AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in...AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in gastricpolypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device.The performance of four second year(year-2)fellows who had undergone one year of clinical training was compared with that of four f irst year(year-1)fellows both before and after a 4-h workshop using the ex vivo simulator.The workshop allowed for hands-on train-ing in the removal of multiple artif icial polyps and the placement of hemoclips at the excision site.Evaluation included observation of technical skills,procedure time,and the fellows' conf idence scale.RESULTS:One week after the workshop,the year-1 fellows were re-evaluated and had significantly im-proved mean performance scores(from 17.9 ± 1.8 to 22.5 ± 0.7),conf idence scale(from 4.5 ± 1.0 to 7.8 ± 0.5)and procedure time(from 615.0 ± 57.4 s to 357.5 ± 85.0 s)compared with their baseline performance.After 4 h of training using the ex vivo simulator,the skills of the year-1 fellows were statistically similar to those of the year-2 fellows.CONCLUSION:Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy.展开更多
Background: Respiratory disorders are the most common diseases among Iranian pilgrims in Hajj. Some studies recommended flu and pneumococcal vaccines separately or in combination to reduce respiratory diseases occurre...Background: Respiratory disorders are the most common diseases among Iranian pilgrims in Hajj. Some studies recommended flu and pneumococcal vaccines separately or in combination to reduce respiratory diseases occurrence and its morbidity. These effects are not clear in afflicted Hajj pilgrims. Objective: This is a cohort study that investigates the effects of above-mentioned vaccines each or their combination on respiratory syndromes and their consequences among Iranian pilgrims in Mecca. Method: The participants were 295 Iranian pilgrims from the beginning to the end of the journey. They were systematically observed for getting afflicted with a respiratory syndrome or not. In this study, we have assessed the effects of flu and pneumococcal vaccines on respiratory disease occurrence and on 8 clinical consequences including as: the duration of fever, duration of cough, duration of bed rest, presence of post nasal discharge and dirty sputum, the total disease length, and the number of referrals to the hospital, physician’s visits and complications. The data for this study were gathered through a questionnaire with 14 basic questions and 60 choices. This was processed using the SPSS software of 11.5 version, T- and Chi-square tests. Results: The results showed no significant correlations between the above-mentioned factors and vaccination with one or both flu and pneumovax-23 except for the duration of coughs which was significantly reduced in all cases (p < 0.01) and also decreased complications of the disease (p < 0.001). Conclusion: The study suggests the high-risk groups, should be vaccinated with combination of flu and pneumovax-23 vaccines in Hajj.展开更多
Rationale:Advances in sleep research have introduced medications like lemborexant,a dual orexin receptor antagonist.While effective for regulating sleep,overdoses are a concern,especially in suicide attempts.However,l...Rationale:Advances in sleep research have introduced medications like lemborexant,a dual orexin receptor antagonist.While effective for regulating sleep,overdoses are a concern,especially in suicide attempts.However,limited data exist on lemborexant overdose,prompting this case report to elucidate its clinical course.Patient’s Concern:A 91-year-old Japanese woman with multiple comorbidities,including insomnia and chronic kidney disease,was admitted after ingesting 315 mg of lemborexant in a suicide attempt.Diagnosis:Lemborexant overdose.Interventions:Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.Outcomes:She gradually regained full consciousness with no residual deficits.Due to persistent suicidal ideation,she was transferred to a psychiatric hospital after seven days of supportive care.Lessons:A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction.Supportive care is generally sufficient for management.However,given the limited data,further case accumulation is needed to enhance clinical understanding.展开更多
This study innovatively employs functional near-infrared spectroscopy(fNIRS)technology to investigate passengers’brain responses to various external stimuli during high-speed train operations,assessing their impact o...This study innovatively employs functional near-infrared spectroscopy(fNIRS)technology to investigate passengers’brain responses to various external stimuli during high-speed train operations,assessing their impact on passenger comfort.Three stimuli are examined:passing through tunnels,sonic booms at tunnel exits,and two trains meeting within the tunnel.The analysis of environmental variables,including cabin noise,cabin-to-external pressure,and cabin-to-body acceleration,reveals that changes in auditory and pressure levels during the tunnel experience led to an 87%increase in oxygenated hemoglobin(HbO)levels in the temporal lobe(TL).This reflects a brief discomfort that subsides as passengers adapt,with HbO levels nearly returning to pre-tunnel levels upon exit.Among the stimuli,the sonic boom triggered the most significant neural response,with HbO fluctuations increased by 175%.In contrast,the impact of train meetings was minor,yielding an average HbO increase of only 14.21%.Connectivity analysis further shows significant enhancements in brain functional connectivity during tunnel entrance and sonic boom scenarios,with increases of 52%and 80%,respectively.Our findings contribute to passenger comfort assessment by establishing objective neurophysiological measures that quantify previously subjective experiences.The application of fNIRS in this dynamic environment creates new possibilities for evidence-based comfort optimization in railway design.展开更多
BACKGROUND The association between ambient air pollution and glycolipid metabolic disorders(GMDs,including diabetes mellitus and dyslipidemia)is still not well understood,especially when it comes to the different effe...BACKGROUND The association between ambient air pollution and glycolipid metabolic disorders(GMDs,including diabetes mellitus and dyslipidemia)is still not well understood,especially when it comes to the different effects of long-term vs short-term exposure and the sources of pollutants(indoor or outdoor).AIM To look at how outdoor particulate matter(PM1,PM_(2.5),PM_(10))and ozone(O3),as well as indoor pollutants from solid fuels,are related to the risk of developing GMDs in a cohort that represents the national population.METHODS We used a longitudinal cohort design to look at how different time periods of air pollution exposure(long-term:5-year averages;short-term:1-year averages)affect the incidence of GMDs in middle-aged and elderly adults.Multivariable logistic regression models,which took into account key factors such as age,sex,and smoking status,were used to calculate odds ratios(ORs)and 95%confidence intervals(CIs).RESULTS Our study found that exposure to air pollution(1μg/m^(3))has different effects on GMDs.Long-term exposure to outdoor pollutants like PM1,PM_(2.5),PM_(10),and O3 consistently increased the risk of diabetes(PM1:OR=1.106,95%CI:1.018-1.205;PM_(2.5):OR=1.038,95%CI:1.007-1.071;PM_(10):OR=1.023,95%CI:1.004-1.043)and dyslipidemia(PM1:OR=1.150,95%CI:1.064-1.249;PM_(2.5):OR=1.053,95%CI:1.023-1.086;PM_(10):OR=1.032,95%CI:1.014-1.052).Short-term exposure showed even stronger associations,particularly for PM1 with dyslipidemia(OR=1.078,95%CI:1.044-1.114)and PM1 with diabetes(OR=1.047,95%CI:1.007-1.089).Notably,certain components of PM_(2.5)-chloride(Cl^(-)),ammonium(NH_(4)^(+)),sulfate(SO_(4)^(2-)),and nitrate(NO3-)-showed a dose-dependent relationship with both conditions(for example,Cl^(-):Diabetes OR=1.797 per 1μg/m^(3),95%CI:1.086-2.991;dyslipidemia OR=2.627,95%CI:1.728-4.012).However,neither long-term nor short-term exposure to indoor solid fuel pollutants was significantly associated with diabetes(long-term OR=1.034,95%CI:0.801-1.333;short-term OR=0.970,95%CI:0.774-1.209)or dyslipidemia(short-term OR=1.159,95%CI:0.967-1.386).CONCLUSION This national cohort study shows that outdoor air pollution-particularly PM1,PM_(2.5),and their chemical components-is an important environmental factor contributing to GMDs,with long-term exposure showing greater metabolic toxicity than short-term exposure.The lack of association between indoor solid fuel pollutants and GMDs underscores the urgent need for targeted interventions to improve outdoor air quality and reduce metabolic risks at the population level.展开更多
BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap ...BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk,the current study utilized three representative cohorts.METHODS In this study,we used three representative cohorts from Asia,Europe,and the Americas:China Health and Retirement Longitudinal Study(CHARLS),English Longitudinal Study of Ageing(ELSA),and Health and Retirement Study(HRS).Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes.The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states:persistently low,decreasing,fluctuating,increasing,and consistently high.Selfreported physician diagnoses were used to evaluate the subsequent stroke events.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)were computed using Cox proportional-risk models adjusted for potential confounding factors.RESULTS A total of 7990 participants from CHARLS(females:52.3%,mean age:63.4 years),5642 participants from ELSA(females:56.2%,mean age:63.7 years),and 12260 participants from HRS(females:61.4%,mean age:64.7 years)participated in this study.The median follow-up periods were 5 years for CHARLS,8 years for ELSA,and 10 years for HRS.In comparison with the persistently low trajectory,consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts(CHARLS:HR=1.80,95% CI:1.36-2.38;ELSA:HR=1.50,95% CI:1.02-2.21;HRS:HR=1.45,95% CI:1.29-1.62 for consistently high;CHARLS:HR=1.47,95% CI:1.14-1.90;ELSA:HR=1.44,95% CI:1.17-1.77;HRS:HR=1.26,95% CI:1.13-1.41 for fluctuating).Increasing trajectories enhanced the risk in the European cohort(ELSA:HR=1.71,95% CI:1.06-2.74),while decreasing trajectories did not increase stroke risk in any cohort.For somatic depressive symptoms,consistently high and fluctuating trajectories increased the risk of stroke across all cohorts(CHARLS:HR=2.16,95% CI:1.67-2.79;ELSA:HR=1.94,95% CI:1.34-2.81;HRS:HR=1.79,95% CI:1.49-2.15 for consistently high;CHARLS:HR=1.35,95% CI:1.20-1.62;ELSA:HR=1.56,95% CI:1.27-1.92;HRS:HR=1.33,95% CI:1.20-1.46 for fluctuating).Increasing trajectories only increased the risk in the European cohort(ELSA:HR=1.95,95% CI:1.11-3.43),while decreasing trajectories did not increase stroke risk in the European and American cohorts.For cognitive-affective depressive symptoms,consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts(CHARLS:HR=2.06,95% CI:1.52-2.81;ELSA:HR=1.25,95% CI:1.02-1.54 for consistently high;CHARLS:HR=1.63,95% CI:1.23-2.16;ELSA:HR=1.58,95% CI:1.11-2.24 for fluctuating).Increasing trajectories increased the risk only in the American cohort(HRS:HR=14.67,95% CI:1.87-114.91).CONCLUSION Consistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations.Consistently high,fluctuating,and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations.These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention,particularly in regions where specific symptom trajectories are prevalent.展开更多
BACKGROUND： Bone marrow stromal cells （BMSCs） or Schwann cells （SCs） transplantation alone can treat spinal cord injury. However, the transplantation either cell-type alone has disadvantages. The co-transplantati...BACKGROUND： Bone marrow stromal cells （BMSCs） or Schwann cells （SCs） transplantation alone can treat spinal cord injury. However, the transplantation either cell-type alone has disadvantages. The co-transplantation of both cells may benefit structural reconstruction and functional recovery of spinal nerves. OBJECTIVE： To verify spinal cord repair and related mechanisms after co-transplantation of BMSCs and SCs in a rat model of hemisected spinal cord injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Department of Histology and Embryology, Mudanjiang Medical College from January 2008 to May 2009. MATERIALS： Rabbit anti-S-100, glial fibrillary acidic protein, neuron specific enolase and neurofilament-200 monoclonal antibodies were purchased from Sigma, USA. METHODS： A total of 100 Wistar rats were used in a model of hemisected spinal cord injury. The rats were randomly assigned to vehicle control, SCs transplantation, BMSCs transplantation, and co-transplantation groups; 25 rats per group. At 1 week after modeling, SCs or BMSCs cultured in vitro were labeled and injected separately into the hemisected spinal segment of SCs and BMSCs transplantation groups through three injection points [5 μL （1 x 107 cells/mL）] cell suspension in each point）. In addition, a 15 μL 1 × 10^7 cells/mL SCs suspension and a 15 μL 1 × 10^7 cells/mL BMSC suspension were injected into co-transplantation group by the above method. MAIN OUTCOME MEASURES： The Basso-Beattie-Bresnahan （BBB） locomotor rating scale and somatosensory evoked potential （SEP） tests were used to assess the functional recovery of rat hind limbs following operation. Structural repair of injured nerve tissue was observed by light microscopy, electron microscopy, immunohistochemistry, and magnetic resonance imaging （MRI）. In vivo differentiation, survival and migration of BMSCs were evaluated by immunofluorescence. RESULTS： BBB scores were significantly greater in all three transplantation groups compared with vehicle control group 8 weeks after transplantation. In particular, the co-transplantation group displayed the highest scores among the groups （P 〈 0.05）. Moreover, recovery of SEP latency and amplitude was observed in all the transplantation groups, particularly after 8 weeks. Again, the co-transplantation group exhibited the greatest improvement （P 〈 0.05）. In the co-transplantation group, imaging showed a smooth surface and intact inner structure at the injury site, with no scar formation, and a large number of orderly cells at the injured site. Axonal regeneration, new myelination, and a large amount of cell division were detected in the co-transplantation group by electron microscopy. Neuron specific enolase （NSE）- and glial fibriilary acidic protein （GFAP）-positive cells were observed in the spinal cord sections 1 week following co-transplantation by immunofluorescence staining. CONCLUSION： Co-transplantation of SCs and BMSCs effectively promoted functional recovery of injured spinal cord in rats compared with SCs or BMSCs transplantation alone. This repair effect is probably achieved because of neuronal-like cells derived from BMSCs to supplement dead neurons in vivo.展开更多
BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there ...BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there are numerous instances of mild symptoms,with only a limited number of reports of severe cases necessitating intensive care.We presented the case of a female who ingested 111 tablets of dextromethorphan,leading to shock and convulsions and requiring intensive care that ultimately saved her life.CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance,having overdosed on 111 tablets of dextromethorphan(15 mg)obtained through an online importer in a suicide attempt.The patient had a history of drug abuse and multiple self-inflicted injuries.At the time of admission,she exhibited symptoms of shock and altered consciousness.However,upon arrival at the hospital,the patient experienced recurrent generalized clonic convulsions and status epilepticus,necessitating tracheal intubation.The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock,and noradrenaline was administered as a vasopressor.Gastric lavage and activated charcoal were also administered after intubation.Through systemic management in the intensive care unit,the patient’s condition stabilized,and the need for vasopressors ceased.The patient regained consciousness and was extubated.The patient was subsequently transferred to a psychiatric facility,as suicidal ideation persisted.CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.展开更多
Periodontitis is a chronic infectious disease characterized by plaque biofilm as its main pathogenic factor;its clinical manifestations include gingival inflammation,alveolar bone resorption,attachment loss,and period...Periodontitis is a chronic infectious disease characterized by plaque biofilm as its main pathogenic factor;its clinical manifestations include gingival inflammation,alveolar bone resorption,attachment loss,and periodontal pocket formation,all of which eventually lead to tooth loss and seriously affect the quality of life of patients[1].This illness has a close relationship with blood sugar levels in patients with diabetes and is one of the most important complications of diabetes[2].Macrophages are an important part of host immune responses and exhibit powerful functions of identifying,phagocytizing,and removing bacteria;macrophage polarization is involved in the pathogenesis of periodontitis[3].展开更多
Periodontitis is a chronic inflammatory disease resulting in the loss of periodontal tissues and ultimately teeth,thus posing a substantial public-health burden worldwide[1].With the widespread increase in mesenchymal...Periodontitis is a chronic inflammatory disease resulting in the loss of periodontal tissues and ultimately teeth,thus posing a substantial public-health burden worldwide[1].With the widespread increase in mesenchymal stem cell(MSC)therapy and the discovery of MSCs in periodontal ligaments[2],periodontal ligament stem cells(PDLSCs)have been used to reconstruct periodontal tissue and repair bone defects[2,3].Furthermore.展开更多
BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic...BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.展开更多
Objective:To develop a self-management behaviour tool for liver cirrhosis patients in China.Methods:A provisional scale comprising 30 items was developed based on the results of literature review,semi-structured inter...Objective:To develop a self-management behaviour tool for liver cirrhosis patients in China.Methods:A provisional scale comprising 30 items was developed based on the results of literature review,semi-structured interviews,expert consultation and pilot study.Patients with hepatic cirrhosis(n=180)from four grade A tertiary hospitals in Tianjin and Handan Infectious Disease Hospital were assessed using the provisional self-management scale comprising 30 items in four dimensions.The reliability and validity of the scale were tested and a final version of the self-management scale for liver cirrhosis comprising 24 items was concluded.Results:The overall Cronbach's a for the scale was 0.80,ranging from 0.60 to 0.69 in each dimension.The testeretest correlation was 0.84,ranging from 0.54 to 0.72 in each dimension.Content validity for the scale was 0.93.Nine factors were extracted by a factor analysis method,which were limited to four factors according to a scree test.The cumulative variance contribution rate was 56.98%.Conclusion:This scale has good reliability and validity and can be used to evaluate selfmanagement behaviour of hepatic cirrhosis patients and provides a reference for behaviour intervention.展开更多
An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomogra...An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomography depicted hepatosplenomegaly and swelling of systemic lymph nodes. The patient died of advanced respiratory failure 5 d after the first occurrence of his dyspnea. At autopsy, the pathological features revealed a diffuse infiltration of large atypical lymphocytes to systemic organs including the spleen and lung. In immunohistochemical staining, these cells expressed CD30, TIA-1, anaplastic lymphoma kinase(ALK), CD5 and CD3. An advanced surface molecule analysis revealed a lack of CD54(intercellular cell adhesion molecule-1) and CD56(neural cell adhesion molecule). We observed the proliferation and infiltration of these lymphoma cells specifically at the intravascular lesions similar to intravascular lymphoma(IVL). T-cell IVL is not established as an independent clinical entity in the World Health Organization classification, and our patient's ALK-positive T-IVL in lung appears to be the first reported case.展开更多
Isolation and culture of ADSCs in vitro,detection of cell surface markers.Detection of alkaline phosphatase(ALP)and mineralized nodules after cell osteogenic induction.Oil red 0 staining after induction of adipogenesi...Isolation and culture of ADSCs in vitro,detection of cell surface markers.Detection of alkaline phosphatase(ALP)and mineralized nodules after cell osteogenic induction.Oil red 0 staining after induction of adipogenesis.Cells were induced to differentiate into SCs,and MTT detected cell viability;Scanning electron microscopy and immunocytochemical staining observed the expression of S100.展开更多
文摘AIM:To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator.METHODS:Eight gastroenterology fellows at Mackay Memorial Hospital,Taipei were evaluated in gastricpolypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device.The performance of four second year(year-2)fellows who had undergone one year of clinical training was compared with that of four f irst year(year-1)fellows both before and after a 4-h workshop using the ex vivo simulator.The workshop allowed for hands-on train-ing in the removal of multiple artif icial polyps and the placement of hemoclips at the excision site.Evaluation included observation of technical skills,procedure time,and the fellows' conf idence scale.RESULTS:One week after the workshop,the year-1 fellows were re-evaluated and had significantly im-proved mean performance scores(from 17.9 ± 1.8 to 22.5 ± 0.7),conf idence scale(from 4.5 ± 1.0 to 7.8 ± 0.5)and procedure time(from 615.0 ± 57.4 s to 357.5 ± 85.0 s)compared with their baseline performance.After 4 h of training using the ex vivo simulator,the skills of the year-1 fellows were statistically similar to those of the year-2 fellows.CONCLUSION:Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy.
文摘Background: Respiratory disorders are the most common diseases among Iranian pilgrims in Hajj. Some studies recommended flu and pneumococcal vaccines separately or in combination to reduce respiratory diseases occurrence and its morbidity. These effects are not clear in afflicted Hajj pilgrims. Objective: This is a cohort study that investigates the effects of above-mentioned vaccines each or their combination on respiratory syndromes and their consequences among Iranian pilgrims in Mecca. Method: The participants were 295 Iranian pilgrims from the beginning to the end of the journey. They were systematically observed for getting afflicted with a respiratory syndrome or not. In this study, we have assessed the effects of flu and pneumococcal vaccines on respiratory disease occurrence and on 8 clinical consequences including as: the duration of fever, duration of cough, duration of bed rest, presence of post nasal discharge and dirty sputum, the total disease length, and the number of referrals to the hospital, physician’s visits and complications. The data for this study were gathered through a questionnaire with 14 basic questions and 60 choices. This was processed using the SPSS software of 11.5 version, T- and Chi-square tests. Results: The results showed no significant correlations between the above-mentioned factors and vaccination with one or both flu and pneumovax-23 except for the duration of coughs which was significantly reduced in all cases (p < 0.01) and also decreased complications of the disease (p < 0.001). Conclusion: The study suggests the high-risk groups, should be vaccinated with combination of flu and pneumovax-23 vaccines in Hajj.
文摘Rationale:Advances in sleep research have introduced medications like lemborexant,a dual orexin receptor antagonist.While effective for regulating sleep,overdoses are a concern,especially in suicide attempts.However,limited data exist on lemborexant overdose,prompting this case report to elucidate its clinical course.Patient’s Concern:A 91-year-old Japanese woman with multiple comorbidities,including insomnia and chronic kidney disease,was admitted after ingesting 315 mg of lemborexant in a suicide attempt.Diagnosis:Lemborexant overdose.Interventions:Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.Outcomes:She gradually regained full consciousness with no residual deficits.Due to persistent suicidal ideation,she was transferred to a psychiatric hospital after seven days of supportive care.Lessons:A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction.Supportive care is generally sufficient for management.However,given the limited data,further case accumulation is needed to enhance clinical understanding.
基金Project(52202426)supported by the National Natural Science Foundation of ChinaProjects(15205723,15226424)supported by the Research Grants Council(RGC)of the Hong Kong Special Administrative Region,ChinaProject(KBBY1)supported by the Innovation and Technology Commission of the Hong Kong Special Administrative Region。
文摘This study innovatively employs functional near-infrared spectroscopy(fNIRS)technology to investigate passengers’brain responses to various external stimuli during high-speed train operations,assessing their impact on passenger comfort.Three stimuli are examined:passing through tunnels,sonic booms at tunnel exits,and two trains meeting within the tunnel.The analysis of environmental variables,including cabin noise,cabin-to-external pressure,and cabin-to-body acceleration,reveals that changes in auditory and pressure levels during the tunnel experience led to an 87%increase in oxygenated hemoglobin(HbO)levels in the temporal lobe(TL).This reflects a brief discomfort that subsides as passengers adapt,with HbO levels nearly returning to pre-tunnel levels upon exit.Among the stimuli,the sonic boom triggered the most significant neural response,with HbO fluctuations increased by 175%.In contrast,the impact of train meetings was minor,yielding an average HbO increase of only 14.21%.Connectivity analysis further shows significant enhancements in brain functional connectivity during tunnel entrance and sonic boom scenarios,with increases of 52%and 80%,respectively.Our findings contribute to passenger comfort assessment by establishing objective neurophysiological measures that quantify previously subjective experiences.The application of fNIRS in this dynamic environment creates new possibilities for evidence-based comfort optimization in railway design.
基金Supported by the Teaching Research and Reform Fund Project of Central South University,No.2024jy178.
文摘BACKGROUND The association between ambient air pollution and glycolipid metabolic disorders(GMDs,including diabetes mellitus and dyslipidemia)is still not well understood,especially when it comes to the different effects of long-term vs short-term exposure and the sources of pollutants(indoor or outdoor).AIM To look at how outdoor particulate matter(PM1,PM_(2.5),PM_(10))and ozone(O3),as well as indoor pollutants from solid fuels,are related to the risk of developing GMDs in a cohort that represents the national population.METHODS We used a longitudinal cohort design to look at how different time periods of air pollution exposure(long-term:5-year averages;short-term:1-year averages)affect the incidence of GMDs in middle-aged and elderly adults.Multivariable logistic regression models,which took into account key factors such as age,sex,and smoking status,were used to calculate odds ratios(ORs)and 95%confidence intervals(CIs).RESULTS Our study found that exposure to air pollution(1μg/m^(3))has different effects on GMDs.Long-term exposure to outdoor pollutants like PM1,PM_(2.5),PM_(10),and O3 consistently increased the risk of diabetes(PM1:OR=1.106,95%CI:1.018-1.205;PM_(2.5):OR=1.038,95%CI:1.007-1.071;PM_(10):OR=1.023,95%CI:1.004-1.043)and dyslipidemia(PM1:OR=1.150,95%CI:1.064-1.249;PM_(2.5):OR=1.053,95%CI:1.023-1.086;PM_(10):OR=1.032,95%CI:1.014-1.052).Short-term exposure showed even stronger associations,particularly for PM1 with dyslipidemia(OR=1.078,95%CI:1.044-1.114)and PM1 with diabetes(OR=1.047,95%CI:1.007-1.089).Notably,certain components of PM_(2.5)-chloride(Cl^(-)),ammonium(NH_(4)^(+)),sulfate(SO_(4)^(2-)),and nitrate(NO3-)-showed a dose-dependent relationship with both conditions(for example,Cl^(-):Diabetes OR=1.797 per 1μg/m^(3),95%CI:1.086-2.991;dyslipidemia OR=2.627,95%CI:1.728-4.012).However,neither long-term nor short-term exposure to indoor solid fuel pollutants was significantly associated with diabetes(long-term OR=1.034,95%CI:0.801-1.333;short-term OR=0.970,95%CI:0.774-1.209)or dyslipidemia(short-term OR=1.159,95%CI:0.967-1.386).CONCLUSION This national cohort study shows that outdoor air pollution-particularly PM1,PM_(2.5),and their chemical components-is an important environmental factor contributing to GMDs,with long-term exposure showing greater metabolic toxicity than short-term exposure.The lack of association between indoor solid fuel pollutants and GMDs underscores the urgent need for targeted interventions to improve outdoor air quality and reduce metabolic risks at the population level.
文摘BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk,the current study utilized three representative cohorts.METHODS In this study,we used three representative cohorts from Asia,Europe,and the Americas:China Health and Retirement Longitudinal Study(CHARLS),English Longitudinal Study of Ageing(ELSA),and Health and Retirement Study(HRS).Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes.The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states:persistently low,decreasing,fluctuating,increasing,and consistently high.Selfreported physician diagnoses were used to evaluate the subsequent stroke events.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)were computed using Cox proportional-risk models adjusted for potential confounding factors.RESULTS A total of 7990 participants from CHARLS(females:52.3%,mean age:63.4 years),5642 participants from ELSA(females:56.2%,mean age:63.7 years),and 12260 participants from HRS(females:61.4%,mean age:64.7 years)participated in this study.The median follow-up periods were 5 years for CHARLS,8 years for ELSA,and 10 years for HRS.In comparison with the persistently low trajectory,consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts(CHARLS:HR=1.80,95% CI:1.36-2.38;ELSA:HR=1.50,95% CI:1.02-2.21;HRS:HR=1.45,95% CI:1.29-1.62 for consistently high;CHARLS:HR=1.47,95% CI:1.14-1.90;ELSA:HR=1.44,95% CI:1.17-1.77;HRS:HR=1.26,95% CI:1.13-1.41 for fluctuating).Increasing trajectories enhanced the risk in the European cohort(ELSA:HR=1.71,95% CI:1.06-2.74),while decreasing trajectories did not increase stroke risk in any cohort.For somatic depressive symptoms,consistently high and fluctuating trajectories increased the risk of stroke across all cohorts(CHARLS:HR=2.16,95% CI:1.67-2.79;ELSA:HR=1.94,95% CI:1.34-2.81;HRS:HR=1.79,95% CI:1.49-2.15 for consistently high;CHARLS:HR=1.35,95% CI:1.20-1.62;ELSA:HR=1.56,95% CI:1.27-1.92;HRS:HR=1.33,95% CI:1.20-1.46 for fluctuating).Increasing trajectories only increased the risk in the European cohort(ELSA:HR=1.95,95% CI:1.11-3.43),while decreasing trajectories did not increase stroke risk in the European and American cohorts.For cognitive-affective depressive symptoms,consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts(CHARLS:HR=2.06,95% CI:1.52-2.81;ELSA:HR=1.25,95% CI:1.02-1.54 for consistently high;CHARLS:HR=1.63,95% CI:1.23-2.16;ELSA:HR=1.58,95% CI:1.11-2.24 for fluctuating).Increasing trajectories increased the risk only in the American cohort(HRS:HR=14.67,95% CI:1.87-114.91).CONCLUSION Consistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations.Consistently high,fluctuating,and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations.These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention,particularly in regions where specific symptom trajectories are prevalent.
基金the National Natural Science Foundation of China, No. C010602the Natural Science Foundation of Heilongjiang Province, No. D200559the Scientific Research Program of Educa-tion Department of Heilong-jiang Province, No. 11511428
文摘BACKGROUND： Bone marrow stromal cells （BMSCs） or Schwann cells （SCs） transplantation alone can treat spinal cord injury. However, the transplantation either cell-type alone has disadvantages. The co-transplantation of both cells may benefit structural reconstruction and functional recovery of spinal nerves. OBJECTIVE： To verify spinal cord repair and related mechanisms after co-transplantation of BMSCs and SCs in a rat model of hemisected spinal cord injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Department of Histology and Embryology, Mudanjiang Medical College from January 2008 to May 2009. MATERIALS： Rabbit anti-S-100, glial fibrillary acidic protein, neuron specific enolase and neurofilament-200 monoclonal antibodies were purchased from Sigma, USA. METHODS： A total of 100 Wistar rats were used in a model of hemisected spinal cord injury. The rats were randomly assigned to vehicle control, SCs transplantation, BMSCs transplantation, and co-transplantation groups; 25 rats per group. At 1 week after modeling, SCs or BMSCs cultured in vitro were labeled and injected separately into the hemisected spinal segment of SCs and BMSCs transplantation groups through three injection points [5 μL （1 x 107 cells/mL）] cell suspension in each point）. In addition, a 15 μL 1 × 10^7 cells/mL SCs suspension and a 15 μL 1 × 10^7 cells/mL BMSC suspension were injected into co-transplantation group by the above method. MAIN OUTCOME MEASURES： The Basso-Beattie-Bresnahan （BBB） locomotor rating scale and somatosensory evoked potential （SEP） tests were used to assess the functional recovery of rat hind limbs following operation. Structural repair of injured nerve tissue was observed by light microscopy, electron microscopy, immunohistochemistry, and magnetic resonance imaging （MRI）. In vivo differentiation, survival and migration of BMSCs were evaluated by immunofluorescence. RESULTS： BBB scores were significantly greater in all three transplantation groups compared with vehicle control group 8 weeks after transplantation. In particular, the co-transplantation group displayed the highest scores among the groups （P 〈 0.05）. Moreover, recovery of SEP latency and amplitude was observed in all the transplantation groups, particularly after 8 weeks. Again, the co-transplantation group exhibited the greatest improvement （P 〈 0.05）. In the co-transplantation group, imaging showed a smooth surface and intact inner structure at the injury site, with no scar formation, and a large number of orderly cells at the injured site. Axonal regeneration, new myelination, and a large amount of cell division were detected in the co-transplantation group by electron microscopy. Neuron specific enolase （NSE）- and glial fibriilary acidic protein （GFAP）-positive cells were observed in the spinal cord sections 1 week following co-transplantation by immunofluorescence staining. CONCLUSION： Co-transplantation of SCs and BMSCs effectively promoted functional recovery of injured spinal cord in rats compared with SCs or BMSCs transplantation alone. This repair effect is probably achieved because of neuronal-like cells derived from BMSCs to supplement dead neurons in vivo.
文摘BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there are numerous instances of mild symptoms,with only a limited number of reports of severe cases necessitating intensive care.We presented the case of a female who ingested 111 tablets of dextromethorphan,leading to shock and convulsions and requiring intensive care that ultimately saved her life.CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance,having overdosed on 111 tablets of dextromethorphan(15 mg)obtained through an online importer in a suicide attempt.The patient had a history of drug abuse and multiple self-inflicted injuries.At the time of admission,she exhibited symptoms of shock and altered consciousness.However,upon arrival at the hospital,the patient experienced recurrent generalized clonic convulsions and status epilepticus,necessitating tracheal intubation.The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock,and noradrenaline was administered as a vasopressor.Gastric lavage and activated charcoal were also administered after intubation.Through systemic management in the intensive care unit,the patient’s condition stabilized,and the need for vasopressors ceased.The patient regained consciousness and was extubated.The patient was subsequently transferred to a psychiatric facility,as suicidal ideation persisted.CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.
基金supported by grants from the National Natural Science Foundation of China [No.81570945 to DING Gang]the Natural Science Foundation of Shandong Province [No.ZR2021MH051 to DING Gang+2 种基金No.ZR2020MH188 to LIU Yun Xia]2021 Youth Innovation Talent Introduction and Education Program of Shandong Province Universities (The innovative team for molecular epidemiology of oral cancer based on multiomics)Postgraduate Education Quality Improvement Plan of Shandong Province [No.SDYAL21150 to DING Gang]
文摘Periodontitis is a chronic infectious disease characterized by plaque biofilm as its main pathogenic factor;its clinical manifestations include gingival inflammation,alveolar bone resorption,attachment loss,and periodontal pocket formation,all of which eventually lead to tooth loss and seriously affect the quality of life of patients[1].This illness has a close relationship with blood sugar levels in patients with diabetes and is one of the most important complications of diabetes[2].Macrophages are an important part of host immune responses and exhibit powerful functions of identifying,phagocytizing,and removing bacteria;macrophage polarization is involved in the pathogenesis of periodontitis[3].
基金supported by grants from the Natural Science Foundation of Shandong Province[No.ZR2021MH051 to DING Gang]the Postgraduate Education Quality Improvement Plan of Shandong Province[No.SDYAL21150 to DING Gang]the National Natural Science Foundation of China[No.81570945 to DING Gang]
文摘Periodontitis is a chronic inflammatory disease resulting in the loss of periodontal tissues and ultimately teeth,thus posing a substantial public-health burden worldwide[1].With the widespread increase in mesenchymal stem cell(MSC)therapy and the discovery of MSCs in periodontal ligaments[2],periodontal ligament stem cells(PDLSCs)have been used to reconstruct periodontal tissue and repair bone defects[2,3].Furthermore.
文摘BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.
文摘Objective:To develop a self-management behaviour tool for liver cirrhosis patients in China.Methods:A provisional scale comprising 30 items was developed based on the results of literature review,semi-structured interviews,expert consultation and pilot study.Patients with hepatic cirrhosis(n=180)from four grade A tertiary hospitals in Tianjin and Handan Infectious Disease Hospital were assessed using the provisional self-management scale comprising 30 items in four dimensions.The reliability and validity of the scale were tested and a final version of the self-management scale for liver cirrhosis comprising 24 items was concluded.Results:The overall Cronbach's a for the scale was 0.80,ranging from 0.60 to 0.69 in each dimension.The testeretest correlation was 0.84,ranging from 0.54 to 0.72 in each dimension.Content validity for the scale was 0.93.Nine factors were extracted by a factor analysis method,which were limited to four factors according to a scree test.The cumulative variance contribution rate was 56.98%.Conclusion:This scale has good reliability and validity and can be used to evaluate selfmanagement behaviour of hepatic cirrhosis patients and provides a reference for behaviour intervention.
文摘An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomography depicted hepatosplenomegaly and swelling of systemic lymph nodes. The patient died of advanced respiratory failure 5 d after the first occurrence of his dyspnea. At autopsy, the pathological features revealed a diffuse infiltration of large atypical lymphocytes to systemic organs including the spleen and lung. In immunohistochemical staining, these cells expressed CD30, TIA-1, anaplastic lymphoma kinase(ALK), CD5 and CD3. An advanced surface molecule analysis revealed a lack of CD54(intercellular cell adhesion molecule-1) and CD56(neural cell adhesion molecule). We observed the proliferation and infiltration of these lymphoma cells specifically at the intravascular lesions similar to intravascular lymphoma(IVL). T-cell IVL is not established as an independent clinical entity in the World Health Organization classification, and our patient's ALK-positive T-IVL in lung appears to be the first reported case.
文摘Isolation and culture of ADSCs in vitro,detection of cell surface markers.Detection of alkaline phosphatase(ALP)and mineralized nodules after cell osteogenic induction.Oil red 0 staining after induction of adipogenesis.Cells were induced to differentiate into SCs,and MTT detected cell viability;Scanning electron microscopy and immunocytochemical staining observed the expression of S100.
