BACKGROUND Congenital short bowel syndrome(SBS)associated with malrotation,gut volvulus and jejuno-ileal atresia is a very rare condition.It is a severe challenge for surgeons to preserve residual ischemic bowel segme...BACKGROUND Congenital short bowel syndrome(SBS)associated with malrotation,gut volvulus and jejuno-ileal atresia is a very rare condition.It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.CASE SUMMARY We report a newborn baby with gut malrotation associated with jejuno-ileal atresia,congenital SBS and jejunal volvulus.Hematemesis and abdominal distention were noted.At laparotomy,malrotation associated with jejuno-ileal atresia,congenital SBS and jenunal volvulus was confirmed.The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm,including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment.The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter.Ladd’s procedure,necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed.The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure.Three months later,to restore the continuity of the isolated gut segment,end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed.The entire functional small bowel length increased to 80 cm.Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively.Twelve months later,her body weight was 9.5 kg.CONCLUSION Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.展开更多
AIM:To determine whether magnified observation of short-segment Barrett’s esophagus(BE)is useful for the detection of specialized intestinal metaplasia(SIM).METHODS:Thirty patients with suspected short-segment BE und...AIM:To determine whether magnified observation of short-segment Barrett’s esophagus(BE)is useful for the detection of specialized intestinal metaplasia(SIM).METHODS:Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to×80.The magnified images were analyzed with respect to their pit-patterns,which were simultaneously classified into five epithelial types[Ⅰ(small round),Ⅱ(straight),Ⅲ(long oval),Ⅳ(tubular),Ⅴ(villous)]by Endo’s classification.Then,a 0.5%solution of methylene blue(MB)was sprayed over columnar mucosa.The patterns of the magnified image and MB staining were analyzed.Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy.RESULTS:Three of five patients with a typeⅤ(villous)epithelial pattern had SIM,whereas 21 patients with a non-typeⅤepithelial patterns did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of pit-patterns in detecting SIM were 100%,91.3%,92.3%,60%and100%,respectively(P=0.004).Three of the 12 patients with positive MB staining had SIM,whereas 14patients with negative MB staining did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MB staining in detecting SIM were 100%,60.9%,65.4%,25%and100%,respectively(P=0.085).The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar’s test(P=0.0391).CONCLUSION:The magnified observation of a shortsegment BE according to the mucosal pattern and its classification can be predictive of SIM.展开更多
The size and shape of the effective test area are crucial to consider when short-crested waves are created by segmented wavemakers. The range of the effective test area of short-crested waves simulated by two-sided se...The size and shape of the effective test area are crucial to consider when short-crested waves are created by segmented wavemakers. The range of the effective test area of short-crested waves simulated by two-sided segmented wavemakers is analyzed in this paper. The experimental investigation on the wave field distribution of short-crested waves generated by two-sided segmented wavemakers is conducted by using an array of wave gauges. Wave spectra and directional spreading function are analyzed and the results show that when the main direction is at a certain angle with the normal line of wave generators, the wave field of 3D short-crested waves generated by two-sided segmented wavemakers has good spatial uniformity within the model test area. The effective test area can provide good wave environments for seakeeping model tests of various ocean engineering structures in the deep ocean engineering basin.展开更多
目的:探讨血清白蛋白/肌酐比值(serum albumin to creatinine ratio,ACR)对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者PCI术后短期临床结局的预测价值。方法:回顾性队列研究纳入2020年1月至2024年6月...目的:探讨血清白蛋白/肌酐比值(serum albumin to creatinine ratio,ACR)对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者PCI术后短期临床结局的预测价值。方法:回顾性队列研究纳入2020年1月至2024年6月间在安徽医科大学第二附属医院接受PCI治疗的892例STEMI患者,按ACR四分位数分为4组。主要终点为30d全因死亡率,次要终点包括对比剂肾病、支架血栓形成、充血性心力衰竭及复发性心肌梗死。采用Logistic回归分析评估ACR与临床结局的关联,并绘制受试者工作特征(ROC)曲线评估ACR的预测价值。进行多种因素的亚组分析以验证结果稳健性。结果:多因素分析结果显示,ACR与STEMI患者30d全因死亡率呈显著负相关(OR=0.60,95%CI:0.45~0.81,P<0.001),表现为明显的剂量-反应关系(P趋势<0.001)。较高ACR还与对比剂肾病(OR=0.71,95%CI:0.60~0.85,P<0.001)和充血性心力衰竭(OR=0.72,95%CI:0.60~0.86,P<0.001)风险降低相关。ROC曲线分析表明,ACR(AUC=0.744)在预测30d全因死亡率方面优于单独的血清肌酐(AUC=0.643)或白蛋白(AUC=0.615)。亚组分析显示,合并高血压患者中ACR与死亡率关联更为显著(交互P=0.007)。结论:较高的ACR与STEMI患者PCI后30d全因死亡率、对比剂肾病及充血性心力衰竭风险降低显著相关,可作为评估STEMI患者短期预后的有效预测工具。展开更多
文摘BACKGROUND Congenital short bowel syndrome(SBS)associated with malrotation,gut volvulus and jejuno-ileal atresia is a very rare condition.It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.CASE SUMMARY We report a newborn baby with gut malrotation associated with jejuno-ileal atresia,congenital SBS and jejunal volvulus.Hematemesis and abdominal distention were noted.At laparotomy,malrotation associated with jejuno-ileal atresia,congenital SBS and jenunal volvulus was confirmed.The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm,including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment.The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter.Ladd’s procedure,necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed.The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure.Three months later,to restore the continuity of the isolated gut segment,end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed.The entire functional small bowel length increased to 80 cm.Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively.Twelve months later,her body weight was 9.5 kg.CONCLUSION Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.
文摘AIM:To determine whether magnified observation of short-segment Barrett’s esophagus(BE)is useful for the detection of specialized intestinal metaplasia(SIM).METHODS:Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to×80.The magnified images were analyzed with respect to their pit-patterns,which were simultaneously classified into five epithelial types[Ⅰ(small round),Ⅱ(straight),Ⅲ(long oval),Ⅳ(tubular),Ⅴ(villous)]by Endo’s classification.Then,a 0.5%solution of methylene blue(MB)was sprayed over columnar mucosa.The patterns of the magnified image and MB staining were analyzed.Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy.RESULTS:Three of five patients with a typeⅤ(villous)epithelial pattern had SIM,whereas 21 patients with a non-typeⅤepithelial patterns did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of pit-patterns in detecting SIM were 100%,91.3%,92.3%,60%and100%,respectively(P=0.004).Three of the 12 patients with positive MB staining had SIM,whereas 14patients with negative MB staining did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MB staining in detecting SIM were 100%,60.9%,65.4%,25%and100%,respectively(P=0.085).The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar’s test(P=0.0391).CONCLUSION:The magnified observation of a shortsegment BE according to the mucosal pattern and its classification can be predictive of SIM.
基金financially supported by the National Natural Science Foundation of China(Grant No.51239007)
文摘The size and shape of the effective test area are crucial to consider when short-crested waves are created by segmented wavemakers. The range of the effective test area of short-crested waves simulated by two-sided segmented wavemakers is analyzed in this paper. The experimental investigation on the wave field distribution of short-crested waves generated by two-sided segmented wavemakers is conducted by using an array of wave gauges. Wave spectra and directional spreading function are analyzed and the results show that when the main direction is at a certain angle with the normal line of wave generators, the wave field of 3D short-crested waves generated by two-sided segmented wavemakers has good spatial uniformity within the model test area. The effective test area can provide good wave environments for seakeeping model tests of various ocean engineering structures in the deep ocean engineering basin.
文摘目的:探讨血清白蛋白/肌酐比值(serum albumin to creatinine ratio,ACR)对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者PCI术后短期临床结局的预测价值。方法:回顾性队列研究纳入2020年1月至2024年6月间在安徽医科大学第二附属医院接受PCI治疗的892例STEMI患者,按ACR四分位数分为4组。主要终点为30d全因死亡率,次要终点包括对比剂肾病、支架血栓形成、充血性心力衰竭及复发性心肌梗死。采用Logistic回归分析评估ACR与临床结局的关联,并绘制受试者工作特征(ROC)曲线评估ACR的预测价值。进行多种因素的亚组分析以验证结果稳健性。结果:多因素分析结果显示,ACR与STEMI患者30d全因死亡率呈显著负相关(OR=0.60,95%CI:0.45~0.81,P<0.001),表现为明显的剂量-反应关系(P趋势<0.001)。较高ACR还与对比剂肾病(OR=0.71,95%CI:0.60~0.85,P<0.001)和充血性心力衰竭(OR=0.72,95%CI:0.60~0.86,P<0.001)风险降低相关。ROC曲线分析表明,ACR(AUC=0.744)在预测30d全因死亡率方面优于单独的血清肌酐(AUC=0.643)或白蛋白(AUC=0.615)。亚组分析显示,合并高血压患者中ACR与死亡率关联更为显著(交互P=0.007)。结论:较高的ACR与STEMI患者PCI后30d全因死亡率、对比剂肾病及充血性心力衰竭风险降低显著相关,可作为评估STEMI患者短期预后的有效预测工具。
