This article provides a critical analysis of a prospective single arm study by Zheng et al,which assessed the impact of oxaliplatin and trastuzumab,administered every 3 weeks,for a total of six cycles in 60 patients w...This article provides a critical analysis of a prospective single arm study by Zheng et al,which assessed the impact of oxaliplatin and trastuzumab,administered every 3 weeks,for a total of six cycles in 60 patients with human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer.The study specifically explored how this treatment regimen influenced serum tumor markers and T lymphocyte subsets.After six cycles of treatment,the levels of the tumor markers carcinoembryonic antigen,carbohydrate antigen 19-9 and carbohydrate antigen 72-4 in the blood significantly dropped compared to their initial values(P<0.001).There was a notable increase in the percentages of CD3+and CD4+T cells(P<0.05),while the percentage of CD8+T cells decreased(P<0.05).As a result,the CD4+/CD8+ratio also rose significantly after treatment(P<0.05).Patients who had a reduction of 50%or more in their tumor markers and an increase of 1.5 times or more in the CD4+/CD8+ratio showed better clinical improvements(P<0.05).In this editorial,we will discuss these findings and how they apply to the current treatment field for advanced HER2 positive gastric cancer.展开更多
Clear cell sarcoma(CCS)is a type of malignant tumor that can arise from tendons and aponeuroses.This malignant proliferation of cells with melanocytic lineage normally occurs in young patients,and it is normally ident...Clear cell sarcoma(CCS)is a type of malignant tumor that can arise from tendons and aponeuroses.This malignant proliferation of cells with melanocytic lineage normally occurs in young patients,and it is normally identified in extremities.However,different sites including gastrointestinal organs are also described.Due difficulties in the molecular and histopathology evaluation,the diagnosis is often confused with malignant melanoma.Most cases are treated with surgical resection,but overall,the prognosis is poor.In this editorial,we will discuss a very interesting case of CCS identified in the pancreas.We will discuss the literature and controversies in the management of this type of cancer.Furthermore,we will address molecular strategies to be incorporated in those cases to better understand the primary location of the tumor.Finally,future perspectives of the field and new strategies of treatment will be described.展开更多
Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric alterations.It occurs in acute and chronic hepatic disease and also in patients with portosystemic shunts.The presence of these po...Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric alterations.It occurs in acute and chronic hepatic disease and also in patients with portosystemic shunts.The presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver depuration.Therefore,the embolization of these shunts has been performed tocontrol HE manifestations,but the presence of portal vein thrombosis is considered a contraindication.In this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic shunt.Case report:a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma,even without precipitant factors.She had a wide portosystemic shunt and also portal vein thrombosis.The abdominal angiography confirmed the splenorenal shunt and showed other shunts.The larger shunt was embolized through placement of microcoils,and the patient had no recurrence of overt HE.There was a little increase of esophageal and gastric varices,but no endoscopic treatment was needed.Since portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients,portal vein thrombosis should be considered a relative contraindication to perform a shunt embolization.However,in particular cases with many shunts and severe HE,we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE recovery.In conclusion,we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein thrombosis.As the patient had other shunts,she was successfully treated by embolization of the larger shunt.展开更多
Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicil...Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.展开更多
uv-decomposition method for solving a mathematical program with equilibrium constraints （MPEC） problem with linear complementarity constraints is presented. The problem is first converted into a nonlinear programmin...uv-decomposition method for solving a mathematical program with equilibrium constraints （MPEC） problem with linear complementarity constraints is presented. The problem is first converted into a nonlinear programming one. The structure of subdifferential a corresponding penalty function and results of its uv-decomposition are given. A conceptual algorithm for solving this problem with a superUnear convergence rate is then constructed in terms of the obtained results.展开更多
While clinical data have suggested that the diabetic heart is more susceptible to ischemic heart disease(IHD),animal data have so far pointed to a lower probability of IHD. Thus,the aim of this present review is to lo...While clinical data have suggested that the diabetic heart is more susceptible to ischemic heart disease(IHD),animal data have so far pointed to a lower probability of IHD. Thus,the aim of this present review is to look at these conflicting results and discuss the protective mechanisms that conditioned hyperglycemia may confer to the heart against ischemic injury. Several mechanisms have been proposed to explain the cardioprotective action of high glucose exposure,namely,upregulation of anti-apoptotic factor Bcl-2,inactivation of pro-apoptotic factor bad,and activation of pro-survival factors such as protein kinase B(Akt),vascular endothelial growth factor(VEGF),hypoxia inducible factor-1α and protein kinase C-ε. Indeed,cytosolic increase in Ca2+ concentration,the mitochondrial permeability transition pore,plays a key role in the genesis of ischemic injury. Previous studies have shown that the diabetic heart decreased Na+/Ca2+ and Na+/H+ exchanger activity and as such it accumulates less Ca2+ in cardiomyocyte,thus preventing cardiac injury and the associated heart dysfunctions. In addition,the expression of VEGFin diabetic animals leads to increased capillary density before myocardial infarction. Despite poor prognostic in the long-term,all these results suggest that diabetes mellitus and consequently hyperglycemia may indeed play a cardioprotective role against myocardial infarction in the short term.展开更多
Objective:To detect Dientamoeba(D.)fragilis and Enterocytozoon(E.)bieneusi and to assess their genetic characteristics in stool samples submitted for routine examination in a clinical laboratory in Southeastern Brazil...Objective:To detect Dientamoeba(D.)fragilis and Enterocytozoon(E.)bieneusi and to assess their genetic characteristics in stool samples submitted for routine examination in a clinical laboratory in Southeastern Brazil.Methods:In this survey,348 stool samples from female and male individuals with age ranging from 0 to≥55 years were analyzed by PCR amplifying and sequencing based on the small subunit ribosomal RNA(SSU r RNA)gene of D.fragilis and the internal transcribed spacer of E.bieneusi.Results:D.fragilis and E.bieneusi isolates were observed in 2.29%(8/348)and 4.59%(16/348)of the samples,respectively.These parasites were detected in stool samples from individuals of both genders,including young children under nine until adults over 55 years old.No statistically significant differences were found.All D.fragilis isolates were classified as genotype 1 and E.bieneusi isolates included genotypes D(n=15)and A(n=1).Conclusions:The findings provide relevant findings on occurrence and genetic diversity of D.fragilis and E.bieneusi,pointing to the need for the diagnosis of these parasites in routine examinations in clinical laboratories.In addition to sensitive diagnostic methods,it is mandatory that these parasites be considered relevant for physicians and laboratory staff.展开更多
BACKGROUND Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection(PJI).However,there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked...BACKGROUND Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection(PJI).However,there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay(ELISA)method,such as sample dilution.AIM To assess the influence of dilution in the synovial fluid during ELISA for the diagnosis of knee PJI;and determine which dilution presents a better performance.METHODS Forty samples of synovial fluid from arthroplasty knees were included,17 in the infected group and 23 in the aseptic group,according to Musculoskeletal Infection Society criteria.Initially,five synovial fluid samples from each group were assessed for quantitative analysis of alpha-defensin using ELISA.Different dilution ratios(1:10,1:100,1:500,1:1000 and 1:5000)were tested based on the predetermined cutoff value of 5.2 mg/L.The dilutions that performed better were used to compare the results of all samples.RESULTS For infected cases,a gradual increase in the dilution of synovial fluid samples led to an equivalent increase in alpha-defensin level.The same was not observed in the aseptic cases.Both 1:1000 and 1:5000 dilutions presented satisfactory results to differentiate infected and aseptic cases.Further analyses were performed using 1:1000 and 1:5000 for all 40 samples.The 1:1000 dilution resulted in a sensitivity of 88.2%(95%CI,66%-98%)and specificity of 95.7%(95%CI,79%-99%),whereas the 1:5000 dilution presented a sensitivity of 94.1%(95%CI,73%-99%)and a specificity of 100%(95%CI,86%-100%).CONCLUSION The synovial fluid dilution had an important influence on the alpha-defensin ELISA results.Dilutions of 1:5000 showed the best performance for the diagnosis of knee PJI.The results of this study set the basis for a more reliable and reproducible alpha-defensin ELISA during the investigation of PJI,contributing to the expansion of this technique in different treatment centers worldwide.展开更多
BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent an...BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.展开更多
Dear Editor, Physicians are looking for methods and techniques to become more efficient and more productive. Not only is efficiency important in the office and clinical setting, but in the operating room as well. ~hi...Dear Editor, Physicians are looking for methods and techniques to become more efficient and more productive. Not only is efficiency important in the office and clinical setting, but in the operating room as well. ~his article will discuss efficiency and productivity in the operating room and its benefit to patients, surgeons and hospitals.展开更多
Background:Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which causes COVID-19,is characterized by an increased risk of thromboembolic events.However,more than 80%of patients are asymptomatic or have onl...Background:Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which causes COVID-19,is characterized by an increased risk of thromboembolic events.However,more than 80%of patients are asymptomatic or have only minor/mild symptoms.In addition,diagnosing thromboembolism in athletes is challenging,as symptoms can be confused with musculoskeletal complaints or physical deconditioning.Case presentation:Here we report the case of a previously healthy 34-year-old professional soccer player with COVID-19 infection and genetic predisposition to thrombosis.At baseline,he was fit,had no symptoms,did not require hospital admission due to a COVID-19 infection,and was started on a five-day course of azithromycin and dexamethasone therapy.After 10 days of returning to professional activity,he developed pulmonary embolism following a COVID-19 infection during a physical exercise session.Angiotomography showed positive acute and subacute pulmonary thromboembolism,being treated with rivaroxaban 20 mg/day continuously.The shared decision-making between the medical team and the athlete was not to return to professional soccer,given the quantifiable risk.Considerations:This case illustrates the potential risk of COVID-19-induced pulmonary thromboembolism,which can be affected by genetic predisposition and dexamethasone therapy or the consequences of COVID-19.In this clinical period,the athlete’s condition may be overlooked due to the masking effects of other clinical conditions and physical abnormalities.The residual effects of COVID-19 disease can appear late,requiring caution and follow-up by the medical team before releasing the athlete into a training program.展开更多
威铂斯酒店集团(Why the Best Hotels)于2010年12月31日在佛罗伦萨正式创立,是一个崭新的意大利酒店集团,由法兰蒂尼家族创建,包含一系列精致典雅而低调奢华的精品酒店。一年多来,威铂斯已成为引领意大利酒店服务新概念的全新时尚品牌,...威铂斯酒店集团(Why the Best Hotels)于2010年12月31日在佛罗伦萨正式创立,是一个崭新的意大利酒店集团,由法兰蒂尼家族创建,包含一系列精致典雅而低调奢华的精品酒店。一年多来,威铂斯已成为引领意大利酒店服务新概念的全新时尚品牌,旗下拥有6家酒店,共300多间客房,每间客房都极具特色。展开更多
文摘This article provides a critical analysis of a prospective single arm study by Zheng et al,which assessed the impact of oxaliplatin and trastuzumab,administered every 3 weeks,for a total of six cycles in 60 patients with human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer.The study specifically explored how this treatment regimen influenced serum tumor markers and T lymphocyte subsets.After six cycles of treatment,the levels of the tumor markers carcinoembryonic antigen,carbohydrate antigen 19-9 and carbohydrate antigen 72-4 in the blood significantly dropped compared to their initial values(P<0.001).There was a notable increase in the percentages of CD3+and CD4+T cells(P<0.05),while the percentage of CD8+T cells decreased(P<0.05).As a result,the CD4+/CD8+ratio also rose significantly after treatment(P<0.05).Patients who had a reduction of 50%or more in their tumor markers and an increase of 1.5 times or more in the CD4+/CD8+ratio showed better clinical improvements(P<0.05).In this editorial,we will discuss these findings and how they apply to the current treatment field for advanced HER2 positive gastric cancer.
文摘Clear cell sarcoma(CCS)is a type of malignant tumor that can arise from tendons and aponeuroses.This malignant proliferation of cells with melanocytic lineage normally occurs in young patients,and it is normally identified in extremities.However,different sites including gastrointestinal organs are also described.Due difficulties in the molecular and histopathology evaluation,the diagnosis is often confused with malignant melanoma.Most cases are treated with surgical resection,but overall,the prognosis is poor.In this editorial,we will discuss a very interesting case of CCS identified in the pancreas.We will discuss the literature and controversies in the management of this type of cancer.Furthermore,we will address molecular strategies to be incorporated in those cases to better understand the primary location of the tumor.Finally,future perspectives of the field and new strategies of treatment will be described.
文摘Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric alterations.It occurs in acute and chronic hepatic disease and also in patients with portosystemic shunts.The presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver depuration.Therefore,the embolization of these shunts has been performed tocontrol HE manifestations,but the presence of portal vein thrombosis is considered a contraindication.In this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic shunt.Case report:a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma,even without precipitant factors.She had a wide portosystemic shunt and also portal vein thrombosis.The abdominal angiography confirmed the splenorenal shunt and showed other shunts.The larger shunt was embolized through placement of microcoils,and the patient had no recurrence of overt HE.There was a little increase of esophageal and gastric varices,but no endoscopic treatment was needed.Since portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients,portal vein thrombosis should be considered a relative contraindication to perform a shunt embolization.However,in particular cases with many shunts and severe HE,we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE recovery.In conclusion,we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein thrombosis.As the patient had other shunts,she was successfully treated by embolization of the larger shunt.
文摘Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.
基金Project supported by the National Natural Science Foundation of China(Nos.10372063,10771026 and 10471015)
文摘uv-decomposition method for solving a mathematical program with equilibrium constraints （MPEC） problem with linear complementarity constraints is presented. The problem is first converted into a nonlinear programming one. The structure of subdifferential a corresponding penalty function and results of its uv-decomposition are given. A conceptual algorithm for solving this problem with a superUnear convergence rate is then constructed in terms of the obtained results.
文摘While clinical data have suggested that the diabetic heart is more susceptible to ischemic heart disease(IHD),animal data have so far pointed to a lower probability of IHD. Thus,the aim of this present review is to look at these conflicting results and discuss the protective mechanisms that conditioned hyperglycemia may confer to the heart against ischemic injury. Several mechanisms have been proposed to explain the cardioprotective action of high glucose exposure,namely,upregulation of anti-apoptotic factor Bcl-2,inactivation of pro-apoptotic factor bad,and activation of pro-survival factors such as protein kinase B(Akt),vascular endothelial growth factor(VEGF),hypoxia inducible factor-1α and protein kinase C-ε. Indeed,cytosolic increase in Ca2+ concentration,the mitochondrial permeability transition pore,plays a key role in the genesis of ischemic injury. Previous studies have shown that the diabetic heart decreased Na+/Ca2+ and Na+/H+ exchanger activity and as such it accumulates less Ca2+ in cardiomyocyte,thus preventing cardiac injury and the associated heart dysfunctions. In addition,the expression of VEGFin diabetic animals leads to increased capillary density before myocardial infarction. Despite poor prognostic in the long-term,all these results suggest that diabetes mellitus and consequently hyperglycemia may indeed play a cardioprotective role against myocardial infarction in the short term.
文摘Objective:To detect Dientamoeba(D.)fragilis and Enterocytozoon(E.)bieneusi and to assess their genetic characteristics in stool samples submitted for routine examination in a clinical laboratory in Southeastern Brazil.Methods:In this survey,348 stool samples from female and male individuals with age ranging from 0 to≥55 years were analyzed by PCR amplifying and sequencing based on the small subunit ribosomal RNA(SSU r RNA)gene of D.fragilis and the internal transcribed spacer of E.bieneusi.Results:D.fragilis and E.bieneusi isolates were observed in 2.29%(8/348)and 4.59%(16/348)of the samples,respectively.These parasites were detected in stool samples from individuals of both genders,including young children under nine until adults over 55 years old.No statistically significant differences were found.All D.fragilis isolates were classified as genotype 1 and E.bieneusi isolates included genotypes D(n=15)and A(n=1).Conclusions:The findings provide relevant findings on occurrence and genetic diversity of D.fragilis and E.bieneusi,pointing to the need for the diagnosis of these parasites in routine examinations in clinical laboratories.In addition to sensitive diagnostic methods,it is mandatory that these parasites be considered relevant for physicians and laboratory staff.
文摘BACKGROUND Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection(PJI).However,there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay(ELISA)method,such as sample dilution.AIM To assess the influence of dilution in the synovial fluid during ELISA for the diagnosis of knee PJI;and determine which dilution presents a better performance.METHODS Forty samples of synovial fluid from arthroplasty knees were included,17 in the infected group and 23 in the aseptic group,according to Musculoskeletal Infection Society criteria.Initially,five synovial fluid samples from each group were assessed for quantitative analysis of alpha-defensin using ELISA.Different dilution ratios(1:10,1:100,1:500,1:1000 and 1:5000)were tested based on the predetermined cutoff value of 5.2 mg/L.The dilutions that performed better were used to compare the results of all samples.RESULTS For infected cases,a gradual increase in the dilution of synovial fluid samples led to an equivalent increase in alpha-defensin level.The same was not observed in the aseptic cases.Both 1:1000 and 1:5000 dilutions presented satisfactory results to differentiate infected and aseptic cases.Further analyses were performed using 1:1000 and 1:5000 for all 40 samples.The 1:1000 dilution resulted in a sensitivity of 88.2%(95%CI,66%-98%)and specificity of 95.7%(95%CI,79%-99%),whereas the 1:5000 dilution presented a sensitivity of 94.1%(95%CI,73%-99%)and a specificity of 100%(95%CI,86%-100%).CONCLUSION The synovial fluid dilution had an important influence on the alpha-defensin ELISA results.Dilutions of 1:5000 showed the best performance for the diagnosis of knee PJI.The results of this study set the basis for a more reliable and reproducible alpha-defensin ELISA during the investigation of PJI,contributing to the expansion of this technique in different treatment centers worldwide.
文摘BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.
文摘Dear Editor, Physicians are looking for methods and techniques to become more efficient and more productive. Not only is efficiency important in the office and clinical setting, but in the operating room as well. ~his article will discuss efficiency and productivity in the operating room and its benefit to patients, surgeons and hospitals.
文摘Background:Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which causes COVID-19,is characterized by an increased risk of thromboembolic events.However,more than 80%of patients are asymptomatic or have only minor/mild symptoms.In addition,diagnosing thromboembolism in athletes is challenging,as symptoms can be confused with musculoskeletal complaints or physical deconditioning.Case presentation:Here we report the case of a previously healthy 34-year-old professional soccer player with COVID-19 infection and genetic predisposition to thrombosis.At baseline,he was fit,had no symptoms,did not require hospital admission due to a COVID-19 infection,and was started on a five-day course of azithromycin and dexamethasone therapy.After 10 days of returning to professional activity,he developed pulmonary embolism following a COVID-19 infection during a physical exercise session.Angiotomography showed positive acute and subacute pulmonary thromboembolism,being treated with rivaroxaban 20 mg/day continuously.The shared decision-making between the medical team and the athlete was not to return to professional soccer,given the quantifiable risk.Considerations:This case illustrates the potential risk of COVID-19-induced pulmonary thromboembolism,which can be affected by genetic predisposition and dexamethasone therapy or the consequences of COVID-19.In this clinical period,the athlete’s condition may be overlooked due to the masking effects of other clinical conditions and physical abnormalities.The residual effects of COVID-19 disease can appear late,requiring caution and follow-up by the medical team before releasing the athlete into a training program.
文摘威铂斯酒店集团(Why the Best Hotels)于2010年12月31日在佛罗伦萨正式创立,是一个崭新的意大利酒店集团,由法兰蒂尼家族创建,包含一系列精致典雅而低调奢华的精品酒店。一年多来,威铂斯已成为引领意大利酒店服务新概念的全新时尚品牌,旗下拥有6家酒店,共300多间客房,每间客房都极具特色。
