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Thrombotic microangiopathy-like disorder after living-donor liver transplantation:A single-center experience in Japan

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World Journal of Gastroenterology 2011年第14期17卷 1848-1857页

作者： Tomohide Hori Toshimi Kaido Fumitaka Oike Yasuhiro Ogura Kohei Ogawa Yukihide Yonekawa Koichiro Hata Yoshiya Kawaguchi Mikiko Ueda Akira Mori Yasutsugu Takada Hiroto Egawa Atsushi Yoshizawa Shinji Uemoto Hajime Segawa Kimiko Yurugi Takuma Kato Kanako Saito Linan Wan Mie Torii Feng Chen Ann-Marie T Baine Lindsay B Gardner departments of Hepato-pancreato-biliary Transplant and Pediatric Surgery Kyoto University Hospital Kyoto 606-8507 Japan Department of critical care Medicine Kyoto University Hospital Kyoto 606-8507 Japan Department of Transfusion Medicine and Cell Therapy Kyoto University Hospital Kyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Hospital Graduate School of Medicine Mie 514-8507 Japan Department of Neuroscience Mayo Clinic Florida FL 32224 United States

AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated,and the TMA-like disorder (TMALD) occurred in seven recipients. RESULTS:These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered,the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells,the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD,the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD,such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies,must be decided according to each case. CONCLUSION:The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT.

关键词： Thrombotic microangiopathy Liver transplan-tation von Willebrand factor A disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs Complication

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Noninvasive ventilation in trauma

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World Journal of critical care Medicine 2015年第1期4卷 47-54页

作者： Marcin K Karcz Peter J Papadakos Department of Anes-thesiology University of Rochester Division of critical care Medicine Departments of Surgery and NeurosurgeryUniversity of Rochester

Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with traumarelated hypoxemia. It is well-known that these patientsare at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma.

关键词： Acute respiratory distress syndrome Noninvasive ventilation Pulmonary contusion Respiratory failure Trauma

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Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

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Military Medical Research 2023年第3期10卷 281-298页

作者： Fei Pei Ren‑Qi Yao Chao Ren Soheyl Bahrami Timothy RBilliar Irshad HChaudry De‑Chang Chen Xu‑Lin Chen Na Cui Xiang‑Ming Fang Yan Kang Wei‑Qin Li Wen‑Xiong Li Hua‑Ping Liang Hong‑Yuan Lin Ke‑Xuan Liu Ben Lu Zhong‑Qiu Lu Marc Maegele Tian‑Qing Peng You Shang Lei Su Bing‑Wei Sun Chang‑Song Wang Jian Wang Jiang‑Huai Wang Ping Wang Jian‑Feng Xie Li‑Xin Xie Li‑Na Zhang Basilia Zingarelli Xiang‑Dong Guan Jian‑Feng Wu Yong‑Ming Yao Department of critical care Medicine the First Affiliated Hospital of Sun Yat-Sen University58 Zhongshan Er RoadYuexiu DistrictGuangzhou 510080GuangdongChina Translational Medicine Research Center Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital28 Fuxing RoadHaidian DistrictBeijing 100853China Department of Burn Surgery the First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology 1200 ViennaAustria Department of Surgery University of Pittsburgh Medical CenterPittsburghPA 15213USA Center for Surgical Research and Department of Surgery University of Alabama at BirminghamBirminghamAL 35294USA Department of critical care Medicine Ruijin HospitalShanghai Jiaotong UniversityShanghai 200025China Department of Burns the First Affiliated Hospital of Anhui Medical UniversityHefei 230022China Department of critical care Medicine Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 31003China Department of critical care Medicine West China Hospital of Sichuan UniversityChengdu 610041China Department of critical care Medicine General Hospital of Eastern Theater Command of Chinese PLANanjing 210002China Department of Surgical Intensive critical Unit Beijing Chao‑Yang HospitalCapital Medical UniversityBeijing 100020China State Key Laboratory of Trauma Burns and Combined InjuryResearch Institute of SurgeryDaping HospitalArmy Medical UniversityChongqing 400042China Department of critical care Medicine Fourth Medical Center of the Chinese PLA General HospitalBeijing 100048China Department of Anesthesiology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515China Department of critical care Medicine and Hematology the Third Xiangya HospitalCentral South UniversityChangs

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of *** provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was *** related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online ***,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus *** consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good *** summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were ***,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this *** summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

关键词： Sepsis Immune function monitoring Immunomodulatory therapy Immunosuppression

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Frameworks for quality improvement in pediatric intensive care: A concise review

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pediatric Investigation 2019年第2期3卷 117-121页

作者： Susan A.Kourtis Jeffrey P.Burns Division of critical care Medicine Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s Hospital.MAUSA Department of Anaesthesia Harvard Medical SchoolBostonMA.USA

Quality improvement programs focused on improving care in intensive care units have become standard at pediatric hospitals around the world over the past several ***,the methodology or framework by which these programs assess quality is not *** review describes the varying quality improvement frameworks that have been promoted by prominent pediatric and critical care societies and the strengths and limitations of these frameworks,as well as several notable international eollaboratives in this domain.

关键词： Quality Frameworks Eollaboratives

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The Management of Pain in Children （and Adults）

The Management of Pain in Children （and Adults）

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第五届全国儿科麻醉学术会议暨首届中美儿科麻醉学术交流会

作者： Myron Yaster departments of Anesthesiology Critical Care Medicineand PediatricsThe Johns Hopkins Medical Institutions

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The Management of Pain in Children（and Adults）

The Management of Pain in Children（and Adults）

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2014年全国小儿麻醉学术年会暨浙江省麻醉学学术年会

作者： Myron Yaster Richard J Traystman departments of Anesthesiology Critical Care Medicine and Pediatrics The Johns Hopkins Medical Institutions

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Trends and challenges of emergency and acute care in Chinese mainland:2005–2017

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World Journal of Emergency Medicine 2021年第1期12卷 5-11页

作者： Chang Pan Jiao-jiao Pang Kai Cheng Feng Xu Yu-guo Chen Department of Emergency Medicine Qilu Hospital of Shandong UniversityJinan 250012China Shandong Provincial Clinical Research Center for Emergency and critical care Medicine Institute of Emergency and Critical Care Medicine of Shandong UniversityChest Pain CenterQilu Hospital of Shandong UniversityJinan 250012China Key Laboratory of Emergency and critical care Medicine of Shandong Province Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceShandong Provincial Engineering Laboratory for Emergency and Critical Care MedicineQilu Hospital of Shandong UniversityJinan 250012China The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of EducationChinese Ministry of Health and Chinese Academy of Medical Sciencesthe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineQilu Hospital of Shandong UniversityJinan 250012China

BACKGROUND:Emergency medical service system(EMSS)is essential in providing acute care services for health ***,trends of emergency and acute care in China haven’t been studied ***:Relevant literature was carefully reviewed,including original and review articles,letters,government reports,yearbooks,both in Chinese and in *** on the number of emergency visits,physicians and beds in emergency departments(EDs),and the workforce of prehospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks(2006–2018).RESULTS:Over the past decade,the number of ED visits tripled from 51.9 million to 166.5 million;and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 *** response to rapid increases in demand,the number of licensed emergency physicians raised from 20,058 to 59,409;the beds’number increased from 10,783 to 42,*** pre-hospital emergency care,the volume of health workforce increased from 3,687 to 8,671,with a 109%increase in the number of physicians from 1,774 to 3,***,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion were still the critical challenges faced by China’s ***:The number of emergency visits has grown with continual capability enhancement during the past ***,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion still need to be solved by China’s *** fi ndings and comparison with the USA could offer experiences and lessons to EMSS development worldwide,especially for developing countries.

关键词： Emergency medical service system Emergency visits Capabilities Challenges

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Validation of a pediatric bedside tool to predict time to death after withdrawal of life support

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World Journal of Clinical pediatrics 2016年第1期5卷 89-94页

作者： Ashima Das Ingrid M Anderson David G Speicher Richard H Speicher Steven L Shein Alexandre T Rotta Division of pediatric critical care Medicine Rainbow Babies and Children’s Hospital Case Western Reserve University School of Medicine

AIM: To evaluate the accuracy of a tool developed to predict timing of death following withdrawal of life support in children. METHODS: Pertinent variables for all pediatric deaths(age ≤ 21 years) from 1/2009 to 6/2014 in our pediatric intensive care unit(PICU) were extracted through a detailed review of the medical records. As originally described, a recently developed tool that predicts timing of death in children following withdrawal of life support(dallas predictor tool [DPT]) was used to calculate individual scores for each patient. Individual scores were calculated for prediction of death within 30 min(DPT30) and within 60 min(DPT60). For various resulting DPT30 and DPT60 scores, sensitivity, specificity and area under the receiver operating characteristic curve were ***: There were 8829 PICU admissions resulting in 132(1.5%) deaths. Death followed withdrawal of life support in 70 patients(53%). After excluding subjects with insufficient data to calculate DPT scores, 62 subjects were analyzed. Average age of patients was 5.3 years(SD: 6.9), median time to death after withdrawal oflife support was 25 min(range; 7 min to 16 h 54 min). Respiratory failure, shock and sepsis were the most common diagnoses. Thirty-seven patients(59.6%) died within 30 min of withdrawal of life support and 52(83.8%) died within 60 min. DPT30 scores ranged from-17 to 16. A DPT30 score ≥-3 was most predictive of death within that time period, with sensitivity = 0.76, specificity = 0.52, AUC = 0.69 and an overall classification accuracy = 66.1%. DPT60 scores ranged from-21 to 28. A DPT60 score ≥-9 was most predictive of death within that time period, with sensitivity = 0.75, specificity = 0.80, AUC = 0.85 and an overall classification accuracy = 75.8%.CONCLUSION: In this external cohort, the DPT is clinically relevant in predicting time from withdrawal of life support to death. In our patients, the DPT is more useful in predicting death within 60 min of withdrawal of life

关键词： Death Organ donation Children Donation after circulatory death

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Developmental dysplasia of the hip: What has changed in the last 20 years?

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World Journal of Orthopedics 2015年第11期6卷 886-901页

作者： Pavel Kotlarsky Reuben Haber Victor Bialik Mark Eidelman pediatric Orthopedic Unit Ruth Rappaport Children’s HospitalRambam Health Care Campus

Developmental dysplasia of the hip(DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.

关键词： Developmental dysplasia Newborn Infant Children Hip Developmental dysplasia of the hip

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Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

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World Journal of critical care Medicine 2014年第1期3卷 15-23页

作者： Mitchell Hamele William Bradley Poss Jill Sweney Division of pediatric critical care Department of Pediatrics School of Medicine University of Utah Salt Lake City UT 84108 United States

Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.

关键词： Terrorism Bioterrorism Chemical terrorism Blast injuries Mass casualty incidents Disasters pediatrics

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