目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相...目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相关临床实践指南(CPG),使用AGREEⅡ和RIGHT工具进行指南质量评价,采用组内相关系数(ICC)用于评估评审者对每个项目理解的一致性。结果共纳入2份临床实践指南,每个领域的评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,2篇指南推荐级别均为B级,CPG所有7个领域的平均报告率为50.64%,其中领域1最高(88.89%),领域3最低(30.95%)。RIGHT评价结果显示,指南平均报告率为29.22%。结论医患沟通相关指南质量与数量仍有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,以期提出高水平、高标准的循证指南,来指导医护人员的临床实践。展开更多
Developmental and epileptic encephalopathies(DEEs)are neurological disorders generally involving medically intractable seizures and a diverse array of comorbid neuropsychiatric delays and deficits that may severely af...Developmental and epileptic encephalopathies(DEEs)are neurological disorders generally involving medically intractable seizures and a diverse array of comorbid neuropsychiatric delays and deficits that may severely affect cognition,mood,sleep,social behavior,movement control,learning,and/or memory.Dravet syndrome(DS),also known as Severe Myoclonic Epilepsy of Infancy.展开更多
BACKGROUND Stress hyperglycemia ratio(SHR)could provide accurate information on the acute status of hyperglycemia.The relationship between SHR and acute coronary syndrome(ACS)prognosis remains unclear.This study was c...BACKGROUND Stress hyperglycemia ratio(SHR)could provide accurate information on the acute status of hyperglycemia.The relationship between SHR and acute coronary syndrome(ACS)prognosis remains unclear.This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS.METHODS A total of 12,010 patients were eventually enrolled in the study.The relationship between SHR and in-hospital major adverse cardiovascular events(MACEs)was then modeled by restricted cubic spline(RCS)curves,and all patients were divided into three groups according to the results.The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes,described as odds ratios(ORs)and 95%confidence intervals(CIs).Subgroup analyses were also performed on different diseases.RESULTS The median age of this cohort was 63(54,71)years old,and 8942(74.5%)were male.Group 1 was defined as SHR<0.6(n=426),Group 2 was defined as SHR between 0.6 and 1(n=5821),and Group 3 was defined as SHR>1(n=5763).Compared with Group 2,Group 1(OR=1.891,95%CI:1.028-3.479,P<0.001)and Group 3(OR=1.868,95%CI:1.434-2.434,P<0.001)had higher risks of suffering from in-hospital MACEs.SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM[OR=2.282,95%CI:1.477-3.524).CONCLUSIONS Both low and high SHR levels were independently associated with in-hospital MACEs.Young males with DM,hypertension,and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.展开更多
BACKGROUND The association of cardiovascular risk burden with disability is unclear.We examined the association between trajectories of the Framingham general cardiovascular disease risk score(FGCRS)with the trajector...BACKGROUND The association of cardiovascular risk burden with disability is unclear.We examined the association between trajectories of the Framingham general cardiovascular disease risk score(FGCRS)with the trajectories of limitations of physical function in older adults.METHODS A total of 1219 participants with no disabilities from the International Mobility in Aging Study(IMIAS)study who had up to three repeated measures of FGCRS between 2012–2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included.FGCRS at baseline was assessed and categorized into tertiles.Physical function was evaluated with the Short Physical Performance Battery(SPPB).The data were analyzed using linear mixed-effects models.RESULTS At baseline,FGCRS ranged between 3–94(mean score:24±15.8),participants were 32(2.6%),502(41.2%)and 685(56.2%)in lowest,middle,and highest tertiles,respectively.In the trajectories of limitations of physical function,the lowest FGCRS had no differences,while the middle and highest had a decrease in physical performance between 2012–2014(P=0.0001).Age,being female,living in Andes Mountains,having middle and highest FGCRS,higher alcohol consumption,being obese,lack of exercise and cognitive impairment increase the probability of disability(P<0.05).Alternatively,living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time(P<0.05).CONCLUSIONS Higher cardiovascular risk burden is associated with decreased physical performance,especially in gait.Results suggest SPPB may provide a measure of cardiovascular health in older adults.展开更多
BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to in...BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to investigate the association between OBS and mortality in hypertensive patients.METHODS This study included 7823 hypertensive patients from the National Health and Nutrition Examination Survey(NHA-NES)1999-2014.Several models,including Cox regression,restricted cubic splines(RCS),Kaplan-Meier survival analysis,subgroup,and sensitivity analyses,were exploited to investigate the relationship between OBS and the risk of mortality.RESULTS Controlling for all potential confounders,a significantly inverse association was observed between elevated OBS and all-cause[hazard ratio(HR)=0.90,95%CI:0.85-0.95]and cardiovascular mortality(HR=0.85,95%CI:0.75-0.95).With adjustment for covariates,significant associations between lifestyle OBS and mortality risks diminished,whereas associations between dietary OBS and these mortality risks remained robust(all-cause mortality:HR=0.91,95%CI:0.86-0.96;cardiovascular mortality:HR=0.85,95%CI:0.76-0.96).RCS demonstrated a linear relationship between OBS and all-cause and cardiovascular mortality risk(P_(nonlinear)=0.088 and P_(nonlinear)=0.447,respectively).Kaplan-Meier curves demonstrated that the mortality rate was lower with a high OBS(P<0.001).The consistency of the association was demonstrated in subgroup and sensitivity analyses.RCS after stratification showed that among current drinkers,those with higher OBS had a lower risk of mortality compared with former or never drinkers.CONCLUSIONS In hypertensive individuals,there was a negative association between OBS and all-cause and cardiovascular mortality.Encouraging hypertensive individuals,especially those currently drinking,to maintain high levels of OBS may be beneficial in improving their prognosis.展开更多
The discharge of nuclear-contaminated water containing radionuclides into the ocean by Japan will lead to its integration into the entire ecosystem through processes of circulation and biomagnification,eventually ente...The discharge of nuclear-contaminated water containing radionuclides into the ocean by Japan will lead to its integration into the entire ecosystem through processes of circulation and biomagnification,eventually entering the human body via the food chain.This poses a substantial risk of irreversible damage to both the ecosystem and human health,a situation that will worsen with the ongoing discharge of such water.The respect and protection of human rights represent an international consensus,and safeguarding fundamental human rights is a substantial obligation that states must undertake in accordance with both international and domestic law.Since the Fukushima nuclear disaster,Japan has continuously violated its international legal obligations to protect human rights in several areas,including the resettlement of disaster victims,the reduction of nuclear radiation levels,and the handling of contaminated water.Such actions have compromised and will continue to compromise the basic human rights of not only its citizens but also those of people worldwide,including environmental rights,the right to life,development rights,and food rights.In the aftermath of the Fukushima meltdown,the public and workers involved in handling nuclear contaminants have been continually exposed to high radiation levels,endangering their rights to life,development,and health.Japan’s inadequate efforts in victim resettlement and environmental restoration have jeopardized the environmental and food rights of its citizens to live healthily and access food in an environment unaffected by nuclear radiation.The release of nuclear-contaminated water poses a risk of Japan’s nuclear pollution to the people of neighboring countries and the global population at large.The principle of human rights underpins the theory of a community with a shared future for humanity,and human rights are a crucial area of China’s active participation in United Nations affairs and global governance.By voicing concerns over Japan’s potential human rights violations globally,China demonstrates its role as a responsible major country.In response to Japan’s breach of legal obligations and human rights violations,China can adopt a reasoned and beneficial approach,including calling on the international community to hold Japan criminally accountable for crimes against humanity under the Rome Statute and advancing scholarly discussions on ecocide and crimes against the marine environment.Furthermore,China should persist in seeking advisory opinions from the International Court of Justice and strive for substantive accountability,utilizing the mechanisms of international human rights organizations to make its voice heard.展开更多
Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry...Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.展开更多
In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraao...In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.展开更多
With the improvement of living standards and changes in dietary habits,the non-alcoholic fatty liver disease(NAFLD)has become one of the most common metabolic diseases clinically,with a global prevalence exceeding 25%...With the improvement of living standards and changes in dietary habits,the non-alcoholic fatty liver disease(NAFLD)has become one of the most common metabolic diseases clinically,with a global prevalence exceeding 25%.NAFLD often presents as a multisystem disease characterized by excessive deposition of triglycerides within hepatocytes,with over 5%of hepatocytes exhibiting steatosis.The clinical progression of NAFLD can mainly be divided into two stages:non-alcoholic fatty liver(NAFL)and non-alcoholic steatohepatitis(NASH).NAFL represents the early stage,primarily characterized by hepatocellular steatosis(which can be reversed with early intervention)and further progression leading to NASH.Besides hepatocellular steatosis,NASH also exhibits hepatocyte inflammation,injury,and fibrosis.Research indicates that 25%of NAFL patients may progress to NASH,and 35%to 50%of NASH patients further develop into liver cirrhosis or even liver cancer.Additionally,NAFLD is closely associated with various chronic diseases and tumors,such as obesity,hyperlipidemia,diabetes,breast cancer,and colorectal cancer.Despite the high and rising incidence of NAFLD,there are currently no clinically proven safe and effective drugs specifically targeting each stage of NAFLD.展开更多
BACKGROUND Pneumoparotid is a rare disease associated with retrograde airflow into the ductal system.There is no established treatment for this disease,which has no known complications.Mouth puffing and playing wind i...BACKGROUND Pneumoparotid is a rare disease associated with retrograde airflow into the ductal system.There is no established treatment for this disease,which has no known complications.Mouth puffing and playing wind instruments are known to be the causes of this disease.CASE SUMMARY We managed a case,in which pneumoparotid suddenly recurred 4 months after surgery for purulent parotiditis.The patient did not report any obvious etiological factors,such as mouth puffing or playing a wind instrument.We reviewed 128 articles(from 1941 to 2023)that reported on a total of 166 patients with pneumoparotid,including the patient from the present case report,with imaging findings.This is the first reported case of pneumoparotid following surgery for purulent parotitis.The etiology in our case was classified as idiopathic.CONCLUSION Imaging findings could be sufficient for accurate pneumoparotid diagnoses and the exclusion of complications;computed tomography could be useful.展开更多
The aorto-ventricular tunnel is a rare congenital cardiac anomaly.We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography.Emergency surgery was performed on the 2nd day of life to close the ...The aorto-ventricular tunnel is a rare congenital cardiac anomaly.We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography.Emergency surgery was performed on the 2nd day of life to close the tun-nel,located just in front of the right coronary ostium,due to the patient’s unstable health condition.The post-operative period revealed complete occlusion of the right coronary artery.Due to the patient’s stability,we opted not to reintervene on the right coronary artery.The patient fully recovered without the need for further coronary intervention.In cases of patients with an aorto-ventricular tunnel(AVT)and associated coronary lesions,it is crucial to exercise caution when intervening in the coronary arteries.展开更多
The pragmatist view of human rights represents a the-oretical condensation of the Chinese practice in human rights devel-opment.In view of the problem of circular idling between rights and claims caused by the traditi...The pragmatist view of human rights represents a the-oretical condensation of the Chinese practice in human rights devel-opment.In view of the problem of circular idling between rights and claims caused by the traditional view of human rights of focusing on contents and not valuing implementation,social segmentation caused by empty talks on interests and claims while ignoring social develop-ment,and the phenomenon of the issue of human rights completely becoming empty and useless political rhetoric,the pragmatic view of human rights,based on the fact that there is a gap between the claims and realization of human rights,emphasizes that instead of blindly ex-panding the types of rights in term of text,it is better to base on prac-tice and promote the maximum realization of existing rights through development.The pragmatist view of human rights attaches impor-tance to relevant economic,social and cultural basis to promote the realization of human rights,rather than only focusing on the claims themselves;it pays greater attention to enhancing the realization of rights,rather than the distribution of rights under the total limit;it ad-vocates more for cooperativism in the realization of rights,rather than confrontation.The pragmatic concept of human rights takes Marxism as its theoretical basis and the gene of practice and the dimension of development as its theoretical characteristics,and promotes the devel-opment of human rights through the realization of rights.展开更多
Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure r...Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.展开更多
On March 14,2004,the Second Session of the 10th National People’s Congress of China adopted the fourth amendment to the Chinese Constitution,the most noticeable highlight of which is the addition of the paragraph“th...On March 14,2004,the Second Session of the 10th National People’s Congress of China adopted the fourth amendment to the Chinese Constitution,the most noticeable highlight of which is the addition of the paragraph“the state respects and protects human rights”as the third clause in Article 33 of Chapter II“Basic Rights and Obligations of Citizens”in the Constitution.The inclusion of the clause of human rights in the Constitution is considered an important milestone in the history of human rights development in the People’s Republic of China.The implementation of the human rights clause not only showcases the values of the Party and the state in respecting and protecting human rights,but also promotes the development of human rights,shapes the culture of human rights,and endows the rule of law with a rich humanistic spirit.Over the past 20 years,the publicity,research and practice of the human rights clause have made the Chi-nese people realize that human rights are not only a“great term”,but also a common value shared by mankind.Amid the once-in-a-century changes of the world,although the development of human rights is facing various challenges,the humanistic spirit contained in the hu-man rights clause has become the internal driving force for building consensus in the whole of society.Reinterpreting the significance and value of the human rights clause can help us conscientiously draw on the experience in the implementation of the clause over the past 20 years and contribute Chinese wisdom and experience to global human rights governance with a more open mind and inclusive attitude.展开更多
As the number of automated guided vehicles(AGVs)within automated container terminals(ACT)continues to rise,conflicts have becomemore frequent.Addressing point and edge conflicts ofAGVs,amulti-AGVconflict-free path pla...As the number of automated guided vehicles(AGVs)within automated container terminals(ACT)continues to rise,conflicts have becomemore frequent.Addressing point and edge conflicts ofAGVs,amulti-AGVconflict-free path planning model has been formulated to minimize the total path length of AGVs between shore bridges and yards.For larger terminalmaps and complex environments,the grid method is employed to model AGVs’road networks.An improved bounded conflict-based search(IBCBS)algorithmtailored to ACT is proposed,leveraging the binary tree principle to resolve conflicts and employing focal search to expand the search range.Comparative experiments involving 60 AGVs indicate a reduction in computing time by 37.397%to 64.06%while maintaining the over cost within 1.019%.Numerical experiments validate the proposed algorithm’s efficacy in enhancing efficiency and ensuring solution quality.展开更多
Universality is one of the essential characteristics of human rights, but there is a substantive difference between idealism and realism in understanding the concept of universality of human rights. The concepts of ra...Universality is one of the essential characteristics of human rights, but there is a substantive difference between idealism and realism in understanding the concept of universality of human rights. The concepts of radical universality and strong universality based on the concept of natural human rights are too idealistic and thus have a high risk of being alienated into a tool of international re-pression in practice. On the contrary, the theory on the subjectivity of human rights can effectively defuse this risk brought about by radical universality and strong universality. Advocating a transition from the universality of human rights to the subjectivity of human rights not only keeps in line with the actual construction process of international human rights, but can also effectively interpret the practical difficul-ties in the realization process of international human rights. Therefore, it can be used as another alternative theory on human rights beyond the theory of natural human rights.展开更多
文摘目的对医患沟通的临床实践指南进行方法学和报告质量评价,以期确定高质量指南,提供临床参考。方法通过检索MEDLINE(PubMed)、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普(VIP),补充医脉通、用药助手、丁香园网站的相关临床实践指南(CPG),使用AGREEⅡ和RIGHT工具进行指南质量评价,采用组内相关系数(ICC)用于评估评审者对每个项目理解的一致性。结果共纳入2份临床实践指南,每个领域的评审人员的总体一致性是可以接受的。AGREEⅡ评价结果显示,2篇指南推荐级别均为B级,CPG所有7个领域的平均报告率为50.64%,其中领域1最高(88.89%),领域3最低(30.95%)。RIGHT评价结果显示,指南平均报告率为29.22%。结论医患沟通相关指南质量与数量仍有待提高,指南制订者应严格按照AGREEⅡ和RIGHT的要求规范撰写,以期提出高水平、高标准的循证指南,来指导医护人员的临床实践。
基金supported by Dravet Syndrome Foundation,NIH/NINDS R01-NS112500.
文摘Developmental and epileptic encephalopathies(DEEs)are neurological disorders generally involving medically intractable seizures and a diverse array of comorbid neuropsychiatric delays and deficits that may severely affect cognition,mood,sleep,social behavior,movement control,learning,and/or memory.Dravet syndrome(DS),also known as Severe Myoclonic Epilepsy of Infancy.
基金The CCC-ACS project is a collaborative project of the American Heart Association and the Chinese Society of Cardiology.The American Heart Association received funding from Pfizer through an independent grant for learning and change and AstraZeneca as a quality improvement initiative.The author(s)disclosed receipt of the following financial support for the research,authorship,and/or publication of this article:81973841,81573744 from the China National Natural Scientific Foundation.
文摘BACKGROUND Stress hyperglycemia ratio(SHR)could provide accurate information on the acute status of hyperglycemia.The relationship between SHR and acute coronary syndrome(ACS)prognosis remains unclear.This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS.METHODS A total of 12,010 patients were eventually enrolled in the study.The relationship between SHR and in-hospital major adverse cardiovascular events(MACEs)was then modeled by restricted cubic spline(RCS)curves,and all patients were divided into three groups according to the results.The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes,described as odds ratios(ORs)and 95%confidence intervals(CIs).Subgroup analyses were also performed on different diseases.RESULTS The median age of this cohort was 63(54,71)years old,and 8942(74.5%)were male.Group 1 was defined as SHR<0.6(n=426),Group 2 was defined as SHR between 0.6 and 1(n=5821),and Group 3 was defined as SHR>1(n=5763).Compared with Group 2,Group 1(OR=1.891,95%CI:1.028-3.479,P<0.001)and Group 3(OR=1.868,95%CI:1.434-2.434,P<0.001)had higher risks of suffering from in-hospital MACEs.SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM[OR=2.282,95%CI:1.477-3.524).CONCLUSIONS Both low and high SHR levels were independently associated with in-hospital MACEs.Young males with DM,hypertension,and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.
基金supported by the Canadian Institutes of Health Research(CIHR),Grant No.AAM 108751.
文摘BACKGROUND The association of cardiovascular risk burden with disability is unclear.We examined the association between trajectories of the Framingham general cardiovascular disease risk score(FGCRS)with the trajectories of limitations of physical function in older adults.METHODS A total of 1219 participants with no disabilities from the International Mobility in Aging Study(IMIAS)study who had up to three repeated measures of FGCRS between 2012–2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included.FGCRS at baseline was assessed and categorized into tertiles.Physical function was evaluated with the Short Physical Performance Battery(SPPB).The data were analyzed using linear mixed-effects models.RESULTS At baseline,FGCRS ranged between 3–94(mean score:24±15.8),participants were 32(2.6%),502(41.2%)and 685(56.2%)in lowest,middle,and highest tertiles,respectively.In the trajectories of limitations of physical function,the lowest FGCRS had no differences,while the middle and highest had a decrease in physical performance between 2012–2014(P=0.0001).Age,being female,living in Andes Mountains,having middle and highest FGCRS,higher alcohol consumption,being obese,lack of exercise and cognitive impairment increase the probability of disability(P<0.05).Alternatively,living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time(P<0.05).CONCLUSIONS Higher cardiovascular risk burden is associated with decreased physical performance,especially in gait.Results suggest SPPB may provide a measure of cardiovascular health in older adults.
基金supported by the National Natural Science Foundation of China(No.81960074)the Natural Science Foundation-Outstanding Youth Fund Project of Jiangxi Province(No.20232ACB216006)。
文摘BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to investigate the association between OBS and mortality in hypertensive patients.METHODS This study included 7823 hypertensive patients from the National Health and Nutrition Examination Survey(NHA-NES)1999-2014.Several models,including Cox regression,restricted cubic splines(RCS),Kaplan-Meier survival analysis,subgroup,and sensitivity analyses,were exploited to investigate the relationship between OBS and the risk of mortality.RESULTS Controlling for all potential confounders,a significantly inverse association was observed between elevated OBS and all-cause[hazard ratio(HR)=0.90,95%CI:0.85-0.95]and cardiovascular mortality(HR=0.85,95%CI:0.75-0.95).With adjustment for covariates,significant associations between lifestyle OBS and mortality risks diminished,whereas associations between dietary OBS and these mortality risks remained robust(all-cause mortality:HR=0.91,95%CI:0.86-0.96;cardiovascular mortality:HR=0.85,95%CI:0.76-0.96).RCS demonstrated a linear relationship between OBS and all-cause and cardiovascular mortality risk(P_(nonlinear)=0.088 and P_(nonlinear)=0.447,respectively).Kaplan-Meier curves demonstrated that the mortality rate was lower with a high OBS(P<0.001).The consistency of the association was demonstrated in subgroup and sensitivity analyses.RCS after stratification showed that among current drinkers,those with higher OBS had a lower risk of mortality compared with former or never drinkers.CONCLUSIONS In hypertensive individuals,there was a negative association between OBS and all-cause and cardiovascular mortality.Encouraging hypertensive individuals,especially those currently drinking,to maintain high levels of OBS may be beneficial in improving their prognosis.
基金supported by the Major Com-missioned Project of Social Science Planning Fund of Liaoning Prov-ince,China:“Research on Legal Issues of Cross-border Nuclear Dam-age Compensation in the Context of Japan’s Discharge of Nuclear Sewage”[Grant No.L23ZD072].
文摘The discharge of nuclear-contaminated water containing radionuclides into the ocean by Japan will lead to its integration into the entire ecosystem through processes of circulation and biomagnification,eventually entering the human body via the food chain.This poses a substantial risk of irreversible damage to both the ecosystem and human health,a situation that will worsen with the ongoing discharge of such water.The respect and protection of human rights represent an international consensus,and safeguarding fundamental human rights is a substantial obligation that states must undertake in accordance with both international and domestic law.Since the Fukushima nuclear disaster,Japan has continuously violated its international legal obligations to protect human rights in several areas,including the resettlement of disaster victims,the reduction of nuclear radiation levels,and the handling of contaminated water.Such actions have compromised and will continue to compromise the basic human rights of not only its citizens but also those of people worldwide,including environmental rights,the right to life,development rights,and food rights.In the aftermath of the Fukushima meltdown,the public and workers involved in handling nuclear contaminants have been continually exposed to high radiation levels,endangering their rights to life,development,and health.Japan’s inadequate efforts in victim resettlement and environmental restoration have jeopardized the environmental and food rights of its citizens to live healthily and access food in an environment unaffected by nuclear radiation.The release of nuclear-contaminated water poses a risk of Japan’s nuclear pollution to the people of neighboring countries and the global population at large.The principle of human rights underpins the theory of a community with a shared future for humanity,and human rights are a crucial area of China’s active participation in United Nations affairs and global governance.By voicing concerns over Japan’s potential human rights violations globally,China demonstrates its role as a responsible major country.In response to Japan’s breach of legal obligations and human rights violations,China can adopt a reasoned and beneficial approach,including calling on the international community to hold Japan criminally accountable for crimes against humanity under the Rome Statute and advancing scholarly discussions on ecocide and crimes against the marine environment.Furthermore,China should persist in seeking advisory opinions from the International Court of Justice and strive for substantive accountability,utilizing the mechanisms of international human rights organizations to make its voice heard.
文摘Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.
文摘In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.
文摘With the improvement of living standards and changes in dietary habits,the non-alcoholic fatty liver disease(NAFLD)has become one of the most common metabolic diseases clinically,with a global prevalence exceeding 25%.NAFLD often presents as a multisystem disease characterized by excessive deposition of triglycerides within hepatocytes,with over 5%of hepatocytes exhibiting steatosis.The clinical progression of NAFLD can mainly be divided into two stages:non-alcoholic fatty liver(NAFL)and non-alcoholic steatohepatitis(NASH).NAFL represents the early stage,primarily characterized by hepatocellular steatosis(which can be reversed with early intervention)and further progression leading to NASH.Besides hepatocellular steatosis,NASH also exhibits hepatocyte inflammation,injury,and fibrosis.Research indicates that 25%of NAFL patients may progress to NASH,and 35%to 50%of NASH patients further develop into liver cirrhosis or even liver cancer.Additionally,NAFLD is closely associated with various chronic diseases and tumors,such as obesity,hyperlipidemia,diabetes,breast cancer,and colorectal cancer.Despite the high and rising incidence of NAFLD,there are currently no clinically proven safe and effective drugs specifically targeting each stage of NAFLD.
文摘BACKGROUND Pneumoparotid is a rare disease associated with retrograde airflow into the ductal system.There is no established treatment for this disease,which has no known complications.Mouth puffing and playing wind instruments are known to be the causes of this disease.CASE SUMMARY We managed a case,in which pneumoparotid suddenly recurred 4 months after surgery for purulent parotiditis.The patient did not report any obvious etiological factors,such as mouth puffing or playing a wind instrument.We reviewed 128 articles(from 1941 to 2023)that reported on a total of 166 patients with pneumoparotid,including the patient from the present case report,with imaging findings.This is the first reported case of pneumoparotid following surgery for purulent parotitis.The etiology in our case was classified as idiopathic.CONCLUSION Imaging findings could be sufficient for accurate pneumoparotid diagnoses and the exclusion of complications;computed tomography could be useful.
文摘The aorto-ventricular tunnel is a rare congenital cardiac anomaly.We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography.Emergency surgery was performed on the 2nd day of life to close the tun-nel,located just in front of the right coronary ostium,due to the patient’s unstable health condition.The post-operative period revealed complete occlusion of the right coronary artery.Due to the patient’s stability,we opted not to reintervene on the right coronary artery.The patient fully recovered without the need for further coronary intervention.In cases of patients with an aorto-ventricular tunnel(AVT)and associated coronary lesions,it is crucial to exercise caution when intervening in the coronary arteries.
基金the National Social Science Fund project“Basic Theoretical Research on Law Science”(22CFX002).
文摘The pragmatist view of human rights represents a the-oretical condensation of the Chinese practice in human rights devel-opment.In view of the problem of circular idling between rights and claims caused by the traditional view of human rights of focusing on contents and not valuing implementation,social segmentation caused by empty talks on interests and claims while ignoring social develop-ment,and the phenomenon of the issue of human rights completely becoming empty and useless political rhetoric,the pragmatic view of human rights,based on the fact that there is a gap between the claims and realization of human rights,emphasizes that instead of blindly ex-panding the types of rights in term of text,it is better to base on prac-tice and promote the maximum realization of existing rights through development.The pragmatist view of human rights attaches impor-tance to relevant economic,social and cultural basis to promote the realization of human rights,rather than only focusing on the claims themselves;it pays greater attention to enhancing the realization of rights,rather than the distribution of rights under the total limit;it ad-vocates more for cooperativism in the realization of rights,rather than confrontation.The pragmatic concept of human rights takes Marxism as its theoretical basis and the gene of practice and the dimension of development as its theoretical characteristics,and promotes the devel-opment of human rights through the realization of rights.
文摘Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.
文摘On March 14,2004,the Second Session of the 10th National People’s Congress of China adopted the fourth amendment to the Chinese Constitution,the most noticeable highlight of which is the addition of the paragraph“the state respects and protects human rights”as the third clause in Article 33 of Chapter II“Basic Rights and Obligations of Citizens”in the Constitution.The inclusion of the clause of human rights in the Constitution is considered an important milestone in the history of human rights development in the People’s Republic of China.The implementation of the human rights clause not only showcases the values of the Party and the state in respecting and protecting human rights,but also promotes the development of human rights,shapes the culture of human rights,and endows the rule of law with a rich humanistic spirit.Over the past 20 years,the publicity,research and practice of the human rights clause have made the Chi-nese people realize that human rights are not only a“great term”,but also a common value shared by mankind.Amid the once-in-a-century changes of the world,although the development of human rights is facing various challenges,the humanistic spirit contained in the hu-man rights clause has become the internal driving force for building consensus in the whole of society.Reinterpreting the significance and value of the human rights clause can help us conscientiously draw on the experience in the implementation of the clause over the past 20 years and contribute Chinese wisdom and experience to global human rights governance with a more open mind and inclusive attitude.
基金supported by National Natural Science Foundation of China(No.62073212)Shanghai Science and Technology Commission(No.23ZR1426600).
文摘As the number of automated guided vehicles(AGVs)within automated container terminals(ACT)continues to rise,conflicts have becomemore frequent.Addressing point and edge conflicts ofAGVs,amulti-AGVconflict-free path planning model has been formulated to minimize the total path length of AGVs between shore bridges and yards.For larger terminalmaps and complex environments,the grid method is employed to model AGVs’road networks.An improved bounded conflict-based search(IBCBS)algorithmtailored to ACT is proposed,leveraging the binary tree principle to resolve conflicts and employing focal search to expand the search range.Comparative experiments involving 60 AGVs indicate a reduction in computing time by 37.397%to 64.06%while maintaining the over cost within 1.019%.Numerical experiments validate the proposed algorithm’s efficacy in enhancing efficiency and ensuring solution quality.
文摘Universality is one of the essential characteristics of human rights, but there is a substantive difference between idealism and realism in understanding the concept of universality of human rights. The concepts of radical universality and strong universality based on the concept of natural human rights are too idealistic and thus have a high risk of being alienated into a tool of international re-pression in practice. On the contrary, the theory on the subjectivity of human rights can effectively defuse this risk brought about by radical universality and strong universality. Advocating a transition from the universality of human rights to the subjectivity of human rights not only keeps in line with the actual construction process of international human rights, but can also effectively interpret the practical difficul-ties in the realization process of international human rights. Therefore, it can be used as another alternative theory on human rights beyond the theory of natural human rights.
