Hepatic Encephalopathy ; classification ; diagnosis ; therapy ; Humans ; Terminology as Topic

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) BACKGROUND: Fluid management is crucial to acute respiratory distress syndrome (ARDS) secondary to sepsis. However, choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem. Our study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to sepsis. METHODS: Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018, and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Definition. RESULTS: Among the 322 sepsis patients, 84 (26.1%) were complicated with ARDS within 72 hours. ARDS patients had a lower oxygenation index (PaO2/FiO2 166.4±71.0 vs. 255.0±91.2, P<0.05), longer duration of mechanical ventilation (11 [6-24] days vs. 0 [0-0] days, P<0.05) than those without ARDS. Sepsis patients with ARDS showed daily positive net fluid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with significant statistical differences. Among the 84 sepsis patients with ARDS, 58 (69.0%) died. Mean daily fluid input volumes were much lower in survivors than in non-survivors (43.2±16.7 mL/kg vs. 51.0±25.2 mL/kg, P<0.05) while output volumes were much higher in survivors (45.2±19.8 mL/kg vs. 40.2±22.7 mL/kg, P<0.05). Using binary logistic regression analysis, we found that the mean daily fluid balance was independently associated with mortality of sepsis patients complicating with ARDS (P<0.05). CONCLUSIONS: Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.

With the development of industrialization,the problem of oil-contamination to the soil is getting more and more serious.How to clear up or remove the oil-contaminants from the soil becomes an important environmental problem for all countries around the world.Bioremediation,as the methods with fast and safe in processing,low cost and non-secondary contamination,is becoming the main solution to soil environment by oil contamination.Biostimulation and bioaugmentation are most commonly used techniques in bioremediation.The theory of bioremediation,including the concept and method of biostimulation and bioaugmentation were introduced,and advance study and progress in this field from the world in recently years were demenstrated.Both of the two methods can lead a significant decrease in soli TPH content,but the efficiency relates to many factors.Accordingly,the bioremediation technique should be tailored specifically to each polluted site.

Objective To observe the serum cardiac troponin I (cTnI) level and to analysis the relations between the serum cTnI level and prognosis in patients with dilated cardiomyopathy (DCM) and Cardiac Dysfunction.Methods Serum cardiac cTnI level was measured by enzyme-linked immunosorbant assay. Results The serum cTnI level in DCM patients with class IV cardiac function (0.53 ?0.31) ?g/L was significantly higher than in DCM patients with class Ⅲ cardiac function (0.45?0.27) ?g/L.There was significantly difference in serum cTnI levels between DCM patients with class Ⅲ cardiac function and DCM patients with class Ⅱ cardiac function(0.29?0.27) ?g/L.Conclusion The higher serum cTnI level is correlated with the severity of cardiac function and may be useful for evaluating prognosis in patients with DCM.

OBJECTIVE:To evaluate the economical efficiency of alogliptin for type 2 diabetes and provide clinical evi-dence for related researches. METHODS:Retrieved from Cochrane Library,Pubmed,EMBase,CNKI,VIP,Wanfang,CBM database up from the start of the database to Mar.,2014,RCTs about alogliptin combined with traditional antidiabetic agents regimen vs. traditional antidiabetic agents regimen in the treatment of type 2 diabetes mellitus were included. Based on the sec-ondary analysis method of literatures,Effectiveness indexes and treatment course were extracted from the literatures,from the perspective of patients,and daily treatment cost was used to calculate the cost;cost-effectiveness analysis was adopted to evalu-ate the economical efficiency of alogliptin combined with traditional antidiabetic agents regimen vs. traditional antidiabetic agents regimen. RESULTS and CONCLUSIONS:6 literatures which met inclusion criteria were included. When alogliptin com-bined with metformin treatment lasted for 12 weeks,the decrease value of HbA1c as effect index showed poor cost-effective-ness;when treatment course increased to 26 weeks,the rate of qualified HbA1c as effect index showed poor cost-effectiveness. When the price of alogliptin decreased by 10% or the effects of trial group was the upper limit of 95%CI,the cost-effective-ness was superior to metformin regimen group. 12 weeks of alogliptin combined with pioglitazone treatment showed better cost-effectiveness than pioglitazone alone using the decrease value of HbA1c as effect;when treatment course increased to 26 weeks,the treatment showed poor cost-effectiveness;when treatment conrse increased to 26 weeks,using the rate of qualified HbA1c as effect indes,the results of sensitirity analysis showed that cost-effectiveness of trial group was better than that of pio-glitazone alone group as the apper limit of 95% CI. When alogliptin combined voglibose treatment lasted for 12 weeks,the de-crease value of HbA1c as effect index showed superior cost-effectiveness to voglibose regimen group. It is suggested to develop alogliptin pharmacoeconomics research based on RCTs and pharmacoeconomics research about improving diabetes patients’ long-term living quality.

Objective To investigate the correlation of serum advanced glycation end products (AGEs) and the expression of receptor for AGE (RAGE) with mental disorders in senile people. Methods All the subjects aged 65～67 years were divided into 4 groups: healthy control (31 cases), Alzheimer's disease (AD) (36 eases), vascular dementia (VD) (20 cases) and mental disorder (MD) (28 cases). Fluorospectrophotometry was carried out to measure the AGEs levels in serum samples, and reverse transcription polymerase chain reaction (RT-PCR) was used to determine the mRNA levels of RAGE in white blood cells. Results AGEs levels were 477. 1±36.2, 512. 6±33.2 and 415.2±32.5 AU/ml in AD, VD and MD group, respectively, which were higher than that in healthy control group (357.4±28. 2) AU/ml (F=3.77,P<0. 05). The mRNA levels of RAGE(RAGE/b- actin) were found to be 1.12±0.34, 1.27±0.41 and 1.18±0.42 in AD, VD and MD group, respectively, which were also significantly higher than that in healthy control group(0. 92±0. 37, F= 4. 07,P<0. 01). However, no significant differences were found in RAGE mRNA levels among the three groups of AD,VD and MD (F=0. 979,P>0. 05). The mRNA levels of RAGE in WBCs were found to be positively correlated with the serum AGEs levels (r=0. 442, P<0. 01). Conclusions Compared with patients in healthy control group, the serum AGEs levels and RAGE mRNA levels are significantly increased in patients with AD, VD and MD. The interaction between AGEs and RAGE may be involved in the pathogenesis of mental disorders in senile people.

Breast ; radiation effects ; Breast Neoplasms ; pathology ; radiotherapy ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Mastectomy ; Mastectomy, Segmental

Animals ; Hepatocytes ; transplantation ; Humans ; Liver Diseases ; genetics ; surgery ; therapy ; Liver Failure ; surgery

Objective To investigate the effects of thiopentone and propofol on cerebral ischemia-reperfusion injury during open heart surgery under deep hypothermia circulatory arrest in infants and young children. Methods Twenty patients with VSD and pulmonary hypertension (13 male, 7 female), aged 3-23 months and weighing 4-11 kg were randomly divided into three groups: in group A thiopentone 5mg.kg was added in CPB machine when body temperature was reduced to 30℃ (n = 7); in group B propofol 2 mg.kg-1 was added ( n =8) and group C served as control ( n - 5). When rectal temperature was reduced to 20℃, CPB was stopped and intracardiac manipulation was started. Anesthesia was induced with midazolarn 0. 2mg.kg -1, fentanyl 20 ?g.kg1 and vecuronium 0. 1mg.kg1 . After tracheal intubation the patients were mechanically ventilated and anesthesia was maintained with O2-N2O-isoflurane and intermittent boluses of fentanyl and vecuronium infusion (70?g.kg-1.h1). Radial artery was cannulated and internal jugular vein (IJV) was retrogradely cannulated until bulb, and blood samples were taken simultaneously from artery and IJV before CPB (T1 ), during circulatory arrest (T2 ) at the beginning of reperfusion ( T3 ) and 24h after operation ( T4 ) for blood gas analysis and determination of plasma concentration of lactic acid (LA), creatine kinase-BB (CKBB) activity and neuron-specific endase (NSE). Cerebral arterial-venous O2 content difference (Ca-vO2) and cerebral O2 extraction ratio (CO2ER) were calculated. Results Plasma concentration of lactic acid was increased at T3 in all three groups and was the highest in group A. Cerebral O2 metabolism decreased at T2 in all three groups and was the lowest in group B and resumed at T4 CKBB activity was increased at T3 and NSE level was increased at T3 and T4 in all 3 groups. The increase in CKBB activity and NSE level was slightest in group B. Conclusion Propofol can protect brain from ischemia-reperfusion injury in infants and young children during open heart surgery under deep hypothermic circulatory arrest.

ObjectiveTo prospectively evaluate the therapeutic effect of Alvenor on symptoms and signs of chronic venous insufficiency of lower extremities.MethodAccording to preset criteria, 133 patients from 8 hospitals in Hangzhou, Beijing, Guanzhou and Shanghai were recruited into this study including 78 males (58.6%) and 55 females (41.4%). The average age was 23～77 (55?13) years. The illness course was from 1～50 years with a mean of (11?11) yrs. Other therapeutic modalities were adopted in 34 before inclusion into this study and 38 cases (28.8% ) had suffered from certain complications. Classification was first defined when the patient was enrolled and clinical symptoms and signs were evaluated. Alvenor was given 500?mg, twice a day orally. Reevaluation and record by the same criteria was carried out 15, 30, and 60 days after treatment, and statistical analysis was conducted. ResultsSwelling, heaviness, spasm, and pain, etc, were statistically improved. ConclusionsAlvenor is effective in the treatment of symptoms and signs of chronic venous insufficiency of the lower extremities.