Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affe...Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth. The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents. Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae. EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD), aseptic meningitis, encephalitis and poliomyelitis-like acute flaccid paralysis. A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997, and caused 41 deaths amongst young children. In late 2000, a recurrence of an outbreak of HFMD occurred in Malaysia with 8 fatalities in peninsular Malaysia. Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities. A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006. The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010. As with other HFMD outbreaks in Malaysia, both EV71 and CA16 were the main aetiological viruses isolated. In similarity with the HFMD outbreak in 2005, the isolation of CA16 preceded the appearance of EV71. Based on the VP1 gene nucleotide sequences, 4 sub-genogroups of EV71 (C1, C2, B3 and B4) co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak. EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003. In the 2005 outbreak, besides the EV71 strains of sub-genogroup C1, EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5. Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia. Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years. In each of the past outbreaks, more than one sub-genogroup of the virus co-circulate.展开更多
Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ ...Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.展开更多
AIM:To examine trends in and correlates of liver disease and viral hepatitis in an human immunodeficiency virus (HIV)-infected cohort. METHODS:The multi-site adult/adolescent spectrum of HIV-related diseases (ASD) fol...AIM:To examine trends in and correlates of liver disease and viral hepatitis in an human immunodeficiency virus (HIV)-infected cohort. METHODS:The multi-site adult/adolescent spectrum of HIV-related diseases (ASD) followed 29 490 HIVinfected individuals receiving medical care in 11 U.S. metropolitan areas for an average of 2.4 years,and a total of 69 487 person-years,between 1998 and 2004. ASD collected data on the presentation,treatment,and outcomes of HIV,including liver disease,hepatitis screening,and hepatitis diagnoses. RESULTS:Incident liver disease,chronic hepatitis B virus (HBV),and hepatitis C virus (HCV) were diagnosed in 0.9,1.8,and 4.7 per 100 person-years. HBV and HCV screening increased from fewer than 20% to over 60% during this period of observation (P < 0.001). Deaths occurred in 57% of those diagnosed with liver disease relative to 15% overall (P < 0.001). Overall 10% of deaths occurred among individuals with a diagnosis of liver disease. Despite care guidelines promoting screening and vaccination for HBV and screening for HCV,screening and vaccination were not universally conducted or,if conducted,not documented. CONCLUSION:Due to high rates of incident liver disease,viral hepatitis screening,vaccination,and treatment among HIV-infected individuals should be a priority.展开更多
The transition to old age involves a series of events, including those that are objectively defined and others that individuals evaluate subjectively. The aim of this review study is the investigation, highlighting an...The transition to old age involves a series of events, including those that are objectively defined and others that individuals evaluate subjectively. The aim of this review study is the investigation, highlighting and information about the multiple effects of cancer on the elderly. An extensive review of the relevant literature was performed via electronic databases （Medline, PubMed, CINAHL and Google scholar） and Greek and international journals. The exclusion criterion for the articles was the language other than Greek and English. The risk of cancer increases with age, resulting in an increased number of older people seeking treatment. Caring for elderly people with cancer differs from that of adults because of the biological differences in tumor, coexistence of morbidity, as well as various psychosocial issues that can affect the effectiveness of treatment. Despite the reduction in the mortality rate of cancer, the aging of the population is accompanied by a significant increase in the overall number of cancer patients. The main nursing care goal is the limitation of biological and atomic forces and characteristics＇ loss and the adjustment of the elderly to the different phases of the disease. Finally, in the later stages of the disease, the nurse often provides just palliative care.展开更多
Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used f...Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used for the treatment of cardiovascular diseases,such as hypertension,coronary artery disease,and stroke,but its mechanisms of actions remain poorly understood.The efficacy of acupuncture depends on multiple constituent elements including acupoints,manipulation skills,and implementation programs,which are termed as acupuncture prescription.This review summarized the previous information of experimental use of acupuncture on animals including species,hypertension models,acupoints selection,acupoint location,stimulation protocols,and evaluation of effectiveness to provide useful guidance for researchers when performing acupuncture in animal experiments.展开更多
Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence...Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United States.The aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the USA.Methods.We utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge diagnosis.The temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for trends.Results.There was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in 2012.The in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).Conclusions.There was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and 2012.However,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.展开更多
文摘Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth. The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents. Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae. EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD), aseptic meningitis, encephalitis and poliomyelitis-like acute flaccid paralysis. A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997, and caused 41 deaths amongst young children. In late 2000, a recurrence of an outbreak of HFMD occurred in Malaysia with 8 fatalities in peninsular Malaysia. Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities. A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006. The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010. As with other HFMD outbreaks in Malaysia, both EV71 and CA16 were the main aetiological viruses isolated. In similarity with the HFMD outbreak in 2005, the isolation of CA16 preceded the appearance of EV71. Based on the VP1 gene nucleotide sequences, 4 sub-genogroups of EV71 (C1, C2, B3 and B4) co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak. EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003. In the 2005 outbreak, besides the EV71 strains of sub-genogroup C1, EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5. Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia. Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years. In each of the past outbreaks, more than one sub-genogroup of the virus co-circulate.
文摘Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.
文摘AIM:To examine trends in and correlates of liver disease and viral hepatitis in an human immunodeficiency virus (HIV)-infected cohort. METHODS:The multi-site adult/adolescent spectrum of HIV-related diseases (ASD) followed 29 490 HIVinfected individuals receiving medical care in 11 U.S. metropolitan areas for an average of 2.4 years,and a total of 69 487 person-years,between 1998 and 2004. ASD collected data on the presentation,treatment,and outcomes of HIV,including liver disease,hepatitis screening,and hepatitis diagnoses. RESULTS:Incident liver disease,chronic hepatitis B virus (HBV),and hepatitis C virus (HCV) were diagnosed in 0.9,1.8,and 4.7 per 100 person-years. HBV and HCV screening increased from fewer than 20% to over 60% during this period of observation (P < 0.001). Deaths occurred in 57% of those diagnosed with liver disease relative to 15% overall (P < 0.001). Overall 10% of deaths occurred among individuals with a diagnosis of liver disease. Despite care guidelines promoting screening and vaccination for HBV and screening for HCV,screening and vaccination were not universally conducted or,if conducted,not documented. CONCLUSION:Due to high rates of incident liver disease,viral hepatitis screening,vaccination,and treatment among HIV-infected individuals should be a priority.
文摘The transition to old age involves a series of events, including those that are objectively defined and others that individuals evaluate subjectively. The aim of this review study is the investigation, highlighting and information about the multiple effects of cancer on the elderly. An extensive review of the relevant literature was performed via electronic databases （Medline, PubMed, CINAHL and Google scholar） and Greek and international journals. The exclusion criterion for the articles was the language other than Greek and English. The risk of cancer increases with age, resulting in an increased number of older people seeking treatment. Caring for elderly people with cancer differs from that of adults because of the biological differences in tumor, coexistence of morbidity, as well as various psychosocial issues that can affect the effectiveness of treatment. Despite the reduction in the mortality rate of cancer, the aging of the population is accompanied by a significant increase in the overall number of cancer patients. The main nursing care goal is the limitation of biological and atomic forces and characteristics＇ loss and the adjustment of the elderly to the different phases of the disease. Finally, in the later stages of the disease, the nurse often provides just palliative care.
基金the National Basic Research Program of China:the Epigenetic Regulatory Mechanism of the Specificity of Acupoints(973 Program,No.2012CB518501)the National Natural Science Foundation of China:the Regulatory Mechanism of AS-Neuron Crosstalk With Energy for Promoting Synaptic Plasticity in Hippocampus Treated by Acupuncture(No.81202743)+1 种基金Deacetylation Modification in Personalized Medicine for Acupuncture-Based Weight-Loss(No.81303019)Mechanistic Study of STAT5-miR-193b Pathway in Obesity and Weight Loss by Acupuncture(No.81273838)
文摘Hypertension is associated with at least 7.6 million annual deaths worldwide.While pharmacotherapy may provide good control for blood pressure,it sometimes induces adverse effects.Meanwhile,acupuncture has been used for the treatment of cardiovascular diseases,such as hypertension,coronary artery disease,and stroke,but its mechanisms of actions remain poorly understood.The efficacy of acupuncture depends on multiple constituent elements including acupoints,manipulation skills,and implementation programs,which are termed as acupuncture prescription.This review summarized the previous information of experimental use of acupuncture on animals including species,hypertension models,acupoints selection,acupoint location,stimulation protocols,and evaluation of effectiveness to provide useful guidance for researchers when performing acupuncture in animal experiments.
文摘Background and aims.Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate.With the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United States.The aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the USA.Methods.We utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge diagnosis.The temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for trends.Results.There was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in 2012.The in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).Conclusions.There was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and 2012.However,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.
