After the publication of History and Class Consciousness, the concept of totality became an important role through Georg Lukacs’ development of thought. Yet, this concept changed with his thinking. Indeed, totality a...After the publication of History and Class Consciousness, the concept of totality became an important role through Georg Lukacs’ development of thought. Yet, this concept changed with his thinking. Indeed, totality as an idea had emerged in his critique of capitalist culture in his pre-Marxism;we can claim that the concept of totality as Marxist dialectics originated in that period. Thus, it is necessary to interpret his idea of totality in pre-Marxism in order to understand wholly the concept of totality.展开更多
Setting out from the categories of totality and histori（ci）sm in Kosik＇s Dialectics of the Concrete, we look at the relationship between theory and praxis： empty, abstract totality versus concrete, reified and ali...Setting out from the categories of totality and histori（ci）sm in Kosik＇s Dialectics of the Concrete, we look at the relationship between theory and praxis： empty, abstract totality versus concrete, reified and alienated practice （Lukacs, Habermas, Honneth）; a bad totality, in which the real polydimensional subject is replaced by the one-dimensional, mythologized, fetishized, and economistically reduced ＂subject＂ of consummation （Marcuse, Baudrillard）. The dialectics of concrete totality implies a marxistic critique of the ethical and juristic universalism, in the context of the ＂positive＂ side of globalization and political unilateralism, as a concrete, militant, hegemonistic, post-colonial, and neo-imperial practice （Apel, Habermas, Chomsky, Zinoviev）; globalization as totali（tari）zation, the ＂last man,＂ the ＂end of history,＂ and the ＂end＂ of dialectics in its neo-liberal, eschatological, empty ideological ＂realization＂ （Hegel, Marx, Fukuyama, Arendt）; the totality of the （invariable） being as a pseudo-concrete and pseudo-dialectical ontologistic speculation （Heidegger）： A ＂return＂ to a concrete history and a return of the ＂positive＂ dialectics as a critical awareness, mind, and method in the discourse ＂game＂ of human＇s cognitive, creative, and practical powers. The assumption of Kosik＇s humanism is a synchrony of nature and history in the ＂absolute＂ totality of human＇s concrete existence （Lukacs, Goldmann, Adorno, Sartre, Kosik）.展开更多
In this study,polyacrylic acid(PAA)films were employed as a model system,and a series of PAA films with tunable water wettability was systematically prepared by varying molecular weight and curing temperature.Using at...In this study,polyacrylic acid(PAA)films were employed as a model system,and a series of PAA films with tunable water wettability was systematically prepared by varying molecular weight and curing temperature.Using attenuated total reflectance Fourier-transform infrared spectroscopy(ATR-FTIR),the molecular configurations of surface carboxyl groups(COOH),free carboxyl(COOH_(f))and hydrogen-bonded carboxyl(COOH_(HB),were directly correlated with the polar component of surface energy(γ^(s,p)).By decomposing theγ^(s,p)values of the PAA thin films as a sum of the contributions of COOH_(f)and COOH_(H B),the intrinsic polar component of surface energy of COOH_(H B)(γ_(H B)^(s,p*))was quantified for the first time as 8.34 mN/m,significantly lower than that of COOH_(f)(γ_(f)^(s,p*)=34 mN/m).This result highlights that hydrogen bonding markedly reduces theγ^(s,p),providing a rational explanation for the relatively large water contact angle observed on PAA thin films.Furthermore,it establishes a thermodynamic basis for estimating the fraction of surface COOH_(H B)groups(f H B)from wettability measurements.Further extension of the model to carboxyl-terminated self-assembled monolayers(COOH-SAMs)revealed that surface COOH density(ΣCOOH)critically regulates wetting behavior:whenΣCOOH ranges from 4.30 to 5.25 nm^(-2),COOH groups predominantly exist in a free state and facilitate effective hydration layers,thereby promoting superhydrophilicity.Overall,this study not only establishes a unified thermodynamic framework linking surface COOH configurations to macroscopic wettability,but also validates its universality by extending it to COOH-SAMs systems,thereby providing a unified theoretical framework for the controllable design of hydrophilicity in various COOH-functionalized surfaces.展开更多
The Comedy is another of Chen Yan's masterpieces of realism after The Backstage Clan and The Protagonist.The difference is that the portrayal of He Jiabei in The Comedy echoes the theoretical idea of"typical ...The Comedy is another of Chen Yan's masterpieces of realism after The Backstage Clan and The Protagonist.The difference is that the portrayal of He Jiabei in The Comedy echoes the theoretical idea of"typical characters under typical circumstances."Through studies on Chen Yan's writing in a tensive theoretical space of"typicality,"we find that he has applied several important"typical"theories to his novels.He Jiabei,as a"typical character under typical circumstances"no longer embodies the ideal value as did Yi Qin'e in The Protagonist.The function of this character regardsthe communication between individuals and thetimes,phenomenon and essence."Typical characters under typical circumstances"is a theory generated from an analysis of realism inseparable from the"totality"of the times and history.The focus of The Comedy,a novel based on this theory,has also shifted from creating characters with distinct traits toexploring the historical essence of theera of"comedy."展开更多
Builders of a New Life(Chuangyeshi)is a novel that takes a deep dive into the essence of historical materialism and dialectical materialism.The novel creates a literary form of political metanarrative and presents the...Builders of a New Life(Chuangyeshi)is a novel that takes a deep dive into the essence of historical materialism and dialectical materialism.The novel creates a literary form of political metanarrative and presents the literary narrative of the rural cooperative movement in China within the framework of socialist revolution,through a plot with the connotation of documentary political economy.At the literary narrative level,Builders of a New Life develops the narrative through the subjective perspectives of numerous characters,which pushes the development of the plot forward and bridges the text world with external reality.The result is the creation of a world of general literature unifying thought,emotion and action,along with the development of a distinctive epic narrative form.展开更多
This study investigates the distinct impacts of eastern Pacific(EP)and central Pacific(CP)El Niño events on winter shortwave solar radiation(SSR)in southern China,revealing different spatial distributions and und...This study investigates the distinct impacts of eastern Pacific(EP)and central Pacific(CP)El Niño events on winter shortwave solar radiation(SSR)in southern China,revealing different spatial distributions and underlying mechanisms.The results show that,during the developing winter of EP El Niño,significant SSR reductions occur in southwestern China and the east coast of southern China due to a strong,zonally extended Northwest Pacific anticyclone that transports moisture from the tropical Northwest Pacific and North Indian Ocean,while the northeast of southern China experiences a weak increase in SSR.In contrast,during the developing winter of CP El Niño,SSR decreases in the east of southern China with a significant decrease in the lower basin of the Yangtze River but an increase in the west of southern China with a remarkable increase in eastern Yunnan.The pronounced east-west dipole pattern in SSR anomalies is driven by a meridionally elongated Northwest Pacific anticyclone,which enhances northward moisture transport to the east of southern China while leaving western areas drier.Further research reveals that distinct moisture anomalies during the developing winter of EP and CP events result in divergent SSR distributions across southern China,primarily through modulating the total cloud cover.These findings highlight the critical need to differentiate between El Niño types when predicting medium and long-term variability of radiation in southern China.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse event...Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.展开更多
BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favo...BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.展开更多
AIM:To evaluate the agreement of axial length(AL),anterior chamber parameters,and total cornea power obtained by swept-source optical coherence tomography(SS-OCT)-based and Scheimpflug-based optical biometers in myopi...AIM:To evaluate the agreement of axial length(AL),anterior chamber parameters,and total cornea power obtained by swept-source optical coherence tomography(SS-OCT)-based and Scheimpflug-based optical biometers in myopic children.METHODS:AL,steep keratometry(K),flat K,posterior corneal keratometry(PK),total keratometry(TK),anterior chamber depth(ACD),horizontal corneal diameter(CD),and central corneal thickness(CCT)were obtained using IOL Master 700 and Pentacam AXL.The agreement between the devices was evaluated using intraclass correlation coefficients(ICC),Bland-Altman plots,and astigmatism vector analysis.RESULTS:Totally 175 myopic children(48.5%male)with a mean age of 10.29±2.14y were enrolled.The ICC and Bland-Altman plots indicated a satisfactory agreement for AL,ACD,and CCT.The mean difference in CD of-0.31±0.30 mm was considered clinically significant(>0.2 mm).Additionally,measurements of K and TK obtained from the IOL Master 700 showed good agreement.Nevertheless,there were clinically significant differences observed in PK,simulated keratometry(simK),total cornea power,and astigmatism(at least 10%of the cases with a difference of>10 degrees in meridian)between the two devices.CONCLUSION:The study findings demonstrate a significant difference in K,PK,astigmatism,and CD,indicating that the two optical biometers cannot be considered interchangeable.Therefore,it is recommended to utilize one kind device for follow-up examinations in myopic children.展开更多
BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar k...BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.展开更多
Conventional multilevel inverters often suffer from high harmonic distortion and increased design complexity due to the need for numerous power semiconductor components,particularly at elevated voltage levels.Addressi...Conventional multilevel inverters often suffer from high harmonic distortion and increased design complexity due to the need for numerous power semiconductor components,particularly at elevated voltage levels.Addressing these shortcomings,thiswork presents a robust 15-level PackedUCell(PUC)inverter topology designed for renewable energy and grid-connected applications.The proposed systemintegrates a sensor less proportional-resonant(PR)controller with an advanced carrier-based pulse width modulation scheme.This approach efficiently balances capacitor voltage,minimizes steady-state error,and strongly suppresses both zero and third-order harmonics resulting in reduced total harmonic distortion and enhanced voltage regulation.Additionally,a novel switching algorithm simplifies the design and implementation,further lowering voltage stress across switches.Extensive simulation results validate the performance under various resistive and resistive-inductive load conditions,demonstrating compliance with IEEE-519 THD standards and robust operation under dynamic changes.The proposed sensorless PR-controlled 15-PUC inverter thus offers a compelling,cost-effective solution for efficient power conversion in next-generation renewable energy systems.展开更多
In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment...In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.展开更多
BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
Despite the advancement of technology and neoadjuvant/adjuvant chemotherapy,molecular targeted agents,gastrectomy,and D2 lymph node dissection are the only curative treatment option for advanced gastric cancer(GC).The...Despite the advancement of technology and neoadjuvant/adjuvant chemotherapy,molecular targeted agents,gastrectomy,and D2 lymph node dissection are the only curative treatment option for advanced gastric cancer(GC).The most common sites of recurrence in patients with GC are the peritoneum and omentum.The omentum contains areas rich in lymphatic tissue(the milky area)that form the connection between the peritoneum and the lymphatic system.Tumor cells are often found in these areas.Therefore,omentectomy is added to radical gastric resection and modified D2 lymph node dissection in the treatment of GC.Total omentectomy is recommended by Western countries for GC diagnosed at T3-4 stage,while Japanese research suggests partial omentectomy at T1-2 stage and total omentectomy at T3-4 stage due to early diagnosis of GC.In addition to the differences in tumor biology,the fact that patients in Western countries are more likely to receive perioperative chemotherapy and the 5%incidence of omental metastasis in advanced disease has led to the belief that partial omentectomy is an adequate surgical procedure compared with total omentectomy.There are studies recommending total omentectomy for the removal of possible tumor foci,and there are some studies reporting that partial omentectomy is sufficient even in advanced GC.The aim of this review was to investigate whether total or partial omentectomy should be performed in patients with GC.展开更多
BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the p...BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.展开更多
With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in Chi...With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in China have changed is insufficient.This study utilized hourly concentration data from ground observation stations and the official air quality guidelines of the Ministry of Ecology and Environment of China and the World Health Organization as standards to systematically investigate the spatiotemporal characteristics and short-term exposure risks of air pollution in China from 2015 to 2022.The results indicate that various atmospheric pollutants except for ozone showed a decreasing trend yearly.Nationwide,both single pollutant air pollution days(SAPDs)and multiple pollutant air pollution days(MAPDs)showed varying degrees of reduction within 15 and 25 days,respectively.SAPD was dominated mainly by excessive PM_(2.5)and PM_(10)pollutants,while MAPD was dominated mainly by excessive pollutant combinations,including PM_(2.5)+PM_(10),CO+PM_(2.5)+PM_(10),and SO_(2)+PM_(2.5)+PM_(10).As the concentration of atmospheric pollutants decreased,the total excess risk(ER)decreased yearly from 2015 to 2022,but there were significant regional differences.Now,the ER is less than 0.25%in southern China,in the range of 0.25%-0.5%in the North China Plain and some cities in the northeast,and higher than 1%in the northwest.Particulate matter is currently the primary pollutant posing short-term exposure risk in China,especially due to the impact of sandstorm weather.This study indicates that China’s atmospheric cleaning action is significantly beneficial for reducing health risks.展开更多
文摘After the publication of History and Class Consciousness, the concept of totality became an important role through Georg Lukacs’ development of thought. Yet, this concept changed with his thinking. Indeed, totality as an idea had emerged in his critique of capitalist culture in his pre-Marxism;we can claim that the concept of totality as Marxist dialectics originated in that period. Thus, it is necessary to interpret his idea of totality in pre-Marxism in order to understand wholly the concept of totality.
文摘Setting out from the categories of totality and histori（ci）sm in Kosik＇s Dialectics of the Concrete, we look at the relationship between theory and praxis： empty, abstract totality versus concrete, reified and alienated practice （Lukacs, Habermas, Honneth）; a bad totality, in which the real polydimensional subject is replaced by the one-dimensional, mythologized, fetishized, and economistically reduced ＂subject＂ of consummation （Marcuse, Baudrillard）. The dialectics of concrete totality implies a marxistic critique of the ethical and juristic universalism, in the context of the ＂positive＂ side of globalization and political unilateralism, as a concrete, militant, hegemonistic, post-colonial, and neo-imperial practice （Apel, Habermas, Chomsky, Zinoviev）; globalization as totali（tari）zation, the ＂last man,＂ the ＂end of history,＂ and the ＂end＂ of dialectics in its neo-liberal, eschatological, empty ideological ＂realization＂ （Hegel, Marx, Fukuyama, Arendt）; the totality of the （invariable） being as a pseudo-concrete and pseudo-dialectical ontologistic speculation （Heidegger）： A ＂return＂ to a concrete history and a return of the ＂positive＂ dialectics as a critical awareness, mind, and method in the discourse ＂game＂ of human＇s cognitive, creative, and practical powers. The assumption of Kosik＇s humanism is a synchrony of nature and history in the ＂absolute＂ totality of human＇s concrete existence （Lukacs, Goldmann, Adorno, Sartre, Kosik）.
文摘In this study,polyacrylic acid(PAA)films were employed as a model system,and a series of PAA films with tunable water wettability was systematically prepared by varying molecular weight and curing temperature.Using attenuated total reflectance Fourier-transform infrared spectroscopy(ATR-FTIR),the molecular configurations of surface carboxyl groups(COOH),free carboxyl(COOH_(f))and hydrogen-bonded carboxyl(COOH_(HB),were directly correlated with the polar component of surface energy(γ^(s,p)).By decomposing theγ^(s,p)values of the PAA thin films as a sum of the contributions of COOH_(f)and COOH_(H B),the intrinsic polar component of surface energy of COOH_(H B)(γ_(H B)^(s,p*))was quantified for the first time as 8.34 mN/m,significantly lower than that of COOH_(f)(γ_(f)^(s,p*)=34 mN/m).This result highlights that hydrogen bonding markedly reduces theγ^(s,p),providing a rational explanation for the relatively large water contact angle observed on PAA thin films.Furthermore,it establishes a thermodynamic basis for estimating the fraction of surface COOH_(H B)groups(f H B)from wettability measurements.Further extension of the model to carboxyl-terminated self-assembled monolayers(COOH-SAMs)revealed that surface COOH density(ΣCOOH)critically regulates wetting behavior:whenΣCOOH ranges from 4.30 to 5.25 nm^(-2),COOH groups predominantly exist in a free state and facilitate effective hydration layers,thereby promoting superhydrophilicity.Overall,this study not only establishes a unified thermodynamic framework linking surface COOH configurations to macroscopic wettability,but also validates its universality by extending it to COOH-SAMs systems,thereby providing a unified theoretical framework for the controllable design of hydrophilicity in various COOH-functionalized surfaces.
文摘The Comedy is another of Chen Yan's masterpieces of realism after The Backstage Clan and The Protagonist.The difference is that the portrayal of He Jiabei in The Comedy echoes the theoretical idea of"typical characters under typical circumstances."Through studies on Chen Yan's writing in a tensive theoretical space of"typicality,"we find that he has applied several important"typical"theories to his novels.He Jiabei,as a"typical character under typical circumstances"no longer embodies the ideal value as did Yi Qin'e in The Protagonist.The function of this character regardsthe communication between individuals and thetimes,phenomenon and essence."Typical characters under typical circumstances"is a theory generated from an analysis of realism inseparable from the"totality"of the times and history.The focus of The Comedy,a novel based on this theory,has also shifted from creating characters with distinct traits toexploring the historical essence of theera of"comedy."
文摘Builders of a New Life(Chuangyeshi)is a novel that takes a deep dive into the essence of historical materialism and dialectical materialism.The novel creates a literary form of political metanarrative and presents the literary narrative of the rural cooperative movement in China within the framework of socialist revolution,through a plot with the connotation of documentary political economy.At the literary narrative level,Builders of a New Life develops the narrative through the subjective perspectives of numerous characters,which pushes the development of the plot forward and bridges the text world with external reality.The result is the creation of a world of general literature unifying thought,emotion and action,along with the development of a distinctive epic narrative form.
基金funded by a Project from China Southern Power Grid Company Ltd.(Nos.ZBKJXM20232481 and ZBKJXM20232482)。
文摘This study investigates the distinct impacts of eastern Pacific(EP)and central Pacific(CP)El Niño events on winter shortwave solar radiation(SSR)in southern China,revealing different spatial distributions and underlying mechanisms.The results show that,during the developing winter of EP El Niño,significant SSR reductions occur in southwestern China and the east coast of southern China due to a strong,zonally extended Northwest Pacific anticyclone that transports moisture from the tropical Northwest Pacific and North Indian Ocean,while the northeast of southern China experiences a weak increase in SSR.In contrast,during the developing winter of CP El Niño,SSR decreases in the east of southern China with a significant decrease in the lower basin of the Yangtze River but an increase in the west of southern China with a remarkable increase in eastern Yunnan.The pronounced east-west dipole pattern in SSR anomalies is driven by a meridionally elongated Northwest Pacific anticyclone,which enhances northward moisture transport to the east of southern China while leaving western areas drier.Further research reveals that distinct moisture anomalies during the developing winter of EP and CP events result in divergent SSR distributions across southern China,primarily through modulating the total cloud cover.These findings highlight the critical need to differentiate between El Niño types when predicting medium and long-term variability of radiation in southern China.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
文摘Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.
文摘BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.
基金Supported by National Natural Science Foundation of Guangdong,China(No.2020A1515010829,No.2023A1515011652,No.2025A1515012389)Science and Technology Program of Guangzhou,China(No.2025A03J4033).
文摘AIM:To evaluate the agreement of axial length(AL),anterior chamber parameters,and total cornea power obtained by swept-source optical coherence tomography(SS-OCT)-based and Scheimpflug-based optical biometers in myopic children.METHODS:AL,steep keratometry(K),flat K,posterior corneal keratometry(PK),total keratometry(TK),anterior chamber depth(ACD),horizontal corneal diameter(CD),and central corneal thickness(CCT)were obtained using IOL Master 700 and Pentacam AXL.The agreement between the devices was evaluated using intraclass correlation coefficients(ICC),Bland-Altman plots,and astigmatism vector analysis.RESULTS:Totally 175 myopic children(48.5%male)with a mean age of 10.29±2.14y were enrolled.The ICC and Bland-Altman plots indicated a satisfactory agreement for AL,ACD,and CCT.The mean difference in CD of-0.31±0.30 mm was considered clinically significant(>0.2 mm).Additionally,measurements of K and TK obtained from the IOL Master 700 showed good agreement.Nevertheless,there were clinically significant differences observed in PK,simulated keratometry(simK),total cornea power,and astigmatism(at least 10%of the cases with a difference of>10 degrees in meridian)between the two devices.CONCLUSION:The study findings demonstrate a significant difference in K,PK,astigmatism,and CD,indicating that the two optical biometers cannot be considered interchangeable.Therefore,it is recommended to utilize one kind device for follow-up examinations in myopic children.
文摘BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.
文摘Conventional multilevel inverters often suffer from high harmonic distortion and increased design complexity due to the need for numerous power semiconductor components,particularly at elevated voltage levels.Addressing these shortcomings,thiswork presents a robust 15-level PackedUCell(PUC)inverter topology designed for renewable energy and grid-connected applications.The proposed systemintegrates a sensor less proportional-resonant(PR)controller with an advanced carrier-based pulse width modulation scheme.This approach efficiently balances capacitor voltage,minimizes steady-state error,and strongly suppresses both zero and third-order harmonics resulting in reduced total harmonic distortion and enhanced voltage regulation.Additionally,a novel switching algorithm simplifies the design and implementation,further lowering voltage stress across switches.Extensive simulation results validate the performance under various resistive and resistive-inductive load conditions,demonstrating compliance with IEEE-519 THD standards and robust operation under dynamic changes.The proposed sensorless PR-controlled 15-PUC inverter thus offers a compelling,cost-effective solution for efficient power conversion in next-generation renewable energy systems.
文摘In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.
文摘BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
文摘Despite the advancement of technology and neoadjuvant/adjuvant chemotherapy,molecular targeted agents,gastrectomy,and D2 lymph node dissection are the only curative treatment option for advanced gastric cancer(GC).The most common sites of recurrence in patients with GC are the peritoneum and omentum.The omentum contains areas rich in lymphatic tissue(the milky area)that form the connection between the peritoneum and the lymphatic system.Tumor cells are often found in these areas.Therefore,omentectomy is added to radical gastric resection and modified D2 lymph node dissection in the treatment of GC.Total omentectomy is recommended by Western countries for GC diagnosed at T3-4 stage,while Japanese research suggests partial omentectomy at T1-2 stage and total omentectomy at T3-4 stage due to early diagnosis of GC.In addition to the differences in tumor biology,the fact that patients in Western countries are more likely to receive perioperative chemotherapy and the 5%incidence of omental metastasis in advanced disease has led to the belief that partial omentectomy is an adequate surgical procedure compared with total omentectomy.There are studies recommending total omentectomy for the removal of possible tumor foci,and there are some studies reporting that partial omentectomy is sufficient even in advanced GC.The aim of this review was to investigate whether total or partial omentectomy should be performed in patients with GC.
文摘BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.
基金supported by the National Natural Science Foundation of China(No.42205178)China Postdoctoral Science Foundation(No.2022M720459).
文摘With the continuous control of anthropogenic emissions,China’s air quality has improved significantly in recent years.Given this background,research on how the short-term exposure risks caused by air pollution in China have changed is insufficient.This study utilized hourly concentration data from ground observation stations and the official air quality guidelines of the Ministry of Ecology and Environment of China and the World Health Organization as standards to systematically investigate the spatiotemporal characteristics and short-term exposure risks of air pollution in China from 2015 to 2022.The results indicate that various atmospheric pollutants except for ozone showed a decreasing trend yearly.Nationwide,both single pollutant air pollution days(SAPDs)and multiple pollutant air pollution days(MAPDs)showed varying degrees of reduction within 15 and 25 days,respectively.SAPD was dominated mainly by excessive PM_(2.5)and PM_(10)pollutants,while MAPD was dominated mainly by excessive pollutant combinations,including PM_(2.5)+PM_(10),CO+PM_(2.5)+PM_(10),and SO_(2)+PM_(2.5)+PM_(10).As the concentration of atmospheric pollutants decreased,the total excess risk(ER)decreased yearly from 2015 to 2022,but there were significant regional differences.Now,the ER is less than 0.25%in southern China,in the range of 0.25%-0.5%in the North China Plain and some cities in the northeast,and higher than 1%in the northwest.Particulate matter is currently the primary pollutant posing short-term exposure risk in China,especially due to the impact of sandstorm weather.This study indicates that China’s atmospheric cleaning action is significantly beneficial for reducing health risks.
