Medicine
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Observational Study
Adenoma detection rate is not influenced by the time of day in computer-aided detection colonoscopy.
Because of endoscopist fatigue, the time of colonoscopy have been shown to influence adenoma detection rate (ADR). Computer-aided detection (CADe) provides simultaneous visual alerts on polyps during colonoscopy and thus to increase adenoma detection rate. This is attributable to the strengthening of endoscopists diagnostic level and alleviation of fatigue. ⋯ Multivariable analysis shows that the ADR of CADe colonoscopy was influenced by the age (P < .001), gender (P = .004) and withdrawal time (P < .001), no correlation was found regarding bowel preparation (P = .993) and endoscopist experience (P = .804). CADe colonoscopy could eliminate the influence of the afternoon fatigue on ADR. The ADR during CADe colonoscopy is significantly affected by age, gender and withdrawal time.
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Fluid resuscitation manages shock effectively. However, shock is not always caused by hypovolemia; various types of shock have variable volumetric reactivity. Combined echocardiography and lung ultrasound (LUS) is a new technique for assessing volume status and pulmonary edema in these patients. We report a case of unexplained acute circulatory failure and acute kidney injury (AKI) aggravated by active fluid resuscitation. We used the critical consultation ultrasonic examination (CCUE) protocol for evaluation, and successfully revived the patient with reverse fluid resuscitation. ⋯ Not all patients with acute circulatory failure require positive fluid resuscitation. Fluid balance should be closely monitored and managed. Potential intolerance to the rapid increase in volume may lead to biventricular interaction, ultimately leading to acute circulatory failure. The shock caused by volume overload should be treated with reverse fluid resuscitation. Combined echocardiography and LUS is a powerful tool for the differential diagnosis of circulatory and respiratory dysfunction.
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Case Reports
Three metachronous primary lung cancers in a chronic smoker: A case report and review of the literature.
Lung cancer is a leading cause of cancer-related deaths. Smoking is major risk factor for initial and subsequent lung cancer especially in active smokers. Treatment of subsequent lung cancer depends on whether it is synchronous or metachronous. We report a rare case of triple metachronous lung cancer and review of literature of patients with triple metachronous cancers. This will be the second case reported of triple metachronous lung cancer. ⋯ Smoking is a major risk factor for developing lung cancer and with continued smoking, patients are at higher risk for developing subsequent primary lung cancers. We recommend, patients with lung cancer must quit smoking, and those who do not, should remain on long-term surveillance.
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Observational Study
Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China.
Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. ⋯ Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression. Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.
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Observational Study
Outcomes of epiduroscopic laser ablation in patients with lumbar disc herniation.
Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation. ⋯ The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block). Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.