BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary tota...BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary total knee replacement(TKR)OP-Rs has never been reported.Therefore,a standardized benchmark for assessment and factors affecting the completeness of TKR OP-Rs needs to be evaluated.AIM To evaluate the completeness rate of primary TKR OP-Rs in a teaching hospital and to assess the factors affecting completeness.METHODS A retrospective review of 58 consecutive primary TKR OP-Rs in a tertiary te-aching hospital were included in this study.We used document analysis to review the OP-Rs against a standardized list of six subsets of mandatory variables.The correlation between the percentage of completeness and the specific variables was determined.RESULTS After analyzing 58 cases,we found that the time to documentation was 1.5 hours.Out of the 52 mandatory variables,a median of 30 variables were documented yielding a completeness of 58%.Administrative,procedural,exposure,and im-plant variables were documented the most often,whereas clinical and process variables were most frequently left uncompleted.The documentation of the operative maneuver was variable.There was no association between the com-pleteness of the reports and the time to documentation,documenter level,com-plication rate,operative duration,or length of hospital stay.CONCLUSION Multiple variables were left undocumented on the unstructured primary TKR OP-Rs.The completeness percentage will likely improve after the implementation of a standardized structured OP-R.展开更多
Cooperative guidance is a method for achieving combat objectives through information sharing and cooperative effects,and has emerged as a significant research area in the fields of missile guidance and systematic warf...Cooperative guidance is a method for achieving combat objectives through information sharing and cooperative effects,and has emerged as a significant research area in the fields of missile guidance and systematic warfare.This study presents a systematic review and analysis of current research on cooperative guidance.First,a bibliometric analysis is conducted on 513 articles using the Scopus database and CiteSpace software to assess keyword clustering,keyword cooccurrence,and keyword burst,and to later visualize the results.Second,fundamental theories of cooperative guidance,including relative motion modeling methods,algebraic graph theory,and multi-agent consensus theory,are summarized.Subsequently,an overview of current cooperative laws and corresponding analysis methods is provided,with categorization based on the cooperative structure and convergence performance.Finally,we summarize current research developments based on five perspectives and propose a developmental framework based on five layers(cyber,physical,decision,information,and system),discussing potential future advancements in cooperative terminal guidance.This framework emphasizes five key areas of research:networked,heterogeneous,integrated,intelligent,and group cooperations,with the goal of offering trends and insights for futurework.展开更多
Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared t...Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.展开更多
A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thorac...A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.展开更多
Under the background of"Digital Commerce for Rural Vitalization",rural E-commerce has experienced rapid development.However,agricultural products like strawberries,often produced by small-scale,fragmented,an...Under the background of"Digital Commerce for Rural Vitalization",rural E-commerce has experienced rapid development.However,agricultural products like strawberries,often produced by small-scale,fragmented,and less competitive individual farmers,struggle to meet the compliance and scalability demands of E-commerce,thereby constraining high-quality local economic development.Aiming to address this issue,this paper,guided by relevant policies and strategies,employs case analysis and logical deduction to explore the industrialization path of the"Cooperative+E-commerce"model for the strawberry industry.The research finds that by optimizing the cooperative's organizational structure,implementing multi-channel E-commerce strategies,upgrading the supply chain(including cold chain and quality traceability),and engaging in collaborative brand building,a robust industrial system can be formed.Supplemented by benefit evaluation,policy support,and regulatory oversight,this system can effectively bridge small-scale production with the broader market.This study concludes that this pathway can enhance the added value of the strawberry industry,increase farmer incomes,and provide practical insights for promoting high-quality local economic development.展开更多
Virtual coupling is a novel technology that enables trains to run closely together without physical connections through communication and automation systems.The paper addresses an adaptive polynomial approximation alg...Virtual coupling is a novel technology that enables trains to run closely together without physical connections through communication and automation systems.The paper addresses an adaptive polynomial approximation algorithm for the cooperative control of high-speed trains(HSTs)under virtual coupling.It aims to solve the cooperative tracking control problem of HST formation operations under various scenarios,including known and unknown parameters.To enable the HST formation system to achieve cooperative operation while ensuring an appropriate spacing distance,the tracking errors of displacement and speed throughout the entire operation converge to zero.The proposed control strategy focuses on adopting polynomial approximation to handle unknown parameters,which are estimated via adaptive laws.Additionally,the unknown parameters of the HSTs are estimated online through adaptive laws.Experimental results verify the effectiveness of this method.展开更多
In this paper,a novel cooperative collision avoidance control strategy with relative velocity information for redundant robotic manipulators is derived to guarantee the behavioral safety of robots in the cooperative o...In this paper,a novel cooperative collision avoidance control strategy with relative velocity information for redundant robotic manipulators is derived to guarantee the behavioral safety of robots in the cooperative operational task.This strategy can generate the collision-free trajectory of the robotic links in real-time,which is to realize that the robot can avoid moving obstacles less conservatively and ensure tracking accuracy of terminal end-effector tasks in performing cooperative tasks.For the case where there is interference between the moving obstacle and the desired path of the robotic end-effector,the method inherits the null-space-based self-motion characteristics of the redundant manipulator,integrates the relative motion information,and uses the improved artificial potential field method to design the control items,which are used to generate the collision avoidance motion and carry out moving obstacles smoothly and less conservatively.At the same time,the strategy maintains the kinematic constraint relationship of dual-arm cooperatives,to meet the real-time collision avoidance task under collaborative tasks.Finally,the algorithm simulation indicates that the method can better ensure the tracking accuracy of the end-effector task and carry out moving obstacles smoothly.The experimental results show that the method can generate the real-time collision-free trajectory of the robot in the cooperative handling task,and the joint movement is continuous and stable.展开更多
AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
Objective: To investigate the operative timing and indi-cations for severe acute pancreatitis(SAP).Methods: Data collected from 172 patients with SAPtreated in our hospital since 1980 were analyzed retro-spectively.Re...Objective: To investigate the operative timing and indi-cations for severe acute pancreatitis(SAP).Methods: Data collected from 172 patients with SAPtreated in our hospital since 1980 were analyzed retro-spectively.Results: In the 94 patients who had undergone early op-eration before June 1992, 57 (62.8%) healed, 35 (37.2%)died, and 16 (17.0%) had no postoperative compli-cations. In the 78 patients who had been treated after July1992 according to the principle of individualization, 66(84.6%) healed, 12 (15.4%) died, and 37 (47.4%)had no postoperative complications. In the 78 patients32 received non-operative treatment but 30 (93.8%)cured, 12 early operation but 7(58.3%)cured, 18 lateoperation but 13 (72.2%) cured, and 16 selected timeoperation but all cured.Conclusions: It is concluded that individualized thera-py is effective and reasonable for treating SAP. Theindications for early, late and selected time operationshould be emphasized.展开更多
ABSTRACT Objective To discuss the effect of electroacupuncture at Chengshan （承山 BL 57） on postoperative pain of mixed hemorrhoids. Methods One hundred and twenty cases with postoperative pain of mixed hemorrhoids ...ABSTRACT Objective To discuss the effect of electroacupuncture at Chengshan （承山 BL 57） on postoperative pain of mixed hemorrhoids. Methods One hundred and twenty cases with postoperative pain of mixed hemorrhoids were divided into an electroacupuncture group （60 cases） and a medication group （60 cases） randomly. In electroacupuncture group disperse-dense wave in frequency of 2 Hz/100 Hz was adopted at Chengshan （承山 BL 57）, the first treatment was given within 30 min after the operation, from the second day on electroacupuncture treatment was applied once a day and each time after hip bath in the morning. While in medication group 2 tablets of Naproxen Sunstained Release Capsule were administered orally within 30 min after operation, later on 2 tablets were taken before dressing change in the day. After 4 times of treatment, evaluate the changed condition of Visual Analogue Scale （VAS） at 5 h, 24 h, 48 h and 72 b after operation. Results In electroacupuncture group all tested pain scores at 5 h, 24 h, 48 h and 72 h after operation （6.78±2.12, 5.56±1.87, 4.34±2.23 and 3.15±2.11） were lower than those in the medication group （7.56±2.01, 6.23±1.15, 5.57±2.21 and 4.34±2.12）, and the difference was statistically significant （all P〈0.05）. Conclusion Electroacupuncture at Chengshan （承山 BL 57） can reduce the postoperative oain of mixed hemorrhoids.展开更多
AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in whic...AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer(GC)most frequently develops.The operative link for gas-tritis assessment(OLGA)staging system ranks the GC risk according to both the topography and the severity of gastric atrophy(as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosal biopsy).Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages Ⅲ-Ⅳ with a higher risk of GC.A recently-proposed modification of the OLGA staging system(OLGIM)basically incorporates the OLGA frame,but replaces the atrophy score with an assessment of intestinal metaplasia(IM)alone.A series of 4552 consecutive biopsy sets(2007-2009)was re-trieved and reassessed according to both the OLGA and the OLGIM staging systems.A set of at least 5 biopsy samples was available for all the cases considered.RESULTS:In 4460 of 4552 cases(98.0%),both the high-risk stages(Ⅲ + Ⅳ)and the low-risk stages(0 +Ⅰ + Ⅱ)were assessed applying the OLGA and OL-GIM criteria.Among the 243 OLGA high-risk stages,14(5.8%)were down-staged to a low risk using OLGIM.The 67(1.5%)incidentally-found neoplastic lesions(intraepithelial or invasive)were consistently associated with high-risk stages,as assessed by both OLGA and OLGIM(P < 0.001 for both).Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage(stage Ⅲ)were associated with a low-risk OLGIM stage(stage Ⅱ).CONCLUSION:Gastritis staging systems(both OLGA and OLGIM)convey prognostically important informa-tion on the gastritis-associated cancer risk.Because of its clinical impact,the stage of gastritis should be included as a conclusive message in the gastritis histol-ogy report.Since it focuses on IM alone,OLGIM staging is less sensitive than OLGA staging in the identif ication of patients at high risk of gastric cancer.展开更多
BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for...BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.展开更多
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa...AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.展开更多
AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed us...AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.展开更多
In relay-assisted cooperative communication,relay nodes help forwarding the information of a source node in case of link failure between the source and a destination.Although user cooperation improves the overall effi...In relay-assisted cooperative communication,relay nodes help forwarding the information of a source node in case of link failure between the source and a destination.Although user cooperation improves the overall efficiency of the network,it requires incentive to stimulate potential relay nodes to assist the source by forwarding its data to the destination.Moreover,the potential relays are better informed than the source about their channel conditions to destination,which results in asymmetric information between the source and the relays.In this paper,we study the problem of lack of forwarding incentive in cooperative communication when channel state information of relays is private information and not known by the source.To tackle this problem,we apply the principle of contract theory to a cooperative wireless system.Source first designs incentive compatible and individually rational contract,consisting of a set of power-credit pairs.Then it broadcasts contract items to nearby nodes.Once the source node receives reply messages from the volunteer relays,it chooses one or more relays based on its requirements and communication starts.Simulation results show how credit assignment works in order to stimulate relays to cooperate and prevents relays from cheating behavior.展开更多
In order to improve network connectivity in clustered wireless sensor networks,a node cooperative algorithm based on virtual antenna arrays is proposed.All the nodes in the network are assumed to be clustered via Pois...In order to improve network connectivity in clustered wireless sensor networks,a node cooperative algorithm based on virtual antenna arrays is proposed.All the nodes in the network are assumed to be clustered via Poisson Voronoi tessellation（PVT）.The activation of the node cooperative algorithm is determined by the cluster heads（CHs） according to communication links.When the cooperative algorithm is activated,the CH selects cooperative nodes（CNs） from its members to form a virtual antenna array.With the cooperation,nodes can extend the inter-cluster communication range to directly contact with further nodes after a coverage hole is detected,or compensate for channel gains while inter-cluster transmission fails due to deep channel fading.Simulation results show that the proposed algorithm achieves better network connectivity and energy efficiency.It can reduce outage probability,sustain network connectivity and maintain operations as long as possible,which prolongs network operation time.展开更多
BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of ...BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.展开更多
BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controll...BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.展开更多
In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its inci...In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its incidence and related post-operative complications.PONV is highly prevalent among patients undergoing bariatric surgery,yet there are relatively few related studies.Currently,the main-stream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.Despite the effectiveness of surgery in helping patients lose weight,postoperative PONV may occur,potentially leading to various complications(such as aspiration and wound dehiscence).A retro-spective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV,providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient’s postoperative experience.展开更多
AIM: To investigate the accuracy of preoperative examinations in follicular type tumors, we re-evaluate results of our operative cases.METHODS: Cases are follicular neoplasms in 36 patients, which are more than 30 mm ...AIM: To investigate the accuracy of preoperative examinations in follicular type tumors, we re-evaluate results of our operative cases.METHODS: Cases are follicular neoplasms in 36 patients, which are more than 30 mm in diameter and underwent surgery in our hospital in 2005-2006. These cases had been suspected of malignancy on one or more of the preoperative examinations, including ultrasound(US), thallium-technecium(Tl-Tc) scinitigram,computed tomography(CT), or fine needle aspiration biopsy(FNA) examinations. Concern about operative procedure, lobectomy plus sentinel lymph node biopsy(SNB) was performed in all 36 follicular tumors at the first surgery. Because we can diagnose a suspected follicular tumor as carcinoma and can change the operative procedure intra-operatively, when the metastasis of lymph nodes, outside of the thyroid, is found. The operative procedure was changed from lobectomy to total thyroidectomy plus lymph nodes dissection(centralcomponent), when the SNB has metastasis. All thirty six cases were obtained to track the prognosis until 2012, for 6-7 years follow up periods.RESULTS: The final pathological results are 3 cases of follicular carcinoma, 6 cases of papillary carcinoma, 1 case of papillary carcinoma follicular type, 1 case of malignant lymphoma, 16 cases of follicular adenoma, and 9 cases of adenomatous goiter. The malignant tumor were observed in 11/36(30.6%) cases. All six papillary carcinomas were less than 20 mm, and present with follicular adenoma and adenomatous goiter, which have more than 40 mm diameter. In physical examination, tumor size of 36 cases of follicular neoplasm is more than 30 mm all at the time of surgery. The tumors were palpable somewhat stiff, such as no cystic component in 34 cases. Occasional dyspnea, dysphagia, and cough was accompanied in all 36 cases. The true ratio of correct diagnosis of preoperative US, Tl-Tc scinitigram, CT, and FNA were 17/36(47.2%), 16/36(44.4%), 24/36(66.7%), 21/36(58.3%), respectively. In 11 malignant cases, there was one SNB positive case(one lymph node metastasis in 3 SNB: 1/3). This case was changed the operative procedure from lobectomy to total thyroidectomy plus lymph node dissection(central component). There is other lymph nodes metastasis in dissected lymph nodes(4/15). For the remaining malignant 10 cases, the observations were selected without additional resection, because surgical margins and SN were negative in postoperative pathology results at the first operation. No recurrence and metastasis are allowed in 11 malignant cases, up to 7 years after post-operation. Over all, the more than 30 mm in diameter follicular neoplasms, which were suspected the malignancy in the one and more preoperative examinations, are present the malignancy by pathological diagnosis in 11/36(30.6%) cases after surgery. The non SNB metastasis cases had no symptoms of lymph nodes metastasis up to 7 years after post-operation.CONCLUSION: We think that more than 30 mm in diameter follicular neoplasms are considered as candidates of surgery from our results.展开更多
文摘BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary total knee replacement(TKR)OP-Rs has never been reported.Therefore,a standardized benchmark for assessment and factors affecting the completeness of TKR OP-Rs needs to be evaluated.AIM To evaluate the completeness rate of primary TKR OP-Rs in a teaching hospital and to assess the factors affecting completeness.METHODS A retrospective review of 58 consecutive primary TKR OP-Rs in a tertiary te-aching hospital were included in this study.We used document analysis to review the OP-Rs against a standardized list of six subsets of mandatory variables.The correlation between the percentage of completeness and the specific variables was determined.RESULTS After analyzing 58 cases,we found that the time to documentation was 1.5 hours.Out of the 52 mandatory variables,a median of 30 variables were documented yielding a completeness of 58%.Administrative,procedural,exposure,and im-plant variables were documented the most often,whereas clinical and process variables were most frequently left uncompleted.The documentation of the operative maneuver was variable.There was no association between the com-pleteness of the reports and the time to documentation,documenter level,com-plication rate,operative duration,or length of hospital stay.CONCLUSION Multiple variables were left undocumented on the unstructured primary TKR OP-Rs.The completeness percentage will likely improve after the implementation of a standardized structured OP-R.
基金supported by the National Natural Science Foundation of China(No.62173274)the National Key R&D Program of China(No.2019YFA0405300)+4 种基金the Natural Science Foundation of Hunan Province of China(Nos.2021JJ10045 and 2025JJ60072)the Open Research Subject of State Key Laboratory of Intelligent Game(No.ZBKF-24-01)the Postdoctoral Fellowship Program of CPSF(No.GZB20240989)the China Postdoctoral Science Foundation(No.2024M754304)the Aeronautical Science Foundation of China(No.2023Z005030001).
文摘Cooperative guidance is a method for achieving combat objectives through information sharing and cooperative effects,and has emerged as a significant research area in the fields of missile guidance and systematic warfare.This study presents a systematic review and analysis of current research on cooperative guidance.First,a bibliometric analysis is conducted on 513 articles using the Scopus database and CiteSpace software to assess keyword clustering,keyword cooccurrence,and keyword burst,and to later visualize the results.Second,fundamental theories of cooperative guidance,including relative motion modeling methods,algebraic graph theory,and multi-agent consensus theory,are summarized.Subsequently,an overview of current cooperative laws and corresponding analysis methods is provided,with categorization based on the cooperative structure and convergence performance.Finally,we summarize current research developments based on five perspectives and propose a developmental framework based on five layers(cyber,physical,decision,information,and system),discussing potential future advancements in cooperative terminal guidance.This framework emphasizes five key areas of research:networked,heterogeneous,integrated,intelligent,and group cooperations,with the goal of offering trends and insights for futurework.
文摘Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.
文摘A case of surgical nursing cooperation during extracorporeal membrane oxygenation(ECMO)-assisted hybrid sleeve left pneumonectomy,which included a right open carinal resection,tracheal bronchial anastomosis,and thoracoscopic left pneumonectomy,has been documented.A thorough nursing intervention focused on patient safety and proactive measures to address potential complications was implemented throughout the surgical process.The procedure was completed without incident,and no postoperative complications were reported.
基金General Project of Philosophy and Social Sciences Research in Universities of Jiangsu Province,2024(2024SJYB1650).
文摘Under the background of"Digital Commerce for Rural Vitalization",rural E-commerce has experienced rapid development.However,agricultural products like strawberries,often produced by small-scale,fragmented,and less competitive individual farmers,struggle to meet the compliance and scalability demands of E-commerce,thereby constraining high-quality local economic development.Aiming to address this issue,this paper,guided by relevant policies and strategies,employs case analysis and logical deduction to explore the industrialization path of the"Cooperative+E-commerce"model for the strawberry industry.The research finds that by optimizing the cooperative's organizational structure,implementing multi-channel E-commerce strategies,upgrading the supply chain(including cold chain and quality traceability),and engaging in collaborative brand building,a robust industrial system can be formed.Supplemented by benefit evaluation,policy support,and regulatory oversight,this system can effectively bridge small-scale production with the broader market.This study concludes that this pathway can enhance the added value of the strawberry industry,increase farmer incomes,and provide practical insights for promoting high-quality local economic development.
基金supported in part by the National Natural Science Foundation of China(Grant Nos.62203246 and 62003127)Shandong Provincial Natural Science Foundation(Grant No.ZR2024QF041)the Natural Science Foundation of Hebei Province(Grant No.F2023202060)。
文摘Virtual coupling is a novel technology that enables trains to run closely together without physical connections through communication and automation systems.The paper addresses an adaptive polynomial approximation algorithm for the cooperative control of high-speed trains(HSTs)under virtual coupling.It aims to solve the cooperative tracking control problem of HST formation operations under various scenarios,including known and unknown parameters.To enable the HST formation system to achieve cooperative operation while ensuring an appropriate spacing distance,the tracking errors of displacement and speed throughout the entire operation converge to zero.The proposed control strategy focuses on adopting polynomial approximation to handle unknown parameters,which are estimated via adaptive laws.Additionally,the unknown parameters of the HSTs are estimated online through adaptive laws.Experimental results verify the effectiveness of this method.
基金supported in part by the Advanced Equipment Manufacturing Technology Innovation Project of Hebei Province under Grant No.22311801D,23311807D,and 236Z1816Gin part by the National Natural Science Foundation of China under Grant No.U20A20283.
文摘In this paper,a novel cooperative collision avoidance control strategy with relative velocity information for redundant robotic manipulators is derived to guarantee the behavioral safety of robots in the cooperative operational task.This strategy can generate the collision-free trajectory of the robotic links in real-time,which is to realize that the robot can avoid moving obstacles less conservatively and ensure tracking accuracy of terminal end-effector tasks in performing cooperative tasks.For the case where there is interference between the moving obstacle and the desired path of the robotic end-effector,the method inherits the null-space-based self-motion characteristics of the redundant manipulator,integrates the relative motion information,and uses the improved artificial potential field method to design the control items,which are used to generate the collision avoidance motion and carry out moving obstacles smoothly and less conservatively.At the same time,the strategy maintains the kinematic constraint relationship of dual-arm cooperatives,to meet the real-time collision avoidance task under collaborative tasks.Finally,the algorithm simulation indicates that the method can better ensure the tracking accuracy of the end-effector task and carry out moving obstacles smoothly.The experimental results show that the method can generate the real-time collision-free trajectory of the robot in the cooperative handling task,and the joint movement is continuous and stable.
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
文摘Objective: To investigate the operative timing and indi-cations for severe acute pancreatitis(SAP).Methods: Data collected from 172 patients with SAPtreated in our hospital since 1980 were analyzed retro-spectively.Results: In the 94 patients who had undergone early op-eration before June 1992, 57 (62.8%) healed, 35 (37.2%)died, and 16 (17.0%) had no postoperative compli-cations. In the 78 patients who had been treated after July1992 according to the principle of individualization, 66(84.6%) healed, 12 (15.4%) died, and 37 (47.4%)had no postoperative complications. In the 78 patients32 received non-operative treatment but 30 (93.8%)cured, 12 early operation but 7(58.3%)cured, 18 lateoperation but 13 (72.2%) cured, and 16 selected timeoperation but all cured.Conclusions: It is concluded that individualized thera-py is effective and reasonable for treating SAP. Theindications for early, late and selected time operationshould be emphasized.
文摘ABSTRACT Objective To discuss the effect of electroacupuncture at Chengshan （承山 BL 57） on postoperative pain of mixed hemorrhoids. Methods One hundred and twenty cases with postoperative pain of mixed hemorrhoids were divided into an electroacupuncture group （60 cases） and a medication group （60 cases） randomly. In electroacupuncture group disperse-dense wave in frequency of 2 Hz/100 Hz was adopted at Chengshan （承山 BL 57）, the first treatment was given within 30 min after the operation, from the second day on electroacupuncture treatment was applied once a day and each time after hip bath in the morning. While in medication group 2 tablets of Naproxen Sunstained Release Capsule were administered orally within 30 min after operation, later on 2 tablets were taken before dressing change in the day. After 4 times of treatment, evaluate the changed condition of Visual Analogue Scale （VAS） at 5 h, 24 h, 48 h and 72 b after operation. Results In electroacupuncture group all tested pain scores at 5 h, 24 h, 48 h and 72 h after operation （6.78±2.12, 5.56±1.87, 4.34±2.23 and 3.15±2.11） were lower than those in the medication group （7.56±2.01, 6.23±1.15, 5.57±2.21 and 4.34±2.12）, and the difference was statistically significant （all P〈0.05）. Conclusion Electroacupuncture at Chengshan （承山 BL 57） can reduce the postoperative oain of mixed hemorrhoids.
基金Supported by An AIRC grant from the Veneto Regional Authorities,2009the"Guido Berlucchi"Foundation+1 种基金the"Morgagni"Association for Oncological Research (PadovaPD)
文摘AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer(GC)most frequently develops.The operative link for gas-tritis assessment(OLGA)staging system ranks the GC risk according to both the topography and the severity of gastric atrophy(as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosal biopsy).Both cross-sectional and long-term follow-up trials have consistently associated OLGA stages Ⅲ-Ⅳ with a higher risk of GC.A recently-proposed modification of the OLGA staging system(OLGIM)basically incorporates the OLGA frame,but replaces the atrophy score with an assessment of intestinal metaplasia(IM)alone.A series of 4552 consecutive biopsy sets(2007-2009)was re-trieved and reassessed according to both the OLGA and the OLGIM staging systems.A set of at least 5 biopsy samples was available for all the cases considered.RESULTS:In 4460 of 4552 cases(98.0%),both the high-risk stages(Ⅲ + Ⅳ)and the low-risk stages(0 +Ⅰ + Ⅱ)were assessed applying the OLGA and OL-GIM criteria.Among the 243 OLGA high-risk stages,14(5.8%)were down-staged to a low risk using OLGIM.The 67(1.5%)incidentally-found neoplastic lesions(intraepithelial or invasive)were consistently associated with high-risk stages,as assessed by both OLGA and OLGIM(P < 0.001 for both).Two of 34 intestinal-type GCs coexisting with a high-risk OLGA stage(stage Ⅲ)were associated with a low-risk OLGIM stage(stage Ⅱ).CONCLUSION:Gastritis staging systems(both OLGA and OLGIM)convey prognostically important informa-tion on the gastritis-associated cancer risk.Because of its clinical impact,the stage of gastritis should be included as a conclusive message in the gastritis histol-ogy report.Since it focuses on IM alone,OLGIM staging is less sensitive than OLGA staging in the identif ication of patients at high risk of gastric cancer.
文摘BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.
文摘AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
基金Supported by In part by a Canada Research Chair to Dr.Bhandariin part by the Canadian Institutes of Health Research and Vancouver Coastal Health Research Institute to Dr.Slobogean
文摘AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.
文摘In relay-assisted cooperative communication,relay nodes help forwarding the information of a source node in case of link failure between the source and a destination.Although user cooperation improves the overall efficiency of the network,it requires incentive to stimulate potential relay nodes to assist the source by forwarding its data to the destination.Moreover,the potential relays are better informed than the source about their channel conditions to destination,which results in asymmetric information between the source and the relays.In this paper,we study the problem of lack of forwarding incentive in cooperative communication when channel state information of relays is private information and not known by the source.To tackle this problem,we apply the principle of contract theory to a cooperative wireless system.Source first designs incentive compatible and individually rational contract,consisting of a set of power-credit pairs.Then it broadcasts contract items to nearby nodes.Once the source node receives reply messages from the volunteer relays,it chooses one or more relays based on its requirements and communication starts.Simulation results show how credit assignment works in order to stimulate relays to cooperate and prevents relays from cheating behavior.
基金The National Natural Science Foundation of China ( No.60872004, 60972026)the Important National Science and Technology Specific Projects (No. 2010ZX03006-002-01)the Research Fund of the National Mobile Communications Research Laboratory of Southeast University (No.2010A08)
文摘In order to improve network connectivity in clustered wireless sensor networks,a node cooperative algorithm based on virtual antenna arrays is proposed.All the nodes in the network are assumed to be clustered via Poisson Voronoi tessellation（PVT）.The activation of the node cooperative algorithm is determined by the cluster heads（CHs） according to communication links.When the cooperative algorithm is activated,the CH selects cooperative nodes（CNs） from its members to form a virtual antenna array.With the cooperation,nodes can extend the inter-cluster communication range to directly contact with further nodes after a coverage hole is detected,or compensate for channel gains while inter-cluster transmission fails due to deep channel fading.Simulation results show that the proposed algorithm achieves better network connectivity and energy efficiency.It can reduce outage probability,sustain network connectivity and maintain operations as long as possible,which prolongs network operation time.
文摘BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.
文摘BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.
文摘In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its incidence and related post-operative complications.PONV is highly prevalent among patients undergoing bariatric surgery,yet there are relatively few related studies.Currently,the main-stream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.Despite the effectiveness of surgery in helping patients lose weight,postoperative PONV may occur,potentially leading to various complications(such as aspiration and wound dehiscence).A retro-spective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV,providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient’s postoperative experience.
文摘AIM: To investigate the accuracy of preoperative examinations in follicular type tumors, we re-evaluate results of our operative cases.METHODS: Cases are follicular neoplasms in 36 patients, which are more than 30 mm in diameter and underwent surgery in our hospital in 2005-2006. These cases had been suspected of malignancy on one or more of the preoperative examinations, including ultrasound(US), thallium-technecium(Tl-Tc) scinitigram,computed tomography(CT), or fine needle aspiration biopsy(FNA) examinations. Concern about operative procedure, lobectomy plus sentinel lymph node biopsy(SNB) was performed in all 36 follicular tumors at the first surgery. Because we can diagnose a suspected follicular tumor as carcinoma and can change the operative procedure intra-operatively, when the metastasis of lymph nodes, outside of the thyroid, is found. The operative procedure was changed from lobectomy to total thyroidectomy plus lymph nodes dissection(centralcomponent), when the SNB has metastasis. All thirty six cases were obtained to track the prognosis until 2012, for 6-7 years follow up periods.RESULTS: The final pathological results are 3 cases of follicular carcinoma, 6 cases of papillary carcinoma, 1 case of papillary carcinoma follicular type, 1 case of malignant lymphoma, 16 cases of follicular adenoma, and 9 cases of adenomatous goiter. The malignant tumor were observed in 11/36(30.6%) cases. All six papillary carcinomas were less than 20 mm, and present with follicular adenoma and adenomatous goiter, which have more than 40 mm diameter. In physical examination, tumor size of 36 cases of follicular neoplasm is more than 30 mm all at the time of surgery. The tumors were palpable somewhat stiff, such as no cystic component in 34 cases. Occasional dyspnea, dysphagia, and cough was accompanied in all 36 cases. The true ratio of correct diagnosis of preoperative US, Tl-Tc scinitigram, CT, and FNA were 17/36(47.2%), 16/36(44.4%), 24/36(66.7%), 21/36(58.3%), respectively. In 11 malignant cases, there was one SNB positive case(one lymph node metastasis in 3 SNB: 1/3). This case was changed the operative procedure from lobectomy to total thyroidectomy plus lymph node dissection(central component). There is other lymph nodes metastasis in dissected lymph nodes(4/15). For the remaining malignant 10 cases, the observations were selected without additional resection, because surgical margins and SN were negative in postoperative pathology results at the first operation. No recurrence and metastasis are allowed in 11 malignant cases, up to 7 years after post-operation. Over all, the more than 30 mm in diameter follicular neoplasms, which were suspected the malignancy in the one and more preoperative examinations, are present the malignancy by pathological diagnosis in 11/36(30.6%) cases after surgery. The non SNB metastasis cases had no symptoms of lymph nodes metastasis up to 7 years after post-operation.CONCLUSION: We think that more than 30 mm in diameter follicular neoplasms are considered as candidates of surgery from our results.
