简介：AbstractOdontogenic sinusitis (ODS) is more common than historically reported, and is under-represented in the sinusitis literature. ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures, and most commonly presents unilaterally. ODS clinical features, microbiology, and diagnostic and treatment paradigms are also distinct from rhinosinusitis. ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers, and clinicians must be able to suspect and confirm the condition. ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography, overt maxillary dental pathology on computed tomography, unilateral middle meatal purulence on nasal endoscopy, foul smell, and odontogenic bacteria in sinus cultures. Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence, edema, or polyps. Dental providers should confirm dental pathology through appropriate examinations and imaging. Once ODS is confirmed, a multidisciplinary shared decision-making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions. Oral antibiotics are generally ineffective at resolving ODS, especially when there is treatable dental pathology. When both the dental pathology and sinusitis are addressed, resolution can be expected in 90%-100% of cases. For treatable dental pathology, while primary dental treatment may resolve the sinusitis, a significant percentage of patients still require endoscopic sinus surgery. For patients with significant sinusitis symptom burdens, primary endoscopic sinus surgery is an option to resolve symptoms faster, followed by appropriate dental management. More well-designed studies are necessary across all areas of ODS.

简介：Theeffectivenessofmechanicalventilation,bothinvasive(byendotrachealintubation)andnon-invasiive(bynegativepressureventilation)wasestablishedduringtheepidemicsofpolioinEuropeandNorthAmericainthelain1950sandearly1960s.Theindicationsforventilationhaveincreasedsincethattime,andinvasiveventilationserviceshavebecomeconcentratedinhighly-staffedcriticalcareunitsand.insomepartsofEurope,respiratorycareunits.

简介：Therehasbeenacontroversialissueinphylogeneticrelationshipsamonganimals,fungi,andplants.

简介：AbstractBackground:Allergic rhinitis (AR) is characterized by mucosal inflammation that leads to a variety of symptoms, such as nasal congestion, rhinorrhea, and sneezing. This rhinitis is triggered by inhalation of allergens, such as pollen, and this condition has a negative impact on the quality of life. AR was shown to be associated with a number of co-morbidities, including hypothyroidism, asthma, and chronic sinusitis.Objective:This study aimed to assess AR-associated comorbidities in patients presenting symptoms and paranasal sinus computed tomography (CT) scan findings in Taif City, Saudi Arabia.Methods:This cross-sectional study evaluated medical and radiological records of AR patients retrospectively from the period of December 2018 to September 2019 in Al-Hada Armed Forces Military Hospital, Taif City, Saudi Arabia.Results:A total of 103 AR patients with a mean age of 39.0 ± 15.6 years with 55.3% males and 44.7% females. The three most common associated comorbidities in allergic rhinitis patients were chronic sinusitis (28.2%), hypothyroidism (21.4%), and asthma (8.7%). Nasal obstruction (30.1%) was the symptom most frequently presented by all patients. Mucosal thickening occurred most frequently in patients with associated chronic sinusitis, while bilateral osteomeatal complex obliteration was observed mostly in asthmatic patients, and bony boundary thinning was more prevalent among patients with associated hypothyroidism.Conclusion:The gender distribution of AR was 10% more common among males; however, the most common three comorbidites in allergic rhinitis patients were chronic sinusitis, hypothyroidism, and asthma, and most of those patients were females. Hypothyroidism can be a hidden predisposing factor for AR, while chronic sinusitis can be caused by AR due to secretion stasis or immune system activation.

简介：瞄准：评估影响多囊肝疾病的非侵略、侵略的治疗的结果的因素。方法：有到2006年6月的从1986年7月的完全的后续的病人的临床的文件的分析。结果：41个病人(男性，7；女性，34)，11.9年变老的47.8+/-，和5.7+/-6.7年后续，被学习。硷性磷酸酯酶(AP)举起(15%病人)与侵略治疗的要求被联系(信息技术，P=0.005)。信息技术率是更高的在比非征兆的病人征兆(65.4%对14.3%，P=0.002)，并且在拿神经质的代替治疗(HRT)的女人(P=0.001)。包囊复杂并发症(CC)是更经常的(22%)在征兆的病人组织(P=0.023)。有身体质量的病人索引(BMI)>(59%)25在它以后有一个趋势到复杂并发症(P=0.075)。腹的疼痛为信息技术(78%)是最普通的症状(56%)和指示。十九个病人(46%)要求了第一种信息技术：12开的开窗术()，4laparoscopic开窗术(LF)和有肝的切除术(FHR)的3开窗术。三要求了第二种信息技术，并且一个人要求了第三个过程。复杂并发症在32%由于第一种信息技术被发现(16.7%，LF25%，FHR66.7%)，并且在在66.7%的第二种信息技术(100%)。后续死亡率是0。结论：症状，提高的AP，和CC的存在与信息技术要求被联系。HRT与症状和信息技术要求的存在被联系。有BMI>的病人25有一个趋势产生信息技术复杂并发症。复杂并发症的比例在FHR和秒信息技术组是更高的。RS是更经常的在以后。

简介：AbstractPeriprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcus aureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%—2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.

简介：Non-invasiveventilation(NIV)istheprovisionofventilatorysupportwithoutinstrumentationoftheairway.Itcanbeachievedusinganegative-pressuremachine(e.g.‘ironlung')or,morecommonly,withpositivepressureadministeredthroughawell-fittingmask.Thiscontributionconsiderspositivepressureventilationonly;negativepressureisnowseldomused.

简介：Spontaneousbacterialperitonitisisacomplicationofasciticpatientswithend-stageliverdisease(ESLD);spontaneousfungalperitonitis(SFP)isacomplicationofESLDlessknownanddescribed.ESLDisassociatedtoimmunodepressionandtheresultingincreasedsusceptibilitytoinfections.RecentperspectivesofthemanagementofthecriticallyillpatientwithESLDdonotspecifytherateofisolationoffungiincriticallyillpatients,noteventheantifungalsusedfortheprophylaxis,neitheroptimaltreatment.Wereviewed,inordertofocustheepidemiology,characteristics,and,consideringthehighmortalityrateofSFP,theuseofoptimalempiricalantifungaltherapythecurrentliterature.

简介：AbstractBackground:Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays.Methods:Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed.Results:The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) (χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) (χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) (χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exact P = 1.000) to and slightly lower specificity (87% [77/89]) (χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) (P = 0.734). Sputum LFD had similar specificity (91% [81/89]) (χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) (χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) (χ2 = 6.95, P = 0.008), BDG (χ2 = 10.43, P = 0.001), and fungal culture (χ2 = 12.70, P < 0.001).Conclusions:Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.

简介：AIM:Toreviewpublishedclinicalstudiesexaminingtheeffectofnatamycininthetreatmentoffungalkeratitis.METHODS:WeselectedthepublicationsinCENTRAL,MEDLINE,EMBASE,CNKI,andCBM.Thisstudysystematicallyreviewedpublishedrandomizedcontrolledtrials(RCTs)thatcomparednatamycintootherantifungalagents,andconductedfeasibleMeta-analysisofefficacyresultsusingRevman5.2software.RESULTS:WeincludedseventrialswhichweremainlycarriedoutindevelopingcountriesofAsia,withfivetrialsconductedinIndia,oneeachinChinaandBangladesh.Atotalof804participantswererandomizedtofollowingcomparisons:2%econazoleversus5%natamycinshowedlittledifferenceintheeffectsoftreatmentoffungalkeratitis[RR=0.99,95%confidenceinterval(CI),0.8to1.21];chlorhexidinegluconateversus5%natamycinindicatedthattheresultsonhealingoftheulcerat21dwaslessconclusive(RR=0.77,95%CI,0.55to1.08;I2=0%);1%voriconazoleversus5%natamycinsuggestedthatnatamycintreatmentappearedtobesignificantlybetteroutcomesthanvoriconazole(regressioncoefficient=-0.18logMAR;95%CI,-0.30to-0.05;P=0.006),especiallyinFusariumcases(regressioncoefficient=-0.41logMAR;95%CI,-0.61to-0.20;P<0.001);natamycinversusfluconazoleshowedasignificantdifferenceincurerate(χ2=5.048,P<0.05)andnatamycingroupwasmoreeffectivethanfluconazoleinaverageperiodoftherapy(t=7.94,P<0.01).CONCLUSION:Natamycinwasapreferablechoiceinthetreatmentoffungalkeratitis,especiallyintheearlyperiodofFusariumcases.

简介：真菌经常被用来在Aquilaria树上导致agarwood。这研究被进行在年轻Aquilariamalaccensis随着时间的过去在agarwood形成上评估几真菌的效果(打)树。在长度和产生褪色的轻紧张的典型变化在三和六月时期追随者接种以后被观察。伍德样品是观察用显微镜并且分类进几个轻紧张组。褪色长度是测量的纵。在接种以后的持续时间影响了褪色长度的平均数：当时，6月的旧样品(1.70厘米)有一个更宽的褪色地区与3月的旧样品(1.17厘米)相比。当测量褪色紧张时，与时间的一种积极关系被察觉。数字图象，使用一台装备照相机的显微镜捕获，表明在六个月以后收集的木头样品显得是1.8-times比在三个月以后黑暗。我们结束了那时间，不是任何测试真菌的种类，褪色长度和紧张上的有的重要效果。6月的旧样品的煤气的层析/团spectrometry(GCMS)分析产出象benzylacetone，anisylacetone，guaiene和palustrol那样的一些重要agarwood混合物。这证明测试真菌有能力在托儿所A导致agarwood形成。malaccensis树。

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简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

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简介：Primaryandmetastaticlivertumorsareanincreasingglobalhealthproblem,withhepatocellularcarcinoma(HCC)nowbeingthethirdleadingcauseofcancer-relatedmortalityworldwide.SystemictreatmentoptionsforHCCremainlimited,withSorafenibastheonlyprospectivelyvalidatedagentshowntoincreaseoverallsurvival.Surgicalresectionand/ortransplantation,locallyablativetherapiesandregionalorlocoregionaltherapieshavefilledthegapinlivertumortreatments,providingimprovedsurvivaloutcomesforbothprimaryandmetastatictumors.Minimallyinvasivelocaltherapieshaveanincreasingroleinthetreatmentofbothprimaryandmetastaticlivertumors.Forpatientswithlowvolumedisease,thesetherapieshavenowbeenestablishedintoconsensuspracticeguidelines.Thisreviewhighlightstechnicalaspectsandoutcomesofcommonlyutilized,minimallyinvasivelocaltherapiesincludinglaparoscopicliverresection(LLR),radiofrequencyablation(RFA),microwaveablation(MWA),high-intensityfocusedultrasound(HIFU),irreversibleelectroporation(IRE),andstereotacticbodyradiationtherapy(SBRT).Inaddition,theroleofcombinationtreatmentstrategiesutilizingtheseminimallyinvasivetechniquesisreviewed.

简介：IntravesicalBacillusCalmette-Guérin(BCG)haslongbeenthegoldstandardtreatmentofnonmuscleinvasivebladdercancer.Recently,therehasbeenanemergenceofnovelimmunotherapeuticagents,whichhaveshownpromiseinthetreatmentofurothelialcellcarcinoma.Theseagentsaimtoaugment,modify,orenhancetheimmuneresponse.SuchstrategiesincluderecombinantBCG,monoclonalantibodies,vaccines,genetherapy,andadoptiveT-celltherapy.Here,wereviewtheemergingimmunotherapeuticsinthetreatmentofnonmuscleinvasivebladdercancer.

简介：Sequence-basedmolecularphylogenieshaveprovidednewmodelsofearlyeukaryoticevolution.Thisincludesthewidelyacceptedhypothesisthatanimalsarerelatedmostcloselytofungi,andthatthetwoshouldbegroupedtogetherastheOpisthokonta.Althoughmostpublishedphylogenieshavesupportedanopisthokontrelationship,anumberofgenescontainatree-buildingsignalthatclustersanimalandgreenplantsequences,totheexclusionoffungi.Thealternativetree-buildingsignalisespeciallyintriguinginlightofemergingdatafromgenomicandproteomicstudiesthatindicatestrikingandpotentiallysynapomorphicsimilaritiesbetweenplantsandanimals.Thispaperreviewsthesenewlinesofevidence,whichhaveyettobeincorporatedintomodelsofbroadscaleeukaryoticevolution.

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简介：由美国腹腔镜内镜外科医师协会（SLS）举办的“瓶美多学科峰会Ⅵ-腹腔镜与微创外科”将于2014年2月12～15日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和做创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜没备，新技术、新概念以及如何提高对患者监护的标准，以及微创外科医师的培训和继续教育等。

简介：ElevenspeciesofalieninvasiveforestinsectpestshavebeenfoundsincetheearlytimethatinsectspecieshadbeentakenrecordedinChina.Theirorigins,inlanddistribution,invasivetime,hosts,causingdamagearerecordedinthispaperfortheevidenceofbiologicalinvasion.Theircontrolmethodsarealsostudiedordiscussed.