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.

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

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 study the effects of cadmium stress on mycelial growth and accumulation of metabolites in Ganoderma lucidum, and to explore the mechanisms affecting growth and accumulation of metabolites, and to provide evidence for controlling cadmium in the production and cultivation of G. lucidum. Methods: The mycelium of G. lucidum was cultured under the conditions of heavy metal ion cadmium concentration of 0, 0.5, 1, 4, 10, and 40 mg/L, and its biomass accumulation, intracellular ROS level, membrane oxidative damage, anti-oxidant enzyme activity, and ROS regulation related enzyme expression were analyzed. Results: When the concentration of cadmium reached 4 mg/L, the mycelial growth was inhibited. The levels of intracellular ROS, H2O2, and MDA increased significantly, increasing by 76%, 46% and 325%, respectively, and increased with the increase of cadmium concentration; The NADPH expression levels of oxidase gene (NOXA), superoxide dismutase gene (SOD1 and SOD4), and CATalase gene (CAT) were significantly up-regulated. When the cadmium concentration reached 10 mg/L, the inhibitory effect was significant. The colony growth diameter and the dry weight inhibition rate of fermentation mycelium were 26.15% and 32.78%, respectively. The total triterpenoid inhibition rate of G. lucidum was 33.7%, and the inhibition rate of total protein synthesis was 30.3%. Inhibition of polysaccharides was not significant. When the cadmium concentration reached 40 mg/L, the expression levels of Ascorbate peroxidase gene (APX) and Glutathione peroxidase gene (GPX) were significantly up-regulated. With the increase of cadmium concentration, the activities of SOD, CAT, APX, and GPX increased first and then decreased. When the concentration of cadmium reached 1 mg/L, the activity of GPX decreased and the activity of APX increased significantly. Exogenous addition of diphenyleneiodonium chloride (DPI), N-acetyl-L-cysteine (NAC) and vitamin C (VC) had significant effects on cadmium-induced G. lucidum clearance of ROS and reduction of MDA content. Conclusion: Cadmium stress causes the decrease of mycelial production and metabolite accumulation of G. lucidum, which may be due to the inhibition of GPX activity by cadmium ions, resulting in the accumulation of H2O2, causing the increase of ROS level and membrane oxidative damage, inhibiting mycelial growth and accumulation of metabolites, and regulating NOX. Up-regulation of gene expression results in an increase in anti-oxidant enzyme activity and expression to increase the clearance of reactive oxygen species. Therefore, the cadmium content should be controlled within the range of 1 mg/L during the production process.

The following measures have been taken with improved teaching effects in our recent practice of lemological teaching Firstly,we adjusted our teaching scope from classical communicable diseases to infectious diseases and brought the newest progress into our contents.Secondly,we adopted rich and colorful teaching methods to boost the students' learning interest.Thirdly,the students' clinical capabilities have been emphasized in our lemological examination.And lastly,multimedia has been employed to display our contents more actively.

Pancreatic cancer is the third leading cause of cancer-related death in the world due to its high malignancy, difficult in early diagnosis, poor treatment efficacy, and high mortality. In recent years, benefiting from the progress of combined chemotherapy and neoadjuvant therapy, the prognosis of patients with pancreatic cancer has been improved to a certain extent. However, compared with other tumors, progress of precision medicine in pancreatic cancer is slow. The authors introduce the latest progress and difficulties in precision medicine of pancreatic cancer including molecular classification based on single gene and omics, monitoring tumor progression and guide treatment by minimally invasive liquid biopsy, as well as targeting therapy and immuno-therapy, in order to accelerate the development of precision medicine of pancreatic cancer.

Objective Investigation and analysis of intelligence and psychomotor function in children born after implementingt universal salt iodization(USI). Methods Historical serious illness areas of water iodine below 10μg/L were selected as study sites, water iodine in 50 - 100 μg/L in the historical non-endemic areas were as control points in Henan, 2008. Cluster sampling was used to select children aged 6 - 15 years as observing subjects,IQ were measured with CRT- Man Test(CRT-C2). A "Tianjin Medical psychomotor test battery" (JPB) was carry out to test psychomotor function. Results In IDD regions 230 children were surveyed post-USI and 1284 children preUSI. The IQs post and pre USI were 99.3 and 99.9, respectively, and the proportion of IQ ≤69 were 2.17%(6/230) and 2.80%(36/1284), respectively. In non-IDD regions 650 children were surveyed post-USI and 2079children pre-USI. The IQs post and pre USI were 95.3 and 93.8, respectively, and the proportion of IQ ≤ 69 were 2.31%(15/650) and 3.37%(70/2079), respectively. In IDD regions, the abnormal rate of T scores and damage index post USI were 3.6%(2/56), 5.3%(3/56), respectively, significantly lower than pre USI [18.1%(29/160),18.1%(29/160), x2 = 7.54, 6.86, all P ＜ 0.01]. Conclusions USI could increase the IQs of children and decrease the positive rate of JPB, and significantly improve the quality of whole nation and persistently eliminating IDD.

Continuous electroencephalographic monitoring (CEEG) has been used for clinical monitoring of acute cerebrovascular diseases for nearly 3 decades,but it has not been used as a conventional monitoring approach in clinical practice.In recent 15 years,CEEG technology has made considerable progress,especially in the field of real-time monitoring of acute cerebral ischemia and epilepsy,which has provided a new possible direction for the diagnosis and treatment of acute cerebrovascular diseases.The article briefly comments the application of CEEG in acute cerebrovascular diseases.