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World Journal of emergency medicine 2020年第1期11卷 18-26页

作者： Yi-wen Fan Shao-wei Jiang Jia-meng Chen Hui-qi Wang Dan Liu Shu-ming Pan Cheng-jin Gao department of emergency medicine Xinhua Hospital Shanghai Jiaotong University School of Medicine

BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with ***,the pathogenesis underlying SA-AKI remains *** hypothesized that the source of infection affects development of *** aim to explore the relationship between the anatomical source of infection and outcome in patients with ***:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of *** each patient,we collected data from admission until either discharge or *** also recorded the clinical outcome after 90 days for the discharged ***:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)*** analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another *** also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent *** injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

关键词： Sepsis Infection source Acute kidney injury Lung injury Renal function

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

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World Journal of emergency medicine 2019年第4期10卷 232-238页

作者： Ali Pourmand Matthew Pyle David Yamane Kazi Sumon Sarah E.Frasure department of emergency medicine George Washington University School of Medicine and Health Sciences

BACKGROUND:Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of *** remaining patients do not respond to volume resuscitation and may even develop adverse outcomes(such as acute pulmonary edema necessitating endotracheal intubation).We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefi t from volume *** RESOURCES:We performed a search using PubMed,Scopus,and *** following search terms were used:fluid responsiveness,ultrasound,non-invasive,hemodynamic,fluid challenge,and passive leg *** was given to clinical trials and review articles that were most relevant to the topic of assessing a patient’s cardiovascular ability to respond to intravenous fl uid administration using ***:Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava,common carotid artery,subclavian vein,internal jugular vein,and femoral *** parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill ***:Ultrasound in combination with passive leg raise is a non-invasive,costand time-effective modality that can be employed to assess volume status and response to fluid *** sonographic studies have focused on the evaluation of large veins such as the inferior vena cava,and internal jugular vein.A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.

关键词： Stroke volume Fluid responsiveness Ultrasound Non-invasive Hemodynamic

New ex vivo demyelination/remyelination models to defeat multiple sclerosis and neuromyelitis optica

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Neural Regeneration Research 2019年第10期14卷 1715-1716页

作者： Yiting Liu department of Neurology School of Medicine University of Colorado

Multiple sclerosis (MS) and neuromyelitis optica (NMO) are inflammatory diseases of the central nervous system (CNS) resulting in CNS inflammation, infiltration of peripheral immune cells, loss of myelin and oligodendrocytes, interruption of axonal communication, and neurologic deficits. Following oligodendrocyte injury, newly generated myelinating oligodendrocytes derived from oligodendrocyte progenitors (OPCs) may produce new myelin sheaths around denuded axons (remyelination) restoring neuronal function (Verden and Macklin, 2016). While remyelination is apparent in MS lesions, the process is often inefficient;in NMO, remyelination is even more limited.

关键词： Multiple sclerosis(MS) inflammatory diseases remyelination is even more limited

Hydrocarbon pneumonitis following fuel siphonage: A case report and literature review

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World Journal of emergency medicine 2019年第2期10卷 69-74页

作者： Yi-jung Chen Chien-chin Hsu Kuo-tai Chen emergency department Chi-Mei Medical Center department of Biotechnology Southern Tainan University of Technology department of emergency medicine School of Medicine College of Medicine Taipei Medical University

BACKGROUND: People sometimes siphon fuel to fill their tanks. However, this is a potentially dangerous procedure and may cause hydrocarbon pneumonitis. We present the case of a patient with severe hydrocarbon pneumonitis after siphoning fuel. The patient underwent artifi cial ventilation and was admitted to hospital for 97 days. METHODS: We review the relevant literature for a better understanding of clinical features and management strategies for hydrocarbon pneumonitis following fuel ***: We reviewed 15 articles, which included 3 original articles and 12 case reports that reported the clinical features of fuel siphonage. In addition, we added our presented case for data analysis. A total of 40 cases were included in this review. The literature review found that hydrocarbon pneumonitis caused by fuel siphonage occurs worldwide and that most patients(80%) became symptomatic within 1 day of aspiration. Cough(70%), chest pain(62.5%), dyspnoea(55%), and fever(52.5%) presented in more than half of all patients. The right middle lobe(80%) was the predominantly involved lung fi eld; more than one-third of patients(36.7%) showed the involvement of two ***: Patient history, computed tomographic scans of the chest, and bronchoalveolar lavage are the commonly used diagnostic tools. Supportive care remains the foundation of treatment, whereas antibiotics, steroids, and bronchoalveolar lavage are practical therapies. Patients' clinical improvement precedes the resolution of lesions on chest X-ray. Most complications arise from pulmonary lesions. The prognosis of patients suffering from hydrocarbon pneumonitis following fuel siphonage might be improved by accurate diagnosis and appropriate care.

关键词： Siphonage Diesel Fuel Aspiration Hydrocarbon pneumonitis

Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

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World Journal of emergency medicine 2019年第1期10卷 46-50页

作者： Genevieve Mazza Carina Mireles Romo Marlene Torres Ali Duffens Annasha Vyas Katherine Moran Joshua Livingston Savannah Gonzales Shadi Lahham Inna Shniter Maxwell Thompson John Christian Fox school of medicine University of California Irvine department of emergency medicine University of California Irvine

BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava(IVC) to the aorta(Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half(n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half(n=18) of these subjects also had an IVC/Ao ratio below the American threshold of ***: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

关键词： Ultrasound Parasitic infection Panama Rural medicine Dehydration Medical education

Estimating the weight of children in Nepal by Broselow, PAWPER XL and Mercy method

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World Journal of emergency medicine 2018年第4期9卷 276-281页

作者： Karun Shrestha Prakriti Subedi Oshna Pandey Likhita Shakya Kailash Chhetri Darlene R.House department of General Practice and emergency medicine Patan Academy of Health Sciences department of emergency medicine Indiana University School of Medicine

BACKGROUND: Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods(Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, ***: This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10%(PW10) and 20%(PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual ***: The study included 813 children. The mean age was 4.2 years(ranging from 4 days to 14 years) with 60% male. The mean percentage error(MPE) for Broselow, PAWPER XL and Mercy were –1.0%(SD 11.8), 0.7%(10.5) and 4.2%(11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL(71.5%) followed by Broselow(63.2%) and Mercy(58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy ***: The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.

关键词： Child Resuscitation Anthropometry Nepal

Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study

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World Journal of Clinical Cases 2019年第12期7卷 1393-1402页

作者： Yosuke Sasaki Fumiya Komatsu Naoyasu Kashima Takahiro Sato Ikutaka Takemoto Sho Kijima Tadashi Maeda Takamasa Ishii Taito Miyazaki Yoshiko Honda Nagato Shimada Yoshihisa Urita department of General medicine and emergency Care Toho University School of Medicine

BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate *** In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In th

关键词： Abdominal pain Acute abdomen Appendicitis Clinical difference Creactive protein Diverticulitis Right lower quadrant pain

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

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World Journal of emergency medicine 2023年第3期14卷 173-178页

作者： Emily Engelbrecht-Wiggans Jamie Palmer Grace Hollis Fernando Albelo Afrah Ali Emily Hart Dominique Gelmann Iana Sahadzic James Gerding Quincy K.Tran Daniel J.Haase university of Maryland school of medicine Baltimore 21201USA The Research Associate Program in emergency medicine and Critical Care Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA department of emergency medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA

BACKGROUND:Blood pressure(BP)monitoring is essential for patient *** arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is *** hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of ***:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,*** plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/*** and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)***:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])*** most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a *** complications were identifi ed with IABP ***:A COM occurred in 94(45.6%)non-hypertensive patients in the *** vasopressors was the greatest factor associated with *** should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation *** studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.

关键词： Non-hypertensive diseases Invasive arterial blood pressure Non-invasive blood pressure

Effect of prolonged cryptorchidism on germ cell apoptosisand testicular sperm count

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Asian Journal of Andrology 2004年第1期6卷 47-51页

作者： Albaha Barqawi Herald Trummer Randall Meacham Division of Urology Department of Surgery University of Colorado School of Medicine Denver Colorado 80262 USADivision of Urology Department of Surgery University of Colorado School of Medicine Denver Colorado 80262 USADivision of Urology Department of Surgery University of Colorado School of Medicine Denver Colorado 80262 USA

Aim: To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats. Methods: Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring. The rats were sacrificed and the testes removed 6 hours and 2, 4, 7, 21, 28 and 56 days after cryptorchidism. Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy. Results: The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism. At 56 days of cryptorchidism, the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis. At this point, a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally. Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism. Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism. Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4. At day 7, 35 % of MGCs were TUNEL positive. At all subsequent time points, however, MGCs fail to stain positive for apoptosis. This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules. Moreover, there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism. Conclusion: The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells. It appears that after a prolonged cryptorchidism (56 days), there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing pr

关键词： cryptorchidism apoptosis germ cell testis

Lipid levels and insulin resistance markers in patients with colorectal cancer:Propensity score matching analysis

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World Journal of Gastrointestinal Oncology 2025年第1期17卷 130-142页

作者： Ren-Hao Hu Dong-Yi Yan Ke-Hui Zhang Di Zhang Xi-Mao Cui Xiao-Hua Jiang Shun Zhang department of Gastrointestinal Surgery Shanghai East HospitalSchool of MedicineTongji UniversityShanghai 200120China school of medicine Tongji UniversityShanghai 200092China department of emergency medicine Shanghai East HospitalSchool of MedicineTongji UniversityShanghai 200120China

BACKGROUND Colorectal cancer(CRC)is a prevalent malignant neoplasm characterized by subtle early *** To investigate the correlation among serum lipid profiles,the triglyceride-glucose(TyG)index,and the atherosclerotic index(AI)in patients with ***,it explored the clinical diagnostic utility of combining serum lipids with cancer antigens in the context of *** A retrospective analysis encompassed 277 patients with CRC and 1034 healthy *** Following propensity score matching,patients with CRC exhibited significantly reduced levels of serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol(LDL-C),as well as a diminished TyG ***,they displayed elevated AI levels compared to their healthy *** in advanced stages exhibited lower serum levels of TG,TC,and LDL-C compared to those in early *** with positive lymph node metastasis demonstrated reduced levels of TG,LDL-C,and the TyG *** operating characteristic analysis revealed that the combination of the TyG index,carcinoembryonic antigen,and carbohydrate antigen 19-9 yielded the highest positive prediction rate for CRC at 75.3%.CONCLUSION Preoperative serum lipid profiles exhibit a robust association with patients with *** concurrent assessment of multiple serum lipids and cancer antigens effectively enhances the diagnostic accuracy for CRC.

关键词： Colorectal cancer Serum lipids Triglyceride-glucose index Atherosclerotic index Diagnostic marker