疫情防控常态下运动队备战大型赛事的研究——以东京残奥会中国代表团游泳队防疫相关工作为例

新冠肺炎大流行在全世界范围内蔓延,它不仅对公民日常生活造成了影响,也对全球体育格局和体育产业造成了重大影响,导致全球多项职业体育比赛取消。其中,运动员最瞩目的奥运会也遭遇推迟。基于疫情的传播速度和方式,奥运会的整体筹备工作难度成倍增加。在此背景下,该文结合笔者参加东京奥运会的亲身经历,讲述中国游泳代表团面对的困难以及运动员需要准备的预防措施,尤其针对残疾运动员面对大型赛事会的特殊困难和相关应对方案。希望这些经验和建议会对疫情防控常态下参与大型赛事的备战带来启示。

中国冬残奥会运动员夏训中的运动损伤流行病学研究

目的:该研究旨在通过分析备战2022年北京冬残奥运动员在2018年6~9月夏季训练期间的运动损伤情况,为残疾人运动员运动损伤的针对性预防提供科学依据。方法:对高山滑雪、冰橇冰球、越野滑雪、单板滑雪4支残奥运动队开展运动损伤流行病学调查,共纳入运动员174人,统计不同项目运动损伤的发生率、损伤率和损伤类型,并对统计结果进行分析。结果:夏季训练期间,4支队伍的总损伤发生率为14.8次/每1000运动员训练日[95%CI:(12.3~17.6)]。其中,冰橇冰球的损伤发生率最高,为25.0次/每1000个运动员训练日[95%CI:(13.4~42.4)]。其次分别是为单板滑雪、高山滑雪和越野滑雪。女性运动员46.4%的损伤率及15.3次/每1000个运动员训练日[95%CI:(11.2~20.4)]的损伤发生率均高于男性运动员。结论:夏季训练期间,4支冬残奥队伍中有44.8%的运动员出现了至少一次的损伤;单板滑雪运动员损伤率最高;冰橇冰球运动员损伤发生率最高;过度使用引起的肌肉劳损在损伤中占比较高;女性运动员损伤发生风险高于男性运动员;26~34岁运动员损伤发生风险较高,应采取针对性预防措施。

急性冠状动脉综合征不同亚型的危险因素分析

目的探讨急性冠状动脉综合征(ACS)患者不同亚型的危险因素差异及其与冠状动脉病变严重程度的关系.方法选取2017年1~12月我院心脏中心急诊行直接经皮冠状动脉介入治疗(PCI)的符合ACS诊断标准的患者296例,对其临床资料进行回顾性分析.根据ACS的临床特点分为三个亚型组:急性ST段抬高型心肌梗死(STEMI)组(106例)、非ST段抬高型心肌梗死(NSTEMI)组(96例)和不稳定型心绞痛(UAP)组(98例),比较ACS亚型患者危险因素及冠状动脉病变Gensini评分的差异.结果①单因素分析显示,NSTEM1组在年龄、空腹血糖、氨基末端脑钠肽前体、肌酸激酶同工酶水平均明显高于UAP组(P均<0.05);甘油三酯、低密度脂蛋白胆固醇、血浆纤维蛋白原、D-二聚体、氨基末端脑钠肽前体、高敏C反应蛋白、肌酸激酶同工酶水平均低于STEMI组(P均<0.05);UAP组合并高血压患者比例高于STEMI组(P<0.05).②Logistic多元回归分析显示,高敏C反应蛋白是NSTEMI组的独立危险因素(OR=1.976,95%CI1.953~6.999,P<0.05),低密度脂蛋白胆固醇是STEMI组的独立危险因素(OR=1.542,95%CI1.064~4.236,P<0.05).③ACS不同亚组冠状动脉狭窄程度两两比较均具有统计学意义(P均<0.05);④Gensini评分与危险因素Spearman秩相关分析显示,三个亚型组Gensini评分均与氨基末端脑钠肽前体水平呈正相关(r=0.324、0.482、0.556,P<0.05);NSTEMI组Gensini评分均与血浆纤维蛋白原、高敏C反应蛋白水平呈正相关(r=0.697、0.324,P均<0.05);STEMI组Gensini评分与D-二聚体水平呈正相关(r=0.429,P<0.05),与左心室射血分数值呈负相关(r=-0.602,P<0.05).结论ACS患者不同亚型危险因素存在显著差异,且评估及预测ACS亚型冠状动脉狭窄程度的指标也存在一定差异,明确其差异性对ACS亚型风险评估及临床治疗具有重要的指导意义.

Elevated alanine aminotransferase activity is not associated with dyslipidemias,but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease

Objective:To explore demographic and metabolic factors associated with increased alanine aminotransferase(ALT)activity in non-diabetic non-alcoholic fatty liver disease(NAFLD)patients.Methods:Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences,Tehran,Iran awere diagnosed as NAFLD entered into analysis.Exclusion criteria were having diabetes mellitus and fasting blood glucose over126 mg/dL,active hepatitis B virus infection,having hepatitis C virus positive serology,and to be under corticosteroid therapy.ALT levels were considered pathologically high when it was over30 IU/L for men and over 19 IU/L for women.Results:Bivariate analyses using t test and chisquare test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations(P=0.003).Moreover,these patients represented significantly higher homeostatic model assessment levels(P=0.003),levels of serum insulin(P=0.002),fasting blood glucose(P<0.001),and uric acid(P=0.02).The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations.Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD(P=0.027)and insulin resistance(P=0.013)were the only variables significantly associated with abnormal ALT levels.Conclusions:This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before.By excluding diabetic patients from our population,we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations.Further studies are needed to confirm our results.

Sonographic assessment of a suspected biloma:A case report and review of the literature

A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.

Diagnosis of deep vein thrombosis,and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014

The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT) should be based on an overall objective post incidence of venous thromboembolism(VTE) of less than 1% during 3 mo fol low-up. Compression ultrasonography(CUS) of the leg veins has a negative predictive value(NPV) of 97%-98% indicating the need of repeated CUS testing within one week. A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99% and 100% at a low clinical score of zero. The combination of low clinical score and a less sensitive D-dimer test(Simplify) is not sensitive enough to exclude DVT and VTE in routine daily practice. From prospective clinical research studies it may be concluded that complete recanalization within 3-6 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT. Partial and complete recanalization after 6 to more than 12 mo is usually complicated by reflux due to valve destruction and symptomatic PTS. Reflux seems to be a main determinant for PTS and DVT recurrence, the latter as a main contributing factor in worsening PTS. This hypothesis is supported by the relation between the persistent residual vein thrombosis(RVT = partial recanalization) and the risk of VTE recurrence in prospective studies. Absence of RVT at 3 mo postDVT and no reflux is predicted to be associated with no recurrence of DVT(1.2%) during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT. The presence or absence of RVT but with reflux at or after 6 mo postDVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment. To test this hypothesis we designed a prospective DVT and postthrombotic syndrome(PTS) Bridging the Gap Study by addressing at least four unanswered questions in the treatment ofDVT and PTS.Which DVT patient has a clear indication for long-term compression stocking therapy to prevent PTS after the initial anticoagulant treatment in the acute phase of DVT?Is 6 mo the appropriate point in time to determine candidates at risk to develop DVT recurrence and PTS?Which high risk symptomatic PTS patients need extended anticoagulant treatment?

Treatment of solitary gastric carcinoid tumor by endoscopic polypectomy in a patient with pernicious anemia

类型我胃的良性肿瘤肿瘤与恶性贫血从 hypergastrinemia 导致病人的 1%-7% 。我们与疲劳的抱怨在一个 48 岁的女病人诊断了恶性贫血三个月。她没有胃肠的症状。内视镜的考试 ot 上面的胃肠道在尺寸在 3-4 公里的语料库揭示了萎缩性胃炎和水虫息似的损害。内视镜的 polypectomy 被执行。标本的组织病理学说的检查与一个良性肿瘤肿瘤的诊断揭示了积极 chromogranin A 和 synaptophysin 染色兼容机。浆液促胃液素水平被增加的、尿 5-hydroxyindoleacetic 酸在正常范围以内。没有另外的症状，症状，或实验室，在病人良性肿瘤症候群发现。没有转移与 indium-111 octreotide 扫描被发现，腹部和胸的计算断层摄影术。类型我胃的良性肿瘤肿瘤仅仅是很少独居并且有在尺寸的 1 厘米可以从内视镜的 polypectomy 有益于的肿瘤 【 的病人。

Unified Field Theory

In the Einstein field equations, the geometry or the curvature of space-time defined as depended on the distribution of mass and energy principally resides on the left-hand side is set identical to a non-geometrical tensorial representation of matter on the right-hand side. In one or another form, general relativity accords a direct geometrical significance only to the gravitational field while the other physical fields are not of space time. They reside only in space time. Less well known, though of comparable importance is Einstein’s dissatisfaction with the fundamental asymmetry between gravitational and non-gravitational fields and his contributions to develop a completely relativistic geometrical field theory of all fundamental interactions, a unified field theory. Of special note in this context and equally significant is Einstein’s demand to replace the symmetrical tensor field by a non-symmetrical one and to drop the condition gik = gki for the field components. Historically, many other attempts were made too, to extend the general theory of relativity’s geometrization of gravitation to non-gravitational interactions, in particular, to electromagnetism. Still, progress has been very slow. It is the purpose of this publication to provide a unified field theory in which the gravitational field, the electromagnetic field and other fields are only different components or manifestations of the same unified field by mathematizing the relationship between cause and effect under conditions of general theory of relativity.

Epstein Barr Virus—The Cause of Multiple Sclerosis

Although many studies have found a kind of a relationship between an Epstein-Barr Virus (EBV) and the development of Multiple Sclerosis (MS), a fundamental aspect of this relationship remains uncertain. What is the cause of Multiple Sclerosis (MS)? In this study, we re-analysed the data as published by Wandinger et al. and were able to establish a new insight: without an Epstein-Barr Virus (EBV) infection no development of Multiple Sclerosis (MS). Furthermore, we determined a highly significant causal relationship between Epstein-Barr Virus (EBV) and multiple sclerosis. Altogether, Epstein-Barr Virus (EBV) is the cause of multiple sclerosis (p-value 0.0004251570).

瑞舒伐他汀钙治疗功能性室性期前收缩患者的疗效及对炎症因子的影响

目的探讨瑞舒伐他汀钙治疗功能性室性期前收缩患者的疗效及对炎症因子的影响。方法选择2018年9月~2020年7月收治的功能性室性期前收缩患者122例,根据随机数字表法,将其分为观察组与对照组,每组61例。对照组给予常规药物治疗,观察组在对照组基础上给予瑞舒伐他汀钙治疗,两组均治疗观察1个月,记录临床疗效。结果治疗后观察组的总有效率为98.4%,显著高于对照组的88.5%(P<0.05)。两组治疗后的TC、TG、LDL-C值都显著低于治疗前,HDL-C值高于治疗前(P<0.05),观察组与对照组对比差异也有统计学意义(P<0.05)。两组治疗后的LVEDV与LVESV值都显著低于治疗前(P<0.05),观察组也显著低于对照组(P<0.05)。两组治疗后的血清CRP值都显著低于治疗前(P<0.05),观察组也显著低于对照组(P<0.05)。结论瑞舒伐他汀钙治疗功能性室性期前收缩患者能抑制炎症因子的释放,改善血脂水平,从而提高患者的心功能与治疗效果。

Emphysematous pancreatitis associated with penetrating duodenal ulcer

In the "proton pump inhibitors era",a penetrating peptic ulcer(PPU) represents an exceptional cause of abdominal pain,and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare,too,and manifests with persistent,intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However,only a few cases of association between PPU and emphysematous pancreatitis(EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas,and typically involves the whole parenchyma in diabetic individuals.Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP.Unlike the classic form of EP,which involves the whole parenchyma and has a poor prognosis,we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration,usual y the pancreatic head,and ulcers most often involve the duodenum.

Ultrasound imaging of abdominal sarcoidosis: State of the art

Since it has been recognized that sarcoidosis(SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound(US)is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs(e.g.,lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.

Contrast-enhanced ultrasound in portal venous system aneurysms: A multi-center study

AIM:To investigate contrast-enhanced ultrasound(CEUS)findings in portal venous system aneurysms(PVSAs).METHODS:In this multi-center,retrospective,case series study,we evaluated CEUS features of seven cases of PVSAs that were found incidentally on conventional ultrasound in the period 2007-2013.Three Ultrasound Centers were involved(Chieti,Italy,Bad Mergentheim,Germany,and Cluj-Napoca,Romania).All patients underwent CEUS with Sonovue?(Bracco,Milan,Italy)at a standard dose of 2.4 m L,followed by10 m L of 0.9%saline solution.The examinations were performed using multifrequency transducers and low mechanical index.We considered aneurysmal a focal dilatation of the portal venous system with a size that was significantly greater than the remaining segments of the same vein,and that was equal or larger than21 mm for the extrahepatic segments of portal venous system,main portal vein and bifurcation,and 9 mm for the intrahepatic branches.RESULTS:After contrast agent injection,all PVSAs were not enhanced in the arterial phase(starting 8-22s).All PVSAs were then rapidly enhanced in the early portal venous phase(starting three to five seconds after the arterial phase,11-30 s),with persistence and slow washout of the contrast agent in the late phase(starting 120 s).In all patients,CEUS confirmed the presence of a"to-and-fro"flow by showing a swirling pattern within the dilatation in the early portal venous phase.CEUS also improved the delineation of the lumen,and was reliable in showing its patency degree and integrity of walls.In one patient,CEUS showed a partial enhancement of the lumen with a uniformly nonenhancing area in the portal venous and late phases,suggesting thrombosis.CONCLUSION:In our case series,we found that CEUS could be useful in the assessment and follow-up of a PVSA.Further studies are needed to validate its diagnostic accuracy.

Anti Heisenberg—The End of Heisenberg’s Uncertainty Principle

In contrast to many other physical theories, quantum mechanics is generally regarded as above any theory we have ever had and perhaps the best candidate for a universal and fundamental description of objective realty as such. Heisenberg’s uncertainty principle is not the only aspect of the conceptual difference between quantum and classical physics but is certainly one of the most important and famous aspects of quantum mechanics. As we will see, quantum mechanics as a theory and especially Heisenberg’s uncertainty principle challenges not only our imagination but violates some fundamental principles of classical logic as such. Heisenberg’s uncertainty principle is refuted.

The Physical Meaning of the Wave Function

Under some well-defined conditions, the mathematical formalism of quantum mechanics enables physicists, chemists and others to calculate and predict the outcome of a vast number of experiments. In fact, especially the Schr?dinger equation which involves an imaginary quantity describes how a quantum state of a physical system changes with time and is one of the main pillars of modern quantum mechanics. The wave function itself is a determining part of the Schr&oumldinger equation, but the physical meaning of the wave function is still not clear. Altogether, does the wave function represent a new kind of reality? This publication will solve the problem of the physical meaning of the wave function by investigating the relationship between the wave function and the theory of special relativity. It is shown that the wave function is determined by notion co-ordinate time of the special theory of relativity. Moreover, the result of this investigation suggests a new understanding of the wave function, according to which the wave function and co-ordinate time of the theory of special relativity are equivalent.

Anti Aristotle—The Division of Zero by Zero

Today, the division of zero by zero (0/0) is a concept in philosophy, mathematics and physics without a definite solution. On this view, we are left with an inadequate and unsatisfactory situation that we are not allowed to divide zero by zero while the need to divide zero by zero (i.e. divide a tensor component which is equal to zero by another tensor component which is equal to zero) is great. A solution of the philosophically, logically, mathematically and physically far reaching problem of the division of zero by zero (0/0) is still not in sight. The aim of this contribution is to solve the problem of the division of zero by zero (0/0) while relying on Einstein’s theory of special relativity. In last consequence, Einstein’s theory of special relativity demands the division of zero by zero. Due to Einstein’s theory of special relativity, it is (0/0) = 1. As we will see, either we must accept the division of zero by zero as possible and defined, or we must abandon Einstein’s theory of special relativity as refuted.

Hemodialysis in Pregnant with Systemic Lupus Erythematosus: Case Report and Review

Systemic lupus erythematosus is an autoimmune disease with an etiopathogenesis that is still unclear. With a higher incidence in women of childbearing age. Pregnancy in patients suffering from this pathology is a constant challenge for multidisciplinary teams. The changes of pregnancy, especially to the immune system and the kidney, have repercussions on the renal compromise secondary to lupus. Lupus nephropathy is more active during pregnancy and leads to adverse outcomes for the mother-fetus binomial. The early identification of pregnant women with a higher risk of complications, access to health resources and the participation of a multidisciplinary team is the strategy that increases maternal-fetal survival. A report case of a 25-year-old black female with SLE and a 10-week pregnancy who was admitted to the emergency department with criteria for dialysis. The literature focused on lupus nephritis and dialysis in pregnancy was reviewed. Articles were reviewed in databases such as PubMed, Cochrane, among others, focused on the topic of pregnancy with SLE and pregnancy with dialysis. A total of 15 review articles, 2 meta-analyses, 3 observational studies and 6 cohort studies (3 prospective and 3 retrospective) were filtered.

Helicobacter pylori——The Cause of Human Gastric Cancer

Background: Many studies documented an association between a Helicobacter pylori infection and the development of human gastric cancer. None of these studies were able to identify Helicobacter pylori as a cause or as the cause of human gastric cancer. The basic relation between gastric cancer and Helicobacter pylori still remains uncertain. Objectives: This systematic review and re-analysis of Naomi Uemura et al. available long-term, prospective study of 1526 Japanese patients are performed so that some new and meaningful inference can be drawn. Materials and Methods: Data obtained by Naomi Uemura et al. who conducted a long-term, prospective study of 1526 Japanese patients with a mean follow up about 7.8 years and endoscopy at enrolment and in the following between one and three years after enrolment were reanalysed. Statistical Analysis Used: The method of the conditio sine qua non relationship was used to proof the hypothesis without a Helicobacter pylori infection no development of human gastric cancer. The mathematical formula of the causal relationship was used to proof the hypothesis, whether there is a cause effect relationship between a Helicobacter pylori infection and human gastric cancer. Significance was indicated by a p-value of less than 0.05. Results: Based on the data published by Uemura et al. we were able to make evidence that without a Helicobacter pylori infection no development of human gastric cancer. In other words, a Helicobacter pylori infection is a conditio sine qua non of human gastric cancer. In the same respect, the data of Uemura et al. provide significant evidence that a Helicobacter pylori infection is the cause of human gastric cancer. Conclusions: Without a Helicobacter pylori infection of human stomach no development of human gastric cancer. Helicobacter pylori is the cause of human gastric cancer (k = +0.07368483, p-value = 0.00399664).

Epstein Bar Virus——The Cause of Hodgkin’s Lymphoma

Objective: Epstein-Barr virus (EBV), a herpes virus which persists in memory B cells in the peripheral blood for the lifetime of a person, is accused to be associated with several malignancies. Hodgkin’s lymphoma (HL) has long been suspected to have an Epstein-Barr virus infection as a causal agent. Some recent studies identified an EBV latent infection to a high degree in Hodgkin’s lymphoma. However, despite intensive study, the role of Epstein-Barr virus infection in Hodgkin lymphoma remains enigmatic. Methods: To explore the cause-effect relationship between EBV and HL and so to understand the role of EBV in HL etiology more clearly, a systematic review and re-analysis of studies published is performed. The method of the conditio per quam relationship was used to proof the hypothesis if Epstein-Barr virus infection (DNA) in human lymph nodes is present then Hodgkin lymphoma is present too. The mathematical formula of the causal relationship k was used to proof the hypothesis, whether there is a cause effect relationship between an Epstein-Barr virus infection (EBV DNA) and Hodgkin lymphoma. Significance was indicated by a p-value of less than 0.05. Result: The data analyzed support the Null-hypotheses that if Epstein-Barr virus infection (EBV DNA) is present in human lymph nodes then Hodgkin lymphoma is present too. In the same respect, the studies analyzed provide highly significant evidence that Epstein-Barr virus the cause of Hodgkin lymphoma. Conclusion: The findings of this study suggest that Epstein-Barr virus is the cause of Hodgkin’s lymphoma besides of the complexity of Hodgkin’s disease.