensive medications and the clinical outcome of COVID-19 patients with hypertension has not been well studied.Methods:We conducted a retrospective cohort study that included all patients admitted with COVID-19 to Huo Shen Shan Hospital and Guanggu District of the Maternal and Child Health Hospital of Hubei Province, Wuhan, China. Clinical and laboratory characteristics were extracted from electronic medical records. Hypertension and anti-hypertensive treatment were confirmed by medical history and clinical records. The primary clinical endpoint was all-cause mortality. Secondary endpoints included the rates of patients in common wards transferred to the intensive care unit and hospital stay duration. Logistic regression was used to explore the risk factors associated with mortality and prognosis. Propensity score matching was used to balance the confounders between different anti-hypertensive treatments. Kaplan-Meier curves were used to compare the cumulative recovery rate. Log-rank tests were performed to test for differences in Kaplan-Meier curves between different groups.Results:Among 4569 hospitalized patients with COVID-19, 31.7% (1449/4569) had a history of hypertension. There were significant differences in mortality rates between hypertensive patients with CCBs (7/359) and those without (21/359) (1.95% vs. 5.85%, risk ratio [RR]: 0.32, 95% confidence interval [CI]: 0.13-0.76, χ2 = 7.61, P = 0.0058). After matching for confounders, the mortality rates were similar between the RAAS inhibitor (4/236) and non-RAAS inhibitor (9/236) cohorts (1.69% vs. 3.81%, RR: 0.43, 95% CI: 0.13-1.43, χ2 = 1.98, P = 0.1596). Hypertensive patients with beta-blockers (13/340) showed no statistical difference in mortality compared with those without (11/340) (3.82% vs. 3.24%, RR: 1.19, 95% CI: 0.53-2.69, χ2= 0.17, P= 0.6777).Conclusions:In our study, we did not find any positive or negative effects of RAAS inhibitors or beta-blockers in COVID-19 patients with hypertension, while CCBs could improve prognosis.

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简介：AbstractBackground:Empiric therapy for patients with unexplained recurrent pregnancy loss (URPL) is not precise. Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age. The clinical outcomes of URPL patients who have undergone in vitro fertilization-embryo transfer (IVF-ET) require elucidation. The IVF outcome and influencing factors of URPL patients need further study.Methods:A retrospective cohort study was designed, and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included. By comparing clinical outcomes between these patients and those with tubal factor infertility (TFI), the factors affecting the clinical outcomes of URPL patients were analyzed.Results:The clinical pregnancy rate (35.18% vs. 34.52% in fresh ET cycles, P = 0.877; 34.48% vs. 40.27% in frozen-thawed ET cycles, P = 0.283) and live birth rate (LBR) in fresh ET cycles (27.67% vs. 26.59%, P = 0.785) were not significantly different between URPL group and TFI group. URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group (23.56% vs. 33.56%, P = 0.047), but the cumulative LBRs (34.69% vs. 38.26%, P = 0.368) were not significantly different between the two groups. The increased endometrial thickness (EMT) on the human chorionic gonadotropin day (odds ratio [OR]: 0.848, 95% confidence interval [CI]: 0.748-0.962, P = 0.010) and the increased number of eggs retrieved (OR: 0.928, 95% CI: 0.887-0.970, P = 0.001) were protective factors for clinical pregnancy in stimulated cycles. The increased number of eggs retrieved (OR: 0.875, 95% CI: 0.846-0.906, P < 0.001), the increased two-pronucleus rate (OR: 0.151, 95% CI: 0.052-0.437, P < 0.001), and increased EMT (OR: 0.876, 95% CI: 0.770-0.997, P = 0.045) in ET day were protective factors for the cumulative live birth outcome.Conclusion:After matching ages, no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI. A thicker endometrium and more retrieved oocytes increase the probability of pregnancy in fresh transfer cycles, but a better normal fertilization potential will increase the possibility of a live birth.

简介：AbstractImportance:CHD2 is a member of the chromodomain helicase DNA-binding (CHD) family of proteins, which have important roles in the regulation of gene expression. Dysregulation of this protein may lead to various disorders.Objective:To delineate the genotypes and phenotypes of CHD2-related epilepsy.Methods:We analyzed the medical history, magnetic resonance imaging findings, and video-electroencephalogram recordings of 17 patients with CHD2 mutations in the Neurology Department of Beijing Children’s Hospital from June 2016 to June 2021.Results:Age at seizure onset ranged from 6 months to 10 years; the median age at onset was 4 years. Generalized tonic-clonic, myoclonic, eyelid myoclonic, atonic, atypical absence, myoclonic-atonic, and spasm seizures were observed. Ten of the 17 patients had multiple types of seizures. One patient exhibited photosensitivity epilepsy and one patient exhibited grid image-induced visual reflex epilepsy. Developmental disability was present in 14 patients, while autism features were present in five patients. Sixteen patients had de novo mutations of CHD2; one patient had an inherited variant. Eleven mutations were novel. One patient had two mutations; that patient exhibited development delay and refractory epilepsy. Seizures were controlled in eight patients, improved in seven patients, and resistant to treatment in two patients.Interpretation:Phenotype severity in patients with CHD2 variants ranged from drug-responsive seizures to severe epileptic encephalopathy. Most patients exhibited developmental disorders.