Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions cont...Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions continue to impact adversely on international tourism,tourism efforts should be placed more on the domestic markets.Via structural equation modeling,this study unearthed different risk factors impacting Korean travelers’choices of alternative local destinations in the post-pandemic era.In addition,this study extended the goal-directed behavior framework with the acquisition of perceived risk and knowledge of COVID-19,which was proven to hold a sig-nificantly superior explanatory power of tourists’decisions of local alternatives over foreign countries during the COVID-19 pandemic.Furthermore,desire was found to play an imminent mediating role in the conceptual mod-el,maximizing the impact of perceived risk on travel intentions.Henceforth,this research offers meaningful the-oretical implication as thefirst empirical study to deepen the goal-directed behaviour framework with perceived risk and knowledge in the context of post-COVID-19 era.It also serves as insightful knowledge for Korean tour-ism authorities and practitioners to understand local tourists’decision-making processes and tailor effective recovery strategy for domestic tourism.展开更多
BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients...BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.展开更多
Correction to:Nano-Micro Letters(2026)18:10.https://doi.org/10.1007/s40820-025-01852-8 Following publication of the original article[1],the authors reported that the last author’s name was inadvertently misspelled.Th...Correction to:Nano-Micro Letters(2026)18:10.https://doi.org/10.1007/s40820-025-01852-8 Following publication of the original article[1],the authors reported that the last author’s name was inadvertently misspelled.The published version showed“Hongzhen Chen”,whereas the correct spelling should be“Hongzheng Chen”.The correct author name has been provided in this Correction,and the original article[1]has been corrected.展开更多
This study utilizes wet/dry cyclic corrosion testing combined with corrosion big data technology to investigate the mechanism by which chloride ions(Cl^(-))influence the corrosion behavior of 650 MPa high-strength low...This study utilizes wet/dry cyclic corrosion testing combined with corrosion big data technology to investigate the mechanism by which chloride ions(Cl^(-))influence the corrosion behavior of 650 MPa high-strength low-alloy(HSLA)steel in industrially polluted environments.The corrosion process of 650 MPa HSLA steel occurred in two distinct stages:an initial corrosion stage and a stable corrosion stage.During the initial phase,the weight loss rate increased rapidly owing to the instability of the rust layer.Notably,this study demonstrated that 650 MPa HSLA steel exhibited superior corrosion resistance in Cl-containing environments.The formation of a corrosion-product film eventually reduced the weight-loss rate.However,the intrusion of Cl^(-)at increasing concentrations gradually destabilized theα/γ^(*)phases of the rust layer,leading to a looser structure and lower polarization resistance(R_(p)).The application of corrosion big data technology in this study facilitated the validation and analysis of the experimental results,offering new insights into the corrosion mechanisms of HSLA steel in chloride-rich environments.展开更多
BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is su...BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.展开更多
BACKGROUND Due to the dry and cold climate,the obvious temperature difference between day and night,and the low oxygen content of the air in the plateau area,people are prone to upper respiratory tract diseases,and of...BACKGROUND Due to the dry and cold climate,the obvious temperature difference between day and night,and the low oxygen content of the air in the plateau area,people are prone to upper respiratory tract diseases,and often the condition is prolonged,and the patients are prone to anxiety and uneasiness,which may be related to the harshness of the plateau environment,somatic discomfort due to the lack of oxygen,anxiety about the disease,and other factors.AIM To investigate the effects of cognitive behavioral therapy(CBT)on anxiety,sleep disorders,and hypoxia tolerance in patients with high-altitude respiratory diseases.METHODS A total of 2337 patients with high-altitude-related respiratory diseases treated at our hospital between November 2023 and January 2024 were selected as the study subjects.The subjects’pre-high-altitude residential altitude was approximately 1700 meters.They were divided into two groups.Both groups were given symptomatic treatment,and the control group implemented conventional nursing intervention,while the research group simultaneously conducted CBT intervention;assessed the degree of health knowledge of the two groups,and applied the Hamilton Anxiety Scale and the Pittsburgh Sleep Quality Index to assess the anxiety and sleep quality of the patients before and after the intervention,respectively.It also observed the length and efficiency of sleep,and detected the level of serum hypoxia inducible factor-1α,erythropoietin(EPO)and clinical intervention before and after intervention.EPO levels,and investigated satisfaction with the clinical intervention.RESULTS The rate of excellent health knowledge in the intervention group was 93.64%,which was higher than that in the control group(74.23%;P<0.05).Before the intervention,there was no significant difference in Hamilton Anxiety Scale and Pittsburgh Sleep Quality Index scores between the two groups(P>0.05),and after the intervention,the scores of the study group were significantly lower than those of the control group(P<0.05).There was no significant difference in sleep duration and sleep efficiency between the groups before the intervention(P>0.05),and after the intervention,the scores of the study group were significantly larger than those of the control group(P<0.05).There was no significant difference in serum hypoxia inducible factor-1αand EPO between the two groups before intervention(P>0.05),and both research groups were significantly lower than the control group after intervention(P<0.05).According to the questionnaire survey,the intervention satisfaction of the study group was 95.53%,which was higher than that of the control group(80.14%;P<0.05).CONCLUSION The CBT intervention in the treatment of patients with high-altitude-related respiratory diseases helps improve patients'health knowledge,relieve anxiety,improve sleep quality and hypoxia tolerance,and improve nursing satisfaction.展开更多
BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emoti...BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emotional states is imperative.AIM To evaluate the efficacy of cognitive behavioral therapy(CBT)-based psychological interventions in improving the psychological well-being and quality of life(QoL)of patients with laryngeal carcinoma.METHODS This study enrolled 120 patients admitted from February 2022 to February 2024.The control group,comprising 50 participants,received standard supportive psychological care,while the research group,consisting 70 participants,underwent CBT-based interventions.Several clinical outcomes were systematically assessed that included postoperative recovery metrics(duration of tracheostomy and nasogastric tube dependence and length of hospitalization),psychological status(Self-Rating Anxiety Scale and Self-Rating Depression Scale),nutritional markers(serum albumin and hemoglobin levels),sleep quality(Self-Rating Scale of Sleep and Athens Insomnia Scale),and QoL(Functional Assessment of Cancer Therapy-Head and Neck).RESULTS The results demonstrated that the research group experienced superior outcomes,with significantly reduced durations of tracheostomy and nasogastric tube dependence,as well as shorter hospital stays,compared with the control group.Additionally,the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale,Self-Rating Depression Scale,Self-Rating Scale of Sleep,and Athens Insomnia Scale scores,along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group.All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group,exceeding those observed in the control group.CONCLUSION CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma,highlighting its potential for broader clinical application.展开更多
Healthy behavior has long been linked to mental health outcomes.However,the role of artificial intelligence(AI)literacy in shaping healthy behaviors and its potential impact on mental health remains underexplored.This...Healthy behavior has long been linked to mental health outcomes.However,the role of artificial intelligence(AI)literacy in shaping healthy behaviors and its potential impact on mental health remains underexplored.This paper presents a scoping review offering a novel perspective on the intersection of healthy behaviors,mental health,and AI literacy.By examining how individuals’understanding of AI influences their choices regarding nutrition and their susceptibility to mental health issues,the current study explores emerging trends in health behavior decision-making.This emphasizes the need for integrating AI literacy into mental health and health behaviors education,as well as the development of AI-driven tools to support healthier behavior choices.It highlights that individuals with low AI literacy may misinterpret or overly depend on AI guidance,resulting in maladaptive health choices,while those with high AI literacy may be more likely to engage reflectively and sustain positive behaviors.The paper outlines the importance of inclusive education,user-centered design,and community-based support systems to enhance AI literacy for digitally marginalized groups.AI literacy may be positioned as a key determinant of health equity,better allowing for interdisciplinary strategies that empower individuals to make informed,autonomous decisions that promote both physical and mental health.展开更多
This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior...This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.展开更多
The dissimilar 2B06 and 7B04 Al alloy joints were prepared by refill friction stir spot welding(RFSSW),and the microstructural evolution and corrosion behavior of the joints were investigated.Based on microstructural ...The dissimilar 2B06 and 7B04 Al alloy joints were prepared by refill friction stir spot welding(RFSSW),and the microstructural evolution and corrosion behavior of the joints were investigated.Based on microstructural analysis,the welded joints exhibit distinct microstructural zones,including the stir zone(SZ),thermomechanically affected zone(TMAZ),and heat-affected zone(HAZ).The grain size of each zone is in the order of HAZ>TMAZ>SZ.Notably,the TMAZ and HAZ contain significantly larger secondary-phase particles compared to the SZ,with particle size in the HAZ increasing at higher rotational speeds.Electrochemical tests indicate that corrosion susceptibility follows the sequence of HAZ>TMAZ>SZ>BM,with greater sensitivity observed at increased rotational speeds.Post-corrosion mechanical performance degradation primarily arises from crevice corrosion at joint overlaps,but not from the changes in the microstructure.展开更多
In the competitive retail industry of the digital era,data-driven insights into gender-specific customer behavior are essential.They support the optimization of store performance,layout design,product placement,and ta...In the competitive retail industry of the digital era,data-driven insights into gender-specific customer behavior are essential.They support the optimization of store performance,layout design,product placement,and targeted marketing.However,existing computer vision solutions often rely on facial recognition to gather such insights,raising significant privacy and ethical concerns.To address these issues,this paper presents a privacypreserving customer analytics system through two key strategies.First,we deploy a deep learning framework using YOLOv9s,trained on the RCA-TVGender dataset.Cameras are positioned perpendicular to observation areas to reduce facial visibility while maintaining accurate gender classification.Second,we apply AES-128 encryption to customer position data,ensuring secure access and regulatory compliance.Our system achieved overall performance,with 81.5%mAP@50,77.7%precision,and 75.7%recall.Moreover,a 90-min observational study confirmed the system’s ability to generate privacy-protected heatmaps revealing distinct behavioral patterns between male and female customers.For instance,women spent more time in certain areas and showed interest in different products.These results confirm the system’s effectiveness in enabling personalized layout and marketing strategies without compromising privacy.展开更多
The functional properties of glasses are governed by their formation history and the complex relaxation processes they undergo.However,under extreme conditions,glass behaviors are still elusive.In this study,we employ...The functional properties of glasses are governed by their formation history and the complex relaxation processes they undergo.However,under extreme conditions,glass behaviors are still elusive.In this study,we employ simulations with varied protocols to evaluate the effectiveness of different descriptors in predicting mechanical properties across both low-and high-pressure regimes.Our findings demonstrate that conventional structural and configurational descriptors fail to correlate with the mechanical response following pressure release,whereas the activation energy descriptor exhibits robust linearity with shear modulus after correcting for pressure effects.Notably,the soft mode parameter emerges as an ideal and computationally efficient alternative for capturing this mechanical behavior.These findings provide critical insights into the influence of pressure on glassy properties,integrating the distinct features of compressed glasses into a unified theoretical framework.展开更多
Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraopera...Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.展开更多
Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examin...Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.展开更多
<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Ver...<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Scoliosis is among interventions with high postoperative com</span><span><span style="font-family:Verdana;">plication rates due to the characteristics of the surgery, where blood los</span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">s,</span></span><span style="font-family:Verdana;"> transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary </span><span style="font-family:Verdana;">analysis to describe outcomes in these patients was realized and presented</span> <span><span style="font-family:Verdana;">here. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To describe intraoperative and postoperative outcomes in</span></span><span style="font-family:Verdana;"> patients under 18 years old in scoliosis surgery included in the initial study and </span><span style="font-family:Verdana;">to propose improvement </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">implementation measures. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ondary analysis of patients undergoing scoliosis surgery </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 1 January 2014 to </span><span style="font-family:Verdana;">17 May 2017 was undertaken in our institution—Necker Enfants Malades</span> <span style="font-family:Verdana;">uni</span><span style="font-family:Verdana;">ver</span><span><span style="font-family:Verdana;">sity hospital. The study was approved by the Ethics Committee. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There </span></span><span style="font-family:Verdana;">were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight pa</span><span style="font-family:Verdana;">tients </span><span style="font-family:Verdana;">(24.1%) presented intraoperative and/or postoperative complications. The most</span> <span style="font-family:Verdana;">common intraoperative complication was hemorrhagic shock in 3 patients </span><span style="font-family:Verdana;">(2.6%). The most common postoperative organ failure was neuro</span><span style="font-family:Verdana;">logic in seven patients (6%), respiratory in 3 patients (2.6%), car</span><span style="font-family:Verdana;">dio-circulatory in 2 patients (1.7%) and renal failure in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (2.6%), and abdominal sepsis and septicemia in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (1.7%). </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">12</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> patients (10.3%) had reoperations. Fif</span><span style="font-family:Verdana;">ty-six patients (48.3%) had </span><span><span style="font-family:Verdana;">intraoperative transfusion. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> The </span><span style="font-family:Verdana;">portion of patients with intraoperative and or postoperative complications </span><span style="font-family:Verdana;">was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.展开更多
Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: T...Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: The enrolled patients underwent esophagectomy, pancreatoduodenectomy, or aortic stent grafting in 2012, and between March 2013 and October 2014. We conducted a comparison study on the effects of GDT, between the before-GDT historical control group (n = 100) and GDT group (n = 100). The hemodynamic indices used for control group patients were conventional: Blood pressure, heart rate, and urine output. For GDT group, additionally, we used stroke volume variation (SVV) and stroke volume index (SVI). The primary outcomes were the length of intensive care unit (ICU) stay and hospital stay (LOS). Regression analysis was used to identify factors affecting LOS. The secondary outcomes were the albumin use, the fluid amount administered, and the variation in the fluid administration rate. Results: The control and GDT groups comprised 96 and 99 patients, respectively. The patient characteristics were similar. The length of ICU stay was significantly shorter (2.1 ± 2.1 days vs. 2.8 ± 1.9 days, P = 0.0009) and LOS was shorter but without statistical significance (24.5 ± 17.7 days vs. 27.7 ± 20.1 days, P = 0.21) in the GDT group than in the control group. The fluid amount administered and the presence/ absence of albumin use were factors affecting LOS. The variation of the fluid administration rate was significantly lower in the GDT group. Conclusion: The simplified GDT may contribute to the improvement of medical economics and standardize the fluid management.展开更多
BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physio...BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.展开更多
<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style=&qu...<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>展开更多
Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patien...Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.展开更多
The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if t...The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if the publication of these trials has influenced the use of EGDT when caring for patients with severe sepsis and septic shock in the emergency department (ED). In February 2014, we surveyed a sample of board-certified emergency medicine physicians regarding their use of EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT following the publication of the above trials. Subgroup analyses were also performed with regard to academic affiliation and emergency department volume. Surveys were sent to 308 and 350 physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI 40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased EGDT use following the sepsis trilogy while nonacademic departments significantly increased EGDT use. Use of EGDT was significantly greater in community departments versus academic departments following the publication of the sepsis trilogy. There was no change overall in the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup analyses revealed that academic departments decreased their use of EGDT while community departments increased use of EGDT. This may be due to varying rates of uptake of the medical literature between academic and community healthcare systems.展开更多
基金supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea(NRF-2020S1A5A2A01046684).
文摘Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions continue to impact adversely on international tourism,tourism efforts should be placed more on the domestic markets.Via structural equation modeling,this study unearthed different risk factors impacting Korean travelers’choices of alternative local destinations in the post-pandemic era.In addition,this study extended the goal-directed behavior framework with the acquisition of perceived risk and knowledge of COVID-19,which was proven to hold a sig-nificantly superior explanatory power of tourists’decisions of local alternatives over foreign countries during the COVID-19 pandemic.Furthermore,desire was found to play an imminent mediating role in the conceptual mod-el,maximizing the impact of perceived risk on travel intentions.Henceforth,this research offers meaningful the-oretical implication as thefirst empirical study to deepen the goal-directed behaviour framework with perceived risk and knowledge in the context of post-COVID-19 era.It also serves as insightful knowledge for Korean tour-ism authorities and practitioners to understand local tourists’decision-making processes and tailor effective recovery strategy for domestic tourism.
基金Supported by the 2024 Hebei Medical Science Research Project,No.20241638Key Research and Development Program of Zhangjiakou City,No.2311041D.
文摘BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.
文摘Correction to:Nano-Micro Letters(2026)18:10.https://doi.org/10.1007/s40820-025-01852-8 Following publication of the original article[1],the authors reported that the last author’s name was inadvertently misspelled.The published version showed“Hongzhen Chen”,whereas the correct spelling should be“Hongzheng Chen”.The correct author name has been provided in this Correction,and the original article[1]has been corrected.
基金financially supported by the National Natural Science Foundation of China(Nos.52104319 and 52374323)。
文摘This study utilizes wet/dry cyclic corrosion testing combined with corrosion big data technology to investigate the mechanism by which chloride ions(Cl^(-))influence the corrosion behavior of 650 MPa high-strength low-alloy(HSLA)steel in industrially polluted environments.The corrosion process of 650 MPa HSLA steel occurred in two distinct stages:an initial corrosion stage and a stable corrosion stage.During the initial phase,the weight loss rate increased rapidly owing to the instability of the rust layer.Notably,this study demonstrated that 650 MPa HSLA steel exhibited superior corrosion resistance in Cl-containing environments.The formation of a corrosion-product film eventually reduced the weight-loss rate.However,the intrusion of Cl^(-)at increasing concentrations gradually destabilized theα/γ^(*)phases of the rust layer,leading to a looser structure and lower polarization resistance(R_(p)).The application of corrosion big data technology in this study facilitated the validation and analysis of the experimental results,offering new insights into the corrosion mechanisms of HSLA steel in chloride-rich environments.
文摘BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.
基金Supported by Army Logistics Department Health Bureau Project,No.QJGYXYJZX-012.
文摘BACKGROUND Due to the dry and cold climate,the obvious temperature difference between day and night,and the low oxygen content of the air in the plateau area,people are prone to upper respiratory tract diseases,and often the condition is prolonged,and the patients are prone to anxiety and uneasiness,which may be related to the harshness of the plateau environment,somatic discomfort due to the lack of oxygen,anxiety about the disease,and other factors.AIM To investigate the effects of cognitive behavioral therapy(CBT)on anxiety,sleep disorders,and hypoxia tolerance in patients with high-altitude respiratory diseases.METHODS A total of 2337 patients with high-altitude-related respiratory diseases treated at our hospital between November 2023 and January 2024 were selected as the study subjects.The subjects’pre-high-altitude residential altitude was approximately 1700 meters.They were divided into two groups.Both groups were given symptomatic treatment,and the control group implemented conventional nursing intervention,while the research group simultaneously conducted CBT intervention;assessed the degree of health knowledge of the two groups,and applied the Hamilton Anxiety Scale and the Pittsburgh Sleep Quality Index to assess the anxiety and sleep quality of the patients before and after the intervention,respectively.It also observed the length and efficiency of sleep,and detected the level of serum hypoxia inducible factor-1α,erythropoietin(EPO)and clinical intervention before and after intervention.EPO levels,and investigated satisfaction with the clinical intervention.RESULTS The rate of excellent health knowledge in the intervention group was 93.64%,which was higher than that in the control group(74.23%;P<0.05).Before the intervention,there was no significant difference in Hamilton Anxiety Scale and Pittsburgh Sleep Quality Index scores between the two groups(P>0.05),and after the intervention,the scores of the study group were significantly lower than those of the control group(P<0.05).There was no significant difference in sleep duration and sleep efficiency between the groups before the intervention(P>0.05),and after the intervention,the scores of the study group were significantly larger than those of the control group(P<0.05).There was no significant difference in serum hypoxia inducible factor-1αand EPO between the two groups before intervention(P>0.05),and both research groups were significantly lower than the control group after intervention(P<0.05).According to the questionnaire survey,the intervention satisfaction of the study group was 95.53%,which was higher than that of the control group(80.14%;P<0.05).CONCLUSION The CBT intervention in the treatment of patients with high-altitude-related respiratory diseases helps improve patients'health knowledge,relieve anxiety,improve sleep quality and hypoxia tolerance,and improve nursing satisfaction.
文摘BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emotional states is imperative.AIM To evaluate the efficacy of cognitive behavioral therapy(CBT)-based psychological interventions in improving the psychological well-being and quality of life(QoL)of patients with laryngeal carcinoma.METHODS This study enrolled 120 patients admitted from February 2022 to February 2024.The control group,comprising 50 participants,received standard supportive psychological care,while the research group,consisting 70 participants,underwent CBT-based interventions.Several clinical outcomes were systematically assessed that included postoperative recovery metrics(duration of tracheostomy and nasogastric tube dependence and length of hospitalization),psychological status(Self-Rating Anxiety Scale and Self-Rating Depression Scale),nutritional markers(serum albumin and hemoglobin levels),sleep quality(Self-Rating Scale of Sleep and Athens Insomnia Scale),and QoL(Functional Assessment of Cancer Therapy-Head and Neck).RESULTS The results demonstrated that the research group experienced superior outcomes,with significantly reduced durations of tracheostomy and nasogastric tube dependence,as well as shorter hospital stays,compared with the control group.Additionally,the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale,Self-Rating Depression Scale,Self-Rating Scale of Sleep,and Athens Insomnia Scale scores,along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group.All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group,exceeding those observed in the control group.CONCLUSION CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma,highlighting its potential for broader clinical application.
文摘Healthy behavior has long been linked to mental health outcomes.However,the role of artificial intelligence(AI)literacy in shaping healthy behaviors and its potential impact on mental health remains underexplored.This paper presents a scoping review offering a novel perspective on the intersection of healthy behaviors,mental health,and AI literacy.By examining how individuals’understanding of AI influences their choices regarding nutrition and their susceptibility to mental health issues,the current study explores emerging trends in health behavior decision-making.This emphasizes the need for integrating AI literacy into mental health and health behaviors education,as well as the development of AI-driven tools to support healthier behavior choices.It highlights that individuals with low AI literacy may misinterpret or overly depend on AI guidance,resulting in maladaptive health choices,while those with high AI literacy may be more likely to engage reflectively and sustain positive behaviors.The paper outlines the importance of inclusive education,user-centered design,and community-based support systems to enhance AI literacy for digitally marginalized groups.AI literacy may be positioned as a key determinant of health equity,better allowing for interdisciplinary strategies that empower individuals to make informed,autonomous decisions that promote both physical and mental health.
文摘This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.
基金supported by the National Natural Science Foundation of China (Nos. 52075449, 51975480)。
文摘The dissimilar 2B06 and 7B04 Al alloy joints were prepared by refill friction stir spot welding(RFSSW),and the microstructural evolution and corrosion behavior of the joints were investigated.Based on microstructural analysis,the welded joints exhibit distinct microstructural zones,including the stir zone(SZ),thermomechanically affected zone(TMAZ),and heat-affected zone(HAZ).The grain size of each zone is in the order of HAZ>TMAZ>SZ.Notably,the TMAZ and HAZ contain significantly larger secondary-phase particles compared to the SZ,with particle size in the HAZ increasing at higher rotational speeds.Electrochemical tests indicate that corrosion susceptibility follows the sequence of HAZ>TMAZ>SZ>BM,with greater sensitivity observed at increased rotational speeds.Post-corrosion mechanical performance degradation primarily arises from crevice corrosion at joint overlaps,but not from the changes in the microstructure.
文摘In the competitive retail industry of the digital era,data-driven insights into gender-specific customer behavior are essential.They support the optimization of store performance,layout design,product placement,and targeted marketing.However,existing computer vision solutions often rely on facial recognition to gather such insights,raising significant privacy and ethical concerns.To address these issues,this paper presents a privacypreserving customer analytics system through two key strategies.First,we deploy a deep learning framework using YOLOv9s,trained on the RCA-TVGender dataset.Cameras are positioned perpendicular to observation areas to reduce facial visibility while maintaining accurate gender classification.Second,we apply AES-128 encryption to customer position data,ensuring secure access and regulatory compliance.Our system achieved overall performance,with 81.5%mAP@50,77.7%precision,and 75.7%recall.Moreover,a 90-min observational study confirmed the system’s ability to generate privacy-protected heatmaps revealing distinct behavioral patterns between male and female customers.For instance,women spent more time in certain areas and showed interest in different products.These results confirm the system’s effectiveness in enabling personalized layout and marketing strategies without compromising privacy.
基金supported by the National Natural Science Foundation of China (Grant Nos.T2325004 and 52161160330)the National Natural Science Foundation of China (Grants No.12504233)+2 种基金Advanced MaterialsNational Science and Technology Major Project (Grant No.2024ZD0606900)the Talent Hub for “AI+New Materials” Basic Researchthe Key Research and Development Program of Ningbo (Grant No.2025Z088)。
文摘The functional properties of glasses are governed by their formation history and the complex relaxation processes they undergo.However,under extreme conditions,glass behaviors are still elusive.In this study,we employ simulations with varied protocols to evaluate the effectiveness of different descriptors in predicting mechanical properties across both low-and high-pressure regimes.Our findings demonstrate that conventional structural and configurational descriptors fail to correlate with the mechanical response following pressure release,whereas the activation energy descriptor exhibits robust linearity with shear modulus after correcting for pressure effects.Notably,the soft mode parameter emerges as an ideal and computationally efficient alternative for capturing this mechanical behavior.These findings provide critical insights into the influence of pressure on glassy properties,integrating the distinct features of compressed glasses into a unified theoretical framework.
基金supported by the Department of Anesthesiologyand Pain MedicineUniversity of California Davis Health System+1 种基金SacramentoCA 95617 and NIH Grant(#UL1 TR000002)
文摘Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.
基金supported by the National High Level Hospital Clinical Research Funding(2022-PUMCHB-119).
文摘Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
文摘<b><span style="font-family:Verdana;">Background: </span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Scoliosis is among interventions with high postoperative com</span><span><span style="font-family:Verdana;">plication rates due to the characteristics of the surgery, where blood los</span><span style="font-family:Verdana;"></span><span style="font-family:Verdana;">s,</span></span><span style="font-family:Verdana;"> transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary </span><span style="font-family:Verdana;">analysis to describe outcomes in these patients was realized and presented</span> <span><span style="font-family:Verdana;">here. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To describe intraoperative and postoperative outcomes in</span></span><span style="font-family:Verdana;"> patients under 18 years old in scoliosis surgery included in the initial study and </span><span style="font-family:Verdana;">to propose improvement </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">implementation measures. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ondary analysis of patients undergoing scoliosis surgery </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 1 January 2014 to </span><span style="font-family:Verdana;">17 May 2017 was undertaken in our institution—Necker Enfants Malades</span> <span style="font-family:Verdana;">uni</span><span style="font-family:Verdana;">ver</span><span><span style="font-family:Verdana;">sity hospital. The study was approved by the Ethics Committee. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There </span></span><span style="font-family:Verdana;">were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight pa</span><span style="font-family:Verdana;">tients </span><span style="font-family:Verdana;">(24.1%) presented intraoperative and/or postoperative complications. The most</span> <span style="font-family:Verdana;">common intraoperative complication was hemorrhagic shock in 3 patients </span><span style="font-family:Verdana;">(2.6%). The most common postoperative organ failure was neuro</span><span style="font-family:Verdana;">logic in seven patients (6%), respiratory in 3 patients (2.6%), car</span><span style="font-family:Verdana;">dio-circulatory in 2 patients (1.7%) and renal failure in </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (2.6%), and abdominal sepsis and septicemia in </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> patients (1.7%). </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">12</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> patients (10.3%) had reoperations. Fif</span><span style="font-family:Verdana;">ty-six patients (48.3%) had </span><span><span style="font-family:Verdana;">intraoperative transfusion. There was no in-hospital mortality. </span><b><span style="font-family:Verdana;">Conclusion:</span></b></span><span style="font-family:Verdana;"> The </span><span style="font-family:Verdana;">portion of patients with intraoperative and or postoperative complications </span><span style="font-family:Verdana;">was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.
文摘Purpose: We investigated whether the simplified intraoperative Goal-Directed Therapy (GDT) could improve the factors affecting medical costs, and contribute in standardizing intraoperative fluid management. Methods: The enrolled patients underwent esophagectomy, pancreatoduodenectomy, or aortic stent grafting in 2012, and between March 2013 and October 2014. We conducted a comparison study on the effects of GDT, between the before-GDT historical control group (n = 100) and GDT group (n = 100). The hemodynamic indices used for control group patients were conventional: Blood pressure, heart rate, and urine output. For GDT group, additionally, we used stroke volume variation (SVV) and stroke volume index (SVI). The primary outcomes were the length of intensive care unit (ICU) stay and hospital stay (LOS). Regression analysis was used to identify factors affecting LOS. The secondary outcomes were the albumin use, the fluid amount administered, and the variation in the fluid administration rate. Results: The control and GDT groups comprised 96 and 99 patients, respectively. The patient characteristics were similar. The length of ICU stay was significantly shorter (2.1 ± 2.1 days vs. 2.8 ± 1.9 days, P = 0.0009) and LOS was shorter but without statistical significance (24.5 ± 17.7 days vs. 27.7 ± 20.1 days, P = 0.21) in the GDT group than in the control group. The fluid amount administered and the presence/ absence of albumin use were factors affecting LOS. The variation of the fluid administration rate was significantly lower in the GDT group. Conclusion: The simplified GDT may contribute to the improvement of medical economics and standardize the fluid management.
文摘BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.
文摘<span style="font-family:Verdana;"> <strong>Background: </strong></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management and fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were eighteen patients with a mean age of 104 ± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had an intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. The transfusion rate was 50% in nine patients. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased;thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.</span></span></span></span>
文摘Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.
文摘The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if the publication of these trials has influenced the use of EGDT when caring for patients with severe sepsis and septic shock in the emergency department (ED). In February 2014, we surveyed a sample of board-certified emergency medicine physicians regarding their use of EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT following the publication of the above trials. Subgroup analyses were also performed with regard to academic affiliation and emergency department volume. Surveys were sent to 308 and 350 physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI 40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased EGDT use following the sepsis trilogy while nonacademic departments significantly increased EGDT use. Use of EGDT was significantly greater in community departments versus academic departments following the publication of the sepsis trilogy. There was no change overall in the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup analyses revealed that academic departments decreased their use of EGDT while community departments increased use of EGDT. This may be due to varying rates of uptake of the medical literature between academic and community healthcare systems.
