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Scrub typhus is a type of natural focal disease caused by a bacteria called Orientia tsutsugamushi and mainly en-demic in East and Southeast Asia.The most common clinical symptoms of scrub typhus include fever,eschar,ulcer,lymph node enlargement and rash,which are not typical on early stage and could easily lead to misdiagnosis and missed diagnosis.By reviewing relevant guidelines and references at home and abroad,combining clinical diagnosis and treatment experiences in Chi-na,the experts from Biodiagnostic Technology Branch of China Medical Biotechnology Association and Chinese Society of Mi-crobiology Committee on Zoonotic Pathogens formed this consensus on the clinical diagnosis and treatment of scrub typhus.
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ObjectiveTo explore the role of efficacy evaluation methods in providing evidence for traditional Chinese medicine （TCM） clinical practice guidelines based on a demonstration study of clinical efficacy evaluation of TCM for allergic rhinitis （AR），aiming to enrich the sources of evidence for guideline development. MethodReal-world data of TCM medication for AR were collected and efficacy evaluation was carried out. SPSS 16.0 software was used to calculate the conformity of clinical syndromes，main prescriptions， and medications to the guidelines. Correlation analysis of efficacy and medications was performed according to guideline conformity to compare the differences in medications between real-world clinical applications and current guidelines. ResultA total of 198 cases were collected and the clinical medications were compared with the relevant guidelines for AR. It was found that the clinical syndrome conformity was above 70%，and in addition to the guideline syndrome，there were also syndromes in six meridians and other mixed syndromes in clinical practice. The guideline conformity of the main prescriptions used in clinical practice showed a positive correlation trend with efficacy. There were some differences between the commonly used drugs in clinical practice and those recommended by the guidelines. For example，for lung Qi deficiency and cold syndrome，drugs such as Angelicae Dahuricae Radix， Magnoliae Flos， and Schisandrae Chinensis Fructus were often used. For kidney Yang deficiency syndrome，drugs such as Atractylodis Macrocephalae Rhizoma and Ostreae Concha were often used. For spleen Qi deficiency and weakness syndrome，drugs such as Poria， Cinnamomi Ramulus， and Magnoliae Flos were used. For lung Qi deficiency and cold syndrome in children，drugs such as Chebulae Fructus， Cicadae Periostracum， Zingiberis Rhizoma， and Ginseng Radix et Rhizoma were used. For lung and spleen Qi deficiency syndrome，drugs such as Dioscoreae Rhizoma， Menthae Haplocalycis Herba， Amomi Fructus， and Zingiberis Rhizoma were used. There were also some differences in the commonly used drugs for adults and children. For example，for lung Qi deficiency and cold syndrome，adults often used Angelicae Dahuricae Radix， Magnoliae Flos， and Tribuli Fructus，while children often used Ginseng Radix et Rhizoma， Paeoniae Radix Alba， and Poria. For lung meridian hidden heat syndrome， adults often used Bupleuri Radix， Asari Radix et Rhizoma， Pinelliae Rhizoma， and Xanthii Fructus， while children often used Houttuyniae Herba， Menthae Haplocalycis Herba， Citri Reticulatae Pericarpium， and Massa Medicata Fermentata. ConclusionEffective medication regimens can be screened out based on efficacy evaluation methods，which can help supplement immediate， objective， and clinically relevant evidence of medication for the development of clinical practice guidelines in TCM from the perspective of clinical effectiveness.
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Children are also at high risk of novel coronavirus infection. However, as children are in the developmental stage and their phylogeny is not yet complete, adult guidelines cannot be directly copied in the diagnosis and treatment of SARS-CoV-2 infection in children. Therefore, The Second Affiliated Hospital of Xi’an Jiaotong University organized relevant professionals of Children’s Hospital. Based on the "Diagnosis and Treatment Plan for SARS-CoV-2 Infection (Trial 10th Edition)" issued by the General Office of the National Health Commission of the State Administration of Traditional Chinese Medicine, the diagnosis and treatment plan suggestions for children with novel coronavirus infection in The Second Affiliated Hospital of Xi’an Jiaotong University were formulated by referring to several instructive diagnosis and treatment plans and combining our hospital’s experience in treating children with SARS-CoV-2 infection. This recommendation makes a concise and practical description from the perspectives of epidemiology, clinical manifestations, clinical typing, treatment and nursing of children infected with SARS-CoV-2, and also makes recommendations for the diagnosis and treatment of high-risk factors and complications for the reference of front-line clinical pediatricians so as to achieve timely and reasonable diagnosis and treatment of children infected with SARS-CoV-2. Early identification and active treatment of high-risk and critically patients can minimize the harm caused by complications.
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Breast cancer is the most common malignant tumor of women, which seriously threatens women's health. Albumin-bound paclitaxel is the basic chemotherapy drug for breast cancer treatment. We can promote reasonable clinical medication and improve patients' quality of life by standardizing chemotherapy plans, rationally optimizing treatment strategy and managing adverse reactions of albumin-bound paclitaxel. In order to standardize the clinical application of albumin-bound paclitaxel in breast cancer, Chinese Medical Doctor Association Oncologist Branch Breast Cancer Group and International Medical Exchange Branch of China Anti-Cancer Association consulted guidelines and the latest evidence-based evidences and formulated Chinese expert consensus of albumin-bound paclitaxel in the treatment of breast cancer to provide reference for clinical diagnosis and treatment of breast cancer. The consensus mainly introduces the clinical application strategies and evidence-based evidences of albumin-bound paclitaxel in advanced therapy, neoadjuvant therapy and adjuvant therapy of breast cancer. Among them, the regimens containing albumin-bound paclitaxel are the better recommended regimens for preoperative neoadjuvant and advanced rescue therapy of breast cancer. However, there is little evidence in adjuvant therapy, so it is recommended to use albumin-bound paclitaxel cautiously. We also invited breast cancer clinical experts to vote on some controversial issues, including but not limited to the usage and dosage of albumin-bound paclitaxel, combined medication and management of peripheral neuropathy, and formed consensus recommendations for the reference of breast cancer clinical workers.
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Female , Humans , Albumin-Bound Paclitaxel/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Consensus , East Asian People , Quality of LifeABSTRACT
Objective A knowledge graph construction pipeline of traditional Chinese medicine(TCM)diagnosis and treatment was designed and applied,aiming at the automatic construction of the"disease-symptom-pathogenesis-and medicine"knowledge graph based on the medical records of famous TCM physicians,to analyze,organize and present medical records efficiently.Methods Firstly,The entity extraction method of medical records combining Deep Learning and Regular Expression was designed to extract disease,symptom,pathogenesis,and TCM entities from unstructured medical records automatically;secondly,entity relationships were defined and the correlations between entities were calculated using HAN method,and then the"entity-relation-entity"triplets were built;the graph database Neo4j and Gephi were used for knowledge storage and visual display separately;Finally,the application was verified in the Medical records of lung cancer treated by the old famous TCM physicians.Results The precision,Recall and F1 of the knowledge extraction model for medical records entities extraction are 88.49%,90.02%and 89.25%,respectively,and each index is better than the comparison methods.A total of 1077 triples are extracted through entity correlation calculation,and the knowledge graph is successfully constructed.It can reflect the relationship between 'disease-symptom-pathogenesis-medicine' in the treatment of lung cancer by the famous specialists of TCM.Conclusion The method in this paper can effectively solve the extraction,organization and expression of clinical medical records of famous TCM physicians,and realize the automatic construction process from the text of medical records to the knowledge graph.Relevant research ideas and methods proposed in this paper could provide a reference for the construction of the diagnosis and treatment knowledge graph of famous TCM physicians based on medical records.
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Chyle leak or chyle ascites is a specific form of lymphatic leakage after radical laparoscopic colorectal cancer surgery,the incidence of which has been reported in the literature to be 1％-6.5％,leading to the development of hydropower imbalance,malnutrition,impaired immune function,prolonged hospital stay and even an impact on oncological prognosis.Different surgical sites,number of lymph nodes dissected,duration of surgery,prognostic nutritional index,metastasis of the main lymph nodes,operator and age are risk factors for postoperative chyle leak in colorectal cancer.It usually occurs 4-8 days after surgery and is characterized by a sudden increase of drainage after eating which is milky,odourless and tasteless,and may be combined with abdominal pain,bloating and increased body temperature.After prolonged chyle leak,patients may develop water-electrolyte disturbance,malnutrition and hypoproteinemia.The chyle test is useful in the qualitative diagnosis of chyle leak and can be performed to detect triglyceride concentrations.Conservative treatment is the preferred treatment strategy for chyle leak,and if conservative treatment fails,surgery may be considered.Knowledge of the distribution pattern of colorectal lymphatic drainage and precise control of lymph node dissection are key measures to prevent chyle leak after laparoscopic colorectal cancer surgery.
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For the issues including inadequate ability for clinical diagnosis and treatment during the training of professional postgraduate students in neurology, this article elaborates on the importance of the application of multidisciplinary team (MDT) teaching from the aspects of the necessity of MDT teaching in the training of professional postgraduate students in neurology and the implementation scope, implementation process, implementation examples, and preliminary teaching results of MDT teaching, so as to provide experience for improving the clinical diagnosis and treatment ability of professional postgraduate students in neurology.
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Based on the difference between disease and syndrome differentiation of acupuncture and moxibustion and each department of TCM, i.e. internal medicine, external medicine, gynecology and pediatrics, it is believed that "differentiation of disease location" is the key of disease and syndrome differentiation of acupuncture and moxibustion. According to the disease location, in the section "treatment" of Science of Acupuncture and Moxibustion, the disorders/illness are classified as zangfu disorder, disorders of limbs and meridians, dermatological disorder, ophthalmological and otorhinolaryngological disorder, gynecological disorder, as well as qi, blood and body fluid disorder. Besides, the rules of disease and syndrome differentiation, as well as treatment characteristics of each category are explained separately. It is considered that the clinical diagnosis and treatment system of acupuncture and moxibustion should be constructed by focusing on "differentiation of disease location".
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Child , Humans , Acupuncture , Acupuncture Therapy , Meridians , Moxibustion , SyndromeABSTRACT
Narrative Medicine to achieve high-quality development on the basis of systematic education effectiveness, it also needs to promote the implementation of clinical diagnosis and treatment practice. Based on the review and analysis of the clinical practice of narrative medicine, the research team will continue to deepen the integration of narrative medicine and palliative care practice, and then demonstrate the compatibility of the two disciplines, to provide thoughts for the clinical diagnosis and treatment practice research of narrative medicine; pay attention to excavate and sort out the existing local clinical practice experience of narrative medicine, and feed back to medical education and practice. This paper demonstrated the compatibility of narrative medicine and palliative care, including the unique value of narrative medicine in the realization of palliative care, the theoretical basis and logic of narrative medicine education, the tools and paths of implementing narrative palliative care, the compatibility of the two subjects in the applicable fields, and the compatibility of the value levels of the two disciplines.
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Objective:To compare the clinical characteristics, clinical efficacy and adverse drug reactions of rheumatoid factor (RF) positive (+ ) and negative (-) polyarticular juvenile idiopathic arthritis (PJIA).Methods:The clinical data of 67 PJIA patients admitted into Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2013 to December 2018 were analyzed retrospectively.They were divided into RF-positive PJIA group [RF (+ ) group, 23 cases] and RF-negative PJIA group [RF (-) group, 44 cases] according to RF titer.The clinical characteristics, laboratory indexes and clinical efficacy evaluation of the two groups were compared.Results:(1)Distribution of affected joints: the top 3 affected joints in the RF (+ ) group were the knuckles (16 cases, 69.57%), the wrists (15 cases, 65.22%) and the ankles (13 cases, 56.52%), and those in the RF (-) group were the knees (33 cases, 75.00%), ankle joints (29 cases, 65.91%) and hip joints (26 cases, 59.09%). The wrist joint involvement of the RF (+ ) group was significantly higher than that of the RF (-) group, while the knee joint involvement was lower than that of the RF (-) group.The difference was statistically significant (all P<0.01). (2)Magnetic resonance changes of the affected joints: articular cavity effusion (54 cases, 84.38%), synovial thickening (44 cases, 68.75%) and bone edema (26 cases, 40.63%) are common in both groups.The incidence of bone destruction (7 cases, 70.00%) and soft tissue edema (7 cases, 70.00%) in the RF (+ ) group was higher than that in the RF (-) group (2 cases, 18.18% and 2 cases, 18.18%), the difference was statistically significant (all P<0.05). (3) Changes in laboratory indicators: the positive rates of C-reactive protein, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibody and anti-nuclear antibody in the RF(+ ) group were significantly higher than those in the RF(-) group, the difference was statistically significant (all P<0.05). (4)Juvenile arthritis disease activity score 27 (JADAS27): the score difference between RF(+ ) group and RF(-) group was not statistically significant [(22.83±5.60) scores vs.(23.07±6.66) scores, t=0.148, P>0.05]. (5) Efficacy analysis: 2 patients were lost to follow-up after discharge, and the remaining 65 patients were treated with traditional therapy, of which 30 were given biologics at the first hospitalization, 9 cases were treated with biologics after the failure of traditional treatments, and 35 patients were treated with biologics to control disease activity.In different dosage regimens, the disease remission rate in the RF(-) group is generally higher than that in the RF(+ ) group. Conclusions:PJIA patients have complicated joint involvement, RF-positive patients are more prone to joint destruction, and traditional treatments are less effective.Biological agents can effectively improve the symptoms of severe PJIA patients, especially those with poor prognosis.
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Objective:To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods:The data were collected by consulting the patient′s detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient′s peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results:The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered.Conclusion:Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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2021 is the 100th anniversary of the founding of the Communist Party of China and the 40 thanniversary of the founding of Chinese Urology Association (CUA). In compliance with the "Plan of Healthy China 2030" , we are ready to gather strength to march again, put forward the slogan "Nourishing Elite to Promote Urology, Aiming High to Forge Ahead" , and scale new heights courageously. With training elite urological talents and developing excellent scientific researches and medical projects as the engine, we will promote the rapid development of Chinese urology, and further achieve the lofty goal of leading Asia and catching up with the international community in the 50 th anniversary of the founding of CUA. In order to achieve this ambitious vision, CUA unites the strength of Chinese urologists to work together on six major tasks: leading academics, strengthening research, cultivating talents, enhancing clinical practice, public welfare and international communication. Alliances in urology should cooperate sincerely and work hand in hand to contribute to the prosperity of urology in China.
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@#Patients seeking implantation often have several systemic diseases, which will introduce complications to treatment. This paper reviews the risk assessments and prevention of systemic diseases in patients with oral implant therapy with the relevant literature. The patients with cardiovascular diseases are prone to stroke and cardiac arrest, and anticoagulants and antihypertensive drugs will complicate cases. The potential risks of endocrine system diseases are infections and crises caused by unstable hormone levels. The risks of respiratory diseases are dyspnea and swallowing devices. The difficulty of treating patients with neuropsychiatric diseases is attributable to poor cooperation and adverse effects of the drugs. Bone and joint system diseases may decrease the success of implantation. Hematological system, digestive system and kidney diseases may lead to hemorrhage. By inquiring about detailed medical and medication history, evaluating vital signs and detecting important objective indicators, performing targeted measures, discussing with specialists, and observing patients closely, clinicians can avoid the abovementioned risks.
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@#Objective To improve the understanding and provide a reasonable plan for clinical diagnosis and treatment of TRE(TSC-related epilepsy,TRE),by analyzing the clinical and genetic characteristics of TRE as well as the treatment effect about medication and surgery.Methods We analyzed the video EEG,imaging,pathology,genetic characteristics,and treatment effect of 10 patients retrospectively.These patients with refractory epilepsy were diagnosed and treated by our epilepsy center from November 2014 to November 2019.The clinical and genetic characteristics of TRE were summarized.Results There were 3 females,7 males,4 patients with seizures before 3 years old,5 patients with seizures from 3 to 6 years old and 1 at 19 years old.There were 5 cases of spastic seizures and 5 cases of focal seizures.The Video EEG showed that 7 patients have epileptiform discharge site located on one side brain hemisphere and 3 patients about both side.Imaging results showed 4 cases of unilateral subventricular or subcortical nodules,5 cases of bilateral abnormalities,and 1 case of Dandy-Walker deformity.Pathology showed brain tissue section of 4 patients with six-story structure disappearance and immature neurons appearance.Genetic testing revealed 5 cases of TSC1 mutations,5 cases of TSC2 mutations,7 cases of family mutations,and 4 cases of surgical patients were nonsense mutations.The treatment effect about 3 patients of Rapamycin improved than before significantly.Conclusion TRE patients usually fall ill in early age,more males than females,mainly spastic and focal seizures.The Video EEG showed epileptiform discharge site located on one side brain hemisphere.Gene testing is useful for treatment.The type of mutation may be related to the degree and location of brain lesions and the origin of the discharge,but there is no significant correlation between the discharge site recorded on the EEG and the abnormal imaging site.Therefore,genetic testing should be considered when clinical treatment is not improvement.
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In clinic, two or more cranial neuropathy is defined as combined hyperactive dysfunction syndrome; combined hyperactive dysfunction syndrome is extremely rare and systemic reports about the syndrome are rather sparse. This article focuses on the pathogenesis, clinical features, surgical treatments and prognoses of combined hyperactive dysfunction syndrome to deepen their understanding and provide evidence for clinical diagnoses and treatments.
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The paper aims to explore clinical symptoms and complication characteristic of lung cancer complicated with pneumothorax, analyze clinical diagnostic value of VATS, and elaborate on specific clinical programs and significance. To investigate diagnosis and therapeutic value of VATS for lung cancer complicated with pneumothorax, 1900 cases of patients with lung cancer complicated with pneumothorax were randomly selected as research objects to be treated with VATS, and then analysis of their clinical data was done. The clinical data showed that many patients were not clearly diagnosed before operation. In VATS operation, lung tumor tissue was removed and then immediately frozen and sliced. Appropriate surgical approach was chosen based on specific circumstances of patients. As can be known from the results, 1000 cases were treated with wedge resection of lung tumor under thoracoscopy, 900 cases were treated with assisted small incision surgery under thoracoscopy. 1400 cases of lung metastasis were treated with pleural friction fixation. All the operations were successful, with pathology being clearly diagnosed. After surgery, 8 patients had mild air leakage, which could be heal without special treatment. There was no perioperative death. The above analysis shows that VATS can clearly diagnose peripheral lung tumor, and fundamentally cure pneumothorax and lung cancer, which is thus recommended in clinic.
o artigo pretende explorar sintomas clínicos e complicações características do câncer de pulmão complicado com pneumotórax, analisar o valor do diagnóstico clínico do VATS e elaborar programas e significados clínicos específicos. Para investigar o diagnóstico e valor terapêutico do VATS para câncer de pulmão complicado com pneumotórax, 1900 casos de pacientes com câncer de pulmão complicado com pneumotórax foram selecionados aleatoriamente como objetos de pesquisa para serem tratados com VATS e, em seguida, foi feita a análise de seus dados clínicos. Os dados clínicos mostraram que muitos pacientes não foram corretamente diagnosticados antes da operação. Na operação VATS, o tecido do tumor pulmonar foi removido e imediatamente congelado e cortado em fatias. A abordagem cirúrgica apropriada foi escolhida com base em circunstâncias específicas dos pacientes. Como pode ser conhecido a partir dos resultados, 1000 casos foram tratados com ressecção em cunha do tumor pulmonar sob toracoscopia, 900 casos foram tratados com cirurgia de incisão pequena assistida sob toracoscopia. 1400 casos de metástases pulmonares foram tratados com fixação de fricção pleural. Todas as operações foram bem-sucedidas, sendo a patologia claramente diagnosticada. Após a cirurgia, 8 pacientes apresentaram vazamento de ar leve, que pode ser curado sem tratamento especial. Não houve morte perioperatória. A análise acima mostra que a VATS pode diagnosticar claramente o tumor pulmonar periférico, e fundamentalmente curar pneumotórax e câncer de pulmão, o que é recomendado na clínica.
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Pneumothorax , Thoracic Surgery, Video-Assisted , Lung Neoplasms , Clinical Diagnosis , Conservative TreatmentABSTRACT
Real world clinical diagnosis and treatment activity is a complicated decision-making task. The effective clinical cases of traditional Chinese medicine (TCM) of highly experienced physicians play an important role in the routine diagnosis and treatment and the formulation of medical knowledge . Based on TCM electronic medical record data, this paper proposed a decision support prototype system on TCM clinical diagnosis and treatment based on TCM effective clinical cases and case-based reasoning (CBR) algorithm, which is used to assist inexperienced clinicians to make more reliable clinical decisions, and thereafter to improve the clinical curative effectiveness. The system integrates TCM clinical cases data set from a TCM clinical data warehouse, and retrieves the similar cases based on CBR method. In particular, according to the underlying personalized diagnosis and treatment for patients in TCM, this system implemented a flexible diagnosis and treatment modification mechanism based on correlation analysis among symptoms, diagnoses (syndrome or pattern in TCM) and medicine. Finally, through a demonstration of clinical application, we made an initial evaluation of the usefulness and practical effects of the system.
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In order to achieve the demand of clinical diagnosis,treatment and research based on TCM clinical literature,we conducted the questionnaire to doctors of Chinese medicine on their demands for medical information in the process of clinical diagnosis and treatment,hoping to make certain the direction and service methods of TCM clinical research database from the actual demands of doctors.
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This article explored dampness disease from several aspects of characteristic,relation between endogenous dampness and exogenous dampness,syndrome differentiation,recognition of the disease by ancient doctors,relation between dampness and the five internal organs,and the treatment of dampness disease.
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Objective To discuss the optimal clinical diagnosis and treatment of ectopic ACTH syndrome with occult tumors. Methods Clinical features, imaging examinations and treatment of 17 patients with ectopic ACTH syndrome were described and compared. Results All patients illustrated the typical clinical features of Cushing’s syndrome. They had hypokalemic alkalosis, elevated serum cortisol and plasma ACTH levels. In the high-dose dexamethasone suppression tests, most patients failed to suppress serum cortisol and 24-hour urinary cortisol. CT and MRI are useful imaging modalities to localize the ACTH-secreting tumor in patients with ectopic ACTH syndrome. The patients with overt ACTH-secreting tumors had surgical curative resection soon after diagnosis. Among patients with occult ACTH-secreting tumors, three underwent subtotal bilateral adrenalectomy, two underwent right adrenalectomy, four received inhibitor of steroidogenesis aminoglutethimide. Their hypercortisolism was controlled. Conclusion Surgical curative resection is the optimal treatment of ectopic ACTH syndrome with overt ACTH-secreting tumor. Bilateral adrenalectomy, right adrenal ectomy or chemotherapy to control hypercortisolism is an available treatment of ectopic ACTH syndrome with occult ACTH-secreting tumors.