Use of bedside ultrasound in the evaluation of acute dyspnea: a comprehensive review of evidence on diagnostic usefulness / Uso de ecografía a pie de cama en la evaluación de la disnea aguda: una revisión exhaustiva de la evidencia sobre su utilidad diagnóstica / Uso de ultrassom à beira do leito na avaliação da dispneia aguda: uma revisão abran-gente das evidencias sobre sua utilidade diagnostica

Introduction: Acute dyspnea is one of the most frequently observed symptoms in emergency departments, which can be caused mainly by pulmonary or cardiac system involvement. Bedside ultrasound is postulated as an inno-vative tool for basic use by the physician, which can complement the physical examination and quickly explore the integrity of thoracic structures. Objectives: To synthesize recent evidence on the use of bedside ultrasound in the evaluation of acute dyspnea. Materials and methods: A bibliographic search was carried out using search terms such as "Bedside Ultrasound" and "Acute Dyspnea," as well as synonyms, which were combined with Boolean operators, in the databases PubMed, ScienceDirect, Embase, EBSCO, and MEDLINE. Results: During the literature review, 10 observational studies, 2 clinical trials and 2 systematic reviews met the inclusion criteria and were ana-lyzed. The use of bedside ultrasound changes the main diagnosis associated with acute dyspnea in more than 60% of cases, the most frequent being acute decompensated heart failure and pneumonia. Protocols such as SEARCH 8Es for the evaluation of dyspnea in the emergency department, has a performance with sensitivity, specificity, positive and negative predictive value parameters above 95%. Conclusions: The current evidence on the use of bedside ultrasound in the management of patients with acute dyspnea in the emergency department is limited, Although the level of evidence is not the best, it suggests that this tool may promote the diagnostic perfomance of acute dyspnea of pulmonary or cardiac causes, improve the time to diagnosis, and enhance physician diagno-stic confidence.

Introducción: La disnea aguda es uno de los síntomas más observados en los servicios de urgencias, que puede estar causada por la afectación del sistema pulmonar o cardiaco. La ecografía a pie de cama se postula como una herramienta innovadora, al complementar la exploración física con la eva-luación rápida de las estructuras intratorácicas. Objetivo: Sintetizar la evidencia reciente sobre el uso de la ecografía a pie de cama en la evaluación de la disnea aguda. Materiales y métodos: Búsqueda bibliográfica utilizando términos de búsqueda como Bedside Ultra-sound y Acute Dyspnea, así como sinónimos, que se combinaron con operadores booleanos, en cinco bases de datos. Resultados: Se evidenció que el uso de la ecografía a pie de cama cambia el diagnóstico principal asociado con la disnea aguda en más del 60 % de los casos, entre los cuales los más frecuentes fueron la insuficiencia cardiaca aguda descompensada y la neumonía. Protocolos como el SEARCH 8Es para la evaluación de la disnea en el servicio de urgencias tiene un rendimiento con parámetros de sensibi-lidad, especificidad, valor predictivo positivo y negativo superiores al 95 %. Conclusión: La evidencia actual sobre el uso de la ecografía a pie de cama en el tratamiento de los pacientes con disnea aguda en el servicio de urgencias es limitada. No obstante, sugiere que esta herramienta puede favorecer el rendimiento diagnóstico de la disnea aguda de causa pulmonar o cardiaca, mejorar el tiempo de diagnóstico y aumentar la confianza del médico en el diagnóstico

Introdução: A dispneia aguda é um dos sintomas mais observados no departamento de emergência, que pode ser causado pela afetação do sistema pulmonar o cardíaco. O ultrassom à beira do leito é proposto como uma ferramenta inovadora, complementando o exame físico com uma rápida ava-liação das estruturas intratorácicas. Objetivo: sintetizar evidências recentes sobre o uso do ultrassom à beira do leito na avaliação da dispneia aguda. Materiais e métodos: Pesquisa de literatura usando termos de busca tais como Bedside Ultrasound e Acute Dyspnea, bem como sinônimos, que foram combinados com operadores booleanos, em cinco bancos de dados. Resultados: O uso do ultrassom á beira do leito mostrou a mudança do principal diagnóstico associa-do com a dispneia aguda em mais de 60% dos casos, sendo o mais frequente a insuficiência cardíaca descompensada aguda e a pneumonia. Protocolos como o SEARCH 8Es para a avaliação da dispneia no serviço de emergência tem um desempenho com parâmetros de sensibilidade, especificidade, valor preditivo positivo e negativo superiores ao 95%. Conclusão: As evidencias atuais sobre o uso do ultrassom á beira do leito no gerenciamento de pa-cientes com dispneia aguda no serviço de emergências são limitadas. No entanto, sugere que esta ferramenta pode favorecer o rendimento diagnóstico da dispneia aguda de causa pulmonar ou car-díaca, melhorar o tempo de diagnóstico e aumentar a confiança do médico no diagnóstico.

Variación espacio-temporal de la respuesta espectral en manglares de La Habana, Cuba, evaluada con sensores remotos

Introducción: Los manglares son una de las formaciones vegetales de mayor relevancia global por los servicios ecosistémicos y roles ecológicos que desempeñan, y representan el 5 % de la superficie emergida de Cuba. No existen estudios previos que describan las variaciones en los índices espectrales de vegetación por sensores remotos en los manglares cubanos, pero con este tipo de variable se pueden constituir indicadores del estado de estos ecosistemas y emplearse en evaluaciones a nivel nacional. Objetivo: En el presente trabajo se evalúa la variabilidad espacial y temporal de dos índices espectrales de vegetación en cuatro manglares periurbanos de la ciudad de La Habana y se comparan con un sitio natural como control. Métodos: El estudio se desarrolló en las localidades de Bajo de Santa Ana, Cojímar, Rincón de Guanabo y la laguna El Cobre - Itabo y el control fue tomado en la ciénaga de Zapata. A través de la plataforma Climate Engine se extrajeron, de 2 460 imágenes satelitales LandSat, los valores promedio de los índices espectrales NDVI y EVI en 5 parcelas por cada localidad de estudio, entre 1984 y 2019. Las variables se compararon estadísticamente entre localidades y se describió su tendencia a lo largo del periodo de estudio. Resultados: Se detectaron diferencias geográficas en los índices, que pueden correlacionarse con las propiedades estructurales y grado de conservación de cada localidad. La tendencia global de los índices fue a un aumento, pero difirió entre localidades. Los menores cambios se produjeron en el sitio control y, entre los humedales periurbanos, en el Rincón de Guanabo y en Cojímar. El ordenamiento de las localidades a partir de variables espectrales fue consistente con el de grado de conservación general. Conclusiones: La respuesta espectral permitió caracterizar cada manglar de manera individualizada, mostrando relación aparente con las características ecológicas y de conservación de cada lugar. Es necesario continuar promoviendo estudios con sensores remotos de estas formaciones boscosas y generar indicadores sólidos que sustenten su uso en futuras investigaciones y monitoreos en manglares del Caribe.

Introduction: Mangroves are one of the most important forest types because of their ecosystem services and ecological roles. They represent 5 % of the emerged land of Cuba. No previous studies are describing spectral vegetation indexes variations by remote sensing in Cuban mangroves, but these variables can be used as indicators of the conservation status of the ecosystem and sustain national wide assessments. Objective: In the current paper we describe spatial and temporal variations in two spectral vegetation indexes in four near-city mangroves at Havana, Cuba and compare them to a natural control site. Methods: Study was conducted in localities named: Bajo de Santa Ana, Cojímar, Rincón de Guanabo, and El Cobre - Itabo lagoon and as control site was selected northern Zapata swamp. By using Climate Engineplatform we extract, from 2 460 Landsat satellite images, mean values of spectral indexes NDVI and EVI in 5 parcels per locality, from 1984 to 2019. Variables were statistically compared among localities and the global trend was described. Results: We detect geographic differences in both indexes, which can be related to structural properties and conservation degree of mangroves in each locality. Global trend of indexes was to increase, but differently among localities. Slighter changes appear in the control site and, among near city mangroves, in Rincón de Guanabo and Cojímar. The ordering of localities from spectral variables was consistent with the ranking in general conservation degree. Conclusions: Spectral responses describe uniquely each mangrove forest, in concordance to each ecological and conservation characteristics. There is a need for promoting studies using remote sensors at these forest types and to generate strong and reliable indicators that can sustain future researches and monitoring schemes in Caribbean mangroves.

The Current Status and Evolution of Clinical Trials on Kampo Medicine : Examining “Evidence Reports of Kampo Treatment” / 日本東洋医学雑誌

The Japan Society for Oriental Medicine has summarized randomized controlled trials (RCTs) using Japanese traditional (Kampo) medicine in structured abstracts, named “Evidence Reports of Kampo Treatment” (EKAT). In this study, we developed a method of classification based on study design, method of intervention, study aim, journal credibility, and year of publication. Then we classified 416 RCTs in EKAT and examined the current status and evolution of RCTs using Kampo medicine in Japan. Double-­blinded RCTs (DB-RCTs) accounted for only 8.9% of the RCTs in EKAT, and 86.5% of DB-RCTs were placebo-controlled. Among the RCTs that aimed to investigate the efficacy of Kampo medicine for diseases without standard Western medical treatment, DB-­RCT accounted for 64.9%. In recent years, there have been fewer envelope RCTs and quasi-­RCTs, which are prone to an increased risk of bias. The proportion of articles reporting RCTs in journals with an impact factor ( > 0.79 points reported by Journal Citation Reports) has been increasing with each passing year. This implies that the recent research in Kampo medicine has improved its quality and has gained an appreciation in modern medicine. The present study was conducted in “Problem-based Learning” in the 2nd grade of Tohoku University School of Medicine.

Clinical significance of expressions of EVI1 and BRE genes in 47 acute leukemia patients with MLL rearrangement / 中华血液学杂志

Objective@#To investigate the overexpression frequencies of BRE and EVI1, the correlation between BRE and EVI1 expressions and their possible clinical implications in 11q23/MLL rearrangement acute leukemia.@*Methods@#Cytogenetic examination of bone marrow cells was performed by short-term culture method. R-banding technique was used for karyotype analysis. 47 patients were detected by interphase fluorescence in situ hybridization (FISH) with dual-color break apart MLL probe. The expressions of EVI1 and BRE genes were detected by real time quantitative reverse transcription polymerase chain reaction (RQ-PCR) . The correlation and prognostic significance were statistically tested.@*Results@#11q23/MLL rearrangements were confirmed by karyotyping and FISH, respectively in 47 patients. According to immunophenotypic analyses of 37 patients, 5 patients showed positive for CD19, CD79a or CD10, 1 for CD7; the others for CD33, CD13, CD14 and CD15, and 16 of them for CD34. Of the 47 patients, 18 patients showed EVI1 overexpression and most of them presented with t (6;11) and M4/M5. The EVI1 expression was high in t (6;11) or t (9;11) subgroup comparable with levels observed in normal subgroup (P=0.038, 0.022, respectively) . 15 patients showed high BRE expression, and most of them presented with t (9;11) and M4/M5. High BRE expression was found in t (4;11) , t (6;11) , t (9;11) and t (11;19) subgroups, respectively by comparing with normal subgroup. The BRE expression was higher in t (4;11) (P=0.004) or t (9;11) (P=0.012) subgroup than in t (6;11) subgroup. Patients with EVI1 overexpression had a short survival compared with those with low EVI1 expression (P=0.049) and it also did in t (9;11) subgroup (P=0.024) . Patients with t (9;11) and high BRE expression had a long survival compared with those with t (9;11) and low BRE expression (P=0.024) .@*Conclusion@#The EVI1 overexpression was significantly frequent in acute leukemia patients with 11q23/MLL rearranged, especially within t (6;11) subgroup and M4/M5, which was associated with an inferior outcome. High BRE expression was observed frequently in 11q23/MLL-rearranged acute leukemia especially within t (9;11) subgroup and M5.

Clinical features and early treatment effects in intermediate risk and poor risk acute myeloid leukemia with EVI1 positive / 北京大学学报(医学版)

Objective:To investigate the clinical biological characteristics of EVI1 positive acute myeloid leukemia (AML) and its effect on early chemotherapy.Methods:The clinical and biological characteristics of 33 AML patients with EVI1 positive were retrospectively analyzed in 361 AML patients who were diagnosed and treated in our institute from March 2015 to July 2016,and the clinical and biological features,and rates of the induced remission were compared between the intermediate risk and poor risk with EVI1 positive AML,moreover,the influential factors on complete remission (CR) were analyzed.The expression of EVI1/ABL was tested in 32 healthy donors to confirm the abnormal threshold of EVI1 expression.Results:The definition of EVI1 positive was that the quantitative expression of EVI1/ABL was more than 8.0％.The 33 AML patients with EVI1 positive were found in 361 newly diagnosed AML patients,in which the female and male patients were 17 and 16 respectively,the median age was 45 (18-67) years,with a median follow-up of 6.6 (0.7-13.2) months.Intermediate karyotype was found in 17 patients (including 9 patients with normal karyotypes,1 patient with + 8);unfavorable karyotype was found in 14 patients [including 7 patients with-7/7q-,4 patients with t (v;11q23),3 patients with inv (3)/t (3;3),and 2 patients without mitotic figures].The rate of CR in the first induction chemotherapy was 42.4％,and the rate of total CR was 60.6％.According to the NCCN,16 intermediate risk patients and poor risk patients were divided,without favorable risk patients.The rate of CR in the first induction chemotherapy were 68.8％ and 17.6％ (P =0.005) in the intermediate risk and poor risk respectively,that of total CR were 81.3％ and 41.2％ (P =0.032),and the rates of relapse were 7.7％ and 14.3％.Univariable analysis revealed that unfavorable karyotype could affect the rate of CR in the first reduction chemotherapy and that of total CR (P =0.004,0.029).The poor risk patients had higher mortality (41.2％ vs.6.3％,P =0.039) and lower overall survival (OS) (P =0.012).Conclusion:EVI1 may be not an independent prognostic factor for the AML patients considering the appearance in the intermediate and poor risk patients.It predicts poor outcome in the EVI1 positive AML patients who have unfavorable karyocytes,such as-7/7q-,t (v;11 q23),and inv (3)/t (3;3),and also a low rate of both CR in the first induction chemotherapy and total CR.It also has a low rate of long-term survival and high mortality in the AML patients with EVI1 positive,who may benefit from allogeneic bone marrow transplantation as soon as possible.

Expression of EVI1 gene and its clinical significance in pediatric acute myeloid leukemia / 临床儿科杂志

Objective To investigate the relationship between EVI1 gene expression and clinical features and prognosis of children with acute myeloid leukemia (AML). Methods EVI1 gene was detected in AML children, correlation of clinical and lab features, prognosis of AML children with EVI1 gene were analyzed. Results EVI1 expression is positive in 38 of 145 children with AML. There were no significant differences in age, gender, hemoglobin concentration, leukocytes and platelet count, subtype of morphology, ratio of chromosomal anomaly and complex karyotypes between EVI1 positive and EVI1 negative group (P>0.05); coexist genes were detected in 9 cases (23.68%) of EVI1 positive group. Rate of complete remission (CR) was 91.67% in 24 cases of EVI1 positive patients received chemotherapy. Relapse rate was 64.29% and 14.29% in EVI1 positive patients who received chemotherapy and allo-hematopoietic stem cell transplantation (allo-HSCT), retrospectively and significant differences were found (P<0.05). There was no significant difference in CR but significant difference was found in event free survival (P<0.05) for EVI1 positive and EVI1 negative patients who received chemotherapy. EVI1 gene kept negative when bone marrow relapse occurred in two patients with EVI1 positive at diagnosis. Conclusion EVI1 gene may play adverse role in pediatric AML; prognosis of EVI1 positive AML patients can be improved by allo-HSCT; follow-up of EVI1 transcript levels is insufficient to monitoring of minimal residual disease.

Effects of Standardization of Clinical Research on Results of Evidence-based Medicine Analysis for Yao-tongning Capsules / 中国药房

OBJECTIVE:To investigate influential factors of standardization of clinical research on therapeutic efficacy of Yao-tongning capsules,and to provide direction for reasonable and standard development of clinical research. METHODS:Retrieved from CJFD,VIP and Wanfang database,RCTs about Yaotongning capsules in the treatment of related disease were collected. After data extraction and quality evaluation,Meta-analysis was conducted by using Rev Man 5.3 statistical software. The effects of the di-alectical situation,treatment course and route of administration on the evaluation of therapeutic efficacy of Yaotongning capsules were compared;based on this,the concepts of index evidence-based value which reflected clinical standardization were put for-ward,and its effects on Yaotongning capsules were investigated. RESULTS:A total of 71 RCTs were included,involving 11009 patients. Results of Meta-analysis showed therapeutic efficacy of Yaotongning capsules was better than that of other drugs in dialecti-cal case(P=0.02),while therapeutic efficacy of Yaotongning capsules was inferior to that of other drugs in non-dialectical case(P<0.01);therapeutic efficacy of Yaotongning capsules was inferior to that of other drugs when treatment course was shorter than 30 days(P<0.05),while treatment course was longer than 30 days,there was no difference in therapeutic efficacy between Yaotongn-ing capsules and other drugs(P=0.99). When did not take medicine according to the instruction,therapeutic efficacy of Yaotongn-ing capsule was inferior to that of other drugs(P<0.05);when taking medicine according to the instruction,there was no differ-ence in therapeutic efficacy between Yaotongning capsules and other drugs(P=0.94). When evidence-based value was ≥5,thera-peutic efficacy of Yaotongning capsules was better than that of other drugs(P=0.03);when evidence-based value was equal to 4, there was no difference in therapeutic efficacy between Yaotongning capsules and other drugs(P=0.56);when evidence-based val-ue was ≤3,therapeutic efficacy of Yaotongning capsules was inferior to that of other drugs(P<0.05),with statistical significance. CONCLUSIONS:It is an important guarantee of playing therapeutic efficacy of Yaotongning capsules to regularly use drugs strictly according to the principle of dialectical treatment,and take drugs according to treatment course and instructions. Clinical trials should be standardized strictly in accordance with the instructions,so as to provide objective and fair clinical findings.

Clinical analysis of pediatric acute myeloid leukemia with EVI1 gene positive / 中华实用儿科临床杂志

Objective To analyze the clinical features and prognosis of pediatric acute myeloid leukemia (AML) with EVI1 gene positive.Methods The nested RT-PCR was performed to detect the EVI1 expression in pediatric AML patients from Jan.2009 to Dec.2011.The patients with EVI1 were investigated on clinical features,curative effects and prognosis.The differences between EVI1 (+) and EVI1 (-) patients were also analyzed.Results The frequency of EVI1 (+) expression was 15.65％ (13/83 cases)in pediatric AML,with the highest incidence in high-risk patients.EVI1 (+) was obviously associated with some unfavorable molecular genetic changes such as complex karyotype,MLL rearrangement,and monosomy 7.There were significant differences for EVI1 (+) group and EVI1 (-) group in the complete remission rate (45.5％ vs 79.3％,x2 =5.497,P ＜ 0.05) and complete remission(CR) rate after the first chemotherapy (18.2％ vs 63.8％,x2 =7.828,P ＜0.01).Although significant difference in death rate was not observed,EVI1(+) group had significantly higher early-death rate (45.5％ vs 8.6％,P ＜0.01).The EVI1(+) group also had lower 4 years event-free survival (EFS) [(21.2 ± 13.8) ％ vs (50.2 ± 9.1) ％,x2 =4.493,P ＜ 0.05] and lower 4 years overall survival(OS) [(32.4 ± 7.1) ％ vs (60.3 ± 10.9) ％,x2 =4.602,P ＜ 0.05] compared with EVI1 (-) group.But binary Logistic analysis did not identify EVI1 (+) as an independent unfavorable prognostic factor.Conclusions The pediatric AML with positive EVI1 expression had lower CR rate,higher early death rate and lower EFS.Positive EVI1 expression is related with an adverse outcome,but is not an independent poor prognostic factor.

Oncogenic mechanism and biological effect of Evi-1 gene / 国际肿瘤学杂志

Ecotropic viral integration site-1 (Evi-1) gene is first identified as a binding site for retrovirus in murine myeloid leukemia.The human homologue with the murine in leukemia oncogene Evi-1 is about 91％ of nuclear sequence and 94％ of amino acid.Evi-1 gene is high expressed in myeloid malignancies and other tumors.The main tumorigenic mechanisms of Evi-1 gene include inhibiting TGF-β signal path by depressing Smad3,adjusting cell cycle,promoting angiogenesis,inhibiting JNK.activating AP-1,and so on.

Expression of the EVI1 gene in acute myeloid leukemia / 白血病·淋巴瘤

Objective Estahlished the method to detect different transcripts of EVI1 gene expression with quantitative PCR and study the expression patterns of EVI1 gene in different leukemia groups to investigate the association between EVI1 gene expression and the incidence and prognosis of leukemia.Methods 60 cases acute myeloid leukemia (AML) and 9 cases normal control were detected in the study,37 cases were male and 32 cases were female,age 10-70 years,median age 42 years,M3 36 cases,M2 16 cases and M4 8 cases according to FAB classification criteria,control samples of nine cases were normal healthy people.Using the quantitative PCR (Taq Man probe) to detect the expression of different transcripts of EVI1 gene.The t test was used to detect the expression difference among different leukemia groups.Results ABL gene was used as internal reference,relative changes of EVI1 gene expression level were detected by EVI1/ABL.In all the control patients,EVI1 gene of different transcription of this expression were detected,expression level of EVI1 gene different transcription was significant with the difference (P ＜ 0.05),transcription 2 and 5 (the same primers) were the lowest,followed for transcription 1 and 6,expression of transcription 3 was the highest.The expression levels of transcripts 2 and 5,1,6,3 were nagative,0.005,0.050 and 0.512 respectively in healthy control samples.In addition,the EVI1 gene expression was negatively correlated with expression of the fusion gene AML-ETO and CBFB-MYH11 in AML.Conclusion The study established a stable,fast and accurate method to detect the expression of EVI1 gene.