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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 *** may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across *** put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further *** the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains *** implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

关键词： physician doctor treatment

Comparison of two nutritional assessment methods in gastroenterology patients

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World Journal of Gastroenterology 2010年第16期16卷 1999-2004页

作者： Branka F Filipovi Milan Gaji Nikola Milini Branislav Milovanovi Branislav R Filipovi Mirjana Cvetkovi Nela ibali Department of Gastroenterohepatology Clinical and Hospital Center "Bezanijska Kosa" School of Medicine Institute for Medical Statistics Faculty of Cardiology School of Medicine Laboratory for Neurocardiology Clinical and Hospital Center "Bezanijska Kosa" Institute of Anatomy "Niko Miljanic" School of Medicine Biochemical Laboratory Clinical and Hospital Center "Bezanijska Kosa"

AIM:To investigate and compare efficacy and differences in the nutritional status evaluation of gastroenterology patients by application of two methods:subjective global assessment(SGA) and nutritional risk index(NRI).METHODS:The investigation was performed on 299 hospitalized patients,aged 18-84 years(average life span 55.57 ± 12.84),with different gastrointe-stinal pathology,admitted to the Department of Gastroenterohepatology,Clinical and Hospital center "bezanijska kosa" during a period of 180 *** the patients,after being informed in detail about the study and signing a written consent,underwent nutritional status analysis,which included two different nutritional indices:SGA and NRI,anthropometric parameters,bioelectrical impedance analysis,and biochemical markers,within 24 h of ***:In our sample of 299 hospitalized patients,global malnutrition prevalence upon admission varied from 45.7% as assessed by the SGA to 63.9% by *** applied methods required different parameters for an adequate approach:glucose level(5.68 ± 1.06 mmol/L vs 4.83 ± 1.14 mmol/L,F = 10.63,P = 0.001);body mass index(26.03 ± 4.53 kg/m2 vs 18.17 ± 1.52 kg/m2,F = 58.36,P < 0.001);total body water(42.62 ± 7.98 kg vs 36.22 ± 9.32 kg,F = 7.95,P = 0.005);basal metabolic rate(1625.14 ± 304.91 kcal vs 1344.62 ± 219.08 kcal,F = 9.06,P = 0.003) were very important for SGA,and lymphocyte count was relevant for NRI:25.56% ± 8.94% vs 21.77% ± 10.08%,F = 11.55,P = *** number of malnourished patients rose with the length of hospital stay according to both nutritional *** discriminative function analysis(DFA) delineated the following parameters as important for prediction of nutritional status according to SGA assessment:concentration of albumins,level of proteins,SGA score and body *** DFA extracted MAMC,glucose level and NRI scores were variables of importance for the prediction of whether admitted patients would be classif ied as well or ***:SGA

关键词： Nutritional status Subjective global assessment Nutritional risk index Comparison

Blood-brain barrier pathology in cerebral small vessel disease

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Neural Regeneration Research 2024年第6期19卷 1233-1240页

作者： Ruxue Jia Gemma Solé-Guardia Amanda J.Kiliaan Department of medical Imaging AnatomyRadboud University Medical CenterDonders Institute for BrainCognition&BehaviorCenter for Medical NeurosciencePreclinical Imaging Center PRIMERadboud Alzheimer CenterNijmegenthe Netherlands

Cerebral small vessel disease is a neurological disease that affects the brain microvasculature and which is commonly observed among the *** at first it was considered innocuous,small vessel disease is nowadays regarded as one of the major vascular causes of *** signs of small vessel disease include small subcortical infarcts,white matter magnetic resonance imaging hyperintensities,lacunes,enlarged perivascular spaces,cerebral microbleeds,and brain atrophy;however,great heterogeneity in clinical symptoms is observed in small vessel disease *** pathophysiology of these lesions has been linked to multiple processes,such as hypoperfusion,defective cerebrovascular reactivity,and blood-brain barrier ***,studies on small vessel disease suggest that blood-brain barrier dysfunction is among the earliest mechanisms in small vessel disease and might contribute to the development of the hallmarks of small vessel ***,the purpose of this review is to provide a new foundation in the study of small vessel disease ***,we discuss the main structural domains and functions of the blood-brain ***,we review the most recent evidence on blood-brain barrier dysfunction linked to small vessel ***,we conclude with a discussion on future perspectives and propose potential treatment targets and interventions.

关键词： blood-brain barrier dysfunction cerebral blood flow cerebral hypoperfusion endothelial dysfunction hypertension inflammation magnetic resonance imaging neurovascular unit oxidative stress small vessel disease tight junctions transcytosis

Designing a medical ethics curriculum in ophthalmology

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Annals of Eye Science 2024年第1期9卷 4-9页

作者： Matthew D.Gearinger Flaum Eye Institute University of Rochester Medical CenterRochesterNYUSA

Ethical principles form a bedrock to medical practice in any specialty,guiding physicians to appropriate attitudes and behaviors.A formal ethics curriculum can be difficult to generate de novo in an ophthalmology training program.A number of barriers exist in most ophthalmology departments:trainees may think ethics is of secondary importance compared to core basic and clinical science topics;most ophthalmology faculty have no formal degree in medical ethics;there is limited didactic time with competing academic,clinical,and surgical priorities;work-hours regulations may limit the time available to deliver“para-professional”lectures;and there is a belief that the medical ethics lectures during medical school is a sufficient amount of coursework to last through a physician’s career with no need for continuing professional *** four pillars of medical ethics are beneficence,non-maleficence,autonomy,and *** addition,morals,ethics,and professionalism are important aspects of sound medical practice.A curriculum specific to medical ethics in ophthalmology can be developed in any of our sub-specialties and include lectures,curated readings,case rounds,and clinic wrap-up *** considerations are part of everyday clinical practice,and a structured ethics curriculum can be incorporated into ophthalmology training *** concept of backward design can be used to structure the curriculum,starting with the expected outcome,then designing authentic assessments,and finally putting together a learning plan that has students actively involved in ethical *** paper will provide a guide to developing an ethics curriculum for an ophthalmology training program utilizing the concept of backwards design and guide the reader through the process of developing expected learning outcomes,authentic assessments,and a unified learning plan.

关键词： medical ethics curriculum design medical education

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 *** safety of psychotropic medications in the reproductive age female has not been well *** review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during ***: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 ***:While nonpharmacological management is preferred,ED visits for agitation often require medical *** should be selected based on the etiology of agitation and the clinical setting to avoid major adverse *** effects are common in pregnant *** mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse *** moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on *** has become the most frequently utilized psychotropic for agitation during *** generation psychotropics are often utilized as second-line therapy,including *** and ketamine have demonstrated adverse fetal ***: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 *** 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

CD4^(+)T cells produce IFN-I to license cDC1s for induction of cytotoxic T-cell activity in human tumors

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Cellular & Molecular Immunology 2024年第4期21卷 374-392页

作者： Xin Lei Daniël C.de Groot Marij J.P.Welters Tom de Wit Ellen Schrama Hans van Eenennaam Saskia J.Santegoets Timo Oosenbrug Annemarthe van der Veen Joris L.Vos Charlotte L.Zuur Noel F.C.C.de Miranda Heinz Jacobs Sjoerd H.van der Burg Jannie Borst Yanling Xiao Department of Immunology Leiden University Medical CenterLeidenThe Netherlands Oncode Institute Leiden University Medical CenterLeidenThe Netherlands Department of Tumor Biology and Immunology The Netherlands Cancer InstituteAmsterdamThe Netherlands Department of medical Oncology Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands IMMIOS B.V. OssThe Netherlands Division of medical Oncology The Netherlands Cancer InstituteAmsterdamThe Netherlands Department of Otorhinolaryngology Leiden University medical center LeidenThe Netherlands Department of Pathology Leiden University Medical CenterLeidenThe Netherlands

CD4^(+)T cells can"help"or"license" conventional type 1 dendritic cells(cDC1s)to induce CD8^(+)cytotoxic T lymphocyte(CTL)anticancer responses,as proven in mouse *** recently identified cDC1s with a transcriptomic imprint of CD4^(+)T-cell help,specifically in T-cell-infiltrated human cancers,and these cells were associated with a good prognosis and response to PD-1-targeting ***,we delineate the mechanism of cDC1 licensing by CD4^(+)T cells in *** CD4^(+)T cells produce IFNβvia the STING pathway,which promotes MHC-I antigen(cross-)presentation by cDC1s and thereby improves their ability to induce CTL anticancer *** cooperation with CD40 ligand(L),IFNβalso optimizes the costimulatory and other functions of cDC1s required for CTL response ***-I-producing CD4^(+)T cells are present in diverse T-cell-infiltrated cancers and likely deliver“help”signals to CTLs locally,according to their transcriptomic profile and colocalization with“helped/licensed”cDCs and tumor-reactive CD8^(+)T *** agreement with this scenario,the presence of IFN-I-producing CD4^(+)T cells in the TME is associated with overall survival and the response to PD-1 checkpoint blockade in cancer patients.

关键词： CD4^(+)T-cell help cDC1 licensing IFN-I signaling CD40 costimulation (cross-)presentation CTL priming Tumor control

Movement Trend Alterations in the Periaqueductal Gray(PAG)-Employed Ratbot Navigation Are Correlated with Stimulation Parameters

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Journal of Bionic Engineering 2024年第2期21卷 866-876页

作者： Sina Khajei Abed Khorasani Mohammad Reza Afarinesh Vahid Sheibani Neuroscience Research center Institute of NeuropharmacologyKerman University of Medical SciencesKerman***Iran Cognitive Neuroscience Research center Institute of NeuropharmacologyKerman University of Medical SciencesKerman***Iran

In previous studies,Periaqueductal Gray(PAG)stimulation was used to stop ratbots from *** to the homology between the PAG and the intercollicular nucleus,which has been used for forward movement in birds,we investigated the possibility of PAG application to induce forward locomotion for the first *** a corridor maze,the traveled distances via PAG electrical stimulation were examined in nine Wistar male rats during three sessions.A custom-designed stimulator was developed to apply the *** results showed reductions in responses to stimulation over ***,the traveled distances had negative slopes during the consecutive trials(in 8 out of the 9 rats),and the slope mean was significantly different from *** was a strong correlation between the stimulation parameters(electric Charge per Phase(CPP)and the Number of Pulses(NP))and the observed *** negative Movement Slopes(MS)were highly correlated with the CPP and the NP,as the Pearson's linear correlation coefficients were−0.87 and−0.79,*** MS-CPP coefficients of determination(R-squared)were also between 0.76 and *** addition,the MS-NP coefficients of determination were between 0.63 and ***,it is concluded that the electrical stimulation parameters influence the behavioral outcomes ***,the PAG area may be considered a suitable candidate for forward locomotion control in the future if the area is harnessed effectively to prevent undesirable chaotic behaviors.

关键词： Periaqueductal Gray(PAG) Navigation Ratbot Animal-robot Forward locomotion Movement slope

Urgent call for attention to diabetes-associated hospital infections

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World Journal of Diabetes 2024年第8期15卷 1683-1691页

作者： Xue-Lu Yu Li-Yun Zhou Xiao Huang Xin-Yue Li Qing-Qing Pan Ming-Ke Wang Ji-Shun Yang Department of Disease Control and Prevention Naval Medical Center of PLANaval Medical UniversityShanghai 200052China medical Care center Naval Medical Center of PLANaval Medical UniversityShanghai 200052China

In this editorial,we discuss the recent article by Zhao et al published in the World Journal of Diabetes,which highlights the importance of recognizing the risk indicators associated with diabetes mellitus(DM).Given the severe implications of healthcare-associated infections(HAIs)in hospitalized individuals-such as heightened mortality rates,prolonged hospitalizations,and increased costs-we focus on elucidating the connection between DM and nosocomial *** patients are susceptible to pathogenic bacterial invasion and subsequent infection,with some already harboring co-infections upon ***,DM is an important risk factor for nosocomial urinary tract infections and surgical site infections,which may indirectly affect the occurrence of nosocomial bloodstream infections,especially in patients with DM with poor glycemic *** evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive,attention to this potential association is *** patients with DM should prioritize meticulous blood glucose management,adherence to standard operating procedures,hand hygiene practices,environmental disinfection,and rational use of drugs during *** studies are imperative to explore the main risk factors of HAIs in patients with DM,enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.

关键词： Diabetes mellitus Healthcare-associated infections Nosocomial urinary tract infections Surgical site infections Nosocomial bloodstream infections

The Combined Effects of High Temperatures and Ozone Pollution on medical Emergency Calls—Jinan City,Shandong Province,China,2013–2019

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China CDC weekly 2024年第2期6卷 30-35,I0001-I0007页

作者： Huiyun Chang Chong Liu Xingyi Geng Xiumiao Peng Ke Huang Liheng Wang Liangliang Cui Department of Scientific Research and Education Jinan Municipal Center for Disease Control and PreventionJinan Municipal Center for Disease Control and Prevention Affiliated to Shandong UniversityJinan CityShandong ProvinceChina Jinan Health Well Development center Jinan CityShandong ProvinceChina Department of Environmental Health Jinan Municipal Center for Disease Control and PreventionJinan CityShandong ProvinceChina Department of Emergency Jinan Medical Emergency CenterJinan CityShandong ProvinceChina

What is already known about this topic?Studies have extensively documented the separate and independent effects of extreme temperature and ozone on morbidity and mortality associated with respiratory and circulatory *** is added by this report?The study revealed a significant association between elevated temperature,ozone pollution,and the combined effect of high temperature and ozone pollution with an increased risk of all-cause medical emergency calls(MECs)and MECs specifically related to neurological *** are the implications for public health practice?Interventional measures should be implemented to mitigate exposure to high temperatures and ozone ***,during the warm season,it is crucial for relevant authorities to focus on disseminating scientific information regarding the health impacts of elevated temperatures and ozone ***,timely public health advisories should be issued to alert the public effectively.

关键词： ozone elevated pollution

Targeting GPR65 alleviates hepatic inflammation and fibrosis by suppressing the JNK and NF-κB pathways

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Military medical Research 2024年第4期11卷 500-520页

作者： Kun Zhang Meng-Xia Zhang Xiao-Xiang Meng Jing Zhu Jia-Jun Wang Yi-Fan He Ye-Hua Li Si-Cong Zhao Zhe-Min Shi Li-Na Zheng Tao Han Wei Hong Department of Histology and Embryology School of Basic Medical SciencesTianjin Medical UniversityTianjin 300070China Department of Hepatology and Gastroenterology Tianjin Union Medical CenterTianjin Medical UniversityTianjin Union Medical Center Affiliated to Nankai UniversityTianjin 300000China

Background:G-protein coupled receptors(GPCRs)are recognized as attractive targets for drug ***,it remains poorly understood how GPCRs,except for a few chemokine receptors,regulate the progression of liver ***,we aimed to reveal the role of GPR65,a proton-sensing receptor,in liver fibrosis and to elucidate the underlying ***:The expression level of GPR65 was evaluated in both human and mouse fibrotic ***,Gpr65-deficient mice were treated with either bile duct ligation(BDL)for 21 d or carbon tetrachloride(CCl4)for 8 weeks to investigate the role of GPR65 in liver fibrosis.A combination of experimental approaches,including Western blotting,quantitative real-time reverse transcription-polymerase chain reaction(qRT-PCR),and enzyme-linked immunosorbent assay(ELISA),confocal microscopy and rescue studies,were used to explore the underlying mechanisms of GPR65’s action in liver ***,the therapeutic potential of GPR65 inhibitor in the development of liver fibrosis was ***:We found that hepatic macrophage(HM)-enriched GPR65 was upregulated in both human and mouse fibrotic ***,knockout of Gpr65 significantly alleviated BDL-and CCl4-induced liver inflammation,injury and fibrosis in vivo,and mouse bone marrow transplantation(BMT)experiments further demonstrated that the protective effect of Gpr65knockout is primarily mediated by bone marrow-derived macrophages(BMMs).Additionally,in vitro data demonstrated that Gpr65 silencing and GPR65 antagonist inhibited,while GPR65 overexpression and application of GPR65 endogenous and exogenous agonists enhanced the expression and release of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and transforming growth factor-β(TGF-β),all of which subsequently promoted the activation of hepatic stellate cells(HSCs)and the damage of hepatocytes(HCs).Mechanistically,GPR65 overexpression,the acidic pH and GPR65 exogenous agonist induced up-regulation of

关键词： GPR65 Hepatic fibrosis Hepatic macrophages Inflammation c-Jun N-terminal kinase Nuclear factorκB