Zhonghua nei ke za zhi最新文献

{"title":"[Guidelines for diagnosis and treatment of glucocorticoid-induced osteoporosis].","authors":"J He,&nbsp;F Li,&nbsp;W H Huang,&nbsp;L P Wang,&nbsp;X W Zhang,&nbsp;Y Zhao","doi":"10.3760/cma.j.cn112138-20221025-00787","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221025-00787","url":null,"abstract":"<p><p>Glucocorticoid-induced osteoporosis (GIOP) is a skeletal disease characterized by decreased bone strength and increased fracture risk associated with long-term glucocorticoid use. GIOP is the most common secondary osteoporosis that critically affects the quality of life of patients. Currently, the incidence of GIOP in China remains high, with insufficient awareness and lack of prevention and treatment norms. Therefore, the Chinese Rheumatology Association has established this standard based on domestic and international experience, with the aim of raising awareness of prevention and treatment among clinicians, guiding the standardized diagnosis and treatment of this disease, and improving the overall prognosis of patients with GIOP.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 6","pages":"631-638"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The topic design of clinical studies].","authors":"Y Wang","doi":"10.3760/cma.j.cn112138-20230221-00103","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230221-00103","url":null,"abstract":"临床研究选题设计的根基是要选择有价值的临床问题，通过发现问题、解决问题使患者更多获益。选题的核心是创新。本文结合临床研究实例，阐明如何从临床实际出发，提出不同层次的创新问题，以及如何通过合适的研究设计实现创新性选题.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 6","pages":"590-593"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Giant hepatic hemangioma manifested as fever of unknown: a case report].","authors":"F P Guo,&nbsp;Y Cong,&nbsp;Y Ge,&nbsp;T S Li","doi":"10.3760/cma.j.cn112138-20220616-00456","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220616-00456","url":null,"abstract":"本文报道1例以不明原因发热起病的50岁女性，伴肝多发血管瘤，较大者位于肝右叶，大小为12 cm×12 cm，伴内出血改变；系统检查未发现感染性疾病、自身免疫性疾病、恶性肿瘤等证据，考虑发热不除外与肝血管瘤伴内出血相关。行肝血管瘤切除术，术后患者体温正常。肝血管瘤伴内出血可作为不明原因发热的病因之一，需积极手术切除。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 6","pages":"718-720"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9626867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dose-response association between fluid overload and hospital mortality in patients with sepsis].","authors":"M P Wang,&nbsp;X M Xi,&nbsp;B Zhu,&nbsp;R Lou,&nbsp;Q Jiang,&nbsp;Y He,&nbsp;L Jiang","doi":"10.3760/cma.j.cn112138-20220516-00377","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220516-00377","url":null,"abstract":"<p><p><b>Objective:</b> To investigate dose-response associations between fluid overload (FO) and hospital mortality in patients with sepsis. <b>Methods:</b> The current cohort study was prospective and multicenter. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged≥18 years who were admitted to intensive care units (ICUs) for at least 3 days were included. Fluid input/output, fluid balance, fluid overload (FO), and maximum FO (MFO) were calculated during the first 3 days of ICU admission. The patients were divided into three groups based on MFO values: MFO<5%L/kg, MFO 5%-10%L/kg, and MFO≥10% L/kg. Kaplan-Meier analysis was used to predict time to death in hospital in the three groups. Associations between MFO and in-hospital mortality were evaluated via multivariable Cox regression models with restricted cubic splines. <b>Results:</b> A total of 2 070 patients were included in the study, of which 1 339 were male and 731 were female, and the mean age was (62.6±17.9) years. Of 696 (33.6%) who died in hospital, 968 (46.8%) were in the MFO<5%L/kg group, 530 (25.6%) were in the MFO 5%-10%L/kg group, and 572 (27.6%) were in the MFO≥10%L/kg group. Deceased patients had significantly higher fluid input than surviving patients during the first 3 days [7 642.0 (2 874.3, 13 639.5) ml vs. 5 738.0 (1 489.0, 7 153.5)ml], and lower fluid output [4 086.0 (1 367.0, 6 354.5) ml vs. 6 130.0 (2 046.0, 11 762.0) ml]. The cumulative survival rates in the three groups gradually decreased with length of ICU stay, and they were 74.9% (725/968) in the MFO<5% L/kg group, 67.7% (359/530) in the MFO 5%-10%L/kg group, and 51.6% (295/572) in the MFO≥10%L/kg group. Compared with the MFO<5%L/kg group, the MFO≥10%L/kg group had a 49% increased risk of inhospital mortality (<i>HR</i>=1.49, 95%<i>CI</i> 1.28-1.73). For each 1% L/kg increase in MFO, the risk of in-hospital mortality increased by 7% (<i>HR</i>=1.07, 95% <i>CI</i> 1.05-1.09). There was a\"J-shaped\"non-linear association between MFO and in-hospital mortality with a nadir of 4.1% L/kg. <b>Conclusion:</b> Higher and lower optimum fluid balance levels were associated with an increased risk of in-hospital mortality, as reflected by the observed J-shaped non-linear association between fluid overload and inhospital mortality.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"513-519"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9390323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Kounis syndrome complicated with Takotsubo cardiomyopathy: a case report].","authors":"Y Long,&nbsp;G Cao,&nbsp;Z Z Zhou,&nbsp;Q S Man,&nbsp;Y Li","doi":"10.3760/cma.j.cn112138-20220429-00321","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220429-00321","url":null,"abstract":"本文报道1例68岁男性患者被蚂蚁叮咬后发生严重过敏性休克，积极抗休克处理期间心电图下壁导联ST段出现一过性抬高，急诊冠状动脉造影显示右冠状动脉重度狭窄，左心室造影显示左室心尖区搏动弥漫性减弱呈球形膨出，出院1个月随访超声显示心脏整体运动恢复正常。该病例显示Kounis综合征和Takotsubo心肌病可共存于同一情境，即ATAK复合病（ATTK），该类疾病相对罕见且具有特定治疗方案和预后。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"553-555"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advances in the role of co-inhibitory receptors on T cell exhaustion in sepsis].","authors":"Q X Liu,&nbsp;M Xue,&nbsp;S Q Liu,&nbsp;Y Yang","doi":"10.3760/cma.j.cn112138-20221027-00794","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221027-00794","url":null,"abstract":"脓毒症引起的免疫抑制与患者不良结局相关。T细胞耗竭是脓毒症免疫抑制的重要原因，表现为T细胞表面多种共抑制分子表达持续升高，T细胞增殖、活化及清除病原体的能力下降。脓毒症早期阻断共抑制分子介导的信号通路，可部分逆转T细胞耗竭，改善脓毒症免疫抑制状态。本文就共抑制分子在脓毒症T细胞耗竭中的研究进行综述，以期为脓毒症相关免疫抑制的靶向治疗提供依据。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"572-575"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9447850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy of high-dose dual therapy for Helicobacter pylori infection eradication in servicemen: a randomized controlled trial].","authors":"X M Zhang,&nbsp;H C Min,&nbsp;J Chen,&nbsp;J L Zhi,&nbsp;H X Dong,&nbsp;J Y Kong,&nbsp;J Y Meng,&nbsp;G Sun,&nbsp;Z K Wang,&nbsp;F Pan,&nbsp;L H Peng,&nbsp;Y S Yang","doi":"10.3760/cma.j.cn112138-20220524-00401","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220524-00401","url":null,"abstract":"<p><p><b>Objective:</b> To assess the efficacy and cost-effectiveness of high-dose dual therapy compared with bismuth-containing quadruple therapy for treating Helicobacter pylori(<i>H.pylori</i>) infection in servicemen patients. <b>Methods:</b> A total of 160 <i>H. pylori</i>-infected, treatment-naive servicemen, including 74 men and 86 women, aged from 20 years to 74 years, with a mean (SD) age of 43 (13) years, tested in the First Center of Chinese PLA General Hospital from March 2022 to May 2022 were enrolled in this open-label, randomized controlled clinical trial. Patients were randomly allocated into 2 groups: the 14-day high-dose dual therapy group and the bismuth-containing quadruple therapy group. Eradication rates, adverse events, patient compliance, and drug costs were compared between the two groups. The <i>t</i>-test was used for continuous variables, and the Chi-square test for categorical variables. <b>Results:</b> No significant difference in <i>H. pylori</i> eradication rates were found between high-dose dual therapy and bismuth-containing quadruple therapy by ITT, mITT and PP analysis[ITT:90.0% (95%<i>CI</i> 81.2%-95.6%) vs. 87.5% (95%<i>CI</i> 78.2%-93.8%), <i>χ</i>²=0.25, <i>P</i>=0.617;mITT:93.5% (95%<i>CI</i> 85.5%-97.9%) vs. 93.3% (95%<i>CI</i> 85.1%-97.8%), <i>χ</i>²<0.01, <i>P</i>=1.000; PP: 93.5% (95%<i>CI</i> 85.5%-97.9%) vs. 94.5% (95%<i>CI</i> 86.6%-98.5%), <i>χ</i>²<0.01, <i>P</i>=1.000 ]. The dual therapy group exhibited significantly less overall side effects compared with the quadruple therapy group [21.8% (17/78) vs. 38.5% (30/78), <i>χ</i>²=5.15,<i>P</i>=0.023]. There were no significant differences in the compliance rates between the two groups [98.7%(77/78) vs. 94.9%(74/78), <i>χ</i>²=0.83,<i>P</i>=0.363]. The cost of medications in the dual therapy was 32.0% lower compared with that in the quadruple therapy (472.10 RMB vs. 693.94 RMB). <b>Conclusions:</b> The dual regimen has a favorable effect on the eradication of <i>H. pylori</i> infection in servicemen patients. Based on the ITT analysis, the eradication rate of the dual regimen is grade B (90%, good). Additionally, it exhibited a lower incidence of adverse events, better compliance and significantly reduced cost. The dual regimen is expected to be a new choice for the first-line treatment of <i>H. pylori</i> infection in servicemen but needs further evaluation.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"520-525"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9390322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effects and questions of prone position in novel coronavirus infection].","authors":"K D Ma,&nbsp;C R Zhu,&nbsp;X An,&nbsp;X C Ma","doi":"10.3760/cma.j.cn112138-20220512-00363","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220512-00363","url":null,"abstract":"俯卧位通气作为治疗急性呼吸窘迫综合征的重要组成部分，可使肺通气更均一及通气血流比更匹配，降低肺损伤的发生率及保护右心功能，改善氧合，降低病死率。俯卧位通气治疗可缓解新型冠状病毒感染患者的低氧血症，降低再插管率及改善患者预后。与传统急性呼吸窘迫综合征比，俯卧位通气治疗新型冠状病毒感染相关低氧血症的机制可能有所不同，仍有一些问题需要进一步厘清。同时必须注意，实施俯卧位通气治疗需要熟练的医护团队及密切监测，更需要警惕实施过程中的不良事件。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"568-571"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Completion rates of bundle treatment of among patients with sepsis shock in intensive care departments of hospitals in Jiangsu Province from 2016 to 2020 years].","authors":"W W Chen,&nbsp;J F Xie,&nbsp;Y Yang,&nbsp;C S Yang","doi":"10.3760/cma.j.cn112138-20230108-00010","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230108-00010","url":null,"abstract":"<p><p>Current clinical approaches for septic shock increasingly incorporate bundle treatment, a multi-component approach that uses a collection of tests and agents to assist in the identification and treatment of infection. The present study analyzed completion rates of 3 h and 6 h bundle treatment among patients with septic shock in intensive care units (ICUs) of hospitals in Jiangsu Province from 2016 to 2020, using data from the Jiangsu Provincial Intensive Care Medical Quality Control Center. Current approaches and factors affecting treatment completion were assessed.The completion rates of 3 h and 6 h bundle treatment in ICUs of all medical units in Jiangsu Province and in ICUs of hospitals of different levels were recorded. Analyses show that the completion rate of 3 h and 6 h bundle treatment for patients with septic shock in ICUs in Jiangsu Province increased year by year from 2016 to 2020.The completion rate of 3 h bundle treatment increased from 69.82% (3 604/5 162) to 82.47% (8 915/10 775) (all <i>P<</i>0.001). The completion rate of 6 h bundle treatment increased from 62.69% (3 236/5 162) to 72.54% (7 816/10 775) (all <i>P<</i>0.001). In addition, year by year, the completion rate of 3 h bundle treatment in ICUs in tertiary hospitals increased, from 69.80% (3 596/5 152) to 82.23% (7 375/8 969), while the completion rate of 6 h bundle treatment increased from 62.69% (3 230/5 152) to 72.18% (6 474/8 969) (all <i>P<</i>0.001). Completion rates in secondary hospitals also increased year by year, from 80.00% (8/10) to 85.27% (1 540/1 806) for 3 h treatment and from 60.00% (6/10) to 74.31% (1 342/1 806) (all <i>P<</i>0.001) for 6 h treatment. Completion rates for 3 h treatment in first-tier cities (83.99% (2 099/2 499)) and second-tier cities (84.68% (3 952/4 667)) was higher than in third-tier cities (79.36% (2 864/3 609)). The completion rate of 6 h bundle treatment gradually decreased in first-line (77.19% (1 929/2 499)), second-line (74.37% (3 471/4 667)), and third-line (66.94% (2 416/3 609)) cities (all <i>P<</i>0.001). The data collectively show that from 2016 to 2020, the completion rate of bundle treatment in septic shock patients in ICUs in Jiangsu Province improved significantly.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"545-549"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The core principles for clinical treatment of critical illness].","authors":"D W Liu","doi":"10.3760/cma.j.cn112138-20220509-00354","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220509-00354","url":null,"abstract":"“连续与动态、目标导向、定量治疗”是重症临床治疗的核心原则。重症治疗是针对重症发生发展的机制，根据重症的临床特点和规律，以恢复机体功能为目的所发生的临床行为。重症临床治疗包括连续监测病情机制关键节点的变化，动态调整干预方法，定量实现干预方法中的最佳治疗效果，目标导向落实整体治疗策略。这项原则是对重症临床治疗行为进行规范，是实现治疗目标导向重症病程进展的基本保证。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"475-479"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}