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Sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 413-423页

作者： Saqib Walayat Peter Stadmeyer Azfar Hameed Minahil Sarfaraz paul Estrada Mark Benson Anurag Soni Patrick Pfau paul Hayes Brittney Kile Toni Cruz Deepak Gopal Department of Gastroenterology University of IllinoisPeoriaIL 61605United States Department of Gastroenterology University of WisconsinMadisonWI 53792United States Department of Internal Medicine Texas Health DentonDentonTX 76201United States Department of Internal Medicine Allama Iqbal Medical CollegeLahore 042Pakistan Department of Gastroenterology Texas Tech University Health Services CenterEl PasoTX 79911United States Department of Gastroenterology and Hepatology University of WisconsinMadisonWI 53705United States Finance Business Partners UW Health University of WisconsinMadisonWI 53792United States UW Health Digestive Health Center Endoscopy University of WisconsinMadisonWI 53792United States Division of Gastroenterology and Hepatology Department of MedicineUniversity of Wisconsin Hospitals and ClinicsMadisonWI 53705United States

BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal *** needs to be reported on rates of reversal across different outpatient *** academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their ***,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage *** To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal *** We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September *** were stratified to their respective sites using a triage *** evaluated each procedure for which sedation reversal with flumazenil and naloxone was *** and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation *** There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study *** these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxo

关键词： Ambulatory care Conscious sedation Endoscopy Colonoscopy Risk assessment Risk factors

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Cell-cell interactions and communication dynamics in lung fibrosis

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Chinese Medical Journal Pulmonary and Critical Care Medicine 2024年第2期2卷 63-71页

作者： Ting Xie Jiurong Liang Barry Stripp paul W.Noble Division of Pulmonary and Critical Care Medicine Department of MedicineWomen’s Guild Lung InstituteCedars-Sinai Medical CenterLos AngelesCA 90048USA

Cell-cell interactions are essential components of coordinated cell function in lung *** diseases involve altered cell-cell interactions and communication between different cell types,as well as between subsets of cells of the same *** identification and understanding of intercellular signaling in lung fibrosis offer insights into the molecular mechanisms underlying these interactions and their implications in the development and progression of lung fibrosis.A comprehensive cell atlas of the human lung,established with the facilita-tion of single-cell RNA transcriptomic analysis,has enabled the inference of intercellular communications using ligand-receptor *** this review,we provide a comprehensive overview of the modified cell-cell commu-nications in lung *** highlight the intricate interactions among the major cell types within the lung and their contributions to *** insights presented in this review will contribute to a better understand-ing of the molecular mechanisms underlying lung fibrosis and may guide future research efforts in developing targeted therapies for this debilitating disease.

关键词： Cell–cell interaction Lung fibrosis Lung homeostasis Targeted therapies

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Concentration of Copper, Zinc, Lead, Cadmium, and Nickel in the Incinerator Bottom Ash in Five County Hospitals in Kenya

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Journal of Geoscience and Environment Protection 2024年第6期12卷 90-114页

作者： Muriithi J. Githinji paul M. Njogu Zipporah Nganga Mohamed Karama Institute of Tropical Medicine and Infectious Diseases (ITROMID) Jomo Kenyatta University of Agriculture and Technology (JKUAT) Nairobi Kenya Institute of Energy and Environmental Technology Jomo Kenyatta University of Agriculture and Technology (JKUAT) Nairobi Kenya Academic Research and Student Affairs South Eastern Kenya University Kitui Kenya School of Public Health Amref International University Nairobi Kenya

Healthcare wastes contain potentially harmful microorganisms, inorganic and organic compounds that pose a risk to human health and the environment. Incineration is a common method employed in healthcare waste management to reduce volume, quantity, toxicity as well as elimination of microorganisms. However, some of the substances remain unchanged during incineration and become part of bottom ash, such as heavy metals and persistent organic pollutants. Monitoring of pollution by heavy metals is important since their concentrations in the environment affect public health. The goal of this study was to determine the levels of Copper (Cu), Zinc (Zn) Lead (Pb), Cadmium (Cd) and Nickel (Ni) in the incinerator bottom ash in five selected County hospitals in Kenya. Bottom ash samples were collected over a period of six months. Sample preparation and treatment were done using standard methods. Analysis of the heavy metals were done using atomic absorption spectrophotometer, model AA-6200. One-Way Analysis of Variance (ANOVA) was performed to determine whether there were significant differences on the mean levels of Cu, Zn, Pd, Cd and Ni in incinerator bottom ash from the five sampling locations. A post-hoc Tukey’s Test (HSD) was used to determine if there were significant differences between and within samples. The significant differences were accepted at p ≤ 0.05. To standardize the results, overall mean of each metal from each site was calculated. The metal mean concentration values were compared with existing permissible levels set by the WHO. The concentrations (mg/kg) were in the range of 102.27 - 192.53 for Cu, Zn (131.68 - 2840.85), Pb (41.06 - 303.96), Cd (1.92 - 20.49) whereas Ni was (13.83 - 38.27) with a mean of 150.76 ± 77.88 for Copper, 131.66 ± 1598.95 for Zinc, 234.60 ± 262.76 for Lead, 12.256 ± 10.86 for Cadmium and 29.45 ± 18.24 for Nickel across the five sampling locations. There were significant differences between levels determined by one-way ANOVA of Zn (

关键词： Healthcare Waste Disposal Public Health Environment Incineration Heavy Metals Bottom Ash

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The Timing of Primary Neurosurgical Repair and Wound-Site Infection in Children with Myelomeningocele

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Open Journal of Modern Neurosurgery 2024年第2期14卷 137-148页

作者： Joseph O. Obande paul T. Bitrus Elizabeth I. Obande Division of Neurosurgery Department of Surgery University of Abuja Teaching Hospital Abuja Nigeria Post-Basic School of Critical Care Nursing University of Abuja Teaching Hospital Abuja Nigeria

Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.

关键词： Spina Bifida Surgical Timing Excision and Repair Surgical Site Infection Myelomeningocele

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Dynamics of Potable Well Water Quality in Key Mining Chiefdoms in Kono District, Eastern Sierra Leone

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Open Journal of Applied Sciences 2024年第7期14卷 1927-1943页

作者： Richard Tamba Simbo Alhaji Brima Gogra Yahaya Kudus Kawa Juana paul Moiwo Department of Science and Mathematics College of Arts and Sciences William V.S. Tubman University Harper Liberia Port Loko University College Campus Ernest Bai Koroma University of Science and Technology Port Loko Sierra Leone Department of Chemistry School of Basic Sciences Njala University Bo Sierra Leone Department of Agricultural Engineering School of Technology Njala University Bo Sierra Leone

Groundwater is increasingly being used due to its universal availability and generally good quality. However, the risk of contamination of groundwater due to various human activities such as mining is equally increasing across the globe. In this study, the physical parameters of potable well waters in the key mining areas in Nimikoro and Tankoro Chiefdoms in Kono District were analyzed for compliance with drinking water quality standard. To do this, both unpurged and purged well water samples were collected once every month for a period of one year. Some of the well water properties like temperature, Total Dissolved Solids (TDS) and Electrical Conductivity (EC) were measured on site and others determined in the laboratory. The data collected from the laboratory analyses were statistically analyzed in MS Excel, SPSS and ArcGIS environments for quality trends in time-space fabric. The results showed that well water quality in the study area generally fell short of drinking water quality standards of Sierra Leone and WHO. There were high temperature and turbidity during the dry season and then high TDS and EC during the rainy season. Temperature and turbidity also significantly influenced well water quality in the study area, much more than TDS and EC. The implications for drinking water of lower quality than the standard could be huge for the local population and therefore needs the attention of stakeholders in the study area and decision makers in the country.

关键词： Temperature Total Dissolved Solids Turbidity Electrical Conductivity Water Quality

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Rare-Element Pegmatites Rocks Rich and Li of the Aïr Massif of the Tchirozerine: Mineralogy and Chemical Composition Agadez Region-Northem Niger

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Open Journal of Applied Sciences 2024年第1期14卷 171-181页

作者： Ntoumbé Mama Hamza Bassara Amaya Adama Awona paul Zéphyrin Nomenjanahary Limbisoa Department of Mines Geology School of Geology and Mining Engineering University of Ngaoundere Meiganga Cameroon Department of Geology Faculty of Sciences and Technic University of Abdou Moumouni Niger Department of Geomatic and Geology Mapping School of Geology and Mining Engineering University of Ngaoundere Meiganga Cameroon National Advance School of Engineering of Yaounde Yaounde Cameroon School of Thematic Doctoral Faculty of Sciences University of Antsiranana Antsiranana Madagascar

The lithium potential in the Aïr massif is represented by mineral index of spodumene pegmatites and, lepidolite pegmatites. The mineral deposits of lithium occur in cluster or veins that cut the host rock or are located near the contact between the greenstone belt and granitic massif. The evidence of lithium is in the form of clusters or disseminated and stockwerk. Mineralogical characteristics show similarities between the Air Massif pegmatites and indicate the same homogenous source during the magma-generation process. The pegmatite rocks attracted the attention due to their wide exposure and composition, well appearance, and economically hosting of significant rare earth metals such as Sn and W. The mineralogical and petrographical investigations on the eight pegmatites rocks samples observed have a relative similarity, while a little difference in the shapes attributed to the ratio in the pegmatite rocks of the minerals. The occurrence of the kink band indicates the influence of the tectonic processes which affected the Aïr massif after the emplacement of late magmatic or post-magmatic pegmatites by injection into fractured rocks in the upper part of the crust. The Air Massif pegmatite has higher concentrations Li and of all trace elements except Hf and occasionally Zr, Ti, Sn and Mg of for the economic exploration.

关键词： Pegmatite Lithium Rare Elements Hydrothermal Processes Aïr Massif

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Lactobacillus acidophilus and Bifidobacterium breve alleviate neonatal maternal separation induced visceral hypersensitivity and non-spatial memory impairment in rats by the NGF/TrkA pathway

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Food Science and Human Wellness 2024年

作者： Chi Chen Bowen Li Mengfan Ding Huizhen Li Jianxin Zhao R.paul Ross Catherine Stanton Wei Chen Bo Yang State Key Laboratory of Food Science and Resources， Jiangnan University School of Food Science and Technology， Jiangnan University International Joint Research Center for Probiotics & Gut Health， Jiangnan University APC Microbiome Ireland， University College Cork Teagasc Food Research Centre， Moorepark National Engineering Research Center for Functional Food， Jiangnan University

Irritable bowel syndrome-diarrhea （IBS-D） is a prevalent functional bowel disease severely impairs the quality of life of patients. Visceral hypersensitivity （VH） is the main symptom of IBS-D. Probiotics have been found to effectively alleviate VH. In this study， neonatal maternal separation （NMS） was used to induce VH in 72 rats and investigated the effects of daily gavage of 3*109CFU of Lactobacillus and Bifidobacterium on alleviating the symptoms of IBS-D and behavioral interventions， as well as exploring potential mechanisms. The results demonstrated that Lactobacillus acidophilus and Bifidobacterium breve could alleviate the symptoms of IBS-D such as VH and increased frequency of bowel movements， as well as improving non-spatial memory in NMS rats. These effects were achieved by modulating the composition of gut microbiota and metabolites （including short-chain fatty acids， deoxycholic acid and adenosine）， and by regulating the expression of genes and proteins associated with the NGF/TrkA signaling pathway， tryptophan metabolism， and inflammatory factors in the hippocampus. This finding suggests that Lactobacillus acidophilus and Bifidobacterium breve have promising potential for the alleviation of IBS.

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Infant feces-derived Bifidobacterium breve CCFM1078 inhibits the occurrence of rheumatoid cachexia by IRS1/PI3K/Akt signaling pathway

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Food Science and Human Wellness 2024年

作者： Bowen Li Mengfan Ding Chen Chi Guoxun Shi Xiaoming Liu Jianxin Zhao paul Ross Catherine Stanton Wei Chen Bo Yang State Key Laboratory of Food Science and Resources， Jiangnan University School of Food Science and Technology， Jiangnan University Department of Rheumatology， Jiangnan University Medical Center International Joint Research Center for Probiotics & Gut Health， Jiangnan University APC Microbiome Ireland， University College Cork Teagasc Food Research Centre National Engineering Research Center for Functional Food， Jiangnan University

This study aimed to investigate the effects of infant feces-derived Bifidobacterium breve CCFM1078 on rheumatoid cachexia （RC）. Twenty-four female Wistar rats were assigned to three groups: CON group （normal saline by gavage）， CIA group （collagen-induced arthritis， normal saline by gavage）， and CCFM1078 group (collagen-induced arthritis， 3×109CFU/rat/day B breve CCFM1078 gavage). The results demonstrated that B. breve CCFM1078 not only improved skeletal muscle function in CIA rats， but also modulated the gut microbiota， skeletal muscle metabolism and hormone levels， reduced inflammation in the knee joint and skeletal muscles， decreased activity of the NF-κB inflammatory signaling pathway， enhanced the IRS1/PI3K/Akt signaling pathway， promoted skeletal muscle differentiation， and maintained skeletal muscle fiber diameter， consequently slowing down the progression of RC. These findings suggested that B. breve CCFM1078 may have a beneficial role as part of a dietary intervention for RC， enhancing overall therapeutic effects.

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A randomized controlled trial of Promoting Physical Activity in Regional and Remote Cancer Survivors(PPARCS)

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Journal of Sport and Health Science 2024年第1期13卷 81-89页

作者： Sarah J.Hardcastle Chloe Maxwell-Smith Vinicius Cavalheri Terry Boyle Marta Leyton Román Cameron Platell Michael Levitt Christobel Saunders Frank Sardelic Sophie Nightingale Jacob McCormick Craig Lynch paul A.Cohen Max Bulsara Dana Hince Sport and Physical Activity Research Centre Sheffield Hallam UniversitySheffieldS102BPUK Institute for Health Research The University of Notre DameFremantleWA 6959Australia Curtin School of Population Health Curtin UniversityPerthWA 6845Australia Curtin School of Allied Health Curtin UniversityPerthWA 6845Australia Allied Health South Metropolitan Health ServiceMurdochWA 6150Australia Australian Centre for Precision Health University of South AustraliaAdelaideSA 5001Australia Department of Didactics of Musical Plastic and Body ExpressionUniversity of ExtremaduraCaceres 10071Spain St.John of God Subiaco Hospital PerthWA 6008Australia Department of Surgery University of MelbourneMelbourneVIC 3010Australia Tamara Private Hospital TamworthNSW 2340Australia Peter MacCallum Cancer Centre MelbourneVIC 3000Australia College of Health and Medicine Australian National UniversityCanberraACT 2600Australia Division of Obstetrics and Gynaecology Medical SchoolUniversity of Western AustraliaPerthWA 6009Australia

Background:Physical activity(PA)is important for cancer *** of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer *** objective of this study was to ascertain whether wearable technology,coupled with health coaching was effective in increasing PA in breast and colorectal cancer survivors living in regional and remote areas in ***:Cancer survivors from 5 states were randomized to intervention and control *** participants were given a Fitbit Charge 2TMand received up to 6 telephone health coaching *** participants received PA print *** assessments at baseline and 12 weeks measured moderate-to-vigorous PA(MVPA),light PA,and sedentary ***:Eighty-seven participants were recruited(age=63±11 years;74(85%)female).There was a significant net improvement in MVPA of 49.8 min/week,favoring the intervention group(95%confidence interval(95%CI):13.6-86.1,p=0.007).There was also a net increase in MVPA bouts of 39.5 min/week(95%CI:11.9-67.1,p=0.005),favoring the intervention *** groups improved light PA and sedentary behavior,but there were no between-group ***:This’s the first study to demonstrate that,when compared to standard practice(i.e.,PA education),a wearable technology intervention coupled with distance-based health coaching,improves MVPA in non-metropolitan cancer *** results display promise for the use of scalable interventions using smart wearable technology in conjunction with phone-based health coaching to foster increased PA in geographically disadvantaged cancer survivors.

关键词： Behavior change Exercise Health disparities Oncology Wearable technology

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Prevalence of diabetic cheiroarthropathy and its association with macrovascular complications:A cross-sectional study

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Rheumatology & Autoimmunity 2024年第3期4卷 189-191页

作者： Athul paul Kothai Gnanamoorthy Gisha Sivan Janardanan S.Kumar Department of General Medicine SRM Medical College Hospital and Research Centre SRMISTKattankalathurTamilNaduIndia Division of Medical Research SRM Medical College Hospital and Research Centre SRMISTKattankalathurTamilNaduIndia

To the Editor,Diabetes mellitus(DM)patients have a higher incidence of musculoskeletal issues compared to those without *** diabetes-related complications increasing,early detection of musculoskeletal diseases is crucial for better quality of life and reduced *** joint mobility(LJM),also known as diabetic stiff hand or diabetic cheiroarthropathy(DCA),is an often overlooked complication of type 2 *** manifests as painless stiffness in hands,restricted joint movement,and tight *** in hand joints can spread to major joints like elbows and knees,severely impacting daily tasks and quality of *** examination aids in diagnosing LJM and related rheumatic conditions like scleroderma.

关键词： diabetic complications sectional

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