Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low...Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.展开更多
BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was ...BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.展开更多
BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effec...BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites.METHODS: A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography(CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fl uid administration, and electrolyte replacement. However, on the 14 th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14 French gauge(Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space.RESULTS: After drainage, the patient recovered well and the last catheter was removed on day 123 of admission.CONCLUSIONS: Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.展开更多
BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published.METHODS: A 60-year-old man was referred to our hospita...BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published.METHODS: A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire basket.RESULTS: Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological complications.CONCLUSION: Emergency physicians should consider sushi suffocation, including its clinical features and management.展开更多
BACKGROUND Gastric lavage(GL)is one of the most important early therapies to remove unabsorbed toxins from the gastrointestinal tract.However,the details of performing gastric lavage remain to be established.There is ...BACKGROUND Gastric lavage(GL)is one of the most important early therapies to remove unabsorbed toxins from the gastrointestinal tract.However,the details of performing gastric lavage remain to be established.There is controversy in clinical practice regarding individual choice of the timing of GL and its efficiency.CASE SUMMARY We report the case of a young woman who presented to the Emergency Department with drug intoxication for four hours.We used the latest toxicological screening techniques to compare drug concentrations in the patient's blood and gastric lavage fluid before and after gastric lavage.The results confirmed that gastric lavage was effective in reducing drug concentrations in the stomach;a small amount of drug remained in the stomach at the end of gastric lavage.CONCLUSION Gastric lavage is effective in reducing drug concentrations in the stomach,with a small amount of drug remaining in the stomach at the end of gastric lavage.展开更多
We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibito...We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.展开更多
The prognosis of CD20-positive (CD20+) diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) recurrence is still poor. A standard treatment for CD20+ DLBCL with CNS recurrence in elderly patients has...The prognosis of CD20-positive (CD20+) diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) recurrence is still poor. A standard treatment for CD20+ DLBCL with CNS recurrence in elderly patients has not been established mainly due to adverse effects. We previously reported the efficacy and safety of MIND-E (ranimustine, ifosfamide, procarbazine, dexamethasone, and etoposide) therapy for elderly CD20+ DLBCL patients with CNS recurrence. Here, we report the use of R-MIND-E therapy (rituximab, ranimustine, ifosfamide, procarbazine, dexamethasone and etoposide) in an elderly CD20+ DLBCL patient with CNS recurrence. The patient achieved a complete response according to Revised Response Criteria for Malignant Lymphoma, and treatment-related toxicity was tolerable. R-MIND-E therapy may be a feasible and useful treatment option for elderly CD20+ DLBCL patients with CNS recurrence.展开更多
Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including ...Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including thalidomide and lenalidomide. On the other hand, treatment strategy remains difficult for refractory and relapse cases. Here, we report the successful treatment of low-dose lenalidomide maintenance therapy followed by salvage ASCT in a heavily treated patient with multiple myeloma. This 58-year-old woman with IgG-λ multiple myeloma had a 5th recurrence in June, 2011. It was 7 years post-diagnosis, and she had received conventional therapies such as VAD, MP therapy. Furthermore, the patient had already been treated with ASCT, bortezomib, and thalidomide therapy. At the 5th recurrence, she had extramedullary plasmacytoma in the left orbit. She initially received bortezomib and dexamethasone therapy as induction therapy. After peripheral blood stem cell collection, radiation therapy was performed. The patient then received a second ASCT. Three months later, the response was very good partial response. Finally, the patient was treated with 5 mg/day lenalidomide orally as a maintenance therapy, and she achieved stringent complete response after 2 months according to International Myeloma Working Group response criteria. Low-dose lenalidomide maintenance therapy might be also useful for ASCT as salvage therapy, although further studies are warranted.展开更多
BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not bee...BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not been reported.METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions(>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of f T3, free thyroxine(f T4), and thyroidstimulating hormone(TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial f T3 levels in group M(1.95±0.37 pg/m L) were signifi cantly lower than those in group C(2.49±0.72 pg/m L; P<0.01) and remained low until 1 week after admission. Initial inter-group f T4 and TSH levels were not significantly different. TSH levels at 1 week(1.99±1.64 μIU/m L) were higher than at admission(1.48±0.5 μIU/m L) in group C(P<0.05).CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.展开更多
Background and Objectives: Several recent reports have demonstrated a close linkage between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (H. pylori) infection in some patient’s populations. Howev...Background and Objectives: Several recent reports have demonstrated a close linkage between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (H. pylori) infection in some patient’s populations. However, the pathogenetic mechanisms of H. pylori-induced thrombocytopenia remain obscure. Therefore, we investigated the prevalence of H. pylori infection pylori and performed a comparative analysis of a subset of H. pylori-infected patients (group A) with non-infected patients (group B) using the standard statistical methods. Design and Methods: From December 2001 to October 2002, we investigated the presence of gastric H. pylori infection in 30 adult ITP patients and 19 patients were treated with standard antibiotic therapy for H. pylori eradication (amoxicillin and clarithromycin plus lansoprazole combination). We used the standard statisticsto analyze the difference between group A and group B. Results: H. pylori eradication was achieved in 17/19 (89.4%) H.pylori-infected patients. An improvement of platelet count was observed in 14/19 patients (73.6%) who achieved the eradication. Five of these patients achieved CR (two patients were with the acute ITP) and nine patients reached PR. The difference between the mean platelet count ± S.D. before and after H. pylori therapy was statistically significant in patients with successful decontamination (65 ± 48 × 109/L vs. 200 ± 140 × 109/L;p = 0.018). Lymphocyte counts at the diagnosis of H. pylori infected cases were significant higher than those of non-infected cases (1.58 ± 0.13 ×展开更多
Waldenstr?m macroglobulinemia (WM) is a rare lymphoid malignancy. Many studies, including clinicopathological, cytogenetic, gene expression profile, and therapy studies have been reported from the US and Europe, altho...Waldenstr?m macroglobulinemia (WM) is a rare lymphoid malignancy. Many studies, including clinicopathological, cytogenetic, gene expression profile, and therapy studies have been reported from the US and Europe, although only a few reports are available from East Asia, including Japan. To further clarify the clinicopathological, radiological, and cytogenetic features of WM in Japan, we performed a retrospective analysis of WM in our institute between March 2007 and January 2012. Clinical data, laboratory data, the results of flow cytometric analysis (FCM), and chromosomal abnormalities were analyzed, and a radiological review was performed. The treatment regimen, response, and survival were also estimated. Six patients were enrolled in this study. The median age was 71 years. All patients were symptomatic, 3 had hyperviscosity syndrome, 1 had bone lesions, and 1 had an extra-medullary mass. FCM data showed that all patients were positive for CD38, while 2 were positive for CD56. Four had chromosomal abnormalities including some abnormalities also reported in myeloma. On radiological review, four showed diffuse invasion of the retro-peritoneum. Five patients received treatment, 4 of which achieved a response. At a median follow-up of 527 days, 4 were alive and 2 died because of disease progression. The present study revealed that WM in Japan might be heterogeneous and have a unique disease manifestation. Invasion sites other than bone marrow were very common, and the results of clinical, FCM, and cytogenetic studies revealed that WM in Japanese cases might have manifestations of both myeloma and B-cell lymphoma.展开更多
Recently, mixed phenotype acute leukemia (MPAL) with t (9;22) (q34;q11.2);bcr-abl1 was described as one kind of acute leukemia of ambiguous lineage in the 2008 World Health Organization Classification of Tumors of Hem...Recently, mixed phenotype acute leukemia (MPAL) with t (9;22) (q34;q11.2);bcr-abl1 was described as one kind of acute leukemia of ambiguous lineage in the 2008 World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. However, treatment strategy remains difficult for this uncommon MPAL. In addition, this type of MPAL is at high risk of tumor lysis syndrome (TLS) because of high chemo-sensitivity. Here, we report a MPAL with t (9;22) (q34;q11.2);bcr-abl1 case that suffered from life-threatening cerebral bleeding associated with disseminated intravascular coagulation (DIC) with TLS after bcr-abl positive acute lymphoblastic leukemia (ALL) type induction therapy who was successfully treated with recombinant human thrombomodulin (rhTM). This case reached complete remission without additive cerebral bleeding. In conclusion, bcr-abl positive ALL type induction therapy was effective for MPAL with t (9;22) (q34;q11.2);bcr-abl1 and rhTM was effective against DIC with TLS.展开更多
This review explores the development of a competency-based orientation curriculum for surgeons in Equatorial Guinea.Surgical training in the region faces significant challenges,including a lack of standardized curricu...This review explores the development of a competency-based orientation curriculum for surgeons in Equatorial Guinea.Surgical training in the region faces significant challenges,including a lack of standardized curricula,inadequate resources,and limited access to advanced medical education.By integrating competency theory,this article proposes a curriculum design framework tailored to the country’s specific context.The review focuses on key components such as curriculum content,teaching methodologies,assessment mechanisms,and their practical applications,emphasizing the need for a structured approach to improve surgical healthcare services.The findings provide theoretical foundations and practical guidance for enhancing surgical training and ultimately improving healthcare outcomes in the region.展开更多
This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games.Data on 567 injuries and other illnesses of athletes treated at the on-site clinic...This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games.Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee.Of these,84 athletes who required outpatient care during the Games were registered for this survey.During the Olympic and Paralympic Games,66(8.3/1000)and 18(7.2/1000)athletes,respectively,consulted external medical facilities.In the Olympic Games,the reasons for these visits included 48 cases(72.7%)of injuries,13(19.7%)cases of illnesses,and 5(7.6%)cases of heat stroke illness(HSI).Of these patients,56(84.9%)were treated as outpatients and 10(15.1%)were hospitalized,while three of these patients required hospitalization for>7 days.On the other hand,in the Paralympics Games,there were 7(38.8%)cases of injuries,9(50.0%)other illnesses,1(5.6%)case of HSI,and 1(5.6%)other cases,of which 11(61.1%)were treated as outpatients and 7(38.9%)were hospitalized,but none was hospitalized for>7 days.Injuries accounted for 70%of the total cases at the 2021 Olympic Games,but only three(0.05%)were severe cases that required hospitalization for more than 1 week.In contrast,in the Paralympic Games,other illnesses accounted for approximately half of the total cases.This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities,which has not been documented in previous games.展开更多
ST2 protein is a soluble splicing variant of ST2L protein, which is the receptor for interleukin-33 （IL-33）. Previously, we reported that soluble ST2 suppressed the signal transduction of lipopolysaccharide （LPS） ...ST2 protein is a soluble splicing variant of ST2L protein, which is the receptor for interleukin-33 （IL-33）. Previously, we reported that soluble ST2 suppressed the signal transduction of lipopolysaccharide （LPS） and cytokine production in monocytic cells. To investigate whether or not this inhibitory effect occurs in dendritic cells, which are the key players in innate and adaptive immunity, human monocyte-derived dendritic cells were pre-treated with soluble ST2 protein before LPS stimulation. Although soluble ST2 did not attenuate the LPS-induced maturation of dendritic cells, pre-treatment with soluble ST2 suppressed cytokine production and inhibited LPS signaling. Moreover, the proliferation of naive T cells was inhibited significantly by soluble ST2 pre-treatment. IL-33 had little effect on the cytokine production of immature monocyte-derived dendritic cells. Furthermore, soluble ST2 protein was internalized into dendritic cells, suggesting that soluble ST2 protein acts by a noncanonical mechanism other than the sequestration of IL-33.展开更多
Dear Editor,A series of novel coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)since the end of 2019 is ongoing and triggering a global public health crisis.The es...Dear Editor,A series of novel coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)since the end of 2019 is ongoing and triggering a global public health crisis.The estimated case fatality rate is approximately 3.4%in China.However,some patients experience dyspnea within 1 week and develop rapidly to organ injury and even death within 2 weeks after dyspnea.1 In addition,early organ injury could lead to higher risks of mortality.Thus,early identification of patients at risk of organ injury and death is crucial,which saves the patients from classified and invasive treatment,improving clinical outcome and prognosis.The human immune system plays significant roles in the resistance of foreign pathogens and the progress of pneumonia.Recent studies have mentioned that T cells were decreased in COVID-19 patients,excessive activated immune response was caused by pathogenic Th1 cells,and inflammatory CD14+CD16+monocytes may connect to pulmonary immunopathology,leading to deleterious clinical manifestations and even acute mortality after SARS-CoV-2 infections.2 SARS-CoV-2 might damage lymphocytes,especially T lymphocytes,and the immune system was impaired during the period of disease to cause tissue injury.展开更多
文摘Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.
文摘BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.
文摘BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access sites.METHODS: A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography(CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fl uid administration, and electrolyte replacement. However, on the 14 th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14 French gauge(Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal space.RESULTS: After drainage, the patient recovered well and the last catheter was removed on day 123 of admission.CONCLUSIONS: Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.
文摘BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published.METHODS: A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire basket.RESULTS: Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological complications.CONCLUSION: Emergency physicians should consider sushi suffocation, including its clinical features and management.
基金Early Diagnosis of Venom-Induced Ventricular Fascia Syndrome Based on High Frequency Ultrasound and Shear Wave Elastography,No.2021YFS0189.
文摘BACKGROUND Gastric lavage(GL)is one of the most important early therapies to remove unabsorbed toxins from the gastrointestinal tract.However,the details of performing gastric lavage remain to be established.There is controversy in clinical practice regarding individual choice of the timing of GL and its efficiency.CASE SUMMARY We report the case of a young woman who presented to the Emergency Department with drug intoxication for four hours.We used the latest toxicological screening techniques to compare drug concentrations in the patient's blood and gastric lavage fluid before and after gastric lavage.The results confirmed that gastric lavage was effective in reducing drug concentrations in the stomach;a small amount of drug remained in the stomach at the end of gastric lavage.CONCLUSION Gastric lavage is effective in reducing drug concentrations in the stomach,with a small amount of drug remaining in the stomach at the end of gastric lavage.
基金Supported by A grant from the National Hospital Organization,No. H21-NHO-01
文摘We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.
文摘The prognosis of CD20-positive (CD20+) diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) recurrence is still poor. A standard treatment for CD20+ DLBCL with CNS recurrence in elderly patients has not been established mainly due to adverse effects. We previously reported the efficacy and safety of MIND-E (ranimustine, ifosfamide, procarbazine, dexamethasone, and etoposide) therapy for elderly CD20+ DLBCL patients with CNS recurrence. Here, we report the use of R-MIND-E therapy (rituximab, ranimustine, ifosfamide, procarbazine, dexamethasone and etoposide) in an elderly CD20+ DLBCL patient with CNS recurrence. The patient achieved a complete response according to Revised Response Criteria for Malignant Lymphoma, and treatment-related toxicity was tolerable. R-MIND-E therapy may be a feasible and useful treatment option for elderly CD20+ DLBCL patients with CNS recurrence.
文摘Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including thalidomide and lenalidomide. On the other hand, treatment strategy remains difficult for refractory and relapse cases. Here, we report the successful treatment of low-dose lenalidomide maintenance therapy followed by salvage ASCT in a heavily treated patient with multiple myeloma. This 58-year-old woman with IgG-λ multiple myeloma had a 5th recurrence in June, 2011. It was 7 years post-diagnosis, and she had received conventional therapies such as VAD, MP therapy. Furthermore, the patient had already been treated with ASCT, bortezomib, and thalidomide therapy. At the 5th recurrence, she had extramedullary plasmacytoma in the left orbit. She initially received bortezomib and dexamethasone therapy as induction therapy. After peripheral blood stem cell collection, radiation therapy was performed. The patient then received a second ASCT. Three months later, the response was very good partial response. Finally, the patient was treated with 5 mg/day lenalidomide orally as a maintenance therapy, and she achieved stringent complete response after 2 months according to International Myeloma Working Group response criteria. Low-dose lenalidomide maintenance therapy might be also useful for ASCT as salvage therapy, although further studies are warranted.
文摘BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not been reported.METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions(>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of f T3, free thyroxine(f T4), and thyroidstimulating hormone(TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial f T3 levels in group M(1.95±0.37 pg/m L) were signifi cantly lower than those in group C(2.49±0.72 pg/m L; P<0.01) and remained low until 1 week after admission. Initial inter-group f T4 and TSH levels were not significantly different. TSH levels at 1 week(1.99±1.64 μIU/m L) were higher than at admission(1.48±0.5 μIU/m L) in group C(P<0.05).CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.
文摘Background and Objectives: Several recent reports have demonstrated a close linkage between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (H. pylori) infection in some patient’s populations. However, the pathogenetic mechanisms of H. pylori-induced thrombocytopenia remain obscure. Therefore, we investigated the prevalence of H. pylori infection pylori and performed a comparative analysis of a subset of H. pylori-infected patients (group A) with non-infected patients (group B) using the standard statistical methods. Design and Methods: From December 2001 to October 2002, we investigated the presence of gastric H. pylori infection in 30 adult ITP patients and 19 patients were treated with standard antibiotic therapy for H. pylori eradication (amoxicillin and clarithromycin plus lansoprazole combination). We used the standard statisticsto analyze the difference between group A and group B. Results: H. pylori eradication was achieved in 17/19 (89.4%) H.pylori-infected patients. An improvement of platelet count was observed in 14/19 patients (73.6%) who achieved the eradication. Five of these patients achieved CR (two patients were with the acute ITP) and nine patients reached PR. The difference between the mean platelet count ± S.D. before and after H. pylori therapy was statistically significant in patients with successful decontamination (65 ± 48 × 109/L vs. 200 ± 140 × 109/L;p = 0.018). Lymphocyte counts at the diagnosis of H. pylori infected cases were significant higher than those of non-infected cases (1.58 ± 0.13 ×
文摘Waldenstr?m macroglobulinemia (WM) is a rare lymphoid malignancy. Many studies, including clinicopathological, cytogenetic, gene expression profile, and therapy studies have been reported from the US and Europe, although only a few reports are available from East Asia, including Japan. To further clarify the clinicopathological, radiological, and cytogenetic features of WM in Japan, we performed a retrospective analysis of WM in our institute between March 2007 and January 2012. Clinical data, laboratory data, the results of flow cytometric analysis (FCM), and chromosomal abnormalities were analyzed, and a radiological review was performed. The treatment regimen, response, and survival were also estimated. Six patients were enrolled in this study. The median age was 71 years. All patients were symptomatic, 3 had hyperviscosity syndrome, 1 had bone lesions, and 1 had an extra-medullary mass. FCM data showed that all patients were positive for CD38, while 2 were positive for CD56. Four had chromosomal abnormalities including some abnormalities also reported in myeloma. On radiological review, four showed diffuse invasion of the retro-peritoneum. Five patients received treatment, 4 of which achieved a response. At a median follow-up of 527 days, 4 were alive and 2 died because of disease progression. The present study revealed that WM in Japan might be heterogeneous and have a unique disease manifestation. Invasion sites other than bone marrow were very common, and the results of clinical, FCM, and cytogenetic studies revealed that WM in Japanese cases might have manifestations of both myeloma and B-cell lymphoma.
文摘Recently, mixed phenotype acute leukemia (MPAL) with t (9;22) (q34;q11.2);bcr-abl1 was described as one kind of acute leukemia of ambiguous lineage in the 2008 World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. However, treatment strategy remains difficult for this uncommon MPAL. In addition, this type of MPAL is at high risk of tumor lysis syndrome (TLS) because of high chemo-sensitivity. Here, we report a MPAL with t (9;22) (q34;q11.2);bcr-abl1 case that suffered from life-threatening cerebral bleeding associated with disseminated intravascular coagulation (DIC) with TLS after bcr-abl positive acute lymphoblastic leukemia (ALL) type induction therapy who was successfully treated with recombinant human thrombomodulin (rhTM). This case reached complete remission without additive cerebral bleeding. In conclusion, bcr-abl positive ALL type induction therapy was effective for MPAL with t (9;22) (q34;q11.2);bcr-abl1 and rhTM was effective against DIC with TLS.
文摘This review explores the development of a competency-based orientation curriculum for surgeons in Equatorial Guinea.Surgical training in the region faces significant challenges,including a lack of standardized curricula,inadequate resources,and limited access to advanced medical education.By integrating competency theory,this article proposes a curriculum design framework tailored to the country’s specific context.The review focuses on key components such as curriculum content,teaching methodologies,assessment mechanisms,and their practical applications,emphasizing the need for a structured approach to improve surgical healthcare services.The findings provide theoretical foundations and practical guidance for enhancing surgical training and ultimately improving healthcare outcomes in the region.
文摘This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games.Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee.Of these,84 athletes who required outpatient care during the Games were registered for this survey.During the Olympic and Paralympic Games,66(8.3/1000)and 18(7.2/1000)athletes,respectively,consulted external medical facilities.In the Olympic Games,the reasons for these visits included 48 cases(72.7%)of injuries,13(19.7%)cases of illnesses,and 5(7.6%)cases of heat stroke illness(HSI).Of these patients,56(84.9%)were treated as outpatients and 10(15.1%)were hospitalized,while three of these patients required hospitalization for>7 days.On the other hand,in the Paralympics Games,there were 7(38.8%)cases of injuries,9(50.0%)other illnesses,1(5.6%)case of HSI,and 1(5.6%)other cases,of which 11(61.1%)were treated as outpatients and 7(38.9%)were hospitalized,but none was hospitalized for>7 days.Injuries accounted for 70%of the total cases at the 2021 Olympic Games,but only three(0.05%)were severe cases that required hospitalization for more than 1 week.In contrast,in the Paralympic Games,other illnesses accounted for approximately half of the total cases.This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities,which has not been documented in previous games.
文摘ST2 protein is a soluble splicing variant of ST2L protein, which is the receptor for interleukin-33 （IL-33）. Previously, we reported that soluble ST2 suppressed the signal transduction of lipopolysaccharide （LPS） and cytokine production in monocytic cells. To investigate whether or not this inhibitory effect occurs in dendritic cells, which are the key players in innate and adaptive immunity, human monocyte-derived dendritic cells were pre-treated with soluble ST2 protein before LPS stimulation. Although soluble ST2 did not attenuate the LPS-induced maturation of dendritic cells, pre-treatment with soluble ST2 suppressed cytokine production and inhibited LPS signaling. Moreover, the proliferation of naive T cells was inhibited significantly by soluble ST2 pre-treatment. IL-33 had little effect on the cytokine production of immature monocyte-derived dendritic cells. Furthermore, soluble ST2 protein was internalized into dendritic cells, suggesting that soluble ST2 protein acts by a noncanonical mechanism other than the sequestration of IL-33.
文摘Dear Editor,A series of novel coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)since the end of 2019 is ongoing and triggering a global public health crisis.The estimated case fatality rate is approximately 3.4%in China.However,some patients experience dyspnea within 1 week and develop rapidly to organ injury and even death within 2 weeks after dyspnea.1 In addition,early organ injury could lead to higher risks of mortality.Thus,early identification of patients at risk of organ injury and death is crucial,which saves the patients from classified and invasive treatment,improving clinical outcome and prognosis.The human immune system plays significant roles in the resistance of foreign pathogens and the progress of pneumonia.Recent studies have mentioned that T cells were decreased in COVID-19 patients,excessive activated immune response was caused by pathogenic Th1 cells,and inflammatory CD14+CD16+monocytes may connect to pulmonary immunopathology,leading to deleterious clinical manifestations and even acute mortality after SARS-CoV-2 infections.2 SARS-CoV-2 might damage lymphocytes,especially T lymphocytes,and the immune system was impaired during the period of disease to cause tissue injury.
