Current Issue Archive 15 December 2020, Volume 11 Issue 4 Previous Issue Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia Rebekah Shaw, Erica Popovsky, Alyssa Abo, Marni Jacobs, Nicole Herrera, James Chamberlain, Andrea Hahn World Journal of Emergency Medicine. 2020, 11(4): 199-205. doi:10.5847/wjem.j.1920-8642.2020.04.001 Asbtract HTML PDF (151KB) Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study Hai-jiang Zhou, Tian-fei Lan, Shu-bin Guo World Journal of Emergency Medicine. 2020, 11(4): 206-215. doi:10.5847/wjem.j.1920-8642.2020.04.002 Asbtract HTML PDF (255KB) Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis Yu-ming Wang, Yan-jun Zheng, Ying Chen, Yun-chuan Huang, Wei-wei Chen, Ran Ji, Li-li Xu, Zhi-tao Yang, Hui-qiu Sheng, Hong-ping Qu, En-qiang Mao, Er-zhen Chen World Journal of Emergency Medicine. 2020, 11(4): 216-222. doi:10.5847/wjem.j.1920-8642.2020.04.003 Asbtract HTML PDF (107KB) Effects of sepsis on hippocampal volume and memory function Miao Yuan, Ding-yi Yan, Fang-shi Xu, Yi-di Zhao, Yang Zhou, Long-fei Pan World Journal of Emergency Medicine. 2020, 11(4): 223-230. doi:10.5847/wjem.j.1920-8642.2020.04.004 Asbtract HTML PDF (138KB) Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland Chuan-qi Ding, Yu-ping Zhang, Yu-wei Wang, Min-fei Yang, Sa Wang, Nian-qi Cui, Jing-fen Jin World Journal of Emergency Medicine. 2020, 11(4): 231-237. doi:10.5847/wjem.j.1920-8642.2020.04.005 Asbtract HTML PDF (144KB) BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients’ deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients’ deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors influenced the family surrogates’ decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confidence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.

objective To evaluate the clinical application value of ileum to the S-type of suture pro- duced orthotopic neobladder.Methods Radical cystectomy and ileal neobladder with"S"shape were per- formed in 3patients with transitional cell carcinoma.Ureter implant into neobladder with embedding nipple techniques,bottom of neobladder coincide with urethra stump.Results The average operative time to form a neobladder was 5 hours,average bleeding volume was 366 ml during operation,3 cases can control urine dur- ing daytime,nycturia 1-3 times every night.Neobladder has a large capacity,low pressure,and electrolytes of blood was normal.Conclusion The construction of an ileal neobladder using a smaller part of ileum that has been completely detubularized and fashioned by S shape is easy and agreeable to perform.This mode of oper- ation has low complication rates,achieves adequate capacity at low pressure,and provides satisfactory conti- nence rates.It is a fine scheme to treat invasion and multiple carcinoma of bladder.

Aged ; Bronchoscopy ; Esophageal Neoplasms ; complications ; Female ; Humans ; Male ; Middle Aged ; Stents ; Thyroid Neoplasms ; complications ; Tracheal Stenosis ; etiology ; therapy

OBJECTIVESTo identify serum biomarkers associated with early gastric cancer.

METHODSSerum proteins or peptides were purified with weak cation exchange magnetic beads in 433 patients with gastric cancer and 120 healthy subjects. Distinct peaks were selected using Biomarker Wizard software. The area under receiver operating characteristic curve(AUC) was generated to analyze discrimination capability of peaks between gastric cancers and health people.

RESULTSThirteen distinct peaks were identified between 42 gastric cancer and 42 health people matched by age and gender(P<0.001). There were 5 peaks (2745, 2768, 6629, 3402, and 6436 m/z) with AUC greater than 0.8. Peak of 6629 m/z was identified to be transthyretin. The sensitivity and specificity of 6629 m/z were 65.5% and 92.0%. The sensitivity of 6629 m/z was 59.4% in I(A gastric cancer.

CONCLUSIONTransthyretin precursor may be of value in the early diagnosis of gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Blood Proteins ; analysis ; Case-Control Studies ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Protein Array Analysis ; Proteomics ; methods ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Stomach Neoplasms ; blood ; Young Adult

Objective To ascertain the energy and main nutrients intake among residents in Changning District of Shanghai.Methods A stratified multistage random survey was conducted among 72 families to collect their ADI (acceptable daily intake) of nutrients through 3 d 24 h dietary recall and family condimentweigh surveys in comparison with recommended ADI.Results A total of 148 persons were included,of whom males were 75 and females 73.Every standard person daily vitamin B1,B2,A and calcium intake was relatively low.Calcium intake for 85.81% of persons was was lower than EAR.Vitamin A intake for 62.84% of persons was lower than EAR.Vitamin B1 intake for 77.7% of persons was lower than EAR.Vitamin B2 intake for 73.65% of persons was lower than EAR.In various age groups,except for women aged 18-49,contribution rate of fat in total energy exceeded recommended ADI.Conclusion Energy and main nutrients intake basically meet the needs of residents in Changning district of Shanghai.But some nutrients were still deficient severely.The source of energy nutrients was not well-balanced.More intake is recommended of milk and dairy product,soybean and bean product,vegetables and fruit.

Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Humans ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; Tomography, X-Ray Computed

Aim To investigate the neuroprotective effects of puerarin on H2O2-induced SH-SY5Y cell ap-optosis and the molecular mechanisms underlying the neuroprotective effects. Methods Neuron injury mod-el was established in vitro through H2O2-induced SH-SY5Y injury. MTT assay was performed to detect the effect of puerarin on H2O2-induced SH-SY5Y survival rates. Hoechst 33342 staining was used to observe the cell apoptosis. JC-1 staining was employed to detect the level of mitochondria membrane poential. Caspase-3 was determined by caspase-3 catalyze the substrate specificity Ac-DEVD-pNA. Caspase-9 was determined by caspase-9 catalyze the substrate specificity Ac-LE-HD-pNA. The effects of puerarin on the protein level of Bcl-2,Bax,p-Akt and Akt were determined by West-ern blot. Results The cell survival rate significantly increased after puerarin pretreatment compared with H2O2model group. Furthermore, puerarin pretreat-ment not only inhibited the decreasing of mitochondrial membrane potential,increasing of caspase-3, caspase-9 enzymatic activity and the expression of Bax,but also promoted the expression of p-Akt and Bcl-2, which was prevented by LY294002, an inhibitor of PI3K/Akt. Conclusion Puerarin can play a neuroprotective role for SH-SY5Y cell apoptosis induced by H2O2, maybe via activating PI3K/Akt signaling pathway.

OBJECTIVETo investigate the expression of multidrug resistance (MDR) gene-associated proteins (MRP) in gastric carcinoma, and their effects on the postoperative adjuvant chemotherapy and the prognosis of patients.

METHODSThe expressions of ToPo II, MRP, GST-pi in 99 patients with gastric carcinoma were detected by immunohistochemistry. The expression and its relationship to the pathological data were analyzed. The positive expression of MRP and GST-pi, and the negative expression of ToPo II were considered as risk factors. Patients were divided into two groups: a high risk drug-resistant group (2-3 risk factors) and the low risk drug-resistant group (0-1 risk factors). Postoperative recurrence, survival rate, and efficacy of adjuvant chemotherapy were compared between two groups.

RESULTSThe positive rate of ToPo II was 74.7%, and the expression was associated with types and differentiation of the tumor. The positive rate of GST-pi was 49.5%, and the expression was related to the gender and the differentiation. The positive rate of MRP was 40.4%, and there was no relationship between the MRP expression and the pathological finding. There were no significant differences in the recurrence, time to recurrence, and the 5-year survival rate between the positive and negative group of the three proteins (P>0.05). Recurrence was found in 25 cases(55.6%) in the high risk drug-resistant group and the mean time to recurrence was (15.2+/-8.1) months. The time to recurrence was shorter in the low risk drug-resistant group [(21.3+/-11.1) months, P<0.05] , but there was no significant difference in the recurrence rate between two groups (P>0.05). The 5-year survival rate of the high risk drug-resistant group and the low risk drug-resistant group was 44.4% and 55.6% (P>0.05). The 5-year survival rates of patients with or without chemotherapy in the high risk drug-resistant group were 45.8% and 42.9% (P>0.05). The 5-year survival rates of patients with or without chemotherapy in the low risk drug-resistant group were 70.4% and 40.7%. The survival rate of patients with chemotherapy was higher than that of the patients without chemotherapy (P<0.05).

CONCLUSIONSThe expression of ToPo II, MRP and GST-pi is associated with the efficacy of postoperative adjuvant chemotherapy. Chemotherapy appears to be more beneficial to patients with low risk drug-resistance.

ATP-Binding Cassette, Sub-Family B, Member 1 ; metabolism ; Adult ; Aged ; Chemotherapy, Adjuvant ; DNA Topoisomerases, Type II ; metabolism ; Female ; Glutathione S-Transferase pi ; metabolism ; Humans ; Male ; Middle Aged ; Multidrug Resistance-Associated Proteins ; metabolism ; Postoperative Period ; Prognosis ; Stomach Neoplasms ; diagnosis ; drug therapy ; metabolism

OBJECTIVETo investigate the safety and efficacy of rotational atherectomy followed by drug-eluting stent implantation for treating patients with heavily calcified coronary lesions.

METHODSFrom March 1, 2010 to September 1, 2012, 65 cases with 78 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stent implantation in Peking University People's Hospital were included, and 36 cases also underwent intravascular ultrasound to guide the rotational atherectomy procedure and drug-eluting stent implantation.All patients were followed up in hospital and post discharge. Procedure parameters, complications and major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention related myocardial infarction, target vessel revascularization, recurrent angina, intra-stent restenosis and stent thrombosis) were analyzed.

RESULTSDirect rotational atherectomy was performed in 64.6%(42/65) patients, rescued rotational atherectomy in 35.4%(23/65) patients, drug-eluting stents implantation was applied to all cases after rotational atherectomy. The immediate procedural success rate was 100% (78/78). The average burr/artery ratio was 0.50 ± 0.04, the average number of burr used per case was 1.15 ± 0.36. The average burr/artery ratio was 0.52 ± 0.03 and the average number of burr used per cases was 1.19 ± 0.40 in 36 cases guided with intravascular ultrasound. Five cases (7.7%) developed complications and were treated accordingly during procedure with satisfactory results. The incidence of major adverse cardiovascular events was 13.8% (9/65) during (17.6 ± 8.5) months follow-up.

CONCLUSIONRotational atherectomy followed by drug-eluting stent implantation is a safe and efficient technique for treating heavily calcified coronary lesions.

Aged ; Atherectomy, Coronary ; methods ; Coronary Artery Disease ; surgery ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the mechanism underlying the effect of combined use of cyclonpamine and hydroxycamptothecin in inducing the apoptosis of human oral squamous cell carcinoma cell line (OSCC) HSQ-89.

METHODSCCK8 assay was used to investigate the inhibitory effect of cyclopamine on HSQ-89 cells. Flow cytometry (FCM) was employed to examine the cell apoptosis following combined treatment with cyclonpamine and hydroxycamptothecin. Reverse transcription polymerase chain reaction (RT-PCR) was applied to detect the mRNA expressions of Bcl-2, Bcl-xl, and Bid in HSQ-89 cells after the treatments.

RESULTSCombined treatment with cyclonpamine and hydroxycamptothecin significantly inhibited the cell proliferation compared with hydroxycamptothecin treatment alone, also resulting in a significantly higher apoptosis rate of the cells (P<0.05). The mRNA level of Bcl-2 was significantly decreased after the treatments, especially after the combined treatment. Cyclopamine produced no significant effect on the mRNA levels of Bcl-xl and Bid in the cells.

CONCLUSIONThe combined use of cyclopamine and hydroxycamptothecin significantly down-regulates the expression on of bcl-2 to induce the apoptosis of human OSCC cell line HSQ-89.

Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Camptothecin ; analogs & derivatives ; pharmacology ; Carcinoma, Squamous Cell ; pathology ; Cell Line, Tumor ; Drug Synergism ; Humans ; Mouth Neoplasms ; pathology ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Veratrum Alkaloids ; pharmacology