The majority of problems are comprehensive and complex in the modern society, which leads to the increasing contradictions in the specialization and comprehensiveness of knowledge. Interdisciplinary cooperation is one approach to improve the effectiveness and transferability. The primary principle of evidence-based medicine is its scientific and transparent procedures. It combines the patient’s preferences with clinical experience and the best evidence. Meanwhile, evidence-based medicine is focused on how to transfer research outcomes into practice and the re-evaluation of the result of practice in order to striving for perfections. Combining this practical pattern of evidence-based medicine with other disciplines can have a significant improvement on scientific methods and thinking patterns, and become an effective way to improve the quality of scientific research and promote the transformation.
The social needs, disciplinary development and humanistic reflection has promoted the emergence and development of evidence-based medicine. Moreover, evidence-based medicine-problems oriented research, evidence based decision, transferring results to practice and outcome evaluation-continues to meet society demands, promote the development of discipline and show humanist concern. The application of evidence-based medicine has gradually extended from the field of clinical medicine to the public health, society, management, economy, policy research and education in the process of solving various problems. The high quality evidence has also been important to decision-making in these fields. Our study explored the emergence and development of evidence-based medicine from the perspective of social needs, disciplinary development and humanistic reflection for the first time.
The primary principle of evidence-based medicine is that the best clinical decision-making is derived from clinical problems with combination of patient’s preferences with clinical experience and the best evidence. Evidence-based medicine by its nature, is a specific application on the evaluation of medical hypothesis. It also emphasize the importance of humanism in clinical practice. Our study explored the scientific and humanistic characteristics of evidence-based medicine from the prospective of philosophy, so as to facilitate the extensive application of evidence based practice paradigm in other fields.
ObjectiveTo verify the feasibility of a self-designed magnetic anchoring and traction device (MATD) for assisting two-port video-assisted thoracoscopic esophagectomy.MethodsThree Beagle dogs were selected as animal models with age ranging from 1-6 years and weight ranging from 8-12 kg, and they underwent two-port video-assisted thoracoscopic esophagectomy after general anesthesia. We used the MATD to retract the esophagus to different directions, which assisted mobilizing esophagus, detecting the nerves along esophagus and dissecting paraesophagus lymph nodes. The operation time, blood loss and feasibility of the MATD were recorded.ResultsWith the aid of the MATD, we successfully retracted and mobilized the esophagus, detected the nerves and dissected the lymph nodes in three Beagle dog models. During the operation, the MATD provided sufficient and steady traction of esophagus to achieve a good exposure of the operative field, effectively decreasing the interference between working instruments. The MATD worked well. The mean operation time was 30 min, and the mean intraoperative blood loss was about 10 mL.ConclusionIt is effective to use the MATD to assist retracting esophagus during video-assisted thoracoscopic esophagectomy. The magnetic anchoring and traction technique can assist to expose the surgical field, decrease the interference between the working instruments and have the potential clinical application.
ObjectiveTo estimate the level and evolving pattern of peptic ulcer disease (PUD) burden from 1990 to 2019. MethodsThe related data of PUD from 1990 to 2019 were obtained from GBD 2019 database. The corresponding age-standardized rate, annual percentage change, average annual percentage change were calculated and analyzed by Excel and R software. ResultsThe global standardized prevalence of PUD was 99.4/100 000 (95%CI 83.9 to 117.5) in 2019, and decreased from 143.4/100 000 (95%CI 120.5 to 170.2) in 1990. The standardized disability-adjusted disease years (DALYs) rate was 74.4 (95%CI 69.0 to 81.9) in 2019. The estimated annual percentage change (EAPC) from 1990 to 2019 was ?3.47% (95%CI ?3.58 to ?3.37), indicating that the standardized DALYs rate was declining. The prevalence and DALYs of PUD increased with age. The standardized DALYs rate was higher in males than in females in the same age group. Sociodemographic index (SDI) was negatively correlated with the standardized prevalence of PUD (R=?0.45, P<2.2e?16) and the standardized DALYs rate (R=?0.79, P<2.2e?16). ConclusionThe worldwide burden of PUD declined from 1990 to 2019, but the decline had begun to slow or pause in countries with better economic development levels.
【摘要】 目的 探討預混門冬胰島素對2型糖尿病（type 2 diabetes mellitus，T2DM）患者血漿成纖維細胞生長因子-21（fibroblast growth factor-21，FGF-21）水平的影響。 方法 2008年2—12月采用酶聯免疫吸附試驗測定44例正常人及37例采用預混門冬胰島素治療前后的T2DM患者的血漿FGF-21水平，分析血漿FGF-21水平與體質量指數（body mass index，BMI）、體內脂肪百分比（FAT%）、腰臀比、血脂、血糖、糖化血紅蛋白（hemoglobin A1c， HbA1c）、游離脂肪酸（free fatty acid，FFA）等的關系。 結果 治療前T2DM組患者血漿FGF-21[（1.79±0.04） μg/L]水平明顯高于正常對照組[（1.35± 0.21） μg/L]，差異有統計學意義（Plt;0.01）。T2DM組經16周預混人胰島素類似物（BIAsp 50和BIAsp 30）治療后FFA、HbA1c、空腹血糖、餐后2 h血糖均降低（Plt;0.01），空腹血漿FGF-21水平降低至（1.33±0.39） μg/L，與治療前比較差異有統計學意義（Plt;0.01）。相關分析發現T2DM組患者血漿FGF-21水平與BMI呈正相關（r=0.53，Plt;0.01），BMI是影響T2DM患者血漿FGF-21水平的獨立相關因素。 結論 預混人胰島素類似物能有效改善T2DM患者代謝紊亂，同時能顯著降低FGF-21水平。【Abstract】 Objective To investigate the effects of treatment with aspart insulin on plasma fibroblast growth factor-21 (FGF-21) levels in patients with type 2 diabetes mellitus (T2DM). Methods From February to December 2008, plasma FGF-21 levels were measured by enzyme-linked immunosorbent assay in 37 patients with T2DM treated with aspart insulin and 44 normal controls. The relationship between plasma FGF-21 levels and body mass index (BMI), percentage of body fat (FAT%), waist-hip ratio (WHR), blood lipid, blood glucose, hemoglobin A1c (HbA1c), and free fatty acid (FFA) was analyzed. Results Before treatment, plasma FGF-21 level was significantly higher in T2DM patients [(1.79±0.04) μg/L] than that in the normal controls [(1.35±0.21) μg/L] (Plt;0.01). After 16 weeks of treatment with premixed human insulin analogues (BIAsp 50 and BIAsp 30), FFA, HbA1c, fasting plasma glucose and 2-hour postprandial blood glucose decreased significantly (Plt;0.01), and fasting plasma FGF-21 level decreased to (1.33±0.39) μg/L which was significantly different from that before treatment (Plt;0.01). Correlation analysis showed that plasma FGF-21 level was positively correlated with BMI (r=0.53,Plt;0.01), which was an independent factor in influencing the FGF-21 level in the patients. Conclusion Aspart insulin treatment can remarkably improve glucose metabolism and significantly decrease the fasting plasma FGF-21 level.
Magnetic anchoring and traction technique is one of the core technologies of magnetic surgery. With the "non-contact" traction force of the outer magnet on the inner magnet, we can drive the inner magnet and the gripper to multiple directions, and pull tissue or organ to required position in operations, so as to get a clearer surgical field of view. On the basis of the previous animal experiments, we applied magnetic anchoring and traction device in 3 human (males aged 63-71 years) thoracoscopic esophagectomies. Using the magnetic anchoring device, we could pull the esophagus dorsally or ventrally to assist in exposing the anatomical plane without special equipment or pleural puncture for retraction of the esophagus. The interference between operating instruments reduced. The mean blood loss in operation was 83 mL, the mean total operation time was 253 min and the mean length of hospital stay was 10 d. Postoperative follow-up showed that all 3 patients had good short-term prognosis. There was no swellling or pain in magnetic anchoring zone of chest wall.
ObjectiveThis study intends to analyze the changing disease burden of mood disorders in China from 1990 to 2021 and project the epidemiological trends in the next two decades. MethodsThis study uses data from the Global Burden of Disease (GBD) 2021 database on three mood disorders in China (bipolar disorder, major depressive disorder, and dysthymia) from 1990 to 2021. The indicators such as age-standardized number of diseases and disability-adjusted life years (DALYs) were used to explore the characteristics of time, gender, and age distribution of the disease burden of mental disorders. The BAPC model was used to predict the disease burden in the next two decades. ResultsIn 2021, the number of cases of dysthymia, MDD, and BD in China was 27.84 million, 26.0 million, and 2.85 million, with an increase of 73.24%, 38.33%, and 36.79% compared with 1990, respectively. In 2021, DALYs of dysthymic disorder, MDD and BD were 2.67 million, 5.2 million and 0.61 million person-years, which increased by 71.45%, 34.29% and 34.76% compared with 1990, respectively. The burden of mood disorders is heavier among women and the middle-aged and elderly population. In addition, it is expected that ASPR and ASDR of dysthymia will continue to increase after a brief decline, MDD will show a downward trend, while BD will show a slight upward trend in the next two decades. ConclusionThe disease burden of mood disorders in China remains substantial, with dysthymia and BD showing persistent upward tendency. More resources should be invested in mental health care.
