Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney...Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Methods:Using convenience sampling,100 elderly patients with diabetes mellitus complicated by chronic kidney disease who received treatment in the endocrinology department of a tertiary A-level hospital from May 2024 to May 2025 were selected as the study subjects.They were randomly divided into an experimental group(50 cases)and a control group(50 cases)using a random number table method.The control group received routine health education and telephone follow-up,while the experimental group,in addition to the control group’s interventions,underwent combined exercise intervention based on the hospital-community-family model.Remote medical guidance was utilized to monitor and study the application effect of exercise intervention on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores in five dimensions of intrinsic capacity(exercise,cognition,psychology,vitality,and sensation)were measured before the intervention,at 4 weeks of intervention,and at 12 weeks of intervention for both groups.Results:Before the exercise intervention,there were no statistically significant differences(p>0.05)between the two groups in terms of fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores across five dimensions of intrinsic capacity:mobility,cognition,psychology,vitality,and sensation.After 12 weeks of intervention,the experimental group demonstrated significantly higher scores than the control group in glomerular filtration rate,6-minute walk distance,and the dimensions of mobility,cognition,and vitality within intrinsic capacity,with all differences being statistically significant(p<0.05).Conversely,the experimental group showed significantly lower scores than the control group in fasting blood glucose,2-hour postprandial blood glucose,and the psychological dimension of intrinsic capacity,with these differences also being statistically significant(p<0.05).Conclusion:Continuous nursing care utilizing telemedicine based on a hospital-community-family model combined with exercise intervention can effectively enhance exercise tolerance and intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease,thereby improving their quality of life.The effectiveness of the intervention is positively correlated with the duration of the intervention.展开更多
BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and te...BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.展开更多
BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diver...BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diverticulitis(CD)mostly requires hospitalization and can be treated within a spectrum from observation to surgery.Treatment choice is formed depending on the patient’s general condition,the presence of diffuse peritonitis,the localization of diverticulitis,Hinchey stage,and responsiveness to the prior treatment.Clinical disparities regarding right and LCD also led to the differences in the incidences of both emergency surgery and future elective surgery.AIM To evaluate the clinical features of CD,display the differences according to colonic localizations,and present treatment approaches.METHODS This was a retrospective study from a single centre analysing data from a prospective database.The 253 patients with history of hospitalization for CD were included and divided into two groups:RCD and LCD.To compare the differences between the two groups,the Student’s t-test was used when the parametric test prerequisites were fulfilled,and the Mann-Whitney U test was used when such requirements were not fulfilled.RESULTS The 208(82.2%)patients were found to have LCD,and 45(17.8%)had RCD.The majority of the patients had Hinchey 1A diverticulitis(49.8%).Male gender was significantly more common in patients who underwent surgery for LCD.While persistent abdominal pain was the main prior finding in the conservative treatment of both localizations,surgery was most performed due to abscess in RCD and perforation in LCD.The presence of an accompanying malignancy during colonoscopy was significantly more common in LCD cases who underwent surgery.Hartmann’s procedure was the most performed technique in emergency settings(56.3%),while laparoscopic colectomy with anastomosis was in elective settings(53.9%).In addition,surgery was found to prolong the mean length of hospital stay in LCD patients.CONCLUSION Although diverticulitis is a benign condition,the need for an individualized and evidence-based approach makes management challenging.Localization of the disease has an important role in determining the appropriate treatment.展开更多
Background In recent years,the incidence of coronary heart disease(CHD)has continued to rise,and its comorbidity with hyperlipidemia significantly increases the mortality risk in patients.Statin monotherapy faces limi...Background In recent years,the incidence of coronary heart disease(CHD)has continued to rise,and its comorbidity with hyperlipidemia significantly increases the mortality risk in patients.Statin monotherapy faces limitations in efficacy for some patients and raises potential safety concerns.Ezetimibe,as a novel lipid-modulating agent,exhibits potential advantages in the treatment of hyperlipidemia.Based on this,the present study investigated the therapeutic efficacy of ezetimibe in CHD patients with hyperlipidemia,as well as its effects on lipid metabolism and the amelioration of atherosclerosis.Methods In this study,150 clinical cases with CHD and hyperlipidemia admitted in our hospital from July 2022 to July 2024 were collected for retrospective analysis.According to different treatment methods,they were randomly divided into the Atorvastatin group(control group,n=75)and the Atorvastatin+Ezetimibe group(experimental group,n=75).Control group received atorvastatin monotherapy,while experimental group were administered additional ezetimibe as an adjunct to the atorvastatin-based treatment regimen.The clinical efficacy of the two treatment groups was analyzed,including cardiac function-related parameters such as the cardiac index(CI),cardiac output(CO),left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)before and after treatment.The observed indicators encompassed coronary angiography findings,the Gensini score for assessing coronary stenosis severity,the inflammatory marker high-sensitivity C-reactive protein(hs-CRP),and lipid profile parameters including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Additionally,the occurrence of adverse reactions during treatment was monitored.Results After treatment,the total effective rate in experimental group was significantly higher than that in control group,with a statistically significant difference(P<0.05).In the comparison of the baseline data,both groups showed marked improvements in CI,CO,LVEF,and HDL-C.However,at the same time points,the experimental group demonstrated significantly better results in these parameters than control group(P<0.05).Additionally,LVEDD,LDL-C,hs-CRP and Gensini scores were significantly reduced after treatment in both groups compared to pretreatment levels.Moreover,at identical time points,the aforementioned parameters in the experimental group demonstrated significantly greater reductions compared to control group(P<0.05).Regarding safety assessment,comparative analysis of adverse drug reaction(ADR)incidence rates between the two treatment groups revealed no statistically significant difference(P>0.05).Conclusions In patients with CHD complicated by hyperlipidemia,ezetimibe demonstrates significant therapeutic advantages.It effectively enhances treatment efficacy,regulates lipid profiles,improves cardiac function,and mitigates the progression of atherosclerosis.This regimen exhibits a favorable safety profile and holds substantial clinical value for both therapeutic processes and rehabilitation outcomes in this patient population.展开更多
The arbitrary Lagrangian-Eulerian（ALE） adaptive remeshing technology and the HyperXtrude software of transient finite element simulations were used on analogue simulation of aluminium extrusion processing.The field ...The arbitrary Lagrangian-Eulerian（ALE） adaptive remeshing technology and the HyperXtrude software of transient finite element simulations were used on analogue simulation of aluminium extrusion processing.The field distributions of strain rate,stress,temperature and velocity of metal flow were obtained.The results are basically consistent with the experiment,which indicates that this method may successfully predict the defects in the actual extrusion process.展开更多
BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the sta...BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).展开更多
BACKGROUND Hepatitis B virus(HBV)infection can lead to renal involvement,commonly manifested as HBV-associated glomerulonephritis(HBV-GN),which typically presents as nephrotic or nephritic syndrome.Antineutrophil cyto...BACKGROUND Hepatitis B virus(HBV)infection can lead to renal involvement,commonly manifested as HBV-associated glomerulonephritis(HBV-GN),which typically presents as nephrotic or nephritic syndrome.Antineutrophil cytoplasmic antibody-associated vasculitis(AAV)is a systemic disease characterized by immune necrotizing inflammation of small blood vessels involving multiple organs with complex and severe clinical implications.The coexistence of HBV-GN and AAV is sporadic,with limited data existing regarding its diagnosis,management,clinical outcomes,and prognosis,especially in patients with AAV.CASE SUMMARY This manuscript presents the case of an older male patient who presented with persistent foamy urine lasting over two weeks.Initial clinical findings included nephrotic syndrome and renal insufficiency,which subsequently progressed to involve the lungs,immune system,hematologic system,and other organ systems.The patient was diagnosed with HBV-GN complicated by AAV,a rare and complex condition.Despite receiving comprehensive treatment,including corticosteroids,cyclophosphamide for immune regulation,plasma exchange,and immunoadsorption targeting antineutrophil cytoplasmic antibody-associated antibodies,the patient required long-term dialysis and demonstrated a poor prognosis.CONCLUSION HBV infection may trigger nephropathy with AAV.Early recognition and intervention are crucial for improving patient prognosis.展开更多
Objective: To compare the level of glutathione(GSH) and oxidized glutathione(GSSG),the ratio of GSH/GSSG and the concentration of albumin in plasma of patients with complicated and un-complicated falciparum malaria.Me...Objective: To compare the level of glutathione(GSH) and oxidized glutathione(GSSG),the ratio of GSH/GSSG and the concentration of albumin in plasma of patients with complicated and un-complicated falciparum malaria.Methods: This research was a cross sectional study using comparison analysis with the plasma GSH and GSSG, the ratio of plasma GSH/GSSG and the concentration of plasma albumin as variables. The complicated malaria patients were obtained from Dr. Saiful Anwar Hospital Malang, whereas uncomplicated malaria patients were obtained from the Regency of Pleihari South Kalimantan. Plasma GSH and GSSG levels were determined by the spectrophotometer at the wave length of 412 nm, whereas the concentration of albumin was determined by bromocresol green method in the p H of 4.1.Results: There were no significant differences between the level of plasma GSH and GSSG in complicated and uncomplicated malaria patients, as well as the ratio of plasma GSH/GSSG in the two groups(P = 0.373; P = 0.538; and P = 0.615, respectively, independent ttest). In contrast, the plasma albumin concentration in complicated malaria patients were significantly higher than uncomplicated malaria patients(P = 0.000, Mann Whitney U test).Conclusions: It can be concluded that the average of plasma GSH and GSSG level, also plasma GSH/GSSG ratio in complicated malaria are not different from uncomplicated malaria. Although plasma concentration of albumin in both groups is below the normal range,there is an increase in complicated malaria that might be as compensation of oxidative stress.展开更多
The geologic conditions of superimposed basins in China are very complicated. This is mainly shown by multi-phase structural evolution, multiple sets of source-reservoir-cap rock combinations, multiple stages of hydro...The geologic conditions of superimposed basins in China are very complicated. This is mainly shown by multi-phase structural evolution, multiple sets of source-reservoir-cap rock combinations, multiple stages of hydrocarbon generation and expulsion from source rocks, multi-cycle hydrocarbon enrichment and accumulation, and multi-phase reservoir adjustment and reconstruction. The enrichment, accumulation and distribution of hydrocarbon is mainly controlled by the source rock kitchen, paleo- anticline, regional cap rock and intensity of tectonic movement. In this paper, the T-BCMS model has been developed to predict favorable areas of hydrocarbon accumulation in complicated superimposed basins according to time and spatial relationships among five key factors. The five factors include unconformity surface representing tectonic balancing （B）, regional cap rock representing hydrocarbon protection （C）, paleo-anticline representing hydrocarbon migration and accumulation （M）, source rock kitchen representing hydrocarbon generation and expulsion （S） and geological time （T）. There are three necessary conditions to form favorable areas of hydrocarbon accumulation. First, four key factors BCMS should be strictly in the order of BCMS from top to bottom. Second, superimposition of four key factors BCMS in the same area is the most favorable for hydrocarbon accumulation. Third, vertically ordered combination and superimposition in the same area of BCMS should occur at the same geological time. The model has been used to predict the most favorable exploration areas in Ordovician in the Tarim Basin in the main hydrocarbon accumulation periods. The result shows that 95% of the discovered Ordovician hydrocarbon reservoirs are located in the predicted areas, which indicates the feasibility and reliability of the key factor matching T-BCMS model for hydrocarbon accumulation and enrichment.展开更多
In order to increase productivity and reduce energy consumption of steelmaking-continuous casting(SCC) production process, especially with complicated technological routes, the cross entropy(CE) method was adopted to ...In order to increase productivity and reduce energy consumption of steelmaking-continuous casting(SCC) production process, especially with complicated technological routes, the cross entropy(CE) method was adopted to optimize the SCC production scheduling(SCCPS) problem. Based on the CE method, a matrix encoding scheme was proposed and a backward decoding method was used to generate a reasonable schedule. To describe the distribution of the solution space, a probability distribution model was built and used to generate individuals. In addition, the probability updating mechanism of the probability distribution model was proposed which helps to find the optimal individual gradually. Because of the poor stability and premature convergence of the standard cross entropy(SCE) algorithm, the improved cross entropy(ICE) algorithm was proposed with the following improvements: individual generation mechanism combined with heuristic rules, retention mechanism of the optimal individual, local search mechanism and dynamic parameters of the algorithm. Simulation experiments validate that the CE method is effective in solving the SCCPS problem with complicated technological routes and the ICE algorithm proposed has superior performance to the SCE algorithm and the genetic algorithm(GA).展开更多
AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patient...AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.展开更多
AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included ...AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.展开更多
Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controv...Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.展开更多
Based on the work discussed on the former study, this article first starts from the mathematical model of a kind of complicated financial system, and analyses all possible things that the model shows in the operation ...Based on the work discussed on the former study, this article first starts from the mathematical model of a kind of complicated financial system, and analyses all possible things that the model shows in the operation of our country's macro_financial system: balance, stable periodic, fractal, Hopf_bifurcation, the relationship between parameters and Hopf_bifurcation, and chaotic motion etc. By the changes of parameters of all economic meanings, the conditions on which the complicated behaviors occur in such a financial system, and the influence of the adjustment of the macro_economic policies and adjustment of some parameter on the whole financial system behavior have been analyzed. This study will deepen people's understanding of the lever function of all kinds of financial policies.展开更多
AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with l...AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.展开更多
In order to investigate the clinical and microbiological characteristics of patients with complicated intra-abdominal infections(cIAIs)in intensive care unit(ICU),the clinical data of 612 cIAIs patients from January 2...In order to investigate the clinical and microbiological characteristics of patients with complicated intra-abdominal infections(cIAIs)in intensive care unit(ICU),the clinical data of 612 cIAIs patients from January 2016 to December 2018 were retrospectively collected.Clinical characteristics,distribution of pathogens and drug resistance were statistically analyzed.It was found that patients with community-acquired intra-abdominal infections(CA-IAIs)made up a majority of cIAIs patients.The positive rate of abdominal drainage fluid culture was 55.56%.Gramnegative bacteria accounted for the majority,the most commonly isolated bacteria of which were Escherichia coli(20.96%),Klebsiella pneumoniae(10.20%)and Pseudomonas aeruginosa(5.57%).The most commonly isolated gram-positive bacteria were Enterococcus(16.88%)and Methicillinresistant staphylococcus aureus(MRSA,3.90%).Enterobacter isolates showed high resistance rate to most cephalosporins and low resistance rate to piperacillin/tazobactam and carbapenems.Extended spectrum beta-lactamase(ESBL)screen positive isolates from CA-IAIs patients showed an increasing trend in past three years.Enterococcus and MRSA showed high resistance rate to clindamycin,quinolone,erythromycin and tetracycline,while they showed high sensitivity rate to linezolid,tegacycline,teicoplanin and vancomycin.Our results indicate that isolated bacteria from abdominal drainage fluid show high resistance rates to commonly used antibiotics in ICU patients with cIAIs.The curative effects on diseases should be monitored continuously when antibiotics are used.Meanwhile,we should always keep eyes on drug-resistant bacteria,especially when the treatment efficacy is not good.展开更多
AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver...AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.METHODS:The study was carried out at Sher-i-Kashmir Institute of Medical Science,Srinagar,Kashmir,India.Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years.It included 27 men and 42 women with a median age of 35 years.An abdominal ultrasound,computed tomography and serology established diagnosis.Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography.Cysts with infection,rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts.Eighteen patients(26%)had complicated cysts and formed the basis for this study.RESULTS:Common complications were infection(14%),intrabiliary rupture(9%)and intraperitoneal rupture(3%).All the patients with infected cysts presented with pain and fever.All the patients with intrabiliary rupture had jaundice,while only four with intrabiliary rupture had pain and only two had fever.Surgical procedures performed in complicated cysts were:infection-omentoplasty in three and external drainage in seven;intrabiliary rupture-omentoplasty in two and internal drainage in four patients.Two patients with intraperitoneal rupture underwent external drainage.There was no mortality.The postoperative morbidity was 50%in complicated cysts and 16%in uncomplicated cysts.CONCLUSION:Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.展开更多
A heterogeneous lamella(HL)design strategy was applied to manipulate mechanical properties of a new cost-effective Fe_(35)Ni_(35)Cr_(25)Mo_(5)compositionally complicated alloy(CCA).The HL structure was produced by sin...A heterogeneous lamella(HL)design strategy was applied to manipulate mechanical properties of a new cost-effective Fe_(35)Ni_(35)Cr_(25)Mo_(5)compositionally complicated alloy(CCA).The HL structure was produced by single-step heat treatment(800℃for 1 h)after cold rolling.This HL structure consists of alternative lamellae regions of coarse-grained FCC matrix(5-20μm),and regions containing ultra-fine grains or subgrains(200-500 nm)together with nanoprecipitates(20-500 nm)and annealing twins.As compared with other cost-effective CCAs,the 800℃annealed sample with HL structure demonstrated a comparable tensile property,with yield strength over 1.0 GPa and total elongation of~13%.Formation of the annealing twins and nanoprecipitates decorated HL structure was a result of the concurrent partial recrystallization and precipitation ofσphase at the shear bands with a high density of lattice defects(e.g.high-density dislocation walls and deformation twins).The latter restricted the growth of recrystallized grains,leading to the formation of ultrafine subgrains within the HL structure.The high yield strength resulted from the multistage hetero-deformation induced(HDI)strengthening and precipitation strengthening associated with heterogeneous lamella structures containing nanoprecipitates.The ductility was originated from the coexistence of multiple deformation mechanisms,which started with dislocation slip and formation of stacking faults at the initial stage,followed by nano-twinning at the higher strain level.This HL design strategy,comprising composition and thermomechanical process designs,and the resultant microstructure tuning,open a broader window for the development of cost-effective CCAs with enhanced performance.展开更多
AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by im...AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.展开更多
基金2024 Medical Science Research Project Plan of Hebei Province:Research on the Rehabilitation Effect of Combined Exercise Intervention Based on a Hospital-Community-Family Model for Elderly Patients with Chronic Diseases(Project No.:20240083)Youth Science and Technology Project of the Hebei Provincial Health Department:Research on the Standardization Level of Self-Management in Patients with Diabetic Foot and Related Factors Affecting Wound Healing(Project No.:20190002)。
文摘Objective:To explore the application effect of combined exercise intervention based on the hospital-community-family model on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Methods:Using convenience sampling,100 elderly patients with diabetes mellitus complicated by chronic kidney disease who received treatment in the endocrinology department of a tertiary A-level hospital from May 2024 to May 2025 were selected as the study subjects.They were randomly divided into an experimental group(50 cases)and a control group(50 cases)using a random number table method.The control group received routine health education and telephone follow-up,while the experimental group,in addition to the control group’s interventions,underwent combined exercise intervention based on the hospital-community-family model.Remote medical guidance was utilized to monitor and study the application effect of exercise intervention on intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease.Fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores in five dimensions of intrinsic capacity(exercise,cognition,psychology,vitality,and sensation)were measured before the intervention,at 4 weeks of intervention,and at 12 weeks of intervention for both groups.Results:Before the exercise intervention,there were no statistically significant differences(p>0.05)between the two groups in terms of fasting blood glucose,2-hour postprandial blood glucose,glomerular filtration rate,6-minute walk distance,and scores across five dimensions of intrinsic capacity:mobility,cognition,psychology,vitality,and sensation.After 12 weeks of intervention,the experimental group demonstrated significantly higher scores than the control group in glomerular filtration rate,6-minute walk distance,and the dimensions of mobility,cognition,and vitality within intrinsic capacity,with all differences being statistically significant(p<0.05).Conversely,the experimental group showed significantly lower scores than the control group in fasting blood glucose,2-hour postprandial blood glucose,and the psychological dimension of intrinsic capacity,with these differences also being statistically significant(p<0.05).Conclusion:Continuous nursing care utilizing telemedicine based on a hospital-community-family model combined with exercise intervention can effectively enhance exercise tolerance and intrinsic capacity in elderly patients with diabetes mellitus complicated by chronic kidney disease,thereby improving their quality of life.The effectiveness of the intervention is positively correlated with the duration of the intervention.
基金Supported by 2021 Disciplinary Construction Project in School of Dentistry,Anhui Medical University,No.2021kqxkFY05.
文摘BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.
文摘BACKGROUND Distribution of the colonic diverticula differs in different populations,and rightsided colon diverticulitis(RCD)and left-sided colon diverticulitis(LCD)manifest distinct clinical features.Complicated diverticulitis(CD)mostly requires hospitalization and can be treated within a spectrum from observation to surgery.Treatment choice is formed depending on the patient’s general condition,the presence of diffuse peritonitis,the localization of diverticulitis,Hinchey stage,and responsiveness to the prior treatment.Clinical disparities regarding right and LCD also led to the differences in the incidences of both emergency surgery and future elective surgery.AIM To evaluate the clinical features of CD,display the differences according to colonic localizations,and present treatment approaches.METHODS This was a retrospective study from a single centre analysing data from a prospective database.The 253 patients with history of hospitalization for CD were included and divided into two groups:RCD and LCD.To compare the differences between the two groups,the Student’s t-test was used when the parametric test prerequisites were fulfilled,and the Mann-Whitney U test was used when such requirements were not fulfilled.RESULTS The 208(82.2%)patients were found to have LCD,and 45(17.8%)had RCD.The majority of the patients had Hinchey 1A diverticulitis(49.8%).Male gender was significantly more common in patients who underwent surgery for LCD.While persistent abdominal pain was the main prior finding in the conservative treatment of both localizations,surgery was most performed due to abscess in RCD and perforation in LCD.The presence of an accompanying malignancy during colonoscopy was significantly more common in LCD cases who underwent surgery.Hartmann’s procedure was the most performed technique in emergency settings(56.3%),while laparoscopic colectomy with anastomosis was in elective settings(53.9%).In addition,surgery was found to prolong the mean length of hospital stay in LCD patients.CONCLUSION Although diverticulitis is a benign condition,the need for an individualized and evidence-based approach makes management challenging.Localization of the disease has an important role in determining the appropriate treatment.
文摘Background In recent years,the incidence of coronary heart disease(CHD)has continued to rise,and its comorbidity with hyperlipidemia significantly increases the mortality risk in patients.Statin monotherapy faces limitations in efficacy for some patients and raises potential safety concerns.Ezetimibe,as a novel lipid-modulating agent,exhibits potential advantages in the treatment of hyperlipidemia.Based on this,the present study investigated the therapeutic efficacy of ezetimibe in CHD patients with hyperlipidemia,as well as its effects on lipid metabolism and the amelioration of atherosclerosis.Methods In this study,150 clinical cases with CHD and hyperlipidemia admitted in our hospital from July 2022 to July 2024 were collected for retrospective analysis.According to different treatment methods,they were randomly divided into the Atorvastatin group(control group,n=75)and the Atorvastatin+Ezetimibe group(experimental group,n=75).Control group received atorvastatin monotherapy,while experimental group were administered additional ezetimibe as an adjunct to the atorvastatin-based treatment regimen.The clinical efficacy of the two treatment groups was analyzed,including cardiac function-related parameters such as the cardiac index(CI),cardiac output(CO),left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)before and after treatment.The observed indicators encompassed coronary angiography findings,the Gensini score for assessing coronary stenosis severity,the inflammatory marker high-sensitivity C-reactive protein(hs-CRP),and lipid profile parameters including total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Additionally,the occurrence of adverse reactions during treatment was monitored.Results After treatment,the total effective rate in experimental group was significantly higher than that in control group,with a statistically significant difference(P<0.05).In the comparison of the baseline data,both groups showed marked improvements in CI,CO,LVEF,and HDL-C.However,at the same time points,the experimental group demonstrated significantly better results in these parameters than control group(P<0.05).Additionally,LVEDD,LDL-C,hs-CRP and Gensini scores were significantly reduced after treatment in both groups compared to pretreatment levels.Moreover,at identical time points,the aforementioned parameters in the experimental group demonstrated significantly greater reductions compared to control group(P<0.05).Regarding safety assessment,comparative analysis of adverse drug reaction(ADR)incidence rates between the two treatment groups revealed no statistically significant difference(P>0.05).Conclusions In patients with CHD complicated by hyperlipidemia,ezetimibe demonstrates significant therapeutic advantages.It effectively enhances treatment efficacy,regulates lipid profiles,improves cardiac function,and mitigates the progression of atherosclerosis.This regimen exhibits a favorable safety profile and holds substantial clinical value for both therapeutic processes and rehabilitation outcomes in this patient population.
基金Project (2009A080205003) supported by the Major Science and Technology Project of Guangdong Province,ChinaProject (30815009) supported by the Foundation of State Key Laboratory of Advanced Design and Manufacture for Vehicle Body,China
文摘The arbitrary Lagrangian-Eulerian（ALE） adaptive remeshing technology and the HyperXtrude software of transient finite element simulations were used on analogue simulation of aluminium extrusion processing.The field distributions of strain rate,stress,temperature and velocity of metal flow were obtained.The results are basically consistent with the experiment,which indicates that this method may successfully predict the defects in the actual extrusion process.
文摘BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).
基金Supported by the Natural Science Foundation of Hunan Province,China,No.2023JJ30842.
文摘BACKGROUND Hepatitis B virus(HBV)infection can lead to renal involvement,commonly manifested as HBV-associated glomerulonephritis(HBV-GN),which typically presents as nephrotic or nephritic syndrome.Antineutrophil cytoplasmic antibody-associated vasculitis(AAV)is a systemic disease characterized by immune necrotizing inflammation of small blood vessels involving multiple organs with complex and severe clinical implications.The coexistence of HBV-GN and AAV is sporadic,with limited data existing regarding its diagnosis,management,clinical outcomes,and prognosis,especially in patients with AAV.CASE SUMMARY This manuscript presents the case of an older male patient who presented with persistent foamy urine lasting over two weeks.Initial clinical findings included nephrotic syndrome and renal insufficiency,which subsequently progressed to involve the lungs,immune system,hematologic system,and other organ systems.The patient was diagnosed with HBV-GN complicated by AAV,a rare and complex condition.Despite receiving comprehensive treatment,including corticosteroids,cyclophosphamide for immune regulation,plasma exchange,and immunoadsorption targeting antineutrophil cytoplasmic antibody-associated antibodies,the patient required long-term dialysis and demonstrated a poor prognosis.CONCLUSION HBV infection may trigger nephropathy with AAV.Early recognition and intervention are crucial for improving patient prognosis.
基金Supported by The Ministry of Research & Technology Republic of Indonesia with grant No.499/J10.2/PL/2009
文摘Objective: To compare the level of glutathione(GSH) and oxidized glutathione(GSSG),the ratio of GSH/GSSG and the concentration of albumin in plasma of patients with complicated and un-complicated falciparum malaria.Methods: This research was a cross sectional study using comparison analysis with the plasma GSH and GSSG, the ratio of plasma GSH/GSSG and the concentration of plasma albumin as variables. The complicated malaria patients were obtained from Dr. Saiful Anwar Hospital Malang, whereas uncomplicated malaria patients were obtained from the Regency of Pleihari South Kalimantan. Plasma GSH and GSSG levels were determined by the spectrophotometer at the wave length of 412 nm, whereas the concentration of albumin was determined by bromocresol green method in the p H of 4.1.Results: There were no significant differences between the level of plasma GSH and GSSG in complicated and uncomplicated malaria patients, as well as the ratio of plasma GSH/GSSG in the two groups(P = 0.373; P = 0.538; and P = 0.615, respectively, independent ttest). In contrast, the plasma albumin concentration in complicated malaria patients were significantly higher than uncomplicated malaria patients(P = 0.000, Mann Whitney U test).Conclusions: It can be concluded that the average of plasma GSH and GSSG level, also plasma GSH/GSSG ratio in complicated malaria are not different from uncomplicated malaria. Although plasma concentration of albumin in both groups is below the normal range,there is an increase in complicated malaria that might be as compensation of oxidative stress.
基金supported by the National Basic Research Program (2006CB202308)
文摘The geologic conditions of superimposed basins in China are very complicated. This is mainly shown by multi-phase structural evolution, multiple sets of source-reservoir-cap rock combinations, multiple stages of hydrocarbon generation and expulsion from source rocks, multi-cycle hydrocarbon enrichment and accumulation, and multi-phase reservoir adjustment and reconstruction. The enrichment, accumulation and distribution of hydrocarbon is mainly controlled by the source rock kitchen, paleo- anticline, regional cap rock and intensity of tectonic movement. In this paper, the T-BCMS model has been developed to predict favorable areas of hydrocarbon accumulation in complicated superimposed basins according to time and spatial relationships among five key factors. The five factors include unconformity surface representing tectonic balancing （B）, regional cap rock representing hydrocarbon protection （C）, paleo-anticline representing hydrocarbon migration and accumulation （M）, source rock kitchen representing hydrocarbon generation and expulsion （S） and geological time （T）. There are three necessary conditions to form favorable areas of hydrocarbon accumulation. First, four key factors BCMS should be strictly in the order of BCMS from top to bottom. Second, superimposition of four key factors BCMS in the same area is the most favorable for hydrocarbon accumulation. Third, vertically ordered combination and superimposition in the same area of BCMS should occur at the same geological time. The model has been used to predict the most favorable exploration areas in Ordovician in the Tarim Basin in the main hydrocarbon accumulation periods. The result shows that 95% of the discovered Ordovician hydrocarbon reservoirs are located in the predicted areas, which indicates the feasibility and reliability of the key factor matching T-BCMS model for hydrocarbon accumulation and enrichment.
基金Project(ZR2014FM036)supported by Shandong Provincial Natural Science Foundation of ChinaProject(ZR2010FZ001)supported by the Key Program of Shandong Provincial Natural Science Foundation of China
文摘In order to increase productivity and reduce energy consumption of steelmaking-continuous casting(SCC) production process, especially with complicated technological routes, the cross entropy(CE) method was adopted to optimize the SCC production scheduling(SCCPS) problem. Based on the CE method, a matrix encoding scheme was proposed and a backward decoding method was used to generate a reasonable schedule. To describe the distribution of the solution space, a probability distribution model was built and used to generate individuals. In addition, the probability updating mechanism of the probability distribution model was proposed which helps to find the optimal individual gradually. Because of the poor stability and premature convergence of the standard cross entropy(SCE) algorithm, the improved cross entropy(ICE) algorithm was proposed with the following improvements: individual generation mechanism combined with heuristic rules, retention mechanism of the optimal individual, local search mechanism and dynamic parameters of the algorithm. Simulation experiments validate that the CE method is effective in solving the SCCPS problem with complicated technological routes and the ICE algorithm proposed has superior performance to the SCE algorithm and the genetic algorithm(GA).
文摘AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.
文摘AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.
文摘Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.
文摘Based on the work discussed on the former study, this article first starts from the mathematical model of a kind of complicated financial system, and analyses all possible things that the model shows in the operation of our country's macro_financial system: balance, stable periodic, fractal, Hopf_bifurcation, the relationship between parameters and Hopf_bifurcation, and chaotic motion etc. By the changes of parameters of all economic meanings, the conditions on which the complicated behaviors occur in such a financial system, and the influence of the adjustment of the macro_economic policies and adjustment of some parameter on the whole financial system behavior have been analyzed. This study will deepen people's understanding of the lever function of all kinds of financial policies.
文摘AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.
基金gants from Research Foundation of Health and Family Planning Commission of Hubei Province(No.WJ2017M041)National Natural Science Foundation of China(No.81770283)Clinical Medical Research Center of Peritoneal Cancer of Wuhan,China(No.2015060911020462).
文摘In order to investigate the clinical and microbiological characteristics of patients with complicated intra-abdominal infections(cIAIs)in intensive care unit(ICU),the clinical data of 612 cIAIs patients from January 2016 to December 2018 were retrospectively collected.Clinical characteristics,distribution of pathogens and drug resistance were statistically analyzed.It was found that patients with community-acquired intra-abdominal infections(CA-IAIs)made up a majority of cIAIs patients.The positive rate of abdominal drainage fluid culture was 55.56%.Gramnegative bacteria accounted for the majority,the most commonly isolated bacteria of which were Escherichia coli(20.96%),Klebsiella pneumoniae(10.20%)and Pseudomonas aeruginosa(5.57%).The most commonly isolated gram-positive bacteria were Enterococcus(16.88%)and Methicillinresistant staphylococcus aureus(MRSA,3.90%).Enterobacter isolates showed high resistance rate to most cephalosporins and low resistance rate to piperacillin/tazobactam and carbapenems.Extended spectrum beta-lactamase(ESBL)screen positive isolates from CA-IAIs patients showed an increasing trend in past three years.Enterococcus and MRSA showed high resistance rate to clindamycin,quinolone,erythromycin and tetracycline,while they showed high sensitivity rate to linezolid,tegacycline,teicoplanin and vancomycin.Our results indicate that isolated bacteria from abdominal drainage fluid show high resistance rates to commonly used antibiotics in ICU patients with cIAIs.The curative effects on diseases should be monitored continuously when antibiotics are used.Meanwhile,we should always keep eyes on drug-resistant bacteria,especially when the treatment efficacy is not good.
文摘AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.METHODS:The study was carried out at Sher-i-Kashmir Institute of Medical Science,Srinagar,Kashmir,India.Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years.It included 27 men and 42 women with a median age of 35 years.An abdominal ultrasound,computed tomography and serology established diagnosis.Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography.Cysts with infection,rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts.Eighteen patients(26%)had complicated cysts and formed the basis for this study.RESULTS:Common complications were infection(14%),intrabiliary rupture(9%)and intraperitoneal rupture(3%).All the patients with infected cysts presented with pain and fever.All the patients with intrabiliary rupture had jaundice,while only four with intrabiliary rupture had pain and only two had fever.Surgical procedures performed in complicated cysts were:infection-omentoplasty in three and external drainage in seven;intrabiliary rupture-omentoplasty in two and internal drainage in four patients.Two patients with intraperitoneal rupture underwent external drainage.There was no mortality.The postoperative morbidity was 50%in complicated cysts and 16%in uncomplicated cysts.CONCLUSION:Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.
基金financially supported by the ARC Discovery Project(No.DP200101408)support from the China Scholarship Council(CSC)+1 种基金the University of Queensland(UQ)the School of Mechanical and Mining Engineering for the CSC and TOP-UP scholarship。
文摘A heterogeneous lamella(HL)design strategy was applied to manipulate mechanical properties of a new cost-effective Fe_(35)Ni_(35)Cr_(25)Mo_(5)compositionally complicated alloy(CCA).The HL structure was produced by single-step heat treatment(800℃for 1 h)after cold rolling.This HL structure consists of alternative lamellae regions of coarse-grained FCC matrix(5-20μm),and regions containing ultra-fine grains or subgrains(200-500 nm)together with nanoprecipitates(20-500 nm)and annealing twins.As compared with other cost-effective CCAs,the 800℃annealed sample with HL structure demonstrated a comparable tensile property,with yield strength over 1.0 GPa and total elongation of~13%.Formation of the annealing twins and nanoprecipitates decorated HL structure was a result of the concurrent partial recrystallization and precipitation ofσphase at the shear bands with a high density of lattice defects(e.g.high-density dislocation walls and deformation twins).The latter restricted the growth of recrystallized grains,leading to the formation of ultrafine subgrains within the HL structure.The high yield strength resulted from the multistage hetero-deformation induced(HDI)strengthening and precipitation strengthening associated with heterogeneous lamella structures containing nanoprecipitates.The ductility was originated from the coexistence of multiple deformation mechanisms,which started with dislocation slip and formation of stacking faults at the initial stage,followed by nano-twinning at the higher strain level.This HL design strategy,comprising composition and thermomechanical process designs,and the resultant microstructure tuning,open a broader window for the development of cost-effective CCAs with enhanced performance.
文摘AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.
