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the complexity of providing humanitarian surgical care in armed conflict: a framework to help categorize needs

Emergency and Critical Care Medicine 2022年第2期2卷 41-44页

作者： Kevin Gianaris barclay t.stewart Sherry M.Wren Adam L.Kushner Indiana University School of Medicine IndianapolisINUSA Department of Surgery University of WashingtonSeattleWAUSA Harborview Injury Prevention and Research Center University of WashingtonSeattleWAUSA Department of Surgery Stanford UniversityPalo AltoCAUSA Surgeons OverSeas New York CityNYUSA Department of International Health Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA

Armed conflicts are increasing globally due to political unrest and the broader effects of climate *** resources to provide quality surgical care,it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income *** understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict,a matrix to identify variables and help with interventions was *** published global surgery matrix based on the PIPES(Personnel,Infrastructure,Procedures,Equipment and Supplies)surgical capacity tool was adapted to this *** novel matrix incorporates 108 *** variables are grossly divided into local and international agency components to address the issue of who is providing *** a time continuum of pre-conflict,conflict,and post-conflict allows organizations to concentrate on when during the conflict to target their *** addition to the previously used personnel,infrastructure,procedures,equipment,and supplies categories,a sixth category called standards was included that addresses the issues such as information technology,data systems,quality improvement programs,and patient *** testing of this matrix to obtain feedback from end users is the next step in ***,peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.

关键词： Armed conflict Emergency care Global surgery Humanitarian assistance trauma care

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techniques and strategies for regional anesthesia in acute burn care—a narrative review

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Burns & trauma 2021年第1期9卷 383-392页

作者： Clifford C.Sheckter barclay t.stewart Christopher Barnes Andrew Walters Paul I.Bhalla tam N.Pham Department of Surgery UWMedicine Regional Burn Center at Harborview Medical CenterUniversity ofWashington3259th Ave.SeattleWA 98104USA Harborview Injury Prevention and Research Center University ofWashington401 Broadway.SeattleWA 98122USA Department of Anesthesia and Pain Medicine Harborview Medical Center.University ofWashington3259th Ave.SeattleWA 98104USA

Burn injuries and their treatments result in severe *** traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(*** pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/*** infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane *** lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient *** centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural *** of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve ***,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.

关键词： Burn Regional anesthesia Nerve block Epidural Nerve catheter Pain

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NOD2 and AtG16L1 polymorphisms affect monocyte responses in Crohn's disease

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World Journal of Gastroenterology 2011年第23期17卷 2829-2837页

作者： Dylan M Glubb Richard B Gearry Murray L barclay Rebecca L Roberts John Pearson Jacqui I Keenan Judy McKenzie Robert W Bentley Department of Medicine University of ChicagoIL 60637-1470United States Department of Medicine University of OtagoChristchurch8140New Zealand Department of Gastroenterology Christchurch HospitalChristchurch8140New Zealand Department of Biochemistry University of OtagoDunedin9054New Zealand Department of Pathology University of OtagoChristchurch8140New Zealand Department of Surgery University of OtagoChristchurch8140New Zealand Department of Haematology University of OtagoChristchurch8140New Zealand Department of Paediatrics University of OtagoChristchurch8140New Zealand

AIM:to assess whether polymorphisms in NOD2 and AtG16L1 affect cytokine responses and mycobacterium avium subspecies paratuberculosis (MAP) survival in monocytes from Crohn's disease (CD) ***:Monocytes were isolated from peripheral blood of CD patients of known genotype for common single nucleotide polymorphisms of NOD2 and *** were challenged with MAP and bacterial persistence assessed at subsequent *** responses were assayed using a Milliplex multi-analyte profiling assay for 13 ***:Monocytes heterozygous for a NOD2 polymorphism (R702W,P268S,or 1007fs) were more permissive for growth of MAP (P=0.045) than those *** was no effect of NOD2 genotype on subsequent cytokine *** t300A polymorphism ofAtG16L1 did not affect growth of MAP in our model (P=0.175),but did increase expression of cytokines interleukin (IL)-10 (P=0.047) and IL-6 (P=0.019).CONCLUSION:CD-associated polymorphisms affected the elimination of MAP fromex vivo monocytes (NOD2),or expression of certain cytokines (AtG16L1),implying independent but contributory roles in the pathogenesis of CD.

关键词：单核苷酸多态性单核细胞反应细胞因子结核分枝杆菌白细胞介素基因多态性 MAP

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肩部骨关节炎的治疗

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中国继续医学教育 2009年第1期1卷 46-48页

作者： Laurie barclay Hien t.Nghiem 乔政孙天胜

根据肩部骨关节炎的严重程度,其治疗方法包括物理治疗、口服消炎镇痛类药物治疗、注射皮质类固醇和手术治疗。肩部骨关节炎是—种肩关节变性病,主要是关节软骨和其他关节组织,如骨和关节囊发生渐进性的机械性和生物化学损伤。随着关节... 详细信息

根据肩部骨关节炎的严重程度,其治疗方法包括物理治疗、口服消炎镇痛类药物治疗、注射皮质类固醇和手术治疗。肩部骨关节炎是—种肩关节变性病,主要是关节软骨和其他关节组织,如骨和关节囊发生渐进性的机械性和生物化学损伤。随着关节面的磨损,关节内部的摩擦增加,引起正常的负载支撑表面逐渐损耗,从而引发疼痛和功能障碍。

关键词：骨关节炎关节置换术退行性关节病肩袖撕裂皮质类固醇物理治疗关节镜关节囊治疗无效治疗方法

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Single nucleotide polymorphism in the tumor necrosis factor-alpha gene affects inflammatory bowel diseases risk

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World Journal of Gastroenterology 2008年第29期14卷 4652-4661页

作者： Lynnette R Ferguson Claudia Huebner Ivonne Petermann Richard B Gearry Murray L barclay Pieter Demmers Alan McCulloch Dug Yeo Han Discipline of Nutrition the University of AucklandPrivate Bag 92019 Auckland 1142 New Zealand Department of Gastroenterology Christchurch HospitalChristchurch 8140 New Zealand Crop and Food Research Mosgiel 9053 New Zealand AgResearch Limited Mosgiel 9053 New Zealand

AIM: to investigate the role that single nucleotide polymorphisms (SNPs) in the promoter of the tumour necrosis factor-alpha (tNF-α) gene play in the risk of inflammatory bowel diseases (IBDs) in a New Zealand population, in the context of international studies. MEtHODS: DNA samples from 388 patients with Crohn's disease (CD), 405 ulcerative colitis (UC), 27 indeterminate colitis (IC) and 201 randomly selected controls, from Canterbury, New Zealand were screened for 3 common polymorphisms in the tNF-α receptor: -238 G→A, -308 G→A and -857C→t, using a taqmanR assay. A meta-analysis was performed on the data obtained on these polymorphisms combined with that from other published studies. RESULtS: Individuals carrying the -308 G/A allele had a significantly (OR = 1.91, χ2 = 17.36, P tis, and a 1.57-fold increased risk (OR = 1.57, χ2 = 4.34, P = 0.037) of requiring a bowel resection in UC. Carrying the -857 C/t variant decreased the risk of ileocolonic CD (OR = 0.56, χ2 =4.32, P = 0.037), and the need for a bowel resection (OR = 0.59, χ2 = 4.85, P = 0.028). the risk of UC was reduced in individuals who were smokers at diagnosis, (OR = 0.48, χ2 = 4.86, P = 0.028). CONCLUSION: tNF-α is a key cytokine known to play a role in inflammatory response, and the locus for the gene is found in the IBD3 region on chromosome 6p21, known to be associated with an increased risk for IBD. the -308 G/A SNP in the tNF-α promoter is functional, and may account in part for the increased UC risk associated with the IBD3 genomic region. the -857 C/t SNP may decrease IBD risk in certain groups. Pharmaco- or nutrigenomic approaches may be desir- able for individuals with such affected genotypes.

关键词：肿瘤坏死因子基因多态性肠溃疡结肠疾病

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全科医生对虚弱老年人预立临终照护计划的看法:定性研究

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中国全科医学 2018年第6期 632-632页

作者： SHARP t MALYON A barclay S 本刊编辑部

背景身体虚弱老年人约占死亡人数的40%。临终照护是国家临终护理战略的重要组成部分,虽然目前大多数人愿意讨论临终照护,却仅有少数人真正这么做。目的调查全科医生对虚弱老年人预立临终照护计划(ACP)的态度。设计及场所2015年9月—2016... 详细信息

背景身体虚弱老年人约占死亡人数的40%。临终照护是国家临终护理战略的重要组成部分,虽然目前大多数人愿意讨论临终照护,却仅有少数人真正这么做。目的调查全科医生对虚弱老年人预立临终照护计划(ACP)的态度。设计及场所2015年9月—2016年1月,在剑桥郡进行全科医生焦点小组研究。方法有目的地最大化多样性选取21名全科医生组成5个焦点小组。采用框架分析方法,解读小组文字记录并生成主题。结果虽然部分全科医生担心ACP可能会造成患者及其亲属的痛苦,但大多数全科医生仍认为提倡ACP是非常必要的,尤其是应对患者可能发生的紧急情况。服务人员应切实了解患者需求,在与患者讨论中充分介绍ACP并提高公众的ACP意识。部分全科医生认为,由于服务上的局限性,ACP很难达到患者的期许,而且可能使患者抱有不切实际的期望。其他反对意见包括预后的不确定性和个人意愿得不到尊重等。结论大多数全科医生认为ACP是有必要的,而现实则不然。本研究突出了因医疗和社会护理系统的限制,鼓励患者讲出其需求与尊重患者个人意愿之间的困难。全国范围的宣传活动和引导患者优先考虑医疗保健,有利于全科医生在提出ACP护理的同时,既不对患者造成伤害又不使患者抱有不切实际的期望。一旦患者同意ACP护理,医生需要记录患者意愿,并由相关医疗和社会护理服务人员审核,以确保患者意愿得到尊重,并根据患者情况变化调整护理计划。

关键词：全科医生 ACP 焦点小组老年人

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t-PA有助于急性中风的治疗

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中国处方药 2005年第2期4卷 86-86页

作者： Laurie barclay 杨麟

据近期出版的杂志报道,NLNDS(国家精神病及中风研究院)对静脉给药的组织型纤溶酶原激活剂(t-PA)重新进行了评价,认为t-PA有助于缺血性中风的紧急处理.

关键词： t—PA 治疗急性中风静脉给药缺血性中风紧急处理组织型纤溶酶原激活剂出版杂志研究院

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Diterpenoids from Scutellaria barbata induce tumour-selective cytotoxicity by taking the brakes off apoptosis

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Medicinal Plant Biology 2022年第1期1卷 8-23页

作者： Matthew L.tomlinson Man Zhao Elaine J.barclay Jie Li Haixiu Li Juri Felix Lionel Hill Gerhard Saalbach Martin Rejzek Dongfeng Yang Qing Zhao Paul Kroon Wei Wang Yongping Bao Melanie-Jayne R.Howes Evangelos C.tatsis Cathie Martin the John Innes Centre NorwichNR47UHUnited Kingdom College of Bioengineering and Biotechnology Zhejiang University of TechnologyHangzhou 310058China National Key Laboratory of Plant Molecular Genetics CAS Center for Excellence in Molecular Plant SciencesShanghai Institute of Plant Physiology and EcologyChinese Academy of SciencesShanghai 200032China Royal Botanic Gardens Kew RichmondSurreyLondon TW93ABUnited Kingdom College of Life Sciences Zhejiang Sci-Tech UniversityXiasha Higher Education ZoneHangzhou 310018China Shanghai Key Laboratory of Plant Functional Genomics and Resources Shanghai Chenshan Botanical GardenShanghai Chenshan Plant Science Research CenterChinese Academy of SciencesShanghai 201602China Quadram Institute Bioscience Norwich Research ParkNorwichNR47UAUnited Kingdom Norwich Medical School University of East AngliaNorwichNorfolkNR47TJUnited Kingdom CEPAMS:CAS-JIC Centre of Excellence in Plant and Microbial Sciences

Medicinal plants are an excellent source of structurally diverse,bio-active compounds with potential in the fight against *** of the most promising is Scutellaria barbata,prescribed traditionally for the treatment of *** A is the major diterpenoid,produced in specialized large,peltate trichomes on leaves of *** induces dose-dependent apoptosis,specifically in cancer *** major class of proteins down-regulated are pro-survival proteins,the Inhibitors of Apoptosis(IAPs),and IAP regulating *** propose that scutebarbatine A works by releasing the molecular brakes(the IAPs)on apoptosis in cell death-evading cancer *** between the cytotoxicity of methanolic extracts of *** leaves and decoctions(Ban Zhi Lian)prepared traditionally,showed substantially different chemical compositions and differential induction of *** suggest polyvalency between the constituents in both extracts,and ways to produce enhanced chemopreventive preparations for the treatment of cancer.

关键词： prescribed methanol structurally

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