Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bl...Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.展开更多
AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was in...AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group remained higher than that in intermittent occlusion groups. Moreover, a 60% animal mortality rate and more severe morphological alterations were also shown in CO-60 group. CONCLUSION: Hepatic inflow occlusion during 60 minutes for liver resection in cirrhotic rats resulted in less hepatocellular injury when occlusion was intermittent rather than continuous. Each period of 15 minutes was the safe upper limit of repeated intermittent vascular occlusion that the cirrhotic liver could tolerate without undergoing irreversible hepatocellular injury.展开更多
There are two interaction mechanisms between shaped charge jet and thin flying plate driven by explosion, that is, the intermittent and continuous disturbance. Determination of the transition criteria for the intermit...There are two interaction mechanisms between shaped charge jet and thin flying plate driven by explosion, that is, the intermittent and continuous disturbance. Determination of the transition criteria for the intermittent and continuous disturbance is of importance for the penetration calculation of the escaping jet and the design of ERA(explosive reactive armour). In this paper a new criteria was presented based on the analysis of interaction process, and the effects of NATO angle and thickness of flying plate on the disturbance frequency were discussed. It is shown that the critical shaped charge jet velocity increases with the plate thickness and NATO angle, especially increases drastically between 45° and 60°.展开更多
Objective: to investigate the effect difference of intermittent and continuous treatment with Yinzhi Huang oral liquid in the treatment of neonatal jaundice (NNJ). Methods: a total of 200 children with NNJ from Januar...Objective: to investigate the effect difference of intermittent and continuous treatment with Yinzhi Huang oral liquid in the treatment of neonatal jaundice (NNJ). Methods: a total of 200 children with NNJ from January 2019 to December 2019 in our hospital were divided into two groups by odd-even method. The levels of bilirubin (BILirubin) before and after treatment, the outcome, the time of disease improvement and the incidence of phototherapy damage events in the two groups were compared. Results: there were significant differences in BILI level, outcome, improvement time and incidence of phototherapy damage events between the intermittent blue light treatment group and the continuous blue light treatment group (P < 0.05). Conclusion: in the aspect of blue light therapy for CHILDREN with NNJ, intermittent intervention can more significantly promote the decline of BILI level, accelerate the regression of yellow skin stain, accelerate the rehabilitation of children, and improve bilirubin level, which is worth promoting.展开更多
BACKGROUND Obstructive sleep apnea(OSA)has been suggested as an independent risk factor for nonalcoholic fatty liver disease(NAFLD),and continuous positive airway pressure(CPAP)is the first-line therapy for OSA.AIM To...BACKGROUND Obstructive sleep apnea(OSA)has been suggested as an independent risk factor for nonalcoholic fatty liver disease(NAFLD),and continuous positive airway pressure(CPAP)is the first-line therapy for OSA.AIM To clarify the efficacy of effective CPAP therapy on NAFLD of OSA patients by serum markers and transient elastography(TE)using FibroScan®(Echosens,Paris,France).METHODS We prospectively enrolled 123 consecutive patients with OSA who met the indications for CPAP.Liver fibrosis and steatosis were assessed using TE.Before and after 6 mo of CPAP therapy,serum markers and TE were assessed for all patients.The mean usage rate of CPAP therapy for 6 mo was arbitrarily calculated in each patient and expressed as“mean compliance index”(m-CI).RESULTS In 50 OSA patients with NAFLD,both aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels were significantly decreased after 6 mo of CPAP therapy.Univariate analysis showed that decreased body weight(BW),decreased body mass index(BMI),decreased AST level,decreased hemoglobin A1c,and high m-CI were significantly related with improved ALT level.In multivariate regression model adjusted for quantities of BW change during 6 mo of CPAP therapy,high m-CI tended to improve ALT level(P=0.051).All 17 OSA patients with NAFLD,high m-CI and no BMI changes showed significant improvements in AST and ALT levels.Meanwhile,no significant changes in TE data or serum fibrosis markers were seen.CONCLUSION Some NAFLD could be associated with chronic intermittent hypoxia due to OSA independent of BW changes.In those cases,adequate reoxygenation from effective CPAP therapy may improve NAFLD.展开更多
Objective To observe the application of continuous renal replacement therapy(CRRT) and heparin anticoagulation in patients with HFRS, and to explore a more suitable anticoagulant strategy. Methods Eighty-five severe-t...Objective To observe the application of continuous renal replacement therapy(CRRT) and heparin anticoagulation in patients with HFRS, and to explore a more suitable anticoagulant strategy. Methods Eighty-five severe-type patients(severe group) and 71 critical-type patients(critical group) were enrolled in this study. The frequency of CRRT was compared between the two groups; the frequency of CRRT treated with and without heparin anticoagulation and the frequency of hemorrhage and channel blood clotting induced by the two anticoagulant strategies were observed. Results The frequency of CRRT in the critical group was higher than that in the severe group(P < 0.001). The frequency of CRRT initiated during the overlapping phases in the critical group was significantly higher than that of the severe group(P = 0.032). The total times of CRRT was 103, and 70 of them were treated with heparin anticoagulation. The frequencies of hemorrhage induced by heparin anticoagulation and no heparinization were 16 and 0, respectively, and the frequencies of channel blood clotting were 2 and 4, respectively. Conclusions CRRT has been used extensively in the critical-type patients with HFRS. The heparin anticoagulation and no anticoagulant strategies should be used more rationally in patients treated with CRRT, according to the clinical characteristics of the disease.展开更多
Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment p...Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment period to the patients that provides some relief from treatment-related side-effects,and reduced treatment costs.IADT may also delay the progression to castration-resistant prostate cancer.However,the use of IADT in the setting of prostate cancer has not been strongly substantiated by data from clinical trials.Multiple factors seem to contribute towards this inadequacy of supportive data for the use of IADT in patients with prostate cancer,e.g.,population characteristics(both demographic and clinical),study design,treatment regimen,on-and off-treatment criteria,duration of active treatment,endpoints,and analysis.The present review article focuses on seven clinical trials that evaluated the efficacy of IADT vs.continuous androgen deprivation therapy for the treatment of prostate cancer.The results from these clinical trials have been discussed in light of the factors that may impact the treatment outcomes,especially the disease(tumor)burden.Based on evidence,potential candidate population for IADT has been suggested along with recommendations for the use of IADT in patients with prostate cancer.展开更多
AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric in...AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU)or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortalityⅢ(PRIsM-Ⅲ)scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV)were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%)failed treatment and required MV.The majority of the patients(74%)had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P=0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲscores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P<0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.展开更多
Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrosto...Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrostomy feeding. The condition presents a substantial management challenge. Surgical approaches to re-establish pharyngo-oesophageal continuity are varied, highly invasive and are associated with unpredictable outcomes. Minimally invasive techniques employing endoscopic and radiological techniques are emerging. This report describes a multidisciplinary approach which translates two interventional radiology techniques used in the management of central venous occlusions and biliary strictures to the management of three cases of complete hypopharyngo-oesophageal occlusion. Methods: Three cases with different underlying aetiologies had treatment initiated between 2009 and 2011. Antegrade pharyngoscopic access to the occlusions was accompanied by retrograde endoscopic access via a small gastrostomy. Luminal continuity was re-established by the interventional radiology technique of “sharp recanalisation” followed by passage of a wide bore nasogastric tube which was maintained in situ for 4-6 months, a duration of treatment analogous to that applied in the radiological management of fibrotic biliary strictures. After treatment a radiological contrast swallows examination was performed to gauge the calibre of the re-established lumen, assess functionality and to rule out aspiration. Results: Pharyngo-oesophageal continuity was re-established in all three cases on the first attempt. No complications occurred as a result of the procedures. In two cases, the excellent swallowing function was re-established, although one of these required prolonged post-treatment adjuvant interventions. In one case no swallowing function resulted, despite apparently successful re-establishment of luminal continuity. Conclusions: Complete fibrotic occlusion of the hypopharyngo-oesophageal lumen is rare and presents a substantial management challenge. A minimally invasive treatment combining antegrade radiological and retrograde endoscopic approaches resulted in successful re-establishment of luminal continuity in three cases of complete fibrotic occlusion of the hypopharyngo-oesophageal lumen. However variable responses to treatment suggest that both the underlying aetiology and the chronicity of the occlusion may influence the likelihood of a successful functional outcome. Until definitive management guidelines are established, we suggest that such cases are managed only by motivated multidisciplinary teams keen to develop their expertise in this area.展开更多
In the hot summer&cold winter zone in China,intermittent heating space for rooms is widely used.However,in comparison with continuous space heating,the energy-saving performance of intermittent space heating has n...In the hot summer&cold winter zone in China,intermittent heating space for rooms is widely used.However,in comparison with continuous space heating,the energy-saving performance of intermittent space heating has not been sufficiently investigated.This paper studied the factors influencing the energy performance of intermittent heating for the representativeoffice inhot summer&coldwinter zone.Basedon theheatbalancemethod,adynamic thermalmodel of the intermittent heating roomwas built and tested by experiments.And then,it analyzed the total space heating load,the amount of energy saving and energy saving ratio of the intermittent heating under different preheating hours,occupation hours,required roomtemperatures,air change rates,overall heat transfer coefficients(U-value)of windows and wall materials.If the adjacent rooms were not heated,for a typical room occupied about 10 h a day,the energy-saving ratio of intermittent heating was about 30%compared with continuous heating.But the preheating power was higher than two times of continuous heating.The results also indicated that the occupation hours had a significant effect on energy saving amount and ratio,it should be noted that the energy saving ratio by intermittent heating was much lower than the unoccupied period ratio.Relative to other factors,the heating temperatures,room air change rates and U-value of windows,and room envelope materials had little effect on energy efficiency.If the adjacent rooms were heated in the same manner as the roomin question,the energy-saving ratio of the total load of intermittent heating was heavily reduced to 8.46%.展开更多
Objective:Systematically evaluate the rehabilitation effect of high-intensity intermittent exercise(HIIT)on cardiovascular function in stroke patients,in order to provide a basis for selecting the best rehabilitation ...Objective:Systematically evaluate the rehabilitation effect of high-intensity intermittent exercise(HIIT)on cardiovascular function in stroke patients,in order to provide a basis for selecting the best rehabilitation plan for stroke patients.Methods:Computer retrieval of CNKI,WanFang Data,VIP,CBM,Pubmed,EMbase,Web of science,The Cochrane Library databases was conducted from the establishment of the database until March 2023.Randomized controlled trials on HIIT improving cardiovascular function in stroke patients were included,and the included literature was screened,data extracted,and bias risk evaluated.Then,metaanalysis was conducted using RevMan 5.4 software and Stata17.0 software.Results:In the end,9 articles met the research criteria,with a total of 428 patients.The meta-analysis results showed that compared with the control group,HIIT had significant effects on peak oxygen uptake(VO2peak)[MD=3.87,95%CI(3.43,4.31),P<0.00001],minute ventilation(VE)[MD=7.14,95%CI(4.34,9.94),P<0.00001],peak power(WRpeak)[MD=17.13,95%CI(13.7320.54),P<0.00001],6-minute walking distance(6MWD)[MD=43.82,95%CI(16.08,71.56),P=0.002],The intervention effect of the 10 meter walking test(10MWT)[MD=-2.00,95%CI(-2.91,-1.08),P<0.0001]was better than that of the control group.Conclusion:The current analysis results show that compared to conventional rehabilitation therapy or continuous aerobic exercise,HIIT has more advantages in improving the cardiopulmonary function of stroke patients.展开更多
Objective: to evaluate the role and efficacy of continuous renal replacement therapy (CRRT) in treating patients with heart failure (HF) complicated with renal failure. Methods: clinical data of 24 patients with HF tr...Objective: to evaluate the role and efficacy of continuous renal replacement therapy (CRRT) in treating patients with heart failure (HF) complicated with renal failure. Methods: clinical data of 24 patients with HF treated with CRRT in our hospital were analyzed. The changes of serum creatinine, urea nitrogen, electrolytes and blood gas as well as the changes of blood pressure and heart rate were observed before and after treatment. Results: 16 cases were cured, 4 cases died, and 4 cases were discharged automatically. Conclusion: CRRT is easy to operate, and it is equivalent to intermittent hemodialysis (IHD) in eliminating metabolites and correcting fluid balance and electrolyte disturbance. Hemodynamic stability is an outstanding advantage in treatment, so it is suitable for patients with HF complicated with renal failure.展开更多
Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF...Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.展开更多
文摘Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.
基金This Work was supported by the grant from the Science and Technology Committee of Zhejiang Province,No.971103132
文摘AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group remained higher than that in intermittent occlusion groups. Moreover, a 60% animal mortality rate and more severe morphological alterations were also shown in CO-60 group. CONCLUSION: Hepatic inflow occlusion during 60 minutes for liver resection in cirrhotic rats resulted in less hepatocellular injury when occlusion was intermittent rather than continuous. Each period of 15 minutes was the safe upper limit of repeated intermittent vascular occlusion that the cirrhotic liver could tolerate without undergoing irreversible hepatocellular injury.
文摘There are two interaction mechanisms between shaped charge jet and thin flying plate driven by explosion, that is, the intermittent and continuous disturbance. Determination of the transition criteria for the intermittent and continuous disturbance is of importance for the penetration calculation of the escaping jet and the design of ERA(explosive reactive armour). In this paper a new criteria was presented based on the analysis of interaction process, and the effects of NATO angle and thickness of flying plate on the disturbance frequency were discussed. It is shown that the critical shaped charge jet velocity increases with the plate thickness and NATO angle, especially increases drastically between 45° and 60°.
文摘Objective: to investigate the effect difference of intermittent and continuous treatment with Yinzhi Huang oral liquid in the treatment of neonatal jaundice (NNJ). Methods: a total of 200 children with NNJ from January 2019 to December 2019 in our hospital were divided into two groups by odd-even method. The levels of bilirubin (BILirubin) before and after treatment, the outcome, the time of disease improvement and the incidence of phototherapy damage events in the two groups were compared. Results: there were significant differences in BILI level, outcome, improvement time and incidence of phototherapy damage events between the intermittent blue light treatment group and the continuous blue light treatment group (P < 0.05). Conclusion: in the aspect of blue light therapy for CHILDREN with NNJ, intermittent intervention can more significantly promote the decline of BILI level, accelerate the regression of yellow skin stain, accelerate the rehabilitation of children, and improve bilirubin level, which is worth promoting.
基金the Japan Society for the Promotion of Science,No.JP16K09564.
文摘BACKGROUND Obstructive sleep apnea(OSA)has been suggested as an independent risk factor for nonalcoholic fatty liver disease(NAFLD),and continuous positive airway pressure(CPAP)is the first-line therapy for OSA.AIM To clarify the efficacy of effective CPAP therapy on NAFLD of OSA patients by serum markers and transient elastography(TE)using FibroScan®(Echosens,Paris,France).METHODS We prospectively enrolled 123 consecutive patients with OSA who met the indications for CPAP.Liver fibrosis and steatosis were assessed using TE.Before and after 6 mo of CPAP therapy,serum markers and TE were assessed for all patients.The mean usage rate of CPAP therapy for 6 mo was arbitrarily calculated in each patient and expressed as“mean compliance index”(m-CI).RESULTS In 50 OSA patients with NAFLD,both aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels were significantly decreased after 6 mo of CPAP therapy.Univariate analysis showed that decreased body weight(BW),decreased body mass index(BMI),decreased AST level,decreased hemoglobin A1c,and high m-CI were significantly related with improved ALT level.In multivariate regression model adjusted for quantities of BW change during 6 mo of CPAP therapy,high m-CI tended to improve ALT level(P=0.051).All 17 OSA patients with NAFLD,high m-CI and no BMI changes showed significant improvements in AST and ALT levels.Meanwhile,no significant changes in TE data or serum fibrosis markers were seen.CONCLUSION Some NAFLD could be associated with chronic intermittent hypoxia due to OSA independent of BW changes.In those cases,adequate reoxygenation from effective CPAP therapy may improve NAFLD.
基金supported by the National Basic Research Program of China (973 Program) (No. 2012CB518905)National Natural Science Foundation of China (No. 81071370)
文摘Objective To observe the application of continuous renal replacement therapy(CRRT) and heparin anticoagulation in patients with HFRS, and to explore a more suitable anticoagulant strategy. Methods Eighty-five severe-type patients(severe group) and 71 critical-type patients(critical group) were enrolled in this study. The frequency of CRRT was compared between the two groups; the frequency of CRRT treated with and without heparin anticoagulation and the frequency of hemorrhage and channel blood clotting induced by the two anticoagulant strategies were observed. Results The frequency of CRRT in the critical group was higher than that in the severe group(P < 0.001). The frequency of CRRT initiated during the overlapping phases in the critical group was significantly higher than that of the severe group(P = 0.032). The total times of CRRT was 103, and 70 of them were treated with heparin anticoagulation. The frequencies of hemorrhage induced by heparin anticoagulation and no heparinization were 16 and 0, respectively, and the frequencies of channel blood clotting were 2 and 4, respectively. Conclusions CRRT has been used extensively in the critical-type patients with HFRS. The heparin anticoagulation and no anticoagulant strategies should be used more rationally in patients treated with CRRT, according to the clinical characteristics of the disease.
基金Ferring Pharmaceuticals provided funding for editorial assistance.The author acknowledges Dr.Payal Bhardwaj of Tata Consultancy Services,who provided editorial assistance.
文摘Intermittent androgen deprivation therapy(IADT)is now being increasingly opted by the treating physicians and patients with prostate cancer.The most common reason driving this is the availability of an off-treatment period to the patients that provides some relief from treatment-related side-effects,and reduced treatment costs.IADT may also delay the progression to castration-resistant prostate cancer.However,the use of IADT in the setting of prostate cancer has not been strongly substantiated by data from clinical trials.Multiple factors seem to contribute towards this inadequacy of supportive data for the use of IADT in patients with prostate cancer,e.g.,population characteristics(both demographic and clinical),study design,treatment regimen,on-and off-treatment criteria,duration of active treatment,endpoints,and analysis.The present review article focuses on seven clinical trials that evaluated the efficacy of IADT vs.continuous androgen deprivation therapy for the treatment of prostate cancer.The results from these clinical trials have been discussed in light of the factors that may impact the treatment outcomes,especially the disease(tumor)burden.Based on evidence,potential candidate population for IADT has been suggested along with recommendations for the use of IADT in patients with prostate cancer.
基金supported by NIH National Center for Advancing Translational Science,No.UL1TR001881
文摘AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV)use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU)or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortalityⅢ(PRIsM-Ⅲ)scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV)were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%)failed treatment and required MV.The majority of the patients(74%)had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P=0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲscores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P<0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.
文摘Background: Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrostomy feeding. The condition presents a substantial management challenge. Surgical approaches to re-establish pharyngo-oesophageal continuity are varied, highly invasive and are associated with unpredictable outcomes. Minimally invasive techniques employing endoscopic and radiological techniques are emerging. This report describes a multidisciplinary approach which translates two interventional radiology techniques used in the management of central venous occlusions and biliary strictures to the management of three cases of complete hypopharyngo-oesophageal occlusion. Methods: Three cases with different underlying aetiologies had treatment initiated between 2009 and 2011. Antegrade pharyngoscopic access to the occlusions was accompanied by retrograde endoscopic access via a small gastrostomy. Luminal continuity was re-established by the interventional radiology technique of “sharp recanalisation” followed by passage of a wide bore nasogastric tube which was maintained in situ for 4-6 months, a duration of treatment analogous to that applied in the radiological management of fibrotic biliary strictures. After treatment a radiological contrast swallows examination was performed to gauge the calibre of the re-established lumen, assess functionality and to rule out aspiration. Results: Pharyngo-oesophageal continuity was re-established in all three cases on the first attempt. No complications occurred as a result of the procedures. In two cases, the excellent swallowing function was re-established, although one of these required prolonged post-treatment adjuvant interventions. In one case no swallowing function resulted, despite apparently successful re-establishment of luminal continuity. Conclusions: Complete fibrotic occlusion of the hypopharyngo-oesophageal lumen is rare and presents a substantial management challenge. A minimally invasive treatment combining antegrade radiological and retrograde endoscopic approaches resulted in successful re-establishment of luminal continuity in three cases of complete fibrotic occlusion of the hypopharyngo-oesophageal lumen. However variable responses to treatment suggest that both the underlying aetiology and the chronicity of the occlusion may influence the likelihood of a successful functional outcome. Until definitive management guidelines are established, we suggest that such cases are managed only by motivated multidisciplinary teams keen to develop their expertise in this area.
基金supported by the National Natural Science Foundation of China(No.71974129).
文摘In the hot summer&cold winter zone in China,intermittent heating space for rooms is widely used.However,in comparison with continuous space heating,the energy-saving performance of intermittent space heating has not been sufficiently investigated.This paper studied the factors influencing the energy performance of intermittent heating for the representativeoffice inhot summer&coldwinter zone.Basedon theheatbalancemethod,adynamic thermalmodel of the intermittent heating roomwas built and tested by experiments.And then,it analyzed the total space heating load,the amount of energy saving and energy saving ratio of the intermittent heating under different preheating hours,occupation hours,required roomtemperatures,air change rates,overall heat transfer coefficients(U-value)of windows and wall materials.If the adjacent rooms were not heated,for a typical room occupied about 10 h a day,the energy-saving ratio of intermittent heating was about 30%compared with continuous heating.But the preheating power was higher than two times of continuous heating.The results also indicated that the occupation hours had a significant effect on energy saving amount and ratio,it should be noted that the energy saving ratio by intermittent heating was much lower than the unoccupied period ratio.Relative to other factors,the heating temperatures,room air change rates and U-value of windows,and room envelope materials had little effect on energy efficiency.If the adjacent rooms were heated in the same manner as the roomin question,the energy-saving ratio of the total load of intermittent heating was heavily reduced to 8.46%.
基金Beijing Hospital Management Center Youth Talent Training"Young Seedlings"Program(No.QML20212201)。
文摘Objective:Systematically evaluate the rehabilitation effect of high-intensity intermittent exercise(HIIT)on cardiovascular function in stroke patients,in order to provide a basis for selecting the best rehabilitation plan for stroke patients.Methods:Computer retrieval of CNKI,WanFang Data,VIP,CBM,Pubmed,EMbase,Web of science,The Cochrane Library databases was conducted from the establishment of the database until March 2023.Randomized controlled trials on HIIT improving cardiovascular function in stroke patients were included,and the included literature was screened,data extracted,and bias risk evaluated.Then,metaanalysis was conducted using RevMan 5.4 software and Stata17.0 software.Results:In the end,9 articles met the research criteria,with a total of 428 patients.The meta-analysis results showed that compared with the control group,HIIT had significant effects on peak oxygen uptake(VO2peak)[MD=3.87,95%CI(3.43,4.31),P<0.00001],minute ventilation(VE)[MD=7.14,95%CI(4.34,9.94),P<0.00001],peak power(WRpeak)[MD=17.13,95%CI(13.7320.54),P<0.00001],6-minute walking distance(6MWD)[MD=43.82,95%CI(16.08,71.56),P=0.002],The intervention effect of the 10 meter walking test(10MWT)[MD=-2.00,95%CI(-2.91,-1.08),P<0.0001]was better than that of the control group.Conclusion:The current analysis results show that compared to conventional rehabilitation therapy or continuous aerobic exercise,HIIT has more advantages in improving the cardiopulmonary function of stroke patients.
文摘Objective: to evaluate the role and efficacy of continuous renal replacement therapy (CRRT) in treating patients with heart failure (HF) complicated with renal failure. Methods: clinical data of 24 patients with HF treated with CRRT in our hospital were analyzed. The changes of serum creatinine, urea nitrogen, electrolytes and blood gas as well as the changes of blood pressure and heart rate were observed before and after treatment. Results: 16 cases were cured, 4 cases died, and 4 cases were discharged automatically. Conclusion: CRRT is easy to operate, and it is equivalent to intermittent hemodialysis (IHD) in eliminating metabolites and correcting fluid balance and electrolyte disturbance. Hemodynamic stability is an outstanding advantage in treatment, so it is suitable for patients with HF complicated with renal failure.
文摘Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.
