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Enteral feeding deficient in vitamin K. Is there a related substantial bleeding risk? 肠内喂养缺乏维生素k是否有相关的出血风险?
Pub Date : 2022-03-29 DOI: 10.31579/2693-4779/087
Jochanan E. Naschitz, Natalia Zaigraykin, Elena Zlotover, Faisal Neime, N. Starikov, Ygor Yalonetski, G. Leibovitz
Vitamin K is essential for clotting factors II, VII, IX and X to be released in their active form. Under vitamin K deficiency a coagulopathy may develop that is marked by prolongation of the prothrombin time (PT). Patients receiving enteral feeding which does not cover the daily vitamin K requirements might be predisposed to develop a bleeding diathesis. Yet, current guidelines do not recommend monitoring the PT in patients receiving enteral feeding. In the present cross-sectional study, we assessed the prevalence of a prolonged PT in patients receiving long-term enteral feeding with one or a combination of the enteral formulas Osmolite®, Jevity®, Easymilk®. Sixty residents in long-term geriatric care received exclusively enteral feeding for a median 27 months (average 34.7, SD 29). The median daily vitamin K supplied by enteral feeding was 63.5 mcg (average 8.3, SD 17.2), i.e. less than the 150 mcg recommended by the Food and Drug Administration. In 57 patients the PT-INR was 0.9 - 1.2 (normal); the PT-INR was prolonged to 1.4 in 3 patients. There were 6 episodes of major bleeding and 4 episodes of minor bleeding during the study period, unrelated to prolonged PT and distributed at random along the time of enteral feeding. Accordingly, long-term vitamin K-deficient enteral nutrition did not affect vitamin K-dependent coagulation. This may argue against the need to regularly monitor the PT in patients receiving long-term enteral nutrition
维生素K是必需的凝血因子II, VII, IX和X的活性形式的释放。维生素K缺乏可导致凝血功能障碍,其特点是凝血酶原时间延长。接受肠内喂养的患者如果不能满足每日所需的维生素K,可能容易发生出血性素质。然而,目前的指南不建议在接受肠内喂养的患者中监测PT。在本横断研究中,我们评估了接受长期肠内喂养的一种或联合肠内配方Osmolite®、Jevity®、Easymilk®的患者中延长PT的患病率。60名长期老年护理的居民接受纯肠内喂养,中位时间为27个月(平均34.7,标准差29)。每日通过肠内喂养提供的维生素K中位数为63.5微克(平均8.3微克,标准差17.2),即低于美国食品和药物管理局推荐的150微克。57例患者PT-INR为0.9 - 1.2(正常);3例患者PT-INR延长至1.4。研究期间发生大出血6次,小出血4次,与PT时间延长无关,随肠内喂养时间随机分布。因此,长期缺乏维生素k的肠内营养不影响维生素k依赖性凝血。这可能反对定期监测接受长期肠内营养的患者PT的必要性
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引用次数: 0
Epidemics in Ancient Imperial China – Myths, Facts and Lessons for Posterity 中国古代帝王时期的流行病——神话、事实和给后人的教训
Pub Date : 2022-03-29 DOI: 10.31579/2693-4779/086
Jsm Leung
The recorded history of China spanned over 47 centuries. Since the beginning of the first century epidemics of each dynasty had been duly, if incompletely, recorded. This study is an attempt to review the epidemics recorded from the beginning of the first century A.D., when epidemic records first appeared as a regular entry, to the beginning of the 20th century which marked the end of the last dynasty in Imperial China. No attempt is made to stratify the types of individual infections as such scientific knowledge was lacking. Rather, epidemics are treated as one subject, in the broadest sense, of massive and highly contagious infections, occurring wave after wave, affecting society, culture, governments and the rise and fall of empires dynasties. Some of the materials had been used in a previous article in this Journal but reused out of necessity. Yet, every attempt has been made to minimize excessive repetition.
中国有记载的历史跨越了47个世纪。自一世纪初以来,每个王朝的流行病都有适当的记录,如果不完整的话。本研究试图回顾从公元1世纪初流行病记录首次作为常规条目出现到20世纪初标志着中国最后一个王朝结束的流行病记录。由于缺乏这样的科学知识,没有尝试对个体感染的类型进行分层。相反,在最广泛的意义上,流行病被视为一种大规模和高度传染性的传染病,一波接一波地发生,影响社会、文化、政府和帝国王朝的兴衰。一些材料在本刊之前的一篇文章中使用过,但出于必要而重新使用。然而,我们尽了一切努力来减少过度的重复。
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引用次数: 0
Describing the Cardiopulmonary Resuscitation Factors and Outcomes 描述心肺复苏的因素和结果
Pub Date : 2022-03-29 DOI: 10.31579/2693-4779/085
S. Kazkaz, Zubaria Altaf, Pocholo Isidro, Almunzer Zakaria
This study is a retrospective, descriptive review of all cardiopulmonary resuscitation (CPR) attempts at Al Wakra Hospital (AWH) conducted for one year i.e. 1st Jan 2020 to 31st Dec 2020. AWH is a 329-bedded, multispecialty secondary care facility, part of Hamad Medical Corporation (HMC), Qatar’s Governmental Healthcare organization in Qatar. In 2020, AWH had 11,862 inpatient admissions which are inclusive of Adult, Pediatric, Neonatal, Geriatric populations. There were also 1,184 admissions to the different Intensive Care Units (Medical, Surgical, Pediatric, and Neonatal). AWH has a Rapid Response Team (RRT) and Code Blue (CPR) team which is responsible for the respective codes. Code Blue team comprises one ICU Physician, one Respiratory Therapist, one Registered Nurse, all trained in Advanced Life Support. All CPR attempts were documented and recorded in CPR Record Sheets which were reviewed and the Electronic Medical Records (Cerner) were sourced for data gathering. One copy of CPR record sheets was kept in Cerner (Patient File) and one was sent to the Quality department for review/audit. After obtaining the list of CPR attempts over 2020, patients were identified, and medical records reviewed. The parameters recorded were demographic information, location, comorbidities and other relevant history, duration of CPR, initial CPR outcome, patient disposition, patient status on disposition (quality of life), etc. All these variables were considered to support the objective of this study i.e. to perform a descriptive analysis of in-hospital CPR. Based on the analysis of 110 patients for whom CPR was done, the percentage of immediate survival on the initial CPR was 53.64%. However, only 8.18% were eventually discharged to home while 11.82% were discharged to other HMC facilities.
本研究是对Al Wakra医院(AWH)一年内(即2020年1月1日至2020年12月31日)进行的所有心肺复苏(CPR)尝试的回顾性描述性综述。AWH是一家拥有329个床位的多专业二级医疗机构,是卡塔尔政府医疗机构哈马德医疗公司(HMC)的一部分。2020年,全国妇产医院有11,862名住院病人,包括成人、儿科、新生儿和老年人口。不同的重症监护病房(内科、外科、儿科和新生儿)也收治了1 184人。AWH有一个快速反应小组(RRT)和一个蓝色代码小组(CPR)负责各自的代码。蓝色警报小组包括一名重症监护室医生,一名呼吸治疗师,一名注册护士,都接受过高级生命支持训练。所有心肺复苏术尝试都记录在心肺复苏术记录表中,并审查电子病历(Cerner)以收集数据。一份CPR记录表保存在Cerner(患者档案),一份送质量部审核。在获得2020年心肺复苏术尝试清单后,确定了患者身份,并审查了医疗记录。记录的参数包括人口统计信息、地点、合并症及其他相关病史、CPR持续时间、CPR初始结果、患者倾向、患者倾向状态(生活质量)等。所有这些变量都被认为支持本研究的目的,即对院内心肺复苏术进行描述性分析。通过对110例实施心肺复苏术的患者的分析,首次心肺复苏术的即时生存率为53.64%。然而,只有8.18%的人最终出院回家,而11.82%的人出院到医疗保健中心的其他设施。
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引用次数: 0
New Product Launches, Approvals, And Acquisitions to Expand Pain Management Devices Portfolio Worldwide 新产品发布,批准和收购,以扩大全球疼痛管理设备组合
Pub Date : 2022-03-29 DOI: 10.31579/2693-4779/084
Ashish M. Gujrathi
Advancements in technology and the approach of innovation by healthcare companies led to considerable improvements in pain management devices over the past years. From management of chronic pain to reliving post-operative pain, innovative devices have been making their way into the world. Leading device manufacturers have been developing and launching their new products that would relive and manage different kinds of pain. From knee braces to cap-sized neuromodulation devices, new products have been launched to help people improve the quality of their lives. Some of the products are in the development stage, while some have been commercialized and launched. The trend of innovation is expected to bring breakthrough devices in the coming years.
在过去的几年里,技术的进步和医疗保健公司的创新方法导致了疼痛管理设备的显著改进。从慢性疼痛的管理到术后疼痛的缓解,创新的设备已经进入世界。领先的设备制造商一直在开发和推出他们的新产品,以缓解和管理各种各样的疼痛。从膝盖支架到帽子大小的神经调节装置,新产品已经推出,以帮助人们提高生活质量。有的产品还在研发阶段,有的已经商业化上市。创新的趋势有望在未来几年带来突破性的设备。
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引用次数: 0
Acute Hepatitis E With Elevated Alpha Fetoprotein: A Case Report and Literature Review 急性戊型肝炎伴甲胎蛋白升高1例并文献复习
Pub Date : 2022-03-29 DOI: 10.31579/2693-4779/088
Wei Liu, Yuan Lu, Shijue Zheng
Acute Hepatitis E (AHE) is an acute self-limiting disease caused by Hepatitis E virus infection, which is mostly transmitted through the digestive tract. A few patients can lead to severe hepatitis and liver failure. Alpha fetoprotein is a sensitive serological marker of primary liver cancer. AFP may increase in different degrees in patients with gastrointestinal tumors, endodermal sinus tumors and germ cell carcinoma originating from endoderm. In addition, serum AFP can also be elevated in varying degrees in non-neoplastic acute and chronic liver diseases. We here report a case of Acute Hepatitis E with elevated serum AFP, and discuss the clinical characteristics and significance of elevated AFP in Acute Hepatitis E through literature review.
急性戊型肝炎(AHE)是由戊型肝炎病毒感染引起的一种急性自限性疾病,主要通过消化道传播。少数患者可导致严重的肝炎和肝功能衰竭。甲胎蛋白是原发性肝癌的敏感血清学标志物。胃肠道肿瘤、内胚层窦肿瘤和源自内胚层的生殖细胞癌患者AFP均有不同程度的升高。此外,血清AFP在非肿瘤性急慢性肝病中也可不同程度升高。我们报告1例急性戊型肝炎伴血清AFP升高的病例,并通过文献复习探讨急性戊型肝炎伴AFP升高的临床特点及意义。
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引用次数: 0
Inclusion of Immunotherapy in the Management of Primary and Metastatic Malignant Tumours of the Kidney Including Adult Renal Cell Carcinoma: A Review and Update 包括成人肾细胞癌在内的原发性和转移性肾恶性肿瘤的免疫治疗:综述和最新进展
Pub Date : 2022-02-25 DOI: 10.31579/2693-4779/071
A. Kodzo-Grey Venyo
Various tumours of primary malignant tumours of the kidney exist bot the most common type of primary malignant tumour of the kidney is renal cell carcinoma (clear cell carcinoma of the kidney tend to be encountered most often globally. The biological behaviour of a kidney tumour tends to depend upon the size of the tumour, the histological grade and stage of the tumour. Most kidney tumours that are very small (less than 7 cm) and localized to the kidney of low-grade histopathology pattern tend not to be aggressive or develop further so these days a number of patients who have small low-grade / low stage renal tumours tend to be offered expectant management of regular periodical radiology imaging and if there is any subsequent evidence of increase in the size of small localized kidney tumours, then patients who have these tumours tend to be offered treatment of curative intent. Larger localised kidney tumours that are clear cell / renal cell carcinoma tend to be treated by surgical complete excision of the tumour with the undertaking of partial nephrectomy or radical complete nephrectomy, Individuals who have locally advanced tumours tend to be treated by means of radical nephrectomy plus excision of the lymph nodes within the para-renal and para-aortic region plus adjuvant radiotherapy plus / chemotherapy. Some of the treatment options that have been used form the management of metastatic renal cell carcinoma do include surgery, immunotherapy, targeted treatment, radiotherapy, and chemotherapy. Some of the systemic font-line treatment options which are available include: immune check point inhibitor based combination (IBC) treatment with the inclusion of pembrozulimab / axitinib, nivolumab / pilimumab, as well as avelimab / axitinib. It has been iterated that with unusual exceptions, the utilization of monotherapy with vascular growth factor tyrosine kinase inhibitors or mTOR inhibitors have been considered not to be appropriate options of treatment with regard to the front-line setting. Some of the immunotherapy strategies that are utilized do include: cancer vaccines, oncolytic viruses, adoptive transfer of ex vivo activated T as well as natural killer cells and administration of antibodies or recombinant proteins which either co-stimulate cells or bloc the so-called immune checkpoint pathways. The success of many immunotherapy treatment options recently, including monoclonal antibody blocking of cytotoxic T lymphocyte-associated protein 4 (CTLA-4) as well as programmed cell death protein 1 (PD1), had boosted the development of immunotherapy and this has been ensued by description of new therapeutic targets and schemes that combine various immunology agents at a fast pace. Despite the confirmed efficacy of frontline IBC in the treatment of renal cell carcinomas, majority of the patients would eventually require the need to undergo additional options of treatment and based upon this oncologists have been advised to take into consideration this k
肾脏原发恶性肿瘤存在多种肿瘤,其中最常见的肾脏原发恶性肿瘤类型是肾细胞癌(全球范围内最常遇到肾透明细胞癌)。肾肿瘤的生物学行为往往取决于肿瘤的大小、组织学分级和肿瘤的分期。大多数很小的肾肿瘤(小于7厘米)局限于肾脏的低级别组织病理学模式往往不具有侵袭性或进一步发展,所以现在许多患有小的低级别/低阶段肾肿瘤的患者倾向于接受定期放射学成像的预期治疗如果有任何后续证据表明小的局限性肾肿瘤的大小增加,然后,患有这些肿瘤的患者往往会接受治疗。较大的透明细胞/肾细胞癌的局部肾肿瘤倾向于手术完全切除肿瘤,同时进行部分肾切除术或根治性完全肾切除术,局部晚期肿瘤患者倾向于根治性肾切除术+肾旁和主动脉旁淋巴结切除术+辅助放疗/化疗。转移性肾细胞癌的一些治疗选择包括手术、免疫治疗、靶向治疗、放疗和化疗。一些可用的系统性字体线治疗方案包括:基于免疫检查点抑制剂的联合(IBC)治疗,包括pembrozulimab / axitinib, nivolumab / pilimumab以及avelimab / axitinib。除了罕见的例外,使用血管生长因子酪氨酸激酶抑制剂或mTOR抑制剂的单一疗法被认为不是关于前线环境的适当治疗选择。使用的一些免疫治疗策略包括:癌症疫苗、溶瘤病毒、体外活化T细胞的过继转移以及自然杀伤细胞,以及使用抗体或重组蛋白,这些抗体或重组蛋白要么共同刺激细胞,要么封锁所谓的免疫检查点途径。最近许多免疫疗法治疗方案的成功,包括单克隆抗体阻断细胞毒性T淋巴细胞相关蛋白4 (CTLA-4)和程序性细胞死亡蛋白1 (PD1),促进了免疫疗法的发展,随之而来的是新的治疗靶点和方案的描述,这些方案结合了各种免疫药物。尽管一线IBC治疗肾细胞癌的疗效得到证实,但大多数患者最终仍需要接受额外的治疗方案,因此建议肿瘤学家在转向其他形式的治疗时仔细考虑这一知识,特别是在药物无法耐受或疾病明显进展的情况下。考虑到肾恶性肿瘤的生物学行为取决于肿瘤的大小、组织学细胞类型、组织学分级和分期,肿瘤学家和泌尿科医生倾向于在晚期/转移性肾肿瘤的治疗中使用不同的治疗方案。不同的免疫疗法有很多常见的副作用也有一些罕见的严重的副作用和与免疫疗法相关的并发症这是临床医生和患者需要了解的。近年来,各种免疫治疗方案已被用于各种恶性肾肿瘤的治疗,但免疫治疗似乎更有利于高风险肾肿瘤组的治疗以及晚期/转移性肾肿瘤的治疗。然而,免疫治疗确实与包括肾病在内的许多副作用有关,临床医生必须了解晚期/转移性肾肿瘤免疫治疗的所有并发症和并发症。考虑到局部肿瘤的根治性手术切除往往是非常有效的,并且具有良好的长期预后,在大多数情况下,使用免疫疗法治疗这类病例并不是很必要。然而,与早期无法获得免疫治疗的晚期/转移性肾肿瘤的治疗相比,免疫治疗已被证明与预后改善相关。
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引用次数: 0
Neurological complications related to COVID-19 infections following exposure to airborne aerosol particles 暴露于空气中气溶胶颗粒后与COVID-19感染相关的神经系统并发症
Pub Date : 2022-02-25 DOI: 10.31579/2693-4779/081
M. Ehsanifar, M. Rafati, Jie Wang
Some of the recent researches show that air pollutants such as particulate matter (PM), including fine particles (PM<2.5μm, PM2.5) and very fine particles (PM <0.1μm, PM 0.1) can reach the brain and affect CNS health. Neurological complications with Coronavirus Disease 2019 (COVID-19) have been observed. The aim of this review the relationship between air pollutants exposure and COVID-19 was focused on the role of airborne aerosol particles in the prevalence of the disease, as well as the neurological effects of COVID-19. It is not yet clear how the virus is transmitted from one sick person to another and why it is so transmissible. Viruses can be probably transmitted through speech and exhalation aerosols. Findings show that SARS-CoV-2 aerosol transmission is possible. Spike (S) proteins of SARS‑CoV‑2 determine tissue tropism using an angiotensin-converting enzyme receptor type2 (ACE-2) to bind to the cells. ACE-2 receptor is found in the tissues of the nervous system. Neurological disorders that occur with COVID-19 can have many pathophysiological backgrounds. Some are the result of a direct viral attack on tissues of the nervous system, others appear to be an autoimmune process post-viral, and still others appear to be the result of systemic and metabolic complications associated with critical illness.
最近的一些研究表明,空气污染物如颗粒物(PM),包括细颗粒物(PM<2.5μm, PM2.5)和极细颗粒物(PM< 0.1μm, PM 0.1)可以到达大脑并影响中枢神经系统的健康。已观察到2019冠状病毒病(COVID-19)的神经系统并发症。本文综述了空气污染物暴露与COVID-19之间的关系,重点关注空气中气溶胶颗粒在疾病流行中的作用,以及COVID-19的神经系统影响。目前尚不清楚这种病毒是如何从一个病人传染给另一个病人的,以及它为何具有如此强的传染性。病毒可能通过说话和呼出的气溶胶传播。研究结果表明,SARS-CoV-2有可能通过气溶胶传播。SARS‑CoV‑2的刺突(S)蛋白利用血管紧张素转换酶受体2型(ACE-2)与细胞结合来决定组织趋向性。ACE-2受体存在于神经系统组织中。与COVID-19一起发生的神经系统疾病可能有许多病理生理背景。一些是病毒直接攻击神经系统组织的结果,另一些似乎是病毒后的自身免疫过程,还有一些似乎是与危重疾病相关的全身和代谢并发症的结果。
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引用次数: 4
Major Problems Confronting the Covid-19 Pandemic 新冠肺炎大流行面临的主要问题
Pub Date : 2022-02-25 DOI: 10.31579/2693-4779/075
Jsm Leung
Beginning from December 2019, the present COVID-19 has ravaged the world for almost two years. While it appears to have peaked in many countries, it is still not under control in other areas. Worse still, new mutations of the virus continue to drive new waves of infection which manage to break through natural and human measures of defence.
2019年12月以来,新冠肺炎疫情肆虐全球已近两年。虽然它在许多国家似乎已经达到顶峰,但在其他地区仍未得到控制。更糟糕的是,病毒的新突变继续引发新的感染浪潮,突破了自然和人类的防御措施。
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引用次数: 0
Gorlin Goltz Syndrome: A Disease in Disguise 戈林·戈尔茨综合症:伪装的疾病
Pub Date : 2022-02-25 DOI: 10.31579/2693-4779/080
N. Jain, Ajay K. Pillai, Nisha Mishra, MD Ishtiyak, G. Reddy, S. Nahar
Gorlin Goltz syndrome also known as nevoid basal cell carcinoma is an autosomal dominant inherited disorder caused due to mutation in patched (PTCH) tumor suppressor gene present in the 9q chromosome. Gorlin goltz syndrome display diversified odontogenic as well as systemic manifestations. Early diagnosis and prompt treatment is mandatory to decrease morbidity and mortality. Here we present a subtle case report of a 17-year-old boy who presented with multiple odontogenic keratocysts of the mandible and maxilla which upon further examination was diagnosed as Gorlin Goltz Syndrome.
Gorlin - Goltz综合征又称瘤状基底细胞癌,是一种常染色体显性遗传疾病,由9q染色体上的肿瘤抑制基因PTCH突变引起。戈林戈尔茨综合征表现出多种牙源性和全身性表现。早期诊断和及时治疗是降低发病率和死亡率的必要条件。在这里我们提出一个细微的病例报告,一个17岁的男孩提出了多个牙源性角化囊肿的下颌骨和上颌骨,经进一步检查被诊断为Gorlin - Goltz综合征。
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引用次数: 0
Pregnancy Following D & C and Hydrotubation After Failed IUI - A Rare Case Report. D & C后妊娠及IUI失败后置管-一例罕见病例报告。
Pub Date : 2022-02-25 DOI: 10.31579/2693-4779/082
Kalyani singh
Infertility is a defined as failure to achieve a pregnancy after 12 months or more of regular, unprotected sex. It affects millions of people of reproductive age worldwide and has an impact on their families and communities. Having babies gives an unparalleled satisfaction to parents and lack of baby may make one’s life miserable at times. Here we are presenting a case where a lady who got pregnant and gave birth to a child just following Dilatation & Curettage and Hydrotuabtion (tubal flushing) when other measures like diagnostic laparoscopy and IUI failed. Dilatation and curettage and tubal patency test/ hydrotubation (D & C & TPT} was an old diagnostic procedure before the advent of ultrasonography and laparoscopic technique. It is an easy, minor operative procedure to evaluate the condition of uterus and tubes. Examination under anesthesia gives information regarding parametrium also to a considerable extent.
不孕症的定义是在12个月或更长时间的常规、无保护的性行为后仍未能怀孕。它影响到全世界数以百万计的育龄人口,并对他们的家庭和社区产生影响。有孩子给父母带来了无与伦比的满足感,没有孩子有时会让一个人的生活很痛苦。在这里,我们介绍一个案例,一位女士怀孕并生下了一个孩子,只是在扩张和刮宫和输卵管冲洗(输卵管冲洗)后,其他措施,如腹腔镜诊断和人工授精都失败了。在超声检查和腹腔镜技术出现之前,扩张、刮除和输卵管通畅试验/插管(d&c&tpt)是一种古老的诊断方法。这是一个简单,小的手术程序,以评估子宫和输卵管的状况。麻醉下的检查也在相当程度上提供了有关参数的信息。
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引用次数: 0
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Applied Clinical Research, Clinical Trials and Regulatory Affairs
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