Acute Kidney Injury in Adults: An Underdiagnosed Condition

Acute kidney injury (AKI) is a complex disease process that is increasingly common and has an increased rate of adverse outcomes and mortality. It is commonly underdiagnosed in inpatient and community settings by many providers. This article is a comprehensive review of AKI from risk factors to diagnosis to management and follow-up.     

SNP interactions of Helicobacter pylori-related host genes PGC,PTPN11, IL1B,and TLR4 in susceptibility to gastric carcinogenesis

A series of host genes that respond to Helicobacter pylori (H. pylori) infection are involved in the process of gastric carcinogenesis. This study sought to examine interactions among polymorphisms of H. pylori-related genes PGC, PTPN11, TLR4, and IL1B and assess whether their interaction effects were modified by H. pylori infection. Thirteen polymorphisms of the aforementioned genes were genotyped by the Sequenom MassARRAY platform in 714 gastric cancer patients, 907 atrophic gastritis cases and 1276 healthy control subjects. When we considered the host genetic effects alone, gene–gene interactions consistently decreased the risks of gastric cancer and/or atrophic gastritis, including three two-way interactions: PGC rs6912200-PTPN11 rs12229892, PGC rs4711690-IL1B rs1143623 and PTPN11 rs12229892-IL1B rs1143623 and a three-way interaction: PGC rs4711690-PGC rs6912200-PTPN11 rs12229892. When the effect modification of H. pylori infection was evaluated, the cumulative effects of the aforementioned three-way interaction on atrophic gastritis susceptibility switched from being beneficial to being risky by the status of H. pylori infection. These data showed that SNP interactions among H. pylori-related genes PGC, PTPN11, and IL1B, are associated with susceptibility to gastric carcinogenesis. Moreover, we provided important hints of an effect modification by H. pylori infection on the cumulative effect of PGC and PTPN11 polymorphisms. Functional experiments and further independent large-scale studies especially in other ethnic populations are still needed to confirm our results.     

Self-injection of intravenous carbolic acid and multiorgan failure

Intravenous self-injection of phenol resulting in multi-organ failure is reported. The case is discussed, because of the unique nature of exposure to phenol and rapid involvement of multiple organ systems including the central nervous,pulmonary, renal and hematological systems.     

Torsion of para-ovarian cyst

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature. However, torsion of para ovarian cyst is rare. We report a rare case of twisted paraovarian cyst. Torsion of the fallopian tube and paraovarian cyst is usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain.     

预防冠状动脉支架术后低血压的护理

目的探讨冠状动脉支架术后患者出现低血压的原因及护理措施。方法对心血管内科2011年2月至2012年7月行冠状动脉支架术后发生低血压患者16例进行原因分析，并采取相应的预防和护理措施。结果16例术后低血压患者经采取积极的抢救护理措施，症状均于0．5～1．5小时内缓解。结论护士加强对术后患者的巡视观察，能及时发现和处理术后低血压的发生，对提高护理质量及提高患者生存质量具有重要意义。     

急性胰腺炎早期肠内营养研究进展

急性胰腺炎是临床常见的急危重症,病死率高,恰当的营养支持在机体高代谢及负氮平衡状态下可降低感染率及病死率,是我们一直关注的热点。过去,我们主张通过禁食让胰腺获得休息,从而改善疾病预后。但是,目前越来越多的试验研究表明,相比禁食早期肠内营养让胰腺炎病人获益显著。接下来我将从肠道屏障功能障碍、肠内营养途径、启动时间、营养制剂及营养量的选择等方面就急性胰腺炎早期肠内营养的最新进展作一综述。     

血清可溶性CD44检测对急性髓系白血病的诊断分型价值研究

目的探讨血清可溶性CD44(solCD44)检测对于急性髓系白血病(AML)的临床诊断分型价值。方法选取2014年1月至2016年1月该院血液科收治的AML患者80例,包括初诊31例、复发24例、缓解25例。同期健康体检者40例为对照组。检测比较各组患者的血清solCD44std、solCD44v5、solCD44v6水平变化。结果 AML患者的血清solCD44s、solCD44v5、solCD44v6水平在初诊、复发组中显著高于缓解组及对照组(P0.05),而缓解组与对照组比较差异无统计学意义(P0.05);不同FAB分型(M1+M2)、M3、M4、M5的血清solCD44std、solCD44v5、solCD44v6水平比较差异有统计学意义,且M3型显著高于非M3型(P0.05)。结论血清solCD44尤其是solCD44std水平与AML患者病情活动变化密切相关,可作为AML的诊断分型、预后判断及复发预测的血清学参考指标。     

The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants

Abstract

Context: Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS’s chronic effects or have evaluated limited respiratory/cardiac parameters.

Objective: We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity.

Method: We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48?h) post-test (within 0.5?h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10?min).

Results: Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7?ppm to 24.4; oxygen consumption decreased (from 1.86?L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51?L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9?mmHg to 129.2; from 45.3?mmHg to 55.6; and from 9.9?mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89?ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91).

Conclusion: Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.     

Influence of cognition and symptoms of schizophrenia on IADL performance

Abstract

People with schizophrenia experience difficulties with instrumental activities of daily living (IADL), which are required for independent living. Yet, factors that influence IADL performance are still poorly understood. Identification of such factors will contribute to the rehabilitation process and recovery. The present study aimed to examine the influence of cognitive abilities, schizophrenia symptoms, and demographic variables on IADL functioning during acute hospital admission. The participants were 81 adults with DSM-IV chronic schizophrenia. They were assessed on the Revised Observed Tasks of Daily Living (OTDL-R), the Positive and Negative Syndrome Scale (PANSS), the Neurobehavioral Cognitive Status Examination (Cognistat), and the Kitchen Task Assessment (KTA) at acute hospitalization. The prediction model of IADL performance at this time consists of executive functioning (explained 21% of variance), memory and abstract thinking (explained 13.5%), negative symptoms (explained 13%), age of illness onset and years of education (explained 8%). The total explained variance is 53.5%. These results provide evidence-based guidelines for the evaluation process in inpatient settings. Such guidelines are important since planning of intervention processes and appropriate community integration programs often occurs during acute hospitalization, while the structured nature of inpatient settings limits natural variability in occupational performance.