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41.
《Digestive and liver disease》2022,54(11):1486-1493
BackgroundCold snare polypectomy (CSP) is a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. However, the efficacy and safety of this technique remain undetermined.AimsWe aimed to comprehensively evaluate the efficacy and safety of CSP for SSPs ≥ 10 mm.MethodsPubMed, EMBASE, Web of Science and Cochrane Library were searched up to January 2021.ResultsA total of 10 studies consisting of 1727 SSPs (range, 10–40 mm) from 1021 patients were included. The overall rates of technical success, adverse events (AEs) and residual SSPs were 100%, 0.7% and 2.9%, respectively. Subgroup analysis showed that the rates of technical success and AEs were comparable between CSP and cold endoscopic mucosal resection (EMR) (99.9% vs. 100% and 1.3% vs. 0.5%, respectively), between the proximal and distal colon (100% vs. 99.9% and 0.3% vs. 0, respectively), and between polyps of 10–19 mm and ≥20 mm (99.8% vs. 100% and 0.9% vs. 0, respectively). However, subgroup analysis showed that the rate of residual SSPs was slightly lower in CSP compared with cold EMR (1.3% vs. 3.9%), as well as in polyps of 10–19 mm compared with those ≥20 mm (3.1% vs. 4.7%).ConclusionCSP was an effective and safe technique for removing SSPs ≥ 10 mm. 相似文献
42.
Comprehensive evidence regarding the treatment of non-anaemic iron deficiency in patients undergoing valvular heart surgery is lacking. This study aimed to investigate the association between non-anaemic iron deficiency and postoperative outcomes in these patients. We retrospectively analysed 321 patients of which 180 (56%) had iron deficiency (defined as serum ferritin < 100 ng.ml-1 or < 300 ng.ml-1 with transferrin saturation < 20%). While the iron-deficient group had lower pre-operative haemoglobin levels than the non-iron deficient group (median (IQR [range]) 134 (127–141 [120–172]) g.l-1, 143 (133–150 [120–179]) g.l-1, p = 0.001), there was no between-group difference in allogeneic red blood cell transfusion. Median (IQR [range]) days alive and out of hospital at postoperative day 90 was 1 day shorter in the iron-deficient group (80 (77–82 [9–85]) days vs. 81 (79–83 [0–85]) days, p = 0.026). In multivariable analysis, only cardiopulmonary bypass duration (p = 0.032) and intra-operative allogeneic red blood cell transfusion (p = 0.011) were significantly associated with reduced days alive and out of hospital at postoperative day 90. Iron deficiency did not exert any adverse influence on secondary outcomes except length of hospital stay. Our findings indicate that non-anaemic iron deficiency alone is not associated with adverse effects in patients undergoing valvular heart surgery when it does not translate into an increased risk of allogeneic transfusion. 相似文献
43.
目的 运用核磁共振弥散张量成像技术(DTI),从皮质脊髓束损伤程度评价的角度,探讨肾虚髓亏证与急性缺血性脑卒中运动功能缺损程度相关性,丰富中风病病机及证候诊断,拓宽缺血性脑卒中的中医药防治思路,为急性缺血性脑卒中肾虚髓亏证患者运动功能损伤程度提供临床依据,强调肾虚髓亏证在急性缺血性脑卒中运动功能损伤中的重要意义。方法 纳入符合诊断标准的90例病例,根据证候分别归入肾虚髓亏组和非肾虚髓亏组,每组各45例。每组患者均给予常规西药治疗。对两组患者入院后行弥散张量成像检测,同时分别于治疗前及治疗后14天,记录两组患者NIHSS评分、改良Barthel指数量表及简化Fugl-Meyer运动功能评分量表评分,比较两组病例发病时的轻重程度及治疗前后两组病例组间的恢复差异。结果 研究显示,治疗前肾虚髓亏组在NIHSS评分方面高于非肾虚髓亏组(P<0.05);治疗前肾虚髓亏组在改良Barthel指数量表及简化Fugl-Meyer运动功能评分方面低于非肾虚髓亏组(P<0.05)。治疗前后NIHSS评分、改良Barthel指数评分及简化Fugl-Meyer运动功能评分改善情况,非肾虚髓亏组要优于肾虚髓亏组(P<0.05)。治疗前两组患者在健侧内囊后肢及大脑脚外侧处FA值及ADC值无明显差异;肾虚髓亏组在患侧内囊后肢及大脑脚外侧处FA值及ADC值均低于非肾虚髓亏组(P<0.05)。相关性分析得出,两组患者患侧内囊后肢FA值与患者治疗前NIHSS评分呈负相关;两组患者患侧内囊后肢FA值与患者改良Barthel指数评分及简化Fugl-Meyer运动功能评分呈正相关;肾虚髓亏组患者患侧内囊后肢FA值与肾虚髓亏证中医证候评分呈负相关。结论 肾虚髓亏是急性缺血性脑卒中运动功能障碍的重要病机。研究结果显示,两组皮质脊髓束损伤程度与神经功能及运动功能损伤存在相关性,且肾虚髓亏组在皮质脊髓束的损伤程度方面与其中医证候评分呈负相关。 相似文献
44.
45.
《Vaccine》2022,40(16):2370-2378
Porcine reproductive and respiratory syndrome virus (PRRSV) and Mycoplasma hyopneumoniae (M. hyopneumoniae, Mhp) are two of the most common pathogens involved in the porcine respiratory disease complex (PRDC) resulting in significant economic losses worldwide. Vaccination is the most effective approach to disease prevention. Since PRRSV and Mhp co-infections are very common, an efficient dual vaccine against these pathogens is required for the global swine industry. Compared with traditional vaccines, multi-epitope vaccines have several advantages, they are comparatively easy to produce and construct, are chemically stable, and do not have an infectious potential. In this study, to develop a safe and effective vaccine, B cell and T cell epitopes of PRRSV-GP5, PRRSV-M, Mhp-P46, and Mhp-P65 protein had been screened to construct a recombinant epitope protein rEP-PM that has good hydrophilicity, strong antigenicity, and high surface accessibility, and each epitope is independent and complete. After immunization in mice, rEP-PM could induce the production of high levels of antibodies, and it had good immunoreactivity with anti-rEP-PM, anti-PRRSV, and anti-Mhp antibodies. The anti-rEP-PM antibody specifically recognizes proteins from PRRSV and Mhp. Moreover, rEP-PM induced a Th1-dominant cellular immune response in mice. Our results showed that the rEP-PM protein could be a potential candidate for the development of a safe and effective multi-epitope peptide combined vaccine to control PRRSV and Mhp infections. 相似文献
46.
47.
The research and development of penicillin started with difficulty before 1949 and achieved certain results. In 1951, after the founding of the People's Republic of China, Zhang Weishen, as the only Chinese scientist who had been trained and worked in a penicillin research and development center in the United States for many years, overcame many difficulties and returned to China. In 1953, with the efforts of Zhang Weishen and his colleagues, China realized the industrialized production of penicillin, alleviating the urgent needs of the masses. Antibiotics has also become the first discipline to achieve major scientific and technological achievements after the founding of the New China. In the mid-1950s, the technical breakthrough in the localization of lactose substitutes marked the localization of the raw materials of the penicillin-producing culture medium, which paved the way for the industrialized production of penicillin with Chinese characteristics. Antibiotics have become one of the most widely used and affordable drugs for hundreds of millions of patients in China, and China has since ended the humiliating history of the “Sick Man of East Asia". 相似文献
48.
目的:了解流动人口基层首诊现状及其影响因素,为推进流动人口分级诊疗提供实证参考依据。方法:基于2017年全国流动人口动态监测调查数据中82734名最近1次患病(负伤)流动人口数据,利用SPSS 25.0统计软件分析其基层首诊情况及影响因素。结果:82734名最近1次患病(负伤)流动人口中首选到基层医疗卫生机构就诊15936人,基层首诊率仅为19.3%;二分类logistic回归分析结果显示:年龄≥65岁、农业户口、流动时间0~5年、患慢性病、至少参加1项医疗保险,居住地到最近医疗服务机构所需时间≤15 min的流动人口患病后更愿意选择到基层首诊。学历大专及以上、家庭月均收入>10000元、市跨县、东北地区、不愿意落户、自评健康状况为不健康的流动人口患病后更不愿意选择到基层首诊。结论:流动人口患病(负伤)后选择到基层首诊率较低,年龄、受教育程度、户口类型、家庭月均总收入、流动时间、流动范围、流入地区域、落户意愿、自评健康状况、是否患慢性病、有无参加医疗保险、居住地到最近医疗服务机构所需时间是影响流动人口患病(负伤)后选择到基层首诊的主要因素。 相似文献
49.
目的 系统评价中药治疗哮喘-慢阻肺(ACO)的疗效与安全性。方法 全面检索PubMed、Cochrane Library、Web of Science、中国知网、万方、维普、中国医学文献数据库,纳入有关中医药治疗ACO的随机对照试验(RCT),运用Cochrane手册对纳入研究的方法学质量进行评估,采用Review Manager 5.3进行Meta分析。结果 共纳入32项RCT,包括2688例ACO患者,其中试验组1361例,对照组1327例。Meta分析结果显示,中医药可以显著改善ACO患者的中医证候疗效[RR=1.19,95% CI(1.13,1.25),P<0.00001]、CAT评分[MD=-3.62,95% CI(-4.37,-2.87),P<0.00001]、ACT评分[MD=3.42,95% CI(2.23,4.62),P<0.00001],、中医证候总积分[MD=-3.61,95% CI(-4.83,-2.39),P<0.00001]、FEV1[MD=0.59,95% CI(0.08,1.10),P=0.02]、FEV1%[MD=8.61,95% CI(5.20,12.1),P<0.00001]、FEV1/FVC[MD=6.52,95% CI(4.24,8.80),P<0.00001]、6 min步行实验[MD=41.18,95% CI(22.15,60.21),P<0.0001]、急性发作次数[MD=-2.46,95% CI(-3.62,-1.13),P<0.0001]。所有研究均未报道严重不良反应。结论 中药治疗ACO,可以显著提高临床疗效,改善患者的肺功能且具有较好安全性,但是需要更高质量、多样本、多中心的随机对照试验进一步确认。 相似文献
50.
《Seminars in Arthroplasty》2022,32(4):681-687
BackgroundThe objective of this study was to compare complication rates between patients undergoing reverse shoulder arthroplasty (RSA) after a prior open reduction and internal fixation (ORIF) for proximal humerus fracture (PHF) to those undergoing RSA as a primary treatment for PHFs, glenohumeral osteoarthritis, or rotator cuff tear arthropathy (CTA).MethodsPatients who underwent RSA between 2015 and 2020 were identified in the Mariner database. Patients were separated into 3 mutually exclusive groups: (1) RSA for osteoarthritis, rotator cuff tear, or CTA (Control-RSA); (2) RSA as a primary treatment for PHF (PHF-RSA); and (3) RSA for patients with prior ORIF of PHFs (ORIF-RSA). Ninety-day medical and 2-year postoperative surgical complications were identified. In addition, patients in the PHF-RSA group were subdivided into those undergoing RSA for PHF within 3 months of the fracture (acute) vs. those treated greater than 3 months from diagnosis (delayed). Multivariate regression was performed to control for differences in comorbidities and demographics.ResultsA total of 30,824 patients underwent primary RSA for arthritis or CTA, 5389 patients underwent RSA as a primary treatment for a PHF, and 361 patients underwent RSA after ORIF of a PHF. ORIF before RSA was associated with an increased risk of overall revision (odds ratio [OR] 2.45, P = .002), infection (OR 2.40, P < .001), instability (OR 2.43, P < .001), fracture (OR 3.24, P = .001), minor medical complications (OR 1.59, P = .008), and readmission (OR 2.55, P = .001) compared with the Control-RSA cohort. RSA as a primary treatment for PHF was associated with an increased risk of 2-year revision (OR 1.60, P < .001), infection (OR 1.51, P < .001), instability (OR 2.84, P < .001), and fracture (OR 2.54, P < .001) in addition to major medical complications (OR 2.02, P < .001), minor medical complications (OR 1.92, P < .001), 90-day emergency department visits (OR 1.26, P < .001) and 90-day readmission (OR 2.03, P < .001) compared with the Control-RSA cohort. The ORIF-RSA group had an increased risk of periprosthetic infection (OR 1.94, P = .002) when compared with the PHF-RSA cohort. There were no differences in medical or surgical complications in the RSA-PHF cohort between patients treated in an acute or delayed fashion.ConclusionRSA following ORIF of a PHF is associated with increased complications compared with patients undergoing RSA for nonfracture indications. Prior ORIF of a PHF is also an independent risk factor for postoperative infection after RSA compared with patients who undergo RSA as a primary operation for fracture. The timing of RSA as a primary operation for PHF does not appear to impact the rates of postoperative medical and surgical complications. 相似文献