简介：Acupuncture,asacomplementarytherapy,hasbeenusedtomanagethecancerassociatedsymptomsofcancerpatients.Toidentifytheefficacyandsafetyofacupunctureinthemanagementofcancer,thisreviewcriticallyanalysestherelevantpublicationsincludingbothexperimentalandclinicalstudies.Themajorityofstudiessuggestthatacupunctureeffectivelyrelievessomecancerrelatedsymptomssuchascancerpain,andsomeadverseeffectscausedbythecancerconventionaltreatmentssuchasnausea,vomiting,neutropeniaandxerostomia.

简介：AbstractAlbumin solutions derived from human plasma have demonstrated clinical benefits as intravenous fluid therapy in clinical settings such as liver disease, sepsis, intensive care, and surgery. For all plasma-derived medicinal products, there is a potential risk from pathogens, including relevant blood-borne viruses, emerging viruses, and prion proteins. To minimize the risk of transmissible infections, the production of human albumin solutions includes rigorous donor selection and plasma testing, and effective pathogen removal and inactivation methods such as fractionation and pasteurization. Compliance with international pharmacopeial standards for purity and prekallikrein activator and aluminum content is crucial, as is post-marketing pharmacovigilance for the continuous monitoring of adverse events. This review focuses on the effectiveness of manufacturing methods in the production of plasma-derived albumin, to ensure the safety of hyperoncotic solutions for volume expansion. We evaluated evidence identified through online database (PubMed) searches and from unpublished sources, on the manufacturing and pathogen safety of plasma-derived albumin solutions. The results confirmed the already established and evolving pathogen reduction capacity of the reviewed manufacturing methods. Up-to-date post-marketing pharmacovigilance data and log10 reduction factors for known and emerging pathogens during albumin production are included. Towards the goal of ever-increasing clinical safety, potential areas of improvement, such as compliance rates for the completion of donor health questionnaires, are also discussed. Taken together, the current manufacturing and pathogen reduction steps result in albumin products of greater purity than previous-generation products, with a high margin of pathogen safety against known and emerging pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

简介：Objective:Thereisnosaferwaytotransportachildthanaschoolbus.FatalcrashesinvolvingoccupantsareextremelyrareeventsintheUS.Inrecentyears,schoolbustransportationbegantodevelopinChina.WewanttobringadvancedexperienceonschoolbussafetyinWesterncountriessuchastheUStodevelopingcountries.Methods:WesearchedthepapersrelatedtoschoolbussafetyfromMedline,ChineseScientificJournalsDatabaseandtheWeboftheNationalHighwayTrafficSafetyAdministration(NHTSA).Results:Therewereonly9papersrelatedtoschoolbussafety,whichshowedthathigherlevelsofsafetystandardsonschoolbuses,schoolbus-relatedtransportationandenvironmentallawsandinjurypreventionweretheprimaryreasonsforthedesiredoutcome.Fewschoolbusisrelatedtodeathsandinjuriesinthedevelopedcountries.Conclusions:Thedevelopingcountriesshouldmakestrictenvironmentallawsandstandardsonschoolbussafetytopreventchildren'sinjuryanddeath.

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简介：AbstractParotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

简介：ObjectivesToevaluatethesafetyandefficacyoftransradialcoronaryprocedures(TRCP).MethodsThedataof83caseswhoacceptedtransradialcoronaryangiography(CAG)andtransradialpercutaneouscoronaryintervention(PCI)inourdepartmentweresummarized.Thesuccessrates,proximalcoronarycomplications,peripheralvascularcomplications,severevagalreflex,meanoperationtime(MOT),meanrecumbenttime(MRT),meanhospital-stayingtime(MHT)wereanalyzed.Thedatawerecomparedwiththatof420casesoftransfemoralcoronaryprocedures(TFCP)inthesameperiod.ResultsSuccessratesandproximalcoronarycomplicationsweresimilarinbothgroups.SeverevagalreflexeswerelessinTRCPgroupthaninTFCPgroup.MOTwaslongerinTRCPgroup.MRTandMHTwereshorterinTRCPgroup.12(14.5%)radialarteryspasm,3(3.6%)radialarteryobstruction,1suddenrespiratoryarrestcausedbyjugularhematomawereobservedinTRCPgroup.ConclusionsTheefficacyandsafetyofTRCParedefinite.TRCPismoreeconomical.ForthepurposeofproperlyevaluatetheperipheralvascularcomplicationsofTRCP,itisnecessarytopayspecialattentiontoradialarteryocclusion,radialarterystenosis,andjugularhematoma.

简介：AbstractTonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients’ families.

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简介：Globaldemographicchangesrelatedtolongevityareleadingtoincreasingnumbersoftheelderly,forwhomhearinglossisasignificantcauseofmorbidityanddisability.Oncemetwithreticence,severelyhearingimpairedolderadultsareincreasinglybeingconsideredforcochlearimplantation(CI).SignificantdataindicatethatCIintheelderlypopulationissafe,well-tolerated,andeffective.RisksfromCIsurgeryandanesthesiaarelowandgenerallycomparabletoratesinotheragegroups.OutcomesstudiesregardingCIinolderadultshaveshownexcellentimprovementstospeechperception,qualityoflife,andevencognition.Overall,currentlyavailabledatasuggeststhatadvancedageshouldnot,initself,beconsideredabarriertoimplantation.ThisreviewpaperwillhighlightselectedarticlesfromrecentmedicalliteratureregardingthesafetyandefficacyofCIintheelderlypopulation.

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简介：AbstractPurpose:Comparison of effective road safety approaches with those of relatively similar countries can be used to identify possibilities for safety improvement. Since there is no clear and comprehensive study of countries' current and successful approaches to road safety in the world, the aim of this study was to identifying common road safety approaches in the world.Methods:This study was performed using scoping review and thematic analysis. The study followed the approach proposed by Arksey and O'Malley. In this study all articles were selected without time limit by searching in the following databases: Web of Science, PubMed, Scopus, ProQuest, and Embase. An initial search of 5612 papers was found and finally, 20 papers met the inclusion criteria and were analyzed.Results:There were different road safety approaches in different countries around the world, which were classified in three themes: traditional approach, systemic approach, and vision zero. The traditional approach includes the sub-theme of the road-user approach, and the causal approach. The systemic approach also includes sub-themes of sustainable safety, safety system, and the United Nations plan for decade of action.Conclusion:A systemic approach to road safety seems to be welcomed by most developed and developing countries, and a paradigm shift towards a safe system has taken place. Also, given the successful results of implementing vision zero in leading countries, most countries are trying to design and implement this approach. Finally, the choice and implementation of road safety approaches varies according to the principles, priorities and infrastructure of each country.

简介：客观：为了选择腰部的transpedicular的一个合适的方法，在三个方法之中在不同腰部的层次拧紧固定(Roy-Camille“s方法，Magerl”s方法和杜“smethod)在中国人口。方法：三维(3-D)图象与被电子横梁CT扫描的42个成年腰部的片断的图象数据被重建。腰部的小花梗螺丝钉固定的三个方法在3-D上被模仿重建的图象和植入小花梗螺丝钉的参数被测量。结果：在从入口点的距离有统计上重要的差别到在三个方法之间的小花梗轴(P<0.001)。Thedistances由“s方法从L1是最短的到L4，并且距离测量了byMagerl”的杜测量了s方法在L5是最短的(P<0.05)。从L1没有重要差别到L2(P>0.05)，但是对在插入TSA(横向的节角度)的安全范围的L5的从L3的重要差别在三个方法之间被发现(P<0.05)。从L3到L4，TSA的插入的安全范围由杜测量了“s”和Magerls方法比那测量byRoy-Camille显著地大“s方法(P<0.05)，但是他们之间没有重要差别(P>0.05)。AtL5，TSA的插入的安全范围由Magerl测量了“s方法在三个方法之中是最大的(P<0.05)。结论：在三个方法之中，杜“因为它到小花梗轴的从入口点的距离最短，TSA的安全范围最大，s方法是从L1toL4的最好的选择；Magerl“s方法能从L3被使用到L5并且是在L5的最好的选择；Roy-Camille”s方法在L1和L2是适用的。

简介：AbstractObjective:To investigate the safety and efficacy of internal electronic fetal heart rate (FHR) monitoring during labor.Methods:This was a retrospective case-control study, which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe (94 pregnant women per group). In the internal monitoring group, when the opening of the uterine orifice was ≥3 cm, the fetal scalp electrode was placed after natural or artificial rupture of the membrane. FHR was simultaneously monitored using a Doppler probe. In the external monitoring group, continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen. The toco transducer was used to record uterine contractions. Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group, respectively. Maternal-infant outcomes (e.g. fever, puerperal infection, puerperal morbidity, delivery mode, Apgar score, and scalp injury) were recorded. Umbilical artery blood was extracted for blood gas analysis. Differences between the two groups were compared using the paired t-test, χ2 test, Yates corrected χ2 test or Fisher exact test.Results:Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis (1/94 (1.06%) vs. 3/94 (3.19%), respectively; χ2= 0.255, P= 0.613), cesarean section/operative vaginal delivery (8/94 (8.51%) vs. 15/94 (15.96%), respectively; χ2 = 2.427, P= 0.181), fever during labor (18/94 (19.15%) vs. 15/94 (15.96%), respectively; χ2=0.331, P= 0.565), puerperal morbidity (2/94 (2.13%) vs. 3/94 (3.19%), respectively; χ2= 0.000, P= 1.000), chorioamnionitis (9/49 (18.37%) vs. 7/48(14.58%), respectively; χ2= 0.252, P= 0.616), and neonatal asphyxia (0/94 (0.00%) vs. 1/94 (1.06%), respectively; χ2= 0.000, P= 1.000). There were no puerperal infections, neonatal scalp injuries, or scalp abscesses found in either group. Using the internal monitoring value as reference, the incidence of FHR false deceleration in external FHR monitoring was 20.21% (19/94 women).Conclusion:Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes. External monitoring was associated with FHR false decelerations.

简介：AbstractPurpose:Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source.Methods:This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system.Results:Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance.Conclusion:All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.

简介：AbstractImportance:Octreotide is an off-label medicine for congenital hyperinsulinism (CHI), but is currently widely used for treatment of patients with CHI. Thus far, variable efficacy and adverse effects have been reported for octreotide.Objective:The present study evaluated the efficacy and safety of a subcutaneous octreotide injection for treatment of diazoxide-unresponsive CHI in China.Methods:This study was a retrospective review of children with diazoxide-unresponsive CHI who were treated with a subcutaneous octreotide injection. The efficacy and side effects of the treatment were assessed.Results:Twenty-five Chinese children (15 boys) were involved in the study. Their median age at diagnosis was 8 weeks (range, 1-24 weeks) and median age at the final follow-up was 1.8 years (range, 0.3-3.3 years). Octreotide therapy effectively increased blood glucose levels in all patients. The intravenous glucose infusion rate was reduced in all patients. Twenty-one patients gradually discontinued the intravenous glucose infusion while receiving octreotide combined with frequent carbohydrate/glucose-rich feeding. Among patients with a monoallelic ATP-sensitive potassium (KATP) channel mutation, 50.0% showed gradual remission during follow up, indicating that the octreotide treatment may be a feasible alternative to surgery, especially for patients with monoallelic KATP-channel mutations. Transient elevation of liver enzymes occurred in 20.0% of patients, while asymptomatic gallbladder pathology occurred in one patient. The growth rates of these patients were normal (height standard deviation score was 0.3 ± 1.5 at the final follow-up).Interpretation:Octreotide was a well-tolerated, effective therapy for most children with diazoxide-unresponsive CHI.

简介：AIM:Toestablishtheefficacyandsafetyofbimatoprost0.03%monotherapyinglaucomaandocularhypertension(OHT)patientswithinadequateintraocularpressure(IOP)oncurrenttherapy.METHODS:Pre-andpost-switchIOPswereanalyzedfor59consecutivepatientswhowereswitchedfromcurrenttherapytobimatoprostmonotherapybetween2011-2015.Demographicinformation,diagnosis,andanyadverseeventswererecorded.ChangeinIOPpost-preswitchwasanalyzedusinga2-sidedStudent'spairedt-testatthe5%significancelevel.RESULTS:TherewasastatisticallysignificantmeanreductioninIOPatthefirstfollowupvisit,whichwasmaintainedatsubsequentfollowupvisitsforpatientsregardlessofdiagnosis,orpre-switchtreatment(P<0.001).SubgroupanalysisalsodemonstratedastatisticallysignificantmeanreductioninIOPwhenlookingatOHTpatientsonly,aswellaspatientswithanydiagnosisswitchedfromlatanoprostmonotherapytobimatoprostmonotherapy(P<0.001).CONCLUSION:Thisisthelargestindependentdatasetwhichsupportsswitchingglaucomapatientswithpoorresponsetocurrenttreatmentontobimatoprostmonotherapybeforeconsideringotheradjuvantmedicalormoreinvasivetherapy.

简介：摘要The present global pandemic of COVID-19 has brought the whole world to a standstill, causing morbidity, death, and changes in personal roles. The more common causes of morbidity and death in these patients include pneumonia and respiratory failure, which cause the patients to require artificial ventilation and other techniques that can improve respiratory function. One of these techniques is chest physiotherapy, and this has been shown to improve gas exchange, reverse pathological progression, and reduce or avoid the need for artificial ventilation when it is provided very early in other respiratory conditions. For patients with COVID-19, there is limited evidence on its effect, especially in the acute stage and in patients on ventilators. In contrast, in patients after discharge, chest physiotherapy in the form of respiratory muscle training, cough exercise, diaphragmatic training, stretching exercise, and home exercise have resulted in improved FEV1 (L), FVC (L), FEV1/FVC%, diffusing lung capacity for carbon monoxide (DLCO%), endurance, and quality of life, and a reduction in anxiety and depression symptoms. However, there are still controversies on whether chest physiotherapy can disperse aerosols and accelerate the rate of spread of the infection, especially since COVID-19 is highly contagious. While some authors believe it is possible, others believe the aerosol generated by chest physiotherapy is not within respirable range. Therefore, measures such as the use of surgical masks, tele-rehabilitation, and self-management tools can be used to limit cross-infection.

简介：BackgroundClinicalapplicationofimplantablecardioverterdefibrillator(ICD)cansignificantlyreducetheincidenceofsuddencardiacdeath(SCD).However,ICDcannotpreventventriculartachycardia(VT)orventricularfibrillation(VF).PreviousstudiesindicatedthatICDcombinedwithreasonableanti-arrhythmicdrugtherapycanimproveanti-arrhythmiceffect.EMIAT,CAMIAandOPTICtrialsreportedthatcombinedtreatmentofAmiodaroneandβreceptorblockerswassuperiortotheirtreatmentalone.Therefore,itisnecessarytogiveanti-arrhythmictreatmentafterICDimplantation.MethodsTotally180ICDimplantationrecipientsenrolledinourhospitalfromJan2011toMarch2014.Amongthem,39recipientsweretreatedwithAmiodarone(GroupA),89recipientsweretreatedwithβblocker(GroupB),and52recipientsweretreatedwithAmiodaronecombinedwithβblocker(GroupC)afterICDimplantation.Patientswerefollowedupfor3to40monthsbymonitoringtheheartrate,LVEFValueandrapidventriculararrhythmiasevents.ResultsTherewerenosignificantdifferencesonheartratebeforeandafterICDimplantationamongthethreegroups(P=1.28,P=0.85),butthechangeofheartratewasstatisticallyhigher(P=0.04)inGroupBcomparedwithGroupAandGroupC.TherewerenostatisticalsignificanceinLVEFvaluebeforeICDimplantationandafterICDimplantationandthechangeofLVEFvalue(P=0.56,P=0.50,P=0.99).TheoccurrencerateofrapidventriculararrhythmiasinGroupA(10.26%)andGroupB(10.11%)wassignificantlyhigher(P=0.04)thaninGroupC(1.92%).whichwaeslightlyincreasedbyAmiodaroneinGroupAandGroupC.Therewere2casesofthyroiddysfunctioninGroupA,1caseinGroupCandnocaseinGroupB.Nopulmonaryinterstitialfibrosiscaseswerefoundinthisstudy.ConclusionsCombinedtreatmentwithAmiodaroneandβreceptorblockerscouldsignificantlyreducerapidventriculararrhythmiaswhencomparedwithtreatmentofAmiodaroneorβblockeralone.