简介：Theeffectivenessofmechanicalventilation,bothinvasive(byendotrachealintubation)andnon-invasiive(bynegativepressureventilation)wasestablishedduringtheepidemicsofpolioinEuropeandNorthAmericainthelain1950sandearly1960s.Theindicationsforventilationhaveincreasedsincethattime,andinvasiveventilationserviceshavebecomeconcentratedinhighly-staffedcriticalcareunitsand.insomepartsofEurope,respiratorycareunits.

简介：瞄准：评估影响多囊肝疾病的非侵略、侵略的治疗的结果的因素。方法：有到2006年6月的从1986年7月的完全的后续的病人的临床的文件的分析。结果：41个病人(男性，7；女性，34)，11.9年变老的47.8+/-，和5.7+/-6.7年后续，被学习。硷性磷酸酯酶(AP)举起(15%病人)与侵略治疗的要求被联系(信息技术，P=0.005)。信息技术率是更高的在比非征兆的病人征兆(65.4%对14.3%，P=0.002)，并且在拿神经质的代替治疗(HRT)的女人(P=0.001)。包囊复杂并发症(CC)是更经常的(22%)在征兆的病人组织(P=0.023)。有身体质量的病人索引(BMI)>(59%)25在它以后有一个趋势到复杂并发症(P=0.075)。腹的疼痛为信息技术(78%)是最普通的症状(56%)和指示。十九个病人(46%)要求了第一种信息技术：12开的开窗术()，4laparoscopic开窗术(LF)和有肝的切除术(FHR)的3开窗术。三要求了第二种信息技术，并且一个人要求了第三个过程。复杂并发症在32%由于第一种信息技术被发现(16.7%，LF25%，FHR66.7%)，并且在在66.7%的第二种信息技术(100%)。后续死亡率是0。结论：症状，提高的AP，和CC的存在与信息技术要求被联系。HRT与症状和信息技术要求的存在被联系。有BMI>的病人25有一个趋势产生信息技术复杂并发症。复杂并发症的比例在FHR和秒信息技术组是更高的。RS是更经常的在以后。

简介：Non-invasiveventilation(NIV)istheprovisionofventilatorysupportwithoutinstrumentationoftheairway.Itcanbeachievedusinganegative-pressuremachine(e.g.‘ironlung')or,morecommonly,withpositivepressureadministeredthroughawell-fittingmask.Thiscontributionconsiderspositivepressureventilationonly;negativepressureisnowseldomused.

简介：AbstractBackground:Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays.Methods:Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed.Results:The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) (χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) (χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) (χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exact P = 1.000) to and slightly lower specificity (87% [77/89]) (χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) (P = 0.734). Sputum LFD had similar specificity (91% [81/89]) (χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) (χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) (χ2 = 6.95, P = 0.008), BDG (χ2 = 10.43, P = 0.001), and fungal culture (χ2 = 12.70, P < 0.001).Conclusions:Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.

简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

简介：

简介：Primaryandmetastaticlivertumorsareanincreasingglobalhealthproblem,withhepatocellularcarcinoma(HCC)nowbeingthethirdleadingcauseofcancer-relatedmortalityworldwide.SystemictreatmentoptionsforHCCremainlimited,withSorafenibastheonlyprospectivelyvalidatedagentshowntoincreaseoverallsurvival.Surgicalresectionand/ortransplantation,locallyablativetherapiesandregionalorlocoregionaltherapieshavefilledthegapinlivertumortreatments,providingimprovedsurvivaloutcomesforbothprimaryandmetastatictumors.Minimallyinvasivelocaltherapieshaveanincreasingroleinthetreatmentofbothprimaryandmetastaticlivertumors.Forpatientswithlowvolumedisease,thesetherapieshavenowbeenestablishedintoconsensuspracticeguidelines.Thisreviewhighlightstechnicalaspectsandoutcomesofcommonlyutilized,minimallyinvasivelocaltherapiesincludinglaparoscopicliverresection(LLR),radiofrequencyablation(RFA),microwaveablation(MWA),high-intensityfocusedultrasound(HIFU),irreversibleelectroporation(IRE),andstereotacticbodyradiationtherapy(SBRT).Inaddition,theroleofcombinationtreatmentstrategiesutilizingtheseminimallyinvasivetechniquesisreviewed.

简介：IntravesicalBacillusCalmette-Guérin(BCG)haslongbeenthegoldstandardtreatmentofnonmuscleinvasivebladdercancer.Recently,therehasbeenanemergenceofnovelimmunotherapeuticagents,whichhaveshownpromiseinthetreatmentofurothelialcellcarcinoma.Theseagentsaimtoaugment,modify,orenhancetheimmuneresponse.SuchstrategiesincluderecombinantBCG,monoclonalantibodies,vaccines,genetherapy,andadoptiveT-celltherapy.Here,wereviewtheemergingimmunotherapeuticsinthetreatmentofnonmuscleinvasivebladdercancer.

简介：由美国腹腔镜内镜外科医师协会（SLS）举办的“瓶美多学科峰会Ⅵ-腹腔镜与微创外科”将于2014年2月12～15日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和做创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜没备，新技术、新概念以及如何提高对患者监护的标准，以及微创外科医师的培训和继续教育等。

简介：ElevenspeciesofalieninvasiveforestinsectpestshavebeenfoundsincetheearlytimethatinsectspecieshadbeentakenrecordedinChina.Theirorigins,inlanddistribution,invasivetime,hosts,causingdamagearerecordedinthispaperfortheevidenceofbiologicalinvasion.Theircontrolmethodsarealsostudiedordiscussed.

简介：

简介：BackgroundThroughaministernotomy'J'shapedapproach,leftinternalmammaryartery(LIMA)bypassgraftingtotheleftanteriordescendingartery(LAD)canbeperformedsafelyoff-pump.Toachieveacompleterevascularization,percutaneouscoronaryinterventions(PCI)withdrugelutingstentimplantationtoothercoronaryarterieswasused.Wereportedoutcomesofthetreatmentofmultivesselcoronaryarterydiseasewithminimallyinvasivecoronaryarterybypass(MICAB)andPCI.MethodsBetweenJanuary2009andDec2012,14patients(11males,3females,meanagewas64.8±10.1years.Two-vesseldiseaseaccountfor35.7%(5/14)ofthesepatients,three-vesseldisease64.2%(9/14)(Table1).Allpatientsunderwentaminimallyinvasivecoronaryarterybypassgraftingviamini-sternotomy'J'shapedapproach.SevenpatientswerefollowedbyPCI,7forobtusemarginalcircumflex,5forrightcoronaryartery(RCA).AngiographicassessmentofgraftpatencywasperformedinallpatientsduringthePCIprocedure.Theclinicalfollow-upperiodlastsfrom11-24months.ResultsThein-hospitalmortalitywas0%.Therewasneitherconversiontoafullmediansternotomynorintraoperativecomplications.Ventilationtimewas6.6±4.1h.Bloodlossranged341±78.8mL.ICUstayranged22.3±12.8h.Hospitalpostoperativestaylastedfor6.5±1.6days.PriortoPCIpatientsshowed100%patentleftinternalmammaryartery.Onepatienthadmediastinitis(Tables2-3).Rateoffreedomfromcardiacreinterventionduringthefollow-upperiodwas92.8%(13/14).ConclusionsTheinferiorJ-shapedsternotomyissimple,reproducible,andthesafesttechniqueforperformingminimallyinvasivecoronarybypasssurgery.MICAB+PCIisalsosafe,feasibleandefficacious.

简介：

简介：无

简介：无

简介：侵略种类被他们的人口的快速的生长和传播在在新产地建立一个立脚点以后描绘，并且现在有否定地影响它是的生物多样性和经济的如此的种类的许多例子不清楚某种类为什么能成为成功的侵略者，而大多数(就算仔细联系了)我们以前建议了的遗体noninvasive如果他们向侵略者是无害的，寄生虫与入侵种联系了的一个假设能支持他们的侵略成功但是对他们在我们讨论的这里的最新开拓殖民地于的产地的竞争者或食肉动物有害最近被发现了在里面的microsporidia侵略瓢虫Harmoniaaxyridis贡献它我们显示出的侵略成功在整个世界从多样的收集地点采购的所有H.axyridis甲壳虫带这建议的丰富的microsporidia本国、侵略的H.axyridis人口与这些被联系，这容忍了寄生虫，它是可能的在扩大前在本国的人口存在而非在最新开拓殖民地于的区域被获得我们在H.axyridis的不同发展阶段期间描述microsporidia的致病，我们探讨它由竞争本国的瓢虫种类的感染的鸡蛋和幼虫的predation可以导致的可能性他们的感染并且最终到他们的衰落最后，我们讨论我们的起始的假设:被一只侵略向量昆虫容忍的microsporidia能对易受影响的本国的竞争者或食肉动物种类是活跃的。

简介：PatientswithAcuteCoronarySyndrome(ACS)areaclinicalcontinuum-withpatientspresentingwithunstableanginaononeend,withpatientswithSTelevationmyocardialinfarction(STEMI)attheotherendofthespectrum.Inbetweenarethosewithnon-ST

简介：Objective:Toreportthedevelopmentofatechniqueforminimallyinvasivethyroidlobectomy.Method:Theprocedurewasacceptedby200patientswithanoduleofthelobeofthethyroid.Weperformedhemithyroidectomysthrougha2-4cmlow-collarhorizontalskinincisionbyconventionalinstrumentation.Results:Therecurrentlaryngealnerveandtheparathyroidglandswereeasilyidentifiedandpreserved.Theamountofbleedingrangedfrom5to50ml(mean15ml).MeanOperationtimewas52.2minutes(ranged32to80minutes).Nocomplicationoccurred.Meanpostoperativestaywas5.5days(ranged4to7days).Theincisionprovidedexcellentcometicresultsbecausethesmallandlowerincisionswerecompletelyhiddenbyclothingcollar.Conclusion:Theabovetechniqueisfeasible,safe,minimallyinvasive,lesstimeandcostconsumingandcosmetical.

简介：

简介：TheCMSIGUANAprojecthasimplementedanopenanalysisarchitecturethatenablesthecreationofanintegratedanalysisenvironment.Inthis"analysisdesktop"environmentaphysicistisabletoperformmostanalysis-relatedtasks,notjustthepresentationandvisualisationstepsusuallyassociatedwithanalysistools.ThemotivationbehindIGUANA'sapproachisthatphsicsanalysisincludesmuchmorethanjustthevisualisationanddatapresentation.Manyfactorscontributetotheincreasingimportanceofmakinganalysisandvisualisationsoftwareanintegralpartoftheexperiment'ssoftware:objectorientedandevermoreadvanceddatamodels,GRID,andautomatedhierarchicalstoragemanagementsystemstonamejustafew.Atthesametimetheanalysistoolkitsshouldbemodularandnon-invasivetobeusableindifferentcontextswithinoneexperimentandgenerallyacrossexperiments.Ideallytheanalysisenvironmentwouldappeartobeperfectlycustomisedtotheexperimentandthecontext,butwouldmostlyconsistofgenericcomponents.WedescribehowtheIGUANAprojectisaddressingtheseissuesandpresentboththearchitectureandexamplesofhowdifferentaspectsofanalysisappeartotheusersandthedevelopers.