Retrograde Arterial Flow Secondary to Median Arcuate Ligament Syndrome as a Contraindication to Gastroduodenal Artery Angioembolization.

Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) exerts external compression on the celiac trunk. Most cases are asymptomatic and diagnosed incidentally on radiographic imaging; however, some patients may experience gastrointestinal (GI) symptoms related to foregut ischemia and/or celiac neuropathy. In the following case, we present a patient with hemorrhagic peptic ulcer disease of the duodenum, which resulted in episodes of hemodynamic instability requiring multiple blood transfusions. Upon attempted transarterial angioembolization of the gastroduodenal artery (GDA), celiac stenosis and retrograde arterial flow from the superior mesenteric artery confirmed the presence of MALS. This rendered GDA angioembolization a contraindication, as the GDA became the dominant arterial supply for the distal celiac organs. The patient then received open surgical MAL release with concurrent surgical ligation of the hemorrhaging duodenal artery, which resolved his symptoms without the need for further intervention.

Standardized emergency protocols to improve the management of patients with suspected or confirmed inherited metabolic disorders (IMDs): An initiative of the French IMDs Healthcare Network for Rare Diseases.

OBJECTIVES: Patients with inherited metabolic disorders (IMDs) may require emergency hospital care to prevent life-threatening situations such as metabolic decompensation. To date, over one thousand different rare IMDs have been identified, which means that healthcare professionals (HCPs) initiating emergency treatment may not be familiar with these conditions. The objective of this initiative was to provide HCPs with practical guidance for the acute management of children and adults with IMDs who need emergency care, regardless of the underlying reason. METHODS: We outline how a multidisciplinary working group from the French IMDs Healthcare Network for Rare Diseases, known as G2M, has created concise and standardized protocols _each consisting of a single double-sided A4 sheet _ focused on a specific disease, a group of diseases, or a particular symptom. Prior to validation, these protocols were reviewed by all French reference and competence centres for IMDs, as well as by medical experts from other specialities when necessary, physicians from emergency and intensive care units, and representatives from patient associations. RESULTS AND CONCLUSION: In total, 51 emergency protocols containing essential information have been developed and provided to affected patients. All the emergency protocols are freely available in both French and English at https://www.filiere-g2m.fr/urgences. These standardized protocols aim to enhance the emergency care of patients without delay, while also assisting HCPs by increasing their confidence and efficiency, minimizing the risk of dosage errors when administering specialized treatments, saving time, and reducing the number of phone calls to metabolic medicine specialists on night duty. The protocols are scheduled for annual review to facilitate further improvements based on feedback from HCPs and patients, as well as to accommodate any changes in management practices as they evolve.

Contraindications in national guidelines for vaginal breech delivery at term: Comparison, consensus, and controversy.

INTRODUCTION: The optimal mode of delivery for vaginal breech presentation remains a clinical dilemma. Planned vaginal delivery offers maternal advantages because it avoids major abdominal surgery and has no consequences for following pregnancies, while elective cesarean delivery proves advantageous for the neonate because adverse outcomes are less frequent. Patient selection for vaginal breech delivery is important based on the individual risk balance. A lack of consensus exists regarding the specific contraindications for vaginal breech delivery, largely due to limited scientific evidence. This systematic review aims to give an overview of contraindications for vaginal breech delivery, as presented in guidelines, analyze relevant literature, and offer evidence-based recommendations for the contraindications stated in the guidelines. MATERIAL AND METHODS: To identify national guidelines PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, NICE, UpToDate, and ClinicalKey were searched using two keywords: "breech presentation" and "vaginal delivery." We systematically reviewed the literature for existing evidence for contraindications for term vaginal breech delivery. The following databases were searched: PubMed (April 2024), the Cochrane Central Register of Controlled Trials, and EMBASE (1947 to 2024). RESULTS: Our search identified eight guidelines that stated a total of 11 contraindications for vaginal breech delivery. Among these guidelines, agreement was limited, with the sole consensus in all guidelines on the contraindication of footling breech. Our comprehensive literature search yielded 43 articles discussing 14 potential contraindications. We found supportive evidence for 7 of 11 contraindications from the guidelines, with only substantial and satisfactory evidence for two contraindications. CONCLUSIONS: The findings of this study underscore the lack of consensus among national guidelines regarding contraindications for term vaginal breech delivery. Furthermore, we found a notable lack of substantial scientific evidence to support these contraindications. In light of these findings, we suggest a reduced list of contraindications in vaginal breech deliveries.

[Place of the electrocardiogram in the visit of non-contra-indication to the practice of competitive sports between the ages of 12 and 35 : Survey of physicians who are members of the Guinean Association of Sports Physicians]. / Place de l'électrocardiogramme dans la visite de non-contre-indication à la pratique sportive de compétition entre 12 et 35 ans : enquête auprès des médecins membres de l'Association Guinéenne des Médecins Sportifs.

INTRODUCTION: An electrocardiogram (ECG), combined with a well-conducted clinical examination, is more effective than the clinical examination alone in detecting underlying cardiac pathologies in athletes. The aim of this study was to evaluate the use of ECGs by physicians who are members of the Guinean Association of Sports Physicians, during the non-contraindication visit for competitive sports between the ages of 12 and 35. METHODOLOGY: We conducted a web-survey from July 15 to August 15, 2023. A survey form was created on "Google Docs" and pre-tested. It was then broadcast on all the communication networks used by these doctors. The data were secured using "Google Drive" software. Analyses were performed using SPSS version 20 software. RESULTS: Of the 51 included, 74.51% said they had received at least one training session on ECG interpretation for athletes. All of them either requested or performed an ECG at least once in a while, as part of the check-up for non-contraindication to competitive sport. The ECG was systematic, according to 72.55% of doctors. Three quarters referred to a sports cardiologist in the event of an abnormal ECG, 66.67% to a cardiology resident and 58.82% to a cardiologist. In the absence of an ECG, the presence of functional signs on exertion, the notion of a family history of cardiovascular disease and the presence of at least two cardiovascular risk factors were the main reasons for seeking an opinion. CONCLUSION: A resting ECG is carried out almost systematically by doctors who are members of the Guinean Association of Sports Doctors, as part of the check-up for non-contraindication to practising sport.

Outcomes of Severe ARDS COVID-19 Patients Denied for Venovenous ECMO Support: A Prospective Observational Comparative Study.

Background: Few data are available concerning the outcome of patients denied venovenous extracorporeal membrane oxygenation (VV-ECMO) relative to severe acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: We compared the 90-day survival rate of consecutive adult patients for whom our center was contacted to discuss VV-ECMO indication. Three groups of patients were created: patients for whom VV-ECMO was immediately indicated (ECMO-indicated group), patients for whom VV-ECMO was not indicated at the time of the call (ECMO-not-indicated group), and patients for whom ECMO was definitely contraindicated (ECMO-contraindicated group). Results: In total, 104 patients were referred for VV-ECMO support due to severe COVID-19 ARDS. Among them, 32 patients had immediate VV-ECMO implantation, 28 patients had no VV-ECMO indication, but 1 was assisted thereafter, and 44 patients were denied VV-ECMO for contraindication. Among the 44 patients denied, 30 were denied for advanced age, 24 for excessive prior duration of mechanical ventilation, and 16 for SOFA score >8. The 90-day survival rate was similar for the ECMO-indicated group and the ECMO-not-indicated group at 62.1 and 61.9%, respectively, whereas it was significantly lower (20.5%) for the ECMO-contraindicated group. Conclusions: Despite a low survival rate, 50% of patients were at home 3 months after being denied for VV-ECMO for severe ARDS due to COVID-19.

Anterior cervical surgery for morbidly obese patients should be performed in-hospitals.

Background: Morbid obesity (MO) is defined by the World Health Organization (WHO) as Class II (i.e. Body Mass Index (BMI) >/= 35 kg/M2 + 2 comorbidities) or Class III (i.e. BMI >/= 40 kg/M2). Here, we reviewed the rates for adverse event/s (AE)/morbidity/mortality for MO patients undergoing anterior cervical surgery as inpatients/in-hospitals, and asked whether this should be considered the standard of care? Methods: We reviewed multiple studies to document the AE/morbidity/mortality rates for performing anterior cervical surgery (i.e., largely ACDF) for MO patients as inpatients/in-hospitals. Results: MO patients undergoing anterior cervical surgery may develop perioperative/postoperative AE, including postoperative epidural hematomas (PEH), that can lead to acute/delayed cardiorespiratory arrests. MO patients in-hospitals have 24/7 availability of anesthesiologists (i.e. to intubate/run codes) and surgeons (i.e. to evacuate anterior acute hematomas) who can best handle typically witnessed cardiorespiratory arrests. Alternatively, after average 4-7.5 hr. postoperative care unit (PACU) observation, Ambulatory Surgical Center (ASC) patients are sent to unmonitored floors for the remainder of their 23-hour stays, while those in Outpatient SurgiCenters (OSC) are discharged home. Either for ASC or OSC patients, cardiorespiratory arrests are usually unwitnessed, and, therefore, are more likely to lead to greater morbidity/mortality. Conclusion: Anterior cervical surgery for MO patients is best/most safely performed as inpatients/in-hospitals where significant postoperative AE, including cardiorespiratory arrests, are most likely to be witnessed events, and appropriately emergently treated with better outcomes. Alternatively, MO patients undergoing anterior cervical procedures in ASC/OSC will more probably have unwitnessed AE/cardiorespiratory arrests, resulting in poorer outcomes with higher mortality rates. Given these findings, isn't it safest for MO patients to undergo anterior cervical surgery as inpatients/in-hospitals, and shouldn't this be considered the standard of care?

Prescription of Opioid Analgesics for Chronic Non-Cancer Pain in Germany despite Contraindications: Administrative Claims Data Analysis.

In Germany, long-term opioid treatment (L-TOT) for chronic non-tumor pain (CNTP) is discussed as not being performed according to the German guideline on L-TOT for CNTP. In the present analysis, the occurrence and predictors of inappropriate care/overuse in a cohort of German insureds with L-TOT for CNTP by the presence of a contraindication with concurrent opioid analgesic (OA) therapy were investigated. We also analyzed whether prescribing physicians themselves diagnosed a contraindication. The retrospective cohort study was based on administrative claims data from a German statutory health insurance. Eight contraindication groups were defined based on the German guideline. Logistic regressions were performed in order to identify predictors for OA prescriptions despite contraindications. The possible knowledge of the prescribing physician about the contraindication was approximated by analyzing concordant unique physician identification numbers of OA prescriptions and contraindication diagnoses. A total of 113,476 individuals (75% female) with a mean age of 72 years were included. The most common documented contraindications were primary headaches (8.7%), severe mood disorders (7.7%) and pain in somatoform disorders (4.5%). The logistic regressions identified a younger age, longer history of OA therapy, opioid related psychological problems, and outpatient psychosomatic primary care as positive predictors for all contraindication groups.

Surgical outcomes of laser in situ keratomileusis (LASIK) in patients with stable systemic disease.

PURPOSE: To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. METHODS: The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p < 0.05. RESULTS: All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group (p = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group (p = 0.004). No intra- or postoperative sight-threatening complications were documented. CONCLUSION: Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.

Tape Eyelid Closure: An Effective Solution for Nocturnal Lagophthalmos in Patients with Ptosis and Poor Bell's Phenomenon.

BACKGROUND: Poor Bell's phenomenon is often considered a relative contraindication for ptosis surgery, as it increases the risk of corneal exposure and dry eye symptoms after surgery. However, the Bell's phenomenon may vary in different individuals and sleep stages, making it inaccurate to predict the position of the eye during sleep based on awake examination. This study aimed to investigate the role of Bell's phenomenon in ptosis surgery and the management of nocturnal lagophthalmos. METHODS: We conducted a retrospective case series of 23 patients with ptosis and poor Bell's phenomenon who underwent different surgical techniques at Xijing Hospital from April 2020 to June 2021. We assessed Bell's phenomenon at different stages of sleep and collected data on ptosis degree, surgical approach, lagophthalmos, complications, and outcomes. RESULTS: Of the total 23 patients originally considered for study, 9 with frontalis muscle advancement technique, 8 with conjoint fascial sheath suspension, 4 with levator resection technique, and 2 with levator aponeurosis plication technique. All patients achieved satisfactory correction of ptosis. One patient had prolonged lagophthalmos and underwent reoperation to lower the eyelid height. Other complications were minor and resolved with conservative treatment. CONCLUSION: We conclude that poor Bell's phenomenon is not a relative contraindication for ptosis surgery. Nocturnal lagophthalmos should be monitored after ptosis surgery regardless of the Bell's phenomenon results. Tape eyelid closure can be an effective solution to protect the corneal surface during nocturnal lagophthalmos. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Herbal Textual Research on Pharbitidis Semen in Famous Classical Formulas / 中国实验方剂学杂志

By consulting the ancient and modern literature， the textual research of Pharbitidis Semen has been conducted to clarify the name， origin， distribution of production areas， quality specification， harvesting， processing and so on， so as to provide reference for the development and utilization of the relevant famous classical formulas. Through textual research， it can be seen that Pharbitidis Semen was first published in Mingyi Bielu（《名医别录》）， and all dynasties have taken Qianniuzi as the correct name. Based on the original research， the main source of Pharbitidis Semen used in previous dynasties is the dried mature seeds of Pharbitis nil， which is consistent in ancient and modern times. The white Pharbitidis Semen appearing in Compendium of Materia Medica（《本草纲目》） from Ming dynasty is similar to the present P. purpurea. It is produced all over the country， and the quality is better if the particles are full and free of impurities. In ancient times， the harvesting time was mostly in the September. Now it is autumn. The fruits are ripe and harvested， dried to remove impurities for standby. In ancient times， the processing methods of Pharbitidis Semen were mainly wine steaming， steaming and frying until half cooked and grinding the head and end. In modern times， they have been simplified to stir-frying method. The nature， taste， meridian tropism and their effects also change supplements with the deepening of practice. Before the Ming dynasty， they were all bitter， cold and toxic. In the Ming dynasty， there appeared the characteristics of pungent， hot and small poisonous. The efficacy has evolved from controlling low Qi， curing foot edema， removing wind toxin， and facilitating urination to facilitating water and defecation， eliminating phlegm and drinking， and eliminating accumulated insects. The main clinical contraindications are those with weak spleen and kidney， those with weak spleen and stomach， pregnant women， and should not be used with croton and croton cream. Based on the textual research， it is suggested that when developing the classic famous formula with Pharbitidis Semen as the main raw material in the future， it is clear that the source should be the dried mature seeds of Pharbitis nil（black product is its black-brown seeds， white product is its beige seeds）. The processing requirements indicated in the original formula are all processed according to the requirements， and the raw product is recommended to be used as medicine if not specified.

Rationale for Contraindications for Pregnant and Breast-Feeding Women in the Package Inserts of Prescription Drugs and Changes in Information by the Revised Instructions / 社会薬学

The package inserts revision regarding prescription drugs is an ongoing process. In this study, we examined the status of this revision and how the content of the information provided has been updated with the new instructions, including the rationale for contraindications for pregnant and breast-feeding women. A total of 407 prescription drugs for pregnant and breast-feeding women were contraindicated, accounting for approximately 15% of the 2,627 nonproprietary names. The number of contraindicated drugs for pregnant, breast-feeding, and both pregnant and breast-feeding women were 406, 44, and 43, respectively. The majority of the contraindications were based on nonclinical data, such as teratogenicity and fetotoxicity data in reproductive toxicity studies involving pregnant animals and pharmacokinetic information in breast-feeding animals. The overall revision rate for the new instructions was 16.2% after three years of revision work for each drug. The alert wording has been revised to provide more clarity and consistency, with three categories of statements: “should not be administered/avoid breastfeeding,” “advisable not to administer/breastfeed,” and “should be administered/breastfeed in consideration of the therapeutic benefit (benefit-risk consideration).” The statement indicating that the drug should not be administered to pregnant women remained in the revised instructions. Conversely, the revision of the description for breast-feeding women from “should be discontinued/avoided” to “benefit-risk consideration” may have improved the usefulness of the product, allowing healthcare professionals to make more informed decisions after considering the transfer of the drug into milk, its pharmacological effects, and other factors.

Endocrowns: Indications, Preparation Techniques, and Material Selection.

Endodontic treatment is often necessary in the field of dentistry. As the tooth structure is lost during such treatment, the tooth may become weaker and lose some of its mechanical qualities. Endodontically treated posterior teeth require cuspal coverage because of their anatomical features. Endocrowns are regarded as a suitable choice for restoring teeth that have undergone endodontic treatment. These restorations are recommended when there is a substantial loss of tooth structure, restricted interocclusal space, or a short clinical crown. They are also contraindicated in case of severe loss of tooth structure where adhesion is not applicable. Endocrowns require a specific preparation design that is distinct from the conventional crown. They can be manufactured by two methods: heat pressing or computer-aided design/computer-aided manufacturing (CAD/CAM). Moreover, several materials have been used in fabricating endocrown restoration. Lithium disilicate glass-ceramic is the most recommended material as it possesses excellent mechanical properties and esthetic results with the ability to bond to tooth structure. In conclusion, several kinds of literature recommend using them for molars. Further research is needed to evaluate this technique for premolar and anterior teeth.

Contraindicaciones para la práctica deportiva. Documento de Consenso de la Sociedad Española de Medicina del Deporte (SEMED). Versión 2023 / Contraindications of sports practice. Consensus document of the Spanish Society of Sports Medicine (SEMED). Version 2023

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios.(AU)

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best-known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it.(AU)

Individuals at risk for severe COVID-19 in whom ritonavir-containing therapies are contraindicated or may lead to interactions with concomitant medications: a retrospective analysis of German health insurance claims data.

Background: Nirmatrelvir/ritonavir is authorized for the treatment of COVID-19 but has several contraindications and potential drug-drug interactions (pDDIs) due to ritonavir-induced irreversible inhibition of cytochrome P450 3A4. We aimed to assess the prevalence of individuals with one or more risk factors for severe COVID-19 along with contraindications and pDDIs due to ritonavir-containing COVID-19 therapy. Methods: Retrospective observational study of individuals with one or more risk factors according to Robert Koch Institute criteria for severe COVID-19 according to German statutory health insurance (SHI) claims data from the pre-pandemic years 2018-2019 based on the German Analysis Database for Evaluation and Health Services Research. Prevalence was extrapolated to the entire SHI population using age-adjusted and sex-adjusted multiplication factors. Results: Nearly 2.5 million fully insured adults, representing 61 million people in the German SHI population, were included in the analysis. In 2019, prevalence of individuals that would have been at risk of severe COVID-19 was 56.4%. Amongst them, the prevalence of contraindications for treatment with ritonavir-containing COVID-19 therapy was approximately 2% according to presence of somatic comorbidities (severe liver or kidney disease). Prevalence of intake of medicines contraindicated for their potential interactions with ritonavir-containing COVID-19 therapy was 16.5% according to Summary of Product Characteristics and 31.8% according to previously published data. The prevalence of individuals at risk of pDDIs during ritonavir-containing COVID-19 therapy without adjustment of their concomitant therapy was 56.0% and 44.3%, respectively. Prevalence data for 2018 were similar. Conclusion: Administering ritonavir-containing COVID-19 therapy can be challenging as thorough medical record review and close monitoring are required. In some cases, ritonavir-containing treatment may not be appropriate due to contraindications, risk of pDDIs, or both. For those individuals, an alternative ritonavir-free treatment should be considered.

Live attenuated vaccines in patients receiving immunosuppressive agents.

The use of live attenuated vaccines in patients with immunosuppressive agents is contraindicated in package inserts and guidelines in Japan and other countries. However, patients receiving immunosuppressants have a high risk of infectious disease becoming severe, and the necessity to prevent infectious disease is high. To date, 2,091 vaccinations have been reported in 25 reports of live attenuated vaccines in people receiving immunosuppressants. Twenty-three patients (1.1%) became infected with the virus strain used in the vaccine, which was varicella virus in 21 patients. No reports have described life-threatening complications. A prospective study at the National Center for Child Health and Development conducted under certain immunological conditions (CD4 cell count ≥ 500/mm3, stimulation index of lymphocyte blast transformation by phytohemagglutinin (PHA) ≥ 101.6, serum immunoglobulin G ≥ 300 mg/dL) confirmed the serological effectiveness and safety. The evidence suggests that live attenuated vaccines can be used even in combination with immunosuppressants. Further evidence must be gathered and immunological criteria investigated to determine the conditions for safe use. Depending on the results of these investigations, the wording in package inserts and guidelines may need to be revised.

[Discussion on the use of occupational contraindication cardiovascular disease in Technical Specifications for Occupational Health Surveillance (GBZ 188-2014)].

Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) has played an important role in screening occupational contraindications and preventing occupational diseases since its implementation. However, during the use of occupational health examination, we found that the use of occupational contraindication on cardiovascular disease was not "homogenized" due to the differences in the understanding of various physical examination institutions. Therefore, this paper mainly discussed the connotation and quantitative standards of organic heart disease, arrhythmia, hypertension in the occupational contraindication cardiovascular disease in the specification for "homogenization".

Spinal Anesthesia in Hemodynamic Instability: A Case Report.

Anesthetic dilemmas are not rare in daily practice. Frequently, patients present with comorbid conditions that make general anesthesia risky (e.g., difficult airway and severe pulmonary dysfunction) and contraindications to neuraxial anesthesia at the same time. Reports on the successful anesthetic management of these patients can provide useful information. We report a case of a patient with severe hemodynamic instability who underwent spinal anesthesia for surgical hip debridement. General anesthesia and airway manipulation were avoided because the patient had recently recovered from SARS-CoV-2 pneumonia amid the first wave of the coronavirus disease 2019 (COVID-19) pandemic when very little was known about the disease and no ventilators were available for postoperative care. We explain in detail the continuous spinal anesthesia technique using a conventional epidural catheter and prophylactic norepinephrine when cardiovascular instability was the major concern.

Discussion on the use of occupational contraindication cardiovascular disease in Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) / 中华劳动卫生职业病杂志

Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) has played an important role in screening occupational contraindications and preventing occupational diseases since its implementation. However, during the use of occupational health examination, we found that the use of occupational contraindication on cardiovascular disease was not "homogenized" due to the differences in the understanding of various physical examination institutions. Therefore, this paper mainly discussed the connotation and quantitative standards of organic heart disease, arrhythmia, hypertension in the occupational contraindication cardiovascular disease in the specification for "homogenization".

Constitution-Based Toxicology:A New Perspective of Study for Assessing the Safety of Traditional Chinese Medicine / 世界科学技术-中医药现代化

At present,research on the safety of traditional Chinese medicine mainly follows the modern medical system,neglecting the crucial role of body factors in adverse events.This research first proposed a new way of thinking about"Constitution-based toxicology"research based on"Contraindication with Constitution differentiation",with"constitutional-herb mutual exclusion"as the core,guided by"Constitution differentiation-disease differentiation-syndrome differentiation"and"Properties Theory of Chinese Medicinal Herbs",with the"toxicological evidence chain"as the method,the pharmacovigilance theory as the foundation,and supported by advanced analytical technology.Constitution-based toxicology,a new interdisciplinary field combining TCM toxicology and TCM constitution theory,is a novel advancement of traditional Chinese medicine.It offers the groundwork for advancing the methodical design of traditional Chinese medicine safety evaluation.