Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone...Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.展开更多
The muzzle blast overpressure induces disturbances in the flow field inside the crew compartment(FFICC)of a truck-mounted howitzer during the artillery firing.This overpressure is the primary factor preventing personn...The muzzle blast overpressure induces disturbances in the flow field inside the crew compartment(FFICC)of a truck-mounted howitzer during the artillery firing.This overpressure is the primary factor preventing personnel from firing artillery within the cab.To investigate the overpressure characteristics of the FFICC,a foreign trade equipment model was used as the research object,and a numerical model was established to analyze the propagation of muzzle blast from the muzzle to the interior of the crew compartment under extreme firing condition.For comparative verification,the muzzle blast experiment included overpressure data from both the flow field outside the crew compartment(FFOCC)and the FFICC,as well as the acceleration data of the crew compartment structure(Str-CC).The research findings demonstrate that the overpressure-time curves of the FFICC exhibit multi-peak characteristics,while the pressure wave shows no significant discontinuity.The enclosed nature of the cab hinders the dissipation of pressure wave energy within the FFICC,leading to sustained high-amplitude overpressure.The frameskin structure helps attenuate the impact of muzzle blast on the FFICC.Conversely,local high overpressure caused by the convex or concave features of the cab's exterior significantly amplifies the overpressure amplitude within the FFICC.展开更多
BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by ...BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by an increase in intra-abdo-minal pressure with physiological disturbance can be caused by severe massive fecal impaction.CASE SUMMARY A 33-year-old female presented to the emergency room with massive abdominal distension that rapidly progressed to abdominal compartment syndrome.The pa-tient was diagnosed with hypoganglionosis.Life-saving emergent proctoco-lectomy was performed to save the patient.CONCLUSION Abdominal compartment syndrome can develop secondary to excessive colonic distension.This extreme but rare situation must be addressed immediately.Hypo-ganglionosis is a potential cause of severe constipation that may present in adu-lthood.展开更多
Deterministic compartment models(CMs)and stochastic models,including stochastic CMs and agent-based models,are widely utilized in epidemic modeling.However,the relationship between CMs and their corresponding stochast...Deterministic compartment models(CMs)and stochastic models,including stochastic CMs and agent-based models,are widely utilized in epidemic modeling.However,the relationship between CMs and their corresponding stochastic models is not well understood.The present study aimed to address this gap by conducting a comparative study using the susceptible,exposed,infectious,and recovered(SEIR)model and its extended CMs from the coronavirus disease 2019 modeling literature.We demonstrated the equivalence of the numerical solution of CMs using the Euler scheme and their stochastic counterparts through theoretical analysis and simulations.Based on this equivalence,we proposed an efficient model calibration method that could replicate the exact solution of CMs in the corresponding stochastic models through parameter adjustment.The advancement in calibration techniques enhanced the accuracy of stochastic modeling in capturing the dynamics of epidemics.However,it should be noted that discrete-time stochastic models cannot perfectly reproduce the exact solution of continuous-time CMs.Additionally,we proposed a new stochastic compartment and agent mixed model as an alternative to agent-based models for large-scale population simulations with a limited number of agents.This model offered a balance between computational efficiency and accuracy.The results of this research contributed to the comparison and unification of deterministic CMs and stochastic models in epidemic modeling.Furthermore,the results had implications for the development of hybrid models that integrated the strengths of both frameworks.Overall,the present study has provided valuable epidemic modeling techniques and their practical applications for understanding and controlling the spread of infectious diseases.展开更多
BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to pat...BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.展开更多
The Pacific oyster Crassostrea gigas,one of the most exploited molluscs in the world,has suffered from massive mortality in recent decades,and the occurrence mechanisms have not been well characterized.In this study,t...The Pacific oyster Crassostrea gigas,one of the most exploited molluscs in the world,has suffered from massive mortality in recent decades,and the occurrence mechanisms have not been well characterized.In this study,to reveal the relationship of associated microbiota to the fitness of oysters,temporal dynamics of microbiota in the gill,hemolymph,and hepatopancreas of C.gigas during April 2018-January 2019 were investigated by 16 S rRNA gene sequencing.The microbiota in C.gigas exhibited tissue heterogeneity,of which Spirochaetaceae was dominant in the gill and hemolymph while Mycoplasmataceae enriched in the hepatopancreas.Co-occurrence network demonstrated that the gill microbiota exhibited higher inter-taxon connectivity while the hemolymph microbiota had more modules.The richness(Chao 1 index)and diversity(Shannon index)of microbial community in each tissue showed no significant seasonal variations,except for the hepatopancreas having a higher richness in the autumn.Similarly,beta diversity analysis indicated a relatively stable microbiota in each tissue during the sampling period,showing relative abundance of the dominant taxa exhibiting temporal dynamics.Results indicate that the microbial community in C.gigas showed a tissue-specific stability with temporal dynamics in the composition,which might be essential for the tissue functioning and environmental adaption in oysters.This work provides a baseline microbiota in C.gigas and is helpful for the understanding of host-microbiota interaction in oysters.展开更多
BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidate...BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.展开更多
BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear hi...BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.展开更多
The gene encoded for tryptophan decarboxylase (TDC), which is the key enzyme in terpenoil indole alkaloids pathway, was targeted to different subcellular compartments and stably expressed in transgenic tobacco (Nicoti...The gene encoded for tryptophan decarboxylase (TDC), which is the key enzyme in terpenoil indole alkaloids pathway, was targeted to different subcellular compartments and stably expressed in transgenic tobacco (Nicotiana tabacum L.) plants at the levels detected by Western blot and tryptamine accumulation analysis. It was shown that the TDC was located in subcellular compartments, the chloroplasts and cytosol. The recombinant TDC targeted to chloroplasts and cytosol in tobacco plants was effectively expressed as soluble protein by Western blot analysis and enzymatic assay. The level of tryptamine accumulation in chloroplast was higher than that in cytosol and very low in vacuole and endoplasmic reticulum (ER) to be hardly detected by Western blot analysis. It was indicated that the highest amount of tryptamine was in chloroplasts, lower in endoplasmic reticula and the lowest in vacuoles as compared to those in wild type plants. The TDC targeted to different subcellular compartments of tobacco plants and its expression level were studied by different nucleotide sequences coding signal peptides at 5'-end of tdc gene in order to know the effects of the TDC in compartmentation on its functionality.展开更多
AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with...AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.展开更多
BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swel...BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.展开更多
The two compartment model with variable extracellular volume is presented and solved by using both perturbation and analytical method. The computation for both creatinine and urea show that the perturbation solution ...The two compartment model with variable extracellular volume is presented and solved by using both perturbation and analytical method. The computation for both creatinine and urea show that the perturbation solution is not only simple but also accurate enough and is a good substitute for the more exact analytical solution.展开更多
Strictosidine synthase (STR) is a key enzyme involved in the biosynthesis of terpenoid indole alkaloids (TIA) by condensing tryptamine and secologanin into strictosidine. The transgenic tobacco plants targeting STR to...Strictosidine synthase (STR) is a key enzyme involved in the biosynthesis of terpenoid indole alkaloids (TIA) by condensing tryptamine and secologanin into strictosidine. The transgenic tobacco plants targeting STR to subcellular compartments were established to express STR in chloroplast, vacuole and endoplasmic reticulum (ER) by the tobacco stable transformation. It was shown that STR was effectively expressed in the above subcellular compartments by Western blot analysis and STR enzymatic assay. In vitro , STR enzymatic assay was measured indirectly by fluorimetrically detecting depletion of tryptamine feeding on secologanin in the reaction mixture. The tryptamine were completely depleted by STR in the crude extract of leaves of transgenic tobacco plants targeting and expressing STR in the chloroplast, vacuole and ER, which ascertained the STR functionally targeted to the three subcellular compartments. To confirm STR correct targeting and expressing in chloroplast, the chloroplasts were isolated and the fractions of purified chloroplasts were analyzed by Western blot. The hypothesis of STR correct targeting to the chloroplast was tested. The results have implications on our understanding of the complex intracellular trafficking in metabolic intermediates of TIA biosynthesis.展开更多
BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the fore...BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.展开更多
Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndr...Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndrome of the foot without a specific major trauma is very rare. I am reporting a rare case with acute compartment syndrome for isolated medial compartment of foot after a traumatic sport event and proper management to prevent long term sequels.展开更多
AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on phys...AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.展开更多
AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment s...AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.展开更多
AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber's salt combined with conservative measures on...AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber's salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients. METHODS: Eighty consecutive SAP patients, admitted for routine non-operative conservative treatment, were randomly divided into study group and control group (40 patients in each group). Patients in the study group received Da Cheng Qi Decoction enema for 2 h and external use of Glauber's salt, once a day for 7 d. Patients in the control group received normal saline (NS) enema. Routine non-operative conservative treatments included non-per os nutrition (NPON), gastrointestinal decompression, life support, total parenteral nutrition (TPN), continuous peripancreatic vascular pharmaceutical infusion and drug therapy. Intra-cystic pressure (ICP) of the two groups was measured during treatment. The effectiveness and outcomes of treatment were observed and APACHE Ⅱ scores were applied in analysis. RESULTS: On days 4 and 5 of treatment, the ICP was lower in the study group than in the control group(P < 0.05). On days 3-5 of treatment, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores for the study and control groups were significantly different (P < 0.05). Both the effectiveness and outcome of the treatment with Da Cheng Qi Decoction on abdominalgia, burbulence relief time, ascites quantity, cyst formation rate and hospitalization time were quite different between the two groups (P < 0.05). The mortality rate for the two groups had no significant difference. CONCLUSION: Da Cheng Qi Decoction enema and external use of Glauber's salt combined with routine non-operative conservative treatment can decrease the intra-abdominal pressure (IAP) of SAP patients and have preventive and therapeutic effects on abdominal compartment syndrome of SAP.展开更多
This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese ...This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.展开更多
Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH...Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.展开更多
文摘Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.
基金supported by the National Natural Science Foundation of China(Grant No.U2341269)。
文摘The muzzle blast overpressure induces disturbances in the flow field inside the crew compartment(FFICC)of a truck-mounted howitzer during the artillery firing.This overpressure is the primary factor preventing personnel from firing artillery within the cab.To investigate the overpressure characteristics of the FFICC,a foreign trade equipment model was used as the research object,and a numerical model was established to analyze the propagation of muzzle blast from the muzzle to the interior of the crew compartment under extreme firing condition.For comparative verification,the muzzle blast experiment included overpressure data from both the flow field outside the crew compartment(FFOCC)and the FFICC,as well as the acceleration data of the crew compartment structure(Str-CC).The research findings demonstrate that the overpressure-time curves of the FFICC exhibit multi-peak characteristics,while the pressure wave shows no significant discontinuity.The enclosed nature of the cab hinders the dissipation of pressure wave energy within the FFICC,leading to sustained high-amplitude overpressure.The frameskin structure helps attenuate the impact of muzzle blast on the FFICC.Conversely,local high overpressure caused by the convex or concave features of the cab's exterior significantly amplifies the overpressure amplitude within the FFICC.
文摘BACKGROUND Hypoganglionosis is a rare gastrointestinal acquired motility disorder that res-embles Hirschsprung’s disease and can manifest in the adult life.Abdominal compartment syndrome,a condition characterized by an increase in intra-abdo-minal pressure with physiological disturbance can be caused by severe massive fecal impaction.CASE SUMMARY A 33-year-old female presented to the emergency room with massive abdominal distension that rapidly progressed to abdominal compartment syndrome.The pa-tient was diagnosed with hypoganglionosis.Life-saving emergent proctoco-lectomy was performed to save the patient.CONCLUSION Abdominal compartment syndrome can develop secondary to excessive colonic distension.This extreme but rare situation must be addressed immediately.Hypo-ganglionosis is a potential cause of severe constipation that may present in adu-lthood.
基金supported by the National Natural Science Foundation of China(Grant Nos.82173620 to Yang Zhao and 82041024 to Feng Chen)partially supported by the Bill&Melinda Gates Foundation(Grant No.INV-006371 to Feng Chen)Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Deterministic compartment models(CMs)and stochastic models,including stochastic CMs and agent-based models,are widely utilized in epidemic modeling.However,the relationship between CMs and their corresponding stochastic models is not well understood.The present study aimed to address this gap by conducting a comparative study using the susceptible,exposed,infectious,and recovered(SEIR)model and its extended CMs from the coronavirus disease 2019 modeling literature.We demonstrated the equivalence of the numerical solution of CMs using the Euler scheme and their stochastic counterparts through theoretical analysis and simulations.Based on this equivalence,we proposed an efficient model calibration method that could replicate the exact solution of CMs in the corresponding stochastic models through parameter adjustment.The advancement in calibration techniques enhanced the accuracy of stochastic modeling in capturing the dynamics of epidemics.However,it should be noted that discrete-time stochastic models cannot perfectly reproduce the exact solution of continuous-time CMs.Additionally,we proposed a new stochastic compartment and agent mixed model as an alternative to agent-based models for large-scale population simulations with a limited number of agents.This model offered a balance between computational efficiency and accuracy.The results of this research contributed to the comparison and unification of deterministic CMs and stochastic models in epidemic modeling.Furthermore,the results had implications for the development of hybrid models that integrated the strengths of both frameworks.Overall,the present study has provided valuable epidemic modeling techniques and their practical applications for understanding and controlling the spread of infectious diseases.
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
基金Supported by the National Natural Science Foundation of China(No.41961124009)the Earmarked Fund for China Agriculture Research System(No.CARS-49)+1 种基金the fund for Outstanding Talents and Innovative Team of Agricultural Scientific Research from MARA,the Innovation Team of Aquaculture Environment Safety from Liaoning Province(No.LT202009)the Dalian High Level Talent Innovation Support Program(No.2022RG14)。
文摘The Pacific oyster Crassostrea gigas,one of the most exploited molluscs in the world,has suffered from massive mortality in recent decades,and the occurrence mechanisms have not been well characterized.In this study,to reveal the relationship of associated microbiota to the fitness of oysters,temporal dynamics of microbiota in the gill,hemolymph,and hepatopancreas of C.gigas during April 2018-January 2019 were investigated by 16 S rRNA gene sequencing.The microbiota in C.gigas exhibited tissue heterogeneity,of which Spirochaetaceae was dominant in the gill and hemolymph while Mycoplasmataceae enriched in the hepatopancreas.Co-occurrence network demonstrated that the gill microbiota exhibited higher inter-taxon connectivity while the hemolymph microbiota had more modules.The richness(Chao 1 index)and diversity(Shannon index)of microbial community in each tissue showed no significant seasonal variations,except for the hepatopancreas having a higher richness in the autumn.Similarly,beta diversity analysis indicated a relatively stable microbiota in each tissue during the sampling period,showing relative abundance of the dominant taxa exhibiting temporal dynamics.Results indicate that the microbial community in C.gigas showed a tissue-specific stability with temporal dynamics in the composition,which might be essential for the tissue functioning and environmental adaption in oysters.This work provides a baseline microbiota in C.gigas and is helpful for the understanding of host-microbiota interaction in oysters.
文摘BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.
文摘BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.
文摘The gene encoded for tryptophan decarboxylase (TDC), which is the key enzyme in terpenoil indole alkaloids pathway, was targeted to different subcellular compartments and stably expressed in transgenic tobacco (Nicotiana tabacum L.) plants at the levels detected by Western blot and tryptamine accumulation analysis. It was shown that the TDC was located in subcellular compartments, the chloroplasts and cytosol. The recombinant TDC targeted to chloroplasts and cytosol in tobacco plants was effectively expressed as soluble protein by Western blot analysis and enzymatic assay. The level of tryptamine accumulation in chloroplast was higher than that in cytosol and very low in vacuole and endoplasmic reticulum (ER) to be hardly detected by Western blot analysis. It was indicated that the highest amount of tryptamine was in chloroplasts, lower in endoplasmic reticula and the lowest in vacuoles as compared to those in wild type plants. The TDC targeted to different subcellular compartments of tobacco plants and its expression level were studied by different nucleotide sequences coding signal peptides at 5'-end of tdc gene in order to know the effects of the TDC in compartmentation on its functionality.
文摘AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.
文摘BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.
文摘The two compartment model with variable extracellular volume is presented and solved by using both perturbation and analytical method. The computation for both creatinine and urea show that the perturbation solution is not only simple but also accurate enough and is a good substitute for the more exact analytical solution.
文摘Strictosidine synthase (STR) is a key enzyme involved in the biosynthesis of terpenoid indole alkaloids (TIA) by condensing tryptamine and secologanin into strictosidine. The transgenic tobacco plants targeting STR to subcellular compartments were established to express STR in chloroplast, vacuole and endoplasmic reticulum (ER) by the tobacco stable transformation. It was shown that STR was effectively expressed in the above subcellular compartments by Western blot analysis and STR enzymatic assay. In vitro , STR enzymatic assay was measured indirectly by fluorimetrically detecting depletion of tryptamine feeding on secologanin in the reaction mixture. The tryptamine were completely depleted by STR in the crude extract of leaves of transgenic tobacco plants targeting and expressing STR in the chloroplast, vacuole and ER, which ascertained the STR functionally targeted to the three subcellular compartments. To confirm STR correct targeting and expressing in chloroplast, the chloroplasts were isolated and the fractions of purified chloroplasts were analyzed by Western blot. The hypothesis of STR correct targeting to the chloroplast was tested. The results have implications on our understanding of the complex intracellular trafficking in metabolic intermediates of TIA biosynthesis.
文摘BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.
文摘Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndrome of the foot without a specific major trauma is very rare. I am reporting a rare case with acute compartment syndrome for isolated medial compartment of foot after a traumatic sport event and proper management to prevent long term sequels.
文摘AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.
文摘AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.
文摘AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber's salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients. METHODS: Eighty consecutive SAP patients, admitted for routine non-operative conservative treatment, were randomly divided into study group and control group (40 patients in each group). Patients in the study group received Da Cheng Qi Decoction enema for 2 h and external use of Glauber's salt, once a day for 7 d. Patients in the control group received normal saline (NS) enema. Routine non-operative conservative treatments included non-per os nutrition (NPON), gastrointestinal decompression, life support, total parenteral nutrition (TPN), continuous peripancreatic vascular pharmaceutical infusion and drug therapy. Intra-cystic pressure (ICP) of the two groups was measured during treatment. The effectiveness and outcomes of treatment were observed and APACHE Ⅱ scores were applied in analysis. RESULTS: On days 4 and 5 of treatment, the ICP was lower in the study group than in the control group(P < 0.05). On days 3-5 of treatment, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores for the study and control groups were significantly different (P < 0.05). Both the effectiveness and outcome of the treatment with Da Cheng Qi Decoction on abdominalgia, burbulence relief time, ascites quantity, cyst formation rate and hospitalization time were quite different between the two groups (P < 0.05). The mortality rate for the two groups had no significant difference. CONCLUSION: Da Cheng Qi Decoction enema and external use of Glauber's salt combined with routine non-operative conservative treatment can decrease the intra-abdominal pressure (IAP) of SAP patients and have preventive and therapeutic effects on abdominal compartment syndrome of SAP.
基金supported by the Medical Scientific Research Foundation of Zhejiang Province, China (No. 2010KYA109)the Administration of Traditional Chinese Medicine of Zhejiang Province, China (No. 2010ZB080)
文摘This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.
文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.
