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The Importance of Adjuvant Agents in Acute Intrathecal Baclofen Withdrawal: Case Report and Review of the Literature

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Open Journal of Anesthesiology 2012年第4期2卷 102-106页

作者： Christopher m. Wang susan E. Opper Department of Anesthesiology University of Missouri – Kansas City School of Medicine Kansas City Missouri USA.

Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally implanted pump. While ideal for long-term attenuation of symptoms, this treatment modality can also become disastrous should the pump empty and withdrawal subsequently ensue. Case Report: A 48-year-old male with a past medical history of T8 spinal cord injury from a motor vehicle crash originally presented with altered mental status. Because of resultant paraplegia and spasticity from his injuries, a neurosurgeon implanted an intrathecal baclofen pump three years prior to presentation with symptomatic relief. Further exploration revealed that he had missed his scheduled pump refill appointment and interrogation of his pump confirmed a completely empty reservoir. The patient endured a protracted hospital course that included rhabdomyolysis, acute renal failure, lactic acidosis, respiratory failure, and systemic inflammatory response syndrome. Treatment included benzodiazepines, dantrolene, aggressive hydration, opiates, and refill of his intrathecal baclofen pump. His mentation and ventilatory status improved with recovery from his critical illness and eventual discharge. Conclusions: Treatment of intrathecal baclofen withdrawal should focus on restoration of previous intrathecal baclofen levels by refill of the intrathecal pump. Adjuvant medications such as benzodiazepines, propofol, cyproheptadine, dantrolene, tizanidine, and opiates may prove crucial in helping with muscle spasticity while these levels are reestablished. A high index of suspicion, leading to timely initiation of proper treatment, may serve as the most important factor in successful recovery from this life-th

关键词： Baclofen GABA GABAB Intrathecal Implantable Infusion Pump Chronic Pain Pain management Spasticity Spinal Cord Injury Neurosurgery Withdrawal Analgesia

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Eosinophils and mast cells as therapeutic targets in pediatric functional dyspepsia

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第4期4卷 86-96页

作者： Craig A Friesen Jennifer V Schurman Jennifer m Colombo susan m Abdel-Rahman Division of Gastroenterology Hepatology and Nutritionthe Children’s Mercy Hospital and Clinics Division of Developmental and Behavioral Sciences the Children’s Mercy Hospital and Clinics Division of Pediatric Pharmacology and medical Toxicology the Children’s Mercy Hospital and Clinics

There is an increasing appreciation for the importance of inflammation as a pathophysiologic entity that contributes to functional gastrointestinal disorders including functional dyspepsia(FD).Importantly,inflammation may serve as a mediator between psychologic and physiologic *** manuscript reviews the literature implicating two inflammatory cell types,mast cells and eosinophils,in the generation of dyspeptic symptoms and explores their potential as targets for the treatment of *** are a number of inciting events which may initiate an inflammatory response,and the subsequent recruitment and activation of mast cells and *** include internal triggers such as stress and anxiety,as well as external triggers such as microbes and *** studies suggest that there may be efficacy in utilizing medications directed at mast cells and *** exists to suggest that combining "anti-inflammatory" medications with other treatments targeting stress can improve the rate of symptom resolution in pediatric FD.

关键词： Eosinophils mast cells Functional dyspepsia Abdominal pain Stress

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The relationship between clutch volume and body mass in birds

The relationship between clutch volume and body mass in bird...

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23rd International Ornithological Congress

作者： susan Anderson David m.Watson Applied Ornithology Group The Johnstone Centre Charles Stun University Bathurst NSW 2795 Australia Applied Ornithology Group The Johnstone Centre Charles Stun University Bathurst NSW 2795 Australia

＜正＞ While commonly used to investigate large-scale patterns in other taxonomic groups, allometric scaling relationships in birds have been examined less frequently. Relationships between body mass and metabolic rate have been the focus of some ornithological research but other relationships-especially those involving reproductive output-have seldom been investigated. Here, we report on our examination of the hitherto

关键词： allometry clutch size egg dimensions scaling relationship

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Weight Loss Impact on Change in Depression in Type 2 Diabetes mellitus: Study to Help Improve Early Evaluation and management of Risk Factors Leading to Diabetes (SHIELD)

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Journal of Diabetes mellitus 2014年第3期4卷 216-224页

作者： susan Grandy Andrew J. Green Kathleen m. Fox AstraZeneca LP Wilmington DE USA midwestern Endocrinology Overland Park KS USA Strategic Healthcare Solutions LLC Baltimore MD USA

Objectives: This study evaluated the association between weight loss and change in depression among patients with type 2 diabetes mellitus (T2Dm). methods: Weight change from 2008 to 2009 among respondents (with and without T2Dm) in the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) was calculated. Change in depression was calculated as change from 2008 to 2009 in Patient Health Questionnaire-9 (PHQ-9) scores. Respondents with weight loss (>1%, >3%, >5%) were compared with respondents with weight gain (≥1%). multivariate regression adjusted for baseline characteristics. Results: Among those with T2Dm, more respondents with weight loss (n = 779) improved their depression scores, compared with respondents with weight gain (n = 731): 32.9%, 36.9%, 39.8% for >1%, >3%, and >5% weight loss, respectively, vs. 28.7% for weight gain (pmore respondents with weight loss improved the severity level of depression compared with respondents with weight gain (p ment, T2Dm respondents with weight loss had significantly greater improvement in depression scores (p mes higher odds of improving depression severity than T2Dm respondents with weight gain (OR: 2.22 for >1%, 2.96 for >3%, and 3.31 for >5% weight loss, p milar improvement in depression scores and severity of depression related to weight loss was observed among all SHIELD respondents (with and without T2Dm). Conclusions: Our findings demonstrate an association between weight loss and improvement in depression over a 1-year period in adults with T2Dm, and suggest the need for further investigation with respect to causality.

关键词： Depression Type 2 Diabetes mellitus Weight Loss

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Statistical Analysis of Small Holder Farmer Financial Exclusion: Case Study of migori County, Kenya

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Open Journal of Statistics 2022年第5期12卷 733-742页

作者： susan A. Okeyo Galcano C. mulaku Collins m. mwange Department of Geospatial and Space Technology University of Nairobi Nairobi Kenya

There are estimated to be approximately 600 million small scale farmers globally, and they produce most of the food consumed, especially in the developing countries. The farmers, however, are often unable to obtain optimal crop yields due to their exclusion from the financial systems in their countries, which deem them too high risk to lend to. This results in the farmers being unable to afford optimal inputs into their farms, hence depressing their yields and the level of food security. This study aimed to statistically determine whether the small scale farmers of migori County in Kenya are financially excluded or not, and to what extent. Data were collected from the farmers through a questionnaire survey, and subsequent statistical analysis has shown that indeed the small scale farmers of migori are financially excluded to a large extent. Consideration of non-financial data in the farmers’ credit rating has been recommended as a way forward towards their financial inclusivity. This study provides scientific proof of smallholder farmer financial exclusion, which proof is generally difficult to find, especially in the developing countries.

关键词： Small Holder Farmer Financial Exclusion migori Kenya

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Leveraging Geospatial Technology for Smallholder Farmer Credit Scoring

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Journal of Geographic Information System 2023年第5期15卷 524-539页

作者： susan A. Okeyo Galcano C. mulaku Collins m. mwange Department of Geospatial and Space Technology University of Nairobi Nairobi Kenya

According to the Food and Agriculture Organization of the United Nations (FAO), there are about 500 million smallholder farmers in the world, and in developing countries, such farmers produce about 80% of the food consumed there;their farming activities are therefore critical to the economies of their countries and to the global food security. However, these farmers face the challenges of limited access to credit, often due to the fact that many of them farm on unregistered land that cannot be offered as collateral to lending institutions;but even when they are on registered land, the fear of losing such land that they should default on loan payments often prevents them from applying for farm credit;and even if they apply, they still get disadvantaged by low credit scores (a measure of creditworthiness). The result is that they are often unable to use optimal farm inputs such as fertilizer and good seeds among others. This depresses their yields, and in turn, has negative implications for the food security in their communities, and in the world, hence making it difficult for the UN to achieve its sustainable goal no.2 (no hunger). This study aimed to demonstrate how geospatial technology can be used to leverage farm credit scoring for the benefit of smallholder farmers. A survey was conducted within the study area to identify the smallholder farms and farmers. A sample of surveyed farmers was then subjected to credit scoring by machine learning. In the first instance, the traditional financial data approach was used and the results showed that over 40% of the farmers could not qualify for credit. When non-financial geospatial data, i.e. Normalized Difference Vegetation Index (NDVI) was introduced into the scoring model, the number of farmers not qualifying for credit reduced significantly to 24%. It is concluded that the introduction of the NDVI variable into the traditional scoring model could improve significantly the smallholder farmers’ chances of accessing cred

关键词： Credit Scoring machine Learning Geospatial Technology migori

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DB2通用数据库自学教程 1

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1999年

作者：（美）susan m.Visser 王晓冬译

本书全面地讲述了DB2通用数据库5.0版所讨论如何满足从Web访问安装、配置、日常管理、命令、性能调整和错误诊断及解决方法，到深入讨论如何满足从Web访问数据库中的并行处理，并且通过一些实例和专家提供的技巧教你如何在最短的时间内... 详细信息

ISBN: (纸本)7900617922

本书全面地讲述了DB2通用数据库5.0版所讨论如何满足从Web访问安装、配置、日常管理、命令、性能调整和错误诊断及解决方法，到深入讨论如何满足从Web访问数据库中的并行处理，并且通过一些实例和专家提供的技巧教你如何在最短的时间内了DB2技术，创建、管理和优化DB2数据库。

关键词：关系型数据库数据库管理系统,DB2

来源：畅想之星图书光盘版（南... 评论

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Epidemiological link between obesity,type 2 diabetes mellitus and cancer

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World Journal of methodology 2021年第3期11卷 23-45页

作者： Cornelius J Fernandez Annu susan George Nikhila A Subrahmanyan Joseph m Pappachan Department of Endocrinology and metabolism Pilgrim HospitalUnited Lincolnshire Hospitals NHS TrustBoston PE219QSUnited Kingdom Department of medical Oncology VPS Lakeshore HospitalCochin 682040India Department of Internal medicine Al-Azhar Medical CollegeThodupuzha 685605India Department of Endocrinology and metabolism Lancashire Teaching Hospitals NHS TrustPreston PR29HTUnited Kingdom Faculty of Science Manchester Metropolitan UniversityManchester M156BHUnited Kingdom

There exists a complex interaction between obesity,type 2 diabetes mellitus(T2Dm)and cancer,and an increase in the incidence of cancer is expected with the growing obesity-diabetes *** association of cancer with diabetes mellitus and obesity appears to be site-specific,the highest risk being for postmenopausal breast cancer,endometrial cancer,and colorectal ***,there is worsening of hyperglycaemia with the onset of cancer,evidencing a bidirectional link between cancer and diabetes mellitus and the need for monitoring for diabetes in cancer *** this review,we look at the epidemiological evidence from observational studies and mendelian randomization studies linking obesity,diabetes,and cancer,as well as the complex pathophysiological mechanisms involved,including insulin resistance with associated hyperinsulinaemia,the effect of chronic low-grade inflammation,and the effect of various adipokines that are associated with obesity and ***,we describe the novel therapeutic strategies,based on their role on the discrete pathophysiological mechanisms involved in the tumourigenesis.

关键词： Cancer Obesity Type 2 diabetes mellitus Hyperinsulinaemia Epidemiological link

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The LONG and SHORT of it

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英语学习 2005年第9期 64-65页

作者： susan Suhua

Suhua:Hi,susan,how are you doing in mexico?I’m just back from the may Day ***’sa week LONG holiday,yet I feel it was onlya SHORT *** we can talk aboutLONG and SHORT in this *** thepairs of

关键词： this

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Severe hypernatremia in hyperglycemic conditions;managing it effectively:A case report

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World Journal of Critical Care medicine 2023年第1期12卷 29-34页

作者： maulik K Lathiya Praveen Errabelli susan m Cullinan Emeka J Amadi Department of Emergency Mayo Clinic Health SystemEau ClaireWI 54703United States Department of Nephrology Mayo Clinic Health SystemEau ClaireWI 54703United States Hospital Internal medicine Mayo Clinic Health SystemEau ClaireWI 54703United States

BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of *** combined with hypernatremia,the complications can be even *** is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or *** a result,a structured and systematic treatment approach is *** discuss the therapeutic approach and implications of this uncommon *** SUmmARY A 62-year-old man with no known past medical history presented to emergency department with altered mental *** work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/*** was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA *** 12 h of ICU admission,blood sugar was 300 mg/*** his mental status didn’t show much *** was dehydrated and had a corrected serum sodium level of>190 mEq/*** a result,dextrose 5%in water and ringer's lactate were *** was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/*** The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these *** case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.

关键词： Diabetic ketoacidosis Hyperglycemic hyperosmolar state Hypernatremia Hyperglycemia Desmopressin Case repot

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