肝性脑病临床指南和共识的质量评价及推荐意见研究

目的:采用AGREEⅡ和RIGHT工具对肝性脑病(HE)指南性文件的方法学质量和报告质量进行评价,并对推荐意见及证据进行总结和比较,为未来HE指南性文件的制定及临床实践提供参考。方法:计算机检索中国知网(CNKI)、PubMed、中国生物医学文献数据库(CBM)、维普(VIP)、万方(Wanfang)、WHO、国际指南协作网(GIN)、美国国立指南文库(NGC)、英国国家临床优化研究所(NICE)、苏格兰院际间协作网(SIGN)和医脉通数据库(Medlive),检索时限为2003年1月至2023年1月。由两名肝病研究人员独立使用AGREEⅡ和RIGHT对纳入指南性文件的方法学质量和报告质量进行评价,并对循证方法制订的指南性文件的推荐意见和证据进行整理和比较。结果:共纳入14篇文献,其中9篇指南,5篇共识;中文2篇,英文12篇;使用循证方法制订的有12篇。B级7部,C级7部。AGREEⅡ各领域平均得分分别为:范围与目的(40.87%)、参与人员(26.98%)、制订严谨性(23.96%)、表达清晰性(47.22%)、应用性(17.26%)、编辑独立性(18.75%)。RIGHT各领域平均得分分别为:基本信息(60.42%)、背景(40.85%)、证据(43.57%)、推荐意见(43.88%)、评审和质量保证(16.96%)、资金资助与利益冲突声明和管理(17.56%)、其他方面(38.10%)。主要推荐意见涉及筛查与诊断、治疗、营养管理和预防。结论:纳入的HE指南性文件在方法学质量和报告质量方面整体得分较低。在方法学质量方面,参与人员、制订严谨性、应用性和编辑独立性仍有待提高。在报告质量方面,评审和质量保证,资金资助与利益冲突声明和管理领域需要进一步报告。未来可增进HE放射性示踪成像和神经生理学研究,为HE的主动诊断提供进一步参考,并形成“药物治疗-营养管理-复发预防”的HE管理模式。

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

基于AGREEⅡ和RIGHT对医患沟通指南的质量评价研究

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。

我国循证针灸临床实践指南评价研究

目的对我国循证针灸临床实践指南透明度及报告完整度进行评价,以期进一步提升针灸临床实践指南的科学性与临床适用性。方法以我国循证针灸临床实践指南为研究对象,利用临床实践指南透明度评价工具及RIGHT for acupuncture进行评价。结果共纳入指南28部,其中4部在人员遴选阶段达到透明,2部在推荐意见形成过程达到透明,1部在指南报告过程达到透明,其余指南未达到透明;RIGHT for acupuncture结果显示,各领域平均报告率依次为基本信息(50.00%)、评审和质量保证(50.00%)、背景(46.75%)、推荐意见(40.18%)、证据(40.00%)、资助与利益冲突声明及管理(7.14%)、其他(4.76%)。结论我国循证针灸临床实践指南存在过程报告不清、方法学不完善或利益冲突管理欠缺的情况。在今后指南制定过程中,应不断完善针灸指南制定方法,提高指南质量和透明度。

Addressing Japan’s disposal of nuclear-contaminated water from the perspective of international human rights law

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.

Association between coronary artery stenosis and myocardial injury in patients with acute pulmonary embolism:A case-control study

Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it?

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.

Risk factors for the prognosis of colon cancer

A study on clinical outcomes and prognostic factors in T4N0M0 colon cancer patients after R0 resection revealed that ileostomy,T stage,right hemicolectomy,irregular follow-up,and CA199 level were independent risk factors affecting overall survival.T4-stage cancer invades the entire thickness of the intestinal tract,increasing the difficulty of treatment and the risk of recurrence,and requires a combination of chemotherapy,immunotherapy,and targeted therapy to control the spread of cancer cells.The prognosis of right hemicolectomy is significantly worse than that of left hemicolectomy,and right hemicolectomy is an independent risk factor for a poor prognosis.Advanced age,histopathological type,and lymph node metastasis are also risk factors for colon cancer.

双碳目标下减压渣油高值利用的RIGHT技术研发

炼油低碳转型发展的关键是高含碳重组分的高效高值利用。通过溶剂脱沥青技术把质量较差的常规焦化原料(即减压渣油)分为脱油沥青(DOA)和脱沥青油(DAO),然后利用相似相溶原理,把两种低价值的以芳烃结构为主的DOA和催化裂化轻循环油(LCO)混合进行加氢(组分炼油),同时DAO单独加氢,形成了中石化石油化工科学研究院有限公司一体化加氢RIGHT(RIPP InteGrated HydroTreating)技术。加氢后DOA进焦化装置可以生产低金属(V、Ni质量分数均小于150μg/g)或低金属低硫(硫质量分数不大于3.0%)的石油焦,为高端炭材料提供高质量前躯体。与常规焦化相比,RIGHT技术可把低档次的高金属和高硫含量的石油焦产率降低约70%。加氢后的LCO满足LTAG进料要求,可以生产轻芳烃(BTX)和高辛烷值汽油调合组分;DAO在比常规渣油加氢质量空速高1倍的情况下进行加氢,加氢后DAO的氢质量分数为12.25%~12.32%,残炭小于2.0%,金属(Ni+V)质量分数小于0.1μg/g,是优质催化裂化/催化裂解原料,可以多产低碳烯烃和高辛烷值汽油调合组分并大幅度降低过程剂耗。基于DOA和LCO混合油中高金属含量特点,研发了脱金属和容金属能力更强的RRC系列资源再造催化剂,运转后催化剂金属V和Ni沉积量高,是获取高价值V和Ni,尤其是V的宝贵资源。DAO加氢装置运转周期可以提高至4年,从根本上解决渣油加氢装置运转周期短的问题,同时后部渣油加氢脱硫催化剂可以再生,能够提高催化剂资源利用率。RIGHT技术能把减压渣油通过组分炼油技术更多地用于生产高价值低硫低金属含量石油焦和化工料,从而实现炼油领域高碳含量组分的低碳化和高值化利用。

Expression of cyclin-dependent kinase 9 is positively correlated with the autophagy level in colon cancer

BACKGROUND Cyclin-dependent kinase 9(CDK9)expression and autophagy in colorectal cancer(CRC)tissues has not been widely studied.CDK9,a key regulator of transcription,may influence the occurrence and progression of CRC.The expression of auto-phagy-related genes BECN1 and drug resistance factor ABCG2 may also play a role in CRC.Under normal physiological conditions,autophagy can inhibit tumorigenesis,but once a tumor forms,autophagy may promote tumor growth.Therefore,understanding the relationship between autophagy and cancer,partic-ularly how autophagy promotes tumor growth after its formation,is a key motivation for this research.AIM To investigate the relationship between CDK9 expression and autophagy in CRC,assess differences in autophagy between left and right colon cancer,and analyze the associations of autophagy-related genes with clinical features and prognosis.METHODS We collected tumor tissues and paracarcinoma tissues from colon cancer patients with liver metastasis to observe the level of autophagy in tissues with high levels of CDK9 and low levels of CDK9.We also collected primary tissue from left and right colon cancer patients with liver metastasis to compare the autophagy levels and the expression of BECN1 and ABCG2 in the tumor and paracarcinoma tissues.RESULTS The incidence of autophagy and the expression of BECN1 and ABCG2 were different in left and right colon cancer,and autophagy might be involved in the occurrence of chemotherapy resistance.Further analysis of the rela-tionship between the expression of autophagy-related genes CDK9,ABCG2,and BECN1 and the clinical features and prognosis of colorectal cancer showed that the high expression of CDK9 indicated a poor prognosis in colorectal cancer.CONCLUSION This study laid the foundation for further research on the combination of CDK9 inhibitors and autophagy inhibitors in the treatment of patients with CRC.

Fate of Right Coronary Artery Occlusion after a Surgically Repaired Aorto- Ventricular Tunnel in a Neonate

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.

Congenital heart“Challenges”in Down syndrome

In this editorial,we comment on the article by Kong et al published in the recent issue of the World Journal of Cardiology.In this interesting case,the authors present the challenges faced in managing a 13-year-old patient with Down syndrome(DS)and congenital heart disease(CHD)associated with pulmonary arterial hypertension.In this distinct population,the Authors underscore the need for early diagnosis and management as well as the need of a multidisciplinary approach for decision making.It seems that the occurrence of CHD in patients with DS adds layers of complexity to their clinical management.This editorial aims to provide a comprehensive overview of the intricate interplay between DS and congenital heart disorders,offering insights into the nuanced diagnostic and therapeutic considerations for physicians.

Survey of Framer Credit Demands in China with Tianjin as an Example

Giving farmers more rights and interests on land property is the basis of achieving balanced and coordinated economic development between urban and rural areas as well as building a sharing economy during the period of economic transition in China.Based on the survey data of suburban households of Tianjin,in this paper,measurement method was adopted to study factors influencing farmer s willingness on land management right mortgage.The results shows that the willingness of individual farmer on mortgage is not strong,however,their willingness on mortgage is bound to have a significant relationship with farmland right confirmation and land transfer and other factors.Finally,it is concluded that it is necessary to promote land transfer on the basis of land right of confirmation while carrying out farmland mortgage under the premise of large-scale operation in China.

Photo-activated microtubule targeting drugs: Advancing therapies for colorectal cancer

Over the years immunotherapy has demonstrably improved the field of cancer treatment.However,achieving long-term survival for colorectal cancer(CRC)patients remains a significant unmet need.Combination immunotherapies incor-porating targeted drugs like MEK or multi-kinase inhibitors have offered some palliative benefit.Nevertheless,substantial gaps remain in the current therapeutic armamentarium for CRC.In recent years,there has been a surge of interest in exploring novel treatment strategies,including the application of light-activated drugs in conjunction with optical devices.This approach holds promise for achie-ving localized and targeted delivery of cytotoxic agents,such as microtubule-targeting drugs,directly to cancerous cells within the colon.

Unroofed coronary sinus,left-sided superior vena cava and mitral insufficiency:A case report and review of the literature

BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

Social and Environmental Impacts of Maryland Oil Palm Plantations on Forests,Biodiversity,and Community Livelihoods in Liberia

Liberia holds 44.5% of the remaining portion of the Upper Guinean Rainforest in West Africa,which is home to critically endangered forest elephants and western chimpanzees.The forests are of vital importance for the livelihoods of millions of West Africans and provide key ecosystem services of local and global importance for food systems transformation and agroecology.Liberia’s efforts toward land reform through legislation and policies recognise communities’rights to own and manage their customary lands and resources.These include the National Forestry Reform Law of 2006,the Community Rights Law Concerning Forest Lands of 2009,and the Land Rights Act of 2018,and more.In May 2022,a program team from the Sustainable Development Institute(SDI)-Friends of the Earth Liberia researched the social and environmental impacts of Maryland Oil Palm Plantations(MOPPs)in Liberia.Twenty-three(23)key informant interviews(KIIs)and 10 focus group discussions(FGDs)were conducted in seven communities in and around the MOPP.They included farmers,contract workers,MOPP staff,local authorities,women and youth leaders,the Environmental Protection Agency(EPA)Inspector,the Civil Society Head,and the Gender Coordinator of Maryland County.The team cross-checked information with formal documents as much as possible and took photographs and global positioning system(GPS)locations of areas of deforestation,pollution,and conflict.The team also used observation to monitor environmental pollution,such as affluent into water bodies and planting oil palm in wetlands.The team used narrative analysis and geospatial landscape analysis to analyze the data.The research finds that land conflict and deforestation have several negative impacts on communities.MOPP has not respected land tenure rights or followed Free Prior and Informed Consent(FPIC)standards,including resettlement without reparation and destruction of farms and old towns without(sufficient)compensation or restitution.During MOPP land acquisition and clearance,communities experienced the loss of their farms and the identification of villages as“village de squatters”,leading to restricted access to farmland,heightened food insecurity,and reduced income from cash crops to support families.MOPP destroyed high conservation value areas and destroyed secondary forest regrowth,which affected important biodiversity areas.MOPP is one of the four large-scale industrial palm oil plantations in Liberia in Maryland County.It has a palm oil mill in a joint venture with Golden Veroleum Liberia(GVL).Its 2011 concession agreement includes 8,800 hectares for industrial palm oil plantations.

Pragmatist View of Human Rights:Theoretical Explanations of China’s Human Rights Practice

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.

Research on the Reform of"Separation of Three Rights"for Rural Homesteads in Juancheng County,Shandong Province

In order to realize rural revitalization in an all-round way and promote the sustainable and healthy development of the economy and society,China is committed to deepening the pace of building a new countryside with Chinese characteristics.The reform of the"Separation of Three Rights"of rural homesteads is a key measure,which aims to activate rural resources,enhance the vitality of rural economic development,and then promote the overall process of rural revitalization.This study selects Juancheng County,Heze City,Shandong Province as a typical case.Through an in-depth analysis of the relevant policy orientation of the national homestead reform and the specific practice of local promotion work,it systematically sorts out the registration of homestead rights,transfer of use rights and relevant policy measures adopted in paid use,qualification conversion,policy publicity and system establishment.After in-depth research on the system reform practice of the"Separation of Three Rights"of homesteads in Juancheng County,this paper reveals the main problems existing in the current reform,including the lack of clear policy support for the mechanism of paid use of homesteads,difficulties in the process of identifying qualification rights and challenges,the imperfection of the transfer mechanism of use rights,and the lack or lag of relevant policies.A series of problem-oriented policy suggestions are put forward,including establishing and improving the system of paid use of rural homesteads,improving the income distribution mechanism,promoting the innovation of the mortgage guarantee system for the right to use homesteads,and optimizing the homestead qualification certification procedures.These suggestions aim to provide a useful reference for the Juancheng County Government in promoting the reform of"Separation of Three Rights"of homesteads,and then promote the rational allocation and efficient utilization of rural homestead resources.

The Historical Position and Value Dimensions of Human Rights Civilization

Human beings are the mainstay and the ultimate goal of civilization.The history of human civilization is a continuous struggle to realize the respect,liberation,protection,and development of humanity.Human rights are an achievement of humanity and a symbol of progress,and the human rights civilization is an important component of human civilization.Understanding and interpreting human rights from the perspective of human rights civilization means that human rights are not only a concept or an idea but also a grand historical and long-term social practice.Up to now,the development of human rights civilization has roughly experienced four awakening eras:initialization,revolution,popularization,and globalization.In terms of its value dimensions,it has the characteristics of progressiveness,diversity,commonality,inclusiveness,indivisibility,openness,and so on.The historical position of human rights civilization and the development of its value dimensions have shown to the world that human rights are the common wealth of humanity,and human rights belong to all mankind;human rights are historical,concrete,and developmental;the concept of human rights is constantly evolving,and its connotations and categories are constantly expanding;achieving the free and well-rounded development of every person is the highest value realm of human rights civilization.The Chinese modernization endows Chinese civilization with modern strength and opens up new horizons for human rights civilization.The new pattern of human rights civilization to be created by Chinese modernization not only possesses the common characteristics of human rights civilization but also enjoys Chinese characteristics based on its own national conditions,enriching and developing the diversity of human rights civilization for all mankind.