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简介：AbstractObjective:To assess the value of magnetic resonance imaging (MRI) in fetal lateral ventriculomegaly diagnosed with ultrasound, and to study the relationship between the degree of isolated lateral ventriculomegaly and neonatal prognosis.Methods:The pregnancy information and outcomes of 97 cases of fetal ventriculomegaly were retrospectively reviewed in the Tianjin Central Hospital of Gynecology Obstetrics from January 2016 to December 2017. The maternal age was 18-42 years, and the fetal gestational age at diagnosis was 19+4 to 37+3 weeks. MRI and ultrasound were used to compared the diagnosis of fetal lateral ventriculomegaly and evaluated the development of the nervous system after birth.Results:Among 97 pregnancy cases, associated central nervous system malformations were observed in 36 cases on ultrasound or ultrasound + MRI. Central nervous system malformations were diagnosed with ultrasound in 15 cases (15/36, 41.7%) and with ultrasound + MRI in 25 cases (25/36, 69.4%). Pearson χ2 test was used to compare the detection rates between the groups, and the difference was statistically significant (P < 0.05). We followed up 61 cases of isolated lateral ventriculomegaly for 1-3 years after birth. According to the width of the lateral ventricle of the fetus in middle pregnancy, the subjects were grouped as follows: mild 33 cases (lateral ventricle width 10.0-12.0 mm), moderate 23 cases (lateral ventricle width 12.1-15.0 mm), and severe 5 cases (lateral ventricle width >15.0 mm). The rate of normal growth and development in the mild group was 90.9% (30/33), that in the moderate group was 69.6% (16/23), and that in the severe group was 40.0% (2/5), and the difference between groups was statistically significant (P < 0.05).Conclusion:Ultrasound combined with MRI can detect more central nervous system malformations, and the degree of isolated lateral ventriculomegaly is closely related to fetal prognosis.

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简介：AbstractBackground:The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. We aimed to screen HIV infection among PWUD and describe their retention in HIV care. Besides, we also screen for hepatitis C virus (HCV) infection among HIV-seropositive PWUD and describe their linkage to care.Methods:We conducted a prospective study in 529 PWUD who visited the "Cañada Real Galiana" (Madrid, Spain). The study period was from June 1, 2017, to May 31, 2018. HIV diagnosis was performed with a rapid antibody screening test at the point-of-care (POC) and HCV diagnosis with immunoassay and PCR tests on dried blood spot (DBS) in a central laboratory. Positive PWUD were referred to the hospital. We used the Chi-square or Fisher’s exact tests, as appropriate, to compare rates between groups.Results:Thirty-five (6.6%) participants were positive HIV antibodies, but 34 reported previous HIV diagnoses, and 27 (76%) had prior antiretroviral therapy. Among patients with a positive HIV antibody test, we also found a higher prevalence of homeless (P < 0.001) and injection drug use (PWID) (P < 0.001), and more decades of drug use (P= 0.002). All participants received HIV test results at the POC. Of the 35 HIV positives, 28 (80%) were retained in HIV medical care at the end of the HIV screening study (2018), and only 22 (62.9%) at the end of 2020. Moreover, 12/35 (34.3%) were positive for the HCV RNA test. Of the latter, 10/12 (83.3%) were contacted to deliver the HCV results test (delivery time of 19 days), 5/12 (41.7%) had an appointment and were attended at the hospital and started HCV therapy, and only 4/12 (33.3%) cleared HCV.Conclusions:We found almost no new HIV-infected PWUD, but their cascade of HIV care was low and remains a challenge in this population at risk. The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.

简介：2006年8月7日～8日，中国石油和化工行业信息化发展大会在北京召开，标志着中国石油和化工行业信息化“十一五”规划工作全面启动。作为行业排头兵．中石油在其主营业务信息化方面取得的成就受到了业界的广泛关注。

简介：摘要BACKGROUNDSystematic reviews of early rehabilitation within intensive care units have highlighted the need for robust multi-centre randomised controlled trials with longer term follow up. This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5days and to assess the impact on possible long term outcome measures for use in a definitive trial.METHODSPatients admitted to a large UK based intensive care unit and invasively ventilated for ≥5 days were randomised to the rehabilitation intervention or standard care on a 1∶1 basis, stratified by age and SOFA score. The rehabilitation intervention involved a structured programme, with progression along a functionally based mobility protocol according to set safety criteria.RESULTS103 out of 128 eligible patients were recruited into the trial, achieving an initial recruitment rate of 80%. Patients in the intervention arm mobilized significantly earlier (8days vs 10 days, P＝0.035), at a more acute phase of illness (SOFA 6 vs 4, P<0.05) and reached a higher level of mobility at the point of critical care discharge (MMS 7 vs 5, P<0.01)．CONCLUSIONWe have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care.

简介：摘要目的对比女性胸部CT检查中应用X-CARE技术的有效性。方法随机选择我院2015年10月~2017年10月收治的胸部CT女性患者108例作为研究对象，分成观察组与对照组，对照组仅通过胸部CT进行检查，不作任何处理；观察组在胸部CT检查中应用X-CARE技术，对比两组患者的扫描结果。结果数据显示，观察组、对照组的ED分别为（1.01±0.11）mSv、（1.59±0.32）mSv，相对于对照组来说，观察组ED明显较低（P＜0.05）；观察组、对照组前部、后部的主观评分、图像噪声、SNP等图像质量对比差异不明显，无统计学意义（P＞0.05）。结论X-CARE技术用于女性胸部CT检查中可获得较为理想的图像效果，不影响影像学图像，还能降低辐射，值得全面推广应用。

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简介：AccordingtoNHFPCwebsite,tostrengthenmoralconstructionofmedicalandhealthcareindustry,promotepracticesinaccordancewiththelawandadvocatehonestmedicalpractices,NationalHealthandFamilyPlanningCommission(NHFPC)andStateAdministrationofTraditionalChineseMedicinejointlyreleasedinDecember26,2013'NineProhibitionsto

简介：AbstractBackground:Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT; however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography.Method:Patients who had VPs (minimum FCT <65 μm and lipid core >90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15-20 mg or atorvastatin 30-40 mg) and combination therapy group (rosuvastatin 5-10 mg or atorvastatin 10-20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student’s t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis.Result:Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = -9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = -9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up (B = -0.203, t = -2.701, P = 0.010), ΔTC% (B = -0.573, t = -2.048, P = 0.046), and Δhs-CRP% (B = -0.302, t = -2.963, P = 0.005) showed an independent association with ΔFCT%.Conclusions:Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.

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简介：AIM:Todescribetheclinicalfeatures,systemicassociations,treatmentandvisualoutcomesinSaudipatientswithscleritis.·METHODS:AretrospectivechartreviewwasperformedforpatientswithscleritispresentingtotwotertiarycareeyehospitalsinRiyadh,SaudiArabia,from2001to2011.Datawerecollectedontheclinicalfeaturesofscleritis,subtypesofscleritis,associatedsystemicdisease,historyofpreviousocularsurgeryandmedicaltherapy,includingtheuseofimmunosuppressants.Treatmentoutcomeswereevaluatedbasedonbest-correctedvisualacuity(BCVA)andresponsetotreatment.·RESULTS:Ofthe52patientsincludedinthestudy,non-necrotizinganteriorscleritiswasthemostcommontypeofscleritisin22patients(42.3%),followedbyposteriorscleritisin14patients(26.9%).Themajorityofcases,31patients(59.6%),wereidiopathicinnature.Systemicassociationswerepresentin12patients(23.1%).Infectiousscleritiswasconfirmedin6patients(11.5%):3withbacterialscleritisafterpterygiumexcision,2patientswithscleritisrelatedtotuberculosisand1patientwithscleritisresultingfromherpessimplexinfection.Forthevarioussubtypesofscleritis,BCVAvaluesaftertreatmentandtimetoremissionsignificantlydiffered(P<0.05,allcases).Systemicimmunosuppressivetherapiesinadditiontosteroidswereadministeredto46.2%ofallpatients.TheT-signwaspresentonB-scanultrasonographyin9(64.3%)ofthe14posteriorscleritispatients.·CONCLUSION:Non-necrotizinganteriorscleritiswasthemostcommonsubtypeofscleritis.Finalvisualoutcomeandtimetoremissiondifferedamongthevariousscleritissubtypes.

简介：AbstractBackground:Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China.Methods:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income.Results:Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households.Conclusions:Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

简介：INTRODUCTIONPulmonaryarteriovenousfistula(PAVF)isararecongenitalpulmonaryvascularmalformationwiththeincidenceof2-3/100,000.Itistheabnormalcommunicationbetweenthepulmonaryarteryandpulmonaryvein.Theclinicalmanifestationsofthisdiseasearevarioussothatitiseasytobemisdiagnosed1.Atpresent,DSAisthegoldstandardforthediagnosisof

简介：BackgroundThevideo-assistedthoracoscopicsurgicaltechniquesarewidelyusedinthetreatmentofpatientswithcongenitalheartdiseaseswithgoodoutcomes.However,thefeasibilityandsignificanceofnursebasedearlycardiacrehabilitationincardiacintensivecareunit(ICU)forpatientswithtotallythoracoscopiccardiacoperationhasbeenseldomstudied.MethodsThirty-sixpatientswithtotallythoracoscopiccardiacoperationundertheconditionofthecardiacICUinGuangdongGeneralHospitalwererandomallocatedtotheinterventiongroupandthecontrolgroupbetweenJanuary2012toDecember2014.Thecontrolgroupreceivedstandardnursingcare,andtheinterventiongroupreceivedearlycardiacrehabilitationnursingcareinadditiontostandardcare.Theoutcomemeasuresincludedtheoxygensaturation(SpO2%),vitalcapacity,forcedexpiratoryvolumein1second(FEV1),andpaininthethoracicwound(visualanaloguescale,VAS),whichweremeasuredatthebaselineandwithin2-dayafter4-weeknursingcare.Forsafetyreason,wealsomonitoredtherateofperceivedexertion(RPE),heartrate,systemicbloodpressure.ResultsTherewerenon-significantdifferencesbetweenthegroupsinage,sex,totalnumberofcomorbidconditions,totalnumberofmedications,surgicaltime,andanesthetictime(P>0.05).Following4weekstreatment,thecardiopulmonaryfunctionsandVASscorewereimproved(P<0.05)inallgroups.Inaddition,theimprovementsweremoreintheearlycardiacrehabilitationnursecaregroupthaninthecontrolgroup(P<0.05).ConclusionTheearlycardiacrehabilitationnursingcareincardiacICUissafe,feasibleandbeneficialforpatientswithtotallythoracoscopiccardiacoperation.

简介：摘要：目的：分析Guided Care护理模式在脑卒中家庭肠内营养支持中的应用效果。方法：从我院2022年5月至2023年5月之间接收的脑卒中患者中选出50例研究对象，将其分为两组，分别应用常规护理、Guided Care护理模式进行干预，并根据观察指标调查结果，分析Guided Care护理模式的作用价值。结果：出院后6个月，研究组的NRS2002评分与PG-SGA评分均低于对照组（P＜0.05），在营养支持掌握程度对比中，研究组的各项评分均高于对照组（P＜0.05）。结论：脑卒中患者在家庭肠内营养支持期间采用Guided Care护理模式可以改善患者的营养状况，提高患者对相关营养知识的认知水平，可以在临床领域积极推广。

简介：Whilecloud-basedBPM(BusinessProcessManagement)showspotentialsofinherentscalabilityandexpenditurereduction,suchissuesasuserautonomy,privacyprotectionandefficiencyhavepoppedupasmajorconcerns.Usersmayhavetheirownrudimentaryorevenfull-edgedBPMsystems,whichmaybeembodiedbylocalEAIsystems,attheirend,butstillintendtomakeuseofcloud-sideinfrastructureservicesandBPMcapabilities,whichmayappearasPaaS(Platform-as-a-Service)services,atthesametime.Awholebusinessprocessmaycontainanumberofnon-compute-intensiveactivities,forwhichcloudcomputingisover-provision.Moreover,someusersfeardataleakageandlossofprivacyiftheirsensitivedataisprocessedinthecloud.Thispaperproposesandanalyzesanovelarchitectureofcloud-basedBPM,whichsupportsuser-enddistributionofnon-compute-intensiveactivitiesandsensitivedata.Anapproachtooptimaldistributionofactivitiesanddataforsyntheticallyutilizingbothuser-endandcloud-sideresourcesisdiscussed.Experimentalresultsshowthatwiththehelpofsuitabledistributionschemes,dataprivacycanbesatisfactorilyprotected,andresourcesonbothsidescanbeutilizedatlowercost.

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简介：Soilqualityassessmenthasbeensuggestedasaneffectivetoolforevaluatingsustainabilityofsoilandcropmanagementpractices.Theobjectiveofthisstudywastodevelopasensitivesoilqualityindex(SQI)basedonbulkdensity(BD),water-holdingcapacity(WHC),water-stableaggregates(WSA),aggregatemeanweightdiameter(AMWD),totalorganicC(TOC)andCinputtoevaluatetheimportantrice-wheatcroppingsystemonanInceptisolinIndia.Along-termexperimenthasbeenconductedfor18yearsattheIndianCouncilofAgriculturalResearch-IndianInstituteofFarmingSystemsResearch,Modipuram,India.Thetreatmentsselectedforthisstudywerecomprisedofano-fertilizercontrolandN,PandKfertilizers(NPK)combinedwithZnandSfertilizers(NPK+Zn+S),farmyardmanure(NPK+FYM),greengramresidues(NPK+GR)andcerealresidues(NPK+CR),laidoutinarandomizedcompleteblockdesignwiththreereplications.SoilsampleswerecollectedandanalyzedforBD,WHC,WSAandTOC.Correlationanalysisrevealedthatbothriceandwheatyieldssigni?cantlyincreasedwiththeincreasesinAMWD,TOCandCinput,butdecreasedwiththeincreaseinBD.TheSQIvalueswerethengeneratedbasedonregressionanalysisofBD,WSA,AMWD,TOCandCinputwithriceandwheatyieldsforthe0–15and15–30cmsoillayers,respectively.RegressionanalysesbetweencropyieldsandSQIvaluesshowedaquadratictypeofrelationwiththecoeffcientofdetermination(R~2)varyingfrom0.78to0.89.Withregardtosoilsustainability,applyingcropresiduestobothriceandwheatcouldmaintainsoilqualityforalongerperiod,whereasthehighestyieldsofboththecropswererecordedintheNPK+Zn+Streatment.Theregressionequationsdevelopedinthisstudycouldbeusedtomonitorsoilqualityinasubhumidtropicalrice-wheatcroppingsystem.

简介：摘要BACKGROUNDEarly physical rehabilitation in the intensive care unit (ICU) has been shown to improve short-term clinical outcomes but long-term benefit has not been proven and the optimum intensity of rehabilitation is not known.METHODSWe conducted a randomised, parallel-group, allocation- concealed，assessor-blinded, controlled trial in patients who had received at least 48 hours of invasive or non-invasive ventilation. Participants were randomised in a 1∶1 ratio, stratified by admitting ICU, admission type and level of independence. The intervention group had a target of 90 min physical rehabilitation per day, the control group a target of 30 min per day (both Monday to Friday). The primary outcome was the Physical Component Summary (PCS) measure of SF-36 at 6 months.RESULTSWe recruited 308 participants over 34 months: 150 assigned to the intervention and 158 to the control group. The intervention group received a median (IQR) of 161 (67-273) min of physical rehabilitation on ICU compared with 86 (31-139) min in the control group. At 6 months, 62 participants in the intervention group and 54 participants in the control group contributed primary outcome data. In the intervention group, 43 had died, 11 had withdrawn and 34 were lost to follow-up, while in the control group, 56 had died, 5 had withdrawn and 43 were lost to follow-up. There was no difference in the primary outcome at 6 months, mean (SD) PCS 37 (12.2) in the intervention group and 37 (11.3) in the control group.CONCLUSIONSIn this study, ICU-based physical rehabilitation did not appear to improve physical outcomes at 6 months compared with standard physical rehabilitation.