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Implications of left atrial volume index in patients with three-vessel coronary disease:A 6.6-year follow-up cohort study

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Chinese Medical Journal 2024年第4期137卷 441-449页

作者： Ru Liu Lei Song Ce Zhang Lin Jiang Jian Tian Lianjun Xu Xinxing Feng Linyuan Wan Xueyan Zhao Ou Xu Chongjian Li Runlin Gao Rutai hui Wei Zhao Jinqing Yuan Department of Cardiology Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Department of Respiratory and Pulmonary Vascular Disease Fuwai Yunnan Cardiovascular HospitalKunmingYunnan 650102China Department of Endocrinology Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Department of Echocardiography Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Information Center Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China

Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain *** study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with ***:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai hospital.A total of 7818 patients with available baseline LAVI data were included in the ***,procedural,and follow-up data were *** primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and *** endpoints included all-cause death,cardiac death,MI,revascularization,and ***-term outcomes were evaluated among LAVI quartile ***:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score ***,there was a significant interaction between LAVI quartiles and treatment strategies for *** was associated with lower risk of MACCE than MT alone,regardless of LAVI *** patients in the fourth quartile,PCI was associated with significantly incre

关键词： Three-vessel coronary disease Left atrial volume index Coronary artery bypass grafting Percutaneous coronary intervention Myocardial ischemia Prognosis

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Relationship between Phenotypic Changes of Dendritic Cell Subsets and the Onset of Plateau Phase during Intermittent Interferon Therapy in Patients with CHB

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Biomedical and Environmental Sciences 2024年第3期37卷 303-314页

作者： YANG Liu WANG Shi Yu JIANG Ting Ting DENG Wen CHANG Min WU Shu Ling CAO Wei Hua LU Yao SHEN Ge LIU Ru Yu GAO Yuan Jiao XU Meng Jiao HU Lei Ping ZHANG Lu XIE Yao LI Ming hui Department of Hepatology Division 2 Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China Center for Infectious Diseases Second Affiliated Hospital of Air Force Medical UniversityXi'an 710038ShaanxiChina Department of Hepatology Division 2 Peking University Ditan Teaching HospitalBeijing 100015China

Objective This study aimed to evaluate whether the onset of the plateau phase of slow hepatitis B surface antigen decline in patients with chronic hepatitis B treated with intermittent interferon therapy is related to the frequency of dendritic cell subsets and expression of the costimulatory molecules CD40,CD80,CD83,and *** This was a cross-sectional study in which patients were divided into a natural history group(namely NH group),a long-term oral nucleoside analogs treatment group(namely NA group),and a plateau-arriving group(namely P group).The percentage of plasmacytoid dendritic cell and myeloid dendritic cell subsets in peripheral blood lymphocytes and monocytes and the mean fluorescence intensity of their surface costimulatory molecules were detected using a flow *** In total,143 patients were enrolled(NH group,n=49;NA group,n=47;P group,n=47).The results demonstrated that CD141/CD1c double negative myeloid dendritic cell(DNmDC)/lymphocytes and monocytes(%)in P group(0.041[0.024,0.069])was significantly lower than that in NH group(0.270[0.135,0.407])and NA group(0.273[0.150,0.443]),and CD86 mean fluorescence intensity of DNmDCs in P group(1832.0[1484.0,2793.0])was significantly lower than that in NH group(4316.0[2958.0,5169.0])and NA group(3299.0[2534.0,4371.0]),Adjusted P all<*** Reduced DNmDCs and impaired maturation may be associated with the onset of the plateau phase during intermittent interferon therapy in patients with chronic hepatitis B.

关键词： CHB Dendritic Cells Intermittent Interferon Therapy Plateau Phase

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Immunoglobulin G-mediated food intolerance and metabolic syndrome influence the occurrence of reflux esophagitis in Helicobacter pylori-infected patients

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World Journal of Gastroenterology 2024年第8期30卷 855-862页

作者： Li-hui Wang Bin-Bin Su Sheng-Shu Wang guan-Chao Sun Kun-Ming Lv Yi Li hui Shi Qian-Qian Chen College Chinese PLA General HospitalBeijing 100853China Department of Gastroenterology Second Medical Center of Chinese PLA General HospitalBeijing 100853China Institute of Geriatrics The 2nd Medical CenterBeijing Key Laboratory of Aging and GeriatricsNational Clinical Research Center for Geriatrics DiseasesSecond Medical Center of Chinese PLA General HospitalBeijing 100853China Department of Gastroenterology First Medical Center of Chinese PLA General HospitalBeijing 100853China

BACKGROUND Reflux esophagitis has an increasing prevalence and complex and diverse *** its risk factors is crucial to understanding the etiology,prevention,and management of the *** occurrence of reflux esophagitis may be associated with food reactions,Helicobacter pylori(***)infection,and metabolic *** To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin(Ig)G-mediated food intolerance,*** infection,and metabolic syndrome on reflux *** Outpatients attending the Second Medical Center of the PLA General hospital between 2017 and 2021 were retrospectively *** patients’basic information,test results,gastroscopy results,*** test results,and IgG-mediated food intolerance results were *** logistic regression analysis was used to analyze risk factors for reflux *** mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on *** infection affecting reflux *** A total of 7954 outpatients were included;the prevalence of reflux esophagitis,IgG-mediated food intolerance,*** infection,and metabolic syndrome were 20.84%,61.77%,35.91%,and 60.15%,*** analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance(OR=1.688,95%CI:1.497-1.903,P<0.00001)and metabolic syndrome(OR=1.165,95%CI:1.030-1.317,P=0.01484),and the independent protective factor for reflux esophagitis was *** infection(OR=0.400,95%CI:0.351-0.456,P<0.00001).IgG-mediated food intolerance had a partially positive mediating effect on *** infection as it was associated with reduced occurrence of reflux esophagitis(P=0.0200).Metabolic syndrome had a partially negative mediating effect on *** infection and reduced the occurrence of reflux esophagitis(P=0.0220).CONCLUSION Patients with IgG-mediated food intol

关键词： Gastroesophageal reflux Esophagitis Food intolerance Metabolic syndrome Helicobacter pylori Chemokines

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long-term tadalafil once daily in Chinese men with erectile dysfunction:a 2-year final analysis of a post-marketing,multicenter,randomized,open-label trial

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Asian Journal of Andrology 2024年第3期26卷 282-287页

作者： hui Jiang Lian-Ming Zhao Su Yan Ji-Hong Liu Zhao-hui Zhu Jin-Dan Luo Yu-Tian Dai Fu-Biao Li Hao-Cheng Lin Zhi-Chao Zhang Department of Urology Peking University First HospitalBeijing 100000China Department of Urology Peking University Third HospitalBeijing 100191China Department of Urology Peking Union Medical College HospitalBeijing 100730China Department of Urology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Urology Union Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Department of Urology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Departmentof Andrology Nanjing Drum Tower HospitalNanjing 210008China Department of Andrology The First Hospital of Jilin UniversityChangchun 130021China Andrology Center Department of UrologyPeking University First HospitalBeijing 100034China

The long-term safety and effectiveness of once-daily tadalafil is crucial,but limited data are available in Chinese patients witherectile dysfunction(ED).In this post-marketing,multicenter,randomized,open-label trial with 2-year follow-up,635 ED caseswere randomized to receive daily oral tadalafil 2.5 mg or 5 mg for 3 months,of whom 580 continued once-daily tadalafil 5 mg for21 ***-emergent adverse events in the 12-month and 24-month period were similar,with the most common beingviral upper respiratory tract infection,upper respiratory tract infection,and *** improvement from baseline inthe International Index of Erectile Function-Erectile Function(IIEF-EF)score was detected at month 12(least squares mean[LSM]change:7.9,95%confidence interval[CI]:7.5–8.4,P<0.001)and was maintained to month 24(LSM change:8.6,95%CI:8.1–9.0,P<0.001).The proportions of patients regaining normal erectile function(IIEF-EF score≥26)were 43.7%and 48.0%at months 12 and 24,*** Assessment Questionnaire results showed improved erection function in 97.5%ofpatients and improved ability to engage in sexual activity in 95.9%of patients at month 12;these values were 96.1%and 95.0%at month 24,*** quality of sexual life score based on the Sexual Life Quality Questionnaire(SLQQ)was increased by52.2%at month 12 and by 55.3%at month 24(both P<0.001).The treatment satisfaction score determined by SLQQ(mean±standard deviation)was 62.4±21.0 at month 12 versus 65.9±20.2 at month ***-year daily application of tadalafil 5mg in Chinese men with ED showed a favorable safety profile and durable improvement in sexual performance and satisfaction.

关键词： clinical trial erectile dysfunction long-term safety once-daily dosing tadalafil

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Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence

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Journal of Integrative Medicine 2024年第3期22卷 258-269页

作者： Chao Yang Shan-ze Wang Sheng Chen Shuo Du guan-qun Wang Wei Guo Xiao-long Xie Bi-hui Peng Shi-hao Du Ji-ping Zhao Department of Acupuncture and Moxibustion Dongzhimen HospitalBeijing University of Chinese MedicineBeijing 100700China Department of Acupuncture and Moxibustion Guangdong provincial hospital of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Shanghai Ninth People’s hospital Shanghai Jiao Tong University School of MedicineShanghai 200011China Institute of Acupuncture and Moxibustion China Academy of Chinese Medical SciencesBeijing 100700China

Urinary incontinence (UI) is a common problem *** has a major impact on physical and social activities and interpersonal *** is common in women,but is under-reported and *** affects the quality of life of female patients *** and moxibustion have been proposed as potentially effective interventions for female ***,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female *** CPG was developed according to the Grading of Recommendations Assessment,Development,and Evaluation (GRADE) methodology,referring to the principles of the World Health Organization Handbook for Guideline *** the development of the CPG,the guideline development group (GDG) played an important *** clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi *** CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions,which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the *** CPG also provides one protocol for conventional filiform needle therapy,two therapy protocols for deep needling stimulation on lumbosacral acupoints,and four moxibustion therapy protocols,based on the protocols presented in randomized controlled trials reviewed by the GDG.

关键词： Acupuncture Clinical practice guideline Female urinary incontinence Moxibustion GRADE

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Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report

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World Journal of Clinical Cases 2024年第10期12卷 1804-1809页

作者： Ti-Dong Zhang Shuai Cao hui-Yong Ren Yu-Min Li Yi-Ming Yuan Department of Orthopedics Civil Aviation General HospitalBeijing 100123China

BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be *** kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone *** is associated with an increased risk of *** studies have reported the use of PVA in patients with *** herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after *** SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk *** to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were *** then received percutaneous vertebroplasty at T12 *** weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar *** again,he was given PVA which was optimized for the refractured *** the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month *** It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of *** may increase the risk of vertebral ***,the PVA surgical technique needs to be optimized according to the condition of the *** medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.

关键词： Chronic kidney disease-mineral and bone disorder Percutaneous vertebral augmentation Vertebral compression fracture Vertebral refracture Cemented vertebra Adjacent vertebra Case report

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The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention

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Journal of Geriatric Cardiology 2024年第2期21卷 232-241页

作者： Xiao-Ying HU Wei-Xian YANG Chang-Dong guan Li-Hua XIE Ke-Fei DOU Yong-Jian WU Jin-Qing YUAN Jie QIAN Yue-Jin YANG Shu-Bin QIAO Lei SONG Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina National Clinical Research Center for Cardiovascular Diseases BeijingChina Catheterization Laboratories Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is *** purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent *** We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and *** patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 *** 0–1)or Rentrop(grade 3 *** 0–2)grading *** primary endpoint was 5-year cardiac *** Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade *** to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading *** In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac ***'s CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.

关键词： coronary collateral occlusion

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Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

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Journal of Geriatric Cardiology 2024年第1期21卷 44-63页

作者： Shao-Yu WU Rui ZHANG Sheng YUAN Zhong-Xing CAI Chang-Dong guan Tong-Qiang ZOU Li-Hua XIE Ke-Fei DOU State Key Laboratory of Cardiovascular Disease BeijingChina Cardiometabolic Medicine Center Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Catheterization Laboratories Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the *** In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk *** An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be signi

关键词： patients coronary prediction

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Clinical practice guideline for acupuncture and moxibustion:Allergic rhinitis

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Journal of Integrative Medicine 2024年第3期22卷 245-257页

作者： Shi-hao Du Sheng Chen Shan-ze Wang guan-qun Wang Shuo Du Wei Guo Xiao-long Xie Bi-hui Peng Chao Yang Ji-ping Zhao Institute of Acupuncture and Moxibustion China Academy of Chinese Medical SciencesBeijing 100700China Department of Acupuncture and Moxibustion Dongzhimen HospitalBeijing University of Chinese MedicineBeijing 100700China Department of Acupuncture and Moxibustion Guangdong Provincial Hospital of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of Traditional Chinese Medicine Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China

Acupuncture is one of the most effective complementary therapies for allergic rhinitis(AR)and has been recommended by several clinical practice guidelines(CPGs)for ***,these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols,therefore limiting the applicability of acupuncture therapies for ***,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat *** CPG was developed according to the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)methodology,referring to the principles of the World Health Organization Handbook for Guideline *** the development of the CPG,the guideline development group(GDG)played an important *** clinical questions,recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi *** CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion *** include one strong recommendation for the intervention based on high-quality evidence,three conditional recommendations for either the intervention or standard care,and 11 conditional recommendations for the intervention based on very low quality of *** CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG.

关键词： Clinical practice guideline Allergic rhinitis Acupuncture Moxibustion GRADE

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Chinese Society of Cardiology guidelines on the diagnosis and treatment of adult fulminant myocarditis

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Science China(Life Sciences) 2024年第5期67卷 913-939页

作者： Chinese Society of Cardiology,Chinese Medical Association,Writing Group Jiangang Jiang Hongyang Shu Dao Wen Wang Rutai hui Chenze Li Xiao Ran Hong Wang Jing Zhang Shaoping Nie guanglin Cui Dingcheng Xiang Qun Shao Shengyong Xu Discussion experts:Ning Zhou Yuming Li Wei Gao Yuguo Chen Yuan Bian Guoping Wang Liming Xia Yan Wang Chunxia Zhao Zhiren Zhang Yuhua Zhao Jianan Wang Shaoliang Chen Hong Jiang Jing Chen Xianjin Du Mao Chen Yinxian Sun Sheng Li Hu Ding Xueping Ma Hesong Zeng Li Lin Shenghua Zhou Likun Ma Ling Tao Juan Chen Yiwu Zhou Xiaomei Guo 不详 Tongji hospital Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Fuwai hospital National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Zhongnan hospital of Wuhan University Wuhan 430062China Fuwai Huazhong Cardiovascular hospital Zhengzhou 450003China beijing Anzhen hospital Capital Medical UniversityBeijing 100029China guangzhou General hospital of guangzhou Military Command Guangzhou 510010China Harbin Medical University Cancer hospital Harbin 150081China Union hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Taida hospital Tianjin 300457China Peking University Third hospital Beijing 100191China Qilu hospital of Shandong University Jinan 250012China Kanghua hospital DongguanGuangzhou 523080China Second Affiliated hospital Zhejiang University School of Medicine Hangzhou 310003China Nanjing First hospital Nanjing Medical UniversityNanjing 210006China Renmin hospital of Wuhan University Wuhan 430060Wuhan West China hospital Sichuan UniversityChengdu 610044China First hospital of China Medical University Shenyang 110002China General hospital of Ningxia Medical University Yinchuan 750003China The Second Xiangya hospital Central South UniversityChangsha 410012China The First Affiliated hospital of USTC University of Science and Technology of ChinaHefei 230002China The First Affiliated hospital of Air Force Medical University Xi’an 710032China Central hospital of Wuhan City Wuhan 430014China Tongji Medical College Huazhong University of Science and TechnologyWuhan 430030China

Fulminant myocarditis is an acute diffuse inflammatory disease of *** is characterized by acute onset,rapid progress and high risk of *** pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory *** to China’s practical experience,the adoption of the“life support-based comprehensive treatment regimen”(with mechanical circulation support and immunomodulation therapy as the core)can significantly improve the survival rate and long-term *** emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.

关键词： fulminant myocarditis guidelines life support-based comprehensive treatment regimen diagnosis treatment cytokine storm overactivation of immunity

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