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正确处理重症监护中出现的医疗纠纷——有人谓之“痴心妄想”

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美国医学会杂志（中文版） 2006年第6期25卷 358-364页

作者： anthony l. back Robert M. Arnold 欧阳泰山（译）欧阳烨（校） Department of Medicine University of Washington Seattle Department of Medicine University of Pittsburgh Pittsburgh Pa 不详

医生常常认为。医患纠纷令人厌烦。还会带来伤害。但是。如果处理得好。医患纠纷也可有所收获。一旦双方把话说明，治疗决策就会更加明确。患者家属、患者本人及临床医生就会感到更加满意。B夫人84岁，处于老年痴呆晚期，先前曾声明不... 详细信息

医生常常认为。医患纠纷令人厌烦。还会带来伤害。但是。如果处理得好。医患纠纷也可有所收获。一旦双方把话说明，治疗决策就会更加明确。患者家属、患者本人及临床医生就会感到更加满意。B夫人84岁，处于老年痴呆晚期，先前曾声明不接受人为补液和营养支持。我们对她的经历进行了回顾分析。在患病过程中，其家属与医生就治疗时短期采用管饲和静脉补液产生了分歧。本文描述了B夫人的医生与其家属间产生的纠纷。介绍了重症监护中常见的纠纷类型（患者家属与治疗小组之间的纠纷、治疗小组成员之间的纠纷）。我们汲取了商业理论、心理学理论和调解理论。总结出一些有用的沟通手段和常见的误区。医生可采用我们概括的方法逐步解决医疗纠纷。也可运用尝试性治疗这一策略消除重症监护中产生的纠纷。

关键词：医疗纠纷重症监护临床医生患者家属妄想谓之医患纠纷静脉补液

Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient:A case report and review of literature

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World Journal of Clinical Cases 2024年第18期12卷 3561-3566页

作者： Binyamin Ravina Abramowitz Michael Coles Ayse Aytaman Bani Chander-Roland Daniel anthony Dileo Department of Gastroenterology and Hepatology SUNY Downstate Health Sciences UniversityBrooklynNY 11203United States Department of Gastroenterology and Hepatology Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare SystemBrooklynNY 11209United States

backGROUND It is well-described that the coronavirus disease 2019(COVID-19)infection is associated with an increased risk of thrombotic complications.While there have been many cases of pulmonary emboli and deep vein thrombosis in these patients,reports of COVID-19 associated portal vein thrombosis(PVT)have been uncommon.We present a unique case of concomitant PVT and splenic artery thrombosis in a COVID-19 patient.CASE SUMMARY A 77-year-old-male with no history of liver disease presented with three days of left-sided abdominal pain.One week earlier,the patient was diagnosed with mildly symptomatic COVID-19 and was treated with nirmatrelvir/ritonavir.Physical exam revealed mild right and left lower quadrant tenderness,but was otherwise unremarkable.Significant laboratory findings included white blood cell count 12.5 K/μl,total bilirubin 1.6 mg/dl,aminoaspartate transferase 40 U/l,and alanine aminotransferase 61 U/l.Computed tomography of the abdomen and pelvis revealed acute PVT with thrombus extending from the distal portion of the main portal vein into the right and left branches.Also noted was a thrombus within the distal portion of the splenic artery with resulting splenic infarct.Hypercoagulable workup including prothrombin gene analysis,factor V leiden,cardiolipin antibody,and JAK2 mutation were all negative.Anticoagulation with enoxaparin was initiated,and the patient’s pain improved.He was discharged on apixaban.CONClUSION It is quite uncommon for PVT to present simultaneously with an arterial thrombotic occlusion,as in the case of our patient.Unusual thrombotic manifestations are classically linked to hypercoagulable states including malignancy and hereditary and autoimmune disorders.Viral infections such as Epstein-Barr virus,cytomegalovirus,viral hepatitis,and COVID-19 have all been found to increase the risk of splanchnic venous occlusions,including PVT.In our patient,prompt abdominal imaging led to early detection of thrombus,early treatment,and an excellent outcome.This case is unique in that it is

关键词： COVID-19 Thromboembolism Portal vein thrombosis Splenic artery thrombosis Anticoagulation lovenox Thrombotic complication Case report

Effect of Dietary Components on the Shear Bond Strength of Orthodontics Brackets after Thermal Aging

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Open Journal of Stomatology 2024年第6期14卷 309-315页

作者： Philip Punzalan Tanya Al Talib anthony Fusco Neamat Hassan Abubakr School of Dental Medicine University of Nevada Las Vegas Nevada USA

Introduction: The stability of orthodontic brackets throughout orthodontic treatment plays a critical role in the treatment’s effectiveness. The present in vitro study was designed to assess the impact of various dietary components on the performance of orthodontic brackets. Methods: Metal orthodontic brackets were bonded to 66 extracted anterior teeth divided into groups based on the solution type: Milk, Gatorade, Cold Coffee, and a control group using water. Each group consisted of 20 teeth except for the control group, which included six teeth. The bracketed teeth were submerged in their respective solutions for 15 minutes three times daily at different intervals to mimic an in vivo environment and were stored in artificial saliva at room temperature (23?C). The specimens underwent artificial aging through 10,000 cycles of thermocycling (representing one clinical year) between 5?C and 55?C. Shade measurements were taken using a VITA Easy Shade device, capturing the classic shade and l*, a*, and b* values. Delta E values were calculated immediately post-bonding and after 7 days, 1 month, 1, and 2 clinical years. The shear bond strength of each bracket was measured using an ultra-tester machine. Results: After two clinical years, significant differences in ΔE color values were observed across all groups, with the most substantial change noted in teeth immersed in cold coffee. Brackets submerged in milk demonstrated lower shear bond strength than other solutions, whereas the control group exhibited the highest shear bond strength (P = 0.01). Conclusion: The study indicates that dietary components significantly influence tooth color stability and the shear bond strength of orthodontic brackets, underscoring the importance of considering these factors in orthodontic treatment planning.

关键词： Shear Bond Orthodontic Brackets Color Stability Thermal Aging

Stress reduction via neuro-emotional technique to achieve the simultaneous resolution of chronic low back pain with multiple inflammatory and biobehavioural indicators:A randomized,double-blinded,placebo-controlled trial

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Journal of Integrative Medicine 2022年第2期20卷 135-144页

作者： Peter Bablis Henry Pollard anthony l.Rosner Universal Health New South Wales 2028Australia School of Medical and Applied Sciences University of Central QueenslandBrisbaneNew South Wales 4000Australia Medical Information Services MA 02479-4149United States

background:Beginning with the concepts of stress developed by Selye,an approach to stress and pain management,known as neuro-emotional technique(NET),has been developed.It is a treatment approach based on the principle that the stressor effects of dormant and/or current unresolved issues or trauma are what determine one’s bodily responses.These responses are relatively personalized to the conditioned,experiential and emotional reality of the individual.Objective:To determine the effect of NET on patients with chronic low back pain(ClBP)over time.Design,setting,participants,and interventions:In a randomized,double-blinded,placebo-controlled study conducted in a single clinic,NET or control treatments were given twice weekly for 4 weeks in a population of 112 patients.Main outcome measures:Outcome measures,including Oswestry Disability Index,Quadruple Visual Analogue Scale,the psychoneuroimmunology markers of blood serum levels of C-reactive protein,tumour necrosis factor-a,interleukin-1(Il-1),Il-6,and Il-10,and 10 dimensions of the Short Form Health Survey scale,were assessed at baseline and at 1,3 and 6 months following the intervention period.Results:Compared to placebo,NET produced clinical and statistical significance(Plines of virtually all physiological,pain and disability markers,accompanied by gains in quality-of-life indicators at 0(baseline),1,3 and 6 months.Reductions of the percentages of patients whose 5 biomarkers lay outside the normative range were achieved at 1,3 and 6 months by NET but not control interventions.Conclusion:A randomized,controlled trial of ClBP patients indicated that 8 NET interventions,compared to placebo,produced clinically and statistically significant reductions in pain,disability and inflammatory biomarkers,and improvements in quality-of-life measures.

关键词： Neuro-emotional technique Biopsychosocial model Emotion Mind-body therapies Inflammation Biomarker

Mapping and Floristic Diversity of the Nakpadjouak Community Forest, Tami Canton, Togo (West Africa)

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Natural Resources 2024年第4期15卷 83-105页

作者： Senyo Kossi Ehlui Christian anthony-Krueger Edinam Kola Wouyo Atakpama Alagie Bah Henrik von Wehrden Tchaa Boukpessi West Africa Science Service Center on Climate Change and Adapted land Use WASCAl University of the Gambia Banjul Gambia laboratoire de Recherche sur la Dynamique des Milieux et des Socié t&#233s Department of Geography University of Lom&#233 Lome Togo Department of Science Education University of Cape Coast Cape Coast Ghana laboratoire de Botanique et É cologie V&#233g&#233tale D&#233partement botanique Facult&#233 des sciences Universit&#233 de Lom&#233 Lome Togo West Africa Plant Red list Authority (WAPRlA) IUCN Species Survival Commission Gland Switzerland Center for International Forestry Research and World Agroforestry (CIFOR-ICRAF) Nairobi Kenya Faculty of Sustainability Center of Methods Leuphana University of L&#252neburg L&#252neburg Germany laboratoire de Recherches Biogé ographiques et d&#8217Etudes Environnementales Department of Geography University of Lome Lome Togo

Since 2015, community forests have been promoted in Togo as an alternative to protect areas from degradation and as a means of contributing to forest landscape restoration. The study focuses on the Nakpadjouak Community Forest (NCF) in Tami (Togo, West Africa) which contributes to community forests sustainable management. It aims in (i) mapping forest ecosystems and analysing their dynamic and (ii) characterizing the floristic diversity of the NCF. The ecosystems were mapped and their dynamic was evaluated based on Google Earth images of 2014 and 2020. Floristic and forestry inventories were carried out using the transect technique in a sample of 20 plots of 50 m × 20 m. The NCF was made up mainly by wooded/shrub savannahs (95.37%) and croplands/fallow (4.63%) in 2014. These two land use types undergone changes over the 6 years prior to 2020. By 2020, the NCF had 3 land use types: wooded/shrub savannahs (77.59%), open forest/wooded savannahs (22.23%), and croplands/fallows (0.18%). A total of 89 plant species belonging to 70 genera and 28 families were recorded within the NCF. The dominant species are: Heteropogon contortus (l.) P.Beauv. and Combretum collinum Fresen. followed by Pteleopsissuberosa Engl. & Diels, Annona senegalensis Pers. The most common species are: lannea acida A.Rich. s.l., A. senegalensis, Vitellaria paradoxa C.F.Gaertner subsp. paradoxa, C. collinum and Acacia dudgeonii Craib ex Holland. Due to its small area of just 40 hectares and its diverse plant life, this community forest of Savannahs Region is a significant biodiversity hotspot and warrants conservation efforts.

关键词： Community Forest Floristic Diversity land Use Change Biodiversity Hotspot Tami Savannah Region Togo

Anthropogenic Threats to Degraded Forest land in the Savannahs’ Region of Togo from 1984 to 2020, West Africa

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Journal of Geoscience and Environment Protection 2024年第1期12卷 164-179页

作者： Kossi Senyo Ehlui Wouyo Atakpama Henrik von Wehrden Alagie Bah Edinam Kola Christian anthony-Krueger Hodabalo Egbelou Kokouvi Bruno Kokou Tchaa Boukpessi West Africa Science Service Center on Climate Change and Adapted land Use (WASCAl) University of the Gambia Banjul Gambia laboratoire de Recherche sur la Dynamique des Milieux et des Sociétés Université de Lomé Lomé Togo laboratoire de Botanique et écologie Végétale Département Botanique Faculté des Sciences Université de Lomé Lomé Togo West Africa Plant Red list Authority (WAPRlA) IUCN Species Survival Commission Gland Switzerland Faculty of Sustainability Center of Methods Leuphana University of Lüneburg Lüneburg Germany Center for International Forestry Research and World Agroforestry (CIFOR-ICRAF) Nairobi Kenya laboratoire de Recherche sur la Dynamique des Milieux et des Sociétés (lARDYMES) Department of Geography FSHS University of Lomé Lome Togo Department of Science Education University of Cape Coast Cape Coast Ghana Institut Togolais de Recherches Agronomiques (ITRA) Lomé Togo laboratoire de Recherches Biogéographiques et d’Etudes Environnementales Department of Geography University of Lome Lome Togo

This study focuses on the landscape dynamics of the savannahs’ region in the far north of Togo. Based on a literature review and satellite images analysis using GIS and remote sensing, the study aims to ascertain the effects of anthropogenic threats on the forest coverage of the Savannahs’ Region between 1984 to 2020. The objective is to clarify the dynamics of land use in the region from 1984 to 2000 and from 2000 to 2020. The findings indicate a significant decline in forest coverage within the region from 1984 to 2020, a trend attributed to land use patterns. Dry forests in the Savannah region are largely converted to farmlands, housing, dry savannahs or agroforestry parks, leading to a steady reduction in forest areas.

关键词： Forest Degradation land Use land Cover Savannahs Region Togo

The proteome of distal nerves: implication in delayed repair and poor functional recovery

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Neural Regeneration Research 2022年第9期17卷 1998-2006页

作者： Song Guo Raymond M.Moore M.Cristine Charlesworth Kenneth l.Johnson Robert J.Spinner anthony J.Windebank Huan Wang Department of Neurologic Surgery Mayo ClinicRochesterMNUSA Biomedical Statistics and Informatics Mayo ClinicRochesterMNUSA Proteomics Core Mayo ClinicRochesterMNUSA Department of Neurology Mayo ClinicRochesterMNUSA

Chronic denervation is one of the key factors that affect nerve regeneration.Chronic axotomy deteriorates the distal nerve stump,causes protein changes,and renders the microenvironment less permissive for regeneration.Some of these factors/proteins have been individually studied.To better delineate the comprehensive protein expression profiles and identify proteins that contribute to or are associated with this detrimental effect,we carried out a proteomic analysis of the distal nerve using an established delayed rat sciatic nerve repair model.Four rats that received immediate repair after sciatic nerve transection served as control,whereas four rats in the experimental group(chronic denervation)had their sciatic nerve repaired after a 12-week delay.All the rats were sacrificed after 16 weeks to harvest the distal nerves for extracting proteins.Twenty-five micrograms of protein from each sample were fractionated in SDS-PAGE gels.NanolC-MS/MS analysis was applied to the gels.Protein expression levels of nerves on the surgery side were compared to those on the contralateral side.Any protein with a P value of less than 0.05 and a fold change of 4 or higher was deemed differentially expressed.All the differentially expressed proteins in both groups were further stratified according to the biological processes.A PubMed search was also conducted to identify the differentially expressed proteins that have been reported to be either beneficial or detrimental to nerve regeneration.Ingenuity Pathway Analysis(IPA)software was used for pathway analysis.The results showed that 709 differentially expressed proteins were identified in the delayed repair group,with a bigger proportion of immune and inflammatory process-related proteins and a smaller proportion of proteins related to axon regeneration and lipid metabolism in comparison to the control group where 478 differentially expressed proteins were identified.The experimental group also had more beneficial proteins that were downregulated and more detrimental proteins that

关键词： chronic axotomy chronic denervation delayed repair distal nerve functional recovery nerve regeneration peripheral nerve prolonged denervation proteome sciatic nerve sciatic nerve transection

Association between ACTN3 R577X genotype and risk of non-contact injury in trained athletes:A systematic review

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Journal of Sport and Health Science 2023年第3期12卷 359-368页

作者： Hassane Zouhal Juan Del Coso Ayyappan Jayavel Claire Toumy Guillaume Ravé Nidhal Jebabli Cain C.T.Clark Benjamin Barthélémy anthony C.Hackney Abderraouf Ben Abderrahman M2S(laboratoire Mouvement SportSanté)-EA 1274Department of Sport SciencesUniversity of RennesRennes F-35000France Rey Juan Carlos University Centre for Sport StudiesMadrid 28032Spain SRM College of Physiotherapy SRM Institute of Science and TechnologySRM NagarKattankulathur 603203India Department of Sport Sciences University of RouenMont Saint AignanCETAPS EA 3832F-76821France Toulouse Football Club Toulouse 31000France Higher Institute of Sport and Physical Education Ksar-SaidUniversity of ManoubaTunis 2010Tunisia Centre for Intelligent Healthcare Coventry UniversityCoventry CV15FBUK Department of Exercise&Sport Science Department of NutritionUniversity of North CarolinaChapel HillNC 27514USA

Purpose:The aim of this study was to review,systematically,evidence concerning the link between the ACTN3 R577X polymorphism and the rates and severity of non-contact injuries and exercise-induced muscle damage in athletes and individuals enrolled in exercise training programs.Methods:A computerized literature search was performed in the electronic databases PubMed,Web of Science,and SPORTDiscus,from inception until November 2020.All included studies compared the epidemiological characteristics of non-contact injury between the different genotypes of the ACTN3 R577X polymorphism.Results:Our search identified 492 records.After the screening of titles,abstracts,and full texts,13 studies examining the association between the ACTN3 genotypes and the rate and severity of non-contact injury were included in the analysis.These studies were performed in 6 different countries(Spain,Japan,Brazil,China,the Republic of Korea,and Italy)and involved a total participant pool of 1093 participants.Of the studies,2 studies involved only women,5 studies involved only men,and 6 studies involved both men and women.All the studies included were classified as highquality studies(≥6 points in the Physiotherapy Evidence Database(PEDro)scale score).Overall,evidence suggests there is an association between the ACTN3 R577X genotype and non-contact injury in 12 investigations.Six studies observed a significant association between A CTN3 R577X polymorphism and exercise induced muscle damage:2 with non-contact ankle injury,3 with non-contact muscle injury,and 1 with overall non-contact injury.Conclusion:The present findings support the premise that possessing the ACTN3 XX genotype may predispose athletes to a higher probability of some non-contact injuries,such as muscle injury,ankle sprains,and higher levels of exercise-induced muscle damage.

关键词： α-actinin-3 deficiency Athletic performance Exercise-related injury Muscle injury Single nucleotide polymorphism

Pluripotent Stem Cells Models for Huntington's Disease:Prospects and Challenges

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Journal of Genetics and Genomics 2012年第6期39卷 253-259页

作者： Richard l. Carter anthony W.S.Chan Yerkes National Primate Research Center 954 Gatewood Rd.N.E.AtlantaGA 39329USA Genetic and Molecular Biology Program Graduate Division of Biologieal and Biomedical SciencesEmory UniversityAtlantaGA 30322USA Department of Human Genetics Emory University School of Medicine615 Michael St.AtlantaGA 30322USA

Pluripotent cellular models have shown great promise in the study of a number of neurological disorders. Several advantages of using a stem cell model include the potential for cells to derive disease relevant neuronal cell types, providing a system for researchers to monitor disease progression during neurogenesis, along with serving as a platform for drug discovery. A number of stem cell derived models have been employed to establish in ~,itro research models of Huntington＇s disease that can be used to investigate cellular pathology and screen lk^r drug and cell-based therapies. Although some progress has been made, there are a number of challenges and limitations that must be overcome before the true potential of this research strategy is achieved. In this article we review current stem cell models that have been reported, as well as discuss the issues that impair these studies. We also highlight the prospective application of Huntington＇s disease stem cell models in the development of novel therapeutic strategies and advancement of personalized medicine.

关键词： Stem cell models Huntington＇s disease Induced pluripotent stem cells Drug discovery