Municipal solid waste generation is strongly linked to rising human population and expanding urban areas, with significant implications on urban metabolism as well as space and place values redefinition. Effective man...Municipal solid waste generation is strongly linked to rising human population and expanding urban areas, with significant implications on urban metabolism as well as space and place values redefinition. Effective management performance of municipal solid waste management underscores the interdisciplinarity strategies. Such knowledge and skills are paramount to uncover the sources of waste generation as well as means of waste storage, collection, recycling, transportation, handling/treatment, disposal, and monitoring. This study was conducted in Dar es Salaam city. Driven by the curiosity model of the solid waste minimization performance at source, study data was collected using focus group discussion techniques to ward-level local government officers, which was triangulated with literature and documentary review. The main themes of the FGD were situational factors (SFA) and local government by-laws (LGBY). In the FGD session, sub-themes of SFA tricked to understand how MSW minimization is related to the presence and effect of services such as land use planning, availability of landfills, solid waste transfer stations, material recovery facilities, incinerators, solid waste collection bins, solid waste trucks, solid waste management budget and solid waste collection agents. Similarly, FGD on LGBY was extended by sub-themes such as contents of the by-law, community awareness of the by-law, and by-law enforcement mechanisms. While data preparation applied an analytical hierarchy process, data analysis applied an ordinary least square (OLS) regression model for sub-criteria that explain SFA and LGBY;and OLS standard residues as variables into geographically weighted regression with a resolution of 241 × 241 meter in ArcMap v10.5. Results showed that situational factors and local government by-laws have a strong relationship with the rate of minimizing solid waste dumping in water bodies (local R square = 0.94).展开更多
Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA...Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.展开更多
BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopi...BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.展开更多
BACKGROUND The main clinical treatment for esophageal cancer is surgery.Since traditional open esophageal cancer resection has the disadvantages of large trauma,long recovery period,and high postoperative complication...BACKGROUND The main clinical treatment for esophageal cancer is surgery.Since traditional open esophageal cancer resection has the disadvantages of large trauma,long recovery period,and high postoperative complication rate,its clinical application is gradually reduced.The current report of minimally invasive Ivor-Lewis esophagectomy(MIILE)is increasing.However,researchers found that patients with MIILE had a higher incidence of early delayed gastric emptying(DGE).AIM To investigate the influencing factors of postoperative early DGE after MIILE.METHODS A total of 156 patients diagnosed with esophageal cancer at Deyang People's Hospital were enrolled.According to the criteria of DGE,patients were assigned to a DGE group(n=49)and a control group(n=107).The differences between the DGE group and the control group were compared.Multivariate logistic regression analysis was used to further determine the influencing factors of postoperative early DGE.The receiver operating characteristic(ROC)curve was used to assess potential factors in predicting postoperative early DGE.RESULTS Age,intraoperative blood loss,chest drainage time,portion of anxiety score≥45 points,analgesia pump use,postoperative to enteral nutrition interval,and postoperative fluid volume in the DGE group were higher than those in the control group.Perioperative albumin level in the DGE group was lower than that in the control group(P<0.05).Age,anxiety score,perioperative albumin level,and postoperative fluid volume were independent factors influencing postoperative early DGE,and the differences were statistically significant(P<0.05).The ROC curve analysis revealed that the area under the curve(AUC)foranxiety score was 0.720.The optimum cut-off value was 39,and the sensitivity and specificity were 80.37%and 65.31%,respectively.The AUC for postoperative fluid volume were 0.774.The optimal cut-off value was 1191.86 mL,and the sensitivity and specificity were 65.3%and 77.6%,respectively.The AUC for perioperative albumin level was 0.758.The optimum cut-off value was 26.75 g/L,and the sensitivity and specificity were 97.2%and 46.9%,respectively.CONCLUSION Advanced age,postoperative anxiety,perioperative albumin level,and postoperative fluid volume can increase the incidence of postoperative early DGE.展开更多
Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hy...Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases) and routine group (41 cases). Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and serum protein (SF), serum substance P (SP) in the 2 groups were detected before treatment and 2 weeks after treatment.Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05). TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01,P<0.05). TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01);The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01,P<0.05). SP in minimally invasive group increased more significantly than that in routine group (P<0.05).Conclusions:Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively.展开更多
Objective: To investigate the effects of minimally invasive evacuation of intracranial hematoma on serum SP, SF, vascular endothelial function and inflammatory factors of patients with hypertensive intracerebral hemor...Objective: To investigate the effects of minimally invasive evacuation of intracranial hematoma on serum SP, SF, vascular endothelial function and inflammatory factors of patients with hypertensive intracerebral hemorrhage. Methods: According to random data table method, a total of 120 patients with hypertensive cerebral hemorrhage from September 2016 to May 2017 were divided into observation group and the control group, 60 cases in each group. The control group was treated with conventional treatment;on the basis of conventional treatment, the observation group underwent minimally invasive evacuation of intracranial hematoma. The levels of serum SF, SP, vascular endothelial function and inflammatory factors changes were compared between the two groups before and after the treatment. Results: Before treatment, the levels of serum SP, SF, NO, ET-1, hs-CRP, IL-6, TNF-α in the two groups were not statistically significant. The levels of hs-CRP, IL-6, TNF-α, SF, ET-1 after treatment in two groups were significantly lower than those in the same group before treatment, and the observation group levels were significantly lower than those in the control group;the levels of SP, NO in the two groups after treatment were significantly higher than before treatment, and the observation group was higher than that the control group with significant difference. Conclusion: The minimally invasive intracranial hematoma evacuation for patients with HICH can effectively improve the levels of SP, SF, inflammatory factors and vascular endothelial function, which is helpful to relieve cerebral edema and lower intracranial pressure, and improve the quality of treatment.展开更多
目的探究女性良性乳腺肿瘤患者行超声引导微创旋切术对手术相关指标、创伤应激指标的影响。方法102例女性良性乳腺肿瘤患者,按手术方式不同分为对照组和观察组,各51例。对照组行传统开放手术治疗,观察组行超声引导微创旋切手术治疗。对...目的探究女性良性乳腺肿瘤患者行超声引导微创旋切术对手术相关指标、创伤应激指标的影响。方法102例女性良性乳腺肿瘤患者,按手术方式不同分为对照组和观察组,各51例。对照组行传统开放手术治疗,观察组行超声引导微创旋切手术治疗。对比两组手术相关指标、创伤应激指标[肾上腺素(E)、皮质醇(Cor)、去甲肾上腺素(NE)]、疼痛因子[神经肽Y(NPY)、前列腺素E_(2)(PGE_(2))、5-羟色胺(5-HT)]水平、乳房美观度、并发症发生情况。结果观察组手术时间(17.61±2.18)min、切口长度(3.41±0.52)mm、住院时间(4.33±1.24)d短于对照组的(34.15±3.64)min、(22.64±5.13)mm、(6.25±1.89)d,术中出血量(10.62±2.93)ml少于对照组的(18.61±3.44)ml(P<0.05)。两组术后24 h E、Cor、NE水平均较术前升高,但观察组术后24 h E(68.24±6.13)ng/ml、Cor(102.39±12.55)nmol/L、NE(71.05±4.16)ng/ml均低于对照组的(95.63±8.24)ng/ml、(180.44±16.18)nmol/L、(99.43±5.19)ng/ml(P<0.05)。两组术后24 h NPY、PGE_(2)、5-HT均较术前升高,但观察组术后24 h NPY(132.09±13.44)ng/L、PGE_(2)(272.09±16.51)ng/L、5-HT(187.31±18.55)ng/ml均低于对照组的(140.43±15.78)ng/L、(288.61±18.47)ng/L、(196.69±20.01)ng/ml(P<0.05)。观察组优良率96.08%(49/51)高于对照组的82.35%(42/51)(P<0.05)。观察组并发症发生率3.92%(2/51)低于对照组的15.69%(8/51)(P<0.05)。结论女性良性乳腺肿瘤患者行超声引导微创旋切手术可进一步优化手术相关指标,减轻疼痛及创伤应激,减少并发症,提高乳房美观度,具有临床推广应用价值。展开更多
文摘Municipal solid waste generation is strongly linked to rising human population and expanding urban areas, with significant implications on urban metabolism as well as space and place values redefinition. Effective management performance of municipal solid waste management underscores the interdisciplinarity strategies. Such knowledge and skills are paramount to uncover the sources of waste generation as well as means of waste storage, collection, recycling, transportation, handling/treatment, disposal, and monitoring. This study was conducted in Dar es Salaam city. Driven by the curiosity model of the solid waste minimization performance at source, study data was collected using focus group discussion techniques to ward-level local government officers, which was triangulated with literature and documentary review. The main themes of the FGD were situational factors (SFA) and local government by-laws (LGBY). In the FGD session, sub-themes of SFA tricked to understand how MSW minimization is related to the presence and effect of services such as land use planning, availability of landfills, solid waste transfer stations, material recovery facilities, incinerators, solid waste collection bins, solid waste trucks, solid waste management budget and solid waste collection agents. Similarly, FGD on LGBY was extended by sub-themes such as contents of the by-law, community awareness of the by-law, and by-law enforcement mechanisms. While data preparation applied an analytical hierarchy process, data analysis applied an ordinary least square (OLS) regression model for sub-criteria that explain SFA and LGBY;and OLS standard residues as variables into geographically weighted regression with a resolution of 241 × 241 meter in ArcMap v10.5. Results showed that situational factors and local government by-laws have a strong relationship with the rate of minimizing solid waste dumping in water bodies (local R square = 0.94).
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.82200215,82170193,and 82370197)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant No.2022-I2M-1-002)。
文摘Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.
文摘BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
基金Supported by Science and Technology Support Plan of Sichuan Deyang Technology Bureau,No.2015SZ023
文摘BACKGROUND The main clinical treatment for esophageal cancer is surgery.Since traditional open esophageal cancer resection has the disadvantages of large trauma,long recovery period,and high postoperative complication rate,its clinical application is gradually reduced.The current report of minimally invasive Ivor-Lewis esophagectomy(MIILE)is increasing.However,researchers found that patients with MIILE had a higher incidence of early delayed gastric emptying(DGE).AIM To investigate the influencing factors of postoperative early DGE after MIILE.METHODS A total of 156 patients diagnosed with esophageal cancer at Deyang People's Hospital were enrolled.According to the criteria of DGE,patients were assigned to a DGE group(n=49)and a control group(n=107).The differences between the DGE group and the control group were compared.Multivariate logistic regression analysis was used to further determine the influencing factors of postoperative early DGE.The receiver operating characteristic(ROC)curve was used to assess potential factors in predicting postoperative early DGE.RESULTS Age,intraoperative blood loss,chest drainage time,portion of anxiety score≥45 points,analgesia pump use,postoperative to enteral nutrition interval,and postoperative fluid volume in the DGE group were higher than those in the control group.Perioperative albumin level in the DGE group was lower than that in the control group(P<0.05).Age,anxiety score,perioperative albumin level,and postoperative fluid volume were independent factors influencing postoperative early DGE,and the differences were statistically significant(P<0.05).The ROC curve analysis revealed that the area under the curve(AUC)foranxiety score was 0.720.The optimum cut-off value was 39,and the sensitivity and specificity were 80.37%and 65.31%,respectively.The AUC for postoperative fluid volume were 0.774.The optimal cut-off value was 1191.86 mL,and the sensitivity and specificity were 65.3%and 77.6%,respectively.The AUC for perioperative albumin level was 0.758.The optimum cut-off value was 26.75 g/L,and the sensitivity and specificity were 97.2%and 46.9%,respectively.CONCLUSION Advanced age,postoperative anxiety,perioperative albumin level,and postoperative fluid volume can increase the incidence of postoperative early DGE.
文摘Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases) and routine group (41 cases). Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and serum protein (SF), serum substance P (SP) in the 2 groups were detected before treatment and 2 weeks after treatment.Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05). TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01,P<0.05). TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01);The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01,P<0.05). SP in minimally invasive group increased more significantly than that in routine group (P<0.05).Conclusions:Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively.
文摘Objective: To investigate the effects of minimally invasive evacuation of intracranial hematoma on serum SP, SF, vascular endothelial function and inflammatory factors of patients with hypertensive intracerebral hemorrhage. Methods: According to random data table method, a total of 120 patients with hypertensive cerebral hemorrhage from September 2016 to May 2017 were divided into observation group and the control group, 60 cases in each group. The control group was treated with conventional treatment;on the basis of conventional treatment, the observation group underwent minimally invasive evacuation of intracranial hematoma. The levels of serum SF, SP, vascular endothelial function and inflammatory factors changes were compared between the two groups before and after the treatment. Results: Before treatment, the levels of serum SP, SF, NO, ET-1, hs-CRP, IL-6, TNF-α in the two groups were not statistically significant. The levels of hs-CRP, IL-6, TNF-α, SF, ET-1 after treatment in two groups were significantly lower than those in the same group before treatment, and the observation group levels were significantly lower than those in the control group;the levels of SP, NO in the two groups after treatment were significantly higher than before treatment, and the observation group was higher than that the control group with significant difference. Conclusion: The minimally invasive intracranial hematoma evacuation for patients with HICH can effectively improve the levels of SP, SF, inflammatory factors and vascular endothelial function, which is helpful to relieve cerebral edema and lower intracranial pressure, and improve the quality of treatment.
文摘目的探究女性良性乳腺肿瘤患者行超声引导微创旋切术对手术相关指标、创伤应激指标的影响。方法102例女性良性乳腺肿瘤患者,按手术方式不同分为对照组和观察组,各51例。对照组行传统开放手术治疗,观察组行超声引导微创旋切手术治疗。对比两组手术相关指标、创伤应激指标[肾上腺素(E)、皮质醇(Cor)、去甲肾上腺素(NE)]、疼痛因子[神经肽Y(NPY)、前列腺素E_(2)(PGE_(2))、5-羟色胺(5-HT)]水平、乳房美观度、并发症发生情况。结果观察组手术时间(17.61±2.18)min、切口长度(3.41±0.52)mm、住院时间(4.33±1.24)d短于对照组的(34.15±3.64)min、(22.64±5.13)mm、(6.25±1.89)d,术中出血量(10.62±2.93)ml少于对照组的(18.61±3.44)ml(P<0.05)。两组术后24 h E、Cor、NE水平均较术前升高,但观察组术后24 h E(68.24±6.13)ng/ml、Cor(102.39±12.55)nmol/L、NE(71.05±4.16)ng/ml均低于对照组的(95.63±8.24)ng/ml、(180.44±16.18)nmol/L、(99.43±5.19)ng/ml(P<0.05)。两组术后24 h NPY、PGE_(2)、5-HT均较术前升高,但观察组术后24 h NPY(132.09±13.44)ng/L、PGE_(2)(272.09±16.51)ng/L、5-HT(187.31±18.55)ng/ml均低于对照组的(140.43±15.78)ng/L、(288.61±18.47)ng/L、(196.69±20.01)ng/ml(P<0.05)。观察组优良率96.08%(49/51)高于对照组的82.35%(42/51)(P<0.05)。观察组并发症发生率3.92%(2/51)低于对照组的15.69%(8/51)(P<0.05)。结论女性良性乳腺肿瘤患者行超声引导微创旋切手术可进一步优化手术相关指标,减轻疼痛及创伤应激,减少并发症,提高乳房美观度,具有临床推广应用价值。
