Tentative New Terminology: Initial Comedonal Phase Preceding Acute Inflammatory Phase of Acne Vulgaris—Importance of Early Treatment

We report a case of a 12-year-old female with closed and open comedo without inflammatory lesions at the first visit. She had been treated with topical adapalene once daily, and closed and open comedo subsided without inflammatory lesions one month after the treatment without any side effects induced by adapalen. The recurrence of comedo had not been observed afterwards. In the Japanese Dermatological Association (JDA) guidelines for the treatment of acne vulgaris, comedonal phase has not been stated. Then we propose the tentative new terminology of a comedonal phase and emphasize its importance in the early initial treatment for comedo to prevent the development of the acute inflammatory phase such as red papules and pustules and formation of acne scars.

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

AIM： To evaluate the outcome predictors of percutaneous ablation therapy in patients with unresectable hepatocellular carcinoma （HCC）, especially to identify whether the initial treatment response contributes to the survival of the patients. METHODS： The study cohort included 153 patients with single （102） and two or three （51） HCC nodules 5 cm or less in maximum diameter. As an initial treatment, 110 patients received radiofrequency ablation and 43 patients received percutaneous ethanol injection. RESULTS： The Kaplan-Meier estimates of overall 3- and S-year survival rates were 75% and 59%, respectively. The log-rank test revealed statistically significant differences in the overall survivals according to ChildPugh class （P = 0.0275）, tumor size （P = 0.0130）, serum albumin level （P = 0.0060）, serum protein induced by vitamin K absence or antagonist Ⅱ level （P = 0.0486）, and initial treatment response （P = 0.0130）. The independent predictors of survival were serum albumin level （dsk ratio, 3.216; 950 CI, 1.407-7.353; P = 0.0056） and initial treatment response （risk ratio, 2.474; 95% CI, 1.076-5.692; P = 0.0330） based on the Cox proportional hazards regression models. The patients had a serum albumin level 3.5 g/dL and the 3- and 5-year survival rates of 86% and 82%. CONCLUSION： In HCC patients treated with percutaneous ablation therapy, serum albumin level and initial treatment response are the independent outcome predictors.

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice.

Initial medication adherence in newly diagnosed glaucoma patients:three adherence measures

AIM:To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs.METHODS:This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013,which in consequence received a first prescription for anti-glaucoma drugs.Data was collected from electronic prescribing records of the primary care units and from pharmacy claims records.Initiation of glaucoma treatment and early discontinuation were measured,and the combination of(non)-initiation and early discontinuation accounted for initial medication(non)-adherence.RESULTS:A total of 3548 new glaucoma patients(40.1%male;59.9%female)were included.The 1133(31.9%)patients were initially classified as non-users,since there was no pharmacy claim found for their first prescription for glaucoma treatment.Additionally,277(11.5%)patients early discontinued their treatment,acquiring only their first prescription.Overall,the initial medication non-adherence rate was 39.7%since 1410 patients either didn’t initiate treatment or discontinued it early.CONCLUSION:This study,reveals a major opportunity to improve glaucoma treatment and its control,since a large proportion of patients fail to engage with their prescribed therapy,which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.

Treatment Initiation among Patients with Multidrug Resistant Tuberculosis in Bhopal District, India

Revised national tuberculosis control programme in India has limited co-hort-wise information about what happens to patients diagnosed with multidrug resistant TB (MDR-TB). We determined the pre-treatment loss to follow-up (non-initiation of treatment by programme within 6 months of diagnosis) and time from diagnosis to treatment initiation in Bhopal district, central India (2014). Pre-treatment loss to follow-up was 13% (0.95 CI: 7%, 23%), not significantly different from the national estimates (18%) and median time to initiate treatment was seven days, lower than that reported elsewhere in the country. Bhopal was performing well with reference to time to treatment initiation in programmatic settings.

Effect of ultrasonic peening treatment on the fatigue behaviors of a magnesium alloy up to very high cycle regime

Ultrasonic fatigue tests are performed on a magnesium alloy with and without ultrasonic peening treatment(UPT).Surface enhancement layer leads to the complete change of crack initiation sites.However,crack initiation mechanism keeps the same and results in a single-faceted morphology at crack initiation site.Microcracks initiate as Mode Ⅱ crack within the original grain,but deflect to Mode I crack outside of the original cracked grain.A threshold SIF value is proposed to evaluate the retarding effect of grain boundary on microcrack propagation.Outside of the original cracked grain,Mode I crack propagation below the threshold ΔK_(σ-th) is responsible for the formation of fine granular area(FGA,a nano-grain layer).Based on the Numerous Cyclic Pressing(NCP) model,it is proposed that crack type should be another necessary condition for the formation of FGA.

Diagnosis and treatment of sudden sensorineural hearing loss

Nationwide epidemiological surveys of idiopathic sudden sensorineural hearing loss(SSNHL) have been performed five times by the Research Committee of the Ministry of Health and Welfare or the Ministry of Health, Welfare and Labour in Japan. These surveys included patients who had SSNHL in 1972, 1987, 1993, 2001, and 2012. Using the criteria for the grading of hearing loss in SSNHL or the criteria for grading the degree of hearing recovery after SSNHL established by the Research Committee, we compared the outcomes of SSNHL between the five nationwide surveys. The results revealed that the outcomes of SSNHL have not changed in the past 40 years. In 1972, 88% of patients received steroids, but none received prostaglandin E1(PGE1). The use of PGE1 has increased since the 1980 s, but its effect on SSNHL may not be significant. Intratympanic steroid injection has been introduced recently for the treatment of SSNHL, but it does not seem to be used widely in Japan. Intratympanic therapy that can reduce the total amount of steroids administered will be used more frequently if the true effects and indications for this therapy are known. Elucidation of the etiologies of SSNHL and development of treatments specific for these etiologies are expected.

Temperature characteristics of wood during microwave treatments

In order to investigate the temperature characteristics of wood during microwave(MW) treatments,optical fiber sensors were used to measure wood(Pinus sylvestris L. var. mongolica Litv.) temperatures. The results show that the development of internal temperatures in wood basically includes two patterns during the process of MW treatment. The first may be divided into three phases: warming, constant temperature, and a sharply rising phase. The second pattern may be divided into two phases: warming, and constant temperature. The maximum temperature(MT) and rate of temperature increase(RTI)rose as the microwave power increased. The initial wood moisture content decreased while the period of constant temperature fell. Temperatures varied in different positions in the wood. The order of MT and RTI levels were the upper surface, center, bottom surface and the end point.Along the direction of wood thickness, the closer the monitoring point was to the generator, the faster the temperature increased. The MT and RTI of the end point was a minimum value because of the rapid removal of steam.

Benzodiazepines and Amphetamines Use among Methadone Maintenance Participants and Their Associations with Treatment Adherence

It has been well documented that methadone maintenance treatment(MMT)can reduce illegal opioid use and drug-related crimes,and decrease the HIV infection risk[1].China initiated its MMT program in 2004,which was rapidly scaled up nationwide[2].By the end of 2016,there were 778 MMT clinics established in 29 provinces。

Study on the combination of brief psychodynamic psychotherapy with Viagra in the treatment of non-organic ED

Background Erectile dysfunction(ED)has gradually become an important issue that seriously affects the quality of life of Chinese men.In addition to classic oral medications,psychotherapeutic interventions are increasingly being used in the treatment of ED.Aim This study aims to investigate the clinical efficacy of brief psychodynamic psychotherapy(BPP)plus Viagra in the treatment of non-organic ED.Methods We initiated this study via a controlled,prospective experimental design with initial optimal efficiency standard greater than 10%.On the standard,63 patients were enrolled who were assigned to control or treatment group.The control group(including 33 cases)received Viagra treatment for 2 months,and the treatment group(including 30 cases)was cured with BPP plus Viagra.After the treatments,the clinical efficacy was assessed using the International Erectile Function Index(IIEF-5)score,the Self-rating Anxiety Scale(SAS),Sexual Satisfaction(SS)score and Erection Hardness Score(EHS).Results In the comparison of efficacy,pretreatment and post-treatment within each group,the two groups showed improvements in IIEF,SAS scores,SS,and EHS(treatment group:PIIEF<0.001,PSAS<0.001,PSS<0.001,PEHS<0.001;control group:PIIEF<0.001,PSAS<0.001,PSS<0.001,PEHS<0.001).Furthermore,the treatment group presented better performances in IIEF(p=0.040),SAS(p=0.006),SS scores(p=0.045)and EHS(p=0.041)than the control group.Conclusion The combination of BPP with Viagra has positive effect on the treatment of non-organic ED.http://creativecommons.org/licenses/by-nc/4.0/Background Erectile dysfunction(ED)has gradually become an important issue that seriously affects the quality of life of Chinese men.In addition to classic oral medications,psychotherapeutic interventions are increasingly being used in the treatment of ED.Aim This study aims to investigate the clinical efficacy of brief psychodynamic psychotherapy(BPP)plus Viagra in the treatment of non-organic ED.Methods We initiated this study via a controlled,prospective experimental design with initial optimal efficiency standard greater than 10%.On the standard,63 patients were enrolled who were assigned to control or treatment group.The control group(including 33 cases)received Viagra treatment for 2 months,and the treatment group(including 30 cases)was cured with BPP plus Viagra.After the treatments,the clinical efficacy was assessed using the International Erectile Function Index(IIEF-5)score,the Self-rating Anxiety Scale(SAS),Sexual Satisfaction(SS)score and Erection Hardness Score(EHS).Results In the comparison of efficacy,pretreatment and post-treatment within each group,the two groups showed improvements in IIEF,SAS scores,SS,and EHS(treatment group:PIIEF<0.001,PSAS<0.001,PSS<0.001,PEHS<0.001;control group:PIIEF<0.001,PSAS<0.001,PSS<0.001,PEHS<0.001).Furthermore,the treatment group presented better performances in IIEF(p=0.040),SAS(p=0.006),SS scores(p=0.045)and EHS(p=0.041)than the control group.Conclusion The combination of BPP with Viagra has positive effect on the treatment of non-organic ED.

THE SCROOPING TREATMENT OF POLYESTER SILKLIKE FIBERS

In this paper the mechanism producing scrooping sound has been discussedtheoretically.It has been recognized that the continuous stick-slip vibrationhaving a certain period and the bigger △E(△E——enery released by stick-slipvibration at one time)are the requisite and surfficient conditions producingscrooping sound.For fiber sample,its surface properties and internal structureare two principal factors influencing scrooping sound. Considering the surface properties of polyester fiber after scrooping treatmentare the synthetic reflection of the properties used treatment reagents and thesurface properties of the fiber,how selecting proper reagents for scroopingtreatment would be the key factor influencing the scrooping effect.Sometreatment solutions having better scrooping effect have been obtained in the paper. In order to cause better scrooping effect,not only the treatment reagent andsurface properties of the fiber,but also the internal structure of the fiber must beconsidered,It has been shown in

Effects of laser shock processing,solid solution and aging,and cryogenic treatments on microstructure and thermal fatigue performance of ZCuAl_(10)Fe_(3)Mn_(2)alloy

The materials used in variable temperature conditions are required to have excellent thermal fatigue performance.The effects of laser shock processing(LSP),solid solution and aging treatment(T6),and cryogenic treatment(CT)on both microstructure and thermal fatigue performance of ZCuAl_(10)Fe_(3)Mn_(2) alloys were studied.Microstructure and crack morphology were then examined by scanning electron microscopy(SEM)and energy-dispersive X-ray spectroscopy(EDS).The result showed that,after being subjected to the combination treatment of T6+CT+LSP,the optimal mechanical properties and thermal fatigue performance were obtained for the ZCuAl_(10)Fe_(3)Mn_(2) alloy with the tensile strength,hardness,and elongation of 720 MPa,300.16 HB,and 16%,respectively,and the thermal fatigue life could reach 7,100 cycles when the crack length was 0.1 mm.Moreover,the ZCuAl_(10)Fe_(3)Mn_(2) after combination treatment shows high resistance to oxidation,good adhesion between the matrix and grain boundaries,and dramatically reduced growth rate of crack.During thermal fatigue testing,under the combined action of thermal and alternating stresses,the microstructure around the sample notch oxidized and became loose and porous,which then converted to micro-cracks.Fatigue crack expanded along the grain boundary in the early stage.In the later stage,under the cyclic stress accumulation,the oxidized microstructure separated from the matrix,and the fatigue crack expanded in both intergranular and transgranular ways.The main crack was thick,and the path was meandering.

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

医保支付方式由治病向健康转型—先期探讨研究

为系统讨论医保支付方式改革驱动由治病向健康转型的可能性和实践模式,以目标—发展重点透视矩阵作为分析框架,以慢性病为切入点,基于安徽省医共体慢性病打包支付的案例,探讨中国情境下的以健康为导向的医保支付方式改革的路径和方法。研究发现,伴随人口结构和社会需求的变化,在理念层面上,医保支付政策已体现出由治病向健康转型的态势,医保支付政策的内容、形式、载体趋向多样化。目前中国复合式医保支付框架已经建立,但改革内容和进展不平衡,尚未发挥向健康转型的激励引领作用。持续推进医保支付方式改革并对改革内容进行适应性调整,将是下一阶段工作的重点。

口腔无托槽隐形矫治联合牙周基础治疗对牙周病致前牙扇形移位患者口腔健康及炎症反应的影响分析

目的分析口腔无托槽隐形矫治联合牙周基础治疗对牙周病致前牙扇形移位患者口腔健康及炎症反应的影响,以期为临床治疗牙周病致前牙扇形移位提供参考依据。方法选取60例牙周病致前牙扇形移位的患者作为观察样本,按照计算机分组法分为对照组与观察组,每组30例。对照组开展牙周夹板固定联合牙周基础治疗,观察组开展口腔无托槽隐形矫治联合牙周基础治疗。对比两组治疗前后牙周指标、口腔健康情况、炎性反应指标、牙齿功能。结果两组治疗前牙周袋深度、牙槽骨高度、牙覆盖距离、龈沟出血指数对比无差异(P>0.05);观察组治疗后牙周袋深度(2.65±0.51)mm、牙覆盖距离(1.78±0.25)mm、龈沟出血指数(1.56±0.42)分显著低于对照组的(4.73±0.62)mm、(3.19±0.35)mm、(3.07±0.30)分,牙槽骨高度(5.71±0.29)mm高于对照组的(5.55±0.20)mm(P<0.05)。两组治疗前独立能力、心理不适、疼痛与不适、功能受限评分对比无差异(P>0.05);观察组治疗后独立能力评分(1.86±0.31)分、心理不适评分(1.63±0.21)分、疼痛与不适评分(1.86±0.19)分、功能受限评分(1.58±0.20)分均显著低于对照组的(2.16±0.40)、(2.07±0.38)、(2.33±0.30)、(2.17±0.15)分(P<0.05)。两组治疗前C反应蛋白(CRP)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平对比无差异(P>0.05);观察组治疗后CRP(4.32±0.30)mg/L、IL-1β(167.26±19.32)pg/ml、IL-6(8.75±1.80)pg/ml均显著低于对照组的(5.20±0.41)mg/L、(210.38±17.95)pg/ml、(10.34±1.23)pg/ml(P<0.05)。两组治疗前牙齿色泽、牙齿形状、边缘密合度及咬合关系评分对比无差异(P>0.05);观察组治疗后牙齿色泽、牙齿形状、边缘密合度及咬合关系评分分别为(6.82±0.46)、(7.12±0.50)、(7.81±0.34)、(7.68±0.22)分,均显著高于对照组的(5.63±0.37)、(5.69±0.38)、(6.19±0.24)、(6.10±0.33)分(P<0.05)。结论口腔无托槽隐形矫治联合牙周基础治疗为牙周病致前牙扇形移位患者提供了一种更舒适的牙齿矫正方式,不仅能够减少炎症反应,还有助于更高效、更精确地矫正患者的牙齿,帮助其恢复正常的口腔健康状态。

2023年慢性阻塞性肺疾病全球倡议更新评述

慢性阻塞性肺病(COPD)发病机制复杂,是一种复杂累积和动态的基因-环境-时间相互作用的最终结果,这些相互作用会损害肺部和/或改变其正常的发育。COPD目前是全球范围内发病率和死亡率的主要原因,其经济和社会负担正在不断增加。本文根据2023年慢性阻塞性肺疾病全球倡议(GOLD)的更新,就COPD定义、诊断和治疗等关键问题进行评述,以期为临床医师诊断和治疗COPD患者提供参考和借鉴。

左甲状腺素治疗先天性甲状腺功能减退症儿童的最佳初始剂量

目的:回顾分析先天性甲状腺功能减退症(congenital hypothyroidism,CH)儿童的发病情况及治疗效果,探讨CH患儿左甲状腺素(levothyroxine,LT4)替代治疗的最佳初始治疗剂量。方法:收集1987年至2018年上海市儿童医院新生儿筛查中心随访并接受LT4治疗的231例CH患儿,根据首次甲状腺功能的血游离甲状腺激素(free thyroxine,fT4)水平分为3组,即轻度CH组(60例)、中度CH组(97例)、重度CH组(74例)。在不同分组内进行剂量效应分析,利用Poisson回归分析各组内LT4不同初始治疗剂量下随访2岁内的用药调整情况。结果:(1)新生儿筛查促甲状腺激素(thyroid stimulating hormone,TSH)水平、首次召回后静脉血fT4水平、甲状腺发育情况对治疗后患儿TSH水平的影响差异有统计学意义(P<0.05);(2)治疗后2周~1个月,轻度CH组患儿LT4初始治疗剂量在6~8μg·(kg·d)^(-1)、中度CH组患儿初始治疗剂量在>8~10μg·(kg·d)^(-1)时TSH恢复正常比例较高(分别为70.37%、70.00%),fT4均可在该年龄段参考值的正常范围内或高于参考值范围,2岁内调整用药的次数也相对较少(分别为22.30%、20.09%),差异具有统计学意义(P<0.05)。结论:LT4治疗CH有效,根据疾病程度,轻度CH患儿和中度CH患儿的最佳初始治疗剂量依次为6~8μg·(kg·d)^(-1)和>8~10μg·(kg·d)^(-1);对于重度CH患儿可适当提高LT4初始治疗剂量[>10μg·(kg·d)^(-1)],以尽快使TSH、fT4恢复至正常。

GOLD关于慢性阻塞性肺疾病合并症更新变迁20年

慢性阻塞性肺疾病是一种慢性炎症性气道疾病,影响着全球近1/10人口的生活质量。慢性阻塞性肺疾病常合并其他疾病,合并症对患者的生活质量、疾病预后、医疗花费等都有不良影响。近年来慢性阻塞性肺疾病全球倡议给予了慢阻肺合并症更多的关注和重视,本文对慢性阻塞性肺疾病全球倡议的共识报告近20年有关合并症的更新进行综述。

86例初治涂阳肺结核患者标准抗结核方案治愈后复发的危险因素Logistic分析

目的探讨86例初治涂阳肺结核患者接受标准抗结核方案治愈后出现复发的影响因素。方法本研究中共纳入86例初治涂阳肺结核患者,所有病例均来源于济源市人民医院,选取时间为2019年5月至2020年5月,进行回顾性分析,所有患者均接受标准抗结核方案治疗,至少半年,在患者治愈后对其进行2年的随访,随访期间对患者进行痰标本细菌培养、痰标本结核分歧杆菌厚涂片检查,统计患者的转阴情况,以及是否出现复发,对初治涂阳肺结核患者采用标准抗结核方案治愈后出现复发的影响因素进行分析,之后进一步对初治涂阳肺结核患者接受标准抗结核方案治愈后出现复发的高危因素进行筛选,分析年龄、转阴时间与复发率的相关性。结果68.60%的初治涂阳肺结核患者在采用标准抗结核方案治疗2个月痰标本细菌培养、痰标本结核分歧杆菌厚涂片检查结果显示转阴,而23.26%的患者在治疗3个月时转阴,8.14%的患者在治疗3个月以上时转阴;共有8例患者出现复发,复发率为9.30%(8/86);初治涂阳肺结核患者治愈后的复发率在不同年龄、痰菌转阴时间下,均有明显差异(均P<0.05);初治涂阳肺结核患者标准抗结核方案治愈后复发的高危因素在于年龄≥60岁、痰菌转阴时间>3个月(OR=1.822、2.801,均P<0.05);初治涂阳肺结核患者标准抗结核方案治愈后的复发率与年龄、痰菌转阴时间均呈正相关(r=0.422、0.495,均P<0.05)。结论初治涂阳肺结核患者标准抗结核方案治愈后复发的危险因素在于年龄≥60岁、痰菌转阴时间>3个月,临床应针对上述因素进行预防并随时对治疗方案进行调整,以降低复发率。

不同浓度的维生素C对不同品种的甜菜种子引发的影响

本研究旨在探究维生素C对甜菜的引发效果并筛选出适宜的引发处理,同时为甜菜种子包衣剂物料的选择提供相关依据。本试验以TD801和TD802甜菜种子为试验材料,并设计了3个浓度梯度(50、100、200 mg/L),3个的时间处理(8、16、24 h),通过对处理后的甜菜种子的发芽势、发芽率、活力指数、发芽指数以及电导率进行分析比较。结果显示,不同处理下的VC溶液对甜菜种子的引发均有促进效果,其中300 mg/L的VC处理24 h后对TD801种子有显著的提升效果,其发芽势为90.67%,发芽率为92.67%,发芽指数为40.36,活力指数为514.60,此时种子的引发效果最好;而对TD802甜菜种子影响最大的VC浓度则为100 mg/L,处理时间为16 h。由此可见,同种引发剂对不同甜菜材料处理时,其引发的最适浓度不同。