简介：背景：测试的HIV-1genotypic和phenotypic危险性(通用终端)优化antiretroviral选择，但是它幸存上的效果是未知的。客观：评估在通用终端和幸存之间的协会。设计：队学习。设定：10个美国HIV诊所。病人：为通过2005从1999看见的通用终端(血浆HIVRNA水平>1000copies/mL)合格的2699个感染HIV的病人。大小：人口统计的特征，临床的因素，通用终端使用，所有原因死亡，和为有幸存的通用终端的协会的粗略、调整的危险比率(HR)。结果：病人们被跟随为一3.3年中部；(34%)915有通用终端。把通用终端有的病人比那些降低死亡率(2.0对2.7死亡每100人年)。在标准考克斯模型，通用终端与改进幸存被联系(调整HR，0.69[95%CI，0.51～0.94]；P=0.017)在为临床的后续的人口统计的特征，CD4⁺房间计数，HIVRNA水平，和紧张控制以后。在亚群分析，通用终端与改进幸存被联系因为2107高度活跃的antiretroviral治疗(HAART)经历了病人(2.2对3.2死亡每为有没有通用终端的通用终端对那些的病人的100人年；调整HR，0.60[CI，0.43～0.82]；P=0.002)并且为921个三倍的antiretroviral班富有经验病人(2.1对3.1死亡每100人年；调整HR，0.61[CI0.40到0.93]；P=0.022)。边缘的结构的模型支持了在通用终端之间的协会并且在全面的队改进了幸存(调整HR，0.54；P=0.001)并且在HAART富有经验的组(调整HR，0.56；P=0.003)。限制：通用终端的使用没被使随机化。剩余惊讶可以存在。结论：通用终端的使用独立地在HAART富有经验的病人之中与改进幸存被联系。

简介：Thereisagrowingneedworldwidetotakemedicalcaretodistantlocationsfarfromthemainurbancenters,particularlytoruralareas.Furthermore,thereistheethicalimperativetoprovideequalaccesstomedicalcaretoallpatients,regardlessoftheirplaceofresidence,soastosatisfyanincreasinglydemandingpopulation.Awidespreadproblem,fromwhichcardiologyisnotexcepted,istheinsufficientnumberofspecialistsandtheirunevendistribution.Theupsurgeininformationandcommunicationstechnologyhasmadeavailablealargecollectionoftools,mainlycomputers,smartphones,e-mail,andtheInternet,tonamejustafew,tomeettheneedsofcommunicationbetweenindividualsandorganizations.ThisarticledefinestelemedicineanddescribesitsapplicationinthepracticeofcardiologyanditsimpactinChile.

简介：AbstractBackgroud:Aspirin-exacerbated respiratory disease (AERD) is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes.Objective:To characterize the most common timeline for development of the clinical triad [asthma, nasal polyposis, and reactions to nonsteroidal anti-inflammatory drugs (NSAIDs)], identify barriers to prompt diagnosis of AERD, and describe indications for an aspirin challenge to facilitate accurate diagnosis.Methods:Six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women’s Hospital AERD registry. Patient reported age at disease onset of asthma, nasal polyposis, and age of first NSAID reaction were obtained from 2013 to 2019 at enrollment.Results:Of the 697 patients identified, diagnosis of asthma preceded diagnosis of nasal polyposis and first NSAID reaction, although there was considerable variability between patients.Conclusions:Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients. Consider diagnostic aspirin challenge in patients without historical reactions to NSAIDs who have an otherwise compatible clinical history, specifically in patients who take daily low-dose aspirin, leukotriene modifiers, avoid NSAIDs, or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.

简介：Cancercellsarewelldocumentedtorewiretheirmetabolismandenergyproductionnetworkstosupportandenablerapidproliferation,continuousgrowth,survivalinharshconditions,invasion,metastasis,andresistancetocancertreatments.SinceDr.OttoWarburg’sdiscoveryaboutalteredcancercellmetabolismin1930,thousandsofstudieshaveshedlightonvariousaspectsofcancermetabolismwithacommongoaltofindnewwaysforeffectivelyeliminatingtumorcellsbytargetingtheirenergymetabolism.Thisreviewhighlightstheimportanceofthemainfeaturesofcancermetabolism,summarizesrecentremarkableadvancesinthisfield,andpointsoutthepotentialstotranslatethesescientificfindingsintolife-savingdiagnosisandtherapiestohelpcancerpatients.