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Discharging patients home from the intensive care unit:A new trend

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World Journal of Clinical Cases 2024年第23期12卷 5313-5319页

作者： Esraa m hassan Abbas B Jama Ahmed Sharaf Asim Shaikh mohamad El Labban Salim Surani Syed A Khan Department of Critical Care medicine Mayo Clinic Health systemMankatoMN 56001United States Department of Internal medicine Baptist Hospital of Southeast TexasBeaumontTX 77701United States Department of medicine Aga Khan UniversityKarachi 74200SindhPakistan Department of Internal medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of medicine and Pharmacology Texas A&M UniversityCollege StationTX 77843United States Department of Anaesthesiology Mayo Clinic Health SystemRochesterMN 55905United States

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new *** review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU *** analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare *** practice of direct discharge from the ICU presents both opportunities and *** it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support *** this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the *** critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal *** insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare ***,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

关键词： Intensive care unit Critical care Early discharge Cost effective critical care Patient comfort Early recovery

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GRADE指南：Ⅸ.证据质量升级

中国循证医学杂志 2011年第12期11卷 1459-1463页

作者： Gordon H.Guyatt Andrew D.Oxman Shahnaz Sultan Paul Glasziou Elie A.Akl Pablo Alonso-Coello David Atkins Regina Kunz Jan Brozek Victor montori Roman Jaeschke David Rind Philipp Dahm Joerg meerpohl Gunn Vist Elise Berliner Susan Norris Yngve Falck-Ytter m.hassan murad Holger J.Schünemann 代表GRADE工作组李幼平杨晓妍李玲王应强机构不详

证据质量升级的最常见原因是效应量大。当方法学严谨的观察性研究表明风险至少降低或增加2倍时,GRADE建议考虑将证据质量升高1级;当风险至少降低或增加5倍时,考虑将证据质量升高2级。当存在剂量-反应关系,或所有合理的混杂、偏倚会降低... 详细信息

证据质量升级的最常见原因是效应量大。当方法学严谨的观察性研究表明风险至少降低或增加2倍时,GRADE建议考虑将证据质量升高1级;当风险至少降低或增加5倍时,考虑将证据质量升高2级。当存在剂量-反应关系,或所有合理的混杂、偏倚会降低明显的治疗效应,或混杂、偏倚使得结果无效为假效应时,系统评价作者和指南制定者也可考虑升高证据质量。其他考虑因素包括起效迅速、潜在的疾病(状态)趋势以及间接证据。

关键词： GRADE 指南证据等级观察性研究效应量大偏倚风险

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抑郁症的非药物治疗：系统性综述与证据图

英国医学杂志中文版 2017年第11期20卷 660-667页

作者： Wigdan H Farah mouaz Alsawas maria mainou Fares Alahdab magdoleen H Farah Ahmed T Ahmed Essa A mohamed Jehad Almasri michael R Gionfriddo Ana Castaneda-Guarderas Khaled mohammed Zhen Wang Noor Asi Craig N Sawchuk mark D Williams Larry J Prokop m hassan murad Annie LeBlanc Evidence-Based Przctiee Center Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA Knowledge and Evaluation Research Unit Mayo Clinic Rochester Minnesota USA Division of Preventive. Occupational and Aerospace medicine mayo Clinic Rochester Minnesota USA Integrated Behavioral Health Departmenl of Psychiatry and Psychology Mayo Clinic Rochester Minnesota USA mayo GraduateSchool Mayo ClinicRochesterMinnesota USA Center for PharmacyInnovation and Outcomes Geislnger Health System Forty Fort PennsylvaniaUSA Department of Emergency medicine Mayo ClinicRochesterMinnesota USA mayo Clinic

背景抑郁症非药物治疗的疗效比较目前仍然不清楚。方法我们对一些系统性综述作了概述，回顾了随机对照试验（RCT），比较抑郁症非药物治疗的有效性和认知行为治疗（CBT）。对多个电子数据库在2016年2月之前发表的所有文献进行了检索，... 详细信息

背景抑郁症非药物治疗的疗效比较目前仍然不清楚。方法我们对一些系统性综述作了概述，回顾了随机对照试验（RCT），比较抑郁症非药物治疗的有效性和认知行为治疗（CBT）。对多个电子数据库在2016年2月之前发表的所有文献进行了检索，不限制语言。成对的评阅人进行资料纳入、数据提炼并评估偏倚的风险。在适用的时候进行了荟萃分析。结果我们收录了367项RCT，纳入了约2000名患者，进行了11种治疗，导出17项独立的头对头比较。通过标准化的量表评估，发现CBT、自然疗法、行为干预与躯体活动干预可以降低抑郁的严重程度。然而，这些非药物干预的相对疗效仍然缺乏。这些干预对临床缓解和复发的效果不清楚。CBT的发生率比抗抑郁药物更低。局限性由于证据缺乏一致性、证据不清或偏倚风险高，导致证据的质量只是低到中等，限制了我们研究结果的可信度。结论抑郁症的非药物治疗能减少抑郁症状，在轻度到重度抑郁症患者中，应当合并抗抑郁药物治疗，一同进行。对于非药物治疗的选择，应当根据患者的价值观、偏好、临床和社会因素来与患者共同作出决定。

关键词：抑郁症非药物治疗系统性综述证据图

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阿拉伯国家绿色经济:发展、困境与中国角色

阿拉伯世界研究 2024年第3期 31-70,158页

作者：王佳 [埃及]艾哈迈德·哈桑湖南师范大学外国语学院长沙410081

进入21世纪后,绿色经济成为国际社会的主流话题,多个阿拉伯国家相继提出了绿色经济转型的战略目标。阿拉伯国家绿色转型过程中的决定因素主要由其作用主体、金融投资、绿色科技及绿色理念构成。在这些因素的主导下,近年来多个阿拉伯国... 详细信息

进入21世纪后,绿色经济成为国际社会的主流话题,多个阿拉伯国家相继提出了绿色经济转型的战略目标。阿拉伯国家绿色转型过程中的决定因素主要由其作用主体、金融投资、绿色科技及绿色理念构成。在这些因素的主导下,近年来多个阿拉伯国家在绿色经济发展上取得了长足进展,但也面临着转型困境,需要解决国家优先事项议程、产业平衡及中小企业发展滞后、技术转让需求增加和技术创新能力不济、可持续发展财政拨款和社会融资贫乏等问题。中国在阿拉伯国家绿色转型过程中扮演了重要角色,其绿色经济发展的经验与策略为阿拉伯国家提供了较好的示范作用,主要体现在战略应和、技术转移、对外投资和智库交流四个方面。伴随阿拉伯国家绿色经济转型的不断深入,中国与阿拉伯国家在该领域的合作也呈现出前所未有的机遇。

关键词：阿拉伯国家绿色经济转型中国角色绿色发展

颈动脉粥样硬化疾病的处理美国血管外科学会临床实践指南

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中华脑血管病杂志（电子版） 2008年第6期2卷 371-377页

作者： Robert W.Hobson Ⅱ William C.mackey Enrico Ascher m.hassan murad Keith D.Calligaro Anthony J.Comerota Victor m.montori mark K.Eskandari Douglas W.massop Ruth L.Bush Brajesh K.Lal Bruce A.Perler 刘德志徐格林刘新峰 From the University of medicine and Dentistry of New Jersey Newark New England medical Center Boston maimonides medical Center Brooklyn mayo Clinic Rochester University of Pennsylvania School of medicine Philadelphia Jobst Vascular Center Toledo mayo Clinic College of medicine Rochester Northwestern University Feinberg School of medicine Chicago The Iowa Clinic Des Moines Texas A&m University Health Science Center College Station University of medicine and Dentistry of New Jersey Newark Johns Hopkins Hospital Baltimore 南京军区南京总医院神经内科 210002

美国血管外科学会(SVS)任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中,该委员会使用系统评价对当前最佳的证据进行了总结,采用GRADE标准对推荐意见的强度(强烈推荐为GRADEⅠ级,一般推荐为GRADE... 详细信息

美国血管外科学会(SVS)任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中,该委员会使用系统评价对当前最佳的证据进行了总结,采用GRADE标准对推荐意见的强度(强烈推荐为GRADEⅠ级,一般推荐为GRADEⅡ级)和证据的质量(高、中、低和极低)进行了分级。对于轻度颈动脉狭窄患者(有症状患者狭窄程度<50%和无症状患者狭窄程度<60%),推荐进行最佳的内科治疗而非血管重建术(Ⅰ级推荐,高质量证据)。对于有症状中到重度狭窄患者(狭窄程度≥50%),推荐行颈动脉内膜切除术(CEA)+最佳的内科治疗(Ⅰ级推荐,高质量证据)。对于围手术期风险高的有症状中到重度狭窄患者(狭窄程度≥50%),建议采用颈动脉支架置入术作为其替代治疗手段(Ⅱ级推荐,低质量证据)。对于中到重度狭窄的无症状患者(狭窄程度≥60%),只要围手术期风险较低,就推荐行CEA+内科治疗(Ⅰ级推荐,高质量证据)。对于中到重度狭窄的无症状患者(狭窄程度≥60%),不推荐行颈动脉支架置入术(Ⅰ级推荐,低质量证据)。颈动脉狭窄≥80%但存在CEA高危解剖学风险的患者可能是一个例外。

关键词：临床实践指南动脉粥样硬化疾病血管外科学会美国颈动脉支架置入术颈动脉内膜切除术颈动脉狭窄

颈动脉粥样硬化疾病的处理美国血管外科学会临床实践指南

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国际脑血管病杂志 2008年第12期16卷 881-887页

作者： Robert W. Hobson, Ⅱ William C. mackey Enrico Ascher m. hassan murad Keith D. Calligaro Anthony J. Comerota Victor m. montori mark K. Eskandari Douglas W. massop Ruth L. Bush Brajesh K. Lal Bruce A. Perler 刘德志(译) 徐格林(译) 刘新峰(译) University of medicine and Dentistry of New Jersey Newark New England medical Center Boston maimonides medical Center Brooklyn mayo Clinic Rochester University of Pennsylvania school of medicine Philadelphia Jobst Vascular Center Toledo mayo Clinic College of medicine Rochester Northwestern University Feinberg School of medicine Chicago The Iowa Clinic Des Moines University of medicine and Dentistry of New Jersey Newark Texas A & m University Health Science Center College Station Johns Hopkins Hospital Baltimore 南京军区南京总医院神经内科 210002

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为G... 详细信息

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为GRADEⅡ级）和证据的质量（高、中、低和极低）进行了分级。对于轻度颈动脉狭窄患者（有症状患者狭窄程度〈50％和无症状患者狭窄程度〈60％），推荐进行最佳的内科治疗而非血管重建术（I级推荐，高质量证据）。对于有症状中到重度狭窄患者（狭窄程度≥50％），推荐行颈动脉内膜切除术（CEA）＋最佳的内科治疗（I级推荐，高质量证据）。对于围手术期风险高的有症状巾到重度狭窄患者（狭窄程度≥50％），建议采用颈动脉支架置入术作为其替代治疗手段（Ⅱ级推荐，低质量证据）。对于中到重度狭窄的无症状患者（狭窄程度≥60％），只要围手术期风险较低，就推荐行CEA＋内科治疗（I级推荐，高质量证据）。对于中到重度狭窄的尢症状患者（狭窄稗度≥60％），不推荐行颈动脉支架置入术（I级推荐，低质量证据）。颈动脉狭窄≥80％但存在CEA高危解剖学风险的患者可能是一个例外。

关键词：临床实践指南动脉粥样硬化疾病血管外科学会美国颈动脉支架置入术颈动脉狭窄颈动脉内膜切除术

multifunctional mXene/Carbon Nanotube Janus Film for Electromagnetic Shielding and Infrared Shielding/Detection in Harsh Environments

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Nano-micro Letters 2024年第10期16卷 543-560页

作者： Tufail hassan Aamir Iqbal Byungkwon Yoo Jun Young Jo Nilufer Cakmakci Shabbir madad Naqvi Hyerim Kim Sungmin Jung Noushad Hussain Ujala Zafar Soo Yeong Cho Seunghwan Jeong Jaewoo Kim Jung min Oh Sangwoon Park Youngjin Jeong Chong min Koo School of Advanced materials Science and Engineering Sungkyunkwan UniversitySeobu-ro 2066Jangan-guSuwon-siGyeonggi-do 16419Republic of Korea Department of materials Science and Engineering Soongsil UniversitySeoul 06978Republic of Korea Institute of Advanced Composite materials Korea Institute of Science and Technology92 Chudong-roBongdong-eupWanju-gunJeollabuk-do 55324Republic of Korea R&D Center INNOmXENE Co. Ltd.Daejeon 34365Republic of Korea School of Chemical Engineering Sungkyunkwan UniversitySeobu-ro 2066Jangan-guSuwon-siGyeonggi-do 16419Republic of Korea

multifunctional,flexible,and robust thin films capable of operating in demanding harsh temperature environments are crucial for various cutting-edge *** study presents a multifunctional Janus film integrating highly-crystalline Ti_(3)C_(2)T_(x) mXene and mechanically-robust carbon nanotube(CNT)film through strong hydrogen *** hybrid film not only exhibits high electrical conductivity(4250 S cm^(-1)),but also demonstrates robust mechanical strength and durability in both extremely low and high temperature environments,showing exceptional resistance to thermal *** hybrid Janus film of 15μm thickness reveals remarkable multifunctionality,including efficient electromagnetic shielding effectiveness of 72 dB in X band frequency range,excellent infrared(IR)shielding capability with an average emissivity of 0.09(a minimal value of 0.02),superior thermal camouflage performance over a wide temperature range(−1 to 300℃)achieving a notable reduction in the radiated temperature by 243℃ against a background temperature of 300℃,and outstanding IR detection capability characterized by a 44%increase in resistance when exposed to 250 W IR *** multifunctional mXene/CNT Janus film offers a feasible solution for electromagnetic shielding and IR shielding/detection under challenging conditions.

关键词： mXene/carbon nanotube Janus film Electromagnetic interference shielding Infrared shielding Thermal camouflage Infrared detection

Intermittent fasting and the liver: Focus on the Ramadan model

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World Journal of Hepatology 2024年第8期16卷 1070-1083页

作者： mohamed H Emara Hanan Soliman Ebada m Said hassan Elbatae mostafa Elazab Shady Elhefnawy Tarik I Zaher Ahmed Abdel-Razik mohamed Elnadry Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of medicine Alyousif HospitalAlkhobar 34622Saudi Arabia Department of Tropical medicine and Infectious Diseases Tanta UniversityTanta 31512Egypt Department of Hepatology Gastroenterology and Infectious DiseasesBenha UniversityBenha 13511Egypt Department of Tropical medicine Zagazig UniversityZagazig 44519Egypt Department of Tropical medicine Mansoura UniversityMansoura 35516Egypt Department of Hepato-Gastroenterology and Infectious Diseases Al-Azhar UniversityCairo 11651Egypt

Intermittent fasting(IF)is an intervention that involves not only dietary modific-ations but also behavioral changes with the main core being a period of fasting alternating with a period of controlled *** duration of fasting differs from one regimen to *** fasting(RF)is a religious fasting for muslims,it lasts for only one month every one lunar *** this model of fasting,observers abstain from food and water for a period that extends from dawn to *** period of daily fasting is variable(12-18 hours)as Ramadan rotates in all seasons of the ***,longer duration of daily fasting is observed during the *** fact,RF is a peculiar type of *** is a dry IF as no water is allowed during the fasting hours,also there are no calorie restrictions during feeding hours,and the mealtime is exclusively *** three variables of the RF model are believed to have a variable impact on different liver *** was evaluated by different observational and interventional studies among patients with non-alcoholic fatty liver disease and it was associated with improve-ments in anthropometric measures,metabolic profile,and liver biochemistry regardless of the calorie restriction among lean and obese *** situation is rather different for patients with liver *** was associated with adverse events among patients with liver cirrhosis irrespective of the underlying etiology of *** patients developed new ascites,ascites were increased,had higher serum bilirubin levels after Ramadan,and frequently developed hepatic encephalopathy and acute upper gastrointestinal *** complications were higher among patients with Child class B and C cirrhosis,and some fatalities occurred due to *** transplant recipients as a special group of patients,are vulnerable to dehydration,fluctuation in blood immunosuppressive levels,likelihood of deterioration and hence observing RF without special precautions

关键词： Intermittent fasting Ramadan fasting Non-alcoholic fatty liver disease Liver cirrhosis Peptic ulcer Liver transplantation Gilbert syndrome

Effect of degree of saturation on stresses and pore water pressure in the subgrade layer caused by railway track loading

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Railway Sciences 2024年第4期3卷 413-436页

作者： mohammed Y.Fattah Qutaiba G.majeed hassan H.Joni Department of Civil Engineering UOTBaghdadIraq Department of Civil Engineering Diyala UniversityDiyalaIraq

Purpose-The experiments of this study investigated the effect of the subgrade degree of saturation on the value of the stresses generated on the surface and the middle(vertical and lateral stresses).The objectives of this study can be identified by studying the effect of subgrade layer degree of saturation variation,load amplitude and load frequency on the transmitted stresses through the ballast layer to the subgrade layer and the stress distribution inside it and investigating the excess pore water pressure development in the clay layer in the case of a fully saturated subgrade layer and the change in matric suction in the case of an unsaturated subgrade ***/methodology/approach-Thirty-six laboratory experiments were conducted using approximately half-scale replicas of real railways,with an iron box measuring 1.5×1.031.0 *** the box,a 0.5 m thick layer of clay soil representing the base layer was *** it is a 0.2 m thick ballast layer made of crushed stone,and on top of that is a 0.8 m long rail line supported by three 0.9 m(0.1×0.1 m)slipper *** subgrade layer has been built at the following various saturation levels:100,80,70 and 60%.Experiments were conducted with various frequencies of 1,2 and 4 Hz with load amplitudes of 15,25 and 35 ***-The results of the study demonstrated that as the subgrade degree of saturation decreased from 100 to 60%,the ratio of stress in the lateral direction to stress in the vertical direction generated in the middle of the subgrade layer decreased as *** average,this ratio changed from approximately 0.75 to approximately ***/value-The study discovered that as the test proceeded and the number of cycles increased,the value of negative water pressure(matric suction)in the case of unsaturated subgrade soils *** frequency of loads had no bearing on the ratio of decline in matric suction values,which was greater under a larger load amplitude than a lower *** the test progr

关键词： Subgrade clay Unsaturated Track matric suction Stresses