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Pressure Ulcers in Institutionalized Elderly People:Association of Sociodemographic and Clinical Characteristics and Risk Factors

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Open Journal of Nursing 2017年第1期7卷 111-122页

作者： Suellen Duarte de Oliveira Matos Iraktania Vitorino Diniz Adriana Lira Rufino de Lucena Smalyanna Sgren da Costa Andrade Karen Krystine Goncalves de Brito Elizabeth Souza Silva de Aguiar Emanuelle Malzac Freire de Santana Mailson Marques de Sousa Ana Paula Marques Andrade de Souza Hemílio Fernandes Campos Coelho Mirian Alves da Silva Marta miriam Lopes Costa Maria Julia Guimaraes Oliveira Soares Simone Helena dos Santos Oliveira Graduate Program in Nursing Universidade Federal da ParaíbaJoao PessoaBrazil Departament of Statistics Universidade Federal da ParaíbaParaíbaBrazil

Objective: To evaluate the association of socio-demographic and clinical characteristics, and risk factors with occurrence of pressure ulcers in institutionalized elderly people. Method: This cross-sectional, analytical study, in quantitative approach, performed from the database analysis linked to the project “Pressure Ulcer in institutionalized elderly people: Association of incidence with the risk factors to functional and nutritional assessment” developed in six long-stay institutions for the elderly people in João Pessoa. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Associations were made through chi square test and Odds Ratio. Results: The clinical conditions of significant associations with the occurrence of pressure ulcers were the variables neurological disorders (p = 0.011) and visual impairment (p = 0.005). As for risk factors, the most important was fecal incontinence (p Conclusion: The analysis of the associations pointed out problems that require intervention in order to prevent health implications of the elderly people and to minimize the risk and occurrence of this injury.

关键词： Elderly People Institutions for the Elderly People Pressure Ulcer Health Profile Risk Factors

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Advanced Stage Stuck Gland Adenocarcinoma:Case Report

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Modern Research in Inflammation 2020年第1期9卷 1-7页

作者： miriam Viviane Baron Michele Paula dos Santos Gabriela Di Lorenzo Garcia Scherer Luis Manuel Ley Dominguez Vitoria Pereira Itaquy Natalia Cardoso Nascimento Fernanda Nerys Tais Michele Werle Carolina Paz Mohamad Isa Carina Marangoni Mariana Martins Dantas Santos Marcus Vinicius de Mello Pinto Janine Koepp Daiana Klein Weber Carissimi Joice Nedel Ott Carolina Goncalves Pinheiro Nathália Ken Pereira Iketani Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Improvement of Higher Education Personnel Brazil(CAPES)Distrito FederalBrazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Celulare Institute PetrópolisRio de JaneiroBrazil Undergraduate Nursing Course of the University of Santa Cruz do Sul(UNISC) Santa Cruz do SulBrazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC(FMABC) Sao PauloBrazil Undergraduate Physiotherapy Course of the Vale do Salgado Faculty(FVS) CearáBrazil Physiotherapy of the Hospital Beneficiente Portuguesa of Belém ParáBrazil

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.

关键词： Parotid Neoplasms Cancer of the Parotid Palliative Care Critical Care

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投资俄罗斯的危险与前景

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商业周刊（中文版） 2010年第1期 74-77页

作者：卡罗尔·马特莱克（Carol Matlack）米里亚姆·埃德尔（miriam Elder）陈逸（译）

虽然这个国家属高风险地区，但对于跨国公司来说，它实在太大太富有。

关键词：俄罗斯危险投资跨国公司高风险

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Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report

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Advances in Lung Cancer 2021年第3期10卷 40-47页

作者： miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Célia Regina Martins Korzenieski Julia Braga da Silveira Carolina Boeira Soares Carina Marangoni Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Joice Nedel Ott Isabel Cristina Reinheimer Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Danielle de Mello Florentino Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&#227 o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Federal University of Ceará (UFC) Fortaleza Brazil Uniredentor University Rio de Janeiro Brazil Centro Universitário do Rio Grande do Norte Natal RN Brazil

Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.

关键词： Acute Kidney Injury Febrile Neutropenia Sepsis Chemotherapy

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Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

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Open Journal of Gastroenterology 2021年第6期11卷 81-88页

作者： miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil Industrial University of Santander (UIS) Bucaramanga Colombia University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Uniredentor University Rio de Janeiro Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC) S&#227o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Rigshospital Copenhagen East K&#248benhavn Denmark Centro Universitário do Rio Grande do Norte Natal Brazil

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

关键词： Ascites Hypernatremia Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy

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娇嫩翠春

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现代装饰（家居） 2015年第4期 64-69页

作者： Charlotte Ronfaut Donald Corey Hallgeir Homstvedt Ivan Kasner Uli Budde Ineke Hans John Brauer Marta Sansoni miriam Mirri Nir Meiri Ola Giertz Quentin de Coster Ryosuke Fukusada Rui Pereira Rami Tiihonen Steve Buss Simon Stevens Serge Atallah 伏平范嘉苑

当三月悄悄地溜走,生机盎然的四月也就这样来到了。如果说冬天是轻描淡写的素雅,那么四月的春天肯定是浓墨重彩的一笔,整个世界被郁郁葱葱的绿意笼罩着,那嫩嫩的黄、新鲜的绿由浅及浓,盈盈环绕,在一阵阵微风中,也能闻到被风薰绿的春草气... 详细信息

当三月悄悄地溜走,生机盎然的四月也就这样来到了。如果说冬天是轻描淡写的素雅,那么四月的春天肯定是浓墨重彩的一笔,整个世界被郁郁葱葱的绿意笼罩着,那嫩嫩的黄、新鲜的绿由浅及浓,盈盈环绕,在一阵阵微风中,也能闻到被风薰绿的春草气息,清新地沁入心扉,令你心旷神怡无比惬意。喜欢绿色的纤尘不染,喜欢它的朝气蓬勃。久居都市,人本能地逐渐开始向钢筋水泥妥协,喧闹的街头、拥堵的车流令人烦心,更令你怀念那古木成林、鸟语花香的自然。那何不将一些可爱的绿色单品请入家中,

关键词：室内装饰装饰材料环保材料现代装饰

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门诊成人社区获得性肺炎的危险因素:生活方式和共病条件(NEUMO-ES-RISK项目)

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英国医学杂志中文版 2019年第8期22卷 483-483页

作者： Irene Rivero-Calle miriam Cebey-López Jacobo Pardo-Seco José Yuste Esther Redondo Diego A Vargas Enrique Mascarós Jose Luis Díaz-Maroto Manuel Linares-Rufo Isabel Jimeno Angel Gil Jesus Molina Daniel Ocana Federico Martinón-Torres 崔晓霞(译) 不详北京协和医院呼吸科

背景社区获得性肺炎(CAP)风险在初级保健中的信息是有限的。我们评估了不同生活方式和共病条件作为初级保健成人CAP的危险因素。方法一项回顾性观察对照研究。使用国家初级保健数据监测系统检索了2009至2013年在西班牙初级保健部门诊断... 详细信息

背景社区获得性肺炎(CAP)风险在初级保健中的信息是有限的。我们评估了不同生活方式和共病条件作为初级保健成人CAP的危险因素。方法一项回顾性观察对照研究。使用国家初级保健数据监测系统检索了2009至2013年在西班牙初级保健部门诊断的成人CAP病例。匹配年龄和匹配性别的对照组采用发病率密度抽样(比例2∶1)。以百分比和比值比来表示关联分析。为了避免偏倚效应,建立二项回归模型。结果51 139例患者和102 372例对照组做比较。平均年龄为61.4(19.9)岁。危险因素与CAP的显著相关性如下:艾滋病[比值比(95%可信区间)5.21(4.35~6.27)]、慢性阻塞性肺病(COPD)[2.97(2.84~3.12)]、哮喘[2.16(2.07~2.26)]、吸烟[1.96(1.91~2.02)]和口腔卫生问题[1.45(1.41~1.49)]。患者组中有危险因素存在的平均患病率为82.2%,对照组为69.2%。CAP患病率的增加与危险因素和年龄的累积有关:1个危险因素时,在18~60岁老人中的风险相关性是1.42,在>60岁人中是1.57;2个危险因素时,是1.88和2.35;≥3个危险因素时,是3.11和4.34。结论成人CAP初级保健中的危险因素普遍较高。主要与危险因素相关的是艾滋病、COPD、哮喘、吸烟、口腔卫生问题。我们的风险叠加结果可以帮助临床医生确定肺炎风险较高的患者。

关键词：社区获得性肺炎危险因素生活方式成人共病慢性阻塞性肺病初级保健门诊

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动脉瘤性蛛网膜下腔出血患者的重症监护处理：神经危重症监护学会多学科共识会议的推荐意见

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国际脑血管病杂志 2013年第5期21卷 324-347页

作者： Michael N. Diringer Thomas P. Bleck J. Claude Hemphill David Menon Lori Shutter Paul Vespa Nicolas Bruder E. Sander Connolly Jr Giuseppe Citerio Daryl Gress Daniel Hanggi Brian L. Hoh Giuseppe Lanzino Peter Le Roux Alejandro Rabinstein, Erich Schmut zhard Nino Stocchetti Jose I. Suarez miriam Tresgiari Ming-Yuan Tseng Mervyn D. I. Vergouwen Stefan Wolf Gregory Zip fel 田飞(译) 宿英英(译) From the Neurology/Neurosurgery Intensive Care Unit Washingion University St. Louis MO USA Rush Medical College Chicago IL USA University of California at San Francisco San Francisco CA USA University of Cambridge Cambridge UK University of Cincinnati Cincinnati OH USA University of California at Los Angeles LOs Angeles CA USA Universit6 de la M.diterranae Marsedle France Columbia University New York NY USA San Gerardo Hospital Monza Italy University of Virginia Charlottesville VA USA Heinrich-Heine University Dttsseldorf Germany University of Florida Gainesville FL USA Mayo Clinic Rochester MN USA University of Pennsylvania Philadelphia PA USA University Hospital Innsbruck lnnsbruck Austria Fondazione IRCCS Ch Granda- Ospedale Policlinico Milan University Milan Italy University of Washington St. Louis MO USA Baylor College of Medicine Houston TX USA Nottingham University Hospitals Nottingham UK University of Utrecht Utrecht The Netherlands Freie Universitit Berlin Berlin Germany Washington University St. Louis MO USA 首都医科大学宣武医院神经内科北京100053

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法... 详细信息

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法各异，可供选择的指导意见不多。现有的指南主要强调危险因素、预防、自然史以及再出血的预防，很少涉及SAH患者的重症监护问题。美国神经危重症监护学会组织了一次国际性多学科共识会议来探讨SAH的重症监护处理。根据发表的文章和研究领域，此次会议召集了来自欧洲和北美地区的神经重症监护科、神经外科、神经内科、介入神经放射科和神经麻醉科方面的专家。根据临床经验和制定实践指南方面的经验，选择4名经验丰富的神经重症监护专家组成评判委员会。应用推荐分级的评估、制定与评价（GradesofRecommendationsAssessment，DevelopmentandEvaluation，GRADE）系统进行文献回顾，结合参会者的经验、评判委员会的审评以及文献讨论产生推荐意见。应用GRADE系统制定推荐意见，其制定原则不仅强调研究资料的质量，而且还重视利弊权衡与实践转化。对SAH患者日常处理过程中面临的所有问题均提供指导和推荐意见，即使缺乏高质量的证据。

关键词：蛛网膜下腔出血重症监护动脉瘤血管痉挛抗惊厥药低钠血症血管内发热

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使用Stratus OCT快速测量黄斑厚度地形图的可重复性和重复能力

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美国医学会眼科杂志（中文版） 2006年第4期18卷 245-245页

作者： Antonio Polito Michele Del Borrello miriam Isola Nicola Zemella Francesco Bandello 陈慧瑾（译）

目的：确定使用Stratus OCT快速测量黄斑厚度地形图的标准程序进行视网膜厚度测量的可重复性和重复能力。

关键词：可重复性黄斑厚度快速测量地形图 OCT 厚度测量标准程序

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“人工智能”责任的法经济学

数字法学评论

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数字法学评论 2024年第1期 83-131页

作者：米里亚姆·布伊顿亚历山大·德·斯特里尔马丁·佩茨单娟瑞士圣加仑大学法学院欧盟监管中心那慕尔大学数字研究所德国曼海姆大学经济系、竞争与改革研究中心山东科技大学文法学院

人工智能系统的应用给责任规则带来了挑战。本文指出了这些挑战，并评估了应如何调整相关责任规则以应对这些挑战。本文讨论了人工智能系统不可预测或(半)自主运行时产生的责任漏洞，同时讨论了当人工智能系统中的错误难以被生产者预见... 详细信息

人工智能系统的应用给责任规则带来了挑战。本文指出了这些挑战，并评估了应如何调整相关责任规则以应对这些挑战。本文讨论了人工智能系统不可预测或(半)自主运行时产生的责任漏洞，同时讨论了当人工智能系统中的错误难以被生产者预见，以及用户的监控责任难以界定时，如何证明过失和因果关系的问题。从经济学角度来看，本文考虑了什么样的责任规则能使与人工智能相关的损害成本最小化。基于对风险和最佳责任规则的分析，本文对欧盟最近发布的《产品责任指令》和《人工智能责任指令》提案进行了评估。

关键词：人工智能责任欧盟法

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