简介：Earlydiagnosisandtreatmentisthekeytoimprovingtheprognosisofgastriccancer.Thepastdecadeshavewitnessedtherapidadvancesinthediagnosisandmanagementofearlygastriccancer(EGC):endoscopyhasplayedanincreasinglyimportantrole,whereaslaparoscopictechniqueshavealsobeenintroducedforEGCtreatment.InChina,the

简介：AbstractIntracranial atherosclerosis (ICAS)-related large vascular occlusion (LVO) was an intractable subtype of acute ischemic stroke (AIS), which always needed rescue angioplasty and stenting and complicated the procedure of endovascular recanalization. Diagnosing ICAS-LVO accurately and early was helpful for both clinical treatment and trials. Digital subtraction angiography (DSA) was unable to provide an early and rapid diagnosis of ICAS-LVO based on current studies. A variety of pre-DSA methods had been used to distinguish ICAS-LVO with other subtypes of ischemic stroke, such as medical histories, clinical presentations, computed tomography or angiography (CT/CTA), and magnetic resonance imaging (MRI/MRA). This article briefly reviewed the status quo of the diagnosis and treatment of ICAS-LVO and summarized early diagnostic methods of ICAS-LVO from different aspects.

简介：AbstractOne in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.

简介：Objective:Tofindaneffective,sensitive,specificandnoninvasivediagnosticmethodofbreastcancer.Methods:109massesof102patientswithbreastlesionssmallerthan2cmindiameterweredividedintothreegroupstoundergo99mTc-MIBIimagingandcomparedwiththeresultsofpathologyexamination.20caseswithoutbreastlesionswereselectedascontrol.Abnormalcondensationof99mTc-MIBIinthebreastreaching10%higherthanthatinthecounterpartofthehealthybreastwasregardedaspositive.Results:Of32breastcancers,positiveimagingappearedin25.Negativeimagingwerefoundin31of38benignbreastlesions.Of39occultbreastlesions,positiveimagingappearedin6and3ofthemwerebreastcancer,2of3patientswithslightlyincreased99mTc-MIBIimagingthresholdwerebreastcanceralso.Nopositiveimagingwasfoundinthecontrolgroup.Thediagnosticaccuracy,sensitivity,specificity,positivepredictivevalue,negativepredictivevalueof99mTc-MIBIwas88.4%,89.2%,88.0%,75.0%and95.3%,respectively.Conclusion:99mTc-MIBIimaginghadhighersensitivityandaccuracyinthediagnosisofbreastcanceranddifferentiationbetweenbenignandmalignantbreastlesions.Itcouldprovideusefulinformationforthediagnosisofclinicallysuspectedbreastcancer.

简介：目的：分析探索MRI在骨梗死诊断与早期诊断中的应用价值。方法：选取我院及协作医院涿州市医院2016年1月-2021年3月间48例均行X线平片、CT及MR检查诊断并最终确诊骨梗死病例，利用数字表法分成CT组与MRI组，观察对比诊断结果。结果：MRI组诊断准确率、诊断敏感性均高于CT组，P<0.05。结论：MRI在骨梗死诊断中具有较高应用价值，可以早期诊断疾病。

简介：AbstractObjective:To identify potential early diagnostic markers for hepatitis B progression to primary liver carcinoma using routine immunological tests based on 6 cytokine combinations.Methods:Eight hundred and ninety-nine patients with hepatitis B progressing to early primary liver carcinoma admitted to and treated at Changhai Hospital, Naval Military Medical University, Shanghai, China between March 2015 and June 2017 were included in this observational study, including 666 patients with HBsAg+, HBeAb+, HBcAb+ liver carcinoma and 233 patients with HBsAg+, HBeAg+, HBcAb+ liver carcinoma. Receiver operating characteristic (ROC) curves were used to evaluate the efficiency of the different cytokine in the diagnosis of hepatocellular carcinoma in patients with hepatitis B. This study was approved by the Institutional Review Board of Changhai Hospital, Naval Military Medical University, China (approval No. CHEC2020-080) on June 6, 2020.Results:Changed levels of interleukin (IL)-1β, IL-2R, IL-8, and tumor necrosis factor (TNF)-α were statistically significant (P < 0.05). The area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for the diagnosis of primary liver carcinoma using the combination of IL-1β, IL-2R, IL-8, and TNF-α were 0.938, 79.2%, 96.7%, 96%, 82.0%, 0.759, respectively. The serum alpha-fetoprotein level in patients with primary liver carcinoma was positively correlated with IL-2R (r=0.3502, P < 0.001), IL-8 (r=0.1558, P=0.0273), and TNF-α (r=0.2544, P < 0.001) levels. The equation fitted to the results was logit(P)=0.086+ 0.01 × IL-2R-0.001 × IL-8-0.033 × TNF-α-0.041 × IL-1β.Conclusion:Our study establishes a novel, potentially valuable diagnostic model based on four cytokines related to the early stages of liver carcinoma.

简介：AbstractBackground:Continuing progress in the global pediatric human immunodeficiency virus (HIV) response depends on timely identification and care of infants with HIV. As countries scale-out improvements to HIV early infant diagnosis (EID), economic evaluations are needed to inform program design and implementation. This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases (Embase, MEDLINE and EconLit) and grey literature for economic analyses of HIV EID in low- and middle-income countries published between January 2008 and June 2021. We extracted data on unit costs, cost savings, and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats. We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records, we included 29 studies: 17 cost analyses and 12 model-based cost-effectiveness analyses. Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests. All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective. Most studies reported costs of EID testing strategies; however, few studies assessed the same intervention or reported costs in the same way, making comparison of costs across studies challenging. Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV, while not directly comparable across studies, covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving. Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

简介：AbstractPurpose:To investigate the clinical value of urine interleukin-18 (IL-8), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for the early diagnosis of acute kidney injury (AKI) in patients with ureteroscopic lithotripsy (URL) related urosepsis.Methods:A retrospective study was carried out in 157 patients with urosepsis after URL. The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8, NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0, 4, 12, 24 and 48 h after the surgery. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.Results:The level of urine IL-8, NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4, 12, 24 and 48 h (p < 0.01). The ROC analysis showed the combined detection of urine IL-8, NGAL and KIM-1 at 12 h had a larger area under curve (AUC) than a single marker (0.997, 95% CI: 0.991-0.998), and the sensitivity and specificity were 98.2% and 96.7%, respectively. Pearson correlation analysis showed that the levels of urine NGAL at 4, 12, 24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18 (p < 0.01).Conclusion:AKI could be quickly recognized by the elevated level of urine IL-8, NGAL and KIM-1 in patients with URL-related urosepsis. Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance, which may be an important reference for the early diagnosis of AKI.

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简介：Acockcrowsinthemorningtotellustorise,Andhewholikeslatewillneverbewise.Forearlytobedandearlytorise,Isthewaytobehealthyandwealthyandwise.

简介：Previousstudiesemphasizetheimportantroleofa'north-ridgeversussouth-trough'dipole(affectingthelatitudesfrom20°to75°NaroundtheTibetanPlateau)ofanomalousgeopotentialheight(Z)intheearly-2008abnormalcryogenicfreezing-rain-and-snoweventsinthesouthernpartofChina.ThepresentstudyintendstoextracttheleadingsignalfacilitatingthedipolebasedonthenumericaloutputsofafullZ-linearmodelfordiagnosingtheglobalZ.Usingthismodelbuiltonfullprimitiveequationsinspherical-isobariccoordinates,wecanfurthersplittheanomalyofZ-Zfζ-uβ(representingtheZcomponentnotexplicitlyassociatedwiththeCoriolisparameterfanditsmeridionalderivativeβ)into15components.Withthemodel-outputZfζ-uβ(mainlyaccountingforthedipoleunderthegeostrophicbalance)andZ-Zfζ-uβmatricesastheleftandrightsingularvectorsrespectively,amaximumcovarianceanalysis(MCA)isperformedtoextractthesignificant2-4-dayleadingsignalcarriedbytheMCAZ-Zfζ-uβmodeintheupstreamareaofthedipole.Thisleadingsignalismainlyattributedto1)theabnormallystrongwesterliescenteredaroundtheexitregionoftheAtlanticjet-streamand2)thecorrespondinganomalous950-300hPaanticyclonetothesouthoftheabnormallystrongcenterofwesterlies.Theenergyofthepositivewavecenteraroundthisjetexitregionfavorsthedownstreamnorth-ridgewhiletheenergyofthenegativewavecenterassociatedwiththeanomalousanticyclonefavorsthedownstreamsouth-trough.

简介：ispaperestablishesaformalmodelforhybriddiagnosis,novelfeaturesincluding:(1)Itprovidesaunifiedtheoreticalframeworkforutilizingdevicemodelsandheuristicsindiagnosis,whichnaturallyintegratesalltheimportantcomponentsofdiagnosis-thestructuralandbehavioraldescriptionofdevices,faultmodes,thelowerandupperfaultbounds,faultpossibilitiesandheuristicrules-intoadiagnosticsystem.Devicemodelspredictoutputsfrominputs,heuristicrulesinferthepossibilitiesofcertaincomponentsbeingfaultyfromsymptons,andyetthecombinationofbothconstrainseachotherforustoreducethehypothesisspace.(2)Itpresentsatypicalwayofmodelingbehaviorofdevices,towhichthekeyistheintroductionofI-Ofunctionswithindefiniteinputs/outputs.(3)Itcaneasilybeimplementedoveraforware-chaininginferenceengine.

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简介：AbstractIntraamniotic infection (IAI) or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes, including neonatal pneumonia, respiratory distress, meningitis, sepsis, and death. Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention, cesarean birth, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. Chorioamnionitis can result from an ascending infection, iatrogenic causes or transplacental passage from maternal blood-borne infections. The clinical findings of chorioamnionitis include maternal fever (≥38 °C), maternal (>100 beats per minute) and/or fetal tachycardia (>160 beats per minute), maternal leukocytosis on complete blood count (>15 000 cells/mm3), and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid. The management of chorioamnionitis mainly includes antibiotic therapy and delivery. Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach. The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible, with appropriate neonatal resuscitation available.

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简介：Assessmentofanacutelypoisondepatientfollowstheestablisedclinicalmethod(Figure1):