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Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

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World Journal of emergency Medicine 2024年第3期15卷 169-174页

作者： Jonathan Chabon Jemer Garrido Deanna Schreiber-Gregory Jefferson Drapkin Sergey Motov Department of emergency Medicine Maimonides Medical CenterBrooklyn 11219USA

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

关键词： Oxycodone Back pain emergency department

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Loss of GATA6-mediated up-regulation of UTX promotes pancreatic tumorigenesis and progression

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Genes & Diseases 2024年第2期11卷 921-934页

作者： Hui-Qing Zhang Fanyang Kong Xiangyu Kong Tingting Jiang Muyuan Ma Shaojiang Zheng Junli Guo Keping Xie The Third Department of Medical Oncology Jiangxi Cancer HospitalNanchangJiangxi 330006China departments of Gastroenterology Changhai HospitalSecond Military Medical UniversityShanghai 200433China Center for Pancreatic Cancer Research The South China University of Technology School of MedicineGuangzhouGuangdong 510006China Hainan Clinical Medical Research Center of the First Affiliated Hospital Hainan Women and Children's Medical CenterHainan Medical UniversityHaikouHainan 570102China Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province Key Laboratory of Emergency and Trauma of Ministry of EducationHainan Medical UniversityHaikouHainan 571199China

Ubiquitously transcribed tetratricopeptide repeat on chromosome X(UTX),also known as lysine(K)-specific demethylase 6A(KDM6A),functions as a tumor suppressor gene or oncogene depending on the tumor type and context.However,its tumor-suppressive mechanisms remain largely unknown.Here,we investigated the clinical significance and biological effects of UTX expression in pancreatic ductal adenocarcinoma(PDA)and determined the potential mechanisms of its dysregulation.UTX expression and its association with clinicopathologic characteristics of PDA patients were analyzed using immunohistochemistry.UTX mRNA and protein expression and their regulation in PDA cell lines were measured using quantitative polymerase chain reaction and Western blot analyses.The biological functions of UTX in PDA cell growth,migration,and invasion were determined using gain-and loss-of-function assays with both in vitro and in vivo animal models.UTX expression was reduced in human PDA cell lines and specimens.Low UTX expression was associated with poor differentiation and prognosis in PDA.Forced UTX expression inhibited PDA proliferation,migration,and invasion in vitro and PDA growth and metastasis in vivo,whereas knockdown of UTX expression did the opposite.Mechanistically,UTX expression was trans-activated by GATA6 activation.GATA6-mediated PDA progression could be blocked,at least partially,by silencing UTX expression.In conclusion,loss of GATA6-mediated UTX expression was evident in human PDA and restored UTX expression suppressed PDA growth and metastasis.Thus,UTX is a tumor suppressor in PDA and may serve as a prognostic biomarker and therapeutic target.

关键词： Growth Invasion Metastasis Pancreatic cancer UTX

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Quantitative assessment of the impact of a triage physician on the Accreditation Council for Graduate Medical Education resident milestones in the emergency department

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World Journal of emergency Medicine 2024年第3期15卷 220-222页

作者： Julie Cueva Duncan Grossman Vishnu Muppala Arlene Chung Mahlaqa Butt Jefferson Drapkin Antonios Likourezos Errel Khordipour Department of emergency Medicine Maimonides Medical CenterNew York 11219USA

The “door-to-doctor” time for patients to be seen by a physician is an increasingly studied metric.Hospitals may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across departments.TPs put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further evaluation.As the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains unclear.We implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

关键词： physician doctor treatment

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emergency department management of acute agitation in the reproductive age female and pregnancy

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World Journal of emergency Medicine 2024年第2期15卷 83-90页

作者： Ariella Gartenberg Kayla Levine Alexander Petrie Department of emergency Medicine Jacobi Medical Center and Montefiore Medical CenterNY 10461USA Department of Psychiatry and Behavioral Sciences Albert Einstein College of Medicine and Montefiore Medical CenterNY 10461USA Department of emergency Medicine Jacobi Medical Center and North Central Bronx HospitalNY 10461USA

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

关键词： Agitation Pregnancy Haloperidol Ketamine Benzodiazepines

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Landslide hazard susceptibility evaluation based on SBAS-InSAR technology and SSA-BP neural network algorithm:A case study of Baihetan Reservoir Area

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Journal of Mountain Science 2024年第3期21卷 952-972页

作者： GUO Junqi XI Wenfei YANG Zhiquan SHI Zhengtao HUANG Guangcai YANG Zhengrong YANG Dongqing Faculty of Geography Yunnan Normal UniversityKunming 650500China Key Laboratory of Early Rapid Identification Prevention and Control of Geological Diseases in Traffic Corridor of High Intensity Earthquake Mountainous Area of Yunnan ProvinceKunming 650093China Faculty of Public Safety and emergency Management Kunming University of Science and TechnologyKunming 650093China Key Laboratory of Geological Disaster Risk Prevention and Control and emergency Disaster Reduction of Ministry of emergency Management of the People’s Republic of China Kunming University of Science and TechnologyKunming 650093China Guizhou Geological Survey Institute Guiyang 550081China College of Big Data and Intelligent Engineering Southwest Forestry UniversityKunming 650224China

Landslide hazard susceptibility evaluation takes on critical significance in early warning and disaster prevention and reduction.In order to solve the problems of poor effectiveness of landslide data and complex calculation of weights for multiple evaluation factors in the existing landslide susceptibility evaluation models,in this study,a method of landslide hazard susceptibility evaluation is proposed by combining SBAS-InSAR(Small Baseline Subsets-Interferometric Synthetic Aperture Radar)and SSA-BP(Sparrow Search Algorithm-Back Propagation)neural network algorithm.The SBAS-InSAR technology is adopted to identify potential landslide hazards in the study area,update the cataloging data of landslide hazards,and 11 evaluation factors are chosen for constructing the SSA-BP model for training and validation.Baihetan Reservoir area is selected as a case study for validation.As indicated by the results,the application of SBAS-InSAR technology,combined with both ascending and descending orbit data,effectively addresses the incomplete identification of landslide hazards caused by geometric distortion of single orbit SAR data(e.g.,shadow,overlay,and perspective contraction)in deep canyon areas,thereby enabling the acquisition of up-to-date landslide hazard data.Moreover,in comparison to the conventional BP(Back Propagation)algorithm,the accuracy of the model constructed by the SSA-BP algorithm exhibits a significant increase,with mean squared error and mean absolute error reduced by 0.0142 and 0.0607,respectively.Additionally,during the process of susceptibility evaluation,the SSA-BP model effectively circumvents the issue of considerable manual interventions in calculating the weight of evaluation factors.The area under the curve of this model reaches 0.909,surpassing BP(0.835),random forest(0.792),and the information value method(0.699).The risk of landslide occurrence in the Baihetan Reservoir area is positively correlated with slope,surface temperature,and deformation rate,while it is negatively correlated with fault

关键词： Baihetan SBAS-InSAR SSA-BP Landslide hazard susceptibility evaluation

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COVID-19 presentation as acute pancreatitis:A case report

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Journal of Acute Disease 2022年第5期11卷 199-201页

作者： Abhyuday Kumar A.Valiyaparambath Neeraj Kumar Amarjeet Kumar Ajeet Kumar Department of Anaesthesiology AIIMS PatnaBiharIndia801505 departments of trauma&emergency AIIMS PatnaBiharIndia801505

Rationale:The gastrointestinal manifestations of COVID-19 include anorexia,nausea,vomiting,abdominal pain,and diarrhea.However,pancreatitis as the presentation of COVID-19 is rarely reported.Patient’s Concern:A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d.Diagnosis:Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction.Interventions:The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness.The patient was started on enteral feeding,analgesics,antibiotics,dexamethasone,low molecular weight heparin,and supportive therapy.Outcomes:The patient developed severe acute respiratory distress syndrome and died 6 days after admission.Lessons:Management of COVID-19 in the presence of pancreatitis is challenging.Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed.Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir.Dexamethasone,even though it has shown a beneficial effect in treating COVID-19,can have an additive effect in causing hyperglycemia in these cases.Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies,keeping in mind the considerations for both diseases.

关键词： Pancreatitis COVID-19 APACHE II Remdesivir Fluid

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Death from caustic ingestion:A case report

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Journal of Acute Disease 2024年第2期13卷 81-84页

作者： Shao Hui Koh Jacqueline C.L.Tan Department of emergency Medicine Sengkang General HospitalSingapore

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

关键词： Phosphoric acid poisoning Caustic ingestion Acid ingestion Cleaner ingestion Corrosive ingestion

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How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

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Journal of Sport and Health Science 2024年第4期13卷 537-547页

作者： Jacqueline Josee van Ierssel Olivia Galea Kirsten Holte Caroline Luszawski Elizabeth Jenkins Jennifer O’Neil Carolyn A Emery Rebekah Mannix Kathryn Schneider Keith Owen Yeates Roger Zemek Children’s Hospital of Eastern Ontario Research Institute OttawaON K1H 8L1Canada The Centre for Health Activity and Rehabilitation ResearchUniversity of OtagoDunedin 9016New Zealand Sport Injury Prevention Research Centre Faculty of KinesiologyUniversity of CalgaryCalgaryAB T2N 1N4Canada Alberta Children’s Hospital Research Institute University of Calgary CalgaryAB T2N 1N4Canada Hotchkiss Brain Institute University of CalgaryCalgaryAB T2N 4N1Canada Department of Psychology University of CalgaryCalgaryAB T2N 1N4Canada g Faculty of MedicineUniversity of OttawaOttawaON K1H 8M5Canada School of Rehabilitation Sciences University of OttawaOttawaON K1H 8M5Canada Bruyere Research Institute OttawaON K1N 5C8Canada departments of Pediatrics and emergency Medicine Harvard Medical SchoolBostonMA 02115USA departments of Pediatrics and emergency Medicine University of OttawaOttawaON K1H 8M5Canada

Purpose:The study aimed to examine the reporting completeness of randomized controlled trials(RCTs)of non-pharmacological interventions following concussion.Methods:We searched MEDLINE,Embase,PsycInfo,CINAHL,and Web of Science up to May 2022.Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication(TIDieR),Consensus on Exercise Reporting Template(CERT),and international Consensus on Therapeutic Exercise aNd Training(i-CONTENT)checklists.Additional information was sought my study authors where reporting was incomplete.Risk of bias(ROB)was assessed with the Cochrane ROB-2 Tool.RCTs examining non-pharmacological interventions following concussion.Results:We included 89 RCTs(n=53 high ROB)examining 11 different interventions for concussion:sub-symptom threshold aerobic exercise,cervicovestibular therapy,physical/cognitive rest,vision therapy,education,psychotherapy,hyperbaric oxygen therapy,transcranial magnetic stimulation,blue light therapy,osteopathic manipulation,and head/neck cooling.Median scores were:TIDieR 9/12(75%;interquartile range(IQR)=5;range:5-12),CERT 17/19(89%;IQR=2;range:10-19),and i-CONTENT 6/7(86%;IQR=1;range:5-7).Percentage of studies completely reporting all items was TIDieR 35%(31/89),CERT 24%(5/21),and i-CONTENT 10%(2/21).Studies were more completely reported after publication of TIDieR(t_(87)=2.08;p=0.04)and CERT(t_(19)=2.72;p=0.01).Reporting completeness was not strongly associated with journal impact factor(TIDieR:rs=0.27;p=0.01;CERT:r_(s)=-0.44;p=0.06;i-CONTENT:r_(s)=-0.17;p=0.48)or ROB(TIDieR:rs=0.11;p=0.31;CERT:rs=0.04;p=0.86;i-CONTENT:rs=0.12;p=0.60).Conclusion:RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness,but are often missing key components,particularly modifications,motivational strategies,and qualified supervisor.Reporting completeness improved after TIDieR and CERT publication,but publication in highly cited journals and low ROB

关键词： Concussion Intervention Randomized controlled trial Systematic review

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Early endotracheal intubation is not associated with the rate of return of spontaneous circulation following cardiac arrest at the emergency department:an exploratory analysis

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World Journal of emergency Medicine 2024年第4期15卷 297-300页

作者： Siwat Neamjun Phichayut Phinyo Borwon Wittayachamnankul Wachira Wongtanasarasin Department of emergency Medicine Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand Department of Family Medicine Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand Center for Clinical Epidemiology and Clinical Statistics Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand Department of emergency Medicine University of California Davis School of MedicineSacramento 95817USA

Cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and respiratory issues.[2]Recommendations emphasize the expertise of responders in airway management.[3]Various options exist,such as chest compression-only cardiopulmonary resuscitation(CPR),bag-mask ventilation(BMV),and advanced airways.The BMV and advanced airways are not deemed equivalent or superior based on previous evidence.[4]Achieving consistency in choosing and timing the optimal airway approach during IHCA is crucial.The current American Heart Association guidelines suggest an advanced airway strategy when endotracheal intubation(ETI)success rates are high,but the optimal time for advanced airway management remains unclear.[5]Wong et al[6]revealed that survival improved by less than 5 min with advanced airway management.According to a subgroup analysis of IHCA patients in emergency departments(EDs),early intubation was associated with a 1.5-fold greater rate of return of spontaneous circulation(ROSC)than in other locations.[7]ED patients’constant monitoring and immediate management,with readily available intubation equipment,enhance early intubation and survival rates.[6]Nonetheless,IHCA patients intubated within the first 15 min had a lower ROSC rate.

关键词： intubation return annually

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Sudden cardiac death in a case of Crohn's disease with COVID-19: A case report

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Journal of Acute Disease 2022年第3期11卷 123-126页

作者： Neeraj Kumar Subhajit Ghosh Abhyuday Kumar Sanjeev Kumar Prem Kumar departments of trauma&emergency All India Institute of Medical SciencesPatnaIndia departments of Anaesthesiology All India Institute of Medical SciencesPatnaIndia departments of CTVS All India Institute of Medical SciencesPatnaIndia departments of Radiology All India Institute of Medical SciencesPatnaIndia

Rationale:The mechanism of sudden cardiac death in COVID-19 can be multifactorial.Cardiac hypersensitivity to 5-ASA therapy leading to myocarditis has been reported in some cases.Cytokine storm syndrome and idiosyncratic reaction with mesalazine use may lead to sudden cardiac death in COVID-19.Use of immunosuppressants in hospitalized COVID-19 patients should be continued with caution,especially in patients with inflammatory bowel disease.Patient’s concern:A 75-year-old man who was tested positive for SARS-CoV-2 was admitted with a history of shortness of breath for the last two days.He was a known case of Crohn’s disease treated with mesalazine.Diagnosis:COVID-19 pneumonia with underlying Crohn’s disease leading to sudden cardiac death.Intervention:Remdesivir,antibiotics,steroids,low molecular weight heparin,tablet zinc,tab vitamin C,and other supportive treatment were started.Because of increased inflammatory markers,itolizumab was given to the patient on the 2nd day.Outcome:On the 5th day of the intensive care unit,the patient complained of sudden chest pain with respiratory distress leading to bradycardia and asystole and could not be resuscitated.Lessons:Causes for sudden cardiac death in COVID-19 pneumonia patients with Crohn’s disease is multifactorial.Although mesalazine may be a safe and effective drug in the management of inflammatory bowel disease,it can induce sytokine strom syndrome and idiosyncratic reactions that could be one of the reasons of sudden cardic death.Therefore,we should be aware of its serious and potentially life-threatening complications,especially in COVID-19 infected patients.

关键词： COVID-19 Sudden cardiac death Chron’s disease

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