检索结果-南通市图书馆

≥60岁高血压病人控制血压在较高或较低水平的药物治疗--美国医师协会和美国家庭医师学会临床实践指南

在线全文

学校读者我要写书评

暂无评论

护理研究（下旬版） 2017年第8期31卷 2945-2950页

作者： Amir Qaseem Timothy j.Wilt Robert Rich Linda L.Humphrey jennifer Frost mary Ann Forciea 美国医师协会临床指南委员会、美国家庭医师学会公共健康与科学委员会

目的:针对≥60岁的高血压病人治疗中较高和较低降压目标的利弊,美国医师协会(ACP)和美国家庭医师学会(AAFP)共同制订了这一指南,为临床治疗提供证据及治疗建议。方法:本指南依据于已发表的主要疗效指标的随机对照试验以及针对危害的观... 详细信息

目的:针对≥60岁的高血压病人治疗中较高和较低降压目标的利弊,美国医师协会(ACP)和美国家庭医师学会(AAFP)共同制订了这一指南,为临床治疗提供证据及治疗建议。方法:本指南依据于已发表的主要疗效指标的随机对照试验以及针对危害的观察性研究的系统性评价。资料来源于EMBASE、系统性综述Cochrane数据库、MEDLINE和Clinical ***,搜索时间为从数据库建立开始至2015年1月,其中MEDLINE数据更新到2016年9月。评估指标包括全因死亡率、与卒中相关的发病率和死亡率、主要心脏事件(包括致死和非致死性心肌梗死和心源性猝死)和危害。本指南采用GRADE法(Grading of Recommendations,Assessment,Development,and Evaluation)对证据和建议进行分级。目标使用者和病人人群:本指南的目标使用者为所有临床医师,目标病人人群包括所有年龄≥60岁的高血压病人。建议1:对≥60岁、收缩压持续≥150mmHg(1mmHg=0.133kPa)的病人治疗时,ACP和AAFP建议临床医师应启动降压治疗以控制收缩压<150mmHg,从而减少死亡、脑卒中和心脏事件的风险(等级:强烈推荐,高质量证据)。对≥60岁高血压病人进行治疗时,建议临床医生定期与病人具体讨论降压目标的利弊,根据讨论情况选择治疗目标。建议2:对≥60岁的有脑卒中或短暂性脑缺血发作病史的病人,ACP和AAFP建议临床医生考虑启动或者加强药物治疗,以控制收缩压<140mmHg,降低脑卒中复发的风险(等级:弱推荐,中等质量证据)。对≥60岁高血压病人进行治疗时,建议临床医生定期与病人具体讨论降压目标的利弊,根据讨论情况选择治疗目标。建议3:对一部分≥60岁有高度心血管风险的病人,ACP和AAFP建议临床医生根据个体评估情况考虑启动或者强化降压药物治疗,控制收缩压到140mmHg以下,从而减少脑卒中或心脏事件发生的风险(等级:弱推荐,低质量证据)。对≥60岁高血压病人进行治疗时,建议临床医生定期与病人具体讨论降压目标的利弊,根据讨论情况选择治疗目标。

关键词：高血压血压药物治疗临床实践指南老年人控制血压

横穿变质带的温度—时间关系:在递进变形的变泥质岩中,变斑晶—基质关系的证据

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

世界地质 1991年第2期10卷 195-206页

作者： j.Reinhardt M.j.Rubenach 李德伦

在递进区域变质作用的岩石中,相当于一定的变质作用的等温线是连续改变的,而由于应变的不断增加,相同岩石也产生递进变形构造。泥质叶理的变斑晶能提供有关变质作用和变形作用方面的证据。它们不仅能够说明这个地体的温度、压力演化,而... 详细信息

在递进区域变质作用的岩石中,相当于一定的变质作用的等温线是连续改变的,而由于应变的不断增加,相同岩石也产生递进变形构造。泥质叶理的变斑晶能提供有关变质作用和变形作用方面的证据。它们不仅能够说明这个地体的温度、压力演化,而且它们的包裹轨迹也能提供在变斑晶生长时变形阶段的线索。利用与基质叶理相对应的包裹轨迹的显微构造关系,结合在递进反应序列的岩石学资料,就能够再造变质体内不同变质带的温度—时间关系。在北昆斯兰的两个元古代地区,mary Kathleen褶皱带和Robertson河亚群,横穿变质带已经发现了包裹轨迹模式的系统变化。显微构造—岩石学的研究,往往限制了不同带的T—t演化。在两个研究区内,包裹轨迹摸式的区域分布表明变形同时影响高级带和低级带。

关键词：变质作用岩石温度-时间变斑晶

在线全文

学校读者我要写书评

暂无评论

4岁女孩的膈肌脂肪瘤1例

世界核心医学期刊文摘（儿科学分册） 2006年第5期2卷 48-49页

作者： Cheon j.S. Kim j.G. 虎小毅 DepartmentofSurgery DaejeonSt.Mary'sHospitalCatholicUniversityofKoreaDaejeon301-723SouthKorea

A lipoma of the diaphragm is extremely rare. Although most congenital diaphragmatic lipomas are encountered in middle or old age because of their typical asymptomatic nature, none have been reported in patients younge... 详细信息

关键词：脂肪瘤膈肌女孩无症状先天性老年

Structure of SARS-CoV-2 main protease in the apo state

在线全文

学校读者我要写书评

暂无评论

Science China(Life Sciences) 2021年第4期64卷 656-659页

作者： Xuelan Zhou Fanglin Zhong Cheng Lin Xiaohui Hu Yan Zhang Bing Xiong Xiushan Yin jinheng Fu Wei He jingjing Duan Yang Fu Huan Zhou Peter j.Mc Cormick Qisheng Wang jian Li jin Zhang School of Basic Medical Sciences Nanchang UiniversinNanchang 330031China College of Pharmaceutical Sciences Gannan Medical UniversityGanzhou 341000 China Laboratory of Prevention and Treatment of Cardovascular and Cerebrovascular Diseases Ministry of EducationGannan Medical UniversiyGanzhou 341000China Shenzhen Crystalo Biopharmacutical Co LtdShenzhen 518118China jiangxi jmerry Biopharmaceutical Co LtdGanzhou 341000China The Second Afiliaed Hospital of Nanchang Universiy Nanchang 330031China Department of Medicinal Chemisry Shanghai Instiute of Materia MedicalChinese Academy of SciencesShanghai 201203China Appled Blology Laboratory Shenyang Untversity of Chemical TechnologyShenyang 110142China Biotech&Biomedicine Science(jiangxi)Co LtdGanzhou 341000China jiangxi-OA1 joint Research Isiution Nanchang UniversityNanchang 330047China Human Aging Research Instiute(HARI) School of Life SciencesNanchang UniversinNanchang 330031China School of Medicine Souhern Universiny of Science and Technologx Shenzhen 518055China Shanghai Synchroron Radiation Facilig Shanghai Advanced Research InstiueChinese Academy of SciencesShanghai 201204China Centre for Endocrinology William Harvey Research InstiuteBari's and the London School of Medicine and DentisrQneen MaryUniversity of LondonLondon ECIM 6BQUK

Dear Editor,Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)has been a global pandemic that severely threatens global health with concordant economic ***,there i... 详细信息

关键词： drugs al. acute

Light treatment for seasonal Winter depression in African-American vs Caucasian outpatients

在线全文

学校读者我要写书评

暂无评论

World journal of Psychiatry 2015年第1期5卷 138-146页

作者： Hyacinth N Uzoma Gloria M Reeves Patricia Langenberg Baharak Khabazghazvini Theodora G Balis mary A johnson Aamar Sleemi Debra A Scrandis Sarah A Zimmerman Dipika Vaswani Gagan Virk Nijjar johanna Cabassa Manana Lapidus Kelly j Rohan Teodor T Postolache Department of Psychiatry University of Maryland School of MedicineBaltimoreMD 21201-1549United States Psychiatry Residency Training Program St.Elizabeth’s HospitalWashingtonDC 20032United States Department of Epidemiology and Preventive Medicine University of Maryland School of MedicineBaltimoreMD 21201-1549United States Department of Ophthalmology and Visual Science University of Maryland School of MedicineBaltimoreMD 21201-1549United States Family and Community Health University of Maryland School of NursingBaltimoreMD 21201-1549United States Department of Psychological Science University of VermontBurlingtonVT 05405-0134United States VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center BaltimoreMD 21201United States VISN 19 Rocky Mountain Mental Illness Research Education and Clinical Center DenverCO 80220United States 不详

AIM: To compare adherence, response, and remission with light treatment in African-American and Caucasian patients with Seasonal Affective ***: Seventy-eight study participants, agerange 18-64(51 African-Americans and 27 Caucasians)recruited from the Greater Baltimore Metropolitan area, with diagnoses of recurrent mood disorder with seasonal pattern, and confirmed by a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Ⅳ, were enrolled in an open label study of daily bright light treatment. The trial lasted6 wk with flexible dosing of light starting with 10000 lux bright light for 60 min daily in the morning. At the end of six weeks there were 65 completers. Three patients had Bipolar Ⅱ disorder and the remainder had Major depressive disorder. Outcome measures were remission(score ≤ 8) and response(50% reduction)in symptoms on the Structured Interview Guide for the Hamilton Rating Scale for Depression(SIGH-SAD)as well as symptomatic improvement on SIGH-SAD and Beck Depression Inventory-Ⅱ. Adherence was measured using participant daily log. Participant groups were compared using t-tests, chi square, linear and logistic regressions. RESULTS: The study did not find any significant group difference between African-Americans and their Caucasian counterparts in adherence with light treatment as well as in symptomatic *** symptomatic improvement and rate of treatment response were not different between the two groups,African-Americans, after adjustment for age, gender and adherence, achieved a significantly lower remission rate(African-Americans 46.3%; Caucasians 75%; P =0.02).CONCLUSION: This is the first study of light treatment in African-Americans, continuing our previous work reporting a similar frequency but a lower awareness of SAD and its treatment in African-Americans. Similar rates of adherence, symptomatic improvement and treatment response suggest that light treatment is a feasible, acceptable,

关键词： Seasonal affective disorder Depression Light treatment African-American Black Remission gap Ethnicity Race

雌激素替代疗法治疗轻到中度Alzheimer病：随机对照试验

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

美国医学会杂志（中文版） 2000年第6期19卷 282-290页

作者： Ruth A. Mulnard, RN, DNSc Anthony Gamst, PhD Michael Grundman, MD,MPH Ronald Thomas, PhD Leon j. Thal, MD Alzheimer病协作组 Carl W. Cotman, PhD Claudia Kawas, MD Christopher H. van Dyck, MD mary Sano, PhD Rachelle Doody, MD, PhD Elizabeth Koss, PhD Eric Pfeiffer, MD Shelia jin, MD, MPH

背景：几项小型临床试验提示雌激素替代疗法可能有助于女性Alzheimer病（AD）患者的治疗。　　目的：确定雌激素替代疗法能否改善轻到中度女性AD患者总体功能、认知或日常生活能力。　　设计：Alzheimer病协作组于1995年10月至1999年1... 详细信息

背景：几项小型临床试验提示雌激素替代疗法可能有助于女性Alzheimer病（AD）患者的治疗。　　目的：确定雌激素替代疗法能否改善轻到中度女性AD患者总体功能、认知或日常生活能力。　　设计：Alzheimer病协作组于1995年10月至1999年1月进行的一项随机、双盲、安慰剂对照临床试验。　　参加单位：美国32个研究中心。　　受试对象：总共120例轻到中度女性AD患者。细微精神状态检查评分介于12～28分间，既往已行子宫切除术。　　干预：受试者随机服用雌激素0.625 mg/d（n=42）、1.25 mg/d（n=39）或者剂型相同的安慰剂（n=39）。1例患者于随机后接受药物治疗前退出试验；97例完成试验。　　主要结果评定：主要结果评定指标为临床整体印象的改变（CGIC），分值为7分，采用意向治疗(intent-to-treat)分析。次要指标包括其他总评估以及情绪、特殊认知功能（记忆、注意力和语言）、运动功能和日常生活能力；于随访 2、6、12和15个月时，对雌激素组与安慰剂组进行比较。　　结果：雌激素组与安慰剂组CGIC评分为5.1比5.0 (P=0.43)；雌激素组80%的患者恶化，而安慰剂组74%恶化(P=0.48)。除临床痴呆评分提示雌激素组恶化外(雌激素组与安慰剂组相比治疗后平均变化为0.5比0.2，P=0.01)，两组次要结果指标无显著差异。　　结论：雌激素替代治疗1年不能延缓轻、中度女性AD患者病情的进展，整体功能、认知和功能预后亦无改善。研究结果不支持雌激素对这种疾病有治疗作用的结论。雌激素对AD的潜在预防作用尚需进一步研究。

关键词：早老性痴呆雌激素替代疗法

偏头痛与缺血性脑卒中有相关性,但风险低且可以控制

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

英国医学杂志中文版 2005年第3期8卷 138-139页

作者： D j Thoma 高晶 St mary's Hospital LondonW21NY

偏头痛和缺血性脑卒中都是常见病,当病人同时出现这两种疾病时我们很少感到惊讶--但它们之间有没有因果关系呢?Etminan等在一篇汇总分析中为证明二者有因果关系提供了进一步的证据1(见本期第151页).而以前有资料证实偏头痛未增加出血性... 详细信息

偏头痛和缺血性脑卒中都是常见病,当病人同时出现这两种疾病时我们很少感到惊讶--但它们之间有没有因果关系呢?Etminan等在一篇汇总分析中为证明二者有因果关系提供了进一步的证据1(见本期第151页).而以前有资料证实偏头痛未增加出血性脑卒中的风险2.

关键词：缺血性脑卒中偏头痛风险相关性控制出血性脑卒中因果关系汇总分析常见病

Improved measurement of the reactor antineutrino flux and spectrum at Daya Bay

在线全文

学校读者我要写书评

暂无评论

Chinese Physics C 2017年第1期41卷 11-46页

作者：安丰鹏 A.B.Balantekin H.R.Band M.Bishai S.Blyth 曹德文曹国富曹俊岑吴镕陳日朗常劲帆張立楚张昀陈和生陈泉佑陈少敏陈义学陈羽程佳樺程捷程雅苹成兆侃 j.j.Cherwinka 朱明中 A.Chukanov j.P.Cummings j.de Arcos 邓子艳丁雪峰丁雅韵 M.V.Diwan M.Dolgareva j.Dove D.A.Dwyer W.R.Edwards R.Gill M.Gonchar 龚光华宫辉 M.Grassi 顾文强关梦云郭磊郭如盼郭新恒郭子溢 R.W.Hackenburg 韩然 S.Hans 何苗 K.M.Heeger 衡月昆 A.Higuera Y.K.Hor 熊怡胡貝禎胡涛胡维黄恩泉黄翰雄黄性涛 P.Huber 霍文驹 G.Hussain D.E.jaffe P.jaffke 任國綸 S.jetter 季向盼季筱璐焦健斌 R.A.johnson D.jones j.joshi 康丽 S.H.Kettell S.Kohn M.Kramer 關健强郭文伟郭天能 T.j.Langford K.Lau L.Lebanowski j.Lee 李曉菁雷瑞庭 R.Leitner 李超李登杰李飞李高嵩李秋菊黎山峰 S.C.Li 李卫东李小男李玉峰李志兵梁昊林政儒林贵林林盛鑫林士凱林禹丞凌家杰 j.M.Link L.Littenberg B.R.Littlejohn 刘大为刘江来刘金昌 C.W.Loh 陆昌国路浩奇陆稼书陆锦标吕志鹏马秋梅马晓妍马续波马宇倩 Y.Malyshkin D.A.Martinez Caicedo K.T.McDonald R.D.McKeown I.Mitchell M.Mooney Y.Nakajima j.Napolitano D.Naumov E.Naumova 倪浩然宁哲 j.P.Ochoa-Ricoux A.Olshevskiy 潘孝儒 j.Park S.Patton V.Pec 彭仁杰 L.Pinsky 潘振声齐法制祁鸣钱鑫 N.Raper 任杰 R.Rosero B.Roskovec 阮锡超 H.Steiner 孙功星孙吉良唐炜 D.Taychenachev K.TVeskov K.V.Tsang C.E.Tull N.Viaux B.Viren V.Vorobei 王正祥王萌王乃彦王瑞光王为王玺王贻芳王喆王铮王志民魏瀚宇温良剑 K.Whisnant C.G.White L.Whitehead T.Wise 黄显诺黄振辉 E.Worcester 吳珈豪吴群吴文杰夏冬梅夏经凯邢志忠徐建一徐吉磊徐晔薛涛杨长根杨海波杨雷阳马生杨梦婷叶梅 Z.Ye 叶铭芳杨炳麟于泽源曾珊占亮张超张宏浩张家文张清民张玄同张一鸣张一心张玉美张志坚张智勇张子平赵洁赵庆旺赵豫斌钟玮丽周莉 N.Zhou 庄红林邹佳恒 Institute of Modern Physics East China University of Science and Technology University of Wisconsin Department of Physics Yale University Brookhaven National Laboratory Department of Physics National Taiwan University National United University Nanjing University Institute of High Energy Physics Chinese University of Hong Kong Institute of Physics National Chiao-Tung University Shandong University Department of Engineering Physics Tsinghua University North China Electric Power University Shenzhen University Sun Yat-Sen (Zhongshan) University joint Institute for Nuclear Research Siena College Department of Physics Illinois Institute of Technology Department of Physics University of Illinois at Urbana-Champaign Lawrence Berkeley National Laboratory Department of Physics and Astronomy Shanghai Jiao Tong University Shanghai Laboratory for Particle Physics and Cosmology Beijing Normal University Department of Chemistry and Chemical Technology Bronx Community College Department of Physics University of Houston Center for Neutrino Physics Virginia Tech China Institute of Atomic Energy University of Science and Technology of China School of Physics Nankai University Department of Physics University of Cincinnati Department of Physics College of Science and Technology Temple University Dongguan University of Technology Department of Physics University of California Department of Physics The University of Hong Kong Charles University Faculty of Mathematics and Physics joseph Henry Laboratories Princeton University Department of Nuclear Science and Technology School of Energy and Power Engineering Xi’an Jiaotong University Instituto de F'?sica Pontificia Universidad Católica de Chile California Institute of Technology College of William and mary Department of Physics Applied Physics and Astronomy Rensselaer Polytechnic Institute China General Nuclear Power Group College of Electronic Science and Engineering National University of Defense Technology Iowa State University Chongqing University

A new measurement of the reactor antineutrino flux and energy spectrum by the Daya Bay reactor neutrino experiment is reported. The antineutrinos were generated by six 2.9 GWth nuclear reactors and detected by eight antineutrino detectors deployed in two near（560 m and 600 m flux-weighted baselines） and one far（1640 m flux-weighted baseline） underground experimental halls. With 621 days of data, more than 1.2 million inverse beta decay（IBD） candidates were detected. The IBD yield in the eight detectors was measured, and the ratio of measured to predicted flux was found to be 0.946±0.020（0.992±0.021） for the Huber＋Mueller（ILL＋Vogel） model. A 2.9σ deviation was found in the measured IBD positron energy spectrum compared to the predictions. In particular, an excess of events in the region of 4–6 MeV was found in the measured spectrum, with a local significance of 4.4σ. A reactor antineutrino spectrum weighted by the IBD cross section is extracted for model-independent predictions.

关键词： antineutrino flux energy spectrum reactor Daya Bay

Chronic hepatitis B virus monoinfection at a university hospital in Zambia

在线全文

学校读者我要写书评

暂无评论

World journal of Hepatology 2018年第9期10卷 622-628页

作者： Michael j Vinikoor Edford Sinkala Annie Kanunga Mutinta Muchimba Bright Nsokolo Roma Chilengi Gilles Wandeler joseph Mulenga Tina Chisenga Debika Bhattacharya Michael S Saag Graham Foster Michael W Fried Paul Kelly Tropical Gastroenterology and Nutrition Group School of MedicineUniversity of ZambiaLusaka 50110Zambia Centre for Infectious Disease Research in Zambia Lusaka 34681Zambia Department of Medicine University of Alabama at BirminghamBirminghamAL 35294United States Department of Infectious Diseases Bern University HospitalUniversity of BernBern 3012Switzerland Institute of Social and Preventive Medicine University of BernBern 3012Switzerland Zambia National Blood Transfusion Service Private Bag RW1X RidgewayLusaka 50110Zambia Zambian Ministry of Health Ndeke HouseLusaka 30205Zambia Department of Medicine University of California at Los AngelesLos AngelesCA 90035United States Blizard Institute Barts and The London School of MedicineQueen Mary University of LondonLondon E1 2ATUnited Kingdom Department of Medicine University of North Carolina at Chapel HillChapel HillNC 27514United States

AIM To characterize antiviral therapy eligibility among hepatitis B virus(HBV)-infected adults at a university hospital in *** Hepatitis B surface antigen-positive adults(n = 160) who were h IV-negative and referred to the hospital after a routine or clinically-driven HBV test were enrolled. Alanine Aminotransferase(ALT),Aspartate Aminotransferase(AST),platelet count,hepatitis B e-antigen,and HBV DNA were measured. Liver fibrosis/cirrhosis was assessed by physical examination,AST-to-platelet ratio index,and transient elastography. In antiviral therapy-na?ve individuals,we described hBV stages and antiviral therapy eligibility per World health Organization(WhO) and by hBV test(routine vs clinical). Elevated ALT was > 19 in women and > 30 U/L in men. Among treatmentexperienced individuals,we described medication side effects,adherence,and viral *** The median age was 33 years,71.9% were men,and 30.9% were diagnosed with HBV through a clinicallydriven test with the remainder identified via routine testing(at the blood bank,community events,etc.). Among 120 treatment-na?ve individuals,2.5% were categorized as immune tolerant,11.7% were immune active,35.6% were inactive carriers,and 46.7% had an indeterminate phenotype. Per WhO guidelines,13(10.8%) were eligible for immediate antiviral therapy. The odds of eligibility were eight times higher for those diagnosed at clinical vs routine settings(adjusted odds ratio,8.33; 95%CI: 2.26-29.41). Among 40 treatmentexperienced hBV patients,virtually all took tenofovir,and a history of mild side effects was reported in 20%. Though reported adherence was good,12 of 29(41.4%) had HBV DNA > 20 IU/m L. CONCLUSION Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.

关键词： Hepatitis B virus Liver fibrosis Treatment Tenofovir Africa