BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revasculariz...BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revascularization,single antiplatelet therapy(SAPT)is standard,but dual antiplatelet therapy(DAPT)may improve outcomes,though duration and bleeding risks are unclear.The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT,yet evidence gaps remain in comparative efficacy and safety.We hypothesized that DAPT reduces cardiovascular events and reinterventions vs SAPT without significantly elevating bleeding in PAD patients’post-lower extremity revascularization.AIM To evaluate the efficacy and safety of DAPT vs SAPT in PAD patients’post-revascularization.METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,searching PubMed,EMBASE,and ScienceDirect up to July 2025.Included were randomized controlled trials(RCTs)and cohort studies from various global settings(e.g.,hospitals,tertiary care)comparing DAPT(aspirin plus P2Y12 inhibitor for>1 month)to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization(n up to 28244 participants selected via eligibility criteria).Data were pooled using random-effects models for risk ratio(RR)with 95%CI;heterogeneity was assessed via the I²statistic.Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs;certainty was evaluated via Grading of Recommendations Assessment,Development and Evaluation(GRADE).RESULTS Twelve studies(3 RCTs,9 cohorts,conducted 2010–2025 with follow-ups of 6 months to 5 years)were included.DAPT showed no significant difference but a trend toward reduced all-cause mortality(RR:0.52,95%CI:0.27–1.01,P=0.05,DAPT of 298/9545 events vs SAPT of 165/566 events)or stroke(RR:0.72,95%CI:0.30–1.72,P=0.46,DAPT of 16/3729 events vs SAPT of 41/7673 events)vs SAPT.DAPT significantly reduced cardiac mortality(RR:0.46,95%CI:0.27–0.80,P=0.006,DAPT of 78/2903 events vs SAPT of 171/1465 events,risk difference:-5.4%),myocardial infarction(RR:0.82,95%CI:0.71–0.94,P=0.004,DAPT of 233/7704 events vs SAPT of 262/9130 events,risk difference:-1.8%),and major reintervention(RR:0.58,95%CI:0.35–0.98,P=0.04,DAPT of 803/205 events vs SAPT of 1197/4 events,risk difference:-42%).Bleeding showed no difference(RR:1.12,95%CI:0.42–3.03,P=0.82,DAPT of 195/2775 events vs SAPT of 202/8234 events).Heterogeneity was high(I^(2)=59%–97%).Quality revealed moderate to serious bias in cohorts and some concerns in RCTs;GRADE certainty moderate for cardiac mortality,myocardial infarction,reintervention,low for others due to inconsistency and imprecision.CONCLUSION DAPT reduces cardiac mortality,myocardial infarction,and major reintervention risks compared to SAPT in PAD post-revascularization without apparent bleeding increase,though limited by heterogeneity and low certainty for some outcomes.展开更多
According to the complex differential accumulation history of deep marine oil and gas in superimposed basins,the Lower Paleozoic petroleum system in Tahe Oilfield of Tarim Basin is selected as a typical case,and the p...According to the complex differential accumulation history of deep marine oil and gas in superimposed basins,the Lower Paleozoic petroleum system in Tahe Oilfield of Tarim Basin is selected as a typical case,and the process of hydrocarbon generation and expulsion,migration and accumulation,adjustment and transformation of deep oil and gas is restored by means of reservoine-forming dynamics simulation.The thermal evolution history of the Lower Cambrian source rocks in Tahe Oilfield reflects the obvious differences in hydrocarbon generation and expulsion process and intensity in different tectonic zones,which is the main reason controlling the differences in deep oil and gas phases.The complex transport system composed of strike-slip fault and unconformity,etc.controlled early migration and accumulation and late adjustment of deep oil and gas,while the Middle Cambrian gypsum-salt rock in inner carbonate platform prevented vertical migration and accumulation of deep oil and gas,resulting in an obvious"fault-controlled"feature of deep oil and gas,in which the low potential area superimposed by the NE-strike-slip fault zone and deep oil and gas migration was conducive to accumulation,and it is mainly beaded along the strike-slip fault zone in the northeast direction.The dynamic simulation of reservoir formation reveals that the spatio-temporal configuration of"source-fault-fracture-gypsum-preservation"controls the differential accumulation of deep oil and gas in Tahe Oilfield.The Ordovician has experienced the accumulation history of multiple periods of charging,vertical migration and accumulation,and lateral adjustment and transformation,and deep oil and gas have always been in the dynamic equilibrium of migration,accumulation and escape.The statistics of residual oil and gas show that the deep stratum of Tahe Oilfield still has exploration and development potential in the Ordovician Yingshan Formation and Penglaiba Formation,and the Middle and Upper Cambrian ultra-deep stratum has a certain oil and gas resource prospect.This study provides a reference for the dynamic quantitative evaluation of deep oil and gas in the Tarim Basin,and also provides a reference for the study of reservoir formation and evolution in carbonate reservoir of paleo-craton basin.展开更多
Objective Venous thromboembolism is a highly prevalent condition after polytrauma,and recognized as an important factor contributing to poor prognosis.The aim of this study was to investigate the risk factors for lowe...Objective Venous thromboembolism is a highly prevalent condition after polytrauma,and recognized as an important factor contributing to poor prognosis.The aim of this study was to investigate the risk factors for lower extremity deep venous thrombosis(LEDVT)in a severely traumatized population and to evaluate their predictive value for LEDVT.Methods This was a retrospective,single-center observational study.All subjects were severely traumatized patients who were admitted to the Traumatic Intensive Care Unit from January 2021 to May 2024.Based on Doppler ultrasound findings of both lower extremities from the time of injury to 30 days post-injury,patients who developed LEDVT were enrolled in the LEDVT group,and those who did not develop LEDVT were enrolled in the NLEDVT group.Demographic,clinical,and laboratory data were collected upon admission.Multivariable logistic regression analysis was performed to identify risk factors for LEDVT.Receiver operating characteristic(ROC)curve was used to evaluate the overall fit of the final model.Results There were 56 patients enrolled in the LEDVT group and 81 patients in the NLEDVT group.Age,Aggregate Index of Systemic Inflammation(AISI),Systemic Inflammation Response Index(SIRI),ICU length of stay,and albumin were identified as independent risk factors for LEDVT(all P<0.05).The area under their ROC curves were 0.604,0.657,0.694,0.668,and 0.405,respectively.Combined model for early clinical prediction of LEDVT in severely traumatized patients by age,SIRI,AISI,and albumin resulted in an area under the ROC curve of 0.805(95%CI:0.73-0.88,SE=0.037).Conclusion The combination of age,SIRI,AISI,and albumin has a predictive value for LEDVT in severely traumatized patients.展开更多
In this article, an unknown system dynamics estimator-based impedance control method is proposed for the lower limb exoskeleton to stimulate the tracking flexibility with the terminal target position when suffering pa...In this article, an unknown system dynamics estimator-based impedance control method is proposed for the lower limb exoskeleton to stimulate the tracking flexibility with the terminal target position when suffering parametric inaccuracies and unexpected disturbances. To reinforce the robust performance, via constructing the filtering operation-based dynamic relation, i.e., invariant manifold, the unknown system dynamics estimators are employed to maintain the accurate perturbation identification in both the hip and knee subsystem. Besides, a funnel control technique is designed to govern the convergence process within a minor overshoot and a higher steady-state precision. Meanwhile, an interactive complaint result can be obtained with the aid of the impedance control, where the prescribed terminal trajectory can be adjusted into the interaction variable-based target position by the force–position mapping, revealing the dynamic influence between the impedance coefficient (stiffness and damping) and the adjusted position magnitude. A sufficient stability analysis verifies the ultimately uniformly bounded results of all the error signals, and even the angle errors can be regulated within the predefined funnel boundary in the whole convergence. Finally, some simulations are provided to demonstrate the validity and superiority including the enhanced interaction flexibility and robustness.展开更多
In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with ...In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.展开更多
Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze...Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze changes in mortality rates and disability-adjusted life year(DALY)rates for lower respiratory infections in the elderly population(aged 70 and above)in China from 1990 to 2050.It also discusses future trends in the burden of lower respiratory infections(LRI)in China under different scenarios.Results According to GBD predictions,the burden of lower respiratory infections in the elderly aged 70 years and above in China is lower than the global average.The burden has been decreasing from 1990 to 2020,but is projected to increase from 2020 to 2050.Scenario-based predictions suggest that,under scenarios involving improvements in nutrition and vaccination,the burden of lower respiratory infections in the elderly in China is expected to be the lowest in 2050.Conclusion This study indicates that the burden of lower respiratory infections in elderly people aged 70 years and above in China remains a significant public health issue and may worsen.The government should consider strengthening the preventive measures and management strategies for respiratory infections in the elderly population.展开更多
BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the cli...BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.展开更多
Here we report a left cheek plate of Psarolepis,a postparietal shield of Youngolepis,a skull of Diabolepis,and a scale of Styloichthys from the Lianhuashan and Nahkaoling formations(Lochkovian,Lower Devonian)of Nannin...Here we report a left cheek plate of Psarolepis,a postparietal shield of Youngolepis,a skull of Diabolepis,and a scale of Styloichthys from the Lianhuashan and Nahkaoling formations(Lochkovian,Lower Devonian)of Nanning,Guangxi.This marks the first report of Diabolepis and Styloichthys beside Qujing,Yunnan,and the latest occurrence of Psarolepis to date.The fossil community displays significant similarities to the Xujiachong Assemblage,and provides new data for the Lower Devonian stratigraphic correlation between southwestern China and northern Vietnam.Given the latest dating constraint based on the conodont evidence,we regard that the Xujiachong Assemblage has a much longer range than previously supposed,extending from the latest Lochkovian to the end of Pragian.We propose that the transition of the Nahkaoling and Lianhuashan formations in Nanning might correspond to the Guijiatun Formation in Qujing.The relatively large size of fish individuals from Guangxi is probably attributed to the increase in the oxygen content of the ocean.展开更多
Shale gas is abundant in the Paleozoic of the Yangtze Platform,and several high-yield shale gas fields have been built in the Upper Yangtze Platform,China.The Permian of the South Yellow Sea Basin(SYSB)in the Lower Ya...Shale gas is abundant in the Paleozoic of the Yangtze Platform,and several high-yield shale gas fields have been built in the Upper Yangtze Platform,China.The Permian of the South Yellow Sea Basin(SYSB)in the Lower Yangtze area is considered a potential target for shale gas exploration;however,the fundamental geological conditions of shale gas have not been studied.Based on the first whole-cored scientific drilling borehole(CSDP-2)in the SYSB,detailed tests involving petrology,organic geochemistry,and reservoir physical properties were conducted to evaluate the shale gas potential of the Lower Permian.The Lower Permian is dominated by organic-rich siliceous,clay,and clay-mixed shales.The average total organic carbon content is 5.99%,and the organic matter is mainly type Ⅱ_(1)−Ⅱ_(2),which has entered the high-over mature evolution stage.The pore types of organic-rich shales mainly include organic pores,dissolution pores,and intergranular pores,of which the meso-/macropores are well developed.The average porosity is 3.04%,and the total specific surface area and pore volume are 3.47 m^(2)/g and 7.21×10^(−3) cm^(3)/g,respectively.The average Langmuir volume obtained from the methane adsorption isotherms is 2.70 cm^(3)/g,and methane is mainly adsorbed in the meso-/macropores.The lower Permian shales are rich in methane as indicated by gas logging results,with an average content of 7.3%,which can reach up to 65.9%.A comparison of the study area with typical shale gas fields shows that the Lower Permian is brittle and shallowly buried and has a high potential for shale gas exploration and low-cost development.The depression areas of the SYSB are overlain by thick Mesozoic-Cenozoic sediments,show higher organic matter maturity,and may have greater shale gas potential.The shale gas exploration breakthrough of the study area is of great significance to ensure the energy supply of economically developed areas on the east China.展开更多
Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and manag...Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.展开更多
Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age w...Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.展开更多
In Switzerland,the Opalinus Clay has been selected as a potential host rock for the deep geological disposal of radioactive waste due to its low hydraulic conductivity and favorable swelling properties.During the oper...In Switzerland,the Opalinus Clay has been selected as a potential host rock for the deep geological disposal of radioactive waste due to its low hydraulic conductivity and favorable swelling properties.During the operational phase of the repository,the host rock will be exposed to pH values as high as 13.5 due to concrete degradation,which will certainly affect its hydraulic properties.This study investigates the effect of pH increase on the water retention properties of Opalinus Clay.A series of samples from the lower sandy facies of the Mont Terri site in Switzerland,at initial dry state,were exposed to a hyperalkaline solution of pH=13.5 and to the synthetic water of pH=7.5 at different water contents.After equilibrium,the total suction was measured with a dew point potentiometer and microstructural analyses were conducted via mercury intrusion porosimetry(MIP)and nitrogen adsorption-desorption technique.It was found that the total suction decreased with hydration and pH increase.Since the two investigated solutions have the same osmotic suction,the decrease in total suction was attributed to the decrease in matric suction.Indeed,the total porosity increased with saturation and pH increase.This was confirmed by MIP data that evidenced an increase in the proportion of macropores,and by Barret eJoynereHalenda(BJH)data that showed mesopore generation.The specific surface area(SSA)also increased.The previous results were due to mineral hydration and,exclusively in the case of alkaline solution,to(1)the dissolution of quartz and calcite and(2)the acid-base reactions,which were concentrated at the edges of the clay particles,leading to an increase in negatively charged groups and thus to a face-to-face association of the clay particles(dispersion),causing an increase in the repulsive forces between the clay particles.In addition,the weakening of covalent bonds led to the primary dissolution of clay minerals,i.e.silicon and aluminum detachment.展开更多
BACKGROUND The prevalence of lower extremity arteriosclerosis obliterans(LEASO)in China is progressively increasing with the increment in age.Certain patients may be diagnosed with lower extremity arterial stenosis an...BACKGROUND The prevalence of lower extremity arteriosclerosis obliterans(LEASO)in China is progressively increasing with the increment in age.Certain patients may be diagnosed with lower extremity arterial stenosis and occlusion that resist complete curative efforts,which will invariably impose a substantial psychological strain on them.AIM To investigate the anxiety and depression conditions among patients with LEASO and analyze the associated risk factors.METHODS The Affiliated Hospital of Bengbu Medical University from January 2019 to December 2022.Their demographic and clinical data were obtained through the basic information questionnaire.The social support situation was assessed with the social support rating scale,and the hospital anxiety and depression scale were used to analyze their depression and anxiety levels.RESULTS The prevalence rate of anxiety was 44.0%among the 159 patients,with a total Self-Rating Anxiety Scale score of 49.01±9.65.The incidence of depression was 40.9%,and the total self-rating depression scale score reached 49.91±9.18.The overall social support score for all participants averaged 24.82±5.80.The correlation analysis between social support scores and anxiety and depression scores revealed that the total social support score,subjective social support,objective social support,as well as the degree of social support utilization,all exhibited a significant negative correlation with the anxiety and depression scores,which was statistically significant(P<0.05).The univariate analysis revealed statistically significant differences in the depression and anxiety states among patients with varying pain manifestations,disease stages,disease durations,and social support magnitudes(P<0.05).The multivariate analysis further demonstrated that patients presenting with intermittent claudication,rest pain,and pain,whose disease course was within half a year,and who had relatively low social support,were more predisposed to anxiety.Intriguingly,a monthly income of>6000 yuan was considered a protective factor in this context(P<0.05).Similarly,patients with intermittent claudication,rest pain,gangrene,and pain,and who had relatively low social support,were more liable to succumb to depressive moods(P<0.05).CONCLUSION Patients with LEASO typically receive relatively scant social support.Notably,those who concurrently present with symptoms,such as pain,claudication,and gangrene,are at a substantially increased risk of developing depression and anxiety disorders.A significant negative correlation is manifested between the social support level that patients receive and the severity of their anxiety and depression symptoms.Hence,the lower the social support score,the greater the propensity for patients to experience anxiety and depressive emotions.Therefore,during clinical practice,the crucial role that social support plays in safeguarding patients’physical and mental well-being as well as facilitating the effectiveness of disease treatment needs to be particularly emphasized.展开更多
BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosi...BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosis and management planning,though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.AIM To comprehensively evaluate the diagnostic accuracy,utility and clinical implications of CT in patients with acute lower abdominal pain,emphasizing rare anatomical variations,pregnancy-related issues,and practical limitations of other imaging modalities in emergency settings in Japan.METHODS This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014.CT findings were systematically correlated with the final clinical diagnoses.Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists.The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.RESULTS Idiopathic pain was the most common diagnosis(104 cases,45.2%),followed by appendicitis(46 cases,20.0%)and diverticulitis(27 cases,11.7%).Right lower quadrant pain predominantly revealed appendicitis(20.2%),whereas left lower quadrant pain frequently indicated diverticulitis(12.1%).Nonspecific pain cases have diverse etiologies.Rare conditions included situs inversus(one case)and intestinal malrotation(one case).Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.CONCLUSION CT significantly aids in the diagnosis of lower abdominal pain,especially given limited access to ultrasonography and MRI during emergency hours in Japan.Awareness of the anatomical variations and pregnancy-related constraints is crucial.Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.展开更多
How the strong segmentation of cascade reservoir dams and the spatiotemporal changes of sediment retention volume affect the river morphology adjustment in the reservoir area is a scientific issue worthy of exploratio...How the strong segmentation of cascade reservoir dams and the spatiotemporal changes of sediment retention volume affect the river morphology adjustment in the reservoir area is a scientific issue worthy of exploration.This study aims to reveal the adjustment mechanism of the thalweg longitudinal profile of cascade reservoirs.This study focuses on the Xiangjiaba and Xiluodu reservoirs located in the lower reaches of the Jinsha River.Utilizing multi-period observational data of thalweg elevation in reservoir reaches both before and after dam construction,the research employs statistical,geomorphological,and sedimentological methodologies to analyze variation characteristics in the measured curves,trend curves,and theoretical fitting curves of the thalweg longitudinal profile.The investigation ultimately reveals two distinct adjustment patterns in the longitudinal profiles of these cascade reservoirs:the concave curve type and the convex curve type.The former is characterized by weak riverbed scouring and silting changed to rapid aggradation in the upstream section of the reservoir area after dam closure,then changed to slow aggradation in the whole reservoir area,which is the common feature of reservoirs that were built earlier and are relatively located in the downstream(such as the Xiangjiaba Reservoir).The latter is characterized by a straight line or concave curve type with weak riverbed scouring and silting before the dam closure changed to a convex curve type with strong siltation after dam closure,which is the characteristic of reservoirs that were built later and are relatively located in the upstream(such as the Xiluodu Reservoir).The adjustment of the cascade reservoir longitudinal profile is controlled by the spatiotemporal changes of the sediment deposition volume and sedimentation rate in the reservoir area,and the alternating changes of the hydrodynamic gradient and regulation mode affect the spatial heterogeneity of the sedimentation rate.The research results are helpful for understanding the adjustment mechanism of the cascade reservoir longitudinal profile in similar areas and have a guiding role in predicting the adjustment trend of the cascade reservoir longitudinal profile without observation data.展开更多
BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in th...BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.展开更多
Understanding mixed infections in the female lower genital tract is a critical challenge in modern infection research.The interplay of multiple pathogens complicates disease progression,often resulting in treatment fa...Understanding mixed infections in the female lower genital tract is a critical challenge in modern infection research.The interplay of multiple pathogens complicates disease progression,often resulting in treatment failure,recurrent infections,and significant public health and economic burdens.These infections are further exacerbated by disrupted host immune responses,which hinder the recovery of the vaginal microecosystem.Additionally,microbial biofilms—a fundamental mode of pathogen coexistence—contribute to the persistence and drug resistance of these infections,complicating management strategies.This review examines the pathogenesis,diagnosis,and treatment of mixed infections in the female lower genital tract while exploring potential avenues for future research.These findings emphasize the need for greater focus on these infections and offer insights to enhance further research in this area.展开更多
Varicose veins of the lower limbs are a cosmopolitan condition, thought to be rare in Africa but widespread in Europe. The aim of this study is to analyze the indications and evaluate the results of surgical managemen...Varicose veins of the lower limbs are a cosmopolitan condition, thought to be rare in Africa but widespread in Europe. The aim of this study is to analyze the indications and evaluate the results of surgical management of varicose pathology of the IM in Dakar. We enrolled 280 patients, with a mean age of 36 and a sex ratio of 2. Factors favouring venous disease were dominated by prolonged orthostatism and multiparity. The average consultation time was 6 years. The reasons for consultation were functional manifestations, progressive complications and aesthetics. The venous trunks concerned were the great saphenous vein (GSV) in 58.9% of cases, the small saphenous vein (SSV) in 29% of cases, perforating veins and varicose veins were unsystematized in 28.5% of cases. Surgery was performed under spinal anaesthesia. Surgical procedures were dominated by stripping of the GSV, crossectomy of the SSV and staged ligations. One patient developed meningismus immediately after the operation. Average follow-up was 2 years. Mortality was null.展开更多
BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph nod...BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.展开更多
Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss sy...Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss syndrome,Dieulafoy’s lesions,and gastric neoplasms.Treatment strategies include acid-suppressive therapy,endoscopic interventions,and surgical or radiological procedures.Endoscopic techniques such as over-the-scope clips,coagulation graspers,and endoscopic ultrasound-guided treatments have significantly improved outcomes,reducing rebleeding rates and the need for surgery.Injectable therapies,mechanical hemostasis via clips,and thermal modalities(e.g.,electrocoagulation,argon plasma coagulation)remain standard approaches for active bleeding.Newer hemostatic powders,such as TC-325,offer promising non-contact treatments,particularly in cases of refractory bleeding or malignancy.Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow,improving the efficacy of endoscopic therapy and reducing rebleeding risks.For small bowel bleeding,endoscopic management with enteroscopy and thermal therapies remains key,though medical therapies are evolving.Lower GIB,which often involves conditions like diverticular disease and angioectasia,requires a comprehensive approach combining endoscopic,radiologic,and surgical interventions.Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks,with reversal agents playing a crucial role in life-threatening bleeding episodes.This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.展开更多
文摘BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revascularization,single antiplatelet therapy(SAPT)is standard,but dual antiplatelet therapy(DAPT)may improve outcomes,though duration and bleeding risks are unclear.The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT,yet evidence gaps remain in comparative efficacy and safety.We hypothesized that DAPT reduces cardiovascular events and reinterventions vs SAPT without significantly elevating bleeding in PAD patients’post-lower extremity revascularization.AIM To evaluate the efficacy and safety of DAPT vs SAPT in PAD patients’post-revascularization.METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,searching PubMed,EMBASE,and ScienceDirect up to July 2025.Included were randomized controlled trials(RCTs)and cohort studies from various global settings(e.g.,hospitals,tertiary care)comparing DAPT(aspirin plus P2Y12 inhibitor for>1 month)to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization(n up to 28244 participants selected via eligibility criteria).Data were pooled using random-effects models for risk ratio(RR)with 95%CI;heterogeneity was assessed via the I²statistic.Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs;certainty was evaluated via Grading of Recommendations Assessment,Development and Evaluation(GRADE).RESULTS Twelve studies(3 RCTs,9 cohorts,conducted 2010–2025 with follow-ups of 6 months to 5 years)were included.DAPT showed no significant difference but a trend toward reduced all-cause mortality(RR:0.52,95%CI:0.27–1.01,P=0.05,DAPT of 298/9545 events vs SAPT of 165/566 events)or stroke(RR:0.72,95%CI:0.30–1.72,P=0.46,DAPT of 16/3729 events vs SAPT of 41/7673 events)vs SAPT.DAPT significantly reduced cardiac mortality(RR:0.46,95%CI:0.27–0.80,P=0.006,DAPT of 78/2903 events vs SAPT of 171/1465 events,risk difference:-5.4%),myocardial infarction(RR:0.82,95%CI:0.71–0.94,P=0.004,DAPT of 233/7704 events vs SAPT of 262/9130 events,risk difference:-1.8%),and major reintervention(RR:0.58,95%CI:0.35–0.98,P=0.04,DAPT of 803/205 events vs SAPT of 1197/4 events,risk difference:-42%).Bleeding showed no difference(RR:1.12,95%CI:0.42–3.03,P=0.82,DAPT of 195/2775 events vs SAPT of 202/8234 events).Heterogeneity was high(I^(2)=59%–97%).Quality revealed moderate to serious bias in cohorts and some concerns in RCTs;GRADE certainty moderate for cardiac mortality,myocardial infarction,reintervention,low for others due to inconsistency and imprecision.CONCLUSION DAPT reduces cardiac mortality,myocardial infarction,and major reintervention risks compared to SAPT in PAD post-revascularization without apparent bleeding increase,though limited by heterogeneity and low certainty for some outcomes.
基金Supported by the Sichuan Province Regional Innovation Cooperation Project(21QYCX0048)Sinopec Science and Technology Department Project(P21048-3)。
文摘According to the complex differential accumulation history of deep marine oil and gas in superimposed basins,the Lower Paleozoic petroleum system in Tahe Oilfield of Tarim Basin is selected as a typical case,and the process of hydrocarbon generation and expulsion,migration and accumulation,adjustment and transformation of deep oil and gas is restored by means of reservoine-forming dynamics simulation.The thermal evolution history of the Lower Cambrian source rocks in Tahe Oilfield reflects the obvious differences in hydrocarbon generation and expulsion process and intensity in different tectonic zones,which is the main reason controlling the differences in deep oil and gas phases.The complex transport system composed of strike-slip fault and unconformity,etc.controlled early migration and accumulation and late adjustment of deep oil and gas,while the Middle Cambrian gypsum-salt rock in inner carbonate platform prevented vertical migration and accumulation of deep oil and gas,resulting in an obvious"fault-controlled"feature of deep oil and gas,in which the low potential area superimposed by the NE-strike-slip fault zone and deep oil and gas migration was conducive to accumulation,and it is mainly beaded along the strike-slip fault zone in the northeast direction.The dynamic simulation of reservoir formation reveals that the spatio-temporal configuration of"source-fault-fracture-gypsum-preservation"controls the differential accumulation of deep oil and gas in Tahe Oilfield.The Ordovician has experienced the accumulation history of multiple periods of charging,vertical migration and accumulation,and lateral adjustment and transformation,and deep oil and gas have always been in the dynamic equilibrium of migration,accumulation and escape.The statistics of residual oil and gas show that the deep stratum of Tahe Oilfield still has exploration and development potential in the Ordovician Yingshan Formation and Penglaiba Formation,and the Middle and Upper Cambrian ultra-deep stratum has a certain oil and gas resource prospect.This study provides a reference for the dynamic quantitative evaluation of deep oil and gas in the Tarim Basin,and also provides a reference for the study of reservoir formation and evolution in carbonate reservoir of paleo-craton basin.
基金Basic Research Spe-cial Project of Suzhou Science and Technology Bureau(SSD2024050).
文摘Objective Venous thromboembolism is a highly prevalent condition after polytrauma,and recognized as an important factor contributing to poor prognosis.The aim of this study was to investigate the risk factors for lower extremity deep venous thrombosis(LEDVT)in a severely traumatized population and to evaluate their predictive value for LEDVT.Methods This was a retrospective,single-center observational study.All subjects were severely traumatized patients who were admitted to the Traumatic Intensive Care Unit from January 2021 to May 2024.Based on Doppler ultrasound findings of both lower extremities from the time of injury to 30 days post-injury,patients who developed LEDVT were enrolled in the LEDVT group,and those who did not develop LEDVT were enrolled in the NLEDVT group.Demographic,clinical,and laboratory data were collected upon admission.Multivariable logistic regression analysis was performed to identify risk factors for LEDVT.Receiver operating characteristic(ROC)curve was used to evaluate the overall fit of the final model.Results There were 56 patients enrolled in the LEDVT group and 81 patients in the NLEDVT group.Age,Aggregate Index of Systemic Inflammation(AISI),Systemic Inflammation Response Index(SIRI),ICU length of stay,and albumin were identified as independent risk factors for LEDVT(all P<0.05).The area under their ROC curves were 0.604,0.657,0.694,0.668,and 0.405,respectively.Combined model for early clinical prediction of LEDVT in severely traumatized patients by age,SIRI,AISI,and albumin resulted in an area under the ROC curve of 0.805(95%CI:0.73-0.88,SE=0.037).Conclusion The combination of age,SIRI,AISI,and albumin has a predictive value for LEDVT in severely traumatized patients.
基金supported in part by the Young Talent Fund of Association for Science and Technology in Shaanxi,China(No.20230126).
文摘In this article, an unknown system dynamics estimator-based impedance control method is proposed for the lower limb exoskeleton to stimulate the tracking flexibility with the terminal target position when suffering parametric inaccuracies and unexpected disturbances. To reinforce the robust performance, via constructing the filtering operation-based dynamic relation, i.e., invariant manifold, the unknown system dynamics estimators are employed to maintain the accurate perturbation identification in both the hip and knee subsystem. Besides, a funnel control technique is designed to govern the convergence process within a minor overshoot and a higher steady-state precision. Meanwhile, an interactive complaint result can be obtained with the aid of the impedance control, where the prescribed terminal trajectory can be adjusted into the interaction variable-based target position by the force–position mapping, revealing the dynamic influence between the impedance coefficient (stiffness and damping) and the adjusted position magnitude. A sufficient stability analysis verifies the ultimately uniformly bounded results of all the error signals, and even the angle errors can be regulated within the predefined funnel boundary in the whole convergence. Finally, some simulations are provided to demonstrate the validity and superiority including the enhanced interaction flexibility and robustness.
基金Supported by The National Research Foundation of Korea Grant funded by the Korea Government,No.00219725.
文摘In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.
基金supported by the National High Level Hospital Clinical Research Funding(No.BJ-2023-066).
文摘Objective This study aims to analyze the burden of lower respiratory infections in Chinese elderly people aged 70 and above.Methods This study utilized Global Burden of Disease(GBD)1990-2050 prediction data to analyze changes in mortality rates and disability-adjusted life year(DALY)rates for lower respiratory infections in the elderly population(aged 70 and above)in China from 1990 to 2050.It also discusses future trends in the burden of lower respiratory infections(LRI)in China under different scenarios.Results According to GBD predictions,the burden of lower respiratory infections in the elderly aged 70 years and above in China is lower than the global average.The burden has been decreasing from 1990 to 2020,but is projected to increase from 2020 to 2050.Scenario-based predictions suggest that,under scenarios involving improvements in nutrition and vaccination,the burden of lower respiratory infections in the elderly in China is expected to be the lowest in 2050.Conclusion This study indicates that the burden of lower respiratory infections in elderly people aged 70 years and above in China remains a significant public health issue and may worsen.The government should consider strengthening the preventive measures and management strategies for respiratory infections in the elderly population.
文摘BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.
文摘Here we report a left cheek plate of Psarolepis,a postparietal shield of Youngolepis,a skull of Diabolepis,and a scale of Styloichthys from the Lianhuashan and Nahkaoling formations(Lochkovian,Lower Devonian)of Nanning,Guangxi.This marks the first report of Diabolepis and Styloichthys beside Qujing,Yunnan,and the latest occurrence of Psarolepis to date.The fossil community displays significant similarities to the Xujiachong Assemblage,and provides new data for the Lower Devonian stratigraphic correlation between southwestern China and northern Vietnam.Given the latest dating constraint based on the conodont evidence,we regard that the Xujiachong Assemblage has a much longer range than previously supposed,extending from the latest Lochkovian to the end of Pragian.We propose that the transition of the Nahkaoling and Lianhuashan formations in Nanning might correspond to the Guijiatun Formation in Qujing.The relatively large size of fish individuals from Guangxi is probably attributed to the increase in the oxygen content of the ocean.
基金supported by the Natural Science Foundation of Shandong Province(ZR2023MD112)financially supported by Laoshan Laboratory(LSKJ202203401).
文摘Shale gas is abundant in the Paleozoic of the Yangtze Platform,and several high-yield shale gas fields have been built in the Upper Yangtze Platform,China.The Permian of the South Yellow Sea Basin(SYSB)in the Lower Yangtze area is considered a potential target for shale gas exploration;however,the fundamental geological conditions of shale gas have not been studied.Based on the first whole-cored scientific drilling borehole(CSDP-2)in the SYSB,detailed tests involving petrology,organic geochemistry,and reservoir physical properties were conducted to evaluate the shale gas potential of the Lower Permian.The Lower Permian is dominated by organic-rich siliceous,clay,and clay-mixed shales.The average total organic carbon content is 5.99%,and the organic matter is mainly type Ⅱ_(1)−Ⅱ_(2),which has entered the high-over mature evolution stage.The pore types of organic-rich shales mainly include organic pores,dissolution pores,and intergranular pores,of which the meso-/macropores are well developed.The average porosity is 3.04%,and the total specific surface area and pore volume are 3.47 m^(2)/g and 7.21×10^(−3) cm^(3)/g,respectively.The average Langmuir volume obtained from the methane adsorption isotherms is 2.70 cm^(3)/g,and methane is mainly adsorbed in the meso-/macropores.The lower Permian shales are rich in methane as indicated by gas logging results,with an average content of 7.3%,which can reach up to 65.9%.A comparison of the study area with typical shale gas fields shows that the Lower Permian is brittle and shallowly buried and has a high potential for shale gas exploration and low-cost development.The depression areas of the SYSB are overlain by thick Mesozoic-Cenozoic sediments,show higher organic matter maturity,and may have greater shale gas potential.The shale gas exploration breakthrough of the study area is of great significance to ensure the energy supply of economically developed areas on the east China.
文摘Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.
文摘Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.
文摘In Switzerland,the Opalinus Clay has been selected as a potential host rock for the deep geological disposal of radioactive waste due to its low hydraulic conductivity and favorable swelling properties.During the operational phase of the repository,the host rock will be exposed to pH values as high as 13.5 due to concrete degradation,which will certainly affect its hydraulic properties.This study investigates the effect of pH increase on the water retention properties of Opalinus Clay.A series of samples from the lower sandy facies of the Mont Terri site in Switzerland,at initial dry state,were exposed to a hyperalkaline solution of pH=13.5 and to the synthetic water of pH=7.5 at different water contents.After equilibrium,the total suction was measured with a dew point potentiometer and microstructural analyses were conducted via mercury intrusion porosimetry(MIP)and nitrogen adsorption-desorption technique.It was found that the total suction decreased with hydration and pH increase.Since the two investigated solutions have the same osmotic suction,the decrease in total suction was attributed to the decrease in matric suction.Indeed,the total porosity increased with saturation and pH increase.This was confirmed by MIP data that evidenced an increase in the proportion of macropores,and by Barret eJoynereHalenda(BJH)data that showed mesopore generation.The specific surface area(SSA)also increased.The previous results were due to mineral hydration and,exclusively in the case of alkaline solution,to(1)the dissolution of quartz and calcite and(2)the acid-base reactions,which were concentrated at the edges of the clay particles,leading to an increase in negatively charged groups and thus to a face-to-face association of the clay particles(dispersion),causing an increase in the repulsive forces between the clay particles.In addition,the weakening of covalent bonds led to the primary dissolution of clay minerals,i.e.silicon and aluminum detachment.
基金Supported by the Key Project of Natural Science Research in Universities of Anhui Province,No.2023AH051985Key Project of Natural Science Research at Bengbu Medical University,No.2023byzd038Anhui Provincial Health Research Project,No.AHWJ2024BAc30042.
文摘BACKGROUND The prevalence of lower extremity arteriosclerosis obliterans(LEASO)in China is progressively increasing with the increment in age.Certain patients may be diagnosed with lower extremity arterial stenosis and occlusion that resist complete curative efforts,which will invariably impose a substantial psychological strain on them.AIM To investigate the anxiety and depression conditions among patients with LEASO and analyze the associated risk factors.METHODS The Affiliated Hospital of Bengbu Medical University from January 2019 to December 2022.Their demographic and clinical data were obtained through the basic information questionnaire.The social support situation was assessed with the social support rating scale,and the hospital anxiety and depression scale were used to analyze their depression and anxiety levels.RESULTS The prevalence rate of anxiety was 44.0%among the 159 patients,with a total Self-Rating Anxiety Scale score of 49.01±9.65.The incidence of depression was 40.9%,and the total self-rating depression scale score reached 49.91±9.18.The overall social support score for all participants averaged 24.82±5.80.The correlation analysis between social support scores and anxiety and depression scores revealed that the total social support score,subjective social support,objective social support,as well as the degree of social support utilization,all exhibited a significant negative correlation with the anxiety and depression scores,which was statistically significant(P<0.05).The univariate analysis revealed statistically significant differences in the depression and anxiety states among patients with varying pain manifestations,disease stages,disease durations,and social support magnitudes(P<0.05).The multivariate analysis further demonstrated that patients presenting with intermittent claudication,rest pain,and pain,whose disease course was within half a year,and who had relatively low social support,were more predisposed to anxiety.Intriguingly,a monthly income of>6000 yuan was considered a protective factor in this context(P<0.05).Similarly,patients with intermittent claudication,rest pain,gangrene,and pain,and who had relatively low social support,were more liable to succumb to depressive moods(P<0.05).CONCLUSION Patients with LEASO typically receive relatively scant social support.Notably,those who concurrently present with symptoms,such as pain,claudication,and gangrene,are at a substantially increased risk of developing depression and anxiety disorders.A significant negative correlation is manifested between the social support level that patients receive and the severity of their anxiety and depression symptoms.Hence,the lower the social support score,the greater the propensity for patients to experience anxiety and depressive emotions.Therefore,during clinical practice,the crucial role that social support plays in safeguarding patients’physical and mental well-being as well as facilitating the effectiveness of disease treatment needs to be particularly emphasized.
文摘BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosis and management planning,though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.AIM To comprehensively evaluate the diagnostic accuracy,utility and clinical implications of CT in patients with acute lower abdominal pain,emphasizing rare anatomical variations,pregnancy-related issues,and practical limitations of other imaging modalities in emergency settings in Japan.METHODS This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014.CT findings were systematically correlated with the final clinical diagnoses.Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists.The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.RESULTS Idiopathic pain was the most common diagnosis(104 cases,45.2%),followed by appendicitis(46 cases,20.0%)and diverticulitis(27 cases,11.7%).Right lower quadrant pain predominantly revealed appendicitis(20.2%),whereas left lower quadrant pain frequently indicated diverticulitis(12.1%).Nonspecific pain cases have diverse etiologies.Rare conditions included situs inversus(one case)and intestinal malrotation(one case).Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.CONCLUSION CT significantly aids in the diagnosis of lower abdominal pain,especially given limited access to ultrasonography and MRI during emergency hours in Japan.Awareness of the anatomical variations and pregnancy-related constraints is crucial.Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.
基金National Key R&D Program of China,No.2022YFC3203903National Natural Science Foundation of China,No.42371010,No.41971004。
文摘How the strong segmentation of cascade reservoir dams and the spatiotemporal changes of sediment retention volume affect the river morphology adjustment in the reservoir area is a scientific issue worthy of exploration.This study aims to reveal the adjustment mechanism of the thalweg longitudinal profile of cascade reservoirs.This study focuses on the Xiangjiaba and Xiluodu reservoirs located in the lower reaches of the Jinsha River.Utilizing multi-period observational data of thalweg elevation in reservoir reaches both before and after dam construction,the research employs statistical,geomorphological,and sedimentological methodologies to analyze variation characteristics in the measured curves,trend curves,and theoretical fitting curves of the thalweg longitudinal profile.The investigation ultimately reveals two distinct adjustment patterns in the longitudinal profiles of these cascade reservoirs:the concave curve type and the convex curve type.The former is characterized by weak riverbed scouring and silting changed to rapid aggradation in the upstream section of the reservoir area after dam closure,then changed to slow aggradation in the whole reservoir area,which is the common feature of reservoirs that were built earlier and are relatively located in the downstream(such as the Xiangjiaba Reservoir).The latter is characterized by a straight line or concave curve type with weak riverbed scouring and silting before the dam closure changed to a convex curve type with strong siltation after dam closure,which is the characteristic of reservoirs that were built later and are relatively located in the upstream(such as the Xiluodu Reservoir).The adjustment of the cascade reservoir longitudinal profile is controlled by the spatiotemporal changes of the sediment deposition volume and sedimentation rate in the reservoir area,and the alternating changes of the hydrodynamic gradient and regulation mode affect the spatial heterogeneity of the sedimentation rate.The research results are helpful for understanding the adjustment mechanism of the cascade reservoir longitudinal profile in similar areas and have a guiding role in predicting the adjustment trend of the cascade reservoir longitudinal profile without observation data.
文摘BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.
基金supported by a grant from the National Natural Science Foundation of China(No.81874483).
文摘Understanding mixed infections in the female lower genital tract is a critical challenge in modern infection research.The interplay of multiple pathogens complicates disease progression,often resulting in treatment failure,recurrent infections,and significant public health and economic burdens.These infections are further exacerbated by disrupted host immune responses,which hinder the recovery of the vaginal microecosystem.Additionally,microbial biofilms—a fundamental mode of pathogen coexistence—contribute to the persistence and drug resistance of these infections,complicating management strategies.This review examines the pathogenesis,diagnosis,and treatment of mixed infections in the female lower genital tract while exploring potential avenues for future research.These findings emphasize the need for greater focus on these infections and offer insights to enhance further research in this area.
文摘Varicose veins of the lower limbs are a cosmopolitan condition, thought to be rare in Africa but widespread in Europe. The aim of this study is to analyze the indications and evaluate the results of surgical management of varicose pathology of the IM in Dakar. We enrolled 280 patients, with a mean age of 36 and a sex ratio of 2. Factors favouring venous disease were dominated by prolonged orthostatism and multiparity. The average consultation time was 6 years. The reasons for consultation were functional manifestations, progressive complications and aesthetics. The venous trunks concerned were the great saphenous vein (GSV) in 58.9% of cases, the small saphenous vein (SSV) in 29% of cases, perforating veins and varicose veins were unsystematized in 28.5% of cases. Surgery was performed under spinal anaesthesia. Surgical procedures were dominated by stripping of the GSV, crossectomy of the SSV and staged ligations. One patient developed meningismus immediately after the operation. Average follow-up was 2 years. Mortality was null.
文摘BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.
文摘Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss syndrome,Dieulafoy’s lesions,and gastric neoplasms.Treatment strategies include acid-suppressive therapy,endoscopic interventions,and surgical or radiological procedures.Endoscopic techniques such as over-the-scope clips,coagulation graspers,and endoscopic ultrasound-guided treatments have significantly improved outcomes,reducing rebleeding rates and the need for surgery.Injectable therapies,mechanical hemostasis via clips,and thermal modalities(e.g.,electrocoagulation,argon plasma coagulation)remain standard approaches for active bleeding.Newer hemostatic powders,such as TC-325,offer promising non-contact treatments,particularly in cases of refractory bleeding or malignancy.Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow,improving the efficacy of endoscopic therapy and reducing rebleeding risks.For small bowel bleeding,endoscopic management with enteroscopy and thermal therapies remains key,though medical therapies are evolving.Lower GIB,which often involves conditions like diverticular disease and angioectasia,requires a comprehensive approach combining endoscopic,radiologic,and surgical interventions.Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks,with reversal agents playing a crucial role in life-threatening bleeding episodes.This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.
