Perforation of the esophagus: an overlooked cause of chest pain as a complication of esophageal foreign bodies / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Chest pain is one of the most common complaints in the emergency department. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera can all cause chest discomfort (Gulati et al., 2021; Jiao et al., 2021; Lu et al., 2022). Clinicians in the emergency department are expected to immediately recognize life-threatening chest pain (Jiao et al., 2021). Delayed diagnosis further increases the risk of complications and mortality (Liu et al., 2021). In this case, we present an elderly Chinese female who had a history of myocardial infarction two years previously, with chest pain eventually found to be caused by ingestion of a duck bone.

Inflammatory granuloma of the trachea: a rare case with Epstin-Barr virus infection / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Epstein-Barr virus (EBV), a double-stranded DNA virus with an envelope, is a ubiquitous pathogen that is prevalent in humans, although most people who contract it do not develop symptoms (Kerr, 2019). While the primary cells EBV attacks are epithelial cells and B lymphocytes, its target range expands to a variety of cell types in immunodeficient hosts. Serological change occurs in 90% of infected patients. Therefore, immunoglobulin M (IgM) and IgG, serologically reactive to viral capsid antigens, are reliable biomarkers for the detection of acute and chronic EBV infections (Cohen, 2000). Symptoms of EBV infection vary according to age and immune status. Young patients with primary infection may present with infectious mononucleosis; there is a typical triad of symptoms including fever, angina, and lymphadenectasis (Houen and Trier, 2021). In immunocompromised patients, response after EBV infection may be atypical, with unexplained fever. The nucleic acid of EBV can be detected to confirm whether high-risk patients are infected (Smets et al., 2000). EBV is also associated with the occurrence of certain tumors (such as lymphoma and nasopharyngeal carcinoma) because it transforms host cells (Shannon-Lowe et al., 2017; Tsao et al., 2017).

Efficacy analysis of sequential nasal high flow oxygen after extubation in patients with acute respiratory failure / 中华急诊医学杂志

Objective To investigate the clinical efficacy of sequential nasal flow ventilation after extubation in patients with acute respiratory failure (referred to as respiratory failure).First of all,before and after extubation in HFNCO group,the respiratory parameters (PaO2,PaCO2,pH,lactic acid value,oxygenation index,HR,RR and LVEF) were compared with each other.The circulatory parameters (PaO2,PaCO2,pH,lactate,oxygenation index,HR,RR),clinical outcomes at the end of treatment / comorbidities (delirium,diarrhea,reintubation,ICU stay after extubation).Methods PaO2,PaCO2,pH value,lactate value at 1 h,6 h,12 h and 24 h after extubation in HFNCO group were not significantly different from those before extubation (all P＞ 0.05) (P ＜0.05).The LVEF of patients after extubation was slightly higher than that before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),and the difference was not statistically significant Significance (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The effect of HFNCO on improving the oxygenation index after extubation was better than that of NPV group (P ＜0.05).HR and RR before extubation were higher or higher in HFNCO group than those in NPV group lower HR,RR better (P ＜0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs 13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium in HFNCO group (18.18％ vs.41.67％) and ICU stay time after extubation (2.00 to 3.50) were statistically significant (all P ＜0.05).Results There were no significant differences in the arterial blood gas analysis (PaO2,PaCO2,pH,lactate value),PaO2,PaCO2,pH value,lactate value and LVEF at 1 h,6 h,12 h and 24 h before and after extubation in HFNCO group (all P＞ 0.05) Slightly higher than before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),the difference was not statistically significant (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs.13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium (18.18％ vs.41.67％),and ICU stay time (2.00 to 3.50) in HFNCO group were significantly lower than those in NIV group (all P＜0.05).Conclusions For acute respiratory failure patients after mechanical ventilation extubation,sequential administration of HFNCO and NIV can provide stable and effective oxygen therapy support;relative to the NIV,HFNCO can effectively improve patients oxygenation index,improve patient comfort and reduce the incidence of delirium And ICU stay time.