The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is no...The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is not a simple theoretical analysis of genetic determinism and environmental determinism in the novel’s plots. It attempts to combine the historical background and the author’s life experience to analyze how the author is deeply influenced by naturalism and pays close attention to Jack London’s contradictory philosophy of life and Fatalism. In order to make readers have a better and comprehensive understanding of the naturalistic views contained in the work.展开更多
Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage...Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage renal failure on continuous ambulatory peritoneal dialysis,who presented with generalized abdominal pain,turbid dialysate and fever.Diagnosis:Peritoneal fluid culture revealed the presence of yeast cells.F.khargensis was identified by polymerase chain reaction method.Interventions:Removal of Tenckhoff catheter and intravenous fluconazole.Outcomes:He succumbed after two weeks of hospitalization.Lessons:This case report highlights the significance of a rare fungal pathogen,F.khargensis,which has been implicated in the mortality of an immunocompromised patient.Due to its rarity,F.khargensis poses significant challenges associated with its identification and has profound implications for clinical practice.展开更多
This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affectiv...This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affective feelings and friendship in the life of the family and the polis.”The principal goal is to demonstrate the remarkable coherence of Xenophon’s concept of erōs despite the diversity of the types of manifestation and visible differences in framing between male-male and male-female relationships.In addition,it will be shown that the principle of self-mastery as a vital criterion for the evaluation of sexual conduct is subordinated to what Xenophon perceives as the primary purpose of sexual intercourse:the procreation of progeny.展开更多
Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency d...Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency decisionmaking.This study using the February 6,2023,M_(S)8.0 and M_(S)7.9 Kahramanmaras,Türkiye earthquakes as an example to estimate the ultimate number of fatalities.An early Quick Rough Estimate(QRE)based on the number of deaths reported by the Disaster and Emergency Management Presidency of Türkiye(AFAD)is conducted,and it dynamically adjusts these estimates as new data becomes available.The range of estimates of the final number of deaths can be calculated as 31384–56475 based on the"the QRE of the second day multiplied by 2–3" rule,which incorporates the reported final deaths 50500.The Quasi-Linear and Adaptive Estimation(QLAE)method adaptively adjusts the final fatality estimate within two days and predicts subsequent reported deaths.The correct order of magnitude of the final death toll can be estimated as early as 13 hr after the M_(S)8.0 earthquake.In addition,additional earthquakes such as May 12,2008,M_(S)8.1 Wenchuan earthquake(China),September 8,2023,M_(S)7.2 Al Haouz earthquake(Morocco),November 3,2023,M_(S)5.8 Mid-Western Nepal earthquake,December 18,2023,M_(S)6.1 Jishishan earthquake(China),January 1,2024,M_(S)7.2 Noto Peninsula earthquake(Japan)and August 8,2023,Maui,Hawaii,fires are added again to verified the correctness of the model.The fatalities from the Maui fires are found to be approximately equivalent to those resulting from an M_(S)7.4 earthquake.These methods complement existing frameworks such as Quake Loss Assessment for Response and Mitigation(QLARM)and Prompt Assessment of Global.展开更多
1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases ...1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases the risk of side effects due to drug-drug interactions(DDIs).Adverse DDIs are a leading cause of morbidity and mortality,with drug-induced fatalities accounting for approximately 100,000 deaths annually in the U.S.,making them the fourth leading cause of death after lung disease[1,2].展开更多
BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are require...BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.展开更多
Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 ...Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 during concurrent outbreaks in Marburg and Frankfurt,Germany,and in Belgrade,Serbia,linked to laboratory use of African green monkeys imported from Uganda.Subsequent outbreaks and isolated cases have been reported in various African countries,including Angola,the Democratic Republic of the Congo,Equatorial Guinea,Ghana,Guinea,Kenya,Rwanda,South Africa(in an individual with recent travel to Zimbabwe),Tanzania,and Uganda.Initial human MVD infections typically occur due to prolonged exposure to mines or caves inhabited by Rousettus aegyptiacus fruit bats,the natural hosts of the virus.展开更多
Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his work...Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his works.The novel describes a tragic life about abeautiful girl after disgrace.This paper analyses what cause Tess' s tragic life.The first part is an introduction of Tess of the D'Urb-ervilles and its writer Thomas Hardy.And then is the analysis on the causes of her tragic life —characters of Tess,Society Influ-ence and influence of Pessimism & Fatalism of Hardy.Though Tess fought with the society,as a common person she is helpless atthat time.In the end,she turned out to be the sacrificial victim of society like all other things which disobey the morality and ethic.展开更多
The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess&#...The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess' tragedy and characters are the products of the capitalist society.展开更多
Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and im...Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among展开更多
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal a...We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.展开更多
Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,B...Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.展开更多
Objective Fatal familial insomnia （FFI） is an autosomal dominant prion disease characterized clinically by inattention, sleep loss, dysautonomia, and motor signs. This study is aimed to investigate clinical and fami...Objective Fatal familial insomnia （FFI） is an autosomal dominant prion disease characterized clinically by inattention, sleep loss, dysautonomia, and motor signs. This study is aimed to investigate clinical and familial characteristics often Chinese Patients with FFI. Methods We identified ten FFI cases from the surveillance network for Creutafeldt- Jakob disease （CJD） in China.Final diagnosis of FFI cases was made in accordance with the WHO criteria for CJD.The main clinical features and family histories of these ten FFI cases were analyzed. Results The median age of ten cases at onset was 38 years （from 19 to 55）. The foremost symptoms seemed to be various, including sleep disturbances, vision disorder, dizziness and anorexia. Sleep disturbances appeared in all cases and lasted in the whole clinical courses. Progressive sympathetic symptoms, memory loss, movement disturbances, myoclonus and hypertension were also frequently observed. The median duration of the disease was 9.5 months. EEG and MRI did not figure out special abnormality. 14-3-3 protein in CSF was positive in five out of eight tested patients. Clear family histories were identified in 8 patients. Conclusion The data from our study confirm that the Chinese FFI cases have similar clinical characteristics as that of the Caucasian cases. Compared with other genetic CJD associated mutations, the genetic frequencies of D178N in PRNP are apparently high among the Chinese cases.展开更多
Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon condition, typically characterized by lymphadenopathy and fevers. It usually has a benign course; however, it may prog...Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon condition, typically characterized by lymphadenopathy and fevers. It usually has a benign course; however, it may progress to fatality in extremely rare occasions. The diagnosis is made via lymph node biopsy and histopathology. Our patient was a young female who presented with shortness of breath, fever, and malaise. Physical examination revealed significant cervical and axillary lymphadenopathy. Chest X-ray displayed multilobar pneumonia. She required intubation and mechanical ventilation for progressive respiratory distress. Histopathology of lymph nodes demonstrated variable involvement of patchy areas of necrosis within the paracortex composed of karyorrhectic debris with abundant histiocytes consistent with KFD. After initial stabilization, the patient's condition quickly deteriorated with acute anemia, thrombocytopenia and elevated prothrombin time, partial prothrombin time, and D-dimer levels. Disseminated intravascular coagulopathy(DIC) ensued resulting in the patient's fatality. DIC in KFD is not well understood, but it is an important cause of mortality in patients with aggressive disease.展开更多
Objective The mechanism through which platelet activating factor （PAF） induces cardiac electrical activity and arrhythmia is not well understood and previous studies have suggested a potential involvement of ion cha...Objective The mechanism through which platelet activating factor （PAF） induces cardiac electrical activity and arrhythmia is not well understood and previous studies have suggested a potential involvement of ion channels in its action. The present study was aimed to clarify the role of PAF in fatal arrhythmias following acute myocardia infarction （AMI） and the underlying mechanism. Methods （1） Blood PAF levels were measured among 72 AMI patients at the time of diagnosis with AMI and 48 h later, and their electrocardiogram （ECG） was recorded continuously. （2） Ischemia simulation and surface electrocardiogram were conducted in 20 pigs and their PAF levels were measured. （3） PAF perfusion and standard microelectrode recording were performed on guinea pig papillarymuscles. Results In both humans and pigs, elevated PAF levels were detected in AMI and simulated ischemia, respectively, and even higher PAF levels were found when fatal arrhythmias occurred. In guinea pig myocardium, PAF induced a shortening of action potential duration at 90% level of repolarization （APD 90 ）under non-ischemic conditions and a more pronounced shortening under early simulated ischemic conditions. Conclusion AMI and ischemia are associated with increased PAF levels in humans and pigs, which are further raised when fatal arrhythmia follows. The effects of PAF on the myocardium may be mediated by multiple ion channels.展开更多
Human genetic prion diseases(gPrDs)are directly associated with mutations and insertions in the PRNP(Prion Protein)gene.We collected and analyzed the data of 218 Chinese gPrD patients identified between Jan 2006 and J...Human genetic prion diseases(gPrDs)are directly associated with mutations and insertions in the PRNP(Prion Protein)gene.We collected and analyzed the data of 218 Chinese gPrD patients identified between Jan 2006 and June 2020.Nineteen different subtypes were identified and gPrDs accounted for 10.9%of all diagnosed PrDs within the same period.Some subtypes of gPrDs showed a degree of geographic association.The age at onset of Chinese gPrDs peaked in the 50–59 year group.Gerstmann–Sträussler–Scheinker syndrome(GSS)and fatal familial insomnia(FFI)cases usually displayed clinical symptoms earlier than genetic Creutzfeldt–Jakob disease(gCJD)patients with point mutations.A family history was more frequently recalled in P105L GSS and D178N FFI patients than T188K and E200K patients.None of the E196A gCJD patients reported a family history.The gCJD cases with point mutations always developed clinical manifestations typical of sporadic CJD(sCJD).EEG examination was not sensitive for gPrDs.sCJD-associated abnormalities on MRI were found in high proportions of GSS and gCJD patients.CSF 14-3-3 positivity was frequently detected in gCJD patients.Increased CSF tau was found in more than half of FFI and T188K gCJD cases,and an even higher proportion of E196A and E200K gCJD patients.63.6%of P105L GSS cases showed a positive reaction in cerebrospinal fluid RT-QuIC.GSS and FFI cases had longer durations than most subtypes of gCJD.This is one of the largest studies of gPrDs in East Asians,and the illness profile of Chinese gPrDs is clearly distinct.Extremely high proportions of T188K and E196A occur among Chinese gPrDs;these mutations are rarely reported in Caucasians and Japanese.展开更多
Dear Editor,Rabies is a generally fatal disease caused by the rabies virus(RABV),and is transmitted mainly by Carnivora and Chiroptera(Fooks A R,et al.,2014;Tao X,et al.,2013).In China,stray dogs and some wild animals...Dear Editor,Rabies is a generally fatal disease caused by the rabies virus(RABV),and is transmitted mainly by Carnivora and Chiroptera(Fooks A R,et al.,2014;Tao X,et al.,2013).In China,stray dogs and some wild animals(e.g.,Chinese ferret badgers,foxes,and raccoon dogs)are the principal reservoirs for RABV(Hu R L,et al.,2009).Historically,rabies in wild foxes and raccoon dogs(Nyctereutes procyonoides)was recorded in the early展开更多
We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause...We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.展开更多
文摘The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is not a simple theoretical analysis of genetic determinism and environmental determinism in the novel’s plots. It attempts to combine the historical background and the author’s life experience to analyze how the author is deeply influenced by naturalism and pays close attention to Jack London’s contradictory philosophy of life and Fatalism. In order to make readers have a better and comprehensive understanding of the naturalistic views contained in the work.
文摘Rationale:Fereydounia(F.)khargensis is a novel yeast species identified in 2014 from environmental samples and has emerged as a rare pathogen causing human infections.Patient concerns:A 61-year-old male with end-stage renal failure on continuous ambulatory peritoneal dialysis,who presented with generalized abdominal pain,turbid dialysate and fever.Diagnosis:Peritoneal fluid culture revealed the presence of yeast cells.F.khargensis was identified by polymerase chain reaction method.Interventions:Removal of Tenckhoff catheter and intravenous fluconazole.Outcomes:He succumbed after two weeks of hospitalization.Lessons:This case report highlights the significance of a rare fungal pathogen,F.khargensis,which has been implicated in the mortality of an immunocompromised patient.Due to its rarity,F.khargensis poses significant challenges associated with its identification and has profound implications for clinical practice.
文摘This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affective feelings and friendship in the life of the family and the polis.”The principal goal is to demonstrate the remarkable coherence of Xenophon’s concept of erōs despite the diversity of the types of manifestation and visible differences in framing between male-male and male-female relationships.In addition,it will be shown that the principle of self-mastery as a vital criterion for the evaluation of sexual conduct is subordinated to what Xenophon perceives as the primary purpose of sexual intercourse:the procreation of progeny.
基金supported by the National Natural Science Foundation of China(NSFC,grant number U2039207).
文摘Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency decisionmaking.This study using the February 6,2023,M_(S)8.0 and M_(S)7.9 Kahramanmaras,Türkiye earthquakes as an example to estimate the ultimate number of fatalities.An early Quick Rough Estimate(QRE)based on the number of deaths reported by the Disaster and Emergency Management Presidency of Türkiye(AFAD)is conducted,and it dynamically adjusts these estimates as new data becomes available.The range of estimates of the final number of deaths can be calculated as 31384–56475 based on the"the QRE of the second day multiplied by 2–3" rule,which incorporates the reported final deaths 50500.The Quasi-Linear and Adaptive Estimation(QLAE)method adaptively adjusts the final fatality estimate within two days and predicts subsequent reported deaths.The correct order of magnitude of the final death toll can be estimated as early as 13 hr after the M_(S)8.0 earthquake.In addition,additional earthquakes such as May 12,2008,M_(S)8.1 Wenchuan earthquake(China),September 8,2023,M_(S)7.2 Al Haouz earthquake(Morocco),November 3,2023,M_(S)5.8 Mid-Western Nepal earthquake,December 18,2023,M_(S)6.1 Jishishan earthquake(China),January 1,2024,M_(S)7.2 Noto Peninsula earthquake(Japan)and August 8,2023,Maui,Hawaii,fires are added again to verified the correctness of the model.The fatalities from the Maui fires are found to be approximately equivalent to those resulting from an M_(S)7.4 earthquake.These methods complement existing frameworks such as Quake Loss Assessment for Response and Mitigation(QLARM)and Prompt Assessment of Global.
基金supported by the Key Program of Jiangsu Science Foundation(BK20243012)the Fundamental Research Funds for the Central Universities(022114380023).
文摘1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases the risk of side effects due to drug-drug interactions(DDIs).Adverse DDIs are a leading cause of morbidity and mortality,with drug-induced fatalities accounting for approximately 100,000 deaths annually in the U.S.,making them the fourth leading cause of death after lung disease[1,2].
文摘BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.
文摘Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 during concurrent outbreaks in Marburg and Frankfurt,Germany,and in Belgrade,Serbia,linked to laboratory use of African green monkeys imported from Uganda.Subsequent outbreaks and isolated cases have been reported in various African countries,including Angola,the Democratic Republic of the Congo,Equatorial Guinea,Ghana,Guinea,Kenya,Rwanda,South Africa(in an individual with recent travel to Zimbabwe),Tanzania,and Uganda.Initial human MVD infections typically occur due to prolonged exposure to mines or caves inhabited by Rousettus aegyptiacus fruit bats,the natural hosts of the virus.
文摘Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his works.The novel describes a tragic life about abeautiful girl after disgrace.This paper analyses what cause Tess' s tragic life.The first part is an introduction of Tess of the D'Urb-ervilles and its writer Thomas Hardy.And then is the analysis on the causes of her tragic life —characters of Tess,Society Influ-ence and influence of Pessimism & Fatalism of Hardy.Though Tess fought with the society,as a common person she is helpless atthat time.In the end,she turned out to be the sacrificial victim of society like all other things which disobey the morality and ethic.
文摘The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess' tragedy and characters are the products of the capitalist society.
文摘Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among
文摘We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.
文摘Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.
基金supported by China Mega-Project for Infectious Disease(2009ZX10004-101,2008ZX)SKLID Development Grant(2008SKLID102,2011SKLID211)+3 种基金National Basic Research Program of China(973 Program)(2007CB310505)sponsored by the Young Scholar Scientific Research Foundation of China CDC(2012A102)Chinese National Natural Science Foundation Grants 30771914 and 30800975 Institution Technique R&D Grant(2008EG150300)
文摘Objective Fatal familial insomnia （FFI） is an autosomal dominant prion disease characterized clinically by inattention, sleep loss, dysautonomia, and motor signs. This study is aimed to investigate clinical and familial characteristics often Chinese Patients with FFI. Methods We identified ten FFI cases from the surveillance network for Creutafeldt- Jakob disease （CJD） in China.Final diagnosis of FFI cases was made in accordance with the WHO criteria for CJD.The main clinical features and family histories of these ten FFI cases were analyzed. Results The median age of ten cases at onset was 38 years （from 19 to 55）. The foremost symptoms seemed to be various, including sleep disturbances, vision disorder, dizziness and anorexia. Sleep disturbances appeared in all cases and lasted in the whole clinical courses. Progressive sympathetic symptoms, memory loss, movement disturbances, myoclonus and hypertension were also frequently observed. The median duration of the disease was 9.5 months. EEG and MRI did not figure out special abnormality. 14-3-3 protein in CSF was positive in five out of eight tested patients. Clear family histories were identified in 8 patients. Conclusion The data from our study confirm that the Chinese FFI cases have similar clinical characteristics as that of the Caucasian cases. Compared with other genetic CJD associated mutations, the genetic frequencies of D178N in PRNP are apparently high among the Chinese cases.
文摘Kikuchi-Fujimoto disease(KFD), also known as histiocytic necrotizing lymphadenitis, is an uncommon condition, typically characterized by lymphadenopathy and fevers. It usually has a benign course; however, it may progress to fatality in extremely rare occasions. The diagnosis is made via lymph node biopsy and histopathology. Our patient was a young female who presented with shortness of breath, fever, and malaise. Physical examination revealed significant cervical and axillary lymphadenopathy. Chest X-ray displayed multilobar pneumonia. She required intubation and mechanical ventilation for progressive respiratory distress. Histopathology of lymph nodes demonstrated variable involvement of patchy areas of necrosis within the paracortex composed of karyorrhectic debris with abundant histiocytes consistent with KFD. After initial stabilization, the patient's condition quickly deteriorated with acute anemia, thrombocytopenia and elevated prothrombin time, partial prothrombin time, and D-dimer levels. Disseminated intravascular coagulopathy(DIC) ensued resulting in the patient's fatality. DIC in KFD is not well understood, but it is an important cause of mortality in patients with aggressive disease.
文摘Objective The mechanism through which platelet activating factor （PAF） induces cardiac electrical activity and arrhythmia is not well understood and previous studies have suggested a potential involvement of ion channels in its action. The present study was aimed to clarify the role of PAF in fatal arrhythmias following acute myocardia infarction （AMI） and the underlying mechanism. Methods （1） Blood PAF levels were measured among 72 AMI patients at the time of diagnosis with AMI and 48 h later, and their electrocardiogram （ECG） was recorded continuously. （2） Ischemia simulation and surface electrocardiogram were conducted in 20 pigs and their PAF levels were measured. （3） PAF perfusion and standard microelectrode recording were performed on guinea pig papillarymuscles. Results In both humans and pigs, elevated PAF levels were detected in AMI and simulated ischemia, respectively, and even higher PAF levels were found when fatal arrhythmias occurred. In guinea pig myocardium, PAF induced a shortening of action potential duration at 90% level of repolarization （APD 90 ）under non-ischemic conditions and a more pronounced shortening under early simulated ischemic conditions. Conclusion AMI and ischemia are associated with increased PAF levels in humans and pigs, which are further raised when fatal arrhythmia follows. The effects of PAF on the myocardium may be mediated by multiple ion channels.
基金This work was supported by the National Natural Science Foundation of China(81630062)the State Key Laboratory for Infectious Disease Prevention and Control,CDC,China(2019SKLID501,2019SKLID603,and 2019SKLID307).
文摘Human genetic prion diseases(gPrDs)are directly associated with mutations and insertions in the PRNP(Prion Protein)gene.We collected and analyzed the data of 218 Chinese gPrD patients identified between Jan 2006 and June 2020.Nineteen different subtypes were identified and gPrDs accounted for 10.9%of all diagnosed PrDs within the same period.Some subtypes of gPrDs showed a degree of geographic association.The age at onset of Chinese gPrDs peaked in the 50–59 year group.Gerstmann–Sträussler–Scheinker syndrome(GSS)and fatal familial insomnia(FFI)cases usually displayed clinical symptoms earlier than genetic Creutzfeldt–Jakob disease(gCJD)patients with point mutations.A family history was more frequently recalled in P105L GSS and D178N FFI patients than T188K and E200K patients.None of the E196A gCJD patients reported a family history.The gCJD cases with point mutations always developed clinical manifestations typical of sporadic CJD(sCJD).EEG examination was not sensitive for gPrDs.sCJD-associated abnormalities on MRI were found in high proportions of GSS and gCJD patients.CSF 14-3-3 positivity was frequently detected in gCJD patients.Increased CSF tau was found in more than half of FFI and T188K gCJD cases,and an even higher proportion of E196A and E200K gCJD patients.63.6%of P105L GSS cases showed a positive reaction in cerebrospinal fluid RT-QuIC.GSS and FFI cases had longer durations than most subtypes of gCJD.This is one of the largest studies of gPrDs in East Asians,and the illness profile of Chinese gPrDs is clearly distinct.Extremely high proportions of T188K and E196A occur among Chinese gPrDs;these mutations are rarely reported in Caucasians and Japanese.
基金funded by the National "973" project(no.2011CB500705)the Special Fund for Agro-Scientific Research in the Public Interest(no.201203056)
文摘Dear Editor,Rabies is a generally fatal disease caused by the rabies virus(RABV),and is transmitted mainly by Carnivora and Chiroptera(Fooks A R,et al.,2014;Tao X,et al.,2013).In China,stray dogs and some wild animals(e.g.,Chinese ferret badgers,foxes,and raccoon dogs)are the principal reservoirs for RABV(Hu R L,et al.,2009).Historically,rabies in wild foxes and raccoon dogs(Nyctereutes procyonoides)was recorded in the early
文摘We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.
