BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This stud...BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients.METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department(ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death def ined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied.RESULTS: In the 100 patients, 21(21%) patients were female and 79(79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage(ICH) or intra-ventricular hemorrhage(IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services(EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes.CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.展开更多
Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in ...Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in Plovdiv region was studied for the period 2006-2010. An analysis of the age structure of the patients was made, while taking into account the time for routine immunization performed against measles and mumps (first and second dose). Results: In 2006-2009 single cases of measles were found occasionally, but in 2010 they were 2787 (incidence 395/100,000). Most of them (51%) were for ages 13 months-12years, 27%-0-13 months and 11%-13 to 18 years. The incidence of mumps for 2006-2010 varied widely, and has increased significantly in 2007 (130/100,000) and 2008 (169/100,000). The majority of patients (over 34%) during the epidemics were aged 13 months-12years, and over 26% of them-13-19 years. For the period 2006-2010 the incidence of hepatitis A ranged from 2.98/100, 000 (2009) to 426/100,000 (2006). Over 50% of the cases involved children aged up to 9 years. For the three diseases over 80% of patients were individuals of Roma origin. Conclusions: 1. Epidemic spread of measles in 2010 was mainly due to shortcomings in the routine immunization carried as a prevention of the disease. 2. There are two reasons for the outbreak of mumps: А) Failure to administer the second vaccine dose at 12 years in Bulgaria until 2001. B) Shortcomings in routinely performed immunization. 3. The extremely high incidence of hepatitis A in 2006 (and in the rest of the years) is due to the lack of routine immunization. 4. Essential for the outbreaks in all three diseases are the poor hygienic living conditions, the low social status and the lack of health promotion of the population at risk 5. To prevent future outbreaks of the diseases hereby in question, we suggest it is appropriate: А) To introduce compulsory immunization against hepatitis A;B) To carry out periodic catch-up vaccination campaigns against measles and mumps.展开更多
Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered imp...Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance;at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Methods: Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used;the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility;subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Results: Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465);Arthritis 52% (241/465);Dental problems 27% (124/465);Hypertension 23% (107/465);Backache 22% (105/465);Malaria 28% (132/465);Hearing problems 26% (121/645);Urinary tract Infection 35% (165/465);Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis;some of the geriatrics had more than two diseases. Conclusion: The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable.展开更多
AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investig...BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.展开更多
Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass...Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.展开更多
Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer...Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer from vision impairment(VI),with over 1 billion of these cases being preventable or treatable yet remaining unaddressed.Despite significant advancements in global eye care services over the past few decades,which have yielded considerable benefits,the challenges continue to mount.展开更多
Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmaco...Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmacological therapies,emerging research,challenges,and future directions of AD.Major findings from recent studies were synthesised,encompassing insights into the global prevalence,molecular pathology,high-risk factors,and therapeutic interventions,including cholinesterase inhibitors,glutamate receptor antagonists,and antibodies against Aβand tau proteins.Additionally,emerging research areas such as gene therapy and lipid nanoparticles were highlighted.This review emphasised the urgent need for ongoing research on novel therapeutic avenues and addressing the challenges in AD diagnosis,treatment,and care.Future perspectives underscore the potential of disease-modifying treatments,personalised medical approaches,and holistic interventions to alleviate the growing burden of AD on individuals,families,and healthcare systems worldwide.By fostering collaboration and innovation,we can strive towards a future where effective prevention,early detection,and personalised treatments enhance the lives of millions affected by AD globally.展开更多
The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created a...The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created at present.Modern endoscopic and morphological methods of verification of the diagnosis of precancerous diseases and changes in the gastric mucosa have been introduced into the practice of gastroenterologists and oncologists.GC risk stratification systems allow the formation of risk groups that require population screening.Practical hints for population serological screening of atrophic gastritis,endoscopic and morphological verification of precancerous changes and diseases of the stomach recommend using it:When developing state programs for the prevention of stomach cancer;when implementing preventive measures for stomach cancer by doctors of all specialties;the authors also offer the possibility of use by anyone over the age of 40,provided that they seek methodological help from their doctor;in the work of health schools in any medical and preventive institutions.The use of an assessment system of certain risk factor signatures with prognostic value would add significant assistance to preventive measures against GC.展开更多
Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general...Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.展开更多
In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratifi...In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratification,prevention,intervention,and management framework for hypertension tailored to the unique characteristics of the Chinese population.Over the past two decades,these guidelines have been widely implemented in clinical practice across China and have played a significant role in the management of hypertension and chronic diseases,the development of grassroots guidelines,the formulation of clinical pathways,and the implementation of health insurance policies.展开更多
To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compress...To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compression and uniaxial loading–unloading tests were conducted under five saturation levels.The effect of saturation on the mechanical properties and elastic energy density was analyzed,and a method for obtaining peak energy density was proposed.The effect of saturation on the energy evolution was examined,and the energy mechanism of water in preventing rockburst was revealed.The results indicate that an increase in saturation of red sandstone decreases the input energy density,elastic energy density,dissipated energy density,peak strength and peak strain;the compaction phase of the stress–strain curve becomes shorter;the failure mode transitions from X-conjugate oblique shear to single oblique shear;the variation in the debris ejection trajectory is as follows:radiation→X-ray→oblique upward parabola→horizontal parabola→oblique downward parabola;the degree of failure intensity and fragmentation is decreased gradually.Elastic energy density is interconnected with both saturation and stress but independent of the loading path.Saturation exhibits a dual effect on the energy storage property,i.e.,increasing saturation increases the energy storage efficiency and reduces the energy storage capacity.The ratio of peak elastic energy density to peak input energy density remains constant irrespective of saturation levels.Water prevents rockburst by decreasing the energy storage capacity of surrounding rock,alleviating the stress of surrounding rock to reduce energy storage,and elevating the energy release threshold of high-energy surrounding rock.The findings of this study contribute to understanding the effect of water on rock failure from an energy perspective,as well as provide theoretical guidance for rockburst prevention by water in deep tunnels.展开更多
Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilizatio...Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilization of train adhesion within the total torque command,reduce the train skidding/sliding phenomenon and achieve optimal adhesion utilization for each axle,thus realizing the optimal allocation of the multi-motor electric locomotives.Design/methodology/approach–In this study,a model predictive control(MPC)-based cooperative maximum adhesion tracking control method for multi-motor electric locomotives is presented.Firstly,train traction system with multiple motors is constructed in accordance with Newton’s second law.These equations include the train dynamics equations,the axle dynamics equations,and the wheel-rail adhesion coefficient equations.Then,a new MPC-based multi-axle adhesion co-optimization method is put forward.This method calculates the optimal output torque through real-time iteration based on the known reference slip speed to achieve multi-axle co-optimization under different circumstances.Findings–This paper presents a MPC system designed for the cooperative control of multi-axle adhesion.The results indicate that the proposed control system is able to optimize the adhesion of multiple axles under numerous different conditions and achieve the optimal power distribution based on the reduction of train skidding/sliding.Originality/value–This study presents a novel cooperative adhesion tracking control scheme.It is designed for multi-motor electric locomotives,which has rarely been studied before.And simulations are carried out in different conditions,including variable surfaces and motor failing.展开更多
Enamel demineralization,the formation of white spot lesions,is a common issue in clinical orthodontic treatment.The appearance of white spot lesions not only affects the texture and health of dental hard tissues but a...Enamel demineralization,the formation of white spot lesions,is a common issue in clinical orthodontic treatment.The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment.The prevention,diagnosis,and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties.This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment,advocating for proactive prevention,early detection,timely treatment,scientific follow-up,and multidisciplinary management of white spot lesions throughout the orthodontic process,thereby maintaining the dental health of patients during orthodontic treatment.展开更多
BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram...BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram(ECG)during resting conditions and physical exertion in individuals diagnosed with IHD and those without the condition using vasodilator-induced stress computed tomography(CT)myocardial perfusion imaging as the diagnostic reference standard.METHODS This single center observational study included 80 participants.The participants were aged≥40 years and given an informed written consent to participate in the study.Both groups,G1(n=31)with and G2(n=49)without post stress induced myocardial perfusion defect,passed cardiologist consultation,anthropometric measurements,blood pressure and pulse rate measurement,echocardiography,cardio-ankle vascular index,bicycle ergometry,recording 3-min single-lead ECG(Cardio-Qvark)before and just after bicycle ergometry followed by performing CT myocardial perfusion.The LASSO regression with nested cross-validation was used to find the association between Cardio-Qvark parameters and the existence of the perfusion defect.Statistical processing was performed with the R programming language v4.2,Python v.3.10[^R],and Statistica 12 program.RESULTS Bicycle ergometry yielded an area under the receiver operating characteristic curve of 50.7%[95%confidence interval(CI):0.388-0.625],specificity of 53.1%(95%CI:0.392-0.673),and sensitivity of 48.4%(95%CI:0.306-0.657).In contrast,the Cardio-Qvark test performed notably better with an area under the receiver operating characteristic curve of 67%(95%CI:0.530-0.801),specificity of 75.5%(95%CI:0.628-0.88),and sensitivity of 51.6%(95%CI:0.333-0.695).CONCLUSION The single-lead ECG has a relatively higher diagnostic accuracy compared with bicycle ergometry by using machine learning models,but the difference was not statistically significant.However,further investigations are required to uncover the hidden capabilities of single-lead ECG in IHD diagnosis.展开更多
Aiming at reducing the dust pollution during the tunneling process and improving the application efficiency of air curtain dust prevention technology,according to the changes of radial jet velocity(v_(r)),axial extrac...Aiming at reducing the dust pollution during the tunneling process and improving the application efficiency of air curtain dust prevention technology,according to the changes of radial jet velocity(v_(r)),axial extraction velocity(v_(e))and extraction distance(L)in the formation process of air curtain,the numerical simulation method was used to analyze the rules of airflow structure evolution and the diffusion characteristics of dust particles in fully mechanized excavation tunnel.The results indicate that as v_(r) and v_(e) increase,the migration path of the wall jet of the air curtain changes into an axial direction;as L decreases,the migration distance increases accordingly.These phenomena make the airflow distribution in the working face tends to be uniform.The dust diffusion distance reduces as well,wherein,the range of the discrete area of dust particles decreases sharply,until all dust particles are concentrated in the accumulation area.On this basis,the v_(r),v_(e) and L were optimized and applied in the 63_(up) 08 fully mechanized working face.By the application of the optimal parameters,the average dust removal efficiency at the driver’s position increased by 71%.The dust concentration was reduced and the working environment had been improved effectively.展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco ...Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.展开更多
Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition ...Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.展开更多
Stroke and Alzheimer's disease are common neurological disorders and often occur in the same individuals.The comorbidity of the two neurological disorders represents a grave health threat to older populations.This...Stroke and Alzheimer's disease are common neurological disorders and often occur in the same individuals.The comorbidity of the two neurological disorders represents a grave health threat to older populations.This review presents a brief background of the development of novel concepts and their clinical potentials.The activity of glutamatergic N-methyl-D-aspartate receptors and N-methyl-D-aspartate receptor-mediated Ca^(2+)influx is critical for neuronal function.An ischemic insult induces prompt and excessive glutamate release and drastic increases of intracellular Ca^(2+)mainly via N-methyl-D-aspartate receptors,particularly of those at the extrasynaptic site.This Ca^(2+)-evoked neuronal cell death in the ischemic core is dominated by necrosis within a few hours and days known as acute excitotoxicity.Furthermore,mild but sustained Ca^(2+)increases under neurodegenerative conditions such as in the distant penumbra of the ischemic brain and early stages of Alzheimer's disease are not immediately toxic,but gradually set off deteriorating Ca^(2+)-dependent signals and neuronal cell loss mostly because of activation of programmed cell death pathways.Based on the Ca^(2+)hypothesis of Alzheimer's disease and recent advances,this Ca^(2+)-activated“silent”degenerative excitotoxicity evolves from years to decades and is recognized as a unique slow and chronic neuropathogenesis.The N-methyl-D-aspartate receptor subunit GluN3A,primarily at the extrasynaptic site,serves as a gatekeeper for the N-methyl-D-aspartate receptor activity and is neuroprotective against both acute and chronic excitotoxicity.Ischemic stroke and Alzheimer's disease,therefore,share an N-methyl-D-aspartate receptor-and Ca^(2+)-mediated mechanism,although with much different time courses.It is thus proposed that early interventions to control Ca^(2+)homeostasis at the preclinical stage are pivotal for individuals who are susceptible to sporadic late-onset Alzheimer's disease and Alzheimer's disease-related dementia.This early treatment simultaneously serves as a preconditioning therapy against ischemic stroke that often attacks the same individuals during abnormal aging.展开更多
Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD pat...Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.展开更多
文摘BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents(MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients.METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department(ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death def ined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied.RESULTS: In the 100 patients, 21(21%) patients were female and 79(79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage(ICH) or intra-ventricular hemorrhage(IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services(EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes.CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.
文摘Aim: To analyze the reasons for epidemic outbreaks of measles, mumps and viral hepatitis A and to propose measures to prevent them in future. Materials and methods: Тhe incidence of measles, mumps and hepatitis A in Plovdiv region was studied for the period 2006-2010. An analysis of the age structure of the patients was made, while taking into account the time for routine immunization performed against measles and mumps (first and second dose). Results: In 2006-2009 single cases of measles were found occasionally, but in 2010 they were 2787 (incidence 395/100,000). Most of them (51%) were for ages 13 months-12years, 27%-0-13 months and 11%-13 to 18 years. The incidence of mumps for 2006-2010 varied widely, and has increased significantly in 2007 (130/100,000) and 2008 (169/100,000). The majority of patients (over 34%) during the epidemics were aged 13 months-12years, and over 26% of them-13-19 years. For the period 2006-2010 the incidence of hepatitis A ranged from 2.98/100, 000 (2009) to 426/100,000 (2006). Over 50% of the cases involved children aged up to 9 years. For the three diseases over 80% of patients were individuals of Roma origin. Conclusions: 1. Epidemic spread of measles in 2010 was mainly due to shortcomings in the routine immunization carried as a prevention of the disease. 2. There are two reasons for the outbreak of mumps: А) Failure to administer the second vaccine dose at 12 years in Bulgaria until 2001. B) Shortcomings in routinely performed immunization. 3. The extremely high incidence of hepatitis A in 2006 (and in the rest of the years) is due to the lack of routine immunization. 4. Essential for the outbreaks in all three diseases are the poor hygienic living conditions, the low social status and the lack of health promotion of the population at risk 5. To prevent future outbreaks of the diseases hereby in question, we suggest it is appropriate: А) To introduce compulsory immunization against hepatitis A;B) To carry out periodic catch-up vaccination campaigns against measles and mumps.
文摘Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance;at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Methods: Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used;the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility;subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Results: Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465);Arthritis 52% (241/465);Dental problems 27% (124/465);Hypertension 23% (107/465);Backache 22% (105/465);Malaria 28% (132/465);Hearing problems 26% (121/645);Urinary tract Infection 35% (165/465);Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis;some of the geriatrics had more than two diseases. Conclusion: The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable.
文摘AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
文摘BACKGROUND:Readmission to intensive care unit(ICU)after discharge to ward has been reported to be associated with increased hospital mortality and longer length of stay(LOS).The objective of this study was to investigate whether ICU readmission are preventable in critically ill cancer patients.METHODS:Data of patients who readmitted to intensive care unit(ICU)at National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College(PUMC)between January 2013 and November 2016 were retrospectively collected and reviewed.RESULTS:A total of 39 patients were included in the final analysis,and the overall readmission rate between 2013 and 2016 was 1.32%(39/2,961).Of 39 patients,32(82.1%)patients were judged as unpreventable and 7(17.9%)patients were preventable.There were no significant differences in duration of mechanical ventilation,ICU LOS,hospital LOS,ICU mortality and in-hospital mortality between patients who were unpreventable and preventable.For 24 early readmission patients,7(29.2%)patients were preventable and 17(70.8%)patients were unpreventable.Patients who were late readmission were all unpreventable.There was a trend that patients who were preventable had longer 1-year survival compared with patients who were unpreventable(100%vs.66.8%,log rank=1.668,P=0.196).CONCLUSION:Most readmission patients were unpreventable,and all preventable readmissions occurred in early period after discharge to ward.There were no significant differences in short term outcomes and 1-year survival in critically ill cancer patients whose readmissions were preventable or not.
文摘Tuberculosis (TB) incidence within Healthcare workers remains one of the lowest occupation specific rates in the United States. We report a case of a 33-year-old African American male presented with a right chest mass and without fever, chills or cough. Bacterial and Fungal cultures were sent during the initial visit and were negative throughout the entire management of his care. After several months of surgical interventions, the patient appeared positive for TB;however a staff member contracted the disease. The patient was managed successfully with the four-drug regimen of Isoniazid, Rifampin, Pyrazinamide and Ethambutol and recovered well from his surgeries.
文摘Good vision is fundamental to human experience,profoundly influencing educational attainment,economic productivity and overall quality of life.Currently,it is estimated that at least 2.2 billion people globally suffer from vision impairment(VI),with over 1 billion of these cases being preventable or treatable yet remaining unaddressed.Despite significant advancements in global eye care services over the past few decades,which have yielded considerable benefits,the challenges continue to mount.
文摘Objective Alzheimer’s disease(AD)presents a significant global health challenge with a steadily increasing prevalence and impact.This comprehensive review aimed to delve into the epidemiology,pathophysiology,pharmacological therapies,emerging research,challenges,and future directions of AD.Major findings from recent studies were synthesised,encompassing insights into the global prevalence,molecular pathology,high-risk factors,and therapeutic interventions,including cholinesterase inhibitors,glutamate receptor antagonists,and antibodies against Aβand tau proteins.Additionally,emerging research areas such as gene therapy and lipid nanoparticles were highlighted.This review emphasised the urgent need for ongoing research on novel therapeutic avenues and addressing the challenges in AD diagnosis,treatment,and care.Future perspectives underscore the potential of disease-modifying treatments,personalised medical approaches,and holistic interventions to alleviate the growing burden of AD on individuals,families,and healthcare systems worldwide.By fostering collaboration and innovation,we can strive towards a future where effective prevention,early detection,and personalised treatments enhance the lives of millions affected by AD globally.
文摘The problem of gastric cancer(GC)prevention remains relevant for a long time.Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created at present.Modern endoscopic and morphological methods of verification of the diagnosis of precancerous diseases and changes in the gastric mucosa have been introduced into the practice of gastroenterologists and oncologists.GC risk stratification systems allow the formation of risk groups that require population screening.Practical hints for population serological screening of atrophic gastritis,endoscopic and morphological verification of precancerous changes and diseases of the stomach recommend using it:When developing state programs for the prevention of stomach cancer;when implementing preventive measures for stomach cancer by doctors of all specialties;the authors also offer the possibility of use by anyone over the age of 40,provided that they seek methodological help from their doctor;in the work of health schools in any medical and preventive institutions.The use of an assessment system of certain risk factor signatures with prognostic value would add significant assistance to preventive measures against GC.
文摘Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
文摘In 1999,China released its first edition of the“Guidelines for the Prevention and Treatment of Hypertension”,which was subsequently updated in 2005,2010,and 2018,establishing a diagnostic,assessment,grading,stratification,prevention,intervention,and management framework for hypertension tailored to the unique characteristics of the Chinese population.Over the past two decades,these guidelines have been widely implemented in clinical practice across China and have played a significant role in the management of hypertension and chronic diseases,the development of grassroots guidelines,the formulation of clinical pathways,and the implementation of health insurance policies.
基金supported by the National Natural Science Foundation of China(52104133,52304227)the Natural Science Foundation of Hunan Province(2021JJ40465,2023JJ40548)the Opening Foundation of the State Key Laboratory of Mining Response and Disaster Prevention and Control in Deep Coal Mines(SKLMRDPC20KF03).
文摘To investigate the effect of saturation on the storage-dissipation properties and failure characteristics of red sandstone,as well as the energy mechanism of rockburst prevention by water,a series of uniaxial compression and uniaxial loading–unloading tests were conducted under five saturation levels.The effect of saturation on the mechanical properties and elastic energy density was analyzed,and a method for obtaining peak energy density was proposed.The effect of saturation on the energy evolution was examined,and the energy mechanism of water in preventing rockburst was revealed.The results indicate that an increase in saturation of red sandstone decreases the input energy density,elastic energy density,dissipated energy density,peak strength and peak strain;the compaction phase of the stress–strain curve becomes shorter;the failure mode transitions from X-conjugate oblique shear to single oblique shear;the variation in the debris ejection trajectory is as follows:radiation→X-ray→oblique upward parabola→horizontal parabola→oblique downward parabola;the degree of failure intensity and fragmentation is decreased gradually.Elastic energy density is interconnected with both saturation and stress but independent of the loading path.Saturation exhibits a dual effect on the energy storage property,i.e.,increasing saturation increases the energy storage efficiency and reduces the energy storage capacity.The ratio of peak elastic energy density to peak input energy density remains constant irrespective of saturation levels.Water prevents rockburst by decreasing the energy storage capacity of surrounding rock,alleviating the stress of surrounding rock to reduce energy storage,and elevating the energy release threshold of high-energy surrounding rock.The findings of this study contribute to understanding the effect of water on rock failure from an energy perspective,as well as provide theoretical guidance for rockburst prevention by water in deep tunnels.
基金supported by Scientific Research Projects of China Association of Metros(CAMET-KY-2022039)State Key Laboratory of Traction and Control System of EMU and Locomotive(2023YJ386).
文摘Purpose–This study aims to propose a cooperative adhesion control method for trains with multiple motors electric locomotives.The method is intended to optimize the output torque of each motor,maximize the utilization of train adhesion within the total torque command,reduce the train skidding/sliding phenomenon and achieve optimal adhesion utilization for each axle,thus realizing the optimal allocation of the multi-motor electric locomotives.Design/methodology/approach–In this study,a model predictive control(MPC)-based cooperative maximum adhesion tracking control method for multi-motor electric locomotives is presented.Firstly,train traction system with multiple motors is constructed in accordance with Newton’s second law.These equations include the train dynamics equations,the axle dynamics equations,and the wheel-rail adhesion coefficient equations.Then,a new MPC-based multi-axle adhesion co-optimization method is put forward.This method calculates the optimal output torque through real-time iteration based on the known reference slip speed to achieve multi-axle co-optimization under different circumstances.Findings–This paper presents a MPC system designed for the cooperative control of multi-axle adhesion.The results indicate that the proposed control system is able to optimize the adhesion of multiple axles under numerous different conditions and achieve the optimal power distribution based on the reduction of train skidding/sliding.Originality/value–This study presents a novel cooperative adhesion tracking control scheme.It is designed for multi-motor electric locomotives,which has rarely been studied before.And simulations are carried out in different conditions,including variable surfaces and motor failing.
基金funded with National Key R&D Program of China(2022YFC2405904)National Natural Science Foundation of China(11932012,and 32171348).
文摘Enamel demineralization,the formation of white spot lesions,is a common issue in clinical orthodontic treatment.The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment.The prevention,diagnosis,and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties.This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment,advocating for proactive prevention,early detection,timely treatment,scientific follow-up,and multidisciplinary management of white spot lesions throughout the orthodontic process,thereby maintaining the dental health of patients during orthodontic treatment.
基金Supported by Government Assignment,No.1023022600020-6RSF Grant,No.24-15-00549Ministry of Science and Higher Education of the Russian Federation within the Framework of State Support for the Creation and Development of World-Class Research Center,No.075-15-2022-304.
文摘BACKGROUND Ischemic heart disease(IHD)impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally.AIM To compare variations in the parameters of the single-lead electrocardiogram(ECG)during resting conditions and physical exertion in individuals diagnosed with IHD and those without the condition using vasodilator-induced stress computed tomography(CT)myocardial perfusion imaging as the diagnostic reference standard.METHODS This single center observational study included 80 participants.The participants were aged≥40 years and given an informed written consent to participate in the study.Both groups,G1(n=31)with and G2(n=49)without post stress induced myocardial perfusion defect,passed cardiologist consultation,anthropometric measurements,blood pressure and pulse rate measurement,echocardiography,cardio-ankle vascular index,bicycle ergometry,recording 3-min single-lead ECG(Cardio-Qvark)before and just after bicycle ergometry followed by performing CT myocardial perfusion.The LASSO regression with nested cross-validation was used to find the association between Cardio-Qvark parameters and the existence of the perfusion defect.Statistical processing was performed with the R programming language v4.2,Python v.3.10[^R],and Statistica 12 program.RESULTS Bicycle ergometry yielded an area under the receiver operating characteristic curve of 50.7%[95%confidence interval(CI):0.388-0.625],specificity of 53.1%(95%CI:0.392-0.673),and sensitivity of 48.4%(95%CI:0.306-0.657).In contrast,the Cardio-Qvark test performed notably better with an area under the receiver operating characteristic curve of 67%(95%CI:0.530-0.801),specificity of 75.5%(95%CI:0.628-0.88),and sensitivity of 51.6%(95%CI:0.333-0.695).CONCLUSION The single-lead ECG has a relatively higher diagnostic accuracy compared with bicycle ergometry by using machine learning models,but the difference was not statistically significant.However,further investigations are required to uncover the hidden capabilities of single-lead ECG in IHD diagnosis.
基金financially supported by the Natural Science Foundation of Shandong Province(ZR2020QE124,ZR2023ME031 and ZR2023ME012)Innovation Achievement Cultivation Project of Qingdao University of Technology(CLZ2022-002)National Natural Science Foundation of China(52404222 and 52374209).
文摘Aiming at reducing the dust pollution during the tunneling process and improving the application efficiency of air curtain dust prevention technology,according to the changes of radial jet velocity(v_(r)),axial extraction velocity(v_(e))and extraction distance(L)in the formation process of air curtain,the numerical simulation method was used to analyze the rules of airflow structure evolution and the diffusion characteristics of dust particles in fully mechanized excavation tunnel.The results indicate that as v_(r) and v_(e) increase,the migration path of the wall jet of the air curtain changes into an axial direction;as L decreases,the migration distance increases accordingly.These phenomena make the airflow distribution in the working face tends to be uniform.The dust diffusion distance reduces as well,wherein,the range of the discrete area of dust particles decreases sharply,until all dust particles are concentrated in the accumulation area.On this basis,the v_(r),v_(e) and L were optimized and applied in the 63_(up) 08 fully mechanized working face.By the application of the optimal parameters,the average dust removal efficiency at the driver’s position increased by 71%.The dust concentration was reduced and the working environment had been improved effectively.
文摘Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.
文摘Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.
基金supported by National Health Institute(NIH)grant NS099596(to LW and SPY),NS114221(to LW and SPY)Veterans Affair(VA)SPiRE grant RX003865(to SPY)+1 种基金supported by the O.Wayne Rollins Endowment Fund(to SPY)John E.Steinhaus Endowment Fund(to LW)。
文摘Stroke and Alzheimer's disease are common neurological disorders and often occur in the same individuals.The comorbidity of the two neurological disorders represents a grave health threat to older populations.This review presents a brief background of the development of novel concepts and their clinical potentials.The activity of glutamatergic N-methyl-D-aspartate receptors and N-methyl-D-aspartate receptor-mediated Ca^(2+)influx is critical for neuronal function.An ischemic insult induces prompt and excessive glutamate release and drastic increases of intracellular Ca^(2+)mainly via N-methyl-D-aspartate receptors,particularly of those at the extrasynaptic site.This Ca^(2+)-evoked neuronal cell death in the ischemic core is dominated by necrosis within a few hours and days known as acute excitotoxicity.Furthermore,mild but sustained Ca^(2+)increases under neurodegenerative conditions such as in the distant penumbra of the ischemic brain and early stages of Alzheimer's disease are not immediately toxic,but gradually set off deteriorating Ca^(2+)-dependent signals and neuronal cell loss mostly because of activation of programmed cell death pathways.Based on the Ca^(2+)hypothesis of Alzheimer's disease and recent advances,this Ca^(2+)-activated“silent”degenerative excitotoxicity evolves from years to decades and is recognized as a unique slow and chronic neuropathogenesis.The N-methyl-D-aspartate receptor subunit GluN3A,primarily at the extrasynaptic site,serves as a gatekeeper for the N-methyl-D-aspartate receptor activity and is neuroprotective against both acute and chronic excitotoxicity.Ischemic stroke and Alzheimer's disease,therefore,share an N-methyl-D-aspartate receptor-and Ca^(2+)-mediated mechanism,although with much different time courses.It is thus proposed that early interventions to control Ca^(2+)homeostasis at the preclinical stage are pivotal for individuals who are susceptible to sporadic late-onset Alzheimer's disease and Alzheimer's disease-related dementia.This early treatment simultaneously serves as a preconditioning therapy against ischemic stroke that often attacks the same individuals during abnormal aging.
文摘Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.
