A Retrospective Study on the Characteristics of Traditional Chinese Medical Syndromes in 3088 Cases of Atherosclerotic Cerebral Infarction / 中医杂志

ObjectiveTo investigate the characteristics of traditional Chinese medicine syndrome and the evolution of pathogenesis in different stages of atherosclerotic thrombotic cerebral infarction （ATCI）. MethodsClinical data of 3088 ATCI patients from 8 hospitals in 6 provinces and cities were collected from the hospital information system during January 1， 2015 to December 31， 2019. After staging and counting clinical symptoms， common factors were extracted using the principal component analysis method in factor analysis. Cluster analysis was then carried out on the basis of the factor analysis. The results of the combination of the evidence element identification， cluster analysis and expert discussion were used to discuss the evidence of the different disease stages of atherosclerotic cerebral infarction. ResultsOf the 3088 ATCI patients included， 2290 cases were in the acute phase and 798 in the non-acute phase. Excluding the main symptoms of ischaemic stroke， such as numbness and weakness of limbs， unfavourable movement， unfavourable speech and dizziness， we identified 84 indicators with a frequency ≥5% of the four diagnostic information variables. Of these， 36 indicators were observed in the acute phase and 35 in the non-acute phase. Factor analysis extracted 14 common factors from each phase. We selected factors with a loading coefficient ＞0.3 for evidence determination. These 14 groups of common factors were used as variables for clustering. After clustering， the acute， non-acute phase were each divided into 5 categories. Based on a combination of clinical practice and expert opinion， the symptoms identified in the acute period were syndrome of deficiency of both qi and yin， syndrome of blockade of wind-phlegm-static blood （36.07%）， syndrome of qi deficiency and blood stasis （20.74%）， syndrome of upward disturbance of wind-fire （15.15%）， syndrome of stirring wind due to yin deficiency （9.43%）， and syndrome of spleen deficiency and liver hyperactivity （3.80%）. In the non-acute phase， the symptoms were qi and yin deficiency with syndrome of qi stagnation and blood stasis （45.49%）， syndrome of deficiency of both qi and yin （20.05%）， syndrome of qi stagnation and blood stasis （16.42%）， spleen-kidney deficiency syndrome （8.52%）， and syndrome of hyperactivity of liver yang （4.89%）. ConclusionThe acute phase of AICI is mainly characterized by blood stasis， fire， internal wind， hyperactivity of yang， qi deficiency and yin deficiency， while the non-acute phase is characterized by yin deficiency， qi deficiency， blood stasis and qi stagnation. The main pathomechanism of ATCI involves deficiency of qi and yin， as well as obstruction of the channels by phlegm and blood stasis， and the fundamental pathomechanism is deficiency of qi and yin.

Systematic review of efficacy and safety of fondaparinux in the treatment of non-ST-elevation acute coronary syndrome in China / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of fondaparinux versus low molecular weight heparin（nadroparin，enoxaparin）in the treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS）. METHODS The computer searched PubMed ，Medline，Embase，EBSCO，CNKI，Wanfang medical network ，VIP Chinese Journal Full-text Database and relevant clinical trial registration network for the clinical retrospective cohort study （RCS）of fondaparinux （as trial group）and low molecular weight heparin （natroparin，enoxaparin）（as control group ）in the treatment of NSTE-ACS. The retrieval time limit was from the establishment of the database to August 2021. Newcastle Ottawa scale （NOS）was used to evaluate the quality of literature. Outcome indicators included primary efficacy indicators （incidence of acute myocardial infarction and recurrent angina pectoris during hospitalization ），secondary efficacy indicators [revascularization of target vessels during 话：0835-2862024。E-mail：xiexingxing07@163.com hospitalization， prothrombin time （PT）， activated partial thromboplastin time （APTT）]，safety indicators （incidence of serious cardiovascular events ，severe bleeding ，slight bleeding and severe puncture site co mplications during hospitalization ），combined endpoint indicators （30 and 180 days combined endpoint）. RevMan 5.3 software was used for Meta-analysis of each effect index. RESULTS Finally，17 RCS articles were included，involving 4 946 patients with NSTE-ACS ，including 2 507 in the trial group and 2 439 in the control group.The results of NOS literature quality evaluation showed that there were 8 high-quality studies ，accounting for 47.06％ . The results of Meta-analysis showed that there was no significant difference in the incidence of acute myocardial infarction ，recurrent angina pectoris，revascularization of target vessels ，PT and serious cardiovascular events between 2 groups （P＞0.05）；there was significant difference in the APTT （MD＝1.34，95％CI of 0.22-2.45，P＜0.05），the incidence of severe bleeding （RR＝0.47， 95％CI of 0.30-0.74，P＜0.05），the incidence of slight bleeding （RR＝0.48，95％CI of 0.32-0.71，P＜0.05），the incidence of severe puncture site complications （RR＝0.48，95％CI of 0.25-0.95，P＜0.05），30 day combined endpoint （RR＝0.57，95％CI of 0.46-0.72，P＜0.05），180 days combined endpoint （RR＝0.73，95％CI of 0.54-0.98，P＜0.05）. CONCLUSIONS Fondaparinux in the treatment of NSTE-ACS in China has the same efficacy as low molecular weight heparin （nadroparin，enoxaparin），and has more obvious advantages in drug safety such as bleeding ，severe puncture site complications.

Facilitating access to pneumococcal vaccine for people living with HIV: an experience report / Como facilitar el acceso a la vacuna neumocócica a las personas que viven con el VIH: informe de una experiencia / Facilitando o acesso à vacina pneumocócica para pessoas vivendo com HIV: relato de experiência

ABSTRACT The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.

RESUMEN El artículo describe una estrategia para facilitar el acceso a la vacuna neumocócica conjugada 13 (PCV-13) a las personas que viven con VIH/SIDA (PVVS) durante la pandemia de COVID-19. Método: relato de experiencia sobre la organización de un servicio de atención a las PVVS en la ciudad de São Paulo, para facilitar el acceso a la PCV-13 en el marco de la campaña de vacunación contra la gripe de 2020, durante la pandemia de COVID-19. Resultados: a través de la integración entre un servicio de atención a las PVVS y un Centro de Inmunización (CRIE), fue posible ofrecer la PCV-13 a las PVVS en su punto de atención, reduciendo las barreras físicas para el acceso a la inmunización. Así, de las 1.906 PVVS que pasaron por el servicio durante el periodo comprendido entre el 23 de marzo y el 31 de julio de 2020, el 84,4% (1.609) recibieron la vacuna de la gripe, la PCV-13 o ambas. De los 1609 vacunados, el 50,6% (814) eran elegibles y recibieron la PCV-13. Conclusión: ofrecer la vacuna en el lugar de atención y orientar a las PVVS sobre la importancia de la vacunación como estrategia de prevención de enfermedades, identificando a las personas elegibles para recibirlas, fue una acción importante realizada por la institución junto con el equipo de enfermería, como estrategia para facilitar el acceso a la vacunación.

RESUMO Descrever uma estratégia para facilitar o acesso à vacina conjugada pneumocócica 13-valente (PCV-13) para pessoas vivendo com HIV (PVHIV), durante a pandemia de COVID-19. Método: relato de experiência sobre a organização de um serviço de atendimento para PVHIV na cidade de São Paulo, para facilitar o acesso à PCV-13 no decorrer da campanha de vacinação de influenza de 2020, durante a pandemia de COVID-19. Resultados: por meio da integração entre um serviço de atendimento para PVHIV e um Centro de Imunizações (CRIE) foi possível oferecer a PCV-13 para as PVHIV em seu local de atendimento, diminuindo barreiras físicas de acesso à imunização. Dessa forma, das 1906 PVHIV que passaram pelo serviço durante o período de 23 de março a 31 de julho de 2020, 84,4% (1609) receberam a vacina influenza, PCV-13 ou ambas. Dos 1609 vacinados, 50,6% (814) foram elegíveis e receberam a PCV-13. Conclusão: oferecer a vacina em seu local de tratamento e orientar as PVHIV sobre a importância da vacinação como estratégia de prevenção de doenças, identificando os elegíveis a recebê-las, foi uma importante ação realizada pela instituição em conjunto com a equipe de enfermagem, como estratégia de facilitar o acesso à vacinação.

SARS-CoV-2 precipitated Kasabach-Merritt syndrome in a child with angioma infantile and acute lymphoblastic leukemia: Case Report / Síndrome de Kasabach-Merritt precipitado por SARS-CoV-2 en un niño con angioma infantil y leucemia linfoblástica aguda: Reporte de Caso

SUMMARY Background: We describe an 8-month-old boy with leukemia and SARS-CoV-2 infection who developed Kasabach-Merritt phenomenon. He had a positive SARS-COV-2 RT-PCR sample. Hematologic tests showed coagulopathy and intestinal involvement. She was managed in emergency receiving transfusion support and in hospitalization with social isolation measures, she started propanolol and corticotherapy as initial treatment of infantile angiomas. She presented with symptoms of intestinal obstruction and underwent surgery and evidence of hemorrhagic infarction with foci of intestinal ischemic necrosis, ending in ileostomy. We tried to understand a pathophysiological explanation of the dermatologic and gastrointestinal tract involvement by the virus and the atypical form of COVID-19. Given the emerging evidence of endothelial and vascular involvement in COVID-19, the development of tests to detect vascular lesions may be critical to guide the use of new therapeutic strategies.

RESUMEN Introducción: a un niño de 8 meses con leucemia e infección por SARS-CoV-2 que desarrolló el fenómeno de Kasabach-Merritt. Tenía una muestra de RT-PCR de SARS-COV-2 positiva. Las pruebas hematológicas mostraron coagulopatía y afectación intestinal. Fue manejada en emergencia recibiendo apoyo transfusional y en hospitalización con medidas de aislamiento social, inició propanolol y corticoterapia como tratamiento inicial de los angiomas infantiles. Presentó síntomas de obstrucción intestinal y fue intervenida quirúrgicamente y se evidenció infarto hemorrágico con focos de necrosis isquémica intestinal, terminando en ileostomía. Intentamos comprender una explicación fisiopatológica de la afectación dermatológica y del tracto gastrointestinal por el virus y la forma atípica de COVID-19. Dada la evidencia emergente de la afectación endotelial y vascular en COVID-19, el desarrollo de pruebas para detectar lesiones vasculares puede ser crítico para guiar el uso de nuevas estrategias terapéuticas.

Síndrome de Guillain-Barré asociado a accidente apídico: reporte de caso / Guillain-Barré syndrome associated with a bee sting accident: a case report / Síndrome de Guillain-Barré associada a acidente elapídico: relato de caso

El accidente apídico implica un bajo riesgo de morir por reacciones agudas como anafilaxia. Es frecuente que se desconozcan otros riesgos como el hepático y el neurológico. Dentro de las complicaciones menos conocidas está la polineuropatía aguda conocida como Guillain- Barré. La causa más ampliamente descrita es la reacción cruzada entre IgE y la proteína básica de mielina. A continuación, se reporta el primer caso en América Latina sobre la asociación entre Guillain-Barré y accidente por picadura de abejas. En este caso, hay criterios de causalidad como el nexo temporal, la plausibilidad biológica y la coherencia con otros artículos reportados en la literatura médica.

Bee sting accident usually implies a low risk of dying from acute reactions such as anaphylaxis. Other risks such as liver and neurological risks are often unknown. Among the lesser-known complications caused by this type of accident is the acute polyneuropathy known as Guillain-Barré. The most widely described cause is the cross reaction between IgE and myelin basic protein. The article reports the first case in Latin America on the association between Guillain-Barré and a bee sting accident. In this case, there are causality criteria such as temporal link, biological plausibility, and consistency with other articles reported in the medical literature

O acidente elapídico implica um baixo risco de morte por reações agudas, como anafilaxia. Outros riscos, como hepáticos e neurológicos, são frequentemente desconhecidos. Entre as complicações menos conhecidas está a polineuropatia aguda conhecida como Guillain-Barré. A causa mais amplamente descrita é a reação cruzada entre a IgE e a proteína básica da mielina. A seguir, é relatado o primeiro caso na América Latina sobre a associação entre Guillain-Barré e um acidente com picada de abelha. Nesse caso, há critérios de causalidade como vínculo temporal, plausibilidade biológica e consistência com outros artigos relatados na literatura médica

Pain and fatigue are predictors of quality of life in primary Sjögren's syndrome

Abstract Background: Few studies have evaluated the relation of quality of life (QoL) with symptoms and disease activity in primary Sjögren's syndrome (pSS). There is also scant information on the predictors of QoL in this population. The aim of this study was to assess QoL in patients with pSS and to investigate their possible predictors. Methods: In a cross-sectional study, 77 patients with pSS were evaluated using the following questionnaires: Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Short Form-36 Health Survey (SF-36) and World Health Organization Quality of Life Assessment (WHOQOL-BREF). Seventy-seven healthy controls responded to the SF-36 and WHOQOL-BREF. The Mann-Whitney test, t-test, Pearson and Spearman correlation, and multiple regression analysis were used in the statistical analysis. Results: Patients with pSS and healthy controls were matched by gender and age. The mean scores for the ESSDAI, ESSPRI and FACIT-Fatigue were 3.34 ±4.61, 6.58 ± 2.29 and 26.17 ± 11.02, respectively. Patients had a lower employment rate (36.4% versus 62.3%, p < 0.01) and higher work disability (10.4% versus 1.3%, p < 0.01). SF-36 and WHOQOL-BREF values were lower in patients with pSS (p < 0.001), except in the WHOQOL-BREF environment domain. Pain (ESSPRI), fatigue (FACIT-Fatigue), antinuclear antibody (ANA), anti-Ro-SSA and economic class (Brazilian Economic Classification Criteria - CCEB) were independent predictors of QoL. Conclusions: The main predictors of poor QoL in patients with pSS were pain and fatigue, and these symptoms had an impact regardless of disease activity, age, schooling, marital status, work disability and fibromyalgia.

Síndrome de Ramsay Hunt. Informe de un caso y revisión de la literatura / Ramsay Hunt syndrome. Case report and literature review

RESUMEN Se presentó paciente masculino de 68 años de edad, con antecedentes de síndrome de Parkinson posinfarto cerebral isquémico antiguo e hipertensión arterial sistémica, con la intensión de describir la experiencia del diagnóstico y tratamiento del síndrome de Ramsay Hunt. El paciente acudió a consulta de Medicina Interna del Policlínico Universitario "Omar Ranedo Pubillones", Guantánamo, por presentar dolor en hemicara izquierda y otalgia homolateral, cefalea y febrícula. Luego, presentó lesiones vesiculosas de aspecto herpético. Se concluyó el diagnóstico definitivo de síndrome de Ramsay Hunt tipo II y se remitió a consulta de Otorrinolaringología, donde se confirmó el diagnóstico. Luego del tratamiento evolucionó satisfactoriamente. Aunque el síndrome de Ramsay Hunt no es un problema de salud, se revela la necesidad de que el médico del nivel primario de atención a la salud se familiarice con las bases teóricas para su diagnóstico y se connota la importancia de la evaluación interdisciplinaria para esta finalidad.

ABSTRACT It was reported a 68 year old male patient with a personal pathological history of post- ischemic stroke Parkinson's syndrome and systemic arterial hypertension and with the intention of describing the experience of diagnosis and treatment of Ramsay Hunt syndrome. Patient presented to his primary health physician at the Univirsity Clinic "Omar Ranedo Pubillones" in Guantanamo, presenting pain in right side of the face and earache, headache and fever. Then, he presented vesicular lesions with a herpetic appearance. It was concluded the definitive diagnosis of Ramsay Hunt syndrome type II and it was referred to Otolaryngology consultation, where the diagnosis was confirmed. After treatment patient's improvement was good. Although Ramsay Hunt syndrome is not a health problem, shows the need for primary care physicians to become familiar with the theoretical basis for its diagnosis and the importance of interdisciplinary evaluation for this purpose.

Level of Betatrophin in PCOS patients

PCOS is known now as an endocrine, metabolic, and chronic inflamatory disorder, with hyperandrogenemia, insulin resistance and obesity being the key factors that influence the expression and symptoms of the condition. Objective: To assess the level of alpha fetoprotein in PCOS women. Patients and method: A case control study conducted at Al-Elwyia. Teaching hospital when 200 women were enrolled in the study and divided into two groups: case group (100) patients with PCOS and control healthy group (100). The patient with PCOS women was diagnosed according to Roterdam criteria. Results: A total of 200 respondents and divided into 2 groups. The mean age of them (27.7 ± 2.3) years, highly significant association (P <0,001) were found between the age group especially (21-30) years in PCOS patients moreover highly significant association were found between the obese patient in PCOS than that in normal group (P<0.001). Betatrophin levels were significantly highly increases in patients than that in control group (P<0.001). Conclusion: the serum betatrophin level was significantly increased in patients with polycystic syndrome (AU)

Evaluación pronóstica del síndrome coronario agudo en pacientes con síndrome metabólico / Prognostic evaluation of acute coronary syndrome in patients with metabolic syndrome / Avaliação prognóstica da síndrome coronariana aguda em pacientes com síndrome metabólica

RESUMEN Introducción: el síndrome metabólico incrementa el riesgo para enfermedad cardiovascular y duplica la mortalidad. Objetivo: identificar los factores pronósticos de muerte por síndrome coronario agudo en pacientes con síndrome metabólico. Método: se realizó estudio observacional analítico de cohorte en 186 pacientes con síndrome coronario agudo admitidos entre 01 febrero de 2015 y 20 de octubre de 2018. Se incluyeron variables clínicas y epidemiológicas; se evaluó la fuerza de asociación entre las variables cualitativas y el riesgo de desarrollar muerte por síndrome coronario agudo en presencia de síndrome metabólico con el Odds Ratio con intervalo de confianza al 95%. Se realizó análisis multivariado utilizando el modelo de regresión logística de Cox. Resultados: la prevalencia del síndrome metabólico fue 45,7 %, con edad media de 60,6 años; sexo femenino y grupo de edades mayor de 61 años duplicaron el riesgo de forma no significativa. Hipertrofia ventricular izquierda, insuficiencia cardiaca y fibrilación auricular incrementaron el riesgo de aparición de síndrome coronario agudo estadísticamente significativa en presencia del síndrome metabólico, p, 000. Disfunción ventricular izquierda moderada a severa [OR 5.7 IC 95 % (1,115-5,961) p, 000], clase de Killip-Kimball ≥II [OR 7,9 IC 95 % (3,10-20,15) p, 000] e infarto sin elevación del ST [OR 2,970 IC 95 % (1,174-7,518) p, 000], se relacionaron significativamente con la muerte. Conclusiones: el síndrome metabólico incrementa el riesgo de sufrir síndrome coronario agudo y muerte pero no está relacionado significativamente con la supervivencia.

ABSTRACT Introduction: metabolic syndrome increases the risk for cardiovascular disease and doubles mortality. Objective: to identify the prognostic factors of death due to acute coronary syndrome in patients with metabolic syndrome. Method: a cohort analytical observational study was conducted in 186 patients with acute coronary syndrome admitted between 01 February 2015 and 20 October 2018. Clinical and epidemiological variables were included; the strength of association between the qualitative variables and the risk of developing death due to acute coronary syndrome in the presence of metabolic syndrome with Odds Ratio with 95% confidence interval was evaluated. Multivariate analysis was performed using the Cox logistic regression model. Results: the prevalence of the metabolic syndrome was 45.7%, with a mean age of 60.6 years; Female sex and age group over 61 years doubled the risk in a non-significant way. Left ventricular hypertrophy, heart failure and atrial fibrillation increased the risk of the appearance of a statistically significant acute coronary syndrome in the presence of the metabolic syndrome, p, 000. Moderate to severe left ventricular dysfunction [OR 5.7 95% CI (1,115-5,961) p, 000], Killip-Kimball class ≥II [OR 7.9 IC 95% (3, 10-20, 15) p, 000] and infarction without ST elevation [OR 2.970 95% CI (1.174-7.518) p, 000], were significantly related to death. Conclusions: metabolic syndrome increases the risk of suffering acute coronary syndrome and death but it is not significantly related to survival.

RESUMO Introdução: a síndrome metabólica aumenta o risco de doença cardiovascular e duplica a mortalidade. Objetivo: identificar os fatores prognósticos do óbito por síndrome coronariana aguda em pacientes com síndrome metabólica. Método: estudo de coorte observacional analítico foi realizado em 186 pacientes com síndrome coronariana aguda admitidos entre 01 de fevereiro de 2015 e 20 de Outubro de 2018. Foram incluídos variáveis ​​clínicas e epidemiológicas; a força de associação entre variáveis ​​qualitativas e o risco de morte por síndrome coronária aguda, na presença de síndrome metabólica com probabilidades confiança Rácio intervalo de 95% foi avaliada. A análise multivariada foi realizada usando o modelo de regressão logística de Cox. Resultados: a prevalência da síndrome metabólica foi de 45,7%, com idade média de 60,6 anos; Sexo feminino e faixa etária acima de 61 anos dobraram o risco de forma não significativa. hipertrofia do ventrículo esquerdo, falha cardíaca e fibrilação atrial aumentou o risco de síndroma coronária aguda estatisticamente significativa na presença de síndroma metabólico, p, 000. Disfunção Ventricular Esquerda moderada a grave [OU 5,7 (IC 95% 1,115-5,961) p.000], Killip-Kimball ≥II [OR 7,9, IC de 95% (3,10-20,15) p.000] e enfarte sem elevação do segmento ST [OR 95% CI 2,970 (1,174-7,518) p.000], estavam significativamente relacionados com a morte. Conclusões: A síndrome metabólica aumenta o risco de síndrome coronariana aguda e morte, mas não significativamente associada com a sobrevivência.

Evaluation of left ventricular myocardial systolic dysfunction in patients with obstructive sleep apnea hypopnea syndrome using three‐dimensional strain echocardiography / 中华超声影像学杂志

Objective To evaluate left ventricular myocardial systolic function in patients with obstructive sleep apnea hypopnea syndrome ( OSA HS) with normal left ventricular ejection fraction( LVEF) using three‐dimensional strain echocardiography . Methods One hundred patients with OSA HS were divided into mild group ,moderate group and severe group according to apnea hypopnea index ( A HI) w hile matched with 32 healthy people as control group . T he parameters such as three‐dimensional LVEF ,global longitudinal strain( GLS) ,global circumferential strain( GCS) ,global area strain( GAS) ,global radial strain ( GRS) ,twist and torsion based on standard three‐dimensional echocardiography were measured by three‐ dimensional strain echocardiography , the above parameters among the four groups were compared for difference .Linear correlationship between A HI ,LVEF and the three dimensional strain parameters was analyzed respectively . Results ①T here was no significant difference in three‐dimensional LVEF ,twist and torsion between each groups( P ＞0 .05 ) . ②GLS ,GAS and GRS were lower in mild ,moderate and severe group compared with control group ,decreasing along with the disease severity ( P ＜0 .01 or P ＜ 0 .05 ) . GCS in severe group was lower than that in control group ( P ＜0 .01 ) . ③GLS and GAS in severe group were lower than those in mild group ( all P ＜0 .05) .GRS in moderate and severe group were lower than that in mild group( all P ＜ 0 .05 ) ,GAS ,GRS in severe group was lower than those in moderate group ( P ＜0 .05) . ④T here was a mild correlation between GLS and A HI ( r ＝0 .342 , P ＜0 .01) ,GAS and A HI ( r＝0 .294 , P ＜0 .01) ,GRS and A HI ( r ＝ －0 .411 , P ＜0 .01 ) . T here was a mild correlation between GCS and three‐dimensional LVEF ( r＝ －0 .354 , P ＜0 .01 ) ,GAS and three‐dimensional LVEF ( r ＝ －0 .326 , P ＜0 .01) ,GRS and three‐dimensional LVEF ( r ＝0 .300 , P ＜0 .01) . Conclusions T he left ventricular myocardial systolic function is impaired in all patients with OSA HS even with normal LVEF and the dysfunction is aggravating with the disease severity . Ultrasonic three‐dimensional strain imaging technology can be used to detect the subclinical myocardial systolic dysfunction quantitatively in the early stage of OSA HS patients .

Analysis of HIV/AIDS epidemic characteristics and spatiotemporal aggregation in Lanzhou City from 2011 to 2018 / 中华疾病控制杂志

Objective To detect the characteristics of acquired immune deficiency syndrom (AIDS) epidemic in Lanzhou City from 2011 to 2018 and the spatiotemporal aggregation of human immunodeficiency virus (HIV) infection and AIDS patients at county level, and to provide scientific reference for prevention and control of HIV/AIDS in Lanzhou City. Methods The space-time scanning and measurement method was used to detect, test, and analyze the spatiotemporal aggregation of HIV/AIDS reports. The aggregation characteristics of the AIDS epidemic in time and space were obtained, and the detection results were visualized by ArcGIS 10.3. Results From 2011 to 2018, there were four statistically significant high spatial and temporal aggregation areas in HIV/AIDS in Lanzhou City. One type of gathering area was Chengguan District, Anning District and Gaolan County. The gathering time was from 2015 to 2018 (LLR=108.63,RR=2.02, P<0.001); The second type of aggregation area was the Qilihe area, which gathered from 2015 to 2018 (LLR=60.93,RR=2.11, P<0.001). It was detected that the Qilihe District had a type Ⅰ aggregation of heterosexual transmission from 2014 to 2017, and Gaolan County, Anning District and Chengguan District had a type II aggregation of heterosexual transmission from 2015 to 2018; It was detected that Gaolan County, Anning District and Chengguan District had a type of gathering of same-sex transmission from 2015 to 2018; In the Qilihe District, there was a second category of same-sex communication between 2017 and 2018. Conclusion The HIV/AIDS epidemic in Lanzhou City has spatiotemporal aggregation regardless of the number of reports or different transmission routes. The prevention and control situation is still severe and should be highly valued by the relevant local departments.

Surgical treatment for acute appendicitis in HIV/AIDS patients / 中华全科医师杂志

Fifty three HIC/AIDS patients with acute appendicitis treated in our hospital from January 2016 to June 2017 were retrospectively analyzed.The anesthesia and surgery were successfully completed in all patients,and there were no serious intraoperative complications.The postoperative complications occurred in 18 cases (34.0 ％),including 13 cases (24.5 ％) of incision infections and 3 cases (5.7 ％) of lung infections,1 case of adhesion obstruction (1.9 ％) and 1 case (1.9 ％) of new opportunistic infections.All patients were clinically cured after treatment and discharged from the hospital without perioperative death.The characteristics of acute appendicitis in HIV/AIDS patients are emergent onset,poor body condition,lower immunity,more comorbities,rapid condition changes,and high frequency of special infections;the patients with lower CD4 count may have higher postoperative infection,the slower recovery and the poorer outcomes.

Children with Down Syndrome and the State of Affairs for them in Pakistani Society

Pakistan is a developing country with a total population of 198.36 million,[1] is categorized among first six most populous countries of the world, and with a high fertility rate. In this overflowing populous country census has never covered the head counting of special needs children of different categories; specifically, the learning disabilities that includes Down syndrome (DS), Autism, and Attention Deficit Hyperactivity Disorder. In the very recent National Census 2017 for the first-time head counting was done for physically disabled persons.  In this scenario one has to dig too hard into the data resources to find exact numbers of our special needs children of various categories; specifically, children with DS. Pertinent question is:  when data is not available regarding the number of children/persons with DS of various age categories; how is it possible to make some comprehensive planning for them? Why has the Government not been able to develop a well-coordinated network for life long rehabilitation of these children at national level?

Psicopatologia em O duplo de Dostoiévski / Psychopathology in Dostoyevsky's The Double / La psychopathologie dans Le Double par Dostoievski / Psicopatología en El Doble de Dostoievski

O duplo aborda o tema da duplicidade do eu. Traz na narrativa descrições psicopatológicas da síndrome de duplos subjetivos e da esquizofrenia numa época em que essas condições ainda não tinham sido descritas. Este artigo situa a obra literária na história da psiquiatria, ressaltando o pioneirismo de Fiodor Dostoiévski, sua forma de narrar o tema e como conseguiu tratar o tema de forma clínica.

The Double addresses the topic of duplicity of self. It presents psychopathological descriptions of the syndrome of subjective doubles and of schizophrenia at a time in which these conditions had not yet been described. This paper situates the book in the history of psychiatry, highlighting the pioneering spirit of Fyodor Dostoyevsky, his way of approaching this topic, and how he managed to address it in a clinical way.

Le Double porte sur le thème de la duplicité du moi. Il contient des descriptions psychopathologiques du syndrome des doubles subjectifs et de la schizophrénie à une époque où ces troubles n'avaient pas encore été décrits. Cet article traite de l'œuvre littéraire dans l'histoire de la psychiatrie et souligne l'esprit pionnier de Fiodor Dostoïevski, sa façon de développer le thème et comment traiter la question de façon clinique.

El Doble, de Dostoyevski aborda el tema de la duplicidad del yo. Trae, a la narrativa, descripciones psicopatológicas del síndrome de dobles subjetivos y de la esquizofrenia en una época en la que todavía no se habían descrito tales condiciones. En este artículo, se sitúa la obra literaria en la historia de la psiquiatría, resaltando el espíritu pionero de Fiódor Dostoyevski, su forma de narrar el tema y cómo logró abordar la cuestión de forma clínica.

Der Doppelgänger behandelt das Thema des doppelten Ichs. Das Werk enthält psychopathologische Beschreibungen des Syndroms des subjektiven Doppelgängers und der Schizophrenie zu einer Zeit, als diese Phänomene noch nicht beschrieben worden waren. Dieser Artikel ordnet das Werk in der Geschichte der Psychiatrie ein, unterstreicht den Pioniergeist von Fjodor Dostojewski, seine Art und Weise, das Thema wiederzugeben und wie er es schaffte, das Problem in klinischen Form zu behandeln.

Toxina botulínica nos músculos masseter e temporal: considerações farmacológicas, anatômicas e clínicas / Botulinum Toxin In Masseter And Temporal Muscles: Pharmacological, Anatomical And Clinical Considerations

A aplicação da Toxina Botulínica (TB) por Cirurgião-Dentista para fins funcionais e estéticos foi autorizada em 2016, através da Resolução CFO 176. Diante dessa realidade, o profissional deverá estar atento a sua ação, indicações, contraindicações e relações anatômicas para se obter uma ação eficaz. O manuscrito apresenta considerações anatômicas nos músculos masseter e temporal bem como áreas circunvizinhas importantes melhoras necessárias a uma aplicação correta da técnica e evitar efeitos indesejáveis. Fotografias de peças cadavéricas da face e situações clínicas serão apresentadas. Nesses músculos, a TB pode ser utilizada para tratar disfunção têmporo-mandibular, hipertrofia do masseter, bruxismo, dentre outras anormalidades. As principais queixas clínicas descritas por pacientes acometidos são: "Muita dor no ouvido e na cabeça. Não consigo dormir direito e ranjo os dentes", com história de tratamento de cefaleia crônica e dor na face. Com isso, pretende-se relacionar os pontos de aplicações clínicas e os cuidados, considerando-se as estruturas anatômicas para evitar complicações e maximizar o efeito terapêutico... (AU)

The application of botulinum toxin (BT) by the Dental Surgeon for functional and aesthetic purposes was authorized in 2016 through a resolution of the Federal Council of Dentistry (CFO 176). Given this reality, the professional should be aware of his action, indications, contraindications and anatomical relationships to obtain an effective action. This manuscript presents anatomical considerations in the masseter and temporal muscles, as well as important surrounding areas which are necessary for a correct application of the technique and to avoid undesirable effects. Photographs of cadaveric face parts and clinical situations will be presented. In these muscles BT can be used to treat temporomandibular dysfunction, masseter hypertrophy, bruxism, among other abnormalities. The main clinical complaints described by affected patients are pain in the ear and head, sleep complaints and grinding of teeth and a history of chronic headache and facial pain. The aim of this study is to relate the points of clinical applications and care considering the anatomical structures to avoid complications and maximize the therapeutic effect... (AU)

Management of syndromic craniosynostosis using posterior cranial vault distraction osteogenesis: preliminary findings / 中华整形外科杂志

Objective@#To explore the effect of managing syndromic craniosynostosis using posterior vault distraction osteogenesis.@*Methods@#The authors conducted a retrospective cohort study of four children with syndromic craniosynostosis treated between 2015 January to 2016 March using posterior vault distraction osteogenesis. The posterior craniotomy was performed from vertex, biparietally to a point above the occipital protuberance. Two distraction devices were fixed in the parasagittal, collinear position. After a latency of 3 days, the device was activated at 0.5 mm/day. After the distraction, the consolidation period was about 6 months.@*Results@#The average distraction distance was 27.3 mm(range, 25 to 30 mm). Cerebrospinal fluid leak happened in one patient. After taken the 3D CT scan, all of them were undertaken the second operation of removing the distraction devices. All the patients were followed up at a mean of 12.8 months (range, 7 to 20 months).@*Conclusions@#It is effective to enlarge the posterior cranial vault using distraction osteogenesis for the syndromic craniosynostosis.

Utilidad clínica de la medición de la hormona antimülleriana en niños / Clinical utility of anti-mullerian hormone measurement in children

Resumen: la hormona antimülleriana, inicialmente denominada sustancia inhibitoria mülleriana, es una glicoproteína homodimérica de 12,5 kDa, que pertenece a la familia del factor de crecimiento transformante beta (TGF-ß) y desempeña un papel crucial en la diferenciación sexual masculina al favorecer la regresión de los conductos de Müller. Dado que su producción en el varón es principalmente por las células de Sertoli inmaduras, en las últimas décadas ha crecido su utilidad más allá de la evaluación de la función ovárica y tratamientos de fertilidad en las mujeres, lo que ha permitido evaluar en el varón la función testicular y los estados de hipogonadismo, trastornos de la diferenciación sexual, pubertad patológica, criptorquidia, entre otras condiciones clínicas revisadas en este manuscrito. Además, esta revisión describe el rol fisiológico de la hormona antimülleriana en los testículos prepuberales y las pruebas de laboratorio disponibles para su medición. (AU)

Abstract: The antimullerian hormone, initially referred as mullerian inhibitory substance, is a 12.5 kDa homodimeric glycoprotein, belonging to the transforming growth factor beta (TGF-ß) family that playing a crucial role in male sexual differentiation by favoring regression of the Mullerian ducts. Since their production in the male is mainly by the immature Sertoli cells, in the last decades its usefulness has growth beyond the evaluation of the ovarian function and female fertility treatments, which has allowed evaluating the testicular function in male and affections such as hypogonadism, disorders of sexual differentiation, pathological puberty, cryptorchidism and others clinical conditions reviewed in this manuscript. In addition, this review describes the physiological role of the antimüllerian hormone in the prepubertal testes and the laboratory tests available for its measurement. (AU)

Accuracy Assessment of Type III Portable Monitor of Sleep Apnea for In-hospital Patients With Cardiovascular Disease / 中国循环杂志

Objective: To assess the accuracy and application value of type III portable monitor (III PM) of sleep apnea (SA) for in-hospital patients with cardiovascular disease (CVD). Methods: A total of 101 CVD patients received sleep apnea monitoring by both type II polysomnography ( II PSG) and III PM were enrolled to compare the apnea-hypopnea index (AHI) measured by 2 instruments. AHI was assigned into 4 grades: Normal (AHI0.05. Kendall correlation coefficient for 4 AHI grades was 0.701, P<0.01 which assumed strong correlation; Kappa value of consistency was 0.493, P<0.01 which assumed medium strong correlation. Using AHI≥15 as cut-off point, Kappa coefficient for the consistency between II PSG and III PM was 0.679, P<0.05, which meant high consistency. Taking II PSG as standard and AHI≥15 as cut-off point, the AUC of III PM measured AHI was 0.918 with the specificity at 80.4% and sensitivity at 87.3%. The best diagnosing cut-off value of III PM was AHI=15.70, at this point, the maximum Youden's index was obtained as 0.695. Conclusion: Using AHI≥15 as standard, III PM and II PSG had the favorable consistency and accuracy for monitoring the severity of SA for in-hospital patients with cardiovascular disease. AHI=15.7 was the best cut-off point of III PM in diagnosing moderate and severe SA in relevant patients.

TCM Syndrom Type Distribution Characteristics for 186 Cases of AIDS Dementia Complex / 中国中医药信息杂志

Objective To study the relationship between different syndromes of AIDS dementia complex (ADC) and different disease severity, age, CD4+ T cell count and infection. Methods Totally 186 patients with ADC were classified into different syndrome types, and the distribution in different degree of disease, different age, different CD4+T cell count and different routes of infection was analyzed. Results There were 48, 51, 15, 37 and 35 cases of deficiency of kidney and marrow, yin deficiency of liver and kidney, deficiency of heart and spleen, syndrome of phlegm obstruction, syndrome of qi deficiency and blood stasis, respectively. Moderate and severe degrees with yin deficiency of liver and kidney were more common. There was statistical significance in the distribution of different syndromes in different degree of disease (χ2=82.495, P=0.000). Deficiency of kidney and marrow, yin deficiency of liver and kidney were more common in different age groups. The distribution of the syndrome types in different age groups was statistically significant (χ2=72.710, P=0.000), the patients were mainly in two age groups of>50–60 years old and>60 years old. The distribution of the syndrom types in diffenrent CD4+T cell count stratum was statistically significant (χ2=66.778, P=0.000). Blood pathway infection mainly included deficiency of kidney and marrow and syndrome of qi deficiency and blood stasis, sexual pathogens mainly yin deficiency of liver and kidney. Conclusion CD4+T cells layers, age group, progression of disease and transmission way are the influencing factors of syndrom type.

Research of difference distribution of intestinal microflora in different types of IBS and the effect of intestinal microecological medicine intervention / 中国基层医药

Objective To understand the distribution of intestinal microflora in different types of IBS,and to observe the effect of intestinal microecological intervention. Methods According to the inclusion criteria,the patients were divided into diarrhea group (IBS-D group) and constipation group (IBS-C group),and the normal control group was also set up. The start of the three groups took gastroscopy examinination and took duodenal fluid for intesti-nal bacteria culture and counting,and electronic colonoscopy to retrieve the terminal ileum fluid for bacteria culture and count. Diarrhea and constipation type IBS patients were given Bifidobacterium triple viable capsules,2 capsules each time,3 times a day,treatment for 4 weeks. After treatment for 4 weeks,took electronic gastroscopy to retrieve the duodenal fluid for bacteria culture and counting,and took electronic colonoscopy examination to retrieve the intestinal fluid for terminal colon intestinal bacteria culture and count. Before and after treatment,IBS patients filled in intestinal symptoms rating scale and the intestinal symptoms were graded. After the test,compared the distribution differences of different segments of bacterial flora with diarrhea type IBS,constipation IBS and normal people. And the differences of intestinal flora bacterial distribution and IBS sympotoms were compared among the three groups after the Bifidobacterium triple viable capsules treatment. Results In the duodenal fluid of the three groups, the culture rate of Escherichia coli,Bacteroides,Bifidobacterium,Enterococcus,Lactobacillus was low,the difference was not statistically significant (all P>0. 05). Compared with the normal group,Enterobacter cultured in terminal ileum intestinal in the IBS-D group increased,Bifidobacterium and Lactobacillus decreased significantly[(2. 17 ± 0. 26)Log10 CFU/g vs (3. 26 ± 0. 44)Log10 CFU/g,(1. 46 ± 0. 25)Log10 CFU/g vs (2. 22 ± 0. 25)Log10 CFU/g] (t=4. 42,8. 98,all P<0. 05), the Bacteroides in the IBS-C group increased significantly (t=14. 27,P<0. 05). After the use of Bifidobacterium triple viable capsule oral treatment,the number of Bifidobacterium in duodenal fluid was increased,but the difference was not statistically significant. The terminal ileum intestinal bifidobacteria culture in the IBS -D group increased significantly (t=4. 42,P=0. 00),Enterobacter decreased significantly (t=20. 30,P<0. 05),the quasi bacterial content in the IBS-C group decreased (t=14. 27,P<0. 05). After 4 weeks of Bifidobacterium triple viable capsule treatment,21 cases were effective in the IBS-D group,the total effective rate was 70. 00%. 13 cases were effective in the IBS-C group,the total effective rate was 43. 33%. The total symptoms scores of the IBS-D group decreased significantly (t=10. 36,P<0. 05). Conclusion IBS type of diarrhea and constipation both have intestinal flora disorder,mainly in ileum. The results showed that the effect of intestinal microecological treatment is obvious in diarrhea and constipation type IBS,especially in diarrhea type IBS.