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Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

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World Journal of Hepatology 2024年第3期16卷 379-392页

作者： sarah Khan Hanna Hong Stephanie Bass Yifan Wang Xiao-Feng Wang Omar T Sims Christine e Koval Aanchal Kapoor Christina C Lindenmeyer Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Cleveland Clinic Lerner College of Medicine Cleveland ClinicClevelandOH 44195United States Department of Pharmacy Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences/Biostatistics Section Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Infectious Disease Cleveland ClinicClevelandOH 44195United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.MeTHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.ReSULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,Pe majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,Pe to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for end-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associa

关键词： Fungal Infection Sepsis Acute on chronic liver failure Intensive care

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Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

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Neural Regeneration Research 2024年第12期19卷 2773-2784页

作者： Hui Zhu James D.Guest sarah Dunlop Jia-Xin Xie Sujuan Gao Zhuojing Luo Joe e.Springer Wutian Wu Wise Young Wai Sang Poon Song Liu Hongkun Gao Tao Yu Dianchun Wang Libing Zhou Shengping Wu Lei Zhong Fang Niu Xiaomei Wang Yansheng Liu Kwok-Fai So Xiao-Ming Xu Kunming Tongren Hospital KunmingYunnan ProvinceChina Neurological Surgery and the Miami Project to Cure ParalysisMiller School of MedicineUniversity of MiamiMiamiFLUSA School of Biological Sciences The University of Western AustraliaPerthWAAustralia Minderoo Foundation PerthWAAustralia Clinical Center for Spinal Cord Injury Kunming General Hospital of Chengdu Military CommandKunmingYunnan ProvinceChina Department of Biostatistics and Health Data Science Indiana University School of MedicineIndianapolisINUSA Department of Orthopedic Spinal Surgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina Spinal Cord and Brain Injury Research Center Department of Physical Medicine and RehabilitationUniversity of Kentucky College of MedicineLexingtonKYUSA Guangdong-HongKong-Macao Institute of CNS Regeneration Jinan UniversityGuangzhouGuangdong ProvinceChina W.M.Keck Center for Collaborative Neuroscience Rutgers UniversityPiscatawayNJUSA Neurosurgery Department Chinese University of Hong KongPrince of Wales HospitalHong Kong Special Administration RegionChina Spinal Cord and Brain Injury Research Group Stark Neurosciences Research InstituteDepartment of Neurological SurgeryIndiana University School of MedicineIndianapolisINUSA

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

关键词： chronic spinal cord injury intensive rehabilitation locomotor training neurological recovery surgical intervention weightbearing walking training

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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 survivors.Trials of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer survivors.The 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 Australia.Methods:Cancer survivors from 5 states were randomized to intervention and control arms.Intervention participants were given a Fitbit Charge 2TMand received up to 6 telephone health coaching sessions.Control participants received PA print materials.Accelerometer assessments at baseline and 12 weeks measured moderate-to-vigorous PA(MVPA),light PA,and sedentary behavior.Results: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 group.Both groups improved light PA and sedentary behavior,but there were no between-group differences.Conclusion: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 survivors.The 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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MOLeCULAR DeSIGN OF FUNCTIONAL BIOMATeRIALS FOR BIOMeDICAL APPLICATIONS

MOLECULAR DESIGN OF FUNCTIONAL BIOMATERIALS FOR BIOMEDICAL A...

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第四届国际高分子化学学术讨论会

作者： Xinqiao Jia Amit K.Jha sarah e.grieshaber Longxi Xiao Chao Liu Department of Materials Science and engineering Delaware Biotechnology Institute University of Delaware

＜正＞Due to their biocompatibility,high water content,and tissue-like viscoelasticity,hydrogels are widely exploited as tissue engineering scaffolds.Traditional hydrogels are macroscopic entities definedby the soluble polymeric precursors that are randomly interconnected,lacking the structural complexity,mechanical robustness and functional diversity seen in the natural extracellular matrices（eCM）.We are

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Roles of Case Studies and Case Reports in US east Asian Medicine:A Narrative-Medicine Perspective

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Chinese Medicine and Culture 2023年第2期6卷 194-204页

作者： sarah e.Rivkin Seattle Institute of east Asian Medicine Seattle 98108USA

Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by east Asian Medicine clinicians in the United States today-the case study and the case report.each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling east Asian Medicine into the arena of modern scientific research.

关键词： Case record Case report Case study Herbal medicine Narrative medicine

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Saving time and effort:Best practice for adapting existing patientreported outcome measures in hepatology

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World Journal of Hepatology 2022年第5期14卷 896-910页

作者： Laith Alrubaiy Hayley A Hutchings sarah e Hughes Thomas Dobbs Department of Gastroenterology St Mark's HospitalLondon HA13UJUnited Kingdom Institute of Life Sciences 2 Swansea University Medical SchoolSingleton ParkSwansea SA28PPUnited Kingdom Swansea University Medical School Swansea UniversitySwansea SA28PPUnited Kingdom Centre for Patient Reported Outcome Research Institute of Applied Health ResearchUniversity of BirminghamBirmingham B152TTUnited Kingdom Swansea University Swansea SA28PPUnited Kingdom

It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holistic view of healthcare provision,there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology.This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions.However,the development and validation of a new PROM is time-consuming and costly.Therefore,before deciding to develop a new PROM,researchers should consider identifying existing PROMs to assess their appropriateness and,if necessary,make adaptations to existing PROMs to ensure their rigour when used with the target population.Little is written in the literature on how to identify and adapt the existing PROMs in hepatology.This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.

关键词： Patient reported outcome measures Adaptation Content validation Hepatology Patient reported outcomes

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Long-term physical,mental and social health effects of COVID-19 in the pediatric population:a scoping review

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World Journal of Pediatrics 2022年第3期18卷 149-159页

作者： Madeline Borel Luyu Xie Olivia Kapera Adrian Mihalcea Jeffrey Kahn sarah e.Messiah School of Public Health University of Texas Health Science CenterDallas Campus2777 N Stemmons FwyDallasTX 75207USA Center for Pediatric Population Health University of Texas Health School of Public Health and Children’s Health System of TexasDallasTXUSA School of Public Health University of Texas Health Science CenterAustin CampusAustinTXUSA School of Public Health University of Texas Health Science CenterHouston CampusHoustonTXUSA Department of Pediatrics University of Texas Southwestern Medical CenterDallasTXUSA Children’s Health System of Texas DallasTXUSA

Background The majority of coronavirus disease 2019(COVID-19)symptom presentations in adults and children appear to run their course within a couple of weeks.However,a subgroup of adults has started to emerge with effects lasting several months or more after initial infection,which raises questions about the long-term physical,mental and social health effects of COVID-19 in the pediatric population.The purpose of this review was to determine these impacts well into the second year of the pandemic.Methods A search was conducted using PubMed,Web of Science,Science Direct,and Cochrane between 11/1/2019 and 9/1/2021.Search inclusion criteria were as follows:(1)COVID-19 illness and symptoms in children;(2)severe acute respiratory syndrome coronavirus 2 in children;(3)english language;and(4)human studies only.Results The few studies that have documented long-term physical symptoms in children show that fatigue,difficulty in concentrating(brain fog),sleep disturbances,and sensory problems are the most reported outcomes.Most studies examining the impact of COVID-19 in pediatric populations have focused on initial clinical presentation,and symptoms,which are similar to those in adult populations.In addition,COVID-19 has had a moderate impact on children and adolescents’social environment,which may exacerbate current and future physiological,psychological,behavioral,and academic outcomes.Conclusions There are limited studies reporting long physical symptoms of COVID-19 in the pediatric population.However,pediatric COVID-19 cases are underreported due to low rates of testing and symptomatic infection,which calls for more longitudinal studies.Children who have experienced COVID-19 illness should be monitored for long physiological,psychological,behavioral,and academic outcomes.

关键词： Adolescents Children Coronavirus disease 2019(COVID-19) Long-COVID symptoms

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Importance of adapted digestion conditions to simulate in vitro lipid digestion of broilers in different life stages

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Animal Nutrition 2023年第1期12卷 151-158页

作者： Daphne Michels sarah H.e.Verkempinck Agnese Panozzo Karen Vermeulen Marc e.Hendrickx Liesbet Thijs Tara Grauwet Laboratory of Food Technology and Leuven Food Science and Nutrition Research Centre(LFoRCe) Department of Microbial and Molecular Systems(M2S)KU LeuvenLeuven3001Belgium Kemin Animal Nutrition and Health Kemin Europa N.V.Herentals2200Belgium

In vitro digestion studies demonstrate large potential to gain more and quicker insights into the underlying mechanisms of feed additives,allowing the optimization of feed design.Unfortunately,current in vitro digestion models relevant for broiler chickens lack sufficient description in terms of protocols and standardisation used.Furthermore,no distinction is made between the different life phases of these animals(starter,grower,and finisher).Hence,our research aimed to establish adapted in vitro digestion conditions,corresponding to the 3 life phases in broilers,with specific focus on lipid digestion.The effect of 3 different bile salt concentrations of 2,10,and 20 mM,and 3 different lipase activities of 5,20,and 100 U/mL,on in vitro lipid digestion kinetics were evaluated using a full factorial design.These values were selected to represent starter,grower,and finisher birds,respectively.Our findings showed that the extent of lipid digestion was mainly influenced by lipase activity.The rate of lipid digestion was affected by an interplay between bile salt concentration and lipase activity,due to possible lipase inhibition at certain bile salt concentrations.Overall,this work resulted in 3 in vitro lipid digestion models representative for starter,grower,and finisher birds.In conclusion,this research showed the impact of adapted in vitro digestion conditions on lipid digestion kinetics and thus the need for these conditions relevant for each life phase of broilers.

关键词： Lipolysis Lipase activity Bile salt In vitro digestion Broiler chicken emulsion

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Post-operative prevention and monitoring of Crohn’s disease recurrence

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Gastroenterology Report 2022年第1期10卷 217-226页

作者： Kate e.Lee sarah Cantrell Bo Shen Adam S.Faye Department of Medicine Duke University Medical CenterDurhamNCUSA Duke University Medical Center Library&Archives Duke University School of MedicineDurhamNCUSA Center for Inflammatory Bowel Diseases NewYork-Presbyterian/Columbia University Irving Medical CenterNew YorkNYUSA Division of Gastroenterology NYU Grossman School of MedicineNew YorkNYUSA

Crohn’s disease(CD)and ulcerative colitis(UC)are relapsing and remitting chronic inflammatory diseases of the gastrointestinal tract.Although surgery for UC can provide a cure,surgery for CD is rarely curative.In the past few decades,research has identified risk factors for postsurgical CD recurrence,enabling patient risk stratification to guide monitoring and prophylactic treatment to prevent CD recurrence.A MeDLINe literature review identified articles regarding post-operative monitoring of CD recurrence after resection surgery.In this review,we discuss the evidence on risk factors for postoperative CD recurrence as well as suggestions on post-operative management.

关键词： post-operative Crohn’s management recurrence biologics

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Hypertensive emergency versus preeclampsia in a patient with sickle cell disease:a case report

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World Journal of emergency Medicine 2023年第4期14卷 329-331页

作者： Jigar Patel Juan A Reyes Ivan Berezowski Quincy K Tran sarah e Frasure Ali Pourmand Division of Hospital Medicine Department of Medicinethe George Washington UniversityWashington DC 20037USA Department of emergency Medicine University of Maryland School of MedicineBaltimore 21201-1544USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of emergency Medicine the George Washington University School of Medicine and Health SciencesWashington DC 20037USA

Sickle cell disease(SCD)is strongly associated with severe preeclampsia and has also been linked to poor pregnancy-related outcomes.Moreover,sickle cell nephropathy(SCN)is a common complication of SCD and results in chronic proteinuria.Pregnant patients with SCD who present to the emergency department(eD)with pulmonary edema,hypertension,and proteinuria may suffer from a hypertensive emergency with or without preeclampsia.Without prior lab work to determine whether a patient’s proteinuria or kidney dysfunction is new or at baseline,it may be impossible for the emergency physician to determine which diagnosis is more likely.Thus,amultidisciplinary approach which involves cardiology,nephrology,medicine and obstetrics consultations should be utilized to help direct treatment.We present the case of a 39-yearold patient with SCD,who was also 26 weeks pregnant,and presented to the eD with markedly elevated blood pressure and dyspnea.Although she was initially admitted to the obstetrics ward for blood pressure management given concern for preeclampsia,she was ultimately diagnosed with hypertensive emergency and sickle cell nephropathy.

关键词： hypertensive admitted markedly

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