Medicine
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Emergency air medical transport (EAMT) is indispensable for acutely or critically ill patients in remote areas. We determined patient-level and transport-specific factors associated with all-cause mortality after EAMT. We conducted a population-based, retrospective cohort study using a prospective registry consisting of clinical/medical records. ⋯ Independent predictors associated with 30-day all-cause mortality were age (OR 1.028, 95% CI 1.007-1.049), GCS (OR 0.686, 95% CI 0.600-0.785), hematocrit (OR 0.940, 95% CI 0.895-0.988), hemodynamic instability (OR 5.088 95% CI 1.769-14.635), and endotracheal intubation (OR 0.131 95% CI 0.030-0.569). The 7-day and 30-day mortality were not significantly related to transport-specific factors, such as length of flight, type of paramedic crew on board, or day and season of transport. Clinical patient-level factors, as opposed to transport-level factors, were associated with 7- and 30-day all-cause mortality in patients undergoing interfacility EAMT from Kinmen to Taiwan.
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Case Reports
Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy: A case report.
Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood. ⋯ This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as "pancreatogenic choledocholithiasis," and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause.
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Traditional digital subtraction angiography (DSA) provides lumen morphology of renal artery as indicators for vascular patency in patients with renal artery stenosis (RAS). It, however, lacks hemodynamic information toward target kidney. To solve this shortcoming, a novel technique, flat-panel detector parenchymal blood volume imaging (FD-PBV), is introduced, which is able to evaluate hemodynamic changes of target kidney intraoperatively. ⋯ FD-PBV technique possesses a remarkable value in quantitatively assessing the changes of kidney blood perfusion and can be a useful auxiliary technique for DSA.
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Case Reports
Scrambler therapy for the treatment of neuropathic pain related to leukemia in a pediatric patient: A case report.
Cancer-related neuropathic pain often responds poorly to standard pain treatments. Scrambler therapy has relieved refractory chronic pain in several uncontrolled clinical trials. ⋯ Scrambler therapy is noninvasive, is not associated with any complications, causes minimal discomfort during treatment, and is very effective in a pediatric patient with cancer-related neuropathic pain.
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Comparative Study
Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients.
In the intensive care unit (ICU), stable hemodynamics are very important. Hemodynamic intervention is often effective against multiple organ failure, such as in tissue hypoxia and shock. The administration of intravenous fluids is the first step in regulating tissue perfusion. ⋯ The dIVC at a threshold value of >23.8% provided 80% sensitivity and 87.5% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.928 (0.842-0.975). The PVI at a threshold value of >14% provided 95% sensitivity and 81.2% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.939 (0.857-0.982). Both PVI and dIVC can be used as a noninvasive method that can be easily applied at the bedside in determining fluid responsiveness in all patients with mechanical ventilation in intensive care.