The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is i...The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.展开更多
Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine...Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine’s Conservation Model as the theoretical framework,an item pool was formed through literature review,and the initial draft of the scale was refined through two rounds of Delphi expert consultation.A total of 200 postoperative patients were selected for item analysis,internal consistency testing,content validity,and structural validity analysis.Results:The final tool comprises four dimensions:energy conservation,structural integrity,personal integrity,and social integrity,with a total of 24 items.It demonstrates good content validity(I-CVI 0.82-1.00,S-CVI/Ave 0.95,S-CVI/UA 0.87)and excellent internal consistency(Cronbach’sαfor the overall scale was 0.934).Exploratory factor analysis revealed a KMO value of 0.931,Bartlett’s test of sphericityχ^(2)=4147.853(p<0.001),and four common factors were extracted,accounting for a cumulative variance contribution rate of 64.345%,indicating ideal structural validity.Conclusion:The results indicate that the assessment tool has good reliability and validity and can systematically evaluate postoperative wound healing,providing a scientific basis for clinical individualized nursing interventions.展开更多
BACKGROUND Scientifically sound and reasonable care strategies in surgical nursing play a crucial role in facilitating postoperative recovery and preventing complications.This study focused on the application of quant...BACKGROUND Scientifically sound and reasonable care strategies in surgical nursing play a crucial role in facilitating postoperative recovery and preventing complications.This study focused on the application of quantitative assessment strategies to postoperative care.By quantitatively analyzing the effects of nursing interventions,we explored their feasibility and effectiveness at improving postoperative recovery quality and reducing the incidence of complications.This study provides a scientific basis for nursing practice and offers new insights into nursing management with significant clinical value.AIM To analyze the efficacy of postoperative quantitative assessment strategy-based nursing care for patients with colorectal cancer(CRC).METHODS This randomized controlled trial evaluated the ability of nursing interventions using a quantitative assessment strategy to prevent postoperative complications and enhance patient recovery.Patients with CRC were randomly divided into routine nursing(RN)and quantitative assessment strategy nursing(QASN)groups.The RN group received standard care,while the QASN group also underwent screenings for visual analog scale for pain,Barthel Index for functional recovery,and self-rating anxiety scale and self-rating depression scale for psychological status.Follow-ups were conducted on postoperative days 1,7,14,28,and 56.RESULTS The participants’baseline characteristics did not significantly differ between study groups,thereby ensuring the reliability of the results.The QASN vs RN group showed significant improvements in pain management(visual analog scale scores)and psychological status(self-rating anxiety scale and self-rating depression scale scores)and a reduced incidence of postoperative complications(P<0.05).The follow-up evaluations at specified intervals confirmed these findings,indicating that quantitative assessment strategies significantly enhanced patients’postoperative pain management and psychological well-being.CONCLUSION Nursing interventions using structured quantitative assessments demonstrated significantly improved postoperative recovery and quality of life in patients with CRC,supporting their integration into standard postoperative care protocols.展开更多
BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomogra...BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.展开更多
AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.METHODS: A prospective study was con...AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer (EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy (EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori (H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively (P = 0.005), the proportions of OLGA stages III-IV cases were 52.1% and 22.4%, respectively (P < 0.001), and the proportions of OLGIM stages III-IV cases were 42.3% and 19.9%, respectively (P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA (OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages III-IV (OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages III-IV (P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA (75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages III-IV (OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.展开更多
Circular agriculture is of practical significance for Jiangsu agriculture. The research conducted quantitative analysis on circular agriculture in Jiangsu by estab- lishing assessment index system of circular agricult...Circular agriculture is of practical significance for Jiangsu agriculture. The research conducted quantitative analysis on circular agriculture in Jiangsu by estab- lishing assessment index system of circular agriculture development, In 2013, most indices of Jiangsu circular agriculture kept higher than national levels, but many problems exist such as excessive uses of chemical fertilizer, pesticide and mulch. Therefore, it is effective for advancing circular agriculture in Jiangsu to stabilize gov- emment fiscal support and broaden financing channels.展开更多
Nitrogen(N)and phosphorus(P)are essential nutrients and can significantly impact primary productivity of the ecosystem causing water environmental problems.However,their cycling mechanisms are not well understood in a...Nitrogen(N)and phosphorus(P)are essential nutrients and can significantly impact primary productivity of the ecosystem causing water environmental problems.However,their cycling mechanisms are not well understood in alpine mountains with climate change.Hence,94 samples of river water were collected from 2018 to 2020 in the headwaters of the Shule River Basin to assess the nutrients spatiotemporal distribution and combined ap-proach of water quality index to assess water quality and potential sources.The findings depict that high nutrient concentrations were found to coincide with snowmelt and glacial meltwater and rainfall recharge periods,while total flux peaked from June to September due to increased runoff.Notably,total nitrogen(TN)concentrations were significantly higher near the town,primarily attributed to the replenishment of nitrate(NO_(3)^(‒)-N)from live-stock manure.The high total P(TP)was near the glacier,which was attributed to the transportation of glacial sediments into the river,and pH was another critical factor.N was the primary nutrient limiting factor for the growth of phytoplankton in river water.Although the migration and transport of nutrients have altered with climate change,river water quality is good in alpine mountains based on an overall evaluation.These findings contribute to enriching nutrient datasets and highlight the importance of water resource management and water quality assessment in sensitive and fragile alpine mountains.展开更多
Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai C...Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai County,Shanxi Province,China,to support population health protection,water resource management,and environmental decision-making.Groundwater samples were collected and analyzed,and a Human Health Risk Model(HHRA)was applied to evaluate groundwater quality.The results showed that both contents of F−and Cd in groundwater exceeded the Class III limits of China's national groundwater quality standard(GB/T 14848—2024).Fluoride levels met the Class V threshold,with enrichment area mainly located in the east part of the study area.Cadmium levels reached Class IV,with elevated concentrations primarily observed in the western and northwestern regions.Correlation analysis revealed that F−showed weak or no correlation with other measured substances,indicating independent sources.Health risk assessment results indicated that F−poses potential health risks to rural residents,while cadmium,due to its relatively low concentrations,does not currently present a significant health risk.Among different demographic groups,the health risk levels of F−exposure followed the order:Infants>children>adult females>adult males.The findings highlight that fluoride is the primary contributor to health risks associated with groundwater consumption in the study area.Strengthened monitoring and prevention of F−contamination are urgently needed.This research provides a scientific basis for the prevention and control of fluoride pollution in groundwater and offers practical guidance for safeguarding drinking water safety in rural China.展开更多
This study compares the environmental sustainability of five alternatives for the remediation of marine sediments of one of the most polluted coastal sites in Europe(Bagnoli-Coroglio bay,Mediterranean Sea),using the L...This study compares the environmental sustainability of five alternatives for the remediation of marine sediments of one of the most polluted coastal sites in Europe(Bagnoli-Coroglio bay,Mediterranean Sea),using the Life Cycle Assessment(LCA)methodology.The treatments are either in-situ or exsitu,the latter requiring an initial dredging to transport the contaminated sediments to the management site.More in detail,four ex-situ remediation technologies based on landfilling,bioremediation,electrokinetic technique and soil washing were identified.These technologies are compared to an in-situ strategy currently under validation for enhancing bioremediation of the polluted sediments of the Bagnoli-Coroglio site.Our results indicate that the disposal in landfilling site is the worst option in most categories(e.g.,650 kg CO_(2) eq./t of treated sediment,considering the nearest landfilling site),followed by the bioremediation,mainly due to the high energy demand.Electrokinetic remediation,soil washing,and innovative in-situ technology represent the most sustainable options.In particular,the new in-situ technology appears to be the least impacting in all categories(e.g.,54 kg CO_(2) eq./t of treated sediment),although it is expected to require longer treatment time(estimated up to 12 months based on its potential efficiency).It can reduce the impact on climate change more than 12 times compared to the disposal and 7 times compared to bioremediation in addition to the possibility to avoid/reduce the dredging operations and the consequent dispersion of pollutants.The results open relevant perspectives towards more eco-sustainable and costly effective actions for the reclamation of contaminated marine sediments.展开更多
Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure f...Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure from the living environment.This study included 1311 women in late pregnancy from the Zunyi birth cohort and measured the urinary concentrations of 10 hydroxylated PAH metabolites(OH-PAHs).Risk assessment was conducted based on the estimated daily intake to calculate the hazard quotient and hazard index(HI).A linear regression model was used to analyze the relationship between creatinine-adjusted OH-PAHs concentrations and living environment and lifestyle factors,while principal component analysis was applied to trace the sources of PAHs exposure.1-OHPYR was detected in all participants’urine,with naphthalene metabolites having the highest concentrations among creatinine-adjusted PAHs.OH-PAHs concentrations were associated with housing type,room number,cooking frequency,household size,exercise frequency,fuel type,distance from main road,and drinking water source.Pregnant women using traditional fuels and living in bungalows had higher health risks than those using clean energy and living in buildings.Those living within 100 m of a main road had higher HI than those farther away.Coal combustion was identified as the primary source of PAHs exposure.The study emphasizes the importance of reducing PAHs exposure,especially for pregnant women living in polluted environments.It recommends public health interventions such as improving indoor ventilation and providing clean energy to reduce related health risks.展开更多
AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in whic...AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer(GC)most frequently develops.The operative link for gas-tritis assessment(OLGA)staging system ranks the GC risk according to both the topography and the severity of gastric atrophy(as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosal biopsy).Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages Ⅲ-Ⅳ with a higher risk of GC.A recently-proposed modification of the OLGA staging system(OLGIM)basically incorporates the OLGA frame,but replaces the atrophy score with an assessment of intestinal metaplasia(IM)alone.A series of 4552 consecutive biopsy sets(2007-2009)was re-trieved and reassessed according to both the OLGA and the OLGIM staging systems.A set of at least 5 biopsy samples was available for all the cases considered.RESULTS:In 4460 of 4552 cases(98.0%),both the high-risk stages(Ⅲ + Ⅳ)and the low-risk stages(0 +Ⅰ + Ⅱ)were assessed applying the OLGA and OL-GIM criteria.Among the 243 OLGA high-risk stages,14(5.8%)were down-staged to a low risk using OLGIM.The 67(1.5%)incidentally-found neoplastic lesions(intraepithelial or invasive)were consistently associated with high-risk stages,as assessed by both OLGA and OLGIM(P < 0.001 for both).Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage(stage Ⅲ)were associated with a low-risk OLGIM stage(stage Ⅱ).CONCLUSION:Gastritis staging systems(both OLGA and OLGIM)convey prognostically important informa-tion on the gastritis-associated cancer risk.Because of its clinical impact,the stage of gastritis should be included as a conclusive message in the gastritis histol-ogy report.Since it focuses on IM alone,OLGIM staging is less sensitive than OLGA staging in the identif ication of patients at high risk of gastric cancer.展开更多
BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for...BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.展开更多
AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
Global warming has led to a gradual extension of the navigable window for the Arctic Route,providing a realistic possibility for the normalized commercial operation of the Northeast Passage(NEP).Based on the changes i...Global warming has led to a gradual extension of the navigable window for the Arctic Route,providing a realistic possibility for the normalized commercial operation of the Northeast Passage(NEP).Based on the changes in the navigable window of the NEP,Russia’s proposed nuclear-powered icebreaker construction scheme,and China’s potential development of a moderately sized ice-class fleet,this study establishes three scenarios for the commercial operation of the NEP.These scenarios include:(a)normalized summer operational scenario(from July to October each year),(b)normalized summer-autumn operational scenario(from June to January of the following year),and(c)normalized year-round operational scenario(12 months per year).The cargo transportation potential of the NEP under three normalized operational scenarios was predicted based on the grey prediction model.On this basis,construction scale plans for China’s ice-class fleet to meet cargo transportation demands under the three normalized operational scenarios were designed.The economic benefits of different plans were evaluated using a profit-maximization linear programming model.The research results show the following:(1)The cargo transportation potential of the NEP demonstrates a rapid growth trend in the future,with annual throughput under year-round normalized operations expected to exceed 100 million tonnes and reach 297 million tonnes.(2)Under different normalized operational scenarios,the fleet scale and vessel type composition vary.Under the normalized summer operational scenario,the optimal scale for China’s ice-class fleet is 20 vessels,consisting solely of ships classed as PC7 by the International Association of Classification Societies(IACS).Under the normalized summer-autumn operational scenario,the optimal fleet scale is 31 vessels,including 30 IACS PC7 ships and 1 IACS PC3 ship.Under the normalized year-round operational scenario,the optimal fleet scale is 45 vessels,composed of 30 IACS PC7 ships,8 IACS PC3 ships,and 7 IACS PC2 ships.(3)Among the three normalized operational scenarios,the normalized year-round operational scenario yields the best economic benefits for the fleet scale,while the normalized summer operational scenario yields the lowest economic benefits.展开更多
Using solid waste as a substitute for conventional cement has become an important way to reduce carbon emissions.This paper attempted to utilize steel slag(SS)and fly ash(FA)as supplementary cementitious material by u...Using solid waste as a substitute for conventional cement has become an important way to reduce carbon emissions.This paper attempted to utilize steel slag(SS)and fly ash(FA)as supplementary cementitious material by utilizing CO_(2)mineralization curing technology.This study examined the dominant and interactive influences of the residual water/cement ratio,CO_(2)pressure,curing time,and SS content on the mechanical properties and CO_(2)uptake rate of CO_(2)mineralization curing SS-FA-Portland cement ternary paste specimens.Additionally,microstructural development was analyzed.The findings demonstrated that each factor significantly affected compressive strength and CO_(2)uptake rate,with factor interactions becoming more pronounced at higher SS dosages(>30%),lower residual water/cement ratios(0.1-0.15),and CO_(2)pressures of 0.1-0.3 MPa.Microscopic examinations revealed that mineralization primarily yielded CaCO_(3)and silica gel.The residual w/c ratio and SS content significantly influenced the CaCO_(3)content and crystallinity of the mineralization products.Post-mineralization curing,the percentage of pores larger than 50 nm significantly decreased,the proportion of harmless pores smaller than 20 nm increased,and pore structure improved.This study also found that using CO_(2)mineralization curing SS-FA-Portland cement solid waste concrete can significantly reduce the negative impact on the environment.展开更多
Growing regulatory demands for industrial safety and environmental protection in the chemical sector necessitate robust operational risk assessment to enhance management efficacy.Here,the HS Chemical Company is evalua...Growing regulatory demands for industrial safety and environmental protection in the chemical sector necessitate robust operational risk assessment to enhance management efficacy.Here,the HS Chemical Company is evaluated through a multidimensional framework encompassing market dynamics,macroeconomic factors,financial stability,governance,supply chains,and production safety.By integrating the Analytic Hierarchy Process(AHP)with entropy weighting,a hybrid weighting model that mitigates the limitations of singular methods is established.The analysis of this study identifies financial risk(weight:0.347)and production safety(weight:0.298)as dominant risk drivers.These quantitative insights offer a basis for resource prioritization and targeted risk mitigation strategies in chemical enterprises.展开更多
The total replacement of old fossil fuels poses obstacles,making the production of efficient biogasoline vital.Despite its potential as an environmentally friendly fossil fuel substitute,the life cycle assessment(LCA)...The total replacement of old fossil fuels poses obstacles,making the production of efficient biogasoline vital.Despite its potential as an environmentally friendly fossil fuel substitute,the life cycle assessment(LCA)of palm oil-derived biogasoline remains underexplored.This study investigated the production of biogasoline fromcrude palm oil(CPO)based biorefinery using catalytic cracking over mesoporousγ-Al_(2)O_(3) catalyst and LCA analysis.High selectivity of converting CPO into biogasoline was achieved by optimizing catalytic cracking parameters,including catalyst dose,temperature,and contact time.γ-Al_(2)O_(3) and CPO were characterized by several methods to study the physical and chemical properties.The physical properties of biogasoline,such as density,calorific value,viscosity,and flash point,were investigated.An overall yield of 60.11%was achieved after catalytic cracking produced several C5-C11 short-chain hydrocarbons.Additionally,this research proposes innovative emission reduction strategies,including waste-to-biogasoline conversion and the use of biodegradable feedstocks that enhance the sustainability of biogasoline production.LCA ofγ-Al_(2)O_(3)’s energy and environmental implications reveals minor effects on global warming(0.0068%)and freshwater ecotoxicity(0.187%).LCAs show a 0.085%impact in the energy sector.This focus on both ecological impacts and practical mitigation strategies deepens the understanding of biogasoline production.展开更多
Introduction: Surgery is a major event in an individual’s life. The complete surgical episode is known as perioperative period. Perioperative nursing in general includes three phases;pre-operative, intra-operative an...Introduction: Surgery is a major event in an individual’s life. The complete surgical episode is known as perioperative period. Perioperative nursing in general includes three phases;pre-operative, intra-operative and post-operative. The first and initial phase (pre-operative) involves the rendering of nursing care to the patients who are planned to undergo surgery (Spry, 2005) [1]. It was evident through literature that during this phase, assessment and education of the patient is the prime responsibility of health care providers to minimize the risk during the surgery and to have better outcomes of the patients. Hence, a seven weeks project was initiated at surgical care units of Aga Khan University Hospital, Karachi, Pakistan. In this project, based on the need assessment, education sessions were conducted for the health care workers which were followed by the distribution of flash cards for their references. In addition, file review and pre operative patient’s interview was conducted for the outcome evaluation. Purpose: To create awareness among healthcare workers to minimize the risk of morbidity and mortality of patients undergoing surgery and to reinforce nurses of surgical areas for the accurate assessment and education of patients, undergoing surgery. Methodology: All three surgical care units of the University teaching hospital were selected as project site and to conduct the project, permission and verbal consent was obtained from manager of these units. A total of 30 patients undergoing surgery were included in the project and were followed for their complete pre-operative assessment and education by nurses and other health care workers. For the data collection, a tool for pre operative assessment and education was developed. Based on the assessment, altogether three educational sessions were conducted for all health care workers working in the surgical care areas. Data was tabulated in Excel and percentages were calculated to analyze the data of before and after the education sessions. Results: Results revealed that education sessions increased the health care worker’s knowledge for assessing all the necessary components of a patient before surgery. Additionally, these sessions enhanced nurses’ awareness regarding the risks the patients might undergo before and after the surgery and how to prevent those risks through a thorough assessment and education of preoperative patients. Conclusion: Nurses and other health care providers should perform a complete and thorough assessment and provide necessary education to patients’ undergoing surgery in order to reduce the bounce back rate from operating room and to avoid any kind of risk for their patients undergoing for any surgical procedure.展开更多
Background: Chronic liver disease may be associated with protein energy malnutrition. Those malnourished patients undergoing liver transplantation suffer great morbidities and even mortalities. Estimating the degree o...Background: Chronic liver disease may be associated with protein energy malnutrition. Those malnourished patients undergoing liver transplantation suffer great morbidities and even mortalities. Estimating the degree of malnutrition in patients with end stage liver disease is a difficult job, Subjective Global Assessment (SGA) and Nutritional Risk Score-2002 (NRS-2002) are among many tools that can give an overview for the nutritional status of the patients. Aim: To detect the efficacy and the predictive validity of SGA and NRS 2002 for post-operative risk detection for liver transplant patients. Patients & Methods: 30 recipients of end stage liver disease had undergone a nutritional assessment by SGA score & NRS-2002 score, to be compared with the parameters of outcome of post-operative liver transplantation (ALT, AST, INR, Bilirubin, time spent in ICU, hospital infective episodes & number of antibiotic courses). Results: Patients declared as malnourished by SGA and NRS-2002 had higher post operative ALT & AST value, more prolonged INR, spent more time at ICU and hospital, suffered from more infective episodes and had more antibiotic courses in a significant statistical manner. Conclusion: SGA and NRS-2002 could be useful, simple and dependable tools to be used for risk detection of post-operative morbidities after liver transplantation.展开更多
Although the pediatric perioperative pain management has been improved in recent years,the valid and reliable pain assessment tool in perioperative period of children remains a challenging task.Pediatric perioperative...Although the pediatric perioperative pain management has been improved in recent years,the valid and reliable pain assessment tool in perioperative period of children remains a challenging task.Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults,but also because there is a lack of effective and specific assessment tool for children.In addition,exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae.The short-term sequelae can induce a series of neurological,endocrine,cardiovascular system stress related to psychological trauma,while long-term sequelae may alter brain maturation process,which can lead to impair neurodevelopmental,behavioral,and cognitive function.Children’s facial expressions largely reflect the degree of pain,which has led to the developing of a number of pain scoring tools that will help improve the quality of pain mana-gement in children if they are continually studied in depth.The artificial inte-lligence(AI)technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks,which can effectively identify and systematically analyze various subtle features of children’s facial expressions.Based on the construction of a large database of images of facial expressions in children with perioperative pain,this study proposes to develop and apply automatic facial pain expression recognition software using AI technology.The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.展开更多
基金supported by the National Natural Science Foundation of China(Grant Nos.82272955 and 22203057)the Natural Science Foundation of Fujian Province(Grant No.2021J011361).
文摘The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.
基金Sichuan Provincial Nursing Research Project of the Sichuan Nursing Association in 2023(Project No.:H23028)。
文摘Objective:This study aims to develop an assessment tool for postoperative wound healing in adult patients with benign anal canal and rectal diseases and to validate its reliability and validity.Methods:Based on Levine’s Conservation Model as the theoretical framework,an item pool was formed through literature review,and the initial draft of the scale was refined through two rounds of Delphi expert consultation.A total of 200 postoperative patients were selected for item analysis,internal consistency testing,content validity,and structural validity analysis.Results:The final tool comprises four dimensions:energy conservation,structural integrity,personal integrity,and social integrity,with a total of 24 items.It demonstrates good content validity(I-CVI 0.82-1.00,S-CVI/Ave 0.95,S-CVI/UA 0.87)and excellent internal consistency(Cronbach’sαfor the overall scale was 0.934).Exploratory factor analysis revealed a KMO value of 0.931,Bartlett’s test of sphericityχ^(2)=4147.853(p<0.001),and four common factors were extracted,accounting for a cumulative variance contribution rate of 64.345%,indicating ideal structural validity.Conclusion:The results indicate that the assessment tool has good reliability and validity and can systematically evaluate postoperative wound healing,providing a scientific basis for clinical individualized nursing interventions.
文摘BACKGROUND Scientifically sound and reasonable care strategies in surgical nursing play a crucial role in facilitating postoperative recovery and preventing complications.This study focused on the application of quantitative assessment strategies to postoperative care.By quantitatively analyzing the effects of nursing interventions,we explored their feasibility and effectiveness at improving postoperative recovery quality and reducing the incidence of complications.This study provides a scientific basis for nursing practice and offers new insights into nursing management with significant clinical value.AIM To analyze the efficacy of postoperative quantitative assessment strategy-based nursing care for patients with colorectal cancer(CRC).METHODS This randomized controlled trial evaluated the ability of nursing interventions using a quantitative assessment strategy to prevent postoperative complications and enhance patient recovery.Patients with CRC were randomly divided into routine nursing(RN)and quantitative assessment strategy nursing(QASN)groups.The RN group received standard care,while the QASN group also underwent screenings for visual analog scale for pain,Barthel Index for functional recovery,and self-rating anxiety scale and self-rating depression scale for psychological status.Follow-ups were conducted on postoperative days 1,7,14,28,and 56.RESULTS The participants’baseline characteristics did not significantly differ between study groups,thereby ensuring the reliability of the results.The QASN vs RN group showed significant improvements in pain management(visual analog scale scores)and psychological status(self-rating anxiety scale and self-rating depression scale scores)and a reduced incidence of postoperative complications(P<0.05).The follow-up evaluations at specified intervals confirmed these findings,indicating that quantitative assessment strategies significantly enhanced patients’postoperative pain management and psychological well-being.CONCLUSION Nursing interventions using structured quantitative assessments demonstrated significantly improved postoperative recovery and quality of life in patients with CRC,supporting their integration into standard postoperative care protocols.
文摘BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.
文摘AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer (EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy (EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori (H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively (P = 0.005), the proportions of OLGA stages III-IV cases were 52.1% and 22.4%, respectively (P < 0.001), and the proportions of OLGIM stages III-IV cases were 42.3% and 19.9%, respectively (P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA (OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages III-IV (OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages III-IV (P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA (75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages III-IV (OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.
基金Supported by Jiangsu Agricultural S&T Self-innovation Project(CX(13)5068)~~
文摘Circular agriculture is of practical significance for Jiangsu agriculture. The research conducted quantitative analysis on circular agriculture in Jiangsu by estab- lishing assessment index system of circular agriculture development, In 2013, most indices of Jiangsu circular agriculture kept higher than national levels, but many problems exist such as excessive uses of chemical fertilizer, pesticide and mulch. Therefore, it is effective for advancing circular agriculture in Jiangsu to stabilize gov- emment fiscal support and broaden financing channels.
基金supported by the Second Tibetan Plateau Scientific Expedition and Research Program(STEP)(No.2019QZKK0208)the National Natural Science Foundation of China(Nos.42171148 and 42330512)the Key R&D Project from the Science and Technology Department of Tibet(No.XZ202501ZY0030).
文摘Nitrogen(N)and phosphorus(P)are essential nutrients and can significantly impact primary productivity of the ecosystem causing water environmental problems.However,their cycling mechanisms are not well understood in alpine mountains with climate change.Hence,94 samples of river water were collected from 2018 to 2020 in the headwaters of the Shule River Basin to assess the nutrients spatiotemporal distribution and combined ap-proach of water quality index to assess water quality and potential sources.The findings depict that high nutrient concentrations were found to coincide with snowmelt and glacial meltwater and rainfall recharge periods,while total flux peaked from June to September due to increased runoff.Notably,total nitrogen(TN)concentrations were significantly higher near the town,primarily attributed to the replenishment of nitrate(NO_(3)^(‒)-N)from live-stock manure.The high total P(TP)was near the glacier,which was attributed to the transportation of glacial sediments into the river,and pH was another critical factor.N was the primary nutrient limiting factor for the growth of phytoplankton in river water.Although the migration and transport of nutrients have altered with climate change,river water quality is good in alpine mountains based on an overall evaluation.These findings contribute to enriching nutrient datasets and highlight the importance of water resource management and water quality assessment in sensitive and fragile alpine mountains.
基金supported by the Northeast Geological Science and Technology Innovation Center of China Geological Survey(Grant NO.QCJJ2022-43)the Natural Resources Comprehensive Survey Project(Grant Nos.DD20230470,DD20230508)the National Groundwater Monitoring Network Operation and Maintenance Program(Grant No.DD20251300109).
文摘Excessive levels of Fluoride(F−)and Cadmium(Cd)in drinking groundwater may pose health risks.This study assessed the health risks associated with F−and Cd contamination in rural drinking groundwater sources in Wutai County,Shanxi Province,China,to support population health protection,water resource management,and environmental decision-making.Groundwater samples were collected and analyzed,and a Human Health Risk Model(HHRA)was applied to evaluate groundwater quality.The results showed that both contents of F−and Cd in groundwater exceeded the Class III limits of China's national groundwater quality standard(GB/T 14848—2024).Fluoride levels met the Class V threshold,with enrichment area mainly located in the east part of the study area.Cadmium levels reached Class IV,with elevated concentrations primarily observed in the western and northwestern regions.Correlation analysis revealed that F−showed weak or no correlation with other measured substances,indicating independent sources.Health risk assessment results indicated that F−poses potential health risks to rural residents,while cadmium,due to its relatively low concentrations,does not currently present a significant health risk.Among different demographic groups,the health risk levels of F−exposure followed the order:Infants>children>adult females>adult males.The findings highlight that fluoride is the primary contributor to health risks associated with groundwater consumption in the study area.Strengthened monitoring and prevention of F−contamination are urgently needed.This research provides a scientific basis for the prevention and control of fluoride pollution in groundwater and offers practical guidance for safeguarding drinking water safety in rural China.
基金support in the literature analysis.This study has been carried out in the framework of the project funded by EU entitled“Bioremediation of contaminated sediments in coastal areas of exindustrial sites-LIFE SEDREMED”(No.LIFE20 ENV/IT/000572).
文摘This study compares the environmental sustainability of five alternatives for the remediation of marine sediments of one of the most polluted coastal sites in Europe(Bagnoli-Coroglio bay,Mediterranean Sea),using the Life Cycle Assessment(LCA)methodology.The treatments are either in-situ or exsitu,the latter requiring an initial dredging to transport the contaminated sediments to the management site.More in detail,four ex-situ remediation technologies based on landfilling,bioremediation,electrokinetic technique and soil washing were identified.These technologies are compared to an in-situ strategy currently under validation for enhancing bioremediation of the polluted sediments of the Bagnoli-Coroglio site.Our results indicate that the disposal in landfilling site is the worst option in most categories(e.g.,650 kg CO_(2) eq./t of treated sediment,considering the nearest landfilling site),followed by the bioremediation,mainly due to the high energy demand.Electrokinetic remediation,soil washing,and innovative in-situ technology represent the most sustainable options.In particular,the new in-situ technology appears to be the least impacting in all categories(e.g.,54 kg CO_(2) eq./t of treated sediment),although it is expected to require longer treatment time(estimated up to 12 months based on its potential efficiency).It can reduce the impact on climate change more than 12 times compared to the disposal and 7 times compared to bioremediation in addition to the possibility to avoid/reduce the dredging operations and the consequent dispersion of pollutants.The results open relevant perspectives towards more eco-sustainable and costly effective actions for the reclamation of contaminated marine sediments.
基金supported by the National Key R&D Program of China(Nos.2018YFC1004300 and 2018YFC1004302)the Science&Technology Program of Guizhou Province(Nos.QKHHBZ[2020]3002,QKHPTRC-GCC[2022]039-1 and QKHPTRCCXTD[2022]014)the Scientific Research Program of Guizhou Provincial Department of Education(No.QJJ[2023]019).
文摘Despite the widespread presence and frequent detection of polycyclic aromatic hydrocarbons(PAHs)in various aspects of life,there is limited research on their exposure levels in pregnant women and cumulative exposure from the living environment.This study included 1311 women in late pregnancy from the Zunyi birth cohort and measured the urinary concentrations of 10 hydroxylated PAH metabolites(OH-PAHs).Risk assessment was conducted based on the estimated daily intake to calculate the hazard quotient and hazard index(HI).A linear regression model was used to analyze the relationship between creatinine-adjusted OH-PAHs concentrations and living environment and lifestyle factors,while principal component analysis was applied to trace the sources of PAHs exposure.1-OHPYR was detected in all participants’urine,with naphthalene metabolites having the highest concentrations among creatinine-adjusted PAHs.OH-PAHs concentrations were associated with housing type,room number,cooking frequency,household size,exercise frequency,fuel type,distance from main road,and drinking water source.Pregnant women using traditional fuels and living in bungalows had higher health risks than those using clean energy and living in buildings.Those living within 100 m of a main road had higher HI than those farther away.Coal combustion was identified as the primary source of PAHs exposure.The study emphasizes the importance of reducing PAHs exposure,especially for pregnant women living in polluted environments.It recommends public health interventions such as improving indoor ventilation and providing clean energy to reduce related health risks.
基金Supported by An AIRC grant from the Veneto Regional Authorities,2009the"Guido Berlucchi"Foundation+1 种基金the"Morgagni"Association for Oncological Research (PadovaPD)
文摘AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer(GC)most frequently develops.The operative link for gas-tritis assessment(OLGA)staging system ranks the GC risk according to both the topography and the severity of gastric atrophy(as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosal biopsy).Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages Ⅲ-Ⅳ with a higher risk of GC.A recently-proposed modification of the OLGA staging system(OLGIM)basically incorporates the OLGA frame,but replaces the atrophy score with an assessment of intestinal metaplasia(IM)alone.A series of 4552 consecutive biopsy sets(2007-2009)was re-trieved and reassessed according to both the OLGA and the OLGIM staging systems.A set of at least 5 biopsy samples was available for all the cases considered.RESULTS:In 4460 of 4552 cases(98.0%),both the high-risk stages(Ⅲ + Ⅳ)and the low-risk stages(0 +Ⅰ + Ⅱ)were assessed applying the OLGA and OL-GIM criteria.Among the 243 OLGA high-risk stages,14(5.8%)were down-staged to a low risk using OLGIM.The 67(1.5%)incidentally-found neoplastic lesions(intraepithelial or invasive)were consistently associated with high-risk stages,as assessed by both OLGA and OLGIM(P < 0.001 for both).Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage(stage Ⅲ)were associated with a low-risk OLGIM stage(stage Ⅱ).CONCLUSION:Gastritis staging systems(both OLGA and OLGIM)convey prognostically important informa-tion on the gastritis-associated cancer risk.Because of its clinical impact,the stage of gastritis should be included as a conclusive message in the gastritis histol-ogy report.Since it focuses on IM alone,OLGIM staging is less sensitive than OLGA staging in the identif ication of patients at high risk of gastric cancer.
文摘BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
基金Funding by Social Science Research of Ministry of Education of the People’s Republic of China“Study on issues related on the development and utilization of the Arctic Passage”(Grant no.20JHQ016)is acknowledged.
文摘Global warming has led to a gradual extension of the navigable window for the Arctic Route,providing a realistic possibility for the normalized commercial operation of the Northeast Passage(NEP).Based on the changes in the navigable window of the NEP,Russia’s proposed nuclear-powered icebreaker construction scheme,and China’s potential development of a moderately sized ice-class fleet,this study establishes three scenarios for the commercial operation of the NEP.These scenarios include:(a)normalized summer operational scenario(from July to October each year),(b)normalized summer-autumn operational scenario(from June to January of the following year),and(c)normalized year-round operational scenario(12 months per year).The cargo transportation potential of the NEP under three normalized operational scenarios was predicted based on the grey prediction model.On this basis,construction scale plans for China’s ice-class fleet to meet cargo transportation demands under the three normalized operational scenarios were designed.The economic benefits of different plans were evaluated using a profit-maximization linear programming model.The research results show the following:(1)The cargo transportation potential of the NEP demonstrates a rapid growth trend in the future,with annual throughput under year-round normalized operations expected to exceed 100 million tonnes and reach 297 million tonnes.(2)Under different normalized operational scenarios,the fleet scale and vessel type composition vary.Under the normalized summer operational scenario,the optimal scale for China’s ice-class fleet is 20 vessels,consisting solely of ships classed as PC7 by the International Association of Classification Societies(IACS).Under the normalized summer-autumn operational scenario,the optimal fleet scale is 31 vessels,including 30 IACS PC7 ships and 1 IACS PC3 ship.Under the normalized year-round operational scenario,the optimal fleet scale is 45 vessels,composed of 30 IACS PC7 ships,8 IACS PC3 ships,and 7 IACS PC2 ships.(3)Among the three normalized operational scenarios,the normalized year-round operational scenario yields the best economic benefits for the fleet scale,while the normalized summer operational scenario yields the lowest economic benefits.
基金Project(52479115)supported by the National Natural Science Foundation of ChinaProject(2024SF-YBXM-615)supported by the Key Research and Development Program of Shaanxi Province,China+1 种基金Project(2022943)supported by the Youth Innovation Team of Shaanxi Universities,ChinaProject(300102283721)supported by the Fundamental Research Funds for the Central Universities,China。
文摘Using solid waste as a substitute for conventional cement has become an important way to reduce carbon emissions.This paper attempted to utilize steel slag(SS)and fly ash(FA)as supplementary cementitious material by utilizing CO_(2)mineralization curing technology.This study examined the dominant and interactive influences of the residual water/cement ratio,CO_(2)pressure,curing time,and SS content on the mechanical properties and CO_(2)uptake rate of CO_(2)mineralization curing SS-FA-Portland cement ternary paste specimens.Additionally,microstructural development was analyzed.The findings demonstrated that each factor significantly affected compressive strength and CO_(2)uptake rate,with factor interactions becoming more pronounced at higher SS dosages(>30%),lower residual water/cement ratios(0.1-0.15),and CO_(2)pressures of 0.1-0.3 MPa.Microscopic examinations revealed that mineralization primarily yielded CaCO_(3)and silica gel.The residual w/c ratio and SS content significantly influenced the CaCO_(3)content and crystallinity of the mineralization products.Post-mineralization curing,the percentage of pores larger than 50 nm significantly decreased,the proportion of harmless pores smaller than 20 nm increased,and pore structure improved.This study also found that using CO_(2)mineralization curing SS-FA-Portland cement solid waste concrete can significantly reduce the negative impact on the environment.
文摘Growing regulatory demands for industrial safety and environmental protection in the chemical sector necessitate robust operational risk assessment to enhance management efficacy.Here,the HS Chemical Company is evaluated through a multidimensional framework encompassing market dynamics,macroeconomic factors,financial stability,governance,supply chains,and production safety.By integrating the Analytic Hierarchy Process(AHP)with entropy weighting,a hybrid weighting model that mitigates the limitations of singular methods is established.The analysis of this study identifies financial risk(weight:0.347)and production safety(weight:0.298)as dominant risk drivers.These quantitative insights offer a basis for resource prioritization and targeted risk mitigation strategies in chemical enterprises.
基金The contract No.PRJ-395/DPKS/2022 or 2383/PKS/ITS/2022 on 14 November 2022.
文摘The total replacement of old fossil fuels poses obstacles,making the production of efficient biogasoline vital.Despite its potential as an environmentally friendly fossil fuel substitute,the life cycle assessment(LCA)of palm oil-derived biogasoline remains underexplored.This study investigated the production of biogasoline fromcrude palm oil(CPO)based biorefinery using catalytic cracking over mesoporousγ-Al_(2)O_(3) catalyst and LCA analysis.High selectivity of converting CPO into biogasoline was achieved by optimizing catalytic cracking parameters,including catalyst dose,temperature,and contact time.γ-Al_(2)O_(3) and CPO were characterized by several methods to study the physical and chemical properties.The physical properties of biogasoline,such as density,calorific value,viscosity,and flash point,were investigated.An overall yield of 60.11%was achieved after catalytic cracking produced several C5-C11 short-chain hydrocarbons.Additionally,this research proposes innovative emission reduction strategies,including waste-to-biogasoline conversion and the use of biodegradable feedstocks that enhance the sustainability of biogasoline production.LCA ofγ-Al_(2)O_(3)’s energy and environmental implications reveals minor effects on global warming(0.0068%)and freshwater ecotoxicity(0.187%).LCAs show a 0.085%impact in the energy sector.This focus on both ecological impacts and practical mitigation strategies deepens the understanding of biogasoline production.
文摘Introduction: Surgery is a major event in an individual’s life. The complete surgical episode is known as perioperative period. Perioperative nursing in general includes three phases;pre-operative, intra-operative and post-operative. The first and initial phase (pre-operative) involves the rendering of nursing care to the patients who are planned to undergo surgery (Spry, 2005) [1]. It was evident through literature that during this phase, assessment and education of the patient is the prime responsibility of health care providers to minimize the risk during the surgery and to have better outcomes of the patients. Hence, a seven weeks project was initiated at surgical care units of Aga Khan University Hospital, Karachi, Pakistan. In this project, based on the need assessment, education sessions were conducted for the health care workers which were followed by the distribution of flash cards for their references. In addition, file review and pre operative patient’s interview was conducted for the outcome evaluation. Purpose: To create awareness among healthcare workers to minimize the risk of morbidity and mortality of patients undergoing surgery and to reinforce nurses of surgical areas for the accurate assessment and education of patients, undergoing surgery. Methodology: All three surgical care units of the University teaching hospital were selected as project site and to conduct the project, permission and verbal consent was obtained from manager of these units. A total of 30 patients undergoing surgery were included in the project and were followed for their complete pre-operative assessment and education by nurses and other health care workers. For the data collection, a tool for pre operative assessment and education was developed. Based on the assessment, altogether three educational sessions were conducted for all health care workers working in the surgical care areas. Data was tabulated in Excel and percentages were calculated to analyze the data of before and after the education sessions. Results: Results revealed that education sessions increased the health care worker’s knowledge for assessing all the necessary components of a patient before surgery. Additionally, these sessions enhanced nurses’ awareness regarding the risks the patients might undergo before and after the surgery and how to prevent those risks through a thorough assessment and education of preoperative patients. Conclusion: Nurses and other health care providers should perform a complete and thorough assessment and provide necessary education to patients’ undergoing surgery in order to reduce the bounce back rate from operating room and to avoid any kind of risk for their patients undergoing for any surgical procedure.
文摘Background: Chronic liver disease may be associated with protein energy malnutrition. Those malnourished patients undergoing liver transplantation suffer great morbidities and even mortalities. Estimating the degree of malnutrition in patients with end stage liver disease is a difficult job, Subjective Global Assessment (SGA) and Nutritional Risk Score-2002 (NRS-2002) are among many tools that can give an overview for the nutritional status of the patients. Aim: To detect the efficacy and the predictive validity of SGA and NRS 2002 for post-operative risk detection for liver transplant patients. Patients & Methods: 30 recipients of end stage liver disease had undergone a nutritional assessment by SGA score & NRS-2002 score, to be compared with the parameters of outcome of post-operative liver transplantation (ALT, AST, INR, Bilirubin, time spent in ICU, hospital infective episodes & number of antibiotic courses). Results: Patients declared as malnourished by SGA and NRS-2002 had higher post operative ALT & AST value, more prolonged INR, spent more time at ICU and hospital, suffered from more infective episodes and had more antibiotic courses in a significant statistical manner. Conclusion: SGA and NRS-2002 could be useful, simple and dependable tools to be used for risk detection of post-operative morbidities after liver transplantation.
文摘Although the pediatric perioperative pain management has been improved in recent years,the valid and reliable pain assessment tool in perioperative period of children remains a challenging task.Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults,but also because there is a lack of effective and specific assessment tool for children.In addition,exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae.The short-term sequelae can induce a series of neurological,endocrine,cardiovascular system stress related to psychological trauma,while long-term sequelae may alter brain maturation process,which can lead to impair neurodevelopmental,behavioral,and cognitive function.Children’s facial expressions largely reflect the degree of pain,which has led to the developing of a number of pain scoring tools that will help improve the quality of pain mana-gement in children if they are continually studied in depth.The artificial inte-lligence(AI)technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks,which can effectively identify and systematically analyze various subtle features of children’s facial expressions.Based on the construction of a large database of images of facial expressions in children with perioperative pain,this study proposes to develop and apply automatic facial pain expression recognition software using AI technology.The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.
