Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that ...Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that acting on deck.There was not any detailed prescript in Chinese code for calculation of longitudinal wind load on cables due to lack of theoretical research and experiment,and conservative simplified calculation was adopted during design,which leads to conservative and uneconomical design of structures.To resolve this problem,cable force experiment was carried out during the design of Sutong Bridge.By comparing with international research results,the calculation formula of longitudinal wind drag coefficient for cables was advanced to fill the blank of bridge wind resistant code of China,and has already been adopted in the Highway Bridge Wind Resistant Design Code(JTG/T D60-01-2004)with great significance for bridge engineering.展开更多
This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use...This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use of inclined cables;however,the international standards for bridge design stipulate different safety factors for stay cables of both types of bridges.To address this misconception,a comparative study was carried out on the safety factors of stay cables under fatigue and ultimate limit states by considering the effects of various untoward and damaging factors,such as overloading,cable loss,and corrosion.The primary goal of this study is to describe the structural disparities between both types of bridges and evaluate their structural redundancies by employing deterministic and nondeterministic methods.To achieve this goal,three-dimensional finite-element models of both bridges were developed based on the current design guidelines for stay cables in Japan.After the balanced states of the bridge models were achieved,static analyses were performed for different safety factors of stay cables in a parametric manner.Finally,the first-order reliability method and Monte Carlo method were applied to determine the reliability index of stay cables.The analysis results show that cable-stayed and extradosed bridges exhibit different structural redundancies for different safety factors under the same loading conditions.Moreover,a significant increase in structural redundancy occurs with an incremental increase in the safety factors of stay cables.展开更多
This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the...This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.展开更多
KICT (Korea Institute of Construction Technology) is conducting a project called “SUPER BRIDGE 200—Development of Low Cost and Long Life Hybrid Cable Stayed Bridge”. This project aims to reduce the construction and...KICT (Korea Institute of Construction Technology) is conducting a project called “SUPER BRIDGE 200—Development of Low Cost and Long Life Hybrid Cable Stayed Bridge”. This project aims to reduce the construction and main- tenance costs of long-span bridges by 20% and double their lifetime through the exploitation of ultra-high performance concrete (UHPC). This paper presents the design and construction of the first pedestrian cable stayed bridge using UHPC developed by KICT. UHPC, compared to conventional concrete, has not only high compressive and tensile strengths but also high ductility. The UHPC developed at KICT is a steel fiber-reinforced cement compound presenting design compressive strength larger than 180 MPa and design tensile strength exceeding 10 MPa with water-to-binder ratio below 0.24 and admixing of 2 volume percentage of steel fiber. To show the applicability of UHPC to structures, a pedestrian cable stayed bridge (Super Bridge I) exploiting the characteristics of the developed UHPC has been planned, designed and erected at KICT. The dimension of UHPC deck is 2.7 m × 7 m as a precast segment with a typical thickness of deck of only 7 cm. However, harmful crack was observed in the deck at the time of the fabrication of the deck segments. Accordingly, new fabrication method was conceived and applied to prevent cracking of the UHPC slender deck. Four UHPC deck segments were fabricated successfully without any crack. After construction, the dynamic characteristics (natural frequencies and mode shapes) were evaluated through vibration tests since several users felt excess vibration. A vertical tuned mass damper (TMD) was proposed and installed on the parapet of the bridge. The TMD reduces the acceleration by about 30% from 0.0316 g to 0.0244 g when two pedestrians are crossing the bridge.展开更多
A simplified fragility analysis of fan type cable stayed bridges usingProbabilistic Risk Analysis (PRA) procedure is presented for determining their failure probabilityunder random ground motion. Seismic input to the ...A simplified fragility analysis of fan type cable stayed bridges usingProbabilistic Risk Analysis (PRA) procedure is presented for determining their failure probabilityunder random ground motion. Seismic input to the bridge support is considered to be a riskconsistent response spectrum which is obtained from a separate analysis. For the response analysis,the bridge deck is modeled as a beam supported on springs at different points. The stiffnesses ofthe springs are determined by a separate 2D static analysis of cable-tower-deck system. The analysisprovides a coupled stiffness matrix for the spring system. A continuum method of analysis usingdynamic stiffness is Used to determine the dynamic properties of the bridges .The response of thebridge deck is obtained by the response spectrum method of analysis as applied to multi-degree offreedom system which duly takes into account the quasi - static component of bridge deck vibration.The fragility analysis includes uncertainties arising due to the variation in ground motion,material property, modeling, method of analysis, ductility factor and damage concentration effect.Probability of failure of the bridge deck is determined by the First Order Second Moment (FOSM)method of reliability. A three span double plane symmetrical fan type cable stayed bridge of totalspan 689 m, is used as an illustrative example. The fragility curves for the bridge deck failure areobtained under a number of parametric variations. Some of the important conclusions of the studyindicate that (ⅰ) not only vertical component but also the horizontal component of ground motionhas considerable effect on the probability of failure; (ⅱ) ground motion with no time lag betweensupport excitations provides a smaller probability of failure as compared to ground motion with verylarge time lag between support excitation; and (ⅲ) probability of failure may considerablyincrease for soft soil condition.展开更多
Recently, research strives to apply Ultra High Performance Concrete (UHPC) to large-sized structures owing to its remarkable mechanical performance and durability compared to normal concrete. The Korea Institute of Co...Recently, research strives to apply Ultra High Performance Concrete (UHPC) to large-sized structures owing to its remarkable mechanical performance and durability compared to normal concrete. The Korea Institute of Construction Technology proposed SuperBridge800, an edge girder type UHPC cable stayed bridge with central span of 800 m, through its detailed design. The bridge is designed to be erected through the connection of precast UHPC segments. The precast UHPC segment is monolithically composed of one ribbed deck slab and edge girders at each side. The connection between the precast segments is achieved by steel bars at the edge girders and by UHPC cast-in-place wet joint at the slab. Despite of the outstanding mechanical performance of UHPC, the fabrication of large-sized members is a difficult task since UHPC hardens faster than normal concrete and requires a special curing process. Therefore, the constructability of large-sized UHPC segment should be secured to achieve SuperBridge800. Besides, the performance of the connection between segments should also be guaranteed, especially in terms of the fatigue performance of the UHPC cast-in-place joint, which constitutes a weak point. To that goal, two half-scaled UHPC segments are manufactured and the constructability is examined by fabricating a large-sized UHPC member connected with respect to the design conditions. This study conducts rolling fatigue test on the so-fabricated large-sized UHPC member. Rolling fatigue test is carried out up to 2 million cycles considering actual vehicle load at each center and quarter points of the member. The test results confirm that the service limit state is satisfied.展开更多
Optimum design of cable stayed bridges depends on number of parameters. Design of Cable stayed bridge satisfying all practical constraints is challenging to the designers. Considering the huge number of design variabl...Optimum design of cable stayed bridges depends on number of parameters. Design of Cable stayed bridge satisfying all practical constraints is challenging to the designers. Considering the huge number of design variables and practical constraints, Genetic Algorithms (GA) is most suitable for optimizing the cable stayed bridge. In the present work the optimum design is carried out by taking total material cost of bridge as objective function. During problem formulation most of the practical design variables and constraints are considered. Using genetic algorithms some parametric studies such as effect of geometric nonlinearity, effect of grouping of cables, effect of practical site constraints on tower height and side span, effect of bridge material, effect of cable layout, effect of extra-dosed bridges on optimum relative cost have been presented. Data base is prepared for new designers to estimate the relative cost of bridge.展开更多
A full scale model test is done and a FEM model is established to investigate the fatigue behavior of the Nancha cable stayed bridge of the Nanjing Second Yangtz River Bridge, a long span steel bridge with a main sp...A full scale model test is done and a FEM model is established to investigate the fatigue behavior of the Nancha cable stayed bridge of the Nanjing Second Yangtz River Bridge, a long span steel bridge with a main span of 628 m. The results of test and FEM are analyzed and compared. It is shown that they are in good agreement. It is verified that the fatigue characteristic of the anchorage structure of cable and girder of the bridge satisfies the requirements specified by Chinese, British and American codes.展开更多
Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long spa...Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long span hybrid girder cable stayed bridge are studied. After theoretical analysis, numerical evaluation and practical test, the loading assistant closure method is employed in Edong Yangtze River Bridge. The loading assistant closure method, with better thermal adaptability and less influence on bridge line and the forced status, can meet the requirements of the unstressed state control method. Based on the mentioned advantages, the loading assistant closure method is applicable to long span hybrid girder cable stayed bridges. The conclusion can provide a reference for the further design of the similar brid^es.展开更多
The main bridge of the North Branch Bridge of Qidu Bridge is a double-tower central cable-stayed bridge with composite beams with a main span of 360m m. The main tower is a circular single-column tower with a tower he...The main bridge of the North Branch Bridge of Qidu Bridge is a double-tower central cable-stayed bridge with composite beams with a main span of 360m m. The main tower is a circular single-column tower with a tower height of 118.6m m. Based on the site and the structural characteristics of the main tower, one tower crane is used as the vertical lifting equipment and one elevator is used as the personnel access, the lower tower column is constructed by turning over the formwork, and the middle and upper tower columns are constructed by hydraulic climbing formwork. The successful application of this construction technology provides reference and guidance for similar projects in the future.展开更多
Cable-stayed bridge is a kind of bridge under bending pressure and tension of supporting system. The main stressed component of this kind of bridge is stay cable, which plays a vital role in the whole bridge structure...Cable-stayed bridge is a kind of bridge under bending pressure and tension of supporting system. The main stressed component of this kind of bridge is stay cable, which plays a vital role in the whole bridge structure. Based on this, this paper takes the D1 cable-stayed bridge project of Malaysia Coastal Avenue as an example to deeply explore the construction technology of parallel steel cable stayed cables of long-span cable-stayed bridges, aiming at providing scientific construction technology support for the construction of cable-stayed bridges and ensuring the quality of bridge construction.展开更多
Taking the bending stiffness, static sag, and geometric non-linearity into consideration, the space nonlinear vibration partial differential equations were derived. The partical differential equations were discretized...Taking the bending stiffness, static sag, and geometric non-linearity into consideration, the space nonlinear vibration partial differential equations were derived. The partical differential equations were discretized in space by finite center difference approximation, then the nonlinear ordinal differential equations were obtained. A hybrid method involving the combination of the Newmark method and the pseudo-force strategy was proposed to analyze the nonlinear transient response of the inclined cable-dampers system subjected to arbitrary dynamic loading. As an example, two typical stay cables were calculated by the present method. The results reveal both the validity and the deficiency of the viscoelasticity damper for vibration control of stay cables. The efficiency and accuracy of the proposed method is also verified by comparing the results with those obtained by using Runge-Kutta direct integration technique. A new time history analysis method is provided for the research on the stay cable vibration control.展开更多
Numerical analyses of the coupled vibrations of vehicle-bridge system and the effects of different types of cable stayed bridges on the coupled vibration responses have been presented in this paper using ANSYS. The br...Numerical analyses of the coupled vibrations of vehicle-bridge system and the effects of different types of cable stayed bridges on the coupled vibration responses have been presented in this paper using ANSYS. The bridge model and vehicle model were independently built which have no internal relationship in the ANSYS. The vehicle-bridge coupled vibration relationship was obtained by using the APDL program which subsequently imposed on the vehicle and bridge models during the numerical analysis. The proposed model was validated through a field measurements and literature data. The judging method, possibility, and criterion of the vehicle-bridge resonance （coupled vibrations） of cable stayed bridges （both the floating system and half floating system） under traffic flows were presented. The results indicated that the interval time between vehicles is the main influence factor on the resonance excitation frequency under the condition of equally spaced traffic flows. Compared to other types of cable stayed bridges, the floating bridge system has relatively high possibility to cause vehicle-bridge resonance.展开更多
Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key...Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data co...BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.展开更多
BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle fact...BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.展开更多
BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensiv...BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.展开更多
基金National Science and Technology Support Program of China(No.2006BAG04B01)
文摘Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that acting on deck.There was not any detailed prescript in Chinese code for calculation of longitudinal wind load on cables due to lack of theoretical research and experiment,and conservative simplified calculation was adopted during design,which leads to conservative and uneconomical design of structures.To resolve this problem,cable force experiment was carried out during the design of Sutong Bridge.By comparing with international research results,the calculation formula of longitudinal wind drag coefficient for cables was advanced to fill the blank of bridge wind resistant code of China,and has already been adopted in the Highway Bridge Wind Resistant Design Code(JTG/T D60-01-2004)with great significance for bridge engineering.
文摘This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use of inclined cables;however,the international standards for bridge design stipulate different safety factors for stay cables of both types of bridges.To address this misconception,a comparative study was carried out on the safety factors of stay cables under fatigue and ultimate limit states by considering the effects of various untoward and damaging factors,such as overloading,cable loss,and corrosion.The primary goal of this study is to describe the structural disparities between both types of bridges and evaluate their structural redundancies by employing deterministic and nondeterministic methods.To achieve this goal,three-dimensional finite-element models of both bridges were developed based on the current design guidelines for stay cables in Japan.After the balanced states of the bridge models were achieved,static analyses were performed for different safety factors of stay cables in a parametric manner.Finally,the first-order reliability method and Monte Carlo method were applied to determine the reliability index of stay cables.The analysis results show that cable-stayed and extradosed bridges exhibit different structural redundancies for different safety factors under the same loading conditions.Moreover,a significant increase in structural redundancy occurs with an incremental increase in the safety factors of stay cables.
文摘This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.
文摘KICT (Korea Institute of Construction Technology) is conducting a project called “SUPER BRIDGE 200—Development of Low Cost and Long Life Hybrid Cable Stayed Bridge”. This project aims to reduce the construction and main- tenance costs of long-span bridges by 20% and double their lifetime through the exploitation of ultra-high performance concrete (UHPC). This paper presents the design and construction of the first pedestrian cable stayed bridge using UHPC developed by KICT. UHPC, compared to conventional concrete, has not only high compressive and tensile strengths but also high ductility. The UHPC developed at KICT is a steel fiber-reinforced cement compound presenting design compressive strength larger than 180 MPa and design tensile strength exceeding 10 MPa with water-to-binder ratio below 0.24 and admixing of 2 volume percentage of steel fiber. To show the applicability of UHPC to structures, a pedestrian cable stayed bridge (Super Bridge I) exploiting the characteristics of the developed UHPC has been planned, designed and erected at KICT. The dimension of UHPC deck is 2.7 m × 7 m as a precast segment with a typical thickness of deck of only 7 cm. However, harmful crack was observed in the deck at the time of the fabrication of the deck segments. Accordingly, new fabrication method was conceived and applied to prevent cracking of the UHPC slender deck. Four UHPC deck segments were fabricated successfully without any crack. After construction, the dynamic characteristics (natural frequencies and mode shapes) were evaluated through vibration tests since several users felt excess vibration. A vertical tuned mass damper (TMD) was proposed and installed on the parapet of the bridge. The TMD reduces the acceleration by about 30% from 0.0316 g to 0.0244 g when two pedestrians are crossing the bridge.
文摘A simplified fragility analysis of fan type cable stayed bridges usingProbabilistic Risk Analysis (PRA) procedure is presented for determining their failure probabilityunder random ground motion. Seismic input to the bridge support is considered to be a riskconsistent response spectrum which is obtained from a separate analysis. For the response analysis,the bridge deck is modeled as a beam supported on springs at different points. The stiffnesses ofthe springs are determined by a separate 2D static analysis of cable-tower-deck system. The analysisprovides a coupled stiffness matrix for the spring system. A continuum method of analysis usingdynamic stiffness is Used to determine the dynamic properties of the bridges .The response of thebridge deck is obtained by the response spectrum method of analysis as applied to multi-degree offreedom system which duly takes into account the quasi - static component of bridge deck vibration.The fragility analysis includes uncertainties arising due to the variation in ground motion,material property, modeling, method of analysis, ductility factor and damage concentration effect.Probability of failure of the bridge deck is determined by the First Order Second Moment (FOSM)method of reliability. A three span double plane symmetrical fan type cable stayed bridge of totalspan 689 m, is used as an illustrative example. The fragility curves for the bridge deck failure areobtained under a number of parametric variations. Some of the important conclusions of the studyindicate that (ⅰ) not only vertical component but also the horizontal component of ground motionhas considerable effect on the probability of failure; (ⅱ) ground motion with no time lag betweensupport excitations provides a smaller probability of failure as compared to ground motion with verylarge time lag between support excitation; and (ⅲ) probability of failure may considerablyincrease for soft soil condition.
文摘Recently, research strives to apply Ultra High Performance Concrete (UHPC) to large-sized structures owing to its remarkable mechanical performance and durability compared to normal concrete. The Korea Institute of Construction Technology proposed SuperBridge800, an edge girder type UHPC cable stayed bridge with central span of 800 m, through its detailed design. The bridge is designed to be erected through the connection of precast UHPC segments. The precast UHPC segment is monolithically composed of one ribbed deck slab and edge girders at each side. The connection between the precast segments is achieved by steel bars at the edge girders and by UHPC cast-in-place wet joint at the slab. Despite of the outstanding mechanical performance of UHPC, the fabrication of large-sized members is a difficult task since UHPC hardens faster than normal concrete and requires a special curing process. Therefore, the constructability of large-sized UHPC segment should be secured to achieve SuperBridge800. Besides, the performance of the connection between segments should also be guaranteed, especially in terms of the fatigue performance of the UHPC cast-in-place joint, which constitutes a weak point. To that goal, two half-scaled UHPC segments are manufactured and the constructability is examined by fabricating a large-sized UHPC member connected with respect to the design conditions. This study conducts rolling fatigue test on the so-fabricated large-sized UHPC member. Rolling fatigue test is carried out up to 2 million cycles considering actual vehicle load at each center and quarter points of the member. The test results confirm that the service limit state is satisfied.
文摘Optimum design of cable stayed bridges depends on number of parameters. Design of Cable stayed bridge satisfying all practical constraints is challenging to the designers. Considering the huge number of design variables and practical constraints, Genetic Algorithms (GA) is most suitable for optimizing the cable stayed bridge. In the present work the optimum design is carried out by taking total material cost of bridge as objective function. During problem formulation most of the practical design variables and constraints are considered. Using genetic algorithms some parametric studies such as effect of geometric nonlinearity, effect of grouping of cables, effect of practical site constraints on tower height and side span, effect of bridge material, effect of cable layout, effect of extra-dosed bridges on optimum relative cost have been presented. Data base is prepared for new designers to estimate the relative cost of bridge.
文摘A full scale model test is done and a FEM model is established to investigate the fatigue behavior of the Nancha cable stayed bridge of the Nanjing Second Yangtz River Bridge, a long span steel bridge with a main span of 628 m. The results of test and FEM are analyzed and compared. It is shown that they are in good agreement. It is verified that the fatigue characteristic of the anchorage structure of cable and girder of the bridge satisfies the requirements specified by Chinese, British and American codes.
文摘Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long span hybrid girder cable stayed bridge are studied. After theoretical analysis, numerical evaluation and practical test, the loading assistant closure method is employed in Edong Yangtze River Bridge. The loading assistant closure method, with better thermal adaptability and less influence on bridge line and the forced status, can meet the requirements of the unstressed state control method. Based on the mentioned advantages, the loading assistant closure method is applicable to long span hybrid girder cable stayed bridges. The conclusion can provide a reference for the further design of the similar brid^es.
文摘The main bridge of the North Branch Bridge of Qidu Bridge is a double-tower central cable-stayed bridge with composite beams with a main span of 360m m. The main tower is a circular single-column tower with a tower height of 118.6m m. Based on the site and the structural characteristics of the main tower, one tower crane is used as the vertical lifting equipment and one elevator is used as the personnel access, the lower tower column is constructed by turning over the formwork, and the middle and upper tower columns are constructed by hydraulic climbing formwork. The successful application of this construction technology provides reference and guidance for similar projects in the future.
文摘Cable-stayed bridge is a kind of bridge under bending pressure and tension of supporting system. The main stressed component of this kind of bridge is stay cable, which plays a vital role in the whole bridge structure. Based on this, this paper takes the D1 cable-stayed bridge project of Malaysia Coastal Avenue as an example to deeply explore the construction technology of parallel steel cable stayed cables of long-span cable-stayed bridges, aiming at providing scientific construction technology support for the construction of cable-stayed bridges and ensuring the quality of bridge construction.
文摘Taking the bending stiffness, static sag, and geometric non-linearity into consideration, the space nonlinear vibration partial differential equations were derived. The partical differential equations were discretized in space by finite center difference approximation, then the nonlinear ordinal differential equations were obtained. A hybrid method involving the combination of the Newmark method and the pseudo-force strategy was proposed to analyze the nonlinear transient response of the inclined cable-dampers system subjected to arbitrary dynamic loading. As an example, two typical stay cables were calculated by the present method. The results reveal both the validity and the deficiency of the viscoelasticity damper for vibration control of stay cables. The efficiency and accuracy of the proposed method is also verified by comparing the results with those obtained by using Runge-Kutta direct integration technique. A new time history analysis method is provided for the research on the stay cable vibration control.
文摘Numerical analyses of the coupled vibrations of vehicle-bridge system and the effects of different types of cable stayed bridges on the coupled vibration responses have been presented in this paper using ANSYS. The bridge model and vehicle model were independently built which have no internal relationship in the ANSYS. The vehicle-bridge coupled vibration relationship was obtained by using the APDL program which subsequently imposed on the vehicle and bridge models during the numerical analysis. The proposed model was validated through a field measurements and literature data. The judging method, possibility, and criterion of the vehicle-bridge resonance （coupled vibrations） of cable stayed bridges （both the floating system and half floating system） under traffic flows were presented. The results indicated that the interval time between vehicles is the main influence factor on the resonance excitation frequency under the condition of equally spaced traffic flows. Compared to other types of cable stayed bridges, the floating bridge system has relatively high possibility to cause vehicle-bridge resonance.
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
文摘Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
基金supported by the National Natural Science Foundation of China(82230074,81971809 and 82372159)the Liangshan Prefecture Science and Technology Plan Project(23ZDYF0180 and 24YYYJ0043).
文摘BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.
基金Supported by Shandong Province Biliary Pancreatic Cancer Clinical Quality Specialty Construction Fund,No.SLCZDZK-2401.
文摘BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.
