BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine lear...BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine learning(ML)model for postoperative pancreatic fistula and identify significant risk factors of the complication.METHODS A single-center retrospective clinical study was conducted which included 150 patients,who underwent pancreat-oduodenectomy.Logistic regression,random forest,and CatBoost were employed for modeling the biochemical leak(symptomless fistula)and fistula grade B/C(clinically significant complication).The performance was estimated by receiver operating characteristic(ROC)area under the curve(AUC)after 5-fold cross-validation(20%testing and 80%training data).The risk factors were evaluated with the most accurate algorithm,based on the parameter“Importance”(Im),and Kendall correlation,P<0.05.RESULTS The CatBoost algorithm was the most accurate with an AUC of 74%-86%.The study provided results of ML-based modeling and algorithm selection for pancreatic fistula prediction and risk factor evaluation.From 14 parameters we selected the main pre-and intraoperative prognostic factors of all the fistulas:Tumor vascular invasion(Im=24.8%),age(Im=18.6%),and body mass index(Im=16.4%),AUC=74%.The ML model showed that biochemical leak,blood and drain amylase level(Im=21.6%and 16.4%),and blood leukocytes(Im=11.2%)were crucial predictors for subsequent fistula B/C,AUC=86%.Surgical techniques,morphology,and pancreatic duct diameter less than 3 mm were insignificant(Im<5%and no correlations detected).The results were confirmed by correlation analysis.CONCLUSION This study highlights the key predictors of postoperative pancreatic fistula and establishes a robust ML-based model for individualized risk prediction.These findings contribute to the advancement of personalized periop-erative care and may guide targeted preventive strategies.展开更多
BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-chann...BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.展开更多
Background: Dementia is a condition with progressive cognitive dysfunction and manifestation of both behavioral and psychosocial symptoms. Non-pharmacological measures such as music therapy are gaining importance sinc...Background: Dementia is a condition with progressive cognitive dysfunction and manifestation of both behavioral and psychosocial symptoms. Non-pharmacological measures such as music therapy are gaining importance since efficacy and safety of people with dementia have been questionable for pharmacological measures. Patient’s response to music is persistent even in the later stage of dementia. Aim: This rapid review aims to identify, analyze, evaluate, and summarize the best available evidence on the effectiveness of music-based therapeutic interventions among people with dementia. Method: CINAHL Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened the literature search results. Effectiveness, music-based therapeutic intervention, dementia, Alzheimer’s disease, systematic review and systematic review with meta-analysis terms were used to abstract data from included studies. Main Findings: 11 SRs and SRs with meta-analysis were reviewed which revealed positive effect of music therapy on five major outcomes with 9 studies effect on behavioral outcome, 6 studies with positive effect on psychosocial outcome reducing anxiety, 6 with improved cognition, 1 study revealed with improved quality of life and 1 study revealed effect on physiological outcomes. Conclusion: Music therapy has positive effect on treatment of dementia but further studies with larger sample size and specified to single intervention should be conducted to provide generalisable and precise results on this topic.展开更多
Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for...Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.展开更多
Objective:Gastric cancer(GC)is a globally common cancer characterized by high incidence and mortality worldwide.Advances in the molecular understanding of GC provide promising targets for GC diagnosis and therapy.Long...Objective:Gastric cancer(GC)is a globally common cancer characterized by high incidence and mortality worldwide.Advances in the molecular understanding of GC provide promising targets for GC diagnosis and therapy.Long non-coding RNAs(lncRNAs)and their downstream regulators are regarded to be implicated in the progression of multiple types of malignancies.Studies have shown that the lncRNA small nucleolar RNA host gene 4(SNHG4)serves as a tumor promoter in various malignancies,while its function in GC has yet to be characterized.Therefore,our study aimed to explore the role and underlying mechanism of SNHG4 in GC.Methods:We used qRT-PCR to analyze SNHG4 expression in GC tissues and cells.Kaplan-Meier analysis was used to assess the correlation between SNHG4 expression and the survival rate of GC patients.Cellular function experiments such as CCK-8,BrdU,colony formation,flow cytometry analysis,and transwell were performed to explore the effects of SNHG4 on GC cell proliferation,apoptosis,cell cycle,migration,and invasion.We also established xenograft mouse models to explore the effect of SNHG4 on GC tumor growth.Mechanically,dual luciferase reporter assay was used to verify the interaction between SNHG4 and miR-409-3p and between miR-409-3p and cAMP responsive element binding protein 1(CREB1).Results:The results indicated that SNHG4 was overexpressed in GC tissues and cell lines,and was linked with poor survival rate of GC patients.SNHG4 promoted GC cell proliferation,migration,and invasion while inhibiting cell apoptosis and cell cycle arrest in vitro.The in vivo experiment indicated that SNHG4 facilitated GC tumor growth.Furthermore,SNHG4 was demonstrated to bind to miR-409-3p.Moreover,CREB1 was directly targeted by miR-409-3p.Rescue assays demonstrated that miR-409-3p deficiency reversed the suppressive impact of SNHG4 knockdown on GC cell malignancy.Additionally,miR-409-3p was also revealed to inhibit GC cell proliferation,migration,and invasion by targeting CREB1.Conclusion:In conclusion,we verified that the SNHG4 promoted GC growth and metastasis by binding to miR-409-3p to upregulate CREB1,which may deepen the understanding of the underlying mechanism in GC development.展开更多
BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of post...BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of postoperative nursing interventions,particularly pain management,is crucial for reducing such complications.AIM To investigate the effects of enhanced recovery nursing on CV complications after gastrointestinal surgery in ICU patients and associated risk factors.METHODS A retrospective analysis was conducted on 78 adult patients who underwent gastrointestinal surgery in the ICU of our hospital between February 2023 and September 2024.Among them,40 patients received standard care(control group),while 38 received enhanced recovery nursing(observation group).We compared the incidence of CV complications and nursing satisfaction between the two groups.Patients were divided into CV complication and non-complication groups based on complication occurrence,and logistic regression analysis was used to identify risk factors.RESULTS In the control and observation groups,the incidence of CV complications was 30.0%(12/40)and 18.4%(7/38),with a nursing satisfaction rate of 70.0%(28/40)and 92.1%(35/38),respectively.The postoperative pain score at 14 days was significantly lower in the observation group(0.27±0.15)compared to the control group(1.65±0.37),with all differences being statistically significant(P<0.05).Univariate analysis indicated significant differences in age,body mass index,hypertension,diabetes,smoking history,history of heart failure,and previous myocardial infarction(P<0.05).Multivariate logistic regression identified heart failure history,previous myocardial infarction,age,hypertension,and diabetes as independent risk factors,with odds ratios of 1.195,1.528,1.062,1.836,and 1.942,respectively(all P<0.05).CONCLUSION Implementing enhanced recovery nursing for ICU patients after gastrointestinal surgery is beneficial in reducing the incidence of CV complications and improving nursing satisfaction.展开更多
BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold st...BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.展开更多
Linear Least Square (LLS) is an approach for modeling regression analysis, applied for prediction and quantification of the strength of relationship between dependent and independent variables. There are a number of m...Linear Least Square (LLS) is an approach for modeling regression analysis, applied for prediction and quantification of the strength of relationship between dependent and independent variables. There are a number of methods for solving the LLS problem but as soon as the data size increases and system becomes ill conditioned, the classical methods become complex at time and space with decreasing level of accuracy. Proposed work is based on prediction and quantification of the strength of relationship between sugar fasting and Post-Prandial (PP) sugar with 73 factors that affect diabetes. Due to the large number of independent variables, presented problem of diabetes prediction also presented similar complexities. ABS method is an approach proven better than other classical approaches for LLS problems. ABS algorithm has been applied for solving LLS problem. Hence, separate regression equations were obtained for sugar fasting and PP severity.展开更多
Background: Due to social, economic, cultural and other factors, the majority of dementia patients are taken care of by relatives or nannies at home in China. This family care model puts a heavy burden on caregivers. ...Background: Due to social, economic, cultural and other factors, the majority of dementia patients are taken care of by relatives or nannies at home in China. This family care model puts a heavy burden on caregivers. Objective: The main aim of this article is to explore the experience and needs of caregivers on dementia elderly, reveal the essence, and provide the basis for formulating relevant policies. Methods: A total of 10 caregivers of dementia elderly were intensively interviewed, and data were analyzed by using Colaizzi content analysis methods during May - October 2019. Results: Three themes were extracted from the interviews, including the burden and strain from the care, lack of trust in pension institutions, and experience and comprehension of care. Conclusion: The caregivers have suffered a lot of pressure from taking care of the patients with senile dementia. They lack trust in pension institutions, so it is appealed that targeted services for family caregivers of dementia patients, so as to reduce caregiver burden and improve the quality of care. <br />展开更多
Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar...Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar’s score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar’s score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.展开更多
In comparison with copper processing industrial leader Furukawa Electric Co., Ltd., Chinese copper processing industry faces many shortcomings and difficulties including but not limited to outdated equipment and techn...In comparison with copper processing industrial leader Furukawa Electric Co., Ltd., Chinese copper processing industry faces many shortcomings and difficulties including but not limited to outdated equipment and technologies, low degree of specialization, and unstable product quality. The review of Furukawa Electric’s development milestones reveals that Chinese copper processing industry has reached a stage in which it must rely on technological research and development (R & D) to promote sustainable productivity. Chinese copper processing firms have to invest in R & D to promote sustainable technological innovations and to improve the precisions of business practice in order to ensure the firms’ improvement.展开更多
BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.MET...BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018.Patients were classified into four groups based on the clinical grading system and treatment:(1)Observation group with score<4(Obs score<4);(2)Surgical group with score<4(Sur score<4);(3)Observation group with score≥4(Obs score≥4);and(4)Surgical group with score≥4(Sur score≥4).The clinico-pathological index and outcomes were evaluated.RESULTS There were significantly fewer symptomatic patients in surgical groups(Sur score≥4 vs Obs score≥4,P<0.001;Sur score<4 vs Obs score<4,χ^(2)=8.60,P=0.004;Sur score≥4 vs Obs score<4,P<0.001).The patients in Sur score≥4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score≥4(P<0.001;P<0.001).Nevertheless,there was no significant difference in need for intervention and total patients with adverse event between the Sur score<4 and Obs score<4(P>0.05;χ^(2)=1.68,P>0.05).CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma.Surgery can be suggested for patients with a score≥4.For those with<4,follow-up should be proposed.展开更多
BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of ...BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.展开更多
BACKGROUND Mucocutaneous separation(MCS)is a common postoperative complication in enterostomy patients,potentially leading to significant morbidity.Early identification of risk factors is crucial for preventing this c...BACKGROUND Mucocutaneous separation(MCS)is a common postoperative complication in enterostomy patients,potentially leading to significant morbidity.Early identification of risk factors is crucial for preventing this condition.However,predictive models for MCS remain underdeveloped.AIM To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.METHODS A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study.Patients were divided into two groups,the MCS group(n=110),and the non-MCS(n=382)based on the occurrence of MCS within the first 3 weeks after surgery.Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed.Receiver operating characteristic curve analysis was used to assess the model’s performance.RESULTS The postoperative MCS incidence rate was 22.4%.Suture dislodgement(P<0.0001),serum albumin level(P<0.0001),body mass index(BMI)(P=0.0006),hemoglobin level(P=0.0409),intestinal rapture(P=0.0043),incision infection(P<0.0001),neoadjuvant therapy(P=0.0432),stoma site(P=0.0028)and elevated intra-abdominal pressure(P=0.0395)were potential predictive factors of MCS.Suture dislodgement[P<0.0001,OR:28.007595%CI:(11.0901-82.1751)],serum albumin level(P=0.0008,OR:0.3504,95%CI:[0.1902-0.6485]),BMI[P=0.0045,OR:2.1361,95%CI:(1.2660-3.6235)],hemoglobin level[P=0.0269,OR:0.5164,95%CI:(0.2881-0.9324)],intestinal rapture[P=0.0351,OR:3.0694,95%CI:(1.0482-8.5558)],incision infection[P=0.0179,OR:0.2885,95%CI:(0.0950-0.7624)]and neoadjuvant therapy[P=0.0112,OR:1.9769,95%CI:(1.1718-3.3690)]were independent predictive factors and included in the model.The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.CONCLUSION The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.展开更多
Background:Hypertrophy of the ligamentumflavum(HLF)is a common contributor to spinal stenosis which results in significant neurological impairments.Circular RNA(circRNA)circ_0003609 has been linked to HLF;however,the ex...Background:Hypertrophy of the ligamentumflavum(HLF)is a common contributor to spinal stenosis which results in significant neurological impairments.Circular RNA(circRNA)circ_0003609 has been linked to HLF;however,the exact mechanism by which it causes this disease is unclear.Methods:Circ_0003609 expressions were regulated in HLF cells by overexpression vectors and RNA interference.Cell proliferation andfibrosis-related gene expression were checked by the Cell Counting Kit-8(CCK-8)assay and western blotting.CircBank’s prediction of the association between miR-155 and circ_0003609 was supported by a dual-luciferase reporter experiment.The function of the miR-155/sirtuin 1(SIRT1)axis in controlling HLFfibrosis was further examined.Results:Overexpression of circ_0003609 suppressed HLF cell propagation andfibrosis compared to its silencing.It was found that circ_0003609 served as the sponge for miR-155 and that the circ_0003609/miR-155 axis controlled thefibrosis of HLF cells.It was found that circ_0003609 acted as a sponge for miR-155,regulating thefibrosis of HLF cells.Further,miR-155 targets SIRT1,and the miR-155/SIRT1 axis promotes HLF cellfibrosis.Conclusion:Circ_0003609 ameliorates hypertrophied ligamentumflavum(LF)by modulating the miR-155/SIRT1 axis,indicating a potential treatment approach for HLF.展开更多
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important fo...BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.展开更多
Due to the ever-increasing air traffic flow,the influence of aircraft noise around the airport has become significant.As most airlines are trying to decrease operation cost,stringent requirements for more simple and e...Due to the ever-increasing air traffic flow,the influence of aircraft noise around the airport has become significant.As most airlines are trying to decrease operation cost,stringent requirements for more simple and efficient departure trajectory are on a rise.Therefore,a departure trajectory design was established for performancebased navigation technology,and a multi-objective optimization model was developed,with constraints of safety and noise influence,as well as optimization targets of efficiency and simplicity.An improved ant colony algorithm was then proposed to solve the optimization problem.Finally,an experiment was conducted using the Lanzhou terminal airspace operation data,and the results showed that the designed departure trajectory was feasible and efficient in decreasing the aircraft noise influence.展开更多
In order to alleviate noise pollution and improve the sustainability of airport operation,it is of great significance to develop an effective method to predict airport aviation noise. A three-layer neural network is c...In order to alleviate noise pollution and improve the sustainability of airport operation,it is of great significance to develop an effective method to predict airport aviation noise. A three-layer neural network is constructed to gain computational simplicity and execution economy. With the preferred node number and transfer functions obtained in comparative tests,the constructed network is further optimized through the genetic algorithm for performance improvements in prediction. Results show that the proposed model in this paper is superior in accuracy and stability for airport aviation noise prediction,contributing to the assessment of future environmental impact and further improvement of operational sustainability for civil airports.展开更多
Service-oriented air combat simulation architecture is proposed.The core design goal is high agility which represents the ability to accommodate the simulation requirements change.Its main idea is to design model unit...Service-oriented air combat simulation architecture is proposed.The core design goal is high agility which represents the ability to accommodate the simulation requirements change.Its main idea is to design model units as services that can communicate and interoperate with any other services at runtime.A service is autonomous and is fully defined by a description contract which contains some combination of syntactic,semantic,and behavioral information.Based on the architecture,air combat simulation system can be described as an abstract composition of description contracts.It becomes concrete at run time as services that implement the constituent description contracts are discovered and bind.The whole process is a continuous run-time activity that responds to simulation needs and the availability of services.This provides benefits of implementation transparency and minimal dependency between models.Thus,simulation system can minimize the impact of change on it and increase the overall efficiency to respond to requirements change.展开更多
Background:Hypothermia is associated with many adverse clinical outcomes in pediatric patients,and thus,it is important to an effective and safe method for preventing peri-operative hypothermia and its associated adve...Background:Hypothermia is associated with many adverse clinical outcomes in pediatric patients,and thus,it is important to an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients.This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β(TGF-β),tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip(DDH).Methods:The study included 123 children undergoing surgery for DDH under general anesthesia.The patients were randomly assigned to three groups,using a random number table:the 32,38,and 43°C groups according to the temperature setting of the forced-air warming blankets.For each patient,body temperature was recorded immediately after anesthesia induction and intubation(T0),at initial incision(T1),at 1 h after incision(T2),at2 h after incision(T3),at the end of surgery(T4),immediately upon return to the ward after surgery(T5),and then at 12 h(T6),24 h(T7),36 h(T8),and 48 h(T9)after the surgery.The serum levels of TGF-β,TNF-α,IL-1β,and IL-10 were measured at To and T4 for all groups.Results:The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups(x^2=6.630,P=0.036).At To,the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group(F=17.992,P<0.001).At T2,the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups(F=12.776,P<0.001).Moreover,at T4,the serum levels of TGF-β(F=3286.548,P<0.001)and IL-10(F=4628.983,P<0.001)were significantly increased in the 38°C group,and the serum levels of TNF-α(F=911.415,P<0.001)and IL-10(F=322.191,P<0.001)were significantly decreased in the 38°C group,compared with the levels in the 32 and 43°C groups.Conclusion:Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.展开更多
文摘BACKGROUND Pancreatic fistula is the most common complication of pancreatic surgeries that causes more serious conditions,including bleeding due to visceral vessel erosion and peritonitis.AIM To develop a machine learning(ML)model for postoperative pancreatic fistula and identify significant risk factors of the complication.METHODS A single-center retrospective clinical study was conducted which included 150 patients,who underwent pancreat-oduodenectomy.Logistic regression,random forest,and CatBoost were employed for modeling the biochemical leak(symptomless fistula)and fistula grade B/C(clinically significant complication).The performance was estimated by receiver operating characteristic(ROC)area under the curve(AUC)after 5-fold cross-validation(20%testing and 80%training data).The risk factors were evaluated with the most accurate algorithm,based on the parameter“Importance”(Im),and Kendall correlation,P<0.05.RESULTS The CatBoost algorithm was the most accurate with an AUC of 74%-86%.The study provided results of ML-based modeling and algorithm selection for pancreatic fistula prediction and risk factor evaluation.From 14 parameters we selected the main pre-and intraoperative prognostic factors of all the fistulas:Tumor vascular invasion(Im=24.8%),age(Im=18.6%),and body mass index(Im=16.4%),AUC=74%.The ML model showed that biochemical leak,blood and drain amylase level(Im=21.6%and 16.4%),and blood leukocytes(Im=11.2%)were crucial predictors for subsequent fistula B/C,AUC=86%.Surgical techniques,morphology,and pancreatic duct diameter less than 3 mm were insignificant(Im<5%and no correlations detected).The results were confirmed by correlation analysis.CONCLUSION This study highlights the key predictors of postoperative pancreatic fistula and establishes a robust ML-based model for individualized risk prediction.These findings contribute to the advancement of personalized periop-erative care and may guide targeted preventive strategies.
文摘BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.
文摘Background: Dementia is a condition with progressive cognitive dysfunction and manifestation of both behavioral and psychosocial symptoms. Non-pharmacological measures such as music therapy are gaining importance since efficacy and safety of people with dementia have been questionable for pharmacological measures. Patient’s response to music is persistent even in the later stage of dementia. Aim: This rapid review aims to identify, analyze, evaluate, and summarize the best available evidence on the effectiveness of music-based therapeutic interventions among people with dementia. Method: CINAHL Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened the literature search results. Effectiveness, music-based therapeutic intervention, dementia, Alzheimer’s disease, systematic review and systematic review with meta-analysis terms were used to abstract data from included studies. Main Findings: 11 SRs and SRs with meta-analysis were reviewed which revealed positive effect of music therapy on five major outcomes with 9 studies effect on behavioral outcome, 6 studies with positive effect on psychosocial outcome reducing anxiety, 6 with improved cognition, 1 study revealed with improved quality of life and 1 study revealed effect on physiological outcomes. Conclusion: Music therapy has positive effect on treatment of dementia but further studies with larger sample size and specified to single intervention should be conducted to provide generalisable and precise results on this topic.
文摘Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.
文摘Objective:Gastric cancer(GC)is a globally common cancer characterized by high incidence and mortality worldwide.Advances in the molecular understanding of GC provide promising targets for GC diagnosis and therapy.Long non-coding RNAs(lncRNAs)and their downstream regulators are regarded to be implicated in the progression of multiple types of malignancies.Studies have shown that the lncRNA small nucleolar RNA host gene 4(SNHG4)serves as a tumor promoter in various malignancies,while its function in GC has yet to be characterized.Therefore,our study aimed to explore the role and underlying mechanism of SNHG4 in GC.Methods:We used qRT-PCR to analyze SNHG4 expression in GC tissues and cells.Kaplan-Meier analysis was used to assess the correlation between SNHG4 expression and the survival rate of GC patients.Cellular function experiments such as CCK-8,BrdU,colony formation,flow cytometry analysis,and transwell were performed to explore the effects of SNHG4 on GC cell proliferation,apoptosis,cell cycle,migration,and invasion.We also established xenograft mouse models to explore the effect of SNHG4 on GC tumor growth.Mechanically,dual luciferase reporter assay was used to verify the interaction between SNHG4 and miR-409-3p and between miR-409-3p and cAMP responsive element binding protein 1(CREB1).Results:The results indicated that SNHG4 was overexpressed in GC tissues and cell lines,and was linked with poor survival rate of GC patients.SNHG4 promoted GC cell proliferation,migration,and invasion while inhibiting cell apoptosis and cell cycle arrest in vitro.The in vivo experiment indicated that SNHG4 facilitated GC tumor growth.Furthermore,SNHG4 was demonstrated to bind to miR-409-3p.Moreover,CREB1 was directly targeted by miR-409-3p.Rescue assays demonstrated that miR-409-3p deficiency reversed the suppressive impact of SNHG4 knockdown on GC cell malignancy.Additionally,miR-409-3p was also revealed to inhibit GC cell proliferation,migration,and invasion by targeting CREB1.Conclusion:In conclusion,we verified that the SNHG4 promoted GC growth and metastasis by binding to miR-409-3p to upregulate CREB1,which may deepen the understanding of the underlying mechanism in GC development.
文摘BACKGROUND Cardiovascular(CV)complications are common in intensive care unit(ICU)patients after gastrointestinal surgery and are associated with increased mortality and prolonged hospital stay.The optimization of postoperative nursing interventions,particularly pain management,is crucial for reducing such complications.AIM To investigate the effects of enhanced recovery nursing on CV complications after gastrointestinal surgery in ICU patients and associated risk factors.METHODS A retrospective analysis was conducted on 78 adult patients who underwent gastrointestinal surgery in the ICU of our hospital between February 2023 and September 2024.Among them,40 patients received standard care(control group),while 38 received enhanced recovery nursing(observation group).We compared the incidence of CV complications and nursing satisfaction between the two groups.Patients were divided into CV complication and non-complication groups based on complication occurrence,and logistic regression analysis was used to identify risk factors.RESULTS In the control and observation groups,the incidence of CV complications was 30.0%(12/40)and 18.4%(7/38),with a nursing satisfaction rate of 70.0%(28/40)and 92.1%(35/38),respectively.The postoperative pain score at 14 days was significantly lower in the observation group(0.27±0.15)compared to the control group(1.65±0.37),with all differences being statistically significant(P<0.05).Univariate analysis indicated significant differences in age,body mass index,hypertension,diabetes,smoking history,history of heart failure,and previous myocardial infarction(P<0.05).Multivariate logistic regression identified heart failure history,previous myocardial infarction,age,hypertension,and diabetes as independent risk factors,with odds ratios of 1.195,1.528,1.062,1.836,and 1.942,respectively(all P<0.05).CONCLUSION Implementing enhanced recovery nursing for ICU patients after gastrointestinal surgery is beneficial in reducing the incidence of CV complications and improving nursing satisfaction.
文摘BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea.In patients under general anesthesia,the symptoms may not be obvious,which may delay diagnosis and treatment.Computed tomography is the gold standard for the diagnosis of pneumothorax,but is not suitable for rapid diagnosis of this complication.In contrast,lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax.CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned.Anesthesia was induced,and tracheal intubation was performed successfully with a video laryngoscope.About 2 min after tracheal intubation,the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%.According to the BLUE protocol,a recommended area of the chest was scanned by ultrasound.The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung.The boundary of pneumothorax(lung points)were rapidly confirmed by ultrasound.To avoid lung injury,a closed thoracic drainage tube was placed in the involved area.On day 9 after surgery,the patient was discharged from the hospital without any complications.CONCLUSION Perioperative pneumothorax is rare but dangerous.It can be rapidly diagnosed and treated with ultrasound guidance.
文摘Linear Least Square (LLS) is an approach for modeling regression analysis, applied for prediction and quantification of the strength of relationship between dependent and independent variables. There are a number of methods for solving the LLS problem but as soon as the data size increases and system becomes ill conditioned, the classical methods become complex at time and space with decreasing level of accuracy. Proposed work is based on prediction and quantification of the strength of relationship between sugar fasting and Post-Prandial (PP) sugar with 73 factors that affect diabetes. Due to the large number of independent variables, presented problem of diabetes prediction also presented similar complexities. ABS method is an approach proven better than other classical approaches for LLS problems. ABS algorithm has been applied for solving LLS problem. Hence, separate regression equations were obtained for sugar fasting and PP severity.
文摘Background: Due to social, economic, cultural and other factors, the majority of dementia patients are taken care of by relatives or nannies at home in China. This family care model puts a heavy burden on caregivers. Objective: The main aim of this article is to explore the experience and needs of caregivers on dementia elderly, reveal the essence, and provide the basis for formulating relevant policies. Methods: A total of 10 caregivers of dementia elderly were intensively interviewed, and data were analyzed by using Colaizzi content analysis methods during May - October 2019. Results: Three themes were extracted from the interviews, including the burden and strain from the care, lack of trust in pension institutions, and experience and comprehension of care. Conclusion: The caregivers have suffered a lot of pressure from taking care of the patients with senile dementia. They lack trust in pension institutions, so it is appealed that targeted services for family caregivers of dementia patients, so as to reduce caregiver burden and improve the quality of care. <br />
基金supported by the Scientific Technology Planning Foundation of Shaanxi Province (2003K10-G80)
文摘Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar’s score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar’s score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.
文摘In comparison with copper processing industrial leader Furukawa Electric Co., Ltd., Chinese copper processing industry faces many shortcomings and difficulties including but not limited to outdated equipment and technologies, low degree of specialization, and unstable product quality. The review of Furukawa Electric’s development milestones reveals that Chinese copper processing industry has reached a stage in which it must rely on technological research and development (R & D) to promote sustainable productivity. Chinese copper processing firms have to invest in R & D to promote sustainable technological innovations and to improve the precisions of business practice in order to ensure the firms’ improvement.
文摘BACKGROUND The optimal approach for managing hepatic hemangioma is controversial.AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience.METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018.Patients were classified into four groups based on the clinical grading system and treatment:(1)Observation group with score<4(Obs score<4);(2)Surgical group with score<4(Sur score<4);(3)Observation group with score≥4(Obs score≥4);and(4)Surgical group with score≥4(Sur score≥4).The clinico-pathological index and outcomes were evaluated.RESULTS There were significantly fewer symptomatic patients in surgical groups(Sur score≥4 vs Obs score≥4,P<0.001;Sur score<4 vs Obs score<4,χ^(2)=8.60,P=0.004;Sur score≥4 vs Obs score<4,P<0.001).The patients in Sur score≥4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score≥4(P<0.001;P<0.001).Nevertheless,there was no significant difference in need for intervention and total patients with adverse event between the Sur score<4 and Obs score<4(P>0.05;χ^(2)=1.68,P>0.05).CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma.Surgery can be suggested for patients with a score≥4.For those with<4,follow-up should be proposed.
文摘BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.
基金Supported by the Zhejiang Province Medical and Health Science and Technology Plan Project,No.2022KY1427.
文摘BACKGROUND Mucocutaneous separation(MCS)is a common postoperative complication in enterostomy patients,potentially leading to significant morbidity.Early identification of risk factors is crucial for preventing this condition.However,predictive models for MCS remain underdeveloped.AIM To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.METHODS A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study.Patients were divided into two groups,the MCS group(n=110),and the non-MCS(n=382)based on the occurrence of MCS within the first 3 weeks after surgery.Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed.Receiver operating characteristic curve analysis was used to assess the model’s performance.RESULTS The postoperative MCS incidence rate was 22.4%.Suture dislodgement(P<0.0001),serum albumin level(P<0.0001),body mass index(BMI)(P=0.0006),hemoglobin level(P=0.0409),intestinal rapture(P=0.0043),incision infection(P<0.0001),neoadjuvant therapy(P=0.0432),stoma site(P=0.0028)and elevated intra-abdominal pressure(P=0.0395)were potential predictive factors of MCS.Suture dislodgement[P<0.0001,OR:28.007595%CI:(11.0901-82.1751)],serum albumin level(P=0.0008,OR:0.3504,95%CI:[0.1902-0.6485]),BMI[P=0.0045,OR:2.1361,95%CI:(1.2660-3.6235)],hemoglobin level[P=0.0269,OR:0.5164,95%CI:(0.2881-0.9324)],intestinal rapture[P=0.0351,OR:3.0694,95%CI:(1.0482-8.5558)],incision infection[P=0.0179,OR:0.2885,95%CI:(0.0950-0.7624)]and neoadjuvant therapy[P=0.0112,OR:1.9769,95%CI:(1.1718-3.3690)]were independent predictive factors and included in the model.The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.CONCLUSION The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.
基金This research was supported by the Shanghai Natural Science Fund(No.21ZR1447500)Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital Baoshan Branch Medical Key Specialty Construction Project(No.rbzdzk-2023-001).
文摘Background:Hypertrophy of the ligamentumflavum(HLF)is a common contributor to spinal stenosis which results in significant neurological impairments.Circular RNA(circRNA)circ_0003609 has been linked to HLF;however,the exact mechanism by which it causes this disease is unclear.Methods:Circ_0003609 expressions were regulated in HLF cells by overexpression vectors and RNA interference.Cell proliferation andfibrosis-related gene expression were checked by the Cell Counting Kit-8(CCK-8)assay and western blotting.CircBank’s prediction of the association between miR-155 and circ_0003609 was supported by a dual-luciferase reporter experiment.The function of the miR-155/sirtuin 1(SIRT1)axis in controlling HLFfibrosis was further examined.Results:Overexpression of circ_0003609 suppressed HLF cell propagation andfibrosis compared to its silencing.It was found that circ_0003609 served as the sponge for miR-155 and that the circ_0003609/miR-155 axis controlled thefibrosis of HLF cells.It was found that circ_0003609 acted as a sponge for miR-155,regulating thefibrosis of HLF cells.Further,miR-155 targets SIRT1,and the miR-155/SIRT1 axis promotes HLF cellfibrosis.Conclusion:Circ_0003609 ameliorates hypertrophied ligamentumflavum(LF)by modulating the miR-155/SIRT1 axis,indicating a potential treatment approach for HLF.
文摘BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
文摘Due to the ever-increasing air traffic flow,the influence of aircraft noise around the airport has become significant.As most airlines are trying to decrease operation cost,stringent requirements for more simple and efficient departure trajectory are on a rise.Therefore,a departure trajectory design was established for performancebased navigation technology,and a multi-objective optimization model was developed,with constraints of safety and noise influence,as well as optimization targets of efficiency and simplicity.An improved ant colony algorithm was then proposed to solve the optimization problem.Finally,an experiment was conducted using the Lanzhou terminal airspace operation data,and the results showed that the designed departure trajectory was feasible and efficient in decreasing the aircraft noise influence.
基金supported by the National Natural Science Foundation of China(No. 61671237)the Foundation of State Key Laboratory of Air Traffic Management System and Technology(No. SKLATM202003)the Fundamental Research Funds for Graduates of Nanjing University of Aeronautics and Astronautics (No. kfjj20200735)
文摘In order to alleviate noise pollution and improve the sustainability of airport operation,it is of great significance to develop an effective method to predict airport aviation noise. A three-layer neural network is constructed to gain computational simplicity and execution economy. With the preferred node number and transfer functions obtained in comparative tests,the constructed network is further optimized through the genetic algorithm for performance improvements in prediction. Results show that the proposed model in this paper is superior in accuracy and stability for airport aviation noise prediction,contributing to the assessment of future environmental impact and further improvement of operational sustainability for civil airports.
文摘Service-oriented air combat simulation architecture is proposed.The core design goal is high agility which represents the ability to accommodate the simulation requirements change.Its main idea is to design model units as services that can communicate and interoperate with any other services at runtime.A service is autonomous and is fully defined by a description contract which contains some combination of syntactic,semantic,and behavioral information.Based on the architecture,air combat simulation system can be described as an abstract composition of description contracts.It becomes concrete at run time as services that implement the constituent description contracts are discovered and bind.The whole process is a continuous run-time activity that responds to simulation needs and the availability of services.This provides benefits of implementation transparency and minimal dependency between models.Thus,simulation system can minimize the impact of change on it and increase the overall efficiency to respond to requirements change.
基金grants from the Guangzhou Institute of Pediatrics/Guangzhou Women and Children's Medical Center(No.YIP-2018-037 and YIP-2019-061).
文摘Background:Hypothermia is associated with many adverse clinical outcomes in pediatric patients,and thus,it is important to an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients.This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β(TGF-β),tumor necrosis factor(TNF)-α,interleukin(IL)-1β,and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip(DDH).Methods:The study included 123 children undergoing surgery for DDH under general anesthesia.The patients were randomly assigned to three groups,using a random number table:the 32,38,and 43°C groups according to the temperature setting of the forced-air warming blankets.For each patient,body temperature was recorded immediately after anesthesia induction and intubation(T0),at initial incision(T1),at 1 h after incision(T2),at2 h after incision(T3),at the end of surgery(T4),immediately upon return to the ward after surgery(T5),and then at 12 h(T6),24 h(T7),36 h(T8),and 48 h(T9)after the surgery.The serum levels of TGF-β,TNF-α,IL-1β,and IL-10 were measured at To and T4 for all groups.Results:The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups(x^2=6.630,P=0.036).At To,the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group(F=17.992,P<0.001).At T2,the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups(F=12.776,P<0.001).Moreover,at T4,the serum levels of TGF-β(F=3286.548,P<0.001)and IL-10(F=4628.983,P<0.001)were significantly increased in the 38°C group,and the serum levels of TNF-α(F=911.415,P<0.001)and IL-10(F=322.191,P<0.001)were significantly decreased in the 38°C group,compared with the levels in the 32 and 43°C groups.Conclusion:Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.
