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The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

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World Journal of Emergency Medicine 2020年第3期11卷 152-156页

作者： Wei-shuyi Ruan yuan-qiang lu Department of Emergency Medicine the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China Department of Geriatric Medicine the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China

BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology *** study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body ***:Twelve cases who met the criteria were enrolled in this *** demographic and clinical data were reviewed for evaluating the characteristics of ***:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 *** distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 *** cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without *** group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE *** of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with *** mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe ***:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.

关键词： Aortoesophageal foreign body injury Thoracic endovascular aorta repair

Severe liver injury and clinical characteristics of occupational exposure to 2-amino-5-chloro-N,3-dimethylbenzamide: A case series

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 186-194页

作者： Meng-Xiao Feng Hua Zou yuan-qiang lu Department of Emergency Medicine The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province Hangzhou 310003China Occupational Health and Radiation Protection Institute Zhejiang Provincial Center for Disease Control and PreventionHangzhou 310051China

Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and ***,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in *** study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide ***:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July *** entire course of the incidents was described in *** 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass ***-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic ***:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective *** typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical *** and fever may be the important premonitory symptoms for further organ *** chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and *** patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive *** patient survived by liver *** postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual ***:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,

关键词： 2-amino-5-chloro-N,3-dimethylbenzamide Poisoning Clinical characteristics Liver injury

Role of routine check-up in the prognosis of patients with pancreatic cancer:A puzzling phenomenon

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 67-73页

作者： Cong-Ying Song Yan Shen yuan-qiang lu Department of Emergency Medicine the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Geriatric Medicine the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Division of Hepatobiliary and Pancreatic Surgery Department of Surgerythe First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the ***,its clinical value is *** this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic ***:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were *** were divided into two groups depending on how their disease was *** A(n=85):Patients were diagnosed with pancreatic cancer in clinic *** B(n=72):Patients were diagnosed with pancreatic cancer in routine *** compared their ***:The tumor stage in group B was earlier than that in group *** 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival ***,early intervention did not improve overall survival in the long-term.

关键词： Pancreatic cancer Routine check-up Early detection Survival rate

Clinical characteristics and outcomes of patients with hepatic veno-occlusive disease induced by Gynura segetum: A retrospective study

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Journal of Integrative Medicine 2020年第5期18卷 434-440页

作者： Meng-xiao Feng Yan Shen yuan-qiang lu Department of Emergengy Medicine the First Afiliated HospitalSchool of MedicineZhejiong UniversityHangzhou 310003Zhejiang ProvinceChina Department of Geriatric Medicine the First Afliated HospitalSchool of MedicineZhejiang UniversityHangzhou 3100030 Zhejiang ProvinceChina Zhejiang Provincial Key Laborotory for Dignosis and Treatment 0f Aging and Physiccemical Injury Diseases the First Aliliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003.Zhefiang ProvinceChina Department of Hepaobillary and Pancrearic Surgery.the First Afilited Hospial School of Medicine.Zhejiang UniversityHangzhou 310003Zhejiang ProvinceChina

Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of ***: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical ***: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood ***, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical

关键词： Hepatic veno-occlusive disease Gynura segetum Clinical characteristics Prognostic Survival analysis

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

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World Journal of Emergency Medicine 2022年第5期13卷 361-366页

作者： Li Li Li-ying Lin yuan-qiang lu Department of Emergency Medicine the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province Hangzhou 310003China

BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high *** always presents atypical clinical manifestations that are easily missed or *** study mainly aims to describe the imaging characteristics and management of TAD ***:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and *** features,imaging characteristics,and management were ***:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were *** intimal tears were mostly initiated from the aortic *** sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all Plue with an area under the receiver operating characteristic curve(AUC)of ***,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated *** progression of aortic dissection or death occurred during the six-month follow-up ***:In blunt trauma,the aortic isthmus is the most common site of proximal intimal *** accurate diagnosis of TAD requires an overall consideration of medical history and imaging *** TEVAR might be an eff ective therapeutic option for TAD.

关键词： Blunt trauma Traumatic aortic dissection Imaging characteristic Diagnosis Delayed thoracic endovascular aortic repair

Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning:grasp for straws?

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World Journal of Emergency Medicine 2021年第3期12卷 232-234页

作者： Meng-xiao Feng yuan-qiang lu Department of Emergency Medicine the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China Department of Geriatric Medicine the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases the First Affi liated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China

Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific *** failure is the main cause of death among patients with PQ ***,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains *** eff ective and safer therapies remain to be *** studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.

关键词： patients lung poisoning

Acute generalized exanthematous pustulosis with airway mucosa involvement:A case report

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World Journal of Clinical Cases 2020年第16期8卷 3578-3582页

作者： lu-lu Li yuan-qiang lu Tong Li Department of Emergency Medicine The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and *** annual incidence of AGEP is estimated to be 1-5 cases per *** of AGEP with oral mucosa involvement have been ***,reports of AGEP involving airway mucosa are *** SUMMARY We report a 42-year-old woman with serious AGEP involving the airway *** patient initially developed fever and a small rash on her forehead and *** the next 2 d,she developed a diffuse,pustular rash over her trunk and *** addition,she complained of a cough with white foam-like sputum,chest tightness and *** days later,due to dyspnea,her mental status started to gradually *** became more and more *** of the skin and airway mucosa suggested the diagnosis of *** to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of *** received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good *** patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of *** was administered for more than 10 d following onset of the disease,and her overall prognosis was *** This case represents a rare clinical feature of AGEP and an important finding for clinicians.

关键词： Acute generalized exanthematous pustulosis Airway mucosa Traditional Chinese medicine Heavy metals Case report

The characteristics of liver injury induced by Amanita and clinical value of α-amanitin detection

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 257-266页

作者： Li-Ying Lin Ya-Ling Tong yuan-qiang lu Department of Emergency Medicine the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province Hangzhou 310003China

Background:Amanita poisoning as a foodborne disease has raised concerning mortality *** the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients,while treatment is highly dependent on a confirmed *** this end,we developed an early detection-guided intervention strategy by optimizing diagnostic process with performingα-amanitin detection,and further explored whether this strategy influenced the progression of Amanita ***:This study was a retrospective analysis of 25 Amanita poisoning *** patients in the detection group were diagnosed mainly based onα-amanitin detection,and 12 patients were diagnosed essentially on the basis of mushroom consumption history,typical clinical patterns and mushroom identification(conventional group).Amanita poisoning patients received uniform therapy,in which plasmapheresis was executed once confirming the diagnosis of Amanita *** compared the demographic baseline,clinical and laboratory data,treatment and outcomes between the two groups,and further explored the predictive value ofα-amanitin concentration in ***:Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase(ALT)rose higher than aspartate aminotransferase(AST).The mortality rate was 7.7%(1/13)in the detection group and 50.0%(6/12)in the conventional group(P=0.030),since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of *** early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ***,the predictive value ofα-amanitin concentration in serum was still considered ***:In the management of mushroom poisoning,consideration should be given to the rapid detection ofα-amanitin in suspected Amanita poisoning patients and the immediate initiation of medi

关键词： Mushroom poisoning α-amanitin Detection Acute liver failure Early diagnosis and intervention

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation:a meta-analysis

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2011年第5期12卷 357-364页

作者： Wei-dong HUANG Jiu-kun JIANG yuan-qiang lu Department of Emergency the First Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310003 China

Objective:To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver ***:Randomized control trials(RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library,MEDLINE(1966/1-2010/4),Scopus(1980/1-2010/4),***(2010/4),the Cochrane Hepato-Biliary Group Controlled Trials Register,and the Cochrane Central Register of Controlled *** and data were extracted and assessed *** outcomes were reported as odds ratios(ORs) and weighted mean difference with 95% confidence intervals(CI).Results:Five RCTs and eight comparative studies with a total of 1 608 subjects were *** data showed that the operation with T-tube had better outcomes for duct stenosis(P=0.01,OR=0.45,95% CI 0.24-0.85).The operations with or without T-tube had equivalent outcomes as follows:overall biliary complications(P=0.85,OR=1.15,95% CI 0.28-4.72),bile leaks(P=0.38,OR=0.75,95% CI 0.39-1.42),and cholangitis(P=0.24,OR=4.64,95% CI 0.36-60.62).These results were strengthened by the analysis of all thirteen non-randomized and randomized ***:Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.

关键词： Liver transplantation Drainage Biliary tract Meta-analysis T-tube