Background Durable polymers used for first-generation drug-eluting stents （DES） potentially contribute to persistent inflammation and late DES thrombosis. We report the first in human experience with the rapamycin-e...Background Durable polymers used for first-generation drug-eluting stents （DES） potentially contribute to persistent inflammation and late DES thrombosis. We report the first in human experience with the rapamycin-eluting biodegradable polymer coated cobalt-chromium FIREHAWK stent with abluminal groove. Methods A total of 21 patients with stable or unstable angina, or prior myocardial infarction, with single de novo native coronary stenoses 〈30 mm in length in vessel sizes ranging from 2.25 to 4.0 mm were enrolled. The primary endpoint was major adverse cardiac events （MACE） at 30 days defined as the composite of cardiac death, myocardial infarction （Q and non-Q）, or ischemia-driven target lesion revascularization. Secondary endpoints include device, lesion, and clinical success rates, 4-month in-stent late lumen loss by quantitative coronary angiography （QCA）, proportion of uncovered or malapposed stent struts by optical coherence tomograpphy （OCT） at 4 months, and MACE at 4, 12, 24 and 36-month follow-up. Results Device success was 95.7%, lesion and clinical success was 100.0%. There were no MACE events at 30 days. One patient died of non-cardiac hemorrhagic stroke 5 days after index procedure. At 4 months, in-stent late loss was （0.13±0.18） mm, and complete strut coverage was 96.2% by OCT with 0.1% strut malapposition. At 4-month follow-up there was no additional MACE events, and a single target vessel （non-target lesion） revascularization. Conclusions The FIREHAWK abluminal groove biodegradable polymer rapamycin-eluting stent demonstrated feasibility, safety and efficacy in this first in human experience. OCT findings indicated excellent stent strut coverage 4 months after implantation. Larger studies are required to confirm whether the early FIREHAWK stent results translate into longer term restenosis and thrombosis benefits.展开更多
BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient mana...BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.展开更多
Pregnancy is a choreographed physiological phenomenon that involves maternal-fetal cross-talk.Elucidating the cellular and molecular mechanisms involved in this communication will allow us to develop therapies for ges...Pregnancy is a choreographed physiological phenomenon that involves maternal-fetal cross-talk.Elucidating the cellular and molecular mechanisms involved in this communication will allow us to develop therapies for gestational complications.Little is known about the role of natural killer(NK)cells in the uterine microenvironment.In a recent study,Fu et al.(2017)used state-of-art technologies and showed that NK cells stimulate fetal growth via growth-promoting factors.展开更多
Cerebral pericytes are perivascular cells that stabilize blood vessels. Little is known about the plasticity of pericytes in the adult brain in vivo. Recently, using stateof-the-art technologies, including two-photon ...Cerebral pericytes are perivascular cells that stabilize blood vessels. Little is known about the plasticity of pericytes in the adult brain in vivo. Recently, using stateof-the-art technologies, including two-photon microscopy in combination with sophisticated Cre/loxP in vivo tracing techniques, a novel role of pericytes was revealed in vascular remodeling in the adult brain. Strikingly, after pericyte ablation, neighboring pericytes expand their processes and prevent vascular dilatation. This new knowledge provides insights into pericyte plasticity in the adult brain.展开更多
Background Implantation of either bare metal stent （BMS） or drug-eluting stent （DES） has been used in every day practice for patients with unprotected left main stenosis （UPLMS）. There are still a lack of data r...Background Implantation of either bare metal stent （BMS） or drug-eluting stent （DES） has been used in every day practice for patients with unprotected left main stenosis （UPLMS）. There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis （ISR）. The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events （MACE）, including cardiac death, myocardial infarction （Ml）, and target vessel revascularization （TVR）.Results UPLMS ISR rate was 14.8% （n=73, 15.7% after BMS, 14.5% for DES） after average of （3.89±2.01） years （range from 1 to 10.5 years） follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention （PCI） was used in 62 （84.9%） patients, with medicine only in 9 （12.4%） and coronary artery bypass graft （CABG） in 2 （2.7%）. Most repeat PCI patients were with unstable angina （87.0%）, and had decreased left ventricular ejection fraction （（42.58±5.12）%）, fewer focal/ostial left circumflex branch （LCX） lesions, in relative to medicine only group. After （31.9±23.3） months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 （1.4%） patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.展开更多
The response of yeast to sharp environmental increases in calcium concentration has been extensively studied. However, systematic studies of the response under more general changes are still lacking. Only limited expl...The response of yeast to sharp environmental increases in calcium concentration has been extensively studied. However, systematic studies of the response under more general changes are still lacking. Only limited exploration of cellular responses has been conducted where calcium concentration is decreased. This article describes a set of luminometric experiments that monitor the cytosolic calcium concentration under changing external concentration conditions. As a decrease in external calcium concentrations requires the use of large sample volumes, the experiments require the use of equipment adapted for this purpose. We describe the modification of commercial luminometric equipment to make the exploration possible. We explore the yeast cellular behavior when an increase in external calcium concentration is followed by a decrease in external calcium concentration. We compare these results with those from the case of a double pulse of concentration increase. Results from the experiment show that the first, concentration increasing pulse produces the well-known sharp increase in cytosolic calcium followed by calcium sequestration to return to a cytosolic concentration near its initial condition. Surprisingly, the calcium decrease step shows similar results with a cytosolic increase followed by a return to lower levels. The results suggest the presence of a calcium sensing mechanism regulating calcium influx from external sources. This mechanism would produce channel opening as a response to any changes in external concentration, be it an enhancement or a depletion.展开更多
AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal compla...AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.展开更多
TRALI是美国目前最常见的输血引起死亡的原因，超过ABO不相容和细菌污染。虽然仍不知道美国TRALI的实际发生率，但随着认识的提高，文献中TRALI病例报告数量自1985年以来显著增加。但对输血引起的许多类似的临床并发症仍然缺乏了解。200...TRALI是美国目前最常见的输血引起死亡的原因，超过ABO不相容和细菌污染。虽然仍不知道美国TRALI的实际发生率，但随着认识的提高，文献中TRALI病例报告数量自1985年以来显著增加。但对输血引起的许多类似的临床并发症仍然缺乏了解。2004年4月，在加拿大的多伦多召开了一次题为“关于TRALI的认识”的交流讨论会议。由加拿大血液机构和Hma-Qubec发起会议，得到了国际输血协会下属的BEST（Biomedical Excellence for Safer Transfusion）委员会的支持。许多专家提供了资料，大约240人出席了会议，包括会议专业组的11名成员。他们广泛代表了内科和其他学科的专家，如输血医学、流行病学、免疫学、麻醉学、急救医学、伦理学以及定期捐血者和长期受血者。完整的会议记录已经发表。展开更多
Background The difference in clinical outcome between paclitaxal-eluting stents （PES） and sirolimus-eluting stents with bio-degradable polymer （SES-BDP） for bifurcation lesions remains unclear. The present study a...Background The difference in clinical outcome between paclitaxal-eluting stents （PES） and sirolimus-eluting stents with bio-degradable polymer （SES-BDP） for bifurcation lesions remains unclear. The present study aimed to investigate the one-year clinical outcome after DK crush stenting using PES （maxusTM） MS. SES-BDP （ExcelTM） from our database. Methods A total of 275 patients （90 from the DKCRUSH-I and 185 from the DKCRUSH-II study） were studied. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at 12 months; including cardiac death, myocardial infarction （MI）, or target vessel revascularization （TVR）. The rate of binary restenosis and stent thrombosis served as secondary endpoints. Results At follow-up, minimal luminal diameter （MLD） in the Taxus group was （2.11＋0.66） mm, with resultant increased target lesion revascularization （TLR） 12.2% and TVR 14.4%, significantly different from the Excel group; （2.47±0.56） mm, P 〈0.001, 3.2%, P=0.006, 4.9%, P=0.019, respectively. As a result there was a significant difference in MACE between the Taxus （20.0%） and Excel （10.3%, P=0.038） groups. Overall stent thrombosis was monitored in 11 patients （4.0%）, with five in the Excel group （2.7%） and six in the Taxus group （6.7%）. All stent thrombosis in the Excel group was classified as early, and all were defined as late in the Taxus group. Conclusion The Excel stent had lower rate of stent thrombosis, TLR, TVR, and composite MACE at 12-month after an indexed stenting procedure, compared to the Taxus stent.展开更多
With the advent of modern techniques, drugs, and monitoring, general anesthesia has come to be considered an unlikely cause of harm, particularly for healthy patients. While this is largely true, newly emerging clinic...With the advent of modern techniques, drugs, and monitoring, general anesthesia has come to be considered an unlikely cause of harm, particularly for healthy patients. While this is largely true, newly emerging clinical and laboratory studies have sug- gested that exposure to anesthetic agents during early childhood may have long-lasting adverse effects on cognitive function. This concern has been the focus of intense study in the field of anesthesia research. A recent high-profile review by Rappaport et al. （2015） concluded that while many questions remain un- answered, there is strong evidence from laboratory studies that commonly used anesthetics interfere with brain development and that clinical studies suggest a correlation between early childhood exposure to these agents and subsequent effects on learning and cognition. The issue is of sufficient public health importance that a public-private partnership known as Smar- Tots （Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots） was developed by the FDA to study pediatric anesthetic neurotoxicity. The mechanism of injury underlying this phe- nomenon has yet to be fully elucidated, and there is evidence to suggest that anesthetics may have direct cytotoxic effects on neurons leading to cell death or suppressed neurogenesis （Strat- mann et al., 2010） and that they may interfere with key pro- cesses in neuronal growth and development that underlie brain circuit development （Wagner et al., 2014）.展开更多
Fibro-muscular dysplasia(FMD)is a rare but well documented disease with multiple arterial aneurysms. The patients,usually women,present with various clinical manifestations according to the specific arteries that are ...Fibro-muscular dysplasia(FMD)is a rare but well documented disease with multiple arterial aneurysms. The patients,usually women,present with various clinical manifestations according to the specific arteries that are affected.Typical findings are aneurysmatic dilatations of medium-sized arteries.The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too.The typical angiographic picture is that of a"string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman,who was hospitalized due to intractable abdominal pain.A routine work-up revealed a liver mass near the portal vein.Before a definite diagnosis was reached,the patient developed massive upper gastrointestinal bleeding.In order to control the hemorrhage,celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery.Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery.The immediate results were satisfactory,and the 5 years follow-up revealed absence of any clinical symptoms.展开更多
Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We r...Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery (RCA) that were related to the aneurysm, restenosis, thrombosis, and vessel occlusion.展开更多
It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented gray...It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,展开更多
Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We r... Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……展开更多
文摘Background Durable polymers used for first-generation drug-eluting stents （DES） potentially contribute to persistent inflammation and late DES thrombosis. We report the first in human experience with the rapamycin-eluting biodegradable polymer coated cobalt-chromium FIREHAWK stent with abluminal groove. Methods A total of 21 patients with stable or unstable angina, or prior myocardial infarction, with single de novo native coronary stenoses 〈30 mm in length in vessel sizes ranging from 2.25 to 4.0 mm were enrolled. The primary endpoint was major adverse cardiac events （MACE） at 30 days defined as the composite of cardiac death, myocardial infarction （Q and non-Q）, or ischemia-driven target lesion revascularization. Secondary endpoints include device, lesion, and clinical success rates, 4-month in-stent late lumen loss by quantitative coronary angiography （QCA）, proportion of uncovered or malapposed stent struts by optical coherence tomograpphy （OCT） at 4 months, and MACE at 4, 12, 24 and 36-month follow-up. Results Device success was 95.7%, lesion and clinical success was 100.0%. There were no MACE events at 30 days. One patient died of non-cardiac hemorrhagic stroke 5 days after index procedure. At 4 months, in-stent late loss was （0.13±0.18） mm, and complete strut coverage was 96.2% by OCT with 0.1% strut malapposition. At 4-month follow-up there was no additional MACE events, and a single target vessel （non-target lesion） revascularization. Conclusions The FIREHAWK abluminal groove biodegradable polymer rapamycin-eluting stent demonstrated feasibility, safety and efficacy in this first in human experience. OCT findings indicated excellent stent strut coverage 4 months after implantation. Larger studies are required to confirm whether the early FIREHAWK stent results translate into longer term restenosis and thrombosis benefits.
文摘BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.
基金A.B.is supported by a grant from Instituto Serrapilheira/Serra-1708-15285,a grant from Pró-reitoria de Pesquisa/Universidade Federal de Minas Gerais(PRPq/UFMG)(Edital 05/2016)a grant from FAPEMIG[Rede Mineira de Engenharia de Tecidos e Terapia Celular(REMETTEC,RED-00570-16)]+2 种基金a grant from FAPEMIG[Rede De Pesquisa Em Doenças Infecciosas Humanas E Animais Do Estado De Minas Gerais(RED-00313-16)]A.M.is supported by the National Institute of Health(1R01CA179072-01A1)by the American Cancer Society Mentored Research Scholar grant(124443-MRSG-13-121-01-CDD).
文摘Pregnancy is a choreographed physiological phenomenon that involves maternal-fetal cross-talk.Elucidating the cellular and molecular mechanisms involved in this communication will allow us to develop therapies for gestational complications.Little is known about the role of natural killer(NK)cells in the uterine microenvironment.In a recent study,Fu et al.(2017)used state-of-art technologies and showed that NK cells stimulate fetal growth via growth-promoting factors.
基金Grants from Instituto Serrapilheira/Serra-1708-15285Pro-reitoria de Pesquisa/Universidade Federal de Minas Gerais(PRPq/UFMG)(Edital 05/2016)+4 种基金the National Institute of Science and Technology in Theranostics and Nanobiotechnology(CNPq/CAPES/FAPEMIG,Process No.465669/2014-0)FAPEMIG [Rede Mineira de Engenharia de Tecidos e Terapia Celular(REMETTEC,RED-00570-16)]FAPEMIG [Rede De Pesquisa Em Doencas Infecciosas Humanas E Animais Do Estado De Minas Gerais(RED-00313-16)]supported by the National Institute of Health(1R01CA179072-01A1)an American Cancer Society Mentored Research Scholar Grant(124443-MRSG-13-121-01-CDD)
文摘Cerebral pericytes are perivascular cells that stabilize blood vessels. Little is known about the plasticity of pericytes in the adult brain in vivo. Recently, using stateof-the-art technologies, including two-photon microscopy in combination with sophisticated Cre/loxP in vivo tracing techniques, a novel role of pericytes was revealed in vascular remodeling in the adult brain. Strikingly, after pericyte ablation, neighboring pericytes expand their processes and prevent vascular dilatation. This new knowledge provides insights into pericyte plasticity in the adult brain.
文摘Background Implantation of either bare metal stent （BMS） or drug-eluting stent （DES） has been used in every day practice for patients with unprotected left main stenosis （UPLMS）. There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis （ISR）. The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events （MACE）, including cardiac death, myocardial infarction （Ml）, and target vessel revascularization （TVR）.Results UPLMS ISR rate was 14.8% （n=73, 15.7% after BMS, 14.5% for DES） after average of （3.89±2.01） years （range from 1 to 10.5 years） follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention （PCI） was used in 62 （84.9%） patients, with medicine only in 9 （12.4%） and coronary artery bypass graft （CABG） in 2 （2.7%）. Most repeat PCI patients were with unstable angina （87.0%）, and had decreased left ventricular ejection fraction （（42.58±5.12）%）, fewer focal/ostial left circumflex branch （LCX） lesions, in relative to medicine only group. After （31.9±23.3） months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 （1.4%） patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.
文摘The response of yeast to sharp environmental increases in calcium concentration has been extensively studied. However, systematic studies of the response under more general changes are still lacking. Only limited exploration of cellular responses has been conducted where calcium concentration is decreased. This article describes a set of luminometric experiments that monitor the cytosolic calcium concentration under changing external concentration conditions. As a decrease in external calcium concentrations requires the use of large sample volumes, the experiments require the use of equipment adapted for this purpose. We describe the modification of commercial luminometric equipment to make the exploration possible. We explore the yeast cellular behavior when an increase in external calcium concentration is followed by a decrease in external calcium concentration. We compare these results with those from the case of a double pulse of concentration increase. Results from the experiment show that the first, concentration increasing pulse produces the well-known sharp increase in cytosolic calcium followed by calcium sequestration to return to a cytosolic concentration near its initial condition. Surprisingly, the calcium decrease step shows similar results with a cytosolic increase followed by a return to lower levels. The results suggest the presence of a calcium sensing mechanism regulating calcium influx from external sources. This mechanism would produce channel opening as a response to any changes in external concentration, be it an enhancement or a depletion.
文摘AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.
文摘TRALI是美国目前最常见的输血引起死亡的原因，超过ABO不相容和细菌污染。虽然仍不知道美国TRALI的实际发生率，但随着认识的提高，文献中TRALI病例报告数量自1985年以来显著增加。但对输血引起的许多类似的临床并发症仍然缺乏了解。2004年4月，在加拿大的多伦多召开了一次题为“关于TRALI的认识”的交流讨论会议。由加拿大血液机构和Hma-Qubec发起会议，得到了国际输血协会下属的BEST（Biomedical Excellence for Safer Transfusion）委员会的支持。许多专家提供了资料，大约240人出席了会议，包括会议专业组的11名成员。他们广泛代表了内科和其他学科的专家，如输血医学、流行病学、免疫学、麻醉学、急救医学、伦理学以及定期捐血者和长期受血者。完整的会议记录已经发表。
文摘Background The difference in clinical outcome between paclitaxal-eluting stents （PES） and sirolimus-eluting stents with bio-degradable polymer （SES-BDP） for bifurcation lesions remains unclear. The present study aimed to investigate the one-year clinical outcome after DK crush stenting using PES （maxusTM） MS. SES-BDP （ExcelTM） from our database. Methods A total of 275 patients （90 from the DKCRUSH-I and 185 from the DKCRUSH-II study） were studied. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at 12 months; including cardiac death, myocardial infarction （MI）, or target vessel revascularization （TVR）. The rate of binary restenosis and stent thrombosis served as secondary endpoints. Results At follow-up, minimal luminal diameter （MLD） in the Taxus group was （2.11＋0.66） mm, with resultant increased target lesion revascularization （TLR） 12.2% and TVR 14.4%, significantly different from the Excel group; （2.47±0.56） mm, P 〈0.001, 3.2%, P=0.006, 4.9%, P=0.019, respectively. As a result there was a significant difference in MACE between the Taxus （20.0%） and Excel （10.3%, P=0.038） groups. Overall stent thrombosis was monitored in 11 patients （4.0%）, with five in the Excel group （2.7%） and six in the Taxus group （6.7%）. All stent thrombosis in the Excel group was classified as early, and all were defined as late in the Taxus group. Conclusion The Excel stent had lower rate of stent thrombosis, TLR, TVR, and composite MACE at 12-month after an indexed stenting procedure, compared to the Taxus stent.
文摘With the advent of modern techniques, drugs, and monitoring, general anesthesia has come to be considered an unlikely cause of harm, particularly for healthy patients. While this is largely true, newly emerging clinical and laboratory studies have sug- gested that exposure to anesthetic agents during early childhood may have long-lasting adverse effects on cognitive function. This concern has been the focus of intense study in the field of anesthesia research. A recent high-profile review by Rappaport et al. （2015） concluded that while many questions remain un- answered, there is strong evidence from laboratory studies that commonly used anesthetics interfere with brain development and that clinical studies suggest a correlation between early childhood exposure to these agents and subsequent effects on learning and cognition. The issue is of sufficient public health importance that a public-private partnership known as Smar- Tots （Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots） was developed by the FDA to study pediatric anesthetic neurotoxicity. The mechanism of injury underlying this phe- nomenon has yet to be fully elucidated, and there is evidence to suggest that anesthetics may have direct cytotoxic effects on neurons leading to cell death or suppressed neurogenesis （Strat- mann et al., 2010） and that they may interfere with key pro- cesses in neuronal growth and development that underlie brain circuit development （Wagner et al., 2014）.
文摘Fibro-muscular dysplasia(FMD)is a rare but well documented disease with multiple arterial aneurysms. The patients,usually women,present with various clinical manifestations according to the specific arteries that are affected.Typical findings are aneurysmatic dilatations of medium-sized arteries.The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too.The typical angiographic picture is that of a"string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman,who was hospitalized due to intractable abdominal pain.A routine work-up revealed a liver mass near the portal vein.Before a definite diagnosis was reached,the patient developed massive upper gastrointestinal bleeding.In order to control the hemorrhage,celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery.Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery.The immediate results were satisfactory,and the 5 years follow-up revealed absence of any clinical symptoms.
文摘Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery (RCA) that were related to the aneurysm, restenosis, thrombosis, and vessel occlusion.
文摘It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,
文摘 Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……
