Neurocritically ill patients are at an increased risk of other organ dysfunctions, especially lung injury. Major pulmonary complications, including acute respiratory distress syndrome, ventilator-associated pneumonia, and neurogenic pulmonary edema, are frequently caused by brain injury, and are associated with poor outcome. Brain and lung have strong interactions via complex pathways from the brain to the lung, and vice versa. Excessive release of catecholamines and systemic inflammatory responses play an integral role in the development of pulmonary dysfunction after brain injuries. Mechanical ventilation is commonly used to manage pulmonary dysfunctions associated with brain injury, and lung protective ventilation strategies reduce injuries to the lung and brain. This review focuses on the current knowledge regarding the epidemiology and pathophysiology of lung injuries in patients with neurocritical illness, and the various strategies of mechanical ventilation used to reduce lung injury.
Brain Injuries ; Brain ; Catecholamines ; Epidemiology ; Humans ; Lung Injury ; Lung ; Pneumonia, Ventilator-Associated ; Pulmonary Edema ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Ventilation

ObjectiveTo compare the clinical efficiency of Shang Ring with that of the disposable circumcision suture device (DCSD) in the treatment of phimosis or redundant prepuce.

METHODSFrom June 2013 to March 2015, we treated 320 patients with phimosis or redundant prepuce using Shang Ring (n=158) or DCSD (n=162). We compared the operation time, intra-operative blood loss, incision healing time, postoperative complications, postoperative satisfaction, and treatment cost between the two groups of patients.

RESULTSComparison between the Shang Ring and DCSD groups showed that the operation time was (5.6±1.3) vs (5.4±1.2) min, intra-operative blood loss (1.2±0.8) vs (1.3±0.9) ml, postoperative delayed hemorrhage 3.16% (5/158) vs 4.32% (7/162), incision healing time (16.1±7.2) vs (7.5±2.3) d, wound infection 15.82% (25/158) vs 7.41% (12/162), 1-month postoperative incision edema 29.11% (46/158) vs 9.26% (15/162), overall postoperative satisfaction rate 63.92% (101/158) vs 90.12% (146/162), and treatment cost (1121.2±15.6) vs (2142.6±10.8) RMB ¥. There were statistically significant differences between the two groups in the latter five parameters (P<0.05 ), but not in the first three (P>0.05 ).

CONCLUSIONSThe DSCD has an obvious superiority over Shang Ring for its relatively lower complication rate, shorter incision healing time, and better cosmetic appearance.

Blood Loss, Surgical ; Circumcision, Male ; instrumentation ; Edema ; epidemiology ; Humans ; Male ; Operative Time ; Penis ; surgery ; Personal Satisfaction ; Phimosis ; surgery ; Postoperative Complications ; Postoperative Hemorrhage ; Postoperative Period ; Prostheses and Implants ; Surgical Wound ; pathology ; Sutures

Poststreptococcal glomerulonephritis (PSGN) is one of the most recognized diseases in pediatric nephrology. Typical clinical features include rapid onset of gross hematuria, edema, and hypertension, and cases are typically preceded by an episode of group A β-hemolytic streptococcus pharyngitis or pyoderma. The most common presenting symptoms of PSGN are the classic triad of glomerulonephritis: gross hematuria, edema, and hypertension . However, patients with PSGN sometimes present with unusual or atypical clinical symptoms that often lead to delayed diagnosis or misdiagnosis of the disease and increased morbidity. Additionally, the epidemiology of postinfectious glomerulonephritis (PIGN), including PSGN, has changed over the past few decades. This paper reviews atypical clinical manifestations of PSGN and discusses the changing demographics of PIGN with a focus on PSGN.
Delayed Diagnosis ; Demography ; Diagnostic Errors ; Edema ; Epidemiology ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Nephrology ; Pharyngitis ; Pyoderma ; Streptococcus

PURPOSE: To report the frequency and clinical features of sterile inflammation after intravitreal aflibercept injection in a Korean population. METHODS: A single-center, retrospective study was performed in patients who received intravitreal aflibercept from July 2013 through January 2015. RESULTS: A total of four cases of post-injection sterile inflammation were identified from 723 aflibercept injections in 233 patients. Patients presented 1 to 13 days after intravitreal aflibercept injection (mean, 5 days). The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60. Three cases had inflammatory cells in the anterior chamber (mean, 2.25+; range, 0 to 4+), and all cases had vitritis (mean, 3+; range, 2+ to 4+). No patients had pain. Only one patient underwent anterior chamber sampling (culture negative) and injection of antibiotics. Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation. CONCLUSIONS: The overall incidence of sterile inflammation after intravitreal aflibercept injection in a Korean population was 4 of 723 injections (0.55%), or 4 of 233 patients (1.79%). Sterile inflammation after intravitreal aflibercept injection typically presents without pain, and the visual outcomes are generally favorable.
Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intravitreal Injections ; Macular Edema/*drug therapy/epidemiology ; Male ; Middle Aged ; Receptors, Vascular Endothelial Growth Factor/*administration & dosage ; Recombinant Fusion Proteins/*administration & dosage ; Republic of Korea/epidemiology ; Retrospective Studies ; Treatment Outcome ; Vascular Endothelial Growth Factor A ; Visual Acuity

For the past several decades, tremendous efforts have been made to decrease the complications of diabetes, including diabetic retinopathy. New diagnostic modalities like ultrawide field fundus fluorescein angiography and spectral domain optical coherence tomography has allowed more accurate diagnosis of early diabetic retinopathy and diabetic macular edema. Antivascular endothelial growth factors are now extensively used to treat diabetic retinopathy and macular edema with promising results. There remains uncertainty over the long term effects and the socioeconomic costs of these agents.
Diabetic Retinopathy* ; Diagnosis ; Endothelial Growth Factors ; Epidemiology ; Fluorescein Angiography ; Macular Edema ; Tomography, Optical Coherence ; Uncertainty ; Vascular Endothelial Growth Factor A

OBJECTIVETo investigate the effectiveness of surgical strategies for Shang Ring circumcision in the treatment of short frenulum praeputii in patients with redundant prepuce or phimosis.

METHODSTotally, 130 cases of short frenulum praeputii with redundant prepuce or phimosis were randomly assigned to an experimental group and a control group of equal number to receive Shang Ring circumcision, the former by transverse incision in the distal penis foreskin and pull-up of the interior board, and the latter by conventional transverse incision and longitudinal suture of the frenulum praeputii. Comparisons were made between the two groups in the surgical duration, intraoperative blood loss, 24 h postoperative pain visual analog score (VAS), postoperative complications, satisfaction with the penile appearance, and the quality of sexual life.

RESULTSThe surgical duration, intraoperative blood loss, 24 h postoperative VAS, postoperative sexual satisfaction, and satisfaction with penile appearance were (4.60 +/- 1.20) min, (2.61 +/- 1.81) ml, 1.73 +/- 0.76, 98.5%, and 98.5%, respectively, in the experimental group, as compared with (21.60 +/- 6.30) min, (11.10 +/- 3.40) ml, 5.37 +/- 1.84, 70.3% and 69.8% in the control, with statistically significant differences between the two groups (P < 0.05). The incidence rates of such major complications as wound dehiscence, infection, and moderate to severe edema were 1.5% (1/65), 3.1% (2/65), and 4.6% (3/65), respectively, in the experimental group in comparison with 12.3% (8/65), 15.3% (10/65), and 30.7% (20/65) in the control, with statistically significant differences between the two groups (P < 0.05). None of patients had any serious complications.

CONCLUSIONShang Ring circumcision by transverse incision in the distal penis foreskin and pull-up of the interior board, with its advantages of shorter operation time, less blood loss, mild pain, fewer complications, and higher satisfaction and acceptance of the patients, can be used as an safe and effective approach to the treatment of short frenulum praeputii.

Aged ; Blood Loss, Surgical ; statistics & numerical data ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Edema ; epidemiology ; Foreskin ; abnormalities ; surgery ; Humans ; Incidence ; Male ; Operative Time ; Pain Measurement ; Pain, Postoperative ; diagnosis ; Patient Satisfaction ; Phimosis ; surgery ; Postoperative Period ; Prostheses and Implants ; Surgical Wound Dehiscence ; epidemiology ; Surgical Wound Infection ; epidemiology

OBJECTIVETo compare the effect and safety of the no-flip method versus the external method in Shang Ring circumcision.

METHODSWe searched relevant randomized controlled trials published in China and abroad comparing the no-flip method and external method of Shang Ring circumcision. Based on the Cochrane Handbook for systematic review, two reviewers independently eval- uated the quality of the included studies and abstracted relevant data, followed by a meta-analysis using the statistical software Review Manager 5.1.0.

RESULTSTotally 7 studies with 1 200 cases were included. Compared with the external method, the no-flip method was associated with a lower total rate of complications (RR = 0.40, 95% CI: 0.18, 0.87, P = 0.02), a lower incidence of postop- erative edema (RR = 0.28, 95% CI: 0.09, 0.81, P = 0.02), and a lower 24 h postoperative pain score (MD = -0.35, 95% CI: -0.55, -0.14, P < 0.001).

CONCLUSIONThe no-flip method of Shang Ring circumcision was superior to the external method for its advantages of fewer complications, lower incidence of postoperative edema, and mild postoperative pain. However, our findings need further support by more high-quality randomized controlled trials.

China ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Edema ; epidemiology ; Humans ; Male ; Pain Measurement ; Pain, Postoperative ; epidemiology ; Randomized Controlled Trials as Topic

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.
Adult ; Aged ; Daegu ; Edema ; Emergency Service, Hospital* ; Epidemiology ; Extreme Heat ; Heat Exhaustion ; Heat Stress Disorders ; Heat Stroke ; Hot Temperature* ; Humans ; Infrared Rays ; Odds Ratio ; Public Health Surveillance ; Risk Factors ; Syncope ; Unemployment

Female ; Humans ; Incidence ; Infant ; Male ; Oxygen ; metabolism ; Prospective Studies ; Pulmonary Edema ; diagnosis ; epidemiology ; Respiration ; Respiration, Artificial

OBJECTIVETo investigate the characteristics of circulatory disturbance and treatment of severe hand-foot-and-mouth disease (HFMD).

METHODThe clinical characteristics, laboratory findings, therapy and outcome of 22 severe HFMD patients were retrospectively analyzed.

RESULTAll the 22 severe HFMD patients came from the countryside. All these patients had encephalitis. Fifteen cases had myocardial injury. All had symptoms of sympathetic excitation and 17 cases had hypertension [(128 ± 16)/(81 ± 14) mm Hg (1 mm Hg = 0.133 kPa)]. Fourteen cases had exacerbation with rapid decline of blood pressure [(61 ± 12)/(33 ± 12) mm Hg]. In cardiorespiratory failure stage, 13 patients had neurogenic pulmonary edema accompanied by circulatory failure and 12 cases had a lower glasgow scores (less than 7). Myocardial injury and ECG change were found in some cases. Inotropic and pressor drugs were given in patients with circulatory collapse. Five cases received fluid resuscitation due to refractoriness to inotropic drugs. Nine patients received blood purification. Seventeen survived and 5 cases died due to circulatory failure.

CONCLUSIONCirculation failure of severe HFMD is the main cause of death. Early and appropriate circulation support is very important to reduce mortality.

Child, Preschool ; China ; epidemiology ; Combined Modality Therapy ; Female ; Hand, Foot and Mouth Disease ; complications ; mortality ; therapy ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Infant ; Intensive Care Units, Pediatric ; Male ; Milrinone ; administration & dosage ; therapeutic use ; Multiple Organ Failure ; etiology ; mortality ; Pulmonary Edema ; etiology ; mortality ; Respiration, Artificial ; Retrospective Studies ; Shock ; etiology ; mortality ; Treatment Outcome