[What is proven in the treatment of systemic lupus erythematosus?] / Was ist gesichert in der Therapie des systemischen Lupus erythematodes?

Systemic lupus erythematosus (SLE) is an autoimmune disease with variable clinical presentation and organ involvement. Early diagnosis and rapid achievement of low disease activity or remission reduces organ damage and improves prognosis. Therapeutic principles can be divided into so-called basic measures and immunosuppressive treatment. Novel drugs have been developed in recent years, with new classes of agents being added for the treatment of SLE. These include biologic therapies and approved therapeutic options for the treatment of lupus nephritis. In light of improved treatment options, good disease control can now frequently be achieved; with savings on glucocorticoids, combination therapies are increasingly being used. Of great importance is the consistent use of basic measures, which include the use of hydroxychloroquine, optimization of cardiovascular risk factors, UV protection, bone-protective measures, and the implementation of vaccinations. In the treatment of lupus nephritis, conservative therapeutic measures for nephroprotection play a crucial role in renal prognosis. Finally, non-pharmacological therapy options such as exercise therapy are of great importance for improving quality of life.

Epicardial Adipose Tissue: a Potential Therapeutic Target for Cardiovascular Diseases.

With increased ageing of the population, cardiovascular disease (CVD) has become the most important factor endangering human health worldwide. Although the treatment of CVD has become increasingly advanced, there are still a considerable number of patients with conditions that have not improved. According to the latest clinical guidelines of the European Cardiovascular Association, obesity has become an independent risk factor for CVD. Adipose tissue includes visceral adipose tissue and subcutaneous adipose tissue. Many previous studies have focused on subcutaneous adipose tissue, but visceral adipose tissue has been rarely studied. However, as a type of visceral adipose tissue, epicardial adipose tissue (EAT) has attracted the attention of researchers because of its unique anatomical and physiological characteristics. This review will systematically describe the physiological characteristics and evaluation methods of EAT and emphasize the important role and treatment measures of EAT in CVD.

A Review on Zoonotic Pathogens Associated with Non-Human Primates: Understanding the Potential Threats to Humans.

Non-human primates (NHP) share a close relationship with humans due to a genetic homology of 75-98.5%. NHP and humans have highly similar tissue structures, immunity, physiology, and metabolism and thus often can act as hosts to the same pathogens. Agriculture, meat consumption habits, tourism development, religious beliefs, and biological research have led to more extensive and frequent contact between NHPs and humans. Deadly viruses, such as rabies virus, herpes B virus, Marburg virus, Ebola virus, human immunodeficiency virus, and monkeypox virus can be transferred from NHP to humans. Similarly, herpes simplex virus, influenza virus, and yellow fever virus can be transmitted to NHP from humans. Infectious pathogens, including viruses, bacteria, and parasites, can affect the health of both primates and humans. A vast number of NHP-carrying pathogens exhibit a risk of transmission to humans. Therefore, zoonotic infectious diseases should be evaluated in future research. This article reviews the research evidence, diagnostic methods, prevention, and treatment measures that may be useful in limiting the spread of several common viral pathogens via NHP and providing ideas for preventing zoonotic diseases with epidemic potential.

Clinical Manifestations, Monitoring, and Prognosis: A Review of Cardiotoxicity After Antitumor Strategy.

The development of various antitumor drugs has significantly improved the survival of patients with cancer. Many first-line chemotherapy drugs are cytotoxic and the cardiotoxicity is one of the most significant effects that could leads to poor prognosis and decreased survival rate. Cancer treatment include traditional anthracycline drugs, as well as some new targeted drugs such as trastuzumab and ICIs. These drugs may directly or indirectly cause cardiovascular injury through different mechanisms, and lead to increasing the risk of cardiovascular disease or accelerating the development of cardiovascular disease. Cardiotoxicity is clinically manifested by arrhythmia, decreased cardiac function, or even sudden death. The cardiotoxicity caused by traditional chemotherapy drugs such as anthracyclines are significantly known. The cardiotoxicity of some new antitumor drugs such like immune checkpoint inhibitors (ICIs) is also relatively clear and requiring further observation and verification. This review is focused on major three drugs with relatively high incidence of cardiotoxicity and poor prognosis and intended to provide an update on the clinical complications and outcomes of these drugs, and we innovatively summarize the monitoring status of survivors using these drugs and discuss the biomarkers and non-invasive imaging features to identify early cardiotoxicity. Finally, we summarize the prevention that decreasing antitumor drugs-induced cardiotoxicity.

Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a controlled clinical trial design.

BACKGROUND: Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the detection of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. METHODS: This study was part of a larger quality improvement project aiming at developing and implementing a new program for early screening and management of patients with CI. This study, evaluating the program are designed as a controlled clinical trial with a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the 4 'A's Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from the electronic medical records (EMR). RESULTS: Implementation of the dementia-friendly hospital program did not show any significant changes in the identification of patients with CI. However, the share of patients screened with 4AT within 24 h increased from 0% to 35.5% (P < .001). The proportion of the patients with CI identified by the clinical staff, who received measures to promote "dementia-friendly" care and reduce the risk for delirium increased by 32.2% (P < .001), compared to the control group. Furthermore, the number of patients with CI who were prescribed antipsychotic, hypnotic or sedative medications was reduced by 24.5% (P < .001). There were no differences in delirium detection, 30-day readmission or 30-day mortality. CONCLUSIONS: A model for early screening and multifactorial non-pharmacological interventions for patients with CI and delirium may improve management of this patient group, and reduce prescriptions of antipsychotic, hypnotic and sedative medications. The implementation in clinical practice of early screening using quality improvement methodology deserves attention. TRIAL REGISTRATION: The protocol of this study was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System with the registration number: NCT04737733 and date of registration: 03/02/2021.

Epidemiological analysis of ocular trauma in Shaanxi and surrounding areas / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analysis the epidemiological and clinical characteristics of ocular trauma in Shaanxi and surrounding areas, and provide research support for the formulation of prevention and treatment measures for ocular trauma. METHODS: Retrospective study. The general data and clinical data of 1 723 unilateral ocular trauma patients(1 723 eyes)admitted to our hospital from January 2 018 to April 2 020 were collected to establish the ocular trauma database and analyzed.RESULTS: Among the 1 723 cases(1 723 eyes)of ocular trauma patients, young and middle-aged patients(20-59 years old)accounted for the majority(1 149 eyes, 66.69%)and mainly were male patients(1 392 eyes, 80.79%), and the vast majority of patients came from rural areas(1 270 eyes, 73.71%)and engaged in manual labor(1 288 eyes, 74.75%). The main causes of ocular trauma were blunt tools(511 eyes, 29.66%), sharp objects(423 eyes, 24.55%), splashing metal(non-metal)foreign bodies(299 eyes, 17.35%), falling(183 eyes, 10.62%), <i>etc</i>. The main places of injury were workplaces(633 eyes, 36.74%), farming places(474 eyes, 27.51%), residential homes(302 eyes, 17.53%), public places(248 eyes, 14.39%), <i>etc</i>. The main type of ocular trauma was open globe injury(1 311 eyes, 76.09%), and the main therapy was surgical treatment(1 638 eyes, 95.07%). Logistic analysis found that age, post-injury visit time, types of ocular trauma, complications of ocular trauma, history of ocular trauma were all important factors influencing prognosis of ocular trauma patients(<i>P</i><0.05). CONCLUSION: Ocular trauma in Shaanxi and surrounding areas has characteristics of age, sex, place of residence, and occupation. For special occupations and special populations, timely targeted health education and prevention measures should be taken to reduce the incidence of ocular trauma. In addition, the timely treatment of ocular trauma can help improve the prognosis of patients.

Adverse reactions and treatment measures of advanced solid tumors treated with antibody-drug conjugates / 国际肿瘤学杂志

Novel antibody-drug conjugates (ADCs) are a hot spot in the research and development of new drugs for advanced solid tumors. ADCs have achieved significant efficacy in the treatment of advanced breast cancer, urothelial carcinoma, gastric cancer and other solid tumors, but their adverse reactions such as ocular toxicity, pulmonary toxicity, hematological toxicity, and liver toxicity cannot be ignored, and it is crucial to effectively deal with the adverse reactions of ADCs.

Chloride Transport Behaviour and Service Performance of Cracked Concrete Linings in Coastal Subway Tunnels.

The concrete lining in subway tunnels often undergoes cracking damage in coastal cities. The combination of cracked tunnel lining structures and high concentrations of corrosive ions in the groundwater (e.g., chlorine) can accelerate concrete erosion, reduce the mechanical performance of the lining structures and shorten the tunnel service life. This paper investigates the chloride ion concentration in the groundwater of several subway tunnels in the coastal city of Qingdao, China. Indoor experiments and numerical simulations are conducted to investigate the chloride ion transport behaviour and service performance of cracked concrete linings. The results are applied to predict the service life of lining structures. The crack depth in concrete linings is found to have the most significant effect on the transport rate of chloride ions, followed by the crack width. The numerical simulations are carried out using COMSOL software to study the chloride transport behaviour in cracked specimens and predict the service lifetimes of lining structures of different thicknesses, and the results correspond well with the experimental data. The durability of a concrete lining can be enhanced by increasing the thickness of the protective concrete layer. Additional measures are proposed for treating cracked concrete linings to resist chloride ion attack in subway tunnels.

Human disease clinical treatment network for the elderly: The analysis of medicare inpatient length of stay data.

Disease clinical treatment measures, such as inpatient length of stay (LOS), have been examined for most if not all diseases. Such analysis has important implications for the management and planning of health care, financial, and human resources. In addition, clinical treatment measures can also informatively reflect intrinsic disease properties such as severity. The existing studies mostly focus on either a single disease (or a few pre-selected and closely related diseases) or all diseases combined. In this study, we take a new and innovative perspective, examine the interconnections in length of stay (LOS) among diseases, and construct the very first disease clinical treatment network on LOS. To accommodate uniquely challenging data distributions, a new conditional network construction approach is developed. Based on the constructed network, the analysis of important network properties is conducted. The Medicare data on 100 000 randomly selected subjects for the period of January 2008 to December 2018 is analyzed. The network structure and key properties are found to have sensible biomedical interpretations. Being the very first of its kind, this study can be informative to disease clinical management, advance our understanding of disease interconnections, and foster complex network analysis.

[Advances in the Pathogenesis,Prevention,and Treatment of Transfusion-related Acute Lung Injury].

Transfusion-related acute lung injury(TRALI)is a severe pulmonary complication of transfusion and has been one of the leading causes of transfusion-associated deaths.However,the pathogenesis of TRALI is still unclear,and treatment and prevention of this condition also face huge challenges.Many recent studies have explored the roles of various effector cells and effector molecules in TRALI and possible related mechanisms based on various hypotheses,in order to find the key factors that induce TRALI and the potential prevention measures.This article reviews the pathogenesis,prevention,and treatment of TRALI.

Adults' dental treatment in 2001-2013 in Finnish public dental service.

BACKGROUND: All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001-2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001-2013. METHODS: Sing each person's unique identifier, demographic data on dental visits during the period 2001-2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. RESULTS: Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel's treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18-39 years; p = 0.033*). CONCLUSION: Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults' dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.

Vocal Fatigue-Do Young Speech-Language Pathologists Practice What They Preach?

PURPOSE: Speech-Language Pathologists can be categorized as Level II professional voice users who play the roles of voice therapist or vocal coach to treat voice problems. SLPs may be at the risk of experiencing vocal fatigue due to vocal loading and other contributing factors. The present study was undertaken to find the percentage of SLPs reporting vocal fatigue, the probable factors resulting in vocal fatigue, the measures that are taken to avoid/reduce the occurrence of vocal fatigue, its effect on their professional and personal life and the measures taken to tackle it. RESULTS: The results of this study are based on data collected from 142 SLPs and 50 controls using a questionnaire. 71.13% SLPs reported that they experience vocal fatigue. Some of the contributing factors that are mainly reported are long durations of voice use, voice use for recreational purposes, speaking loudly, frequent throat clearing, lack of adequate hydration and working in noisy or air-conditioned environments. The major symptoms reported were dryness in throat, tightness in neck and shoulder, choking sensation, effortful speech and pain in the throat. 59% SLPs reported that vocal fatigue affected their professional life while 44% SLPs reported that it affects their personal life also to varying degrees. Measures taken to avoid/ reduce the occurrence of vocal fatigue included vocal warm up, break in between sessions, and play activities. Only a few SLPs took intervention measures like ENT consultation, voice therapy, and home remedies. CONCLUSION: SLPs are inevitably at high risk of experiencing vocal fatigue which, if left untreated, will lead to organic voice problems. However, many young SLPs who experience vocal fatigue reported vocal abuse, do not follow vocal hygiene program and do not follow evidence-based preventive or intervention practices to treat vocal fatigue.

Research progress of linezolid-induced lactic acidosis / 中国临床药理学与治疗学

Linezolid is an oxazolidinone antibacterial agent used in infections caused by gram-positive cocci such as methicillin-resistant staphylococcus aureus, penicillin-resistant pneumococcus and vancomycin-resistant enterococcus. Lactic acidosis is one of the adverse reactions of linezolid. The risk factors of lactic acidosis caused by linezolid are long-term exposure, liver dysfunction, renal dysfunction, mitochondrial DNA A2706G polymorphism, combined use of drugs affecting mitochondrial function, etc. The symptoms of lactic acidosis caused by linezolid are nausea, vomiting, drowsiness, shortness of breath, tachycardia, and hypotension, etc., which can be identified early by close monitoring of laboratory indicators such as blood lactic acid, pH, and blood drug concentration. The mechanism of lactic acidosis induced by linezolid may be related to mitochondrial toxicity. The lactic acidosis of linezolid can be caused by reducing drug dose, stopping drug or even in vitro renal replacement therapy, and strengthening symptomatic support therapy if necessary. This review is intended to provide ideas for the clinical prevention and treatment of lactate acidosis caused by linezolid.

Research updates of diagnosis and treatment of COVID-19 / 解放军医学杂志

From December 2019, the outbreak of corona virus disease 2019 (COVID-19) hits Hubei Province of China. It causes severe acute respiratory syndrome in some patients and notable number of cases died of multiple organ failures. SARS-CoV-2 mainly spread by respiratory droplets and close contact. It is highly infectious and has been found in many countries and regions around the world. So far, no specific vaccine and specific drugs against SARS-CoV-2 have been developed for clinical use. This article reviews the virological characteristics, clinical symptoms, infection mechanism, epidemiology, research progress and clinical effect of COVID-19. It could provide new insights for clinical prevention of COVID-19.

Understanding, prevention and treatment of COVID-19 from perspective of ethnic medicine / 中草药

The coronavirus disease 2019 (COVID-19) has been developing rapidly since the outbreak of Wuhan in December 2019. It has spread to many regions in the world in the short term, which has attracted wide attention at home and abroad. With the active intervention of traditional medicine, the epidemic situation has been effectively controlled, especially for the treatment of severe and critical patients, which shows its unique advantages. Since the outbreak of COVID-19, ethnic medical practitioners have made suggestions on the understanding and prevention measures of COVID-19 based on the theory of ethnic medicine. We should optimize the individual internal environment of patients with individualized traditional medicine prescription, combine the environmental factors such as the soil and space for the emergence and spread of the disease, and contribute our own strength to fighting against the epidemic as soon as possible and ensure the life and health of the minority people. It was suggested to set up a project to excavate, sort out, research and develop the preparations of medical institutions for the prevention and treatment of “pestilence” by national medicine, and make sufficient preparations for the prevention and treatment of “pestilence” caused by various viruses that may occur frequently, so as to protect human health.

Children and adolescents´ dental treatment in 2001-2013 in the Finnish public dental service.

BACKGROUND: The Public Dental Service (PDS) in Finland has catered for the overwhelming majority of the young for more than 50 years. They have had examinations, preventive measures and all other necessary treatment free of charge. This study aimed to survey the treatment needs and treatment measures provided for children and adolescents and changes in these during the period 2001-2013. METHODS: Using each person's unique identifier, data on patients (< 18 years), their oral health (CPI > 2, D + d > 0) and treatment received in the period 2001-2013 were collected retrospectively from municipal databases in five PDS-units covering 320,000 inhabitants. The National Institute for Health and Welfare gave ethical approval. Permission to use local data was received from the Directors in the PDS units. Treatment measures were grouped into 14 categories and patients into three age categories (0-6 years, 7-13 years and 14-17 years). Trend analysis was used to test changes over time. RESULTS: About 40,000 children and adolescents visited the PDS each year and 2,488,805 treatment measures were provided for them during the entire study period. The proportion of those in need of treatment decreased from 44.4 to 33.2% during the study period. The most common treatment categories were examinations (613,753, 24.7%), orthodontics (499,033, 20.1%), preventive measures (372,473, 15.0%) and restorative treatment (355,325, 14.3%); these made up 74% of all treatment measures. During the study period, statistically highly significant (p < 0.001***) increasing trends were found for examinations, anaesthesia and the total number of treatment measures, and a significant (p < 0.001***) decreasing trend in restorative treatment were found for all the young. More preventive treatment measures were provided for those not in need of treatment compared with those in need of treatment. CONCLUSION: Although children's oral health had improved and restorative treatment provided had decreased, the total number of treatment measures increased. Healthy children received frequent examinations and high numbers of preventive treatment measures. Targeting treatment according to needs was not satisfactory.

Prevalence and mortality due to acute kidney injuries in patients with influenza A (H1N1) viral infection: A systemic narrative review.

INTRODUCTION: There is limited evidence of studying the associated factors of acute kidney injury (AKI) among patients with influenza A (H1N1) virus infection pandemic in 2009. AKI is one of the most prevalent complications in the intensive care unit. Its incidence is associated with high mortality and negative impacts on long-term survival. The aim of this narrative review was to determine the prevalence and mortality due to AKI, among patients admitted with the H1N1 virus. MATERIALS AND METHODS: A narrative review of studies reporting about treatment measures and mortality associated with AKI during the H1N1 pandemic over a 10-year period (from September 2009 to August 2018), was performed. We searched the following databases; EMBASE, Medline/PubMed, NHS evidence, Google Scholar, and the Cochrane Library. Our inclusion revealed 20 studies of patients (n = 3579) who were admitted with H1N1 infection and developed AKI. RESULTS: In this study, 33% of patients (n = 1164) who were admitted with H1N1 infection had developed AKI. Within the first 5 years (2009 to 2013), 36% of patients (n = 1013) developed AKI. Within the next 5 years (2014-2018), 812 patients were admitted with the H1N1 infection and 18% of patients (n = 150) had developed AKI. Over the 10 years, there was a 50% reduction in the number of patients who developed AKI (2009 and 2018) (P < 0.0001). CONCLUSION: Patients showed varied responses to treatment measures, depending on their geographical location, comorbidities, and other characteristics. Despite a reasonable prevalence of AKI among patients with the H1N1 virus infection, the mortality over the last 10 years was reduced, with renal replacement therapy as a common therapy in most studies.

Evaluation for therapeutic measures to small gastric stromal tumor: A retrospective study of 90 cases.

Surgery and regular follow-up are two main measures for small gastric stromal tumors (sGST) less than 2cm in diameter, while there is no sound evidence to prove which treatment is more beneficial to sGST patients. In this study, we reviewed the clinical and pathological features of patients with sGST receiving surgery and discussed the value of surgical intervention. In all, 90 patients who were diagnosed as sGST(less than 2cm) and accepted surgical treatment were enrolled, correspondently, another 104 patients with GSTs between 2-5cm and 74 patients with GSTs >5cm were collected as Control groups 1 and 2, respectively, and all of them received surgical treatment. Results showed that there were no significant difference among 3 groups in terms of gender, age, clinical features, tumor locations, and mutations of the exon 9 or 11 in C-kit gene, and immunohistochemical results of CD117, CD34, and DOG-1 proteins (P > 0.05). However, we observed growing percentage of medium-/high-risk GSTs and nucleus mitotic counts >5/50 HPF in Control groups (P < 0.05). Patients with sGST were more suitable for minimally invasive procedures than the other 2 groups, with shorter hospital stay (P < 0.05). During the follow-up period (medium 45.4 months), the recurrence rate was also associated with tumor size, which surged from 1.11% in sGST group to 7.69% and 17.56% in Control groups 1 and 2, respectively. In all, we concluded that patients with sGST experienced low proportions of medium-/high-risk tumors; however, they still suffered from potential risk of tumor progression. Due to satisfied surgical outcome, surgical treatment could be suggested for sGST.

The solutions and common problems analysis on the application of syringe pump / 中国医学装备

Objective:To study the trace injection pump in the application of the common problems and treatment measures.Methods: 246 cases of general surgery patients were used trace injection pump problems for retrospective analysis, in order to propose the improvements about engineering and management.Results: The incidence rate of non-standard operation procedures or the incidents are 6.1%, injection pump failure and infusion speed is 2.03%, mismatched injection pump attachments is 1.22% and phlebophlogosis is 0.41%. The non-standard operation procedures and imperfect trace injection pump management are the major problems. Therefore, some solutions are proposed, which includes strengthening technical training for medical staff, standard operation procedures, regular quality monitoring and healthy education to the patients.Conclusion: The operation procedures of trace injection pump should be standard and programmatic. It is of great significance to clinical application of the trace injection pump and to work properly by strengthening operation personnel quality, dealing with problems timely and correctly.