Journal of the Chinese Medical Association : JCMA
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Chronic hepatitis B virus (HBV) infection is the primary risk factor for the development of hepatocellular carcinoma worldwide. After decades of chronic hepatitis, about 30-40% of patients progress into liver cirrhosis, and of them, around 1-5% subsequently develop hepatocellular carcinoma (HCC) annually. ⋯ Studying the genetic factors predisposing hepatocarcinogenesis in both host and viral genomes will help illuminate the critical carcinogenic mechanisms, and create molecular targets for future therapy. In this article, we thus review the epidemiology of HBV-related HCC and viral factors involved in hepatocarcinogenesis.
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Review Case Reports
Severe hypophosphatemia in a patient with diabetic ketoacidosis and acute respiratory failure.
Although hypophosphatemia is a common complication during therapy of diabetic ketoacidosis, it is seldom severe and rarely causes clinical manifestations. We report a 39-year-old woman with diabetic ketoacidosis who developed acute respiratory failure after therapy. Although hyperglycemia and acidosis were corrected after treatment, respiratory distress and weakness still persisted. ⋯ The patient's clinical condition improved steadily over the next few days, and after 4 weeks of hospitalization, she was discharged home without obvious long-term sequelae. In a critically ill patient, the symptoms of hypophosphatemia are not apparent and may mimic the symptoms of other underlying disease. Although phosphate replacement is not recommended routinely in diabetic ketoacidosis, if the patient develops cardiopulmonary distress, anemia or severe hypophosphatemia, phosphate therapy under close surveillance is indicated.
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Cyanide poisoning may result from different exposures: residential fires, industrial accidents, drug and plant intoxication. Clinical features include coma, respiratory arrest and cardiovascular collapse. The biological hallmark is lactic acidosis. ⋯ In conclusion, antidotes are beneficial in cyanide poisoning. In suspected cyanide-poisoned patients, we recommend the use of hydroxocobalamin as first-line antidote, owing to its safety. In massive cyanide poisoning, due to the limited potency of hydroxocobalamin, continuous infusion of sodium thiosulfate should be associated.
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In 1680 Sydenham wrote, "Among the remedies which has pleased almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium." This appraisal is still true today. Morphine, the principal analgesic agent of the opium alkaloids, has provided the structural model from which modern synthetic opiates have been designed and synthesized. Morphine, as well as the synthetic opioids, has become a permanent part of the armamentarium of an anesthesiologist. ⋯ With the improved anesthetic management, surgeries have been pushed to new heights, which would have never been possible without creative and optimal anesthetic management. Unfortunately, surgery and anesthesia are continued to be pressured by medical economics to cut costs, while there is increased risk of managing the critically ill patients. This trend will continue; therefore, anesthesiologists today must rise to the challenge.