Medicine
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Case Reports
Desflurane and remifentanil anesthesia in a child with citrin deficiency: A case report.
Hyperammonemia, metabolic derangement, and/or the prolonged effects of anesthetics may lead to delayed emergence from general anesthesia as well as the onset of type 2 citrullinemia, even in compensated patients with citrin deficiency. ⋯ General anesthesia of the shortest duration with the least metabolized drugs using desflurane and remifentanil, would be beneficial for rapid emergence in surgical patients with citrin deficiency. Maintenance of nitrogen scavenging medication, a protein-rich diet, and serial measurement of ammonia levels in the perioperative period are also important for avoiding hyperammonemia-related neurological dysfunction.
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This study aimed to evaluate the association of imaging signs, and to establish a predictive model through selecting highly relevant imaging signs in combination with clinical parameters for hematoma expansion. Intracerebral Hemorrhage (ICH) patients who received 2 consecutive noncontrast computed tomography scans were examined and recruited through January 2014 to December 2020. Demographic information and clinical characteristics were collected. ⋯ The logistic analysis found that radiation attenuation, liquid level, the midline shift, Glasgow Coma Scale score, history of ischemic stroke, and smoking could predict the occurrence of ICH expansion. In summary, the model combined radiological characteristics with clinical indicators showed considerable predictive performance. Further validation is needed to verify the findings and help transfer to clinical practice.
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Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are rare, virally-induced malignancies that occur almost exclusively in immunocompromised individuals. We report a very rare case of a dura-based EBV-SMT with superimposed local cryptococcal infection. ⋯ Epstein-Barr virus associated smooth muscle tumors are rare malignancies that occur in immunocompromised patients. Prognosis is largely dependent on immune reconstitution and treatment of concomitant infections.
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The local economy is often supported by small and medium-sized enterprises. There is a need to consider effective promotion methods for mental health measures in these enterprises in depopulated mountainous areas. It is important to understand managers' awareness when considering effective mental health measures in these enterprises. ⋯ The 3 categories were: "Individual support, including their life's aspect, while taking advantage of formal and informal relationships," "The difficulty of drawing out an employees' motivation to work, due to the changes over time in the work size or in their working relationships," and "Creating a comfortable working environment for employees, by complying with the labor standards and adjusting relationships." Regarding managers' awareness of the measures for mental health problems, four categories and 8 subcategories emerged. The 4 categories were: "Prevention and awareness of the incidence of mental health problems," "Individual support based on the enterprise's or employee's characteristics," "A lack of support for the manager to address employees' mental health problems," and "Employees quitting the job, due to the lack of appropriate support."Though managers in depopulated mountainous areas were well aware of the mental health activities offered, the categories showed the need to foster social capital. It also showed the need to collaborate with external support organizations, and the difficulties faced by small and medium-sized enterprises.
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The technique of transosseous tunnels is widely used in lower pole patella fracture (LPP). Though the extensor mechanism can be restored, distal avulsion fragments are usually unstable. The subsequent fracture gap and nonunion impair the extensor mechanism in turn. ⋯ In radiological assessment, no fracture gap or nonunion occurred. The average Insall-Salvati ratio (I-S ratio) was 1.03. The hybrid technique offers further stabilization for the avulsion fragments and strengthens attachment of the patellar tendon, which brings forward time of rehabilitation and achieves good clinical outcomes.