As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatri...As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.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
BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation...BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
Organic and pharmaceutical synthesis have traditionally relied on the stepwise transformation ofactivated functional groups to synthesize cyclic molecules.The design of valuable heterocyclic compounds,for instance,has...Organic and pharmaceutical synthesis have traditionally relied on the stepwise transformation ofactivated functional groups to synthesize cyclic molecules.The design of valuable heterocyclic compounds,for instance,has depended on multi-step routes such as polar or radical cyclization,cycloadditions,and the manipulation of various functional groups to achieve ring formation or connection[1,2].展开更多
Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 199...Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.T...To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.This source is based on spontaneous four-wave mixing(SFWM)in a piece of shallow-ridge silicon waveguide.Theoretical analysis shows that the waveguide dispersion could be tailored by adjusting the ridge width,enabling broadband photon pair generation by SFWM across C band and O band.The spontaneous Raman scattering(SpRS)in silicon waveguides is also investigated experimentally.It shows that there are two regions in the spectrum of generated photons from SpRS,which could be used to achieve cross-band photon pair generation.A chip of shallow-ridge silicon waveguide samples with different ridge widths has been fabricated,through which cross-band photon pair generation is demonstrated experimentally.The experimental results show that the source can be achieved using dispersion-optimized shallow-ridge silicon waveguides.This cross-band quantum light source provides a way to develop new fiber-based quantum communication functions utilizing both C band and O band and extends applications of quantum networks.展开更多
AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:Thi...AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.展开更多
Climate warming is significantly altering the distribution of tree species,which holds crucial implications for China’s Larix species as they are important afforestation efforts.Understanding their optimal habitats a...Climate warming is significantly altering the distribution of tree species,which holds crucial implications for China’s Larix species as they are important afforestation efforts.Understanding their optimal habitats and environmental constraints is vital for predicting range shifts and guiding adaptive forest management.Previous studies prioritized changing climate impacts on horizontal range shifts of Larix,neglecting the influence of soil factors and range shift along altitudinal gradients.To address this,we applied an optimized MaxEnt model to assess current and future SSP126/SSP585 scenarios,three-dimensional habitat suitability(latitude,longitude,altitude)for four major Larix species(L.principis-rupprechtii,L.gmelinii,L.kaempferi,L.olgensis),while identifying key environmental drivers.Our results indicate that elevation and extreme moisture conditions universally constrain their distribution.Soil chemistry properties exhibited species-specific influences:cation exchange capacity critically shaped L.principis-rupprechtii and L.gmelinii ranges,whereas exchangeable aluminum determined L.kaempferi and L.olgensis distribution.Under future climate scenarios,habitat areas show divergent trajectories-L.principis-rupprechtii maximum gains 5.1%under SSP126,while L.kaempferi maximum expands 15.1%.Conversely,SSP585 triggered a 3.7% decline for L.gmelinii during the 2040s−2100s,and L.olgensis faces a net reduction to 0.4% by 2100s despite transient gains.Spatially,three species(L.kaempferi,L.gmelinii,L.olgensis)shifted northward,while L.principis-rupprechtii migrated northwest.All species distribution ascended altitudinally reflecting thermal adaptation strategies.These multidimensional insights enable targeted species selection for climate-resilient afforestation and underscore the need for soil-inclusive management planning.展开更多
CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be...CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.展开更多
Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabe...Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabetic patients in Dakar. Methodology: It was a retrospective, multicenter and descriptive study, carried out over a period of 12 months from 19 September 2019 to 19 September 2020 in four cardiology centers in Dakar. Included was any diabetic patient admitted for STEMI. Data analysis was done with the SPSS (Statistical Package for Sciences Socials) software. Results: A total of 87 diabetic patients were included, for a prevalence of 29.7%. The average age of patients was 60 years. The predominance was male with a sex ratio of 1.1. Diabetes was mostly type 2 (99%) and most patients were on oral antidiabetics (56%). Glycemic imbalance was noted in 24.1% of patients. The associated cardiovascular risk factors were hypertension (51%), dyslipidemia (51%) and physical inactivity (41.4%). Chest pain was typical in 76% of cases. The average time between onset of pain and first medical contact was 47 hours. The electrocardiogram had reached mainly the anterior (25%) and inferior (27%) territories with necrosis Q waves in 37.9% of cases. The coronary angiography was done for 63 patients and found one hundred and twenty-three significant lesions distributed in three-vessel (48%), single-vessel (33%) and two-vessel (14%) disease. Percutaneous coronary intervention (PCI) was performed in 37 patients (42.2%) and thrombolysis in 7 patients. The evolution was favourable in most cases (82%). The reported complications were: 4 cardiogenic shocks, 3 rhythm disorders, 2 conduction disorders and 2 strokes. Four patients had died during hospitalization, for a hospital mortality of 4.59%. Conclusion: STEMI in diabetics are diagnosed with considerable delay in Dakar. The coronary involvement is severe. Their support under optimal. Improving management requires a multidisciplinary approach involving the diabetologist, emergency physician and cardiologist.展开更多
Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following...Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.展开更多
The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exace...The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.展开更多
Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October...Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October 2019 were randomly divided into two groups (control group and observation group) with 43 cases in each group. The operation time, incidence of side effects and satisfaction were observed. Results: the operation time of the observation group was 21.33±4.81 min, and the satisfaction score (89.37±2.61) was lower than that of the control group (P < 0.05). The incidence of adverse reactions in the observation group (4.65%) was lower than that in the control group (20.93%), P < 0.05. Conclusion: the application of four-hand operation in the nursing cooperation of stomatology department can reduce the operation time, reduce the incidence of adverse reactions and improve patient satisfaction, which is worthy of reference.展开更多
The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a ...The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a novel carrier-interleaved pulse width modulation(CIPWM)method that satisfies the volt-sec balance principle is proposed with an advanced carrier distribution rule.By adopting the proposed CIPWM method,the redundant switching states of 4L-NNPC inverters can be evenly distributed into the output PWM waveform in each carrier period,and natural flying-capacitor voltage balance can be achieved.Furthermore,an active balancing strategy is also proposed to eliminate the voltage unbalance caused by nonideal factors,which is realized by simply adjusting the duty cycle and with no need to adjust the redundant switching states for 4L-NNPC inverters.The simulation and experimental results verify the effectiveness of the proposed CIPWM method and the flying-capacitor voltage balancing strategy.展开更多
Background:Hemorrhagic expansion into the fourth ventricle is an independent risk factor for poor outcomes in intraventricular hemorrhage(IVH)patients.However,to date,available animal models of IVH are limited to mode...Background:Hemorrhagic expansion into the fourth ventricle is an independent risk factor for poor outcomes in intraventricular hemorrhage(IVH)patients.However,to date,available animal models of IVH are limited to models of supratentorial ventricular hemorrhage,and there are no specific models of fourth ventricle hemorrhage.This limitation hinders comprehensive basic research and the understanding of the pathophysiological changes that occur following fourth ventricle hemorrhage.Therefore,the development of an animal model of fourth ventricle hemorrhage is highly important.Methods:In this study,a novel rat model of fourth ventricle hemorrhage was established via autologous blood injection through the foramen of Magendie.Anesthetized rats were positioned in a stereotaxic apparatus with their heads tilted downward at an angle of approximately 20°relative to the vertical axis.A needle was inserted through the foramen,and autologous blood obtained from the rat's heart was injected into the fourth ventricle via a microinfusion pump.Systematic evaluations of the model were conducted using small-animal magnetic resonance imaging,histopathological analysis,and neurological function assessment.Results:The rats developed stable and reproducible fourth ventricle hematomas and ventricular dilation.They also exhibited acute-phase hydrocephalus and pathological features of perilesional brain tissue injury,with observed neurological deficits comparable to patients with fourth ventricle hemorrhage.Conclusion:This model successfully recapitulates the clinicopathological and pathophysiological characteristics of patients with fourth ventricle hemorrhage and can be utilized for further investigation into the pathophysiological mechanisms underlying posthemorrhagic hydrocephalus and perilesional brainstem tissue injury.展开更多
Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)at...Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.展开更多
VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a ra...VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.展开更多
Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with m...Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.展开更多
文摘As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.
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BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
基金supported by the MSIT(2022R1F1A106268,RS-2023-00213491,RS-2023-00219859,RS-2024-00405261,RS-2024-00409589,RS-2025-25460522,and RS-2025-00642970)Republic of Korea,the InnoCORE program of the Ministry of Science and ICT of Korea(N10250153 and 1.250022.01)the Creative Research Program and KAIST Cross-Generation Collaborative Lab Project.
文摘Organic and pharmaceutical synthesis have traditionally relied on the stepwise transformation ofactivated functional groups to synthesize cyclic molecules.The design of valuable heterocyclic compounds,for instance,has depended on multi-step routes such as polar or radical cyclization,cycloadditions,and the manipulation of various functional groups to achieve ring formation or connection[1,2].
基金Supported by the National Natural Science Foundation of China(No.82070991).
文摘Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
基金supported by the Quantum Science and Technology-National Science and Technology Major Project (Grant No.2024ZD0302502 for WZ)the National Natural Science Foundation of China(Grant No.92365210 for WZ)+1 种基金Tsinghua Initiative Scientific Research Program (for WZ)the project of Tsinghua University-Zhuhai Huafa Industrial Share Company Joint Institute for Architecture Optoelectronic Technologies (JIAOT,for YH)。
文摘To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.This source is based on spontaneous four-wave mixing(SFWM)in a piece of shallow-ridge silicon waveguide.Theoretical analysis shows that the waveguide dispersion could be tailored by adjusting the ridge width,enabling broadband photon pair generation by SFWM across C band and O band.The spontaneous Raman scattering(SpRS)in silicon waveguides is also investigated experimentally.It shows that there are two regions in the spectrum of generated photons from SpRS,which could be used to achieve cross-band photon pair generation.A chip of shallow-ridge silicon waveguide samples with different ridge widths has been fabricated,through which cross-band photon pair generation is demonstrated experimentally.The experimental results show that the source can be achieved using dispersion-optimized shallow-ridge silicon waveguides.This cross-band quantum light source provides a way to develop new fiber-based quantum communication functions utilizing both C band and O band and extends applications of quantum networks.
文摘AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.
基金supported by the National Key Research and Development Program of China(2022YFD2200501).
文摘Climate warming is significantly altering the distribution of tree species,which holds crucial implications for China’s Larix species as they are important afforestation efforts.Understanding their optimal habitats and environmental constraints is vital for predicting range shifts and guiding adaptive forest management.Previous studies prioritized changing climate impacts on horizontal range shifts of Larix,neglecting the influence of soil factors and range shift along altitudinal gradients.To address this,we applied an optimized MaxEnt model to assess current and future SSP126/SSP585 scenarios,three-dimensional habitat suitability(latitude,longitude,altitude)for four major Larix species(L.principis-rupprechtii,L.gmelinii,L.kaempferi,L.olgensis),while identifying key environmental drivers.Our results indicate that elevation and extreme moisture conditions universally constrain their distribution.Soil chemistry properties exhibited species-specific influences:cation exchange capacity critically shaped L.principis-rupprechtii and L.gmelinii ranges,whereas exchangeable aluminum determined L.kaempferi and L.olgensis distribution.Under future climate scenarios,habitat areas show divergent trajectories-L.principis-rupprechtii maximum gains 5.1%under SSP126,while L.kaempferi maximum expands 15.1%.Conversely,SSP585 triggered a 3.7% decline for L.gmelinii during the 2040s−2100s,and L.olgensis faces a net reduction to 0.4% by 2100s despite transient gains.Spatially,three species(L.kaempferi,L.gmelinii,L.olgensis)shifted northward,while L.principis-rupprechtii migrated northwest.All species distribution ascended altitudinally reflecting thermal adaptation strategies.These multidimensional insights enable targeted species selection for climate-resilient afforestation and underscore the need for soil-inclusive management planning.
文摘CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.
文摘Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabetic patients in Dakar. Methodology: It was a retrospective, multicenter and descriptive study, carried out over a period of 12 months from 19 September 2019 to 19 September 2020 in four cardiology centers in Dakar. Included was any diabetic patient admitted for STEMI. Data analysis was done with the SPSS (Statistical Package for Sciences Socials) software. Results: A total of 87 diabetic patients were included, for a prevalence of 29.7%. The average age of patients was 60 years. The predominance was male with a sex ratio of 1.1. Diabetes was mostly type 2 (99%) and most patients were on oral antidiabetics (56%). Glycemic imbalance was noted in 24.1% of patients. The associated cardiovascular risk factors were hypertension (51%), dyslipidemia (51%) and physical inactivity (41.4%). Chest pain was typical in 76% of cases. The average time between onset of pain and first medical contact was 47 hours. The electrocardiogram had reached mainly the anterior (25%) and inferior (27%) territories with necrosis Q waves in 37.9% of cases. The coronary angiography was done for 63 patients and found one hundred and twenty-three significant lesions distributed in three-vessel (48%), single-vessel (33%) and two-vessel (14%) disease. Percutaneous coronary intervention (PCI) was performed in 37 patients (42.2%) and thrombolysis in 7 patients. The evolution was favourable in most cases (82%). The reported complications were: 4 cardiogenic shocks, 3 rhythm disorders, 2 conduction disorders and 2 strokes. Four patients had died during hospitalization, for a hospital mortality of 4.59%. Conclusion: STEMI in diabetics are diagnosed with considerable delay in Dakar. The coronary involvement is severe. Their support under optimal. Improving management requires a multidisciplinary approach involving the diabetologist, emergency physician and cardiologist.
文摘Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.
基金The Henan Key Research and Development and Promotion Project(Grant No.232102310245)the Joint Construction Project of Medical Science and Technology of Henan Province(Grant No.LHGJ20220426).
文摘The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.
文摘Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October 2019 were randomly divided into two groups (control group and observation group) with 43 cases in each group. The operation time, incidence of side effects and satisfaction were observed. Results: the operation time of the observation group was 21.33±4.81 min, and the satisfaction score (89.37±2.61) was lower than that of the control group (P < 0.05). The incidence of adverse reactions in the observation group (4.65%) was lower than that in the control group (20.93%), P < 0.05. Conclusion: the application of four-hand operation in the nursing cooperation of stomatology department can reduce the operation time, reduce the incidence of adverse reactions and improve patient satisfaction, which is worthy of reference.
基金supported by Beijing Natural Science Foundation under Grant L242006.
文摘The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a novel carrier-interleaved pulse width modulation(CIPWM)method that satisfies the volt-sec balance principle is proposed with an advanced carrier distribution rule.By adopting the proposed CIPWM method,the redundant switching states of 4L-NNPC inverters can be evenly distributed into the output PWM waveform in each carrier period,and natural flying-capacitor voltage balance can be achieved.Furthermore,an active balancing strategy is also proposed to eliminate the voltage unbalance caused by nonideal factors,which is realized by simply adjusting the duty cycle and with no need to adjust the redundant switching states for 4L-NNPC inverters.The simulation and experimental results verify the effectiveness of the proposed CIPWM method and the flying-capacitor voltage balancing strategy.
基金Natural Science Foundation of Hubei Province,Grant/Award Number:2024AFB877the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science&Technology Bureau),Grant/Award Number:2023GGXM003+3 种基金Chongqing Municipal Health Commission,Grant/Award Number:YXGD202451Organization Department of Chongqing Municipal Party Committee,Grant/Award Number:cstc2024ycjh-bgzxm0103National Natural Science Foundation of China,Grant/Award Number:82371361Jingmen Science and Technology Bureau,Grant/Award Number:2024ZDYF012。
文摘Background:Hemorrhagic expansion into the fourth ventricle is an independent risk factor for poor outcomes in intraventricular hemorrhage(IVH)patients.However,to date,available animal models of IVH are limited to models of supratentorial ventricular hemorrhage,and there are no specific models of fourth ventricle hemorrhage.This limitation hinders comprehensive basic research and the understanding of the pathophysiological changes that occur following fourth ventricle hemorrhage.Therefore,the development of an animal model of fourth ventricle hemorrhage is highly important.Methods:In this study,a novel rat model of fourth ventricle hemorrhage was established via autologous blood injection through the foramen of Magendie.Anesthetized rats were positioned in a stereotaxic apparatus with their heads tilted downward at an angle of approximately 20°relative to the vertical axis.A needle was inserted through the foramen,and autologous blood obtained from the rat's heart was injected into the fourth ventricle via a microinfusion pump.Systematic evaluations of the model were conducted using small-animal magnetic resonance imaging,histopathological analysis,and neurological function assessment.Results:The rats developed stable and reproducible fourth ventricle hematomas and ventricular dilation.They also exhibited acute-phase hydrocephalus and pathological features of perilesional brain tissue injury,with observed neurological deficits comparable to patients with fourth ventricle hemorrhage.Conclusion:This model successfully recapitulates the clinicopathological and pathophysiological characteristics of patients with fourth ventricle hemorrhage and can be utilized for further investigation into the pathophysiological mechanisms underlying posthemorrhagic hydrocephalus and perilesional brainstem tissue injury.
文摘Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.
基金National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital).
文摘VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.
文摘Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
