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The pathogenesis of chronic subdural hematoma in the perspective of neomembrane formation and related mechanisms

BIOCELL 2024年第6期48卷 889-896页

作者： MINGYUE HUANG JUNFEI DAI XIANLIANG ZHONG JIN WANG JIANZHONG XU BO DU School of Medicine Southern University of Science and TechnologyShenzhen518055China department of emergency Shenzhen People’s HospitalThe Second Clinical Medical College of Jinan UniversityThe First Affiliated Hospital of Southern University of Science and TechnologyShenzhen518055China

Chronic subdural hematoma(CSDH)is a disease characterized by capsuled blood products that progressively occupy the intracranial space,causing intracranial hypertension and compression in the brain.CSDH frequently occurs in all demographics,especially in the elderly,but the pathogenesis of CSDH remains unclear.In this review,we discuss the origin,development,and current treatment strategies of CSDH.For theﬁrst time,we analyzed the cellular and molecular compositions of hematoma membranes with a focus on neomembrane formation,a complex early-stage interactive event in hematoma pathogenesis.We hypothesize that in patients with CSDH,dural border cells(DBCs)might be induced to synthesize collagen or serum proteins might accumulate at the dura and arachnoid layers at the site of injury,thereby encapsulating the hemorrhage.Membrane formation may trigger inﬂammatory responses after subdural hemorrhage,promotingﬁbroblast-involved extracellular matrix(ECM)deposition and aberrant angiogenesis within the outer membrane.Consequently,ECM deposition and angiogenesis mutually inﬂuence each other and are modulated by inﬂammatory processes.By illustrating the complex and interactive mechanism of neomembrane formation,we aim to provide a novel insight into CSDH pathogenesis and propose directions for future research as well as advancements in treatment strategies for this disease.

关键词： Chronic subduralhematoma Inflammation Angiogenesis Extracellular matrix Hyperfibrinolysis

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Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit

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Journal of Intensive Medicine 2024年第1期4卷 125-132页

作者： Ping Xu Basma Nasr Liang Li Wenbin Huang Wei Liu Xuelian Wang emergency department Zigong Fourth People’s HospitalZigongChina Institute of Medical Big Data Zigong Academy of Artificial Intelligence and Big Data for Medical ScienceZigongChina Artificial Intelligence Key Laboratory of Sichuan Province ZigongChina department of Cardiology First Affiliated Hospital of Dalian Medical UniversityDalianChina

Background:No convenient,inexpensive,and non-invasive screening tools exist to identify pulmonary hypertension(PH)-left heart disease(LHD)patients during the early stages of the disease course.This study investigated whether different methods of lung ultrasound(LUS)could be used for the initial investigation of PH-LHD.Methods:This was a single-center prospective observational study which was performed in the Zigong Fourth People’s Hospital.We consecutively enrolled patients with heart failure(HF)admitted to the emergency intensive care unit from January 2018 to May 2020.Transthoracic echocardiography and LUS were performed within 24 h before discharge.We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure(PASP).Bland-Altman plots were generated to inspect possible bias,and receiver operating characteristic(ROC)curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.Results:Seventy-one patients were enrolled in this study,with an overall median age of 79(interquartile range:71.5–84.0)years.Among the 71 patients,36(50.7%)cases were male,and 26(36.6%)had an intermediate and high echocardiographic probability of PH.All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH(P<0.05).The correlation coefficient(r)between different LUS scoring methods and PASP was moderate for the 6-zone(r=0.455,P<0.001),8-zone(r=0.385,P=0.001),12-zone(r=0.587,P<0.001),and 28-zone(r=0.535,P<0.001)methods.In Bland-Altman plots,each of the four LUS scoring methods had a good agreement with PASP(P<0.001).The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH(P<0.05).

关键词： Acute heart failure Pulmonary arterial systolic pressure Pulmonary hypertension Left heart disease Lung ultrasound

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Phrenic nerve block: the key to managing acute biliary pain?

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World Journal of emergency Medicine 2024年第1期15卷 62-63页

作者： Michael Shalaby Joshua Luftig department of emergency Medicine and Critical Care Herbert Wertheim College of Medicine at Florida International UniversityMiami 33199USA Advanced emergency Ultrasound Mount Sinai Medical CenterMiami Beach 33140USA department of emergency Medicine Highland HospitalAlameda Health SystemOakland 94602USA

Over the past two decades,the USA has witnessed a steep rise in the incidence of acute cholecystitis(AC),[1]even among children,[2]with over 200,000 cases annually.[3]Patients with AC often present to the emergency department(ED)experiencing severe distress,with most describing their pain level as“intolerable.”[4]Furthermore,there is usually a considerable delay before surgery,with a median time from diagnosis of AC to surgery of 28.5 h,[5]and a substantial percentage of patients wait as long as 10 d.[6]Prolonged delays before surgery lead to increased opioid use,which is associated with extended hospital stays and higher rates of readmission after cholecystectomy.[7]Furthermore,opioids can lead to vomiting,respiratory depression,delirium,and ultimately addiction.[8]We propose a novel regional anesthesia technique for managing AC:right phrenic nerve blockade.This method could offer improved pain control and a more favorable risk profile in selected patients when compared to current ED practices.

关键词： pain anesthesia diagnosis

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Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report

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World Journal of Clinical Cases 2024年第4期12卷 782-786页

作者： Xiao-Qin Song Yun-Long Jiang Xian-Bao Zou Shi-Chao Chen Ai-Jun Qu Ling-Ling Guo emergency department Liaocheng People’s HospitalLiaocheng 252000Shandong ProvinceChina

BACKGROUND Venovenous extracorporeal membrane oxygenation(V-V ECMO)has become an important treatment for severe pneumonia,but there are various complications during the treatment.This article describes a case with severe pneumonia success-fully treated by V-V ECMO,but during treatment,the retrovenous catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.The ECMO was safely withdrawn after multidiscip-linary consultation.Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations.CASE SUMMARY A 64-year-old man had severe pulmonary infection and respiratory failure.He was admitted to our hospital and was given ventilation support(fraction of inspired oxygen 100%).The respiratory failure was not improved and he was treated by V-V ECMO,during which the venous return catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn.Finally,the patient underwent vena cava angiography+balloon attachment+ECMO with-drawal in the operating room(prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery)after multidiscip-linary consultation.ECMO was safely withdrawn,and the patient recovered and was discharged.CONCLUSION Patients may have different vascular conditions.Multidisciplinary cooperation can ensure patient safety.Our experience will provide a reference for similar cases.

关键词： Severe pneumonia Extracorporeal membrane oxygenation Complications Superior vena cava Multidisciplinary consultation Case report

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^(18)F-FDG PET/CT findings of paratesticular alveolar rhabdomyosarcoma

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Cancer Innovation 2024年第2期3卷 68-71页

作者： Xueqi Chen Jiayin Shou Shanshi Li Yan Fan Jianhua Zhang department of Nuclear Medicine Peking University First HospitalBeijingChina department of Radiation Oncology Peking University First HospitalBeijingChina

Rhabdomyosarcoma(RMS)originates from primitive mesenchymal cells and is the most common soft tissue tumor in childhood.^(18)F-fluoro-deoxyglucose(^(18)F-FDG)positron emission tomography(PET)/computed tomography(CT)has been reported to be valuable in RMS staging and risk stratification.Paratesticular RMS is a relatively uncommon form of RMS,most of which are of the embryonal histologic type.Paratesticular alveolar RMS is associated with aggressive behavior,high metastatic potential,and poor outcomes.To the best of our knowledge,^(18)F-FDG PET/CT imaging findings of paratesticular alveolar RMS have never been described.Here,we report on a 16-year-old boy's rare paratesticular alveolar RMS with multiple metastases and its findings on^(18)F-FDG PET/CT.This case also demonstrates the potential value of^(18)F-FDG PET/CT in RMS staging and treatment decisions,and may aid in the differential diagnosis.

关键词： ^(18)F-FDG paratesticular alveolar rhabdomyosarcoma PET/CT

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Investigation of Student Nurses’Attitudes towards End-of-Life Care and Their Influencing Factors

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Open Journal of Nursing 2024年第5期14卷 183-191页

作者： Lei Peng Jingxian Wang Jia Wang Qiangqiang Liu department of emergency Medicine The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Background: This cross-sectional investigative study aimed to determine student nurses’ attitudes towards end-of-life care. Methods: This study used a descriptive research design with stratified sampling to survey student nurses enrolled in one of four nursing colleges in China from January 2023 to December 2023. Student nurses’ general demographic and prior related information, attitudes towards death and attitudes towards end-of-life care were determined using a general information questionnaire, the Death Attitude Profile—Revised scale and the Professional End-of-Life Attitude Scale (PEAS), respectively. Results: The total PEAS score was 122.91 ± 16.123. Significant differences were noted in the attitude towards end-of-life care scores according to sources of end-of-life care knowledge (P Conclusions: Student nurses lacked an optimistic attitude towards end-of-life care, which was influenced by differences in the sources of end-of-life care knowledge.

关键词： Nursing Students End-of-Life Care Attitude

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A Systematic Review of Contrast-Induced Acute Kidney Injury

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Open Journal of Nephrology 2024年第2期14卷 185-195页

作者： Xing Li Qiong Liu The first Clinical College of Chongqing Medical University Chongqing China department of emergency The First Affiliated Hospital of Chongqing Medical University Chongqing China

Background: Contrast-induced acute kidney injury (CI-AKI) is the third most common cause of AKI in hospitalized patients. Contrast agents mainly cause acute kidney injury through hypoxic damage to renal parenchyma and toxic effects on renal capillaries and tubules. Patients with CI-AKI are more likely to experience adverse events, including longer hospital stay and costs, longer ICU stay, and higher mortality rates. This article elaborates on the definition, epidemiology, risk factors, pathogenesis, and prevention strategies of CI-AKI. Methods: We conducted an extensive literature search using contrast agents and AKI as keywords to identify relevant studies on CI-AKI. Conclusion: CI-AKI is a significant clinical challenge that requires a multifaceted approach to prevention and management. Understanding the risk factors, pathophysiology, and current best practices is essential for healthcare providers to optimize patient care and improve outcomes in those undergoing contrast-enhanced imaging procedures. Hydration therapy is currently the main prevention method, but antioxidants may also become a new strategy.

关键词： CI-AKI ROS Preventive Strategies Antioxidants

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Spontaneous coronary artery rupture after lung cancer surgery:A case report and review of literature

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World Journal of Cardiology 2024年第2期16卷 92-97页

作者： Ying-Ding Ruan Jian-Wei Han department of Thoracic Surgery The First People's Hospital of JiandeJiande 311600Zhejiang ProvinceChina

BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.

关键词： Spontaneous coronary artery rupture Lung cancer Surgery Case report

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Mediastinal emphysema in the context of perforated gastric ulcer

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World Journal of Clinical Cases 2024年第15期12卷 2479-2481页

作者： Debkumar Chowdhury department of emergency Medicine Wythenshawe HospitalManchester M239LTUnited Kingdom

In the context of mediastinal emphysema/pneumomediastinum,the main aetiologies are associated with oesophageal perforation,lung pathology or post head and neck surgery related.The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging.The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic.Oesophageal perforation(Boerhaave syndrome)is associated with Mackler’s triad in upto 50%of patients(severe retrosternal chest pain,pneumomediastinum,mediastinitis).Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.

关键词： Pneumomediastinum Duodenal ulcer Computed tomography Visceral perforation Diagnostic imaging emergency care

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When Glanzmann thrombasthenia encounters antithrombin defi ciency: how do we balance the risk and benefi t of antithrombotic therapy?

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World Journal of emergency Medicine 2024年第1期15卷 67-69页

作者： Yu Wang Zhihao Liu Haoyu Weng Jianping Li department of Endocrinology Peking University First HospitalBeijing 100034China department of Cardiology Peking University First HospitalBeijing 100034China Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education Health Science CenterPeking UniversityBeijing 100034China

Glanzmann’s thrombasthenia(GT)is an inherited autosomal recessive bleeding disorder,resulting from mutations in the ITGA2B and ITGB3 genes,that lead to a defect in the platelet membrane integrinαIIbβ3.[1]As integrinαIIbβ3 plays an important role in thrombus formation,the clinical manifestation of GT includes bleeding(mostly mucocutaneous)and purpura.For this reason,patients with GT are typically thought to be unlikely to suffer from thromboembolic incidents.Antithrombin is an anticoagulant that inhibits thrombin and is activated factor X and other serine proteases in the coagulation cascade.[2]Antithrombin deficiency is an autosomal dominant hereditary disease with an approximate prevalence of 1/500 in the overall population.[3]In contrast to the hemorrhagic tendency of GT,patients with antithrombin deficiency are at increased risk of thromboembolism,especially in the venous system.Herein,we describe a rare case of GT and antithrombin deficiency coexisting in a single patient.Rivaroxaban was used for the treatment of pulmonary embolism(PE)and deep vein thrombosis(DVT).

关键词： thrombin throm bleeding

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