2D and 3D refraction-based visualization of breast cancer for early clinical check

Ductal carcinoma in-situ (DCIS) has been visualized by 2D XDFI (X-ray dark-field imaging) and further by a 3D X-ray CT, and the data was acquired by the X-ray optics DEI (diffraction-enhanced imaging). A newly made algorithm was used for CT. Data of 900 projections with interval of 0.2 degrees were used. Ductus lactiferi, microcalci-fication in a 3D form have been clearly visible. The spatial resolution available was approximately 30μm.

Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea

AIM:To explore the value of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea.METHODS:Patients with acute infectious diarrhea ranging from 3 mo to 10 years in age were enrolled,and one to three stool samples from each subject were collected.Certain parameters,including white blood cells /differential count,C-reactive protein,fecal mucus,fecal pus cells,duration of fever,vomiting,diarrhea and severity(indicated by Clark and Vesikari scores),were recorded and analyzed.Fecal lactoferrin was determined by enzyme-linked immunosorbent assay and compared in different pathogen and disease activity.Generalized estimating equations(GEE) were also used for analysis.RESULTS:Data included 226 evaluations for 117 individuals across three different time points.Fecal lactoferrin was higher in patients with Salmonella(11.17 μg/g ± 2.73 μg/g) or Campylobacter(10.32 μg/g ± 2.94 μg/g) infections and lower in patients with rotavirus(2.82 μg/g ± 1.27 μg/g) or norovirus(3.16 μg/g ± 1.18 μg/g) infections.Concentrations of fecal lactoferrin were significantly elevated in patients with severe(11.32 μg/g ± 3.29 μg/g) or moderate(3.77 μg/g ± 2.08 μg/g) disease activity compared with subjects with mild(1.51 μg/g ± 1.36 μg/g) disease activity(P < 0.05).GEE analysis suggests that this marker could be used to monitor the severity and course of gastrointestinal infections and may provide information for disease management.CONCLUSION:Fecal lactoferrin increased during bacterial infection and with greater disease severity and may be a good marker for predicting and monitoring intestinal inflammation in children with infectious diarrhea.

美国护理信息的应用与发展趋势

美国的护理人数高达310万人，是健康照护专业人员最多的国家。在照护团队中，护士作为患者与家属之间的沟通枢纽，负责护理、协调与整合工作。医学研究所（Institute of Medicine）的研究报告显示：医护差错及医疗护理质量的差异性已被广泛认可。

Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding

Over the past two decades,transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis.Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options,have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications,such as peptic ulcerbleeding,malignant disease,hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding.Transcatheter interventions include the following:selective embolization of the feeding artery,sandwich coil occlusion of the gastroduodenal artery,blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery.Transcatheter embolization is a fast,safe and effective,minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract.This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies.

Time trend and seasonality in medically attended respiratory syncytial virus (RSV) infections in US children aged 0-5 years, January 2010-January 2023

Objective The long-term time trend and seasonality variations of first-time medically attended respiratory syncytial virus(RSV)infections among young children are unknown.We aim to examine the time trend of medically attended first-time RSV infections among young children in the USA from January 2010 through January 2023.Design This is a population-based cohort study using electronic health records(EHRs).Monthly incidence rate of medically attended first-time RSV infection(cases per 10000000 person-days).A time-series regression model was used to model and predict time trends and seasonality.Setting Multicenter and nationwide TriNetX Network in the USA.Participants The study population comprised children aged 0–5 years who had medical visits during the period of January 2010 to January 2023.Results The data included 29013937 medical visits for children aged 0–5 years(46.5%girls and 53.5%boys)from January 2010 through January 2023.From 2010 through 2019,the monthly incidence rate of first-time medically attended RSV infection in children aged 0–5 years followed a consistent seasonal pattern.Seasonal patterns of medically attended RSV infections were significantly disrupted during the COVID-19 pandemic.In 2020,the seasonal variation disappeared with a peak incidence rate of 20 cases per 1000000 person-days,a decrease of 97.4%from the expected peak rate(rate ratio or RR:0.026,95%CI 0.017 to 0.040).In 2021,the seasonality returned but started 4 months earlier,lasted for 9 months,and peaked in August at a rate of 753 cases per 1000000 person-days,a decrease of 9.6%from the expected peak rate(RR:0.90,95%CI 0.82 to 0.99).In 2022,the seasonal pattern is similar to prepandemic years but reached a historically high rate of 2182 cases per 10000000 person-days in November,an increase of 143%from the expected peak rate(RR:2.43,95%CI 2.25 to 2.63).The time trend and seasonality of the EHR-based medically attended RSV infections are consistent with those of RSV-associated hospitalisations from the Centers for Disease Control and Prevention(CDC)survey-based surveillance system.Conclusion The findings show the disrupted seasonality during the COVID-19 pandemic and a historically high surge of paediatric RSV cases that required medical KEY POINTS⇒Question What are the long-term trends and recent seasonality pattern changes in medically attended respiratory syncytial virus(RSV)infections in chil-dren aged 0–5 years in the USA?⇒Findings This population-based cohort study of 29013937 medical visits for children aged 0–5 years found that the monthly incidence rate of first-time medically attended RSV infections followed a consistent seasonal pattern during 2010–2019,the seasonal pattern was significantly disrupted during the COVID-19 pandemic.The seasonal variation dis-appeared in 2020,returned in 2021 but started ear-lier and reached a historical high rate of 2182 cases per 10000000 person-days in November 2022.⇒Meaning These data suggest that COVID-19 pan-demic contributed to the disrupted seasonality and the 2022 surge of paediatric RSV cases that need-ed medical attention.This study demonstrates the potential of electronic health records as a cost-effective alternative for real-time surveillance of un-expected disease patterns including RSV infection.attention in 2022.Our study demonstrates the potential of EHRs as a cost-effective alternative for real-time pathogen and syndromic surveillance of unexpected disease patterns including RSV infection.

Association of COVID- 19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study

Objective To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus(RSV)infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA.Design This is a retrospective population-based cohort study.Five outcomes were examined,including overall RSV infection,positive lab test-confirmed RSV infection,clinically diagnosed RSV diseases,RSV-associated bronchiolitis and unspecified bronchiolitis.Risk ratio(RR)and 95%CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts.Setting Nationwide multicentre database of electronic health records(EHRs)of 61.4million patients in the USA including 1.7million children 0–5 years of age,which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals,primary care and specialty treatment providers.Participants The study population consisted of 228940 children of 0–5 years with no prior RSV infection who had medical encounters in October 2022.Findings were replicated in a separate study population of 370919 children of 0–5 years with no prior RSV infection who had medical encounters in July 2021–August 2021 during a non-overlapping time period.Results For the 2022 study population(average age 2.4 years,46.8%girls,61%white,16%black),the risk for incident RSV infection during October 2022–December 2022 was 6.40%for children with prior COVID-19 infection,higher than 4.30%for the matched children without COVID-19(RR 1.40,95%CI 1.27 to 1.55);and among children aged 0–1year,the overall risk was 7.90%for those with prior COVID-19 infection,higher than 5.64%for matched children without(RR 1.40,95%CI 1.21 to 1.62).For the 2021 study population(average age 2.2 years,46%girls,57%white,20%black),the risk for incident RSV infection during July 2021–December 2021 was 4.85%for children with prior COVID-19 infection,higher than 3.68%for the matched children without COVID-19(RR 1.32,95%CI 1.12 to 1.56);and 7.30%for children aged 0–1year with prior COVID-19 infection,higher than 4.98%for matched children without(RR 1.47,95%CI 1.18 to 1.82).Conclusion COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022.Similar findings were replicated for a study population of children aged 0-5 years in 2021.Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.

"笑气"有时并不好笑一氧化二氮的娱乐性使用成为新的公共健康问题

一氧化二氮(N2O)的娱乐性吸入具有潜在的严重健康风险,在英国对此认识不足。在伦敦东区的急诊科,经常收到因反复吸入N2O导致严重神经系统并发症的青少年及年轻的成年人患者。应更加关注这一新出现的公共健康问题。