简介：ThisarticlereviewstheeffectivenessofintratympaniccorticosteroidsforvertigocontrolinM_eni_ere'sdiseaseat2-yearsfollow-upaccordingtotheguidelinesexpressedbytheAmericanAcademyofOtolaryngology-Head&NeckSurgery.DespitetheincreaseduseofintratympaniccorticosteroidsforvertigocontrolinM_eni_ere'sdiseasethereisdebateastotheireffectiveness,particularlycomparedtogentamicin.Evenso,afterjustasinglecourseofinjections,corticosteroidscanreliablyprovidecompletevertigocontrol(ClassA)at2-yearsinabout50%ofcasesasindicatedinarecentdouble-blindrandomizedcontrolledclinicaltrial(Pateletal.,2016).Buttheeffectivenessofintratympaniccorticosteroidstrulyincreaseswhentreatmentisprovided'as-needed',wherebycompletevertigocontrolisestablishedinupto91%ofcases.Onthebasisofavailableliterature,thereisgoodevidencetorecommendtheuseofintratympanicsteroidtreatmentforvertigocontrolinM_eni_ere'sdisease,butpatientsmustbemonitoredfornon-response.Therationalefortreatingpatientsas-neededandthepossiblereasonsforcorticosteroidnonresponsearediscussed.

简介：Cardiovasculardisease(CVD)anddepressionandanxietycontributesubstantiallytothecurrentdiseaseburdenworldwideaswellasinChina.BothdepressionandanxietyarehighlyprevalentamongpatientswithCVD.WesystematicallyreviewedtheliteraturetodisentangletheroleofdepressionandanxietydisordersintheonsetandprognosisofCVDwithanemphasisoncohortstudiesconductedintheChinesepopulation.Despitethelackoflarge-scaleprospectivestudiesinChina,theavailableevidenceimpliesthatbothdepressionandanxietyarecloselyassociatedwiththeonsetandprognosisofCVD,includingischemicheartdiseaseandstroke,inChineseadults.Putativebehavioralandbiologicalmechanismsareimplicatedinthelinkbetweendepression/anxietyandCVD.TimelyscreeninganddiagnosisfollowedbypropertreatmentshouldbeimplementedfordepressionandanxietyinboththegeneralpopulationandpatientswithCVD.CurrentstandardtreatmentssuchasselectiveserotoninreuptakeinhibitorsandpsychotherapiesarerecommendedforCVDpatientswithdepression,althoughtheirefficacyforreducingCVDmorbidityandmortalityremainsuncertain.Inconclusion,prospectivestudiesonthelinkbetweendepression/anxietyandtheonsetandprognosisofCVDareurgentlyneededintheChinesepopulation,andmoreeffortsarewarrantedtoexaminetheefficacyofdepressionandanxietytreatmentsforCVDpatients,particularlytheintegratedcaremodelofincludingpsychiatristsinamultidisciplinaryclinicalgroup.

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简介：BackgroundPulseoximetryscreening(POS)hasbeenproposedasaneffective,noninvasive,inexpensivetoolallowingearlierdiagnosisofcriticalcongenitalheartdisease(CCHD).However,mostneonatesaredischargedfromthehospitalwithoutthisevaluationinChina.ThisstudyaimedatassessingthefeasibilityofPOSfornewbornsindetectingCCHDinthedepartmentofobstetricsandneonatalintensivecareunit(NICU).MethodsPOSwasperformedin355neonatesborninthedepartmentofobstetricsoradmittedtotheNICUbetweenJanuary2015andJune2015.Theseneonatesweredividedintonormalgroup,mildcongenitalheartdiseasegroup(MCHD)andCCHDgroup,accordingtotheresultofechocardiographyorcomputerizedtomography(CT).Thegestationalage,birthweightandarterialoxygensaturation(SpO_2)werecomparedamongthethreegroups.TheSpO_2valueanddiagnosistimeoftheCCHDcaseswereclassifiedandanalyzed.ResultsTheprematurebirthandlowbirthweightwerethehighriskfactorsofmildcongenitalheartdisease.Therewasnodifference(P>0.05)inSpO_2betweentheMCHDgroupandthenormalgroup.SignificantdifferenceintheSpO_2appearedbetweentheCCHDgroupandthenormalgroup(P<0.05).CombinationofPOSandclinicalexaminationcanreducethemissingdiagnosisrateinscreeningforCCHD.ConclusionsPOSincursverylowcostandriskofharmandisnotrequiredforspecialtraining,therefore,aneffectivewaytoidentifyCCHDinneonates.

简介：目的:观察推拿和呼吸体操治疗对缓解期慢性阻塞性肺病患者肺功能、呼吸困难、运动能力和生活质量的影响.方法:缓解期慢性阻塞性肺病患者66例,随机数字表法分为2组,推拿组(n=33)和对照组(n=33),治疗3个月.治疗前后进行呼吸困难、生活质量评分和肺功能、6min步行测试.结果:推拿组,肺功能观察指标显著改善;对照组,肺功能改善不明显.两种方法对生活质量均有提高,但推拿疗法优于呼吸体操.两种方法均能增加患者6min步行距离,均能改善呼吸困难,但两者差异无显著意义.结论:两种治疗方法显示对缓解期慢性阻塞性肺病患者呼吸困难、生活质量、运动耐受能力和肺功能有着较好的治疗效果,特别是推拿治疗对缓解期慢性阻塞性肺病的肺功能和生活质量的影响优于对照方法.

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简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

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简介：AbstractAge-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers’ understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.

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简介：AIM:Toanalyzethepotentialrelationshipbetweengastroesophagealrefluxdisease(GERD)andthedevelopmentofatrialfibrillation(AF).METHODS:Usingthekeywords'atrialfibrillationandgastroesophagealreflux','atrialfibrillationandesophagitis,peptic','atrialfibrillationandhernia,hiatal'thePubMed,EMBASE,CochraneLibrary,OVIDSP,WILEYdatabaseswerescreenedforrelevantpublicationsonGERDandAFinadultsbetweenJanuary1972-December2013.StudieswritteninlanguagesotherthanEnglishorFrench,studiesnotperformedinhumans,reviews,casereports,abstracts,conferencepresentations,letterstotheeditor,editorials,commentsandopinionswerenottakenintoconsideration.ArticlestreatingthesubjectofradiofrequencyablationofAFandtheconsecutivedevelopmentofGERDwerealsoexcluded.RESULTS:Twothousandonehundredsixty-onetitleswerefoundofwhich8articlesmettheinclusioncriteria.ThepresenceofAFinpatientswithGERDwasreportedtobebetween0.62%-14%,highercomparedtothosewithoutGERD.EpidemiologicaldataprovidedbytheseobservationalstudiesshowedthatpatientswithGERD,especiallythosewithmoresevereGERD-relatedsymptoms,hadanincreasedriskofdevelopingAFcomparedwiththosewithoutGERD,butacausalrelationshipbetweenGERDandAFcouldnotbeestablishedbasedonthesestudies.ThemechanismsofAFasaconsequenceofGERDremainlargelyunknown,withinflammationandvagalstimulationplayingapossibleroleinthedevelopmentofthesedisorders.TreatmentwithprotonpompinhibitorsmayimprovesymptomsrelatedtoAFandfacilitateconversiontosinusrhythm.CONCLUSION:AlthoughlinksbetweenAFandGERDexist,largerandomizedclinicalstudiesarerequiredforabetterunderstandingoftherelationshipbetweenthesetwoentities.

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简介：Objective:Toobservetheclinicalefficacyofacupuncture-moxibustionintreatingAlzheimer’sdisease(AD).Methods:Forty-eighteligibleADpatientswereenrolledtoreceiveacupunctureplusherb-partitionedmoxibustion.Mini-mentalstateexamination(MMSE)wasadoptedforevaluationbeforeandafterintervention,andthetherapeuticefficacywasobserved.Results:Afterintervention,theMMSEscorechangedsignificantly(P<0.01),andthetotaleffectiveratewas83.3%.Conclusion:Acupuncture-moxibustioncansignificantlyimprovethecognitivefunctionofADpatients,beneficialtothegeneralpromotionofthequalityoflife.

简介：AbstractPeyronie’s disease (PD) is a benign, progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea (TA) of the penis. This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines, cell signaling pathways, biochemical mechanisms, genetic factors responsible for fibrogenesis. A growing body of literature has shown that PD is a chronically impaired, localized, wound healing process within the TA and the Smith space. It is caused by the influence of different pathological stimuli, most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features, imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP), and suppressed antioxidant systems during chronic inflammation. Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling. The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.

简介：Hirschsprungs疾病是现场发生在1:5000的先天的混乱出生。它被伤寒神经原的缺席沿着胃肠的道的一个可变区域描述。Hirschsprungs疾病作为multigenic混乱被分类，因为一样的显型在多重不同基因与变化被联系。而且，Hirschsprungs疾病的遗传高度复杂、不严格地孟德尔。在Hirschsprungs疾病观察的phenotypic可变性和不完全的外显率也建议修饰词基因的参与。这里，我们总结基于人和动物研究位于Hirschsprungs疾病下面的遗传的当前的知识，集中于修饰词基因的主要原因的基因，他们的相互作用，和角色。

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