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Management of obstructed colorectal carcinoma in an emergency setting:An update

World Journal of Gastrointestinal Oncology 2024年第3期16卷 598-613页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis 2nd Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Colorectal carcinoma is common,particularly on the left *** 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/*** best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains *** the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or *** operative plan should be either one-stage or two-stage ***-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and ***-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of *** control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or *** the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic *** role of minimally invasive surgery(laparoscopic or robotic)is a subject of *** laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic *** decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival *** combination with neoadjuvant chemotherapy or radiation may have a p

关键词： Acute abdomen Obstructive ileus Colorectal carcinoma emergency surgery Colectomy Intraluminal metal stents

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Identification of clinical subphenotypes of sepsis after laparoscopic surgery

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第1期7卷 16-26页

作者： Jie Yang Bo Zhang Chaomin Hu Xiaocong Jiang Pengfei Shui Jiajie Huang Yucai Hong Hongying Ni Zhongheng Zhang Department of emergency Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China Department of emergency Medicine Huzhou Central HospitalHuzhou 313000China Department of Critical Care Medicine Affiliated Jinhua HospitalZhejiang University School of MedicineJinhua 321000China

Objective:Some patients exhibit septic symptoms following laparoscopic surgery,leading to a poor *** clinical subphenotyping is critical for guiding tailored therapeutic strategies in these *** identifying predisposing factors for postoperative sepsis,clinicians can implement targeted interventions,potentially improving *** study outlines a workflow for the subphenotype methodology in the context of laparoscopic surgery,along with its practical ***:This study utilized data routinely available in clinical case systems,enhancing the applicability of our *** data included vital signs,such as respiratory rate,and laboratory measures,such as blood sodium *** process of categorizing clinical routine data involved technical complexities.A correlation heatmap was used to visually depict the relationships between *** points were used to identify the clustering structure and combined with Consensus K clustering methods to determine the optimal ***:Our study highlighted the intricacies of identifying clinical subphenotypes following laparoscopic surgery,and could thus serve as a valuable resource for clinicians and researchers seeking to explore disease heterogeneity in clinical *** simplifying complex methodologies,we aimed to bridge the gap between technical expertise and clinical application,fostering an environment where professional medical knowledge is effectively utilized in subphenotyping ***:This tutorial could primarily serve as a guide for beginners.A variety of clustering approaches were explored,and each step in the process contributed to a comprehensive understanding of clinical subphenotypes.

关键词： Laparoscopic surgery Phenotype Precision medicine Sepsis

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Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging

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World Journal of Clinical Cases 2024年第25期12卷 5673-5680页

作者： Wei-Wei Ding Lei Ding Li Li Pan Zhang Rui Gong Jian Li Meng-Ying Xu Feng Ding Bing Chen Department of Radiology General Hospital of Ningxia Medical UniversityYinchuan 198793Ningxia Hui Autonomous RegionChina Department of emergency The First People’s hospital of Yinchuan in NingxiaYinchuan 198794Ningxia Hui Autonomous RegionChina

BACKGROUND Due to frequent and high-risk sports activities,the elbow joint is susceptible to injury,especially to cartilage tissue,which can cause pain,limited movement and even loss of joint *** To evaluate magnetic resonance imaging(MRI)multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage *** A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective *** analyzed the accuracy of conventional MRI sequences(T1-weighted imaging,T2-weighted imaging,proton density weighted imaging,and T2 star weighted image)and Three-Dimensional Coronary Imaging by Spiral Scanning(3D-CISS)in the diagnosis of elbow cartilage *** was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with *** The diagnostic accuracy of 3D-CISS sequence was 89.34%±4.98%,the sensitivity was 90%,and the specificity was 88.33%,which showed the best performance among all sequences(P<0.05).The combined application of the whole sequence had the highest accuracy in all sequence combinations,the accuracy of mild injury was 91.30%,the accuracy of moderate injury was 96.15%,and the accuracy of severe injury was 93.33%(P<0.05).Compared with arthroscopy,the combination of all MRI sequences had the highest consistency of 91.67%,and the kappa value reached 0.890(P<0.001).CONCLUSION Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in *** MRI is recommended to ensure the best diagnosis and treatment.

关键词： MRI multisequence imaging Cartilage injury of elbow joint Accuracy of diagnosis Arthroscopy 3D-CISS

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Artificial intelligence in the anterior segment of eye diseases

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International Journal of Ophthalmology(English edition) 2024年第9期17卷 1743-1751页

作者： Yao-Hong Liu Lin-Yu Li Si-Jia Liu Li-Xiong Gao Yong Tang Zhao-Hui Li Zi Ye School of Medicine Nankai UniversityTianjin 300071China Medical School of Chinese PLA Beijing 100039China Department of Ophthalmology Chinese PLA General HospitalBeijing 100039China Chinese PLA general Hospital Medicine Innovation Research Department Beijing 100039China

Ophthalmology is a subject that highly depends on imaging *** intelligence(AI)technology has great potential in medical imaging analysis,including image diagnosis,classification,grading,guiding treatment and evaluating *** combination of the two can realize mass screening of grass-roots eye health,making it possible to seek medical treatment in the mode of“first treatment at the grass-roots level,two-way referral,emergency and slow treatment,and linkage between the upper and lower levels”.On the basis of summarizing the AI technology carried out by scholars and their teams all over the world in the field of ophthalmology,quite a lot of studies have confirmed that machine learning can assist in diagnosis,grading,providing optimal treatment plans and evaluating prognosis in corneal and conjunctival diseases,ametropia,lens diseases,glaucoma,iris diseases,*** paper systematically shows the application and progress of AI technology in common anterior segment ocular diseases,the current limitations,and prospects for the future.

关键词： artificial intelligence anterior segment ocular disease ametropia glaucoma

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Clinical analysis of patients with deep sternal wound infection-induced sepsis:a retrospective cohort study

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emergency and Critical Care Medicine 2024年第2期4卷 67-73页

作者： Bin Song Zhentian Cui Hongyan Ju Yue Sun Dandan Liu Guanggang Li Department of Critical Care 7th Medical Center of Chinese PLA General HospitalBeijingChina Department of Cardiac and Macrovascular Surgery 7th Medical Center of Chinese PLA General HospitalBeijingChina

Background:This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related ***:A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical *** clinical manifestations,laboratory test results,infection control,and organ and nutritional support of the patients were summarized,and the follow-up data were ***:The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea,high fever,chills,and altered state of *** test results revealed increased inflammatory markers and decreased oxygenation *** and liver function injury were observed in 8 and 4 patients,respectively;18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels,*** the 8 patients whose wound secretions tested positive for bacteria,Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients,*** of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans *** patients received ventilator-assisted ventilation and 2 patients received renal replacement *** all the 21 patients,17 were cured,2 died,and 2 were ***:Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting *** most prominent clinical manifestation is dyspnea,which is sometimes accompanied by the impairment of organ *** prevention,proper nutrition support,and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.

关键词： Clinical analysis Deep sternal wound infection Sepsis

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Prognostic Factors for Mortality in Severe Traumatic Brain Injury at HGZ 46, Villahermosa, Tabasco, Period from March 1, 2021 to December 31, 2022

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Open Journal of emergency Medicine 2024年第1期12卷 1-9页

作者： América del Carmen Flores Jiménez Eduardo Guillermo Aguilar López Rafael Blanco De La Vega Pérez Juan Manuel Hernández Vázquez emergency Room at general Zone Hospital #46 (HGZ46) “Dr. Bartolomé Reynés Berezaluce” from Mexican Institute of Social Security Tabasco Mexico Intensive Care Unit at general Zone Hospital #46 (HGZ46) “Dr. Bartolomé Reynés Berezaluce” from Mexican Institute of Social Security Tabasco Mexico

Introduction: A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or by an object that pierces the skull and interrupts the normal function of the brain. Severe TBI is estimated at 73 cases per 100,000 people. The mortality of severe TBI can be reduced if a timely diagnosis and treatment of the injuries are made through prognostic factors. Objective: To determine the prognostic factors related to mortality in severe traumatic brain injury at the Hospital general de Zona No. 46. Material and Methods: Retrospective, cross-sectional and descriptive study in beneficiaries admitted to the Hospital general de Zona (HGZ) No. 46 of the Mexican Institute of Social Security (IMSS by its acronym in Spanish), with a diagnosis of severe TBI;the possible prognostic factors related to mortality of severe TBI were obtained from their records. Measures of central tendency and chi square were used for data analysis. Results: The study sample consisted of 60 subjects diagnosed with severe traumatic brain injury, of which 5 (8%) were women and 55 (92%) were men, and all 60 (100%) patients died. The average age of the sample was 26 with a standard deviation of 9 years. The variables that had a p value less than or equal to 0.05 were: Mydriasis, seizures, Hyperglycemia, Normoglycemia, Hypothermia and Hypotension. This means that these variables were associated with mortality. Conclusion: Statistical significance is demonstrated in prognostic factors of mortality in severe traumatic brain injury with p < 0.05 in the case of mydriasis, seizures, hyperglycemia, normoglycemia, hypothermia and hypotension.

关键词： Traumatic Brain Injury Prognostic Factors Mortality Severity

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Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage

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Stroke & Vascular Neurology 2024年第4期9卷 446-456,I0147页

作者： Yunke Li Sung-Min Cho Radhika Avadhani Hassan Ali Yi Hao Santosh B Murthy Joshua N Goldstein Fan Xia Xin Hu Natalie L Ullman Issam Awad Daniel Hanley Wendy C Ziai The George Institute for Global Health BeijingChina Department of Neurology Division of Neurocritical CareJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA Department of Neurology Division of Brain Injury OutcomesJohns Hopkins Medical Institutions CampusBaltimoreMarylandUSA Department of Neurology Weill Cornell Medical CollegeNew YorkNew YorkUSA Department of emergency Medicine Massachusetts General HospitalBostonMassachusettsUSA Department of Neurosurgery West China Hospital of MedicineChengduSichuanChina Department of Neurosurgery University of Chicago Pritzker School of MedicineChicagoIllinoisUSA

Background Minimally invasive surgery(MIS)for spontaneous supratentorial intracerebral haemorrhage(ICH)is controversial but may be beneficial if end-of-treatment(EOT)haematoma volume is reduced to≤15 *** explored whether MRI findings of cerebral small vessel disease(CSVD)modify the effect of MIS on long-term *** Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation(MISTIE)*** tested for heterogeneity in the effects of MIS and MIS+EOT volume≤15 mL on the trial’s primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable *** Of 499 patients enrolled in MISTIE III,288 patients had MRI,149(51.7%)randomised to MIS and 139(48.3%)to standard medical care(SMC).Median(IQR)ICH volume was 42(30–53)*** the full MRI cohort,there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores(all P_(interaction)>0.05).In 94 MIS patients with EOT ICH volume≤15 mL,significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score<2(OR,0.14(0.05–0.42);P_(interaction)=0.006),absence of lacunes(OR,0.37(0.18–0.80);P_(interaction)=0.02)and absence of severe white matter hyperintensities(WMHs)(OR,0.22(0.08–0.58);P_(interaction)=0.03).Conclusions Following successful haematoma reduction by MIS,we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe *** features may have utility for prognostication and patient selection in clinical trials of MIS.

关键词： Surgery surgery absence

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Role of bioinformatics databases and tools in radiation biology

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Radiation Medicine and Protection 2024年第3期5卷 165-169页

作者： Yizhe Gao Qingjie Liu China CDC Key Laboratory of Radiological Protection and Nuclear emergency National Institute for Radiological ProtectionChinese Center for Disease Control and PreventionBeijing100088China

Bioinformatics has become increasingly integral to radiation biology,also known as radiobiology,providing substantial support through data storage,conversion,visualization,and *** review aims to deepen understanding of bioinformatics application in radiobiology by introducing key databases and analytical tools in radiobiology,including general bioinformatics databases,radiobiology-specific databases,data processing tools,and statistical analysis tools for differentially expressed genes(DEGs)and LC/MS *** review also discusses bioinformatics applications in radiobiological fields,such as radioresistance and immune cell *** these advances,challenges such as data interoperability *** and projects to address these issues,such as GeCo and GMQL,are also examined.

关键词： Radiobiology Bioinformatics Radioresistance Immune cell enrichment

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Fine-tuning the structure-tolerance-antitumor efficacy axis of prodrug nanoassemblies via branched aliphatic functionalization

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Nano Research 2024年第4期17卷 2908-2918页

作者： Guanting Li Fengli Xia Hongying Xiao Shunzhe Zheng Shuwen Fu Han Qiao Qianhui Jin Xuanbo Zhang Dun Zhou Chutong Tian Jin Sun Zhonggui He Bingjun Sun Department of Pharmaceutics Wuya College of InnovationShenyang Pharmaceutical UniversityShenyang 110016China Department of Pharmaceutics College of PharmacyShenyang Pharmaceutical UniversityShenyang 110016China emergency Department The First Affiliated Hospital of Jinzhou Medical UniversityJinzhou 121001China

Small-molecule prodrug nanoassemblies have emerged as efficient antitumor drug delivery ***,in the case of camptothecins-based prodrug nanoassemblies,linear aliphatic side chain modification often results in rod-shaped or irregularly shaped nanoassemblies,which are highly unfavorable for sterilization through filtration,and may cause capillary blockage upon intravenous *** rational design of camptothecins-based prodrug nanoassemblies remains a ***,we propose that branched aliphatic alcohol(BAA)functionalization could fine-tune the structure-tolerance-antitumor efficacy axis of prodrug ***,four SN38-BAA prodrugs were synthesized by conjugating 7-ethyl-10-hydroxycamptothecin(SN38)with BAAs of varying lengths via a tumor redox-responsive disulfide bond,which self-assemble into uniform spherical *** length of BAA was found to significant impact the multiple drug delivery process,including colloidal stability,drug release profiles and ***,SN38-C21 NPs(SN38-11-heneicosanol nanoparticles),featuring the longest BAA,showcased multiple therapeutic advantages,ultimately culminating the optimal antitumor efficacy and *** findings underscore the potential of BAA functionalization in strengthening the therapeutic outcomes of prodrug nanoassemblies,and provide valuable insights for developing translational camptothecins-based nanomedicines.

关键词： prodrug nanoassembly self-assembly antitumor efficacy tolerance 7-ethyl-10-hydroxycamptothecin(SN_(3)8)

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REBOA: A novel life-saving tool for non-compressible traumatic hemorrhage

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中华医学杂志(英文版) 2024年第19期137卷 2024 Aug 5页

作者： Hu Wei Tian Xiaomei Li Xin Liu Fengyong Department of Interventional Radiology Senior Department of Oncology The Fifth Medical Center of Chinese PLA General Hospital Beijing China Department of emergency The Fifth Medical Center of Chinese PLA General Hospital Beijing China Senior Department of Infectious Diseases The Fifth Medical Center of Chinese PLA General Hospital National Clinical Research Center for Infectious Diseases Beijing China

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