BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical...BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies.METHODS: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED departure.RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory pain.CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.展开更多
In recent decades,silicon photonics has attracted much attention in telecom and data-com areas.Constituted of high refractive-index contrast waveguides on silicon-on-insulator(SOI),a variety of integrated photonic pas...In recent decades,silicon photonics has attracted much attention in telecom and data-com areas.Constituted of high refractive-index contrast waveguides on silicon-on-insulator(SOI),a variety of integrated photonic passive and active devices have been implemented supported by excellent optical properties of silicon in the mid-infrared spectrum.The main advantage of the silicon photonics is the ability to use complementary metal oxide semiconductor(CMOS)process-compatible fabrication technologies,resulting in high-volume production at low cost.On the other hand,explosively growing traffic in the telecom,data center and high-performance computer demands the data flow to have high speed,wide bandwidth,low cost,and high energy-efficiency,as well as the photonics and electronics to be integrated for ultra-fast data transfer in networks.In practical applications,silicon photonics started with optical interconnect transceivers in the data-com first,and has been now extended to innovative applications such as multi-port optical switches in the telecom network node and integrated optical phased arrays(OPAs)in light detection and ranging(LiDAR).This paper overviews the progresses of silicon photonics from four points reflecting the recent advances mentioned above.CMOS-based silicon photonic platform technologies,applications to optical transceiver in the data-com network,applications to multi-port optical switches in the telecom network and applications to OPA in LiDAR system.展开更多
BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothe...BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.展开更多
Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosurgical intervention can mitigate negative outcomes.However,variable mechanisms of injury may be associated with inappro...Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosurgical intervention can mitigate negative outcomes.However,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical interventions.Patients with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006-2017.We excluded patients transferred to other facilities,and those not injured in the water.Primary outcome was IAT,defined as patients with NSSI requiring transfer to another trauma center.To avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma center.We used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with outcome.Results:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had IAT.Compared to appropriately transported patients,diving was associated with higher percentages of IAT(28.6%vs.3.9%,p=0.014)and more were transported by air(50.0%vs.20.6%,p=0.01).In multivariable regression,patients'oxygenation saturation(odds ratio[OR]=0.8,95%confidence intervals[Cl]:077-0.98)and diving(OR=7.5,95%Cl:1.2-46)were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low.However,first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.展开更多
Tumor cells are characterized by metabolic reprogram-ming,a step that is necessary to support their high demand for energy and nutrients[1,2].Furthermore,once metastatic tumor cells are seeded,tumor microen-vironment ...Tumor cells are characterized by metabolic reprogram-ming,a step that is necessary to support their high demand for energy and nutrients[1,2].Furthermore,once metastatic tumor cells are seeded,tumor microen-vironment remodeling is immediately initiated,leading to the formation of more suitable conditions for growth.Tumor cells secrete several types of growth factors,cytokines,and chemokines to induce angiogenesis and tumor-associated immune cell recruitment,all of which can promote proliferation and metastasis,as well as trig-ger immune tolerance and drug resistance[3].Exploring the synergistic effect between metabolic reprogramming and microenvironment remodeling will likely facili-tate the discovery of novel biomarkers and therapeutic targets.展开更多
文摘BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies.METHODS: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED departure.RESULTS: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory pain.CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.
文摘In recent decades,silicon photonics has attracted much attention in telecom and data-com areas.Constituted of high refractive-index contrast waveguides on silicon-on-insulator(SOI),a variety of integrated photonic passive and active devices have been implemented supported by excellent optical properties of silicon in the mid-infrared spectrum.The main advantage of the silicon photonics is the ability to use complementary metal oxide semiconductor(CMOS)process-compatible fabrication technologies,resulting in high-volume production at low cost.On the other hand,explosively growing traffic in the telecom,data center and high-performance computer demands the data flow to have high speed,wide bandwidth,low cost,and high energy-efficiency,as well as the photonics and electronics to be integrated for ultra-fast data transfer in networks.In practical applications,silicon photonics started with optical interconnect transceivers in the data-com first,and has been now extended to innovative applications such as multi-port optical switches in the telecom network node and integrated optical phased arrays(OPAs)in light detection and ranging(LiDAR).This paper overviews the progresses of silicon photonics from four points reflecting the recent advances mentioned above.CMOS-based silicon photonic platform technologies,applications to optical transceiver in the data-com network,applications to multi-port optical switches in the telecom network and applications to OPA in LiDAR system.
文摘BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.
文摘Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosurgical intervention can mitigate negative outcomes.However,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical interventions.Patients with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006-2017.We excluded patients transferred to other facilities,and those not injured in the water.Primary outcome was IAT,defined as patients with NSSI requiring transfer to another trauma center.To avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma center.We used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with outcome.Results:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had IAT.Compared to appropriately transported patients,diving was associated with higher percentages of IAT(28.6%vs.3.9%,p=0.014)and more were transported by air(50.0%vs.20.6%,p=0.01).In multivariable regression,patients'oxygenation saturation(odds ratio[OR]=0.8,95%confidence intervals[Cl]:077-0.98)and diving(OR=7.5,95%Cl:1.2-46)were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low.However,first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.
文摘Tumor cells are characterized by metabolic reprogram-ming,a step that is necessary to support their high demand for energy and nutrients[1,2].Furthermore,once metastatic tumor cells are seeded,tumor microen-vironment remodeling is immediately initiated,leading to the formation of more suitable conditions for growth.Tumor cells secrete several types of growth factors,cytokines,and chemokines to induce angiogenesis and tumor-associated immune cell recruitment,all of which can promote proliferation and metastasis,as well as trig-ger immune tolerance and drug resistance[3].Exploring the synergistic effect between metabolic reprogramming and microenvironment remodeling will likely facili-tate the discovery of novel biomarkers and therapeutic targets.
