BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen b...AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.展开更多
Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy....Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy.Methods In total,63 consecutive patients with CEC who received definitive radiotherapy between 2010 and 2018 were included in this study.The survival outcomes were analyzed based on statistics.Results The median progression-free survival(PFS)and overall survival(OS)of the patients were 12 and 19 months,respectively.There were no significant differences in terms of survival outcomes between the groups who received radiation doses≥60 and<60 Gy.Interestingly,in the proximal CEC subgroup,the PFS(P=0.039),OS(P=0.031),and loco-regional failure-free survival(LRFFS)(P=0.005)improved significantly in patients who received a radiation dose≥60 Gy compared with those who received a radiation dose<60 Gy.However,in the distal CEC subgroup,the PFS,OS,and LRFFS did not significantly improve between patients who received radiation doses≥60 and<60 Gy.Definitive radiotherapy was well tolerated,and no significant differences were observed in terms of treatment-related toxicities between the groups who received radiation doses≥60 and<60 Gy.Conclusion The survival outcomes of patients with CEC should be improved.In proximal CEC,a radiation dose≥60 Gy is significantly correlated with better PFS,OS,and LRFFS.However,further research must be performed to validate this finding.展开更多
Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease f...Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.展开更多
Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Alth...Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.展开更多
Among the 135 million births in 2020,0.6 million were extremely preterm(<28 weeks’gestation),and 1.4 million were very preterm(between 28 and<32 weeks’gestation)[1].Intraventricular hemorrhage(IVH)remains a ma...Among the 135 million births in 2020,0.6 million were extremely preterm(<28 weeks’gestation),and 1.4 million were very preterm(between 28 and<32 weeks’gestation)[1].Intraventricular hemorrhage(IVH)remains a major concern for these infants,particularly those<29 weeks’gestation[2].Midline head positioning(MHP)is a widely adopted intervention in care bundles for IVH prevention in preterm infants.However,high-quality evidence supporting the efcacy and efectiveness of MHP for IVH prevention is lacking.Here,we summarize the issues with the existing evidence on MHP,including its widespread adoption in care bundles on the basis of poor quality of evidence,and highlight the urgent need for a defnitive trial to determine the causal role,if any,of MHP in IVH prevention.展开更多
Background:Angiostrongyliasis is a food-borne parasitic zoonosis.Human infection is caused by infection with the third-stage larvae of Angiostrongylus cantonensis.The life cycle of A.cantonensis involves rodents as de...Background:Angiostrongyliasis is a food-borne parasitic zoonosis.Human infection is caused by infection with the third-stage larvae of Angiostrongylus cantonensis.The life cycle of A.cantonensis involves rodents as definitive hosts and molluscs as intermediate hosts.This study aims to investigate on the infection status and characteristics of spatial distribution of these hosts,which are key components in the strategy for the prevention and control of angiostrongyliasis.Methods:Three villages from Nanao Island,Guangdong Province,China,were chosen as study area by stratified random sampling.The density and natural infection of Pomacea canaliculata and various rat species were surveyed every three months from December 2015 to September 2016,with spatial correlations of the positive P.canaliculata and the infection rates analysed by ArcGIS,scan statistics,ordinary least squares(OLS)and geographically weighted regression(GWR)models.Results:A total of 2192 P.canaliculata specimens were collected from the field,of which 1190 were randomly chosen to be examined for third-stage larvae of A.cantonensis.Seventy-two Angiostrongylus-infected snails were found,which represents a larval infection rate of 6.1%(72/1190).In total,110 rats including 85 Rattus norvegicus,10 R.flavipectus,one R.losea and 14 Suncus murinus were captured,and 32 individuals were positive(for adult worms),representing an infection rate of 29.1%of the definitive hosts(32/110).Worms were only found in R.norvegicus and R.flavipectus,representing a prevalence of 36.5%(31/85)and 10%(1/10),respectively in these species,but none in R.losea and S.murinus,despite testing as many as 32 of the latter species.Statistically,spatial correlation and spatial clusters in the spatial distribution of positive P.canaliculata and positive rats existed.Most of the spatial variability of the host infection rates came from spatial autocorrelation.Nine spatial clusters with respect to positive P.canaliculata were identified,but only two correlated to infection rates.The results show that corrected Akaike information criterion,R2,R2 adjusted andσ2 in the GWR model were superior to those in the OLS model.Conclusions:P.canaliculata and rats were widely distributed in Nanao Island and positive infection has also been found in the hosts,demonstrating that there was a risk of angiostrongyliasis in this region of China.The distribution of positive P.canaliculata and rats exhibited spatial correlation,and the GWR model had advantage over the OLS model in the spatial analysis of hosts of A.cantonensis.展开更多
Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,...Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,such as chemotherapy,is always the first choice to achieve improved QOL.This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S+RT between January 2012 and August 2016.A total of 59 patients were identified,of whom 31 were treated with DRT,and 28 were treated with S+RT.In the 31 cases of DRT,23 cases were treated with concurrent chemoradiotherapy(CRT),one case was treated with DRT plus cetuximab,and seven cases were treated with DRT alone.Of the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent CRT.Survival analysis was used to compare the overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)between DRT and S+RT groups.Results:The median follow-up was 20 months(range,4-67 months).The patients of the two groups were similar with respect to mean age,original sites,and tumor stages.The 1-,2-,and 5-year OS rates were 80.6%,53.4%,and 24.7% for the DRT group and 85.7%,67.1%,and 24.7%for the S+RT group,respectively.There was no significant difference between the two groups(x^2=3.183,P=0.074).The 1-,2-,and 5-year LRFS and DMFS were 90.4%,61.7%,and 18.0%and 87.4%,49.2%,and 9.9%,respectively,and no statistical difference was observed between the two groups(LRFS:x^2=0.028,P=0.868;DMFS:x^2=3.347,P=0.067).No significant difference was found between the two groups in acute radiotoxicity.Conclusions:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.展开更多
Mountain road tunnels are prone to water leakage and lining corrosion under the complex geological conditions and corrosive envi-ronments,which will reduce the strength of the lining structure until it loses its load-...Mountain road tunnels are prone to water leakage and lining corrosion under the complex geological conditions and corrosive envi-ronments,which will reduce the strength of the lining structure until it loses its load-bearing capacity;eventually,the definitive lining will need to be replaced.In this paper,a highway tunnel in a mountainous area in Southwest China is taken as an example.Field investi-gation found that the tunnel was seriously corroded by sulfate,the strength of the definitive lining decreased,and large-scale cracks and spalling appeared on the surface,so the operator decided to replace the definitive lining by the method of interval replacement.Based on the data obtained from drilling and coring,a numerical model of long-distance replacement of the definitive lining of the damaged tunnel is established.First,the back analysis of the calculation parameters is carried out,and the modified calculation results are com-pared with the field monitoring results for verification.Then,the deformation trend of the tunnel and the development of the plastic zone during the process of long-distance replacement of the definitive lining are studied.Finally,the construction scheme is optimized.Numer-ical analysis results show that the replacement of the definitive lining of the tunnel mainly leads to the settlement of the arch crown and the uplift of the inverted arch.The deformation of the tunnel shows two rapid growth stages and two stable stages during the replace-ment process;after replacement,the deformation of the arch crown and the inverted arch is divided into two buffer zones and one stable zone.In the progress of the replacement of the definitive lining,the plastic zone does not change.Regarding the reinforcement measures,with the increase in the grouting range,the grouting efficiency decreases,and the effect of the temporary steel arch on controlling the overall deformation is not obvious.The length of the replacement of the single section should be determined according to the geological conditions of the replacement section and the monitoring data during construction.The research results can provide a reference for sim-ilar projects for the replacement of the definitive lining.展开更多
Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,...Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.展开更多
Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacter...Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacterial interactions,molecular responses,and therapeutic approaches,the mortality rate associated with sepsis has consistently ranged between 10%and 16%.This elevated mortality highlights critical gaps in our comprehension of sepsis etiology.Traditionally linked to bacterial and fungal pathogens,recent outbreaks of acute viral infections,including Middle East respiratory syndrome coronavirus(MERS-CoV),influenza virus,and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),among other regional epidemics,have underscored the role of viral pathogenesis in sepsis,particularly when critically ill patients exhibit classic symptoms indicative of sepsis.However,many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels.Moreover,these viruses not only activate conventional pattern recognition receptors(PRRs)and retinoic acid-inducible gene-I(RIG-I)-like receptors(RLRs)but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate(GMP-AMP)synthase(cGAS)-stimulator of interferon genes(STING)signaling and interferon response mechanisms.Such activations lead to cellular stress,metabolic disturbances,and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations.This complexity poses substantial challenges for the clinical management of affected cases.In this review,we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology,epidemiology,and pathophysiology,molecular mechanisms involved therein as well as their impact on immune-mediated organ damage.Additionally,we discuss clinical considerations related to both existing therapies and advanced treatment interventions,aiming to enhance the comprehensive understanding surrounding viral sepsis.展开更多
The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacatio...The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacation in junior high school,my teacher asked us to read more classics,so I read a variety of books like The Little Prince and Harry Potter,which taught me to be brave in the face of difficulties and never give up.After that,no matter how busy I was,I would read for an hour every day.展开更多
Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's ...Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's disease. Therefore, the current study aimed to investigate m VEMP responses in individuals with definite Meniere's disease and compare them with those of a reference group.Method:The present study investigated narrowband Claus Elberling chirp-evoked m VEMP responses in 22 ears diagnosed with definite Meniere's disease and 22 ears with hearing sensitivity ≤ 15 dB HL across three stimulation frequencies.Results:m VEMP responses in participants with definite Meniere's disease varied from normal to reduced or absent across three octave frequencies. These individuals exhibited significantly reduced P11-N21 peak-to-peak amplitudes compared to those in the reference group. Although a frequency tuning shift toward 1000 Hz was observed, the inter-frequency amplitude ratio of m VEMP was not found to be a sensitive parameter for detecting individuals with definite Meniere's disease. Additionally, no association was found between the degree of hearing loss or the duration of the disease and m VEMP responses. Conclusion: Participants with definite Meniere's disease exhibited reduced P11-N21 amplitude and a tuning shift toward 1000 Hz. These findings suggest the involvement of the vestibulo-trigeminal reflex pathway in this condition.展开更多
BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effecti...BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.展开更多
BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or ...BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.展开更多
Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact e...Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).展开更多
In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and l...In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and lower constraints and the sensor in the feedback loop is subjected to network-induced unknown time-varying delay and noise.With this nonlinear control method,we first employ right coprime factorization based on isomorphism and operator theory to factorize the plant,so that bounded input bounded output(BIBO)stability can be guaranteed.Next,continuous-time generalized predictive control(CGPC)is utilized for the unstable operator of the right coprime factorized plant to guarantee inner stability and enables the closed-loop dynamics of the system with predictive characteristics.Meanwhile,a second-Do F(degrees of freedom)switched controller that satisfies a perturbed Bezout identity and a robustness condition is designed.By using the CGPC controller that possesses predictive behavior and the second-Do F switched stabilizer,the overall stability of the plant subjected to actuator limitations is guaranteed.To address sensor limitations that exist in networked plants in the form of delay and noise which often cause system performance degradation,we implement an identity operator definition in the feedback loop to compensate for these adverse effects.Further,a pre-operator is designed to ensure that the plant output tracks the reference input.Finally,the effectiveness of the proposed design scheme is demonstrated by simulations.展开更多
Objective:To evaluate the treatment outcomes and toxicity of volumetric modulated arc therapy(VMAT)in definitive radiotherapy for patients with cervical cancer.Methods:Medical records of 440 patients with cervical can...Objective:To evaluate the treatment outcomes and toxicity of volumetric modulated arc therapy(VMAT)in definitive radiotherapy for patients with cervical cancer.Methods:Medical records of 440 patients with cervical cancer treated with VMAT in definitive radiotherapy with or without concurrent chemotherapy between January 2010 and June 2015 in our institution were retrospectively reviewed.A dose of 45 Gy was prescribed to the planning target volume with VMAT in 25 fractions,followed by high-dose rate intracavitary brachytherapy with 28–36 Gy in 4–6 fractions.Survival time was estimated using Kaplan-Meier method.Risk factors for treatment failure were identified using Cox proportional hazards regression model.Results:The median follow-up periods were 58.3 months(range:2.7–112.9 months).The 3-and 5-year survival rates were overall survival(OS)79.4%and 74.4%,cancer-specific survival(CSS)81.4%and 77.1%,progressionfree survival(PFS)73.3%and 71.1%,locoregional control(LC)83.3%and 82%and distant metastasis-free survival(DMFS)80.8%and 77.7%,respectively.The 5-year OS for patients with different stages was IB191.6%,IB2100%,IIA 82.5%,IIB 74.4%,IIIA 57.1%,IIIB 61.7%and IVB 17.6%,respectively.Of the 124 patients with recurrence,93 patients(75.0%)experienced distant failure.Multivariate analysis showed that non-squamous cell carcinoma of the cervix(P<0.001),more advanced stage(P=0.004),pelvic lymph node metastasis(P<0.001)and para-aortic lymph node metastasis(P=0.019)were all independent risk factors of PFS.The incidence of grades 3–4 late bowel toxicities was 2.7%.No grades 3–4 bladder toxicity was observed.Conclusion:This study demonstrated that the use of VMAT in definitive radiotherapy resulted in satisfactory outcomes with acceptable toxicities for patients with cervical cancer.Distant metastasis predominated as the pattern of disease relapse.Further studies are needed to investigate the intensified systemic therapies.展开更多
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
文摘AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.
基金Supported by a grant from the Natural Science Foundation of Hubei Province(No.2015CFB541).
文摘Objective Cervical esophageal cancer(CEC)is a relatively rare condition,with limited treatment options.The current study aimed to assess the survival outcomes of patients with CEC who received definitive radiotherapy.Methods In total,63 consecutive patients with CEC who received definitive radiotherapy between 2010 and 2018 were included in this study.The survival outcomes were analyzed based on statistics.Results The median progression-free survival(PFS)and overall survival(OS)of the patients were 12 and 19 months,respectively.There were no significant differences in terms of survival outcomes between the groups who received radiation doses≥60 and<60 Gy.Interestingly,in the proximal CEC subgroup,the PFS(P=0.039),OS(P=0.031),and loco-regional failure-free survival(LRFFS)(P=0.005)improved significantly in patients who received a radiation dose≥60 Gy compared with those who received a radiation dose<60 Gy.However,in the distal CEC subgroup,the PFS,OS,and LRFFS did not significantly improve between patients who received radiation doses≥60 and<60 Gy.Definitive radiotherapy was well tolerated,and no significant differences were observed in terms of treatment-related toxicities between the groups who received radiation doses≥60 and<60 Gy.Conclusion The survival outcomes of patients with CEC should be improved.In proximal CEC,a radiation dose≥60 Gy is significantly correlated with better PFS,OS,and LRFFS.However,further research must be performed to validate this finding.
文摘Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.
文摘Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.
文摘Among the 135 million births in 2020,0.6 million were extremely preterm(<28 weeks’gestation),and 1.4 million were very preterm(between 28 and<32 weeks’gestation)[1].Intraventricular hemorrhage(IVH)remains a major concern for these infants,particularly those<29 weeks’gestation[2].Midline head positioning(MHP)is a widely adopted intervention in care bundles for IVH prevention in preterm infants.However,high-quality evidence supporting the efcacy and efectiveness of MHP for IVH prevention is lacking.Here,we summarize the issues with the existing evidence on MHP,including its widespread adoption in care bundles on the basis of poor quality of evidence,and highlight the urgent need for a defnitive trial to determine the causal role,if any,of MHP in IVH prevention.
基金This study was funded by The Special Foundation of Basic Science and Technology Resources Survey of Ministry of Science and Technology of China(No.2017FY101203)the National Key Research and Development Program of China(No.2016YFC1202000,2016YFC1202001)the National Science and Technology Major Project of China(No.2012ZX1004–220,2008ZX1004–011).
文摘Background:Angiostrongyliasis is a food-borne parasitic zoonosis.Human infection is caused by infection with the third-stage larvae of Angiostrongylus cantonensis.The life cycle of A.cantonensis involves rodents as definitive hosts and molluscs as intermediate hosts.This study aims to investigate on the infection status and characteristics of spatial distribution of these hosts,which are key components in the strategy for the prevention and control of angiostrongyliasis.Methods:Three villages from Nanao Island,Guangdong Province,China,were chosen as study area by stratified random sampling.The density and natural infection of Pomacea canaliculata and various rat species were surveyed every three months from December 2015 to September 2016,with spatial correlations of the positive P.canaliculata and the infection rates analysed by ArcGIS,scan statistics,ordinary least squares(OLS)and geographically weighted regression(GWR)models.Results:A total of 2192 P.canaliculata specimens were collected from the field,of which 1190 were randomly chosen to be examined for third-stage larvae of A.cantonensis.Seventy-two Angiostrongylus-infected snails were found,which represents a larval infection rate of 6.1%(72/1190).In total,110 rats including 85 Rattus norvegicus,10 R.flavipectus,one R.losea and 14 Suncus murinus were captured,and 32 individuals were positive(for adult worms),representing an infection rate of 29.1%of the definitive hosts(32/110).Worms were only found in R.norvegicus and R.flavipectus,representing a prevalence of 36.5%(31/85)and 10%(1/10),respectively in these species,but none in R.losea and S.murinus,despite testing as many as 32 of the latter species.Statistically,spatial correlation and spatial clusters in the spatial distribution of positive P.canaliculata and positive rats existed.Most of the spatial variability of the host infection rates came from spatial autocorrelation.Nine spatial clusters with respect to positive P.canaliculata were identified,but only two correlated to infection rates.The results show that corrected Akaike information criterion,R2,R2 adjusted andσ2 in the GWR model were superior to those in the OLS model.Conclusions:P.canaliculata and rats were widely distributed in Nanao Island and positive infection has also been found in the hosts,demonstrating that there was a risk of angiostrongyliasis in this region of China.The distribution of positive P.canaliculata and rats exhibited spatial correlation,and the GWR model had advantage over the OLS model in the spatial analysis of hosts of A.cantonensis.
文摘Background:Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcin improve the quality of life(QOL).Definitive radiotherapy(DRT)with or without systematic treatment,such as chemotherapy,is always the first choice to achieve improved QOL.This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy(S+RT)in supraglottic and hypopharyngeal carcinoma.Methods:This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S+RT between January 2012 and August 2016.A total of 59 patients were identified,of whom 31 were treated with DRT,and 28 were treated with S+RT.In the 31 cases of DRT,23 cases were treated with concurrent chemoradiotherapy(CRT),one case was treated with DRT plus cetuximab,and seven cases were treated with DRT alone.Of the other 28 cases of S+RT,15 cases were treated with adjuvant concurrent CRT.Survival analysis was used to compare the overall survival(OS),local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)between DRT and S+RT groups.Results:The median follow-up was 20 months(range,4-67 months).The patients of the two groups were similar with respect to mean age,original sites,and tumor stages.The 1-,2-,and 5-year OS rates were 80.6%,53.4%,and 24.7% for the DRT group and 85.7%,67.1%,and 24.7%for the S+RT group,respectively.There was no significant difference between the two groups(x^2=3.183,P=0.074).The 1-,2-,and 5-year LRFS and DMFS were 90.4%,61.7%,and 18.0%and 87.4%,49.2%,and 9.9%,respectively,and no statistical difference was observed between the two groups(LRFS:x^2=0.028,P=0.868;DMFS:x^2=3.347,P=0.067).No significant difference was found between the two groups in acute radiotoxicity.Conclusions:Without loss of laryngeal function,the survival of DRT is comparable to that of S+RT in supraglottic and hypopharyngeal carcinoma.
基金supported by the National Natural Science Foundation of China,China(Grant Nos.41972266,52104076,and 12102230)the China Postdoctoral Science Foundation,China(Grant No.2022M711862).
文摘Mountain road tunnels are prone to water leakage and lining corrosion under the complex geological conditions and corrosive envi-ronments,which will reduce the strength of the lining structure until it loses its load-bearing capacity;eventually,the definitive lining will need to be replaced.In this paper,a highway tunnel in a mountainous area in Southwest China is taken as an example.Field investi-gation found that the tunnel was seriously corroded by sulfate,the strength of the definitive lining decreased,and large-scale cracks and spalling appeared on the surface,so the operator decided to replace the definitive lining by the method of interval replacement.Based on the data obtained from drilling and coring,a numerical model of long-distance replacement of the definitive lining of the damaged tunnel is established.First,the back analysis of the calculation parameters is carried out,and the modified calculation results are com-pared with the field monitoring results for verification.Then,the deformation trend of the tunnel and the development of the plastic zone during the process of long-distance replacement of the definitive lining are studied.Finally,the construction scheme is optimized.Numer-ical analysis results show that the replacement of the definitive lining of the tunnel mainly leads to the settlement of the arch crown and the uplift of the inverted arch.The deformation of the tunnel shows two rapid growth stages and two stable stages during the replace-ment process;after replacement,the deformation of the arch crown and the inverted arch is divided into two buffer zones and one stable zone.In the progress of the replacement of the definitive lining,the plastic zone does not change.Regarding the reinforcement measures,with the increase in the grouting range,the grouting efficiency decreases,and the effect of the temporary steel arch on controlling the overall deformation is not obvious.The length of the replacement of the single section should be determined according to the geological conditions of the replacement section and the monitoring data during construction.The research results can provide a reference for sim-ilar projects for the replacement of the definitive lining.
文摘Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.
基金supported by the National Natural Science Foundation of China(82372176,82272217,82002026,81971818)the Hubei Provincial Key Research and Development Program of China(2023BCB091)the National Key Research and Development Program of China(2021YFC2500802,2021YFC2300200).
文摘Sepsis,characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection,remains a significant challenge in clinical practice.Despite advancements in understanding host-bacterial interactions,molecular responses,and therapeutic approaches,the mortality rate associated with sepsis has consistently ranged between 10%and 16%.This elevated mortality highlights critical gaps in our comprehension of sepsis etiology.Traditionally linked to bacterial and fungal pathogens,recent outbreaks of acute viral infections,including Middle East respiratory syndrome coronavirus(MERS-CoV),influenza virus,and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),among other regional epidemics,have underscored the role of viral pathogenesis in sepsis,particularly when critically ill patients exhibit classic symptoms indicative of sepsis.However,many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels.Moreover,these viruses not only activate conventional pattern recognition receptors(PRRs)and retinoic acid-inducible gene-I(RIG-I)-like receptors(RLRs)but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate(GMP-AMP)synthase(cGAS)-stimulator of interferon genes(STING)signaling and interferon response mechanisms.Such activations lead to cellular stress,metabolic disturbances,and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations.This complexity poses substantial challenges for the clinical management of affected cases.In this review,we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology,epidemiology,and pathophysiology,molecular mechanisms involved therein as well as their impact on immune-mediated organ damage.Additionally,we discuss clinical considerations related to both existing therapies and advanced treatment interventions,aiming to enhance the comprehensive understanding surrounding viral sepsis.
文摘The time went by fairly fast.I have definitely changed a lot in the past three years.I used to be short,but now I am taller.The biggest change,though,is that I enjoy reading more than I used to.During my first vacation in junior high school,my teacher asked us to read more classics,so I read a variety of books like The Little Prince and Harry Potter,which taught me to be brave in the face of difficulties and never give up.After that,no matter how busy I was,I would read for an hour every day.
文摘Background:The masseter vestibular evoked myogenic potential(mVEMP) is a novel test that has been explored in various brainstem lesions. However, it has not yet been studied in individuals with definite Meniere's disease. Therefore, the current study aimed to investigate m VEMP responses in individuals with definite Meniere's disease and compare them with those of a reference group.Method:The present study investigated narrowband Claus Elberling chirp-evoked m VEMP responses in 22 ears diagnosed with definite Meniere's disease and 22 ears with hearing sensitivity ≤ 15 dB HL across three stimulation frequencies.Results:m VEMP responses in participants with definite Meniere's disease varied from normal to reduced or absent across three octave frequencies. These individuals exhibited significantly reduced P11-N21 peak-to-peak amplitudes compared to those in the reference group. Although a frequency tuning shift toward 1000 Hz was observed, the inter-frequency amplitude ratio of m VEMP was not found to be a sensitive parameter for detecting individuals with definite Meniere's disease. Additionally, no association was found between the degree of hearing loss or the duration of the disease and m VEMP responses. Conclusion: Participants with definite Meniere's disease exhibited reduced P11-N21 amplitude and a tuning shift toward 1000 Hz. These findings suggest the involvement of the vestibulo-trigeminal reflex pathway in this condition.
文摘BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
文摘BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.
基金supported by the National Natural Science Foundation of China(Grant No.42471027).
文摘Accurate drought assessment demands thoughtful consideration of drought definition first of all.Drought is commonly defined as a prolonged period of below-average precipitation leading to water shortages that impact ecosystems,agriculture,and human societies.However,meteorologists,hydrologists,and agronomists often use different criteria to define drought,depending on their specific focus areas.For example,hydrologists define drought according to water deficits in some components of the hydrological cycle(such as precipitation,soil moisture,river flow,and groundwater)or its impacts on the level of services provided to public water supply,irrigation,or hydropower demands(Tate and Gustard,2000).Differences in drought definitions may result in great uncertainties in drought assessment(Satoh et al.,2021).We cannot expect the existence of any workable generalized objective definition of drought(Lloyd-Hughes,2014).
文摘In this paper,a nonlinear control approach for an unstable networked plant in the presence of actuator and sensor limitations using robust right coprime factorization is proposed.The actuator is limited by upper and lower constraints and the sensor in the feedback loop is subjected to network-induced unknown time-varying delay and noise.With this nonlinear control method,we first employ right coprime factorization based on isomorphism and operator theory to factorize the plant,so that bounded input bounded output(BIBO)stability can be guaranteed.Next,continuous-time generalized predictive control(CGPC)is utilized for the unstable operator of the right coprime factorized plant to guarantee inner stability and enables the closed-loop dynamics of the system with predictive characteristics.Meanwhile,a second-Do F(degrees of freedom)switched controller that satisfies a perturbed Bezout identity and a robustness condition is designed.By using the CGPC controller that possesses predictive behavior and the second-Do F switched stabilizer,the overall stability of the plant subjected to actuator limitations is guaranteed.To address sensor limitations that exist in networked plants in the form of delay and noise which often cause system performance degradation,we implement an identity operator definition in the feedback loop to compensate for these adverse effects.Further,a pre-operator is designed to ensure that the plant output tracks the reference input.Finally,the effectiveness of the proposed design scheme is demonstrated by simulations.
基金This work was supported by the Clinical Technology Innovation Project of Beijing Hospital Authority(No.XMLX201842).
文摘Objective:To evaluate the treatment outcomes and toxicity of volumetric modulated arc therapy(VMAT)in definitive radiotherapy for patients with cervical cancer.Methods:Medical records of 440 patients with cervical cancer treated with VMAT in definitive radiotherapy with or without concurrent chemotherapy between January 2010 and June 2015 in our institution were retrospectively reviewed.A dose of 45 Gy was prescribed to the planning target volume with VMAT in 25 fractions,followed by high-dose rate intracavitary brachytherapy with 28–36 Gy in 4–6 fractions.Survival time was estimated using Kaplan-Meier method.Risk factors for treatment failure were identified using Cox proportional hazards regression model.Results:The median follow-up periods were 58.3 months(range:2.7–112.9 months).The 3-and 5-year survival rates were overall survival(OS)79.4%and 74.4%,cancer-specific survival(CSS)81.4%and 77.1%,progressionfree survival(PFS)73.3%and 71.1%,locoregional control(LC)83.3%and 82%and distant metastasis-free survival(DMFS)80.8%and 77.7%,respectively.The 5-year OS for patients with different stages was IB191.6%,IB2100%,IIA 82.5%,IIB 74.4%,IIIA 57.1%,IIIB 61.7%and IVB 17.6%,respectively.Of the 124 patients with recurrence,93 patients(75.0%)experienced distant failure.Multivariate analysis showed that non-squamous cell carcinoma of the cervix(P<0.001),more advanced stage(P=0.004),pelvic lymph node metastasis(P<0.001)and para-aortic lymph node metastasis(P=0.019)were all independent risk factors of PFS.The incidence of grades 3–4 late bowel toxicities was 2.7%.No grades 3–4 bladder toxicity was observed.Conclusion:This study demonstrated that the use of VMAT in definitive radiotherapy resulted in satisfactory outcomes with acceptable toxicities for patients with cervical cancer.Distant metastasis predominated as the pattern of disease relapse.Further studies are needed to investigate the intensified systemic therapies.
