Interpretation of Consensus on the Optimal Treat-and-Extend Regimen of Neovascular Age-Related Macular Degeneration(2022 Taiwan, China) / 国际眼科杂志(Guoji Yanke Zazhi)

In 2022, the Taiwan, China fundus disease expert group issued the Consensus on the Optimal Treat-and-Extend Regimens for Neovascular Age-Related Macular Degeneration. The following explanations are given to help Chinese ophthalmologists better to refer to and use the Consensus. The main contents are as follows: The treat-and-extend(T& E)regimen of anti-vascular endothelial growth factor(VEGF)treatment in patients with neovascular age-related macular degeneration(nARMD)should aim at maintaining long-term vision and reducing the number of injections. We can start the treatment by injecting once a month for consecutive 3mo. After the initial treatment, the treatment interval of patients with stable conditions can be gradually extended(2 or 4wk each time)until 16wk. If the disease is still steady after injecting 2 or 3 times at the most prolonged interval, we can suspend the treatment, and then the patient needs to be rechecked every 3-4mo; If the disease is active again, the treatment interval needs to be shortened and can be extended again after controlling the disease. We can adopt a relatively conservative approach for patients with apparent negative recovery factors. Complications such as subconjunctival hemorrhage, macular fibrosis and macular atrophy deserve our attention during treatment. In the future, we can explore the best injection scheme for nARMD patients with different subtypes and baseline conditions to realize personalized therapy.

Treat and extend comparado con pro re nata en degeneración macular asociada a la edad neovascular / Treat and extend compared to pro re nata regimen in neovascular age-related macular degeneration

INTRODUCCIÓN: La degeneración macular asociada a la edad es la principal causa de ceguera en personas mayores en el mundo. El tratamiento más eficaz consiste en inyecciones intravítreas de fármacos anti factor del crecimiento vascular endotelial (anti-VEGF). Sin embargo, no existe consenso sobre su frecuencia de administración, siendo pro re nata y treat and extend los protocolos más utilizados, pero existe controversia sobre su efectividad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos dos revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos observacionales. Concluimos que no es posible establecer con claridad si el protocolo treat and extend en comparación a pro re nata es superior en términos de ganancia visual, disminución del grosor de la retina, número de inyecciones ni en el desarrollo de efectos adversos serios a los 12 meses, debido a que la certeza de la evidencia existente es muy baja.

INTRODUCTION: Age-related macular degeneration is the leading cause of blindness in older people in the world. One of the most effective treat-ments consists of injection intravitreal of anti-endothelial vascular growth factor (anti-VEGF) drugs. However, there is no con-sensus on their frequency of administration, being the treat and extend and the pro re nata the most commonly used regimens, but there is still controversy regarding their effectiveness. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified two systematic reviews that together included two primary studies, both observational studies. We concluded that we are uncertain whether the treat and extend regimen is superior in terms of visual gain, decrease in retinal thickness, number of injections and serious adverse effects at 12 months in comparison with the pro re nata regimen, because the certainty of the existing evidence has been assessed as very low.

Construção e validação de simulação em vídeo para ensino da ressuscitação cardiopulmonar / Construcción y evaluación de una simulación en video para la enseñanza de resucitación cardiopulmonar / Construction and validation of a video simulation for teaching cardiopulmonary resuscitation

RESUMO Objetivo: desenvolver Tecnologia Educacional Digital (vídeo de simulação) sobre Ressuscitação Cardiopulmonar no adulto em Suporte Básico de Vida com o uso do Desfibrilador Externo Automático no ambiente hospitalar. Metodologia: trata-se de uma pesquisa de produção tecnológica, aplicada. Desenvolvida na Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, no período de janeiro de 2017 a março de 2018. Expertises na área de Urgência e Emergência, 16 enfermeiros, participaram do estudo. Estatística AC1 foi utilizada para avaliar a concordância inter-avaliadores. Resultados: o roteiro/script e storyboard foi validado e alcançado 100% da avaliação em "concordo" ou "concordo fortemente". Classificados em "concordância considerável", com AC1 0,70 e p<0,0001, na concordância inter-avaliadores geral. Conclusão: este estudo proporciona contribuição exponencial no processo ensino-aprendizagem sobre o ensino de Ressuscitação Cardiopulmonar no adulto em Suporte Básico de Vida com o uso do Desfibrilador Externo Automático no ambiente hospitalar, pelo desenvolvimento do vídeo de simulação validado.

RESUMEN: Objetivo: desarrollar Tecnología Educativa Digital (video de simulación) sobre Resucitación Cardiopulmonar en adultos en Soporte Vital Básico con el uso del Desfibrilador Externo Automático en el entorno hospitalario. Metodología: se trata de una investigación de producción tecnológica aplicada que se desarrolló en la Universidad de San Pablo, Facultad de Enfermería de Ribeirão Preto, durante el período de enero de 2017 a marzo de 2018. Los participantes del estudio fueron especialistas en el área de Urgencia y Emergencia, específicamente 16 profesionales de Enfermería. Se utilizó la estadística AC1 para evaluar la concordancia entre los evaluadores. Resultados: se validaron el guion y el desarrollo secuencial (storyboard) con un 100% de las evaluaciones calificadas como "De acuerdo" o "Plenamente de acuerdo", clasificadas como "Concordancia considerable", con valores de AC1=0,70 y p<0,0001 en la concordancia general entre evaluadores. Conclusión: este estudio proporciona un aporte exponencial en el proceso de enseñanza-aprendizaje sobre la enseñanza de Resucitación Cardiopulmonar en adultos en Soporte Vital Básico con el uso del Desfibrilador Externo Automático en el entorno hospitalario, mediante el desarrollo del video de simulación validado.

ABSTRACT Objective: to develop Digital Educational Technology (simulation video) on Cardiopulmonary Resuscitation in adults in Basic Life Support with the use of the External Automated Defibrillator in the hospital environment. Methodology: this is an applied technological production research study developed at the University of São Paulo, Ribeirão Preto College of Nursing, from January 2017 to March 2018. Experts in the area of Urgency and Emergency, namely 16 nurses, participated in the study. The AC1 statistics was used to assess inter-rater agreement. Results: the script and storyboard were validated and reached 100% of the evaluation in "I agree" or "I strongly agree", classified as "Considerable agreement", with AC1=0.70 and p<0.0001, in general inter-rater agreement. Conclusion: this study provides an exponential contribution to the teaching-learning process on the teaching of Cardiopulmonary Resuscitation in adults in Basic Life Support with the use of the Automatic External Defibrillator in the hospital environment, through the development of the validated simulation video.

ABPSE: Alineador de ADN Basado en Paralelismo a Nivel de Bit y la Estrategia Siembra y Extiende / ABPSE: DNA Aligner Based on Bit-level Parallelism and the Seed and Extend Strategy

Resumen La alineación de ADN es un proceso clave para la reconstrucción de genomas, a partir de los millones de lecturas cortas producidas por las máquinas de secuenciación paralela masiva. Tal proceso suele realizarse mediante algoritmos con elevada complejidad espacial y temporal, requiriendo varias horas para entregar los resultados, así como decenas de GB de RAM. Esto ha motivado la búsqueda de nuevos algoritmos y/o estrategias que permitan disminuir los tiempos de ejecución, mientras se utilizan recursos mínimos de memoria. En este artículo se presenta ABPSE, un nuevo alineador de ADN que combina el algoritmo de Ferragina y Manzini (o índices de FM) y el algoritmo de Myers, mediante la estrategia siembra y extiende. En la siembra, los índices de FM permiten calcular de manera rápida regiones con alta probabilidad de alineación; mientras que en la extensión, el algoritmo de Myers refina la alineación utilizando operaciones basadas en vectores de bits, calculando simultáneamente varias celdas de la matriz de programación dinámica. Los resultados muestran un 96.1% de lecturas alineadas correctamente, un factor de aceleración de 2.45x en relación a BWA-SW y un uso de memoria de apenas 7.6 GB, cuando se alinea el genoma humano completo.

Abstract DNA alignment is a key process in the assembly of genomes from the millions of short reads that are produced by massive parallel sequencing machines. Such a process is usually done by means of high spatial and temporal complexity algorithms, which takes hours to deliver the results as well as tens of GB of RAM. This has prompted the search for new algorithms and/or strategies that allow shorter runtimes, while using minimal memory footprint. In this article, we present ABPSE, a new DNA aligner that combines the Ferragina and Manzini algorithm (or FM indexes) and the Myers algorithm, by means of the seed and extend strategy. In the seeding, the FM indices allow a rapid calculation of the regions with high probability of alignment. In the extension, the Myers algorithm refines the alignment using operations based on bit vectors. It simultaneously calculates several cells of the dynamic programming matrix. The results show 96.1% of correctly aligned reads, an acceleration factor of 2.45x in relation to BWA-SW and a memory footprint of only 7.6 GB when aligning the entire human genome.

Value of the multi-slice spiral CT angiography, CT colonography and image fusion technology in preoperative evaluation of laparoscopic right colon cancer / 中华消化外科杂志

Objective To observe the distribution and variation of right colonic vessels,and investigate the clinical value of computed tomography angiography (CTA),computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People's Hospital of Nanjing Medical University between January 2015 and July 2017 were collected.Patients received preoperative plain and enhanced scans of abdominal and pelvic CT.The original images were reconstructed and fused by CTA and CTC,and then coming out with three-dimensional images of blood vessels and gut.Observation indicators:(1) branches of superior mesenteric artery (SMA);(2) positional relationship between SMA and superior mesenteric vein (SMV);(3) composition of gastrocolic venous trunk.Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard,with a good imaging performance.Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy,showing a coincidence rate of 100.0％ (38/38).(1) Branches of SMA:results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery,middle colonic artery and ileocolic artery were respectively 94.7％ (36/38),92.1％ (35/38) and 100.0％ (38/38).A right colonic artery was found in 28 patients.Ten patients had structure variation of right colonic artery,including 3 with 2 right colonic arteries and 2 without right colonic artery.The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients;the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients.(2) Positional relationship between SMA and SMV:results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0％ (38/38).The SMA in 20 patients was located in the ventral side of SMV;SMA in 18 patients was located in the dorsal side of SMV.(3) Composition of gastrocolic venous trunk:results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks,which belonged to four sources,including right colonic vein,middle colonic vein,fight gastric epiploic vein and anterior superior pancreaticoduodenal vein.Among 29 patients,18 had 2-or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein,middle colonic vein and right colonic vein;3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein;8 had 3-or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein,anterior superior pancreaticoduodenal vein,right colonic vein and middle colonic vein.Conclusion CTA,CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels,with a high clinical value.

Design and application of "summary", "extension" and "preview" combination combined holiday counseling after the half teaching of internal medicine nursing / 中华医学教育探索杂志

Internal medicine nursing is a very important learning course for nursing students. It is divided into two semesters in our university. Because the knowledge of the course is more complex and in-volves a wide range, many students have a poor learning effect. In order to improve the teaching effect of the course, the students leave the time to build the "summary", "extension" and "preview" combined guidance method. "Summary" is on the learning content of the summary, "extension" is the effective extension of learning content to the students, "preview" is the key content of the pre term learning habit. Then, accord-ing to the final score of medical nursing in the last semester, we can flexibly design the teaching link. For students under 60 points, holiday guidance is mainly "summary", for the students between 60 points to 85 points, holiday guidance is combined with "summary" "extension" and "preview", for students above 85 points, holiday guidance is the main "extension". Thus, the students' study and holiday time are integrated into a whole to improve their overall learning efficiency.

"Study on ""four-step"" teaching methods in traditional Chinese medicine course" / 中华医学教育探索杂志

Objective To evaluate the results of Four-Step methods in traditional Chinese medicine Course.Methods 40 five-academic-year clinical medical students and 40 seven-academicyear undergraduate students were randomized assigned into experimental group (n=40, 20 five-academicyear clinical medical students and 20 seven-academic-year students) and control group (n=40, 20 five-academic-year students and 20 seven-academic-year students).The control group received conventional teaching, while four-step teaching break the gap between Chinese medicine and western medicine, build the base, form the framework of Chinese medicine and extend knowledge was implemented in the experimental group.Through questionnaire score, group discussion, the final evaluation of the theory and clinical training evaluation, the learning of the experimental group students and the control group students was compared.SPSS 18.0 statistical software was used and t test was employed to make analysis of the relevant data.Results The questionnaire at the end of the semester showed that the average score of students in the experimental group (36.18 ± 0.96) was higher than that in the control group (26.62 ± 1.00), and the difference was statistically significant (P=0.017).In the discussion at the end of the semester, the experimental group paid more attention to the theory and technology of traditional Chinese medicine's learning persistence in future and its application in their professional practice.Scores in theory test were higher in seven-academic-year students in experimental group (88.40 ± 8.79) than in control group (82.15 ± 6.83) and the difference was statistically significant (P=0.017), but there was no difference in five-academic-year students between experimental group (75A0 ± 12.09) and control group (77.85 ± 11.99), which was not considered statistically significant different (P=0.524).In clinical practice, the rate of outstanding students in the experimental group of seven-academic-year was five percentage points higher than the control group, while the rate of outstanding students in the experimental group of five-academic-year was 10 percentage points higher than the control group.Conclusions Four step teaching is helpful to stimulating the learning enthusiasm of the students of traditional Chinese medicine, expanding students' vision of medical field, and promoting their construction of a more comprehensive medical knowledge framework.

Distribution and drug resistance of Klebsiella pneumoniae from 2011 to 2013 in a hospital / 国际检验医学杂志

Objective The distribution and drug resistance of Klebsiella pneumonia isolated from clinical department were ana‐lyzed in this article .It will provide evidence for the clinical rational medication and the control of nosocomial infections .Methods In this hospital ,892 strains of Klebsiella pneumonia isolated from January 2011 to December 2013 were performed a statistical analy‐sis .Results Among all the samples ,the extended spectrumβ‐lactamases(ESBLs) positive Klebsiella pneumoniae accounted for 40 . 92% .The highest detection rate in the all the clinical department is the ICU with a value of 46 .46% .The highest detection rate in the sample is the sputum with a value of 43 .51% .In addition ,the ESBLs positive strains had a trend of multiple drug resistance . The Klebsiella pneumonia was the most sensitive bacteria to imipenem ,meropenem ,piperacillin/tazobactam and cefoperazone/sul‐bactam ,no matter whether they produced ESBLs or not .Conclusion The resistant rate of ESBLs positive strains is higher than that of ESBLs negative strains .It was recommended to the rational use of antibiotics based on the duration of disease and the products with or without ESBLs .Furthermore ,it will be of great importance to reduce the incidence of multiple drug resistance ,and to con‐trol the hospital infection effectively .

Study on the New Rural Cooperative Medical Demand in Jiangsu Province Based on Extend Linear Expenditure System Model / 中国卫生经济

Objective: The demand of new rural cooperative medical system in Jiangsu province of the quantitative research is analyzed. Methods: To analyze cross-sectional data in 2011 statistical yearbook of Jiangsu province and China Statistical yearbook by using Extend Linear Expenditure System ( ELES) Model. Results: The farmers of Jiangsu for medical need a lower tendency and middle-income households below the expenditure on basic medical needs. In the premise of the farmers’ live, increase the income of medical and the demand will increase too. Conclusion:It needs to carry out effective propaganda work, improve the level of financing of the new rural cooperative medical system, implement the reform of the medical system.

Total hip arthroplasty for severe congenital dislocation of adult hip mellitus / 中国矫形外科杂志

[Objective]To discuss the methods and results of total hip arthroplasty for the adult hip of severe congenital dislocation.[Method]Thirteen patients with unilateral Crowe type-Ⅳ dislocation underwent total hip replacement.All patients were distracted for two weeks preoperatively,and in the operation procedure,the acetabulat rotation center and abductor function were reconstructed on the basis of soft tissue release.The evaluations after surgery included the leg-length and Harris scores.[Result]According to the follow-up with an average of 18 months,the Harris hip score averaged 90 points.The leg-length extended 3.1 cm on average.One patient appeared sciatic nerve palsy.[Conclusion]Total hip arthroplasty could effectively treat server congenital dislocation of adult hip by the methods of tissue release,reconstruction of acetabular,proper selection of prosthetic and protection of nerve.