BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 199...Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)at...Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.展开更多
CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be...CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.展开更多
VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a ra...VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.展开更多
The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imag...The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.展开更多
BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a ne...BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a neglected tropical disease,a World Health Organi-zation report estimates that it affects approximately 2.4 million people worldwide,with high endemicity in regions characterized by poor sanitation and limited access to clean water.Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multiorgan involvement.CASE SUMMARY We report 4 cases with varied and unusual presentations.Case 1:A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy.Case 2:A 34-year-old woman who presented with urticaria and eosinophilia,initially suspected to be vasculitis.Case 3:A 67-year-old man who presented with dyspeptic symptoms,easy fatigability,headache,and fever.Case 4:A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.CONCLUSION Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools,especially in resource-limited settings.It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management.This case report aims to contribute to the growing body of literature on F.hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide,as these are effective and reduce unnecessary interventions.展开更多
Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with m...Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.展开更多
BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminat...BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.展开更多
Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and manag...Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.展开更多
The cure rate for chronic neurodegenerative diseases remains low,creating an urgent need for improved intervention methods.Recent studies have shown that enhancing mitochondrial function can mitigate the effects of th...The cure rate for chronic neurodegenerative diseases remains low,creating an urgent need for improved intervention methods.Recent studies have shown that enhancing mitochondrial function can mitigate the effects of these diseases.This paper comprehensively reviews the relationship between mitochondrial dysfunction and chronic neurodegenerative diseases,aiming to uncover the potential use of targeted mitochondrial interventions as viable therapeutic options.We detail five targeted mitochondrial intervention strategies for chronic neurodegenerative diseases that act by promoting mitophagy,inhibiting mitochondrial fission,enhancing mitochondrial biogenesis,applying mitochondria-targeting antioxidants,and transplanting mitochondria.Each method has unique advantages and potential limitations,making them suitable for various therapeutic situations.Therapies that promote mitophagy or inhibit mitochondrial fission could be particularly effective in slowing disease progression,especially in the early stages.In contrast,those that enhance mitochondrial biogenesis and apply mitochondria-targeting antioxidants may offer great benefits during the middle stages of the disease by improving cellular antioxidant capacity and energy metabolism.Mitochondrial transplantation,while still experimental,holds great promise for restoring the function of damaged cells.Future research should focus on exploring the mechanisms and effects of these intervention strategies,particularly regarding their safety and efficacy in clinical settings.Additionally,the development of innovative mitochondria-targeting approaches,such as gene editing and nanotechnology,may provide new solutions for treating chronic neurodegenerative diseases.Implementing combined therapeutic strategies that integrate multiple intervention methods could also enhance treatment outcomes.展开更多
Bemisia tabaci is a polyphagous herbivore that feeds on a wide range of horticultural and ornamental crops cultivated under diverse ecological zones. In Sierra Leone, B. tabaci is found to infest a wide range of veget...Bemisia tabaci is a polyphagous herbivore that feeds on a wide range of horticultural and ornamental crops cultivated under diverse ecological zones. In Sierra Leone, B. tabaci is found to infest a wide range of vegetable crops by directly feeding on phloem sap thereby inducing physiological disorders, and also serve as a vector to gemini viruses. Invariably the destructive feeding of B. tabaci affects the productivity and aesthetic values of vegetables and other horticultural crops and hence is considered a serious economic pest. A bioassay experiment was carried out by rearing B. tabaci populations on four vegetable crops under controlled laboratory conditions to determine its life table and demographic parameters. Results showed that the intrinsic rate of growth which measures the population size and growth pattern was highest for populations reared on tomato crops with the following values: rm 0.145 female female−1 day−1, the gross reproduction rate (Ro), and finite growth rate λ were highest for population reared on tomato, correspondingly the development period from egg-adult emergence was shortest with a value of 26 d. Conversely, the computed demographical parameters rm, λ and Ro for the population reared on sweet pepper were 0.106 female female−1 day−1 respectively, with a corresponding development period egg-adult emergence as 36d. The computed biological parameters for okra and garden egg varied with intermediary values between tomato and pepper host materials. The survivorship rates were quite significant for the smaller instars (Instars 1-III) with over 80% surviving to pre-pupa and pupa stage for the populations reared for all the test materials. High mortality was noticed for the pre-pupa and pupa stages as their survival rates were significantly low compared to the high survival rates of the smaller instars. Less than 50% of pupae failed to emerge to adults except for populations reared on tomato test materials where 52% emerged to adults. The study indicated tomato as the most suitable host among the four vegetable crops. Although life table and demographic parameters are invaluable information for forecasting pest populations and help in designing pest management efforts, further investigations such as the economic threshold and economic injury levels of B. tabaci population are requisite decision tools for sound pest management decisions of B. tabaci on these vegetable crops. The information obtained from this investigation would be quite relevant for extension service and pest management practitioners where mixed vegetable farming is a common practice.展开更多
Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientati...Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientation,psychosis,cardiotoxicity,and hallucinogenic effects.Consequently,the PCP began to be illicitly distributed.The use methods include snorting,inhalation,IV,and subcutaneous(SC) injection.[1-5] The characteristic toxidrome of PCP includes altered mental status,tachycardia,and nystagmus.At higher doses,patients may become comatose and develop sympathomimetic effects such as tachycardia,hypertension,hypersalivation,urinary retention,and bronchospasm.In cases of intoxication,the pupillary light reflex remains intact,although the pupil size may vary.[1,3-6] PCP has a direct cardiotoxic effect and may induce arrhythmias.[2] Hyperreflexia,muscle rigidity,choreiform movements and muscle fasciculations may occur.[2,4,6] PCP-induced acute respiratory distress syndrome(ARDS) and alveolar hemorrhage(AH) are rare but potentially life-threatening complications.The main causes of non-traumatic death in patients with PCP intoxication include cardiopulmonary arrest,intracranial hemorrhage and rhabdomyolysis.[2,3,5] This case report aims to emphasize the management and potential benefits of inhaled N-acetylcysteine(NAC) and tranexamic acid(TXA)for PCP-induced ARDS and AH.展开更多
BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for as...BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.AIM To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.METHODS Nine pediatric patients(7-14 years old,5 male and 4 female)with history or suspicion of bowel pathology,who underwent magnetic resonance(MR)enterography with 4D flow MR protocol from November 2022 to October 2023.Field strength/sequence:3T MRI using 4D flow MR protocol.Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery(SMA)and superior mesenteric vein(SMV)at three predetermined levels.Bland-Altman analysis,showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.RESULTS Mean SMV flow velocity increased from proximal to mid to distal(0.14 L/minute,0.17 L/minute,0.22 L/minute respectively).Mean SMA flow velocity decreased from proximal to mid to distal(0.35 L/minute,0.27 L/minute,0.21 L/minute respectively).Observed agreement was good for flow velocity measurements of SMV(mean bias-0.01 L/minute and 95%limits of agreement,-0.09 to 0.08 L/minute)and SMA(mean bias-0.03 L/minute and 95%limits of agreement,-0.23 to 0.17 L/minute)between two readers.Good agreement for peak speed measurements of SMV(mean bias-1.2 cm/second and 95%limits of agreement,-9.4 to 7.0 cm/second)and SMA(mean bias-3.2 cm/second and 95%limits of agreement,-31.4 to 24.9 cm/second).CONCLUSION Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.展开更多
BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriat...BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.展开更多
BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospit...BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.展开更多
Alga toxins have recently emerged as an environmental risk factor,especially to neurodegenerative diseases,such as Alzheimer's disease,Parkinson's disease and amyotrophic lateral sclerosis.However,the associat...Alga toxins have recently emerged as an environmental risk factor,especially to neurodegenerative diseases,such as Alzheimer's disease,Parkinson's disease and amyotrophic lateral sclerosis.However,the association between the alga toxinsβ-N-methylamino-L-alanine(BMAA),brevetoxin B,cyanoginosin LR,okadaic acid and neurodegenerative diseases remains inadequately investigated.Therefore,the aim of this study was to elucidate the potential associations.Four sets of differentially expressed genes related with BMAA,brevetoxin B,cyanoginosin LR and okadaic acid in Homo sapiens and genes linked to neurodegenerative disease development were respectively collected from the Comparative Toxicogenomic Database.Metascape analysis and cluster community analysis of four alga toxins highlighted protein-protein interaction enrichment and hub genes,while biological processes analysis showed that the dominant pathways involved in harmful effects triggered by four alga toxins were the apoptotic signaling pathway,regulation of amyloid protein formation,inflammatory response and endoplasmic reticulum stress.Genes related to the interactions between four alga toxins and neurodegenerative diseases were selected and analyzed,revealing that the relevant pathways and genes were those involved in apoptotic mitochondrial changes and neuroinflammatory response pathways.The adverse outcome pathway frameworks were constructed according to the analysis results for toxins and associated neurodegenerative diseases.These discoveries provide a new perspective for us to gain a deeper understanding of the neurotoxic effects of four alga toxins.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
基金Supported by the National Natural Science Foundation of China(No.82070991).
文摘Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
文摘Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.
文摘CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.
基金National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital).
文摘VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.
文摘The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.
文摘BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a neglected tropical disease,a World Health Organi-zation report estimates that it affects approximately 2.4 million people worldwide,with high endemicity in regions characterized by poor sanitation and limited access to clean water.Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multiorgan involvement.CASE SUMMARY We report 4 cases with varied and unusual presentations.Case 1:A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy.Case 2:A 34-year-old woman who presented with urticaria and eosinophilia,initially suspected to be vasculitis.Case 3:A 67-year-old man who presented with dyspeptic symptoms,easy fatigability,headache,and fever.Case 4:A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.CONCLUSION Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools,especially in resource-limited settings.It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management.This case report aims to contribute to the growing body of literature on F.hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide,as these are effective and reduce unnecessary interventions.
文摘Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
文摘BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.
文摘Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.
基金partly supported by the Yan’an University Qin Chuanyuan“Scientist+Engineer”Team Special Fund,No.2023KXJ-012(to YL)Yan’an University Transformation of Scientific and Technological Achievements Fund,No.2023CGZH-001(to YL)+2 种基金College Students Innovation and Entrepreneurship Training Program,Nos.D2023158,202410719056(to XS,JM)Yan’an University Production and Cultivation Project,No.CXY202001(to YL)Kweichow Moutai Hospital Research and Talent Development Fund Project,No.MTyk2022-25(to XO)。
文摘The cure rate for chronic neurodegenerative diseases remains low,creating an urgent need for improved intervention methods.Recent studies have shown that enhancing mitochondrial function can mitigate the effects of these diseases.This paper comprehensively reviews the relationship between mitochondrial dysfunction and chronic neurodegenerative diseases,aiming to uncover the potential use of targeted mitochondrial interventions as viable therapeutic options.We detail five targeted mitochondrial intervention strategies for chronic neurodegenerative diseases that act by promoting mitophagy,inhibiting mitochondrial fission,enhancing mitochondrial biogenesis,applying mitochondria-targeting antioxidants,and transplanting mitochondria.Each method has unique advantages and potential limitations,making them suitable for various therapeutic situations.Therapies that promote mitophagy or inhibit mitochondrial fission could be particularly effective in slowing disease progression,especially in the early stages.In contrast,those that enhance mitochondrial biogenesis and apply mitochondria-targeting antioxidants may offer great benefits during the middle stages of the disease by improving cellular antioxidant capacity and energy metabolism.Mitochondrial transplantation,while still experimental,holds great promise for restoring the function of damaged cells.Future research should focus on exploring the mechanisms and effects of these intervention strategies,particularly regarding their safety and efficacy in clinical settings.Additionally,the development of innovative mitochondria-targeting approaches,such as gene editing and nanotechnology,may provide new solutions for treating chronic neurodegenerative diseases.Implementing combined therapeutic strategies that integrate multiple intervention methods could also enhance treatment outcomes.
文摘Bemisia tabaci is a polyphagous herbivore that feeds on a wide range of horticultural and ornamental crops cultivated under diverse ecological zones. In Sierra Leone, B. tabaci is found to infest a wide range of vegetable crops by directly feeding on phloem sap thereby inducing physiological disorders, and also serve as a vector to gemini viruses. Invariably the destructive feeding of B. tabaci affects the productivity and aesthetic values of vegetables and other horticultural crops and hence is considered a serious economic pest. A bioassay experiment was carried out by rearing B. tabaci populations on four vegetable crops under controlled laboratory conditions to determine its life table and demographic parameters. Results showed that the intrinsic rate of growth which measures the population size and growth pattern was highest for populations reared on tomato crops with the following values: rm 0.145 female female−1 day−1, the gross reproduction rate (Ro), and finite growth rate λ were highest for population reared on tomato, correspondingly the development period from egg-adult emergence was shortest with a value of 26 d. Conversely, the computed demographical parameters rm, λ and Ro for the population reared on sweet pepper were 0.106 female female−1 day−1 respectively, with a corresponding development period egg-adult emergence as 36d. The computed biological parameters for okra and garden egg varied with intermediary values between tomato and pepper host materials. The survivorship rates were quite significant for the smaller instars (Instars 1-III) with over 80% surviving to pre-pupa and pupa stage for the populations reared for all the test materials. High mortality was noticed for the pre-pupa and pupa stages as their survival rates were significantly low compared to the high survival rates of the smaller instars. Less than 50% of pupae failed to emerge to adults except for populations reared on tomato test materials where 52% emerged to adults. The study indicated tomato as the most suitable host among the four vegetable crops. Although life table and demographic parameters are invaluable information for forecasting pest populations and help in designing pest management efforts, further investigations such as the economic threshold and economic injury levels of B. tabaci population are requisite decision tools for sound pest management decisions of B. tabaci on these vegetable crops. The information obtained from this investigation would be quite relevant for extension service and pest management practitioners where mixed vegetable farming is a common practice.
文摘Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientation,psychosis,cardiotoxicity,and hallucinogenic effects.Consequently,the PCP began to be illicitly distributed.The use methods include snorting,inhalation,IV,and subcutaneous(SC) injection.[1-5] The characteristic toxidrome of PCP includes altered mental status,tachycardia,and nystagmus.At higher doses,patients may become comatose and develop sympathomimetic effects such as tachycardia,hypertension,hypersalivation,urinary retention,and bronchospasm.In cases of intoxication,the pupillary light reflex remains intact,although the pupil size may vary.[1,3-6] PCP has a direct cardiotoxic effect and may induce arrhythmias.[2] Hyperreflexia,muscle rigidity,choreiform movements and muscle fasciculations may occur.[2,4,6] PCP-induced acute respiratory distress syndrome(ARDS) and alveolar hemorrhage(AH) are rare but potentially life-threatening complications.The main causes of non-traumatic death in patients with PCP intoxication include cardiopulmonary arrest,intracranial hemorrhage and rhabdomyolysis.[2,3,5] This case report aims to emphasize the management and potential benefits of inhaled N-acetylcysteine(NAC) and tranexamic acid(TXA)for PCP-induced ARDS and AH.
文摘BACKGROUND Four-dimensional(4D)flow magnetic resonance imaging(MRI)is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications.The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.AIM To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.METHODS Nine pediatric patients(7-14 years old,5 male and 4 female)with history or suspicion of bowel pathology,who underwent magnetic resonance(MR)enterography with 4D flow MR protocol from November 2022 to October 2023.Field strength/sequence:3T MRI using 4D flow MR protocol.Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery(SMA)and superior mesenteric vein(SMV)at three predetermined levels.Bland-Altman analysis,showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.RESULTS Mean SMV flow velocity increased from proximal to mid to distal(0.14 L/minute,0.17 L/minute,0.22 L/minute respectively).Mean SMA flow velocity decreased from proximal to mid to distal(0.35 L/minute,0.27 L/minute,0.21 L/minute respectively).Observed agreement was good for flow velocity measurements of SMV(mean bias-0.01 L/minute and 95%limits of agreement,-0.09 to 0.08 L/minute)and SMA(mean bias-0.03 L/minute and 95%limits of agreement,-0.23 to 0.17 L/minute)between two readers.Good agreement for peak speed measurements of SMV(mean bias-1.2 cm/second and 95%limits of agreement,-9.4 to 7.0 cm/second)and SMA(mean bias-3.2 cm/second and 95%limits of agreement,-31.4 to 24.9 cm/second).CONCLUSION Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.
文摘BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
文摘BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.
基金supported by the Natural Science Foundation of Shandong province(Nos.ZR2019MH048 and ZR2022QC149)the Double First-class Disciplines Construction Fund Project from Harbin Institute of Technology at Weihai(No.2023SYLHY18)Weihai Science and Technology Development Program。
文摘Alga toxins have recently emerged as an environmental risk factor,especially to neurodegenerative diseases,such as Alzheimer's disease,Parkinson's disease and amyotrophic lateral sclerosis.However,the association between the alga toxinsβ-N-methylamino-L-alanine(BMAA),brevetoxin B,cyanoginosin LR,okadaic acid and neurodegenerative diseases remains inadequately investigated.Therefore,the aim of this study was to elucidate the potential associations.Four sets of differentially expressed genes related with BMAA,brevetoxin B,cyanoginosin LR and okadaic acid in Homo sapiens and genes linked to neurodegenerative disease development were respectively collected from the Comparative Toxicogenomic Database.Metascape analysis and cluster community analysis of four alga toxins highlighted protein-protein interaction enrichment and hub genes,while biological processes analysis showed that the dominant pathways involved in harmful effects triggered by four alga toxins were the apoptotic signaling pathway,regulation of amyloid protein formation,inflammatory response and endoplasmic reticulum stress.Genes related to the interactions between four alga toxins and neurodegenerative diseases were selected and analyzed,revealing that the relevant pathways and genes were those involved in apoptotic mitochondrial changes and neuroinflammatory response pathways.The adverse outcome pathway frameworks were constructed according to the analysis results for toxins and associated neurodegenerative diseases.These discoveries provide a new perspective for us to gain a deeper understanding of the neurotoxic effects of four alga toxins.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
