Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. We describe the anesthetic management of a partu...Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. We describe the anesthetic management of a parturient with IIH who required multiple lumbar punctures during pregnancy and delivery secondary to worsening neurological symp-toms.展开更多
<strong>Introduction:</strong> Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. <strong>Objectives:&l...<strong>Introduction:</strong> Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. <strong>Objectives:</strong> To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. <strong>Methodology:</strong> This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. <strong>Results:</strong> The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. <strong>Conclusion:</strong> Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.展开更多
Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with m...Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.展开更多
Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound iso...Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.展开更多
Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treati...Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.展开更多
To investigate the formation mechanism of stalk mechanical strength,clarify the mechanical mechanisms underlying stalk rot resistance,and establish core mechanical indicators for evaluating stalk strength,this study u...To investigate the formation mechanism of stalk mechanical strength,clarify the mechanical mechanisms underlying stalk rot resistance,and establish core mechanical indicators for evaluating stalk strength,this study utilized six maize varieties with different levels of stalk rot resistance including ZD619,HXD88,XZY801,XY696,LS1,and ZH431 as test materials.The density,moisture content,bending strength,rind puncture strength,and elastic modulus of maize stalks at different growth stages were determined,and their intrinsic relationships with stalk rot resistance were analyzed.Our results indicated that the stalk density,moisture content,bending strength,and rind puncture strength were responsive to stalk rot resistance.However,these indicators were in significant correlations with stalk rot resistance only after the physiological maturity of maize.In particular,stalk rind puncture strength exhibited the closest correlation with stalk rot resistance at the late stage of physiological maturity.Stalk density directly affected bending strength and rind puncture strength,and it indirectly affected the elastic modulus.The elastic modulus encompassing both load and displacement can improve the reliability of stalk strength evaluation,serving as the best indicator of stalk toughness.The attenuation amplitude of the elastic modulus was always the largest whether it was caused by the aggravation of the disease,the growth stage delay,or the internode position rise,which significantly improved the sensitivity of stalk strength evaluation.The elastic modulus of maize stalks was correlated with stalk rot resistance from the silking stage to late physiological maturity stage,which not only effectively improved the accuracy of stalk strength evaluation but also was beneficial to improving the efficiency of maize variety selection.In conclusion,the elastic modulus of maize stalks can be used to evaluate the maize stalk strength truly and accurately.Especially in the region with a high stalk rot incidence,it was beneficial to improving the breeding efficiency of the maize varieties suitable for mechanical harvesting.展开更多
BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)wit...BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.展开更多
Acute lung injury(ALI)is a significant complication of sepsis,characterized by high morbidity,mortality,and poor prognosis.Neutrophils,as critical intrinsic immune cells in the lung,play a fundamental role in the deve...Acute lung injury(ALI)is a significant complication of sepsis,characterized by high morbidity,mortality,and poor prognosis.Neutrophils,as critical intrinsic immune cells in the lung,play a fundamental role in the development and progression of ALI.During ALI,neutrophils generate neutrophil extracellular traps(NETs),and excessive NETs can intensify inflammatory injury.Research indicates that Taohe Chengqi decoction(THCQD)can ameliorate sepsis-induced lung inflammation and modulate immune function.This study aimed to investigate the mechanisms by which THCQD improves ALI and its relationship with NETs in sepsis patients,seeking to provide novel perspectives and interventions for clinical treatment.The findings demonstrate that THCQD enhanced survival rates and reduced lung injury in the cecum ligation and puncture(CLP)-induced ALI mouse model.Furthermore,THCQD diminished neutrophil and macrophage infiltration,inflammatory responses,and the production of pro-inflammatory cytokines,including interleukin-1β(IL-1β),IL-6,and tumor necrosis factorα(TNF-α).Notably,subsequent experiments confirmed that THCQD inhibits NET formation both in vivo and in vitro.Moreover,THCQD significantly decreased the expression of peptidyl arginine deiminase 4(PAD4)protein,and molecular docking predicted that certain active compounds in THCQD could bind tightly to PAD4.PAD4 overexpression partially reversed THCQD’s inhibitory effects on PAD4.These findings strongly indicate that THCQD mitigates CLP-induced ALI by inhibiting PAD4-mediated NETs.展开更多
The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,...The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,to address the shortcomings of the current medical education model and,secondly,to enhance medical students’independent thinking abilities and clinical diagnostic skills.The study enrolled 87 clinical medicine interns rotating at Jiangning Hospital in Nanjing from January to December 2024,dividing them into an experimental group(receiving ultrasound-guided puncture procedure training)and a control group(receiving conventional puncture procedure training).It was evident that both groups had successfully completed the requisite two-hour comprehensive course training program.A subsequent analysis of the teaching outcomes was then conducted through intergroup comparison.The findings indicated that the experimental group exhibited lower DOPS assessment scores in comparison to the control group(4.91±1.01 vs.5.84±1.22,p<0.05).However,the satisfaction levels of the experimental group with the teaching method reached 95.45%.This finding indicates that ultrasound-guided puncture techniques may offer a substantial advantage in terms of pedagogical approaches.However,it should be noted that students in the experimental group faced challenges such as high operational complexity and the need to pay attention to numerous details during actual procedures,leading to lower assessment scores.Conducting a systematic analysis of these issues can provide clear directions for the optimization of teaching methods in the future,thereby enhancing students’learning outcomes and clinical application capabilities.展开更多
Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operato...Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.展开更多
BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a co...BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a common complication in patients who underwent these treatments of HHC.Bile leak should be treated effectively as uncontrolled biliary fistula may lead to life-treating conditions such as severe cholangitis,intraabdominal abscesses and septicemia.Endoscopic retrograde cholangiopancreatography(ERCP)has become the main treatment of post-interventional biliary fistula.AIM To evaluate the efficacy and safety of ERCP in the management of biliary fistula following HHC-related surgery or PAIR.METHODS We evaluated data of patients who developed bile leakage following HHC-related interventions from endemic area during the period of March 2017 and February 2025.We included 88 patients(50 female,57%)with a median age of 33 years(range:8-83 years)at the time of ERCP.Bile leak occurred following surgery in 72(82%)patients and after PAIR in 16(18%)patients.Low-grade leakage(<400 mL/day)was identified in 46(52%)patients.RESULTS Initial mode of ERCP was endoscopic sphincterotomy(ES)with biliary drainage(plastic stent or nasobiliary drain)in 73(83%)patients and ES alone in remaining 15(17%)patients.Six patients who initially treated by ES alone had persistent fistula and underwent repeat ERCP with stent placement.ERCP type(ES+biliary stenting)and fistula flow rate(<400 mL/day)were significantly associated with 20-days complete closure of the fistula[P=0.020;odds ratio(OR)=5.27,95%confidence interval(95%CI):1.30-21.37]and(P=0.008;OR=3.43,95%CI:1.37-8.55),respectively.ERCP-related complications were mild pancreatitis in 5(5.9%)patients and minor bleeding in 4(4.7%)patients and mild-moderate cholangitis in 4(4.7%)patients.CONCLUSION This case based-study from endemic area demonstrates that ERCP is highly effective and safe for managing bile leakage following both surgery and PAIR.ES+biliary stenting seems better mode of ERCP procedure.展开更多
Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients sche...Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients scheduled for surgery were randomly divided into two groups,with 30 patients in each.The control group received subarachnoid anesthesia with 2–2.5 mL of 0.33%ropivacaine.The experimental group received the same ropivacaine dose,followed by withdrawal of the needle to the epidural space and administration of 0.1 mg hydromorphone diluted to 5 mL.The anesthetic and analgesic effects,incidence of complications,and postoperative family satisfaction were observed in both groups.Results:Compared with the control group,the experimental group showed a higher anesthesia success rate,a shorter onset time,and a longer maintenance time of anesthesia(p<0.05).Postoperative analgesia at various time points was significantly better in the experimental group(p<0.05).The total incidence of complications was lower in the experimental group,though the difference was not statistically significant(p>0.05).Family satisfaction was significantly higher in the experimental group(p<0.05).Conclusion:CSE anesthesia using a 25G fine needle via a single puncture for pediatric lower limb surgery is safe and effective.It can significantly improve surgical outcomes and is worthy of clinical promotion.展开更多
BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions ...BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions are relatively rare,and some may be misdiagnosed as pulmonary tuberculosis.CASE SUMMARY In this report,we present an uncommon instance of IgG4-related lung disease,which was diagnosed through lung tissue biopsy conducted via puncture.A 67-year-old male was hospitalized with a two-month history of cough and sputum production.Chest computed tomography(CT)revealed infiltrative pulmonary tuberculosis in both upper lungs.However,the initial diagnosis was unclear,and the patient received HZRE quadruple therapy for tuberculosis at a local hospital.After 45 days of anti-tuberculosis treatment,the patient's cough and sputum worsened,and he began coughing up blood,prompting transfer to our hospital.Serum tests revealed elevated IgG4 levels.A biopsy of a right lung showed localized fibrous and extensive plasma cell infiltration,with 30-40 IgG4-positive cells per high-power field,and an IgG4/IgG ratio of 40%.These findings led to a diagnosis of IgG4-related lung disease.Following treatment with prednisone and mycophenolate mofetil,follow-up lung CT scans showed significant lesion improvement.CONCLUSION The chest CT findings of IgG4-RD are diverse and nonspecific,often leading to misdiagnosis as pulmonary tuberculosis,especially in primary care settings with limited diagnostic resources.We confirmed the diagnosis of IgG4-related lung disease through histological examination.展开更多
Trophectoderm(TE)biopsy has become the preferred approach in preimplantation genetic testing,providing clear advantages over polar body and cleavage-stage biopsy.However,the optimal timing and methodology for blastocy...Trophectoderm(TE)biopsy has become the preferred approach in preimplantation genetic testing,providing clear advantages over polar body and cleavage-stage biopsy.However,the optimal timing and methodology for blastocyst biopsy remain subjects of ongoing debate.McArthur et al in 2005 were the first to demonstrate the safety of TE biopsy at the hatching blastocyst stage with laser-assisted opening in the zona pellucida(ZP)on Day 3,reporting 100%survival of 1050 biopsied blastocysts,all of which re-expanded,with an implantation rate of 41%[1].Nearly a decade later,Capalbo et al in 2014 introduced a modified strategy,performing biopsy on fully expanded blastocysts by creating a laser-assisted ZP opening and immediately aspirating TE cells on Day 5.展开更多
文摘Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. We describe the anesthetic management of a parturient with IIH who required multiple lumbar punctures during pregnancy and delivery secondary to worsening neurological symp-toms.
文摘<strong>Introduction:</strong> Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. <strong>Objectives:</strong> To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. <strong>Methodology:</strong> This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. <strong>Results:</strong> The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. <strong>Conclusion:</strong> Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.
文摘Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
基金supported by the National Natural Science Foundation of China(81803547)the Natural Science Foundation of Fujian Province,China(2021J01204)Fujian Provincial Regional Development Project(2021N3005)。
文摘Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.
基金the financial contribution of the Groupe de Recherche En Médecine d’Urgence du CHUL (GREMUC)which is the local emergency department research group。
文摘Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.
文摘To investigate the formation mechanism of stalk mechanical strength,clarify the mechanical mechanisms underlying stalk rot resistance,and establish core mechanical indicators for evaluating stalk strength,this study utilized six maize varieties with different levels of stalk rot resistance including ZD619,HXD88,XZY801,XY696,LS1,and ZH431 as test materials.The density,moisture content,bending strength,rind puncture strength,and elastic modulus of maize stalks at different growth stages were determined,and their intrinsic relationships with stalk rot resistance were analyzed.Our results indicated that the stalk density,moisture content,bending strength,and rind puncture strength were responsive to stalk rot resistance.However,these indicators were in significant correlations with stalk rot resistance only after the physiological maturity of maize.In particular,stalk rind puncture strength exhibited the closest correlation with stalk rot resistance at the late stage of physiological maturity.Stalk density directly affected bending strength and rind puncture strength,and it indirectly affected the elastic modulus.The elastic modulus encompassing both load and displacement can improve the reliability of stalk strength evaluation,serving as the best indicator of stalk toughness.The attenuation amplitude of the elastic modulus was always the largest whether it was caused by the aggravation of the disease,the growth stage delay,or the internode position rise,which significantly improved the sensitivity of stalk strength evaluation.The elastic modulus of maize stalks was correlated with stalk rot resistance from the silking stage to late physiological maturity stage,which not only effectively improved the accuracy of stalk strength evaluation but also was beneficial to improving the efficiency of maize variety selection.In conclusion,the elastic modulus of maize stalks can be used to evaluate the maize stalk strength truly and accurately.Especially in the region with a high stalk rot incidence,it was beneficial to improving the breeding efficiency of the maize varieties suitable for mechanical harvesting.
文摘BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
基金supporteded by the National Natural ScienceFoundation of China(Nos.82374183,82405092,82204991,82274246,and 82374341)the Planned Science TechnologyProjectofGuangzhouCity(Nos.2023A03J0419and2023A03J0420)+3 种基金the General Project of Natural Science Foundationof Guangdong Province(No.2023A1515011090)Hong KongScholars Program 2024(No.XJ2024005)the Basic and AppliedBasic Research Foundation of Guangdong Province(No.2021A151510809)the Project of Administration of TraditionalChinese Medicine of Guangdong Province of China(No.20223013).
文摘Acute lung injury(ALI)is a significant complication of sepsis,characterized by high morbidity,mortality,and poor prognosis.Neutrophils,as critical intrinsic immune cells in the lung,play a fundamental role in the development and progression of ALI.During ALI,neutrophils generate neutrophil extracellular traps(NETs),and excessive NETs can intensify inflammatory injury.Research indicates that Taohe Chengqi decoction(THCQD)can ameliorate sepsis-induced lung inflammation and modulate immune function.This study aimed to investigate the mechanisms by which THCQD improves ALI and its relationship with NETs in sepsis patients,seeking to provide novel perspectives and interventions for clinical treatment.The findings demonstrate that THCQD enhanced survival rates and reduced lung injury in the cecum ligation and puncture(CLP)-induced ALI mouse model.Furthermore,THCQD diminished neutrophil and macrophage infiltration,inflammatory responses,and the production of pro-inflammatory cytokines,including interleukin-1β(IL-1β),IL-6,and tumor necrosis factorα(TNF-α).Notably,subsequent experiments confirmed that THCQD inhibits NET formation both in vivo and in vitro.Moreover,THCQD significantly decreased the expression of peptidyl arginine deiminase 4(PAD4)protein,and molecular docking predicted that certain active compounds in THCQD could bind tightly to PAD4.PAD4 overexpression partially reversed THCQD’s inhibitory effects on PAD4.These findings strongly indicate that THCQD mitigates CLP-induced ALI by inhibiting PAD4-mediated NETs.
基金Education Foundation of Kangda College of Nanjing Medical University(Project No.:KDJYYJYB202332)Science Foundation of Kangda College of Nanjing Medical University(Project No.:KD2023KYJJ250)。
文摘The present study aims to explore the implementation pathway for practical teaching of basic clinical puncture procedures under the guidance of point-of-care ultrasound(POCUS).The goal of the study is twofold:firstly,to address the shortcomings of the current medical education model and,secondly,to enhance medical students’independent thinking abilities and clinical diagnostic skills.The study enrolled 87 clinical medicine interns rotating at Jiangning Hospital in Nanjing from January to December 2024,dividing them into an experimental group(receiving ultrasound-guided puncture procedure training)and a control group(receiving conventional puncture procedure training).It was evident that both groups had successfully completed the requisite two-hour comprehensive course training program.A subsequent analysis of the teaching outcomes was then conducted through intergroup comparison.The findings indicated that the experimental group exhibited lower DOPS assessment scores in comparison to the control group(4.91±1.01 vs.5.84±1.22,p<0.05).However,the satisfaction levels of the experimental group with the teaching method reached 95.45%.This finding indicates that ultrasound-guided puncture techniques may offer a substantial advantage in terms of pedagogical approaches.However,it should be noted that students in the experimental group faced challenges such as high operational complexity and the need to pay attention to numerous details during actual procedures,leading to lower assessment scores.Conducting a systematic analysis of these issues can provide clear directions for the optimization of teaching methods in the future,thereby enhancing students’learning outcomes and clinical application capabilities.
基金Supported by Liaoning Province People's Livelihood Science and Technology(Health)Plan Joint Project,No.2021JH2/10300127the State Scholarship Funding of CSC,No.201908865001。
文摘Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.
文摘BACKGROUND Surgery and percutaneous radiological methods[puncture,aspiration,injection,re-aspiration(PAIR)]are the current invasive treatment strategies for patients with hepatic hydatid cyst(HHC).Biliary leak is a common complication in patients who underwent these treatments of HHC.Bile leak should be treated effectively as uncontrolled biliary fistula may lead to life-treating conditions such as severe cholangitis,intraabdominal abscesses and septicemia.Endoscopic retrograde cholangiopancreatography(ERCP)has become the main treatment of post-interventional biliary fistula.AIM To evaluate the efficacy and safety of ERCP in the management of biliary fistula following HHC-related surgery or PAIR.METHODS We evaluated data of patients who developed bile leakage following HHC-related interventions from endemic area during the period of March 2017 and February 2025.We included 88 patients(50 female,57%)with a median age of 33 years(range:8-83 years)at the time of ERCP.Bile leak occurred following surgery in 72(82%)patients and after PAIR in 16(18%)patients.Low-grade leakage(<400 mL/day)was identified in 46(52%)patients.RESULTS Initial mode of ERCP was endoscopic sphincterotomy(ES)with biliary drainage(plastic stent or nasobiliary drain)in 73(83%)patients and ES alone in remaining 15(17%)patients.Six patients who initially treated by ES alone had persistent fistula and underwent repeat ERCP with stent placement.ERCP type(ES+biliary stenting)and fistula flow rate(<400 mL/day)were significantly associated with 20-days complete closure of the fistula[P=0.020;odds ratio(OR)=5.27,95%confidence interval(95%CI):1.30-21.37]and(P=0.008;OR=3.43,95%CI:1.37-8.55),respectively.ERCP-related complications were mild pancreatitis in 5(5.9%)patients and minor bleeding in 4(4.7%)patients and mild-moderate cholangitis in 4(4.7%)patients.CONCLUSION This case based-study from endemic area demonstrates that ERCP is highly effective and safe for managing bile leakage following both surgery and PAIR.ES+biliary stenting seems better mode of ERCP procedure.
文摘Objective:To investigate the efficacy and safety of combined spinal-epidural(CSE)anesthesia using a 25G spinal fine needle via a single puncture for lower limb surgery in children.Methods:Sixty pediatric patients scheduled for surgery were randomly divided into two groups,with 30 patients in each.The control group received subarachnoid anesthesia with 2–2.5 mL of 0.33%ropivacaine.The experimental group received the same ropivacaine dose,followed by withdrawal of the needle to the epidural space and administration of 0.1 mg hydromorphone diluted to 5 mL.The anesthetic and analgesic effects,incidence of complications,and postoperative family satisfaction were observed in both groups.Results:Compared with the control group,the experimental group showed a higher anesthesia success rate,a shorter onset time,and a longer maintenance time of anesthesia(p<0.05).Postoperative analgesia at various time points was significantly better in the experimental group(p<0.05).The total incidence of complications was lower in the experimental group,though the difference was not statistically significant(p>0.05).Family satisfaction was significantly higher in the experimental group(p<0.05).Conclusion:CSE anesthesia using a 25G fine needle via a single puncture for pediatric lower limb surgery is safe and effective.It can significantly improve surgical outcomes and is worthy of clinical promotion.
文摘BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions are relatively rare,and some may be misdiagnosed as pulmonary tuberculosis.CASE SUMMARY In this report,we present an uncommon instance of IgG4-related lung disease,which was diagnosed through lung tissue biopsy conducted via puncture.A 67-year-old male was hospitalized with a two-month history of cough and sputum production.Chest computed tomography(CT)revealed infiltrative pulmonary tuberculosis in both upper lungs.However,the initial diagnosis was unclear,and the patient received HZRE quadruple therapy for tuberculosis at a local hospital.After 45 days of anti-tuberculosis treatment,the patient's cough and sputum worsened,and he began coughing up blood,prompting transfer to our hospital.Serum tests revealed elevated IgG4 levels.A biopsy of a right lung showed localized fibrous and extensive plasma cell infiltration,with 30-40 IgG4-positive cells per high-power field,and an IgG4/IgG ratio of 40%.These findings led to a diagnosis of IgG4-related lung disease.Following treatment with prednisone and mycophenolate mofetil,follow-up lung CT scans showed significant lesion improvement.CONCLUSION The chest CT findings of IgG4-RD are diverse and nonspecific,often leading to misdiagnosis as pulmonary tuberculosis,especially in primary care settings with limited diagnostic resources.We confirmed the diagnosis of IgG4-related lung disease through histological examination.
文摘Trophectoderm(TE)biopsy has become the preferred approach in preimplantation genetic testing,providing clear advantages over polar body and cleavage-stage biopsy.However,the optimal timing and methodology for blastocyst biopsy remain subjects of ongoing debate.McArthur et al in 2005 were the first to demonstrate the safety of TE biopsy at the hatching blastocyst stage with laser-assisted opening in the zona pellucida(ZP)on Day 3,reporting 100%survival of 1050 biopsied blastocysts,all of which re-expanded,with an implantation rate of 41%[1].Nearly a decade later,Capalbo et al in 2014 introduced a modified strategy,performing biopsy on fully expanded blastocysts by creating a laser-assisted ZP opening and immediately aspirating TE cells on Day 5.
