一种用于CRRT/ECMO血路管的多功能可视固定装置的设计与应用

目的探讨一种用于连续性肾脏替代治疗/体外膜肺氧合(CRRT/ECMO)血路管的多功能可视固定装置在治疗过程中的应用效果。方法将2024年1月至5月进行连续性肾脏替代(CRRT)治疗和(或)体外膜肺氧合(ECMO)治疗的156例患者随机分为对照组和观察组,每组78例。对照组采用弹力绷带和胶布固定体外循环管路,观察组使用多功能可视固定装置对血路管进行固定,比较两组患者留置导管发生移位的例次、患者舒适度和医患满意度。结果观察组留置导管发生扭曲或移位、置管处有渗出、辅料污染需要更换发生率均低于对照组(P<0.05),观察组满意度及护士满意度均高于对照组。结论用于CRRT/ECMO血路管的多功能可视固定装置能提高管路固定效果,有效降低患者治疗过程中意外事件的发生率,提高患者舒适度和护患满意度,值得在临床推广应用。

氟吡菌酰胺和吡唑醚菌酯在葡萄上的残留及膳食风险评估

为明确氟吡菌酰胺和吡唑醚菌酯在葡萄上的残留风险,开展了一年十地的规范残留试验,建立了高效液相色谱法(HPLC)测定葡萄中氟吡菌酰胺和吡唑醚菌酯残留的分析方法。结果表明,在0.1~20.0 mg·L^(-1)范围内,氟吡菌酰胺和吡唑醚菌酯质量浓度与其峰面积均呈良好的线性关系,相关系数大于0.99。在0.05、0.50 mg·kg^(-1)和2.00 mg·kg^(-1)添加水平下,氟吡菌酰胺和吡唑醚菌酯在葡萄中的平均回收率分别为88.1%~112.3%和90.5%~101.5%,相对标准偏差(RSD)分别为3.1%~8.2%和3.5%~9.1%,检测方法定量限(LOQ)均为0.05 mg·kg^(-1)。采收间隔期为14 d,时葡萄中氟吡菌酰胺和吡唑醚菌酯的残留中值(STMR)分别为0.16 mg·kg^(-1)和0.12 mg·kg^(-1),最高残留值(HR)分别为1.44 mg·kg^(-1)和1.48 mg·kg^(-1)。葡萄中氟吡菌酰胺和吡唑醚菌酯对一般人群的长期膳食摄入风险的贡献率分别为0.142%和0.036%,短期膳食摄入风险商分别为7.8%和5.7%,对1~6岁儿童的短期膳食摄入风险商分别为19.6%和14.4%。研究表明,按照推荐剂量规范使用,氟吡菌酰胺和吡唑醚菌酯在葡萄中的残留量对1~6岁儿童和一般人群造成的健康风险处于安全水平。

虾青素戊二酸酯的酶法合成

为提高虾青素(astaxanthin,AST)的水溶性,该研究采用酯酶Est3-14催化虾青素和戊二酸酐(glutaric anhydride,GA)酯化合成虾青素戊二酸酯(astaxanthin glutarates,AG),包括虾青素戊二酸单酯(astaxanthin glutarate monoester,AGM)和虾青素戊二酸二酯(astaxanthin glutarate diester,AGD),以改善虾青素的水溶性。采用薄层层析色谱、高效液相色谱和质谱对目标产物进行表征,确认虾青素戊二酸酯可经酶催化合成。采用高效液相色谱验证AG的水溶性,结果表明AG的水溶性较游离形式虾青素有明显提升。采用单因素试验对催化条件进行优化,确定AG合成的最优条件为以三氯甲烷为反应溶剂、反应温度50℃、AST与GA摩尔比1∶4 000、加酶量100 U。在最优条件下反应48 h,虾青素的酯化率达到75.8%,其中,AGM、AGD的产率分别为29.9%、45.9%。

Overview of ectopic pancreas

This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.

基于ITHBC的个体化呼吸训练及营养支持在COPD患者中的应用研究

目的 探讨基于健康行为改变整合理论(ITHBC)的个体化呼吸训练及营养支持在慢性阻塞性肺疾病(COPD)患者中的应用。方法 选择重庆市急救医疗中心2018年1月—2021年12月呼吸科接诊的108例COPD患者进行研究,通过随机数表法将患者分为观察组和对照组,各54例,对照组采用常规护理干预,观察组采用基于ITHBC的个体化呼吸训练及营养支持干预,两组患者均接受2周的护理干预。比较两组干预前、干预2周后的营养指标[血红蛋白(Hb)、前白蛋白(PAB)、白蛋白(ALB)]、动脉血气指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、氧合指数]、肺功能指标[第一秒最大呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)%、最大呼气流量(PEF)]、呼吸困难指标[6 min步行试验(6MWT)、改良英国医学研究委员会呼吸困难指数(mMRC)]的水平变化。结果 观察组住院时间为(16.31±2.03)d,明显短于对照组的(19.41±2.52)d,差异有统计学意义(P<0.05);观察组干预后的Hb、PAB、ALB、PaO_(2)、氧合指数、FEV1、FEV1/FVC、PEF水平分别为(129.51±16.87)g/L、(178.17±31.20)mg/L、(40.81±4.50)g/L、(105.47±16.94)mmHg、(309.91±35.31)mmHg、(1.45±0.26)L、(756.19±6.73)%、(2.88±0.41)L/s,均明显高于对照组的(120.30±15.26)g/L、(165.14±28.31)mg/L、(38.10±4.23)g/L、(98.33±16.80)mmHg、(288.37±35.62)mmHg、(1.36±0.10)L、(54.48±4.04)%、(2.73±0.28)L/s,PaCO_(2)为(41.11±12.43)mmHg,明显低于对照组的(47.63±13.24)mmHg,差异有统计学意义(P<0.05);观察组干预后的6 MWT为(398.79±41.24)m,明显长于对照组(355.18±34.09)m,mMRC评分为(2.02±0.24)分,明显低于对照组的(2.68±0.29)分,差异有统计学意义(P<0.05)。结论 基于ITHBC的个体化呼吸训练及营养支持能明显促进COPD患者的营养吸收,减少住院时间,提高肺功能和动脉血气指标,并改善呼吸困难程度。

气相色谱-串联质谱法测定小麦中氟嘧菌酯和戊唑醇的残留量

建立了气相色谱-串联质谱(GC-MS/MS)测定小麦中氟嘧菌酯、氟嘧菌酯Z体和戊唑醇残留量的分析方法。样品中氟嘧菌酯、氟嘧菌酯Z体和戊唑醇用乙腈提取,提取液经分散固相萃取净化,以HP-5ms色谱柱分离,GC-MS/MS多反应监测(MRM)模式测定,外标法-溶剂标准曲线法定量。结果表明:5~500 ng/mL质量浓度范围内,氟嘧菌酯、氟嘧菌酯Z体和戊唑醇的峰面积与质量浓度之间呈现出良好线性关系;氟嘧菌酯、氟嘧菌酯Z体和戊唑醇在小麦籽粒、小麦秸秆中的最低检测浓度均为0.02 mg/kg。在添加浓度为0.02~10 mg/kg,氟嘧菌酯、氟嘧菌酯Z体和戊唑醇在小麦籽粒中的平均回收率为92%~104%,相对标准偏差为1.1%~15.3%;氟嘧菌酯、氟嘧菌酯Z体和戊唑醇在小麦秸秆中的平均回收率为88%~106%,相对标准偏差为1.4%~10.9%。该方法具有精密度好、灵敏度和准确度高、杂质干扰少等特点,符合农药残留检测分析的基本要求。

Atmospheric nitrogen deposition affects forest plant and soil system carbon:nitrogen:phosphorus stoichiometric flexibility:A meta-analysis

Background:Nitrogen(N)deposition affects forest stoichiometric flexibility through changing soil nutrient availability to influence plant uptake.However,the effect of N deposition on the flexibility of carbon(C),N,and phosphorus(P)in forest plant-soil-microbe systems remains unclear.Methods:We conducted a meta-analysis based on 751 pairs of observations to evaluate the responses of plant,soil and microbial biomass C,N and P nutrients and stoichiometry to N addition in different N intensity(050,50–100,>100 kg·ha^(-1)·year^(-1)of N),duration(0–5,>5 year),method(understory,canopy),and matter(ammonium N,nitrate N,organic N,mixed N).Results:N addition significantly increased plant N:P(leaf:14.98%,root:13.29%),plant C:P(leaf:6.8%,root:25.44%),soil N:P(13.94%),soil C:P(10.86%),microbial biomass N:P(23.58%),microbial biomass C:P(12.62%),but reduced plant C:N(leaf:6.49%,root:9.02%).Furthermore,plant C:N:P stoichiometry changed significantly under short-term N inputs,while soil and microorganisms changed drastically under high N addition.Canopy N addition primarily affected plant C:N:P stoichiometry through altering plant N content,while understory N inputs altered more by influencing soil C and P content.Organic N significantly influenced plant and soil C:N and C:P,while ammonia N changed plant N:P.Plant C:P and soil C:N were strongly correlated with mean annual precipitation(MAT),and the C:N:P stoichiometric flexibility in soil and plant under N addition connected with soil depth.Besides,N addition decoupled the correlations between soil microorganisms and the plant.Conclusions:N addition significantly increased the C:P and N:P in soil,plant,and microbial biomass,reducing plant C:N,and aggravated forest P limitations.Significantly,these impacts were contingent on climate types,soil layers,and N input forms.The findings enhance our comprehension of the plant-soil system nutrient cycling mechanisms in forest ecosystems and plant strategy responses to N deposition.

Analysis of vascular thrombus and clinicopathological factors in prognosis of gastric cancer:A retrospective cohort study

BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors in the world,and its prognosis is closely related to many factors.In recent years,the incidence of vascular thrombosis in patients with GC has gradually attracted increasing attention,and studies have shown that it may have a significant impact on the survival rate and prognosis of patients.However,the specific mechanism underlying the association between vascular thrombosis and the prognosis of patients with GC remains unclear.AIM To analyze the relationships between vascular cancer support and other clinicopathological factors and their influence on the prognosis of patients with GC.METHODS This study retrospectively analyzed the clinicopathological data of 621 patients with GC and divided them into a positive group and a negative group according to the presence or absence of a vascular thrombus.The difference in the 5-year cumulative survival rate between the two groups was compared,and the relationships between vascular cancer thrombus and other clinicopathological factors and their influence on the prognosis of patients with GC were analyzed.RESULTS Among 621 patients with GC,the incidence of vascular thrombi was 31.7%(197 patients).Binary logistic regression analysis revealed that the degree of tumor differentiation,depth of invasion,and extent of lymph node metastasis were independent influencing factors for the occurrence of vascular thrombi in GC patients(P<0.01).The trend of the χ^(2) test showed that the degree of differentiation,depth of invasion,and extent of lymph node metastasis were linearly correlated with the percentage of vascular thrombi in GC patients(P<0.01),and the correlation between lymph node metastasis and vascular thrombi was more significant(r=0.387).Univariate analysis revealed that the 5-year cumulative survival rate of the positive group was significantly lower than that of the negative group(46.7%vs 73.3%,P<0.01).Multivariate analysis revealed that age,tumor diameter,TNM stage,and vascular thrombus were independent risk factors for the prognosis of GC patients(all P<0.05).Further stratified analysis revealed that the 5-year cumulative survival rate of stage Ⅲ GC patients in the thrombolase-positive group was significantly lower than that in the thrombolase-negative group(36.1%vs 51.4%;P<0.05).CONCLUSION Vascular cancer status is an independent risk factor affecting the prognosis of patients with GC.The combination of vascular cancer suppositories and TNM staging can better judge the prognosis of patients with GC and guide more reasonable treatment.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal involvement.However,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are unknown.In the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical treatment.They found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal BD.This work has clinical significance for evaluating the postoperative condition of intestinal BD.The editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical outcomes.We hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

Impact of immunotherapy on liver metastasis

This editorial discusses the article“Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis”published in the latest edition of the World Journal of Gastrointestinal Surgery.Immunotherapy has achieved outstanding success in tumor treatment.However,the presence of liver metastasis(LM)restrains the efficacy of immunotherapy in various tumors,including lung cancer,colorectal cancer,renal cell carcinoma,melanoma,and gastric cancer.A decrease in CD8+T cells and nature killer cells,along with an increase in macrophages and regulatory T cells,was observed in the microenvironment of LM,leading to immunotherapy resistance.More studies are necessary to determine the best strategy for enhancing the effectiveness of immunotherapy in patients with LM.

Mutational landscape of TP53 and CDH1 in gastric cancer

In this editorial we comment on an article published in a recent issue of the World J Gastrointest Surg.A common gene mutation in gastric cancer(GC)is the TP53 mutation.As a tumor suppressor gene,TP53 is implicated in more than half of all tumor occurrences.TP53 gene mutations in GC tissue may be related with clinical pathological aspects.The TP53 mutation arose late in the progression of GC and aided in the final switch to malignancy.CDH1 encodes E-cadherin,which is involved in cell-to-cell adhesion,epithelial structure maintenance,cell polarity,differentiation,and intracellular signaling pathway modulation.CDH1 mutations and functional loss can result in diffuse GC,and CDH1 mutations can serve as independent prognostic indicators for poor prognosis.GC patients can benefit from genetic counseling and testing for CDH1 mutations.Demethylation therapy may assist to postpone the onset and progression of GC.The investigation of TP53 and CDH1 gene mutations in GC allows for the investigation of the relationship between these two gene mutations,as well as providing some basis for evaluating the prognosis of GC patients.

Is there a place for endoscopic management in postcholecystectomy iatrogenic bile duct injuries?

In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.

三黄一龙汤对佐剂性关节炎继发心血管病变大鼠血管紧张素Ⅱ、醛固酮及相关炎性因子的影响

目的:探讨三黄一龙汤对佐剂性关节炎大鼠心脏的病理组织学、肾素-血管紧张素-醛固酮系统(RAAS)效应因子血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)和炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)表达的影响,探讨三黄一龙汤对佐剂性关节炎大鼠继发心血管病变的干预作用及调节机制。方法:70只Wistar健康雌性大鼠按照随机数字表法分为正常组、模型组、阳性药物组、三黄一龙汤低剂量组、三黄一龙汤中剂量组、三黄一龙汤高剂量组和安慰剂组,每组10只。除正常组,其余各组大鼠建立佐剂性关节炎模型。三黄一龙汤低剂量组、三黄一龙汤中剂量组、三黄一龙汤高剂量组分别给予每日生药量19.8、39.6、79.2 g/kg灌胃,阳性药物组给予来氟米特2.1 mg/kg灌胃,安慰剂组灌胃等量生理盐水,连续干预4周。苏木精-伊红(HE)染色观察心脏的病理组织学变化,酶联免疫吸附测定法、蛋白印迹法和免疫组化法检测外周血和心脏组织AngⅡ、ALD、TNF-α和IL-6的变化。结果:病理结果显示,相对于正常组,模型组继发心肌损伤,主要表现为心肌组织发生局部炎症,局部心肌细胞排列紊乱,个别大鼠心肌有轻微间质水肿。方药三黄一龙汤能够显著改善心肌损伤,使其炎症病灶缩小,水肿程度减轻,下调心脏组织AngⅡ和ALD的表达(P<0.05),降低外周血和心脏组织TNF-α、IL-6水平(P<0.05)。结论:方药三黄一龙汤可能通过抑制RAAS中AngⅡ和ALD的表达,减少TNF-α、IL-6的产生,从而缓解佐剂性关节炎继发的心血管病变。

Personalized treatment of perihilar cholangiocarcinoma based on tumor genetic and molecular characteristics

This editorial discusses the article written by Tchilikidi et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Genetic and molecular profiling of perihilar cholangiocarcinoma(pCCA)has identified a number of key abnormalities that drive tumor growth and spread,including pyruvate kinase M2,proline rich 11,and transcription factor 7,etc.pCCA has specific genetic and molecular features that can be used to develop personalized treatment plans.Personalized treatment approaches offer new opportunities for effectively targeting the underlying drivers of tumor growth and progression.The findings based on tumor genetic and molecular characteristics highlight the importance of developing personalized treatment strategies.

Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery

Among minimally invasive surgical procedures,colorectal surgery is associated with a notably higher incidence of incisional hernia(IH),ranging from 1.7% to 24.3%.This complication poses a significant burden on the healthcare system annually,necessitating urgent attention from surgeons.In a study published in the World Journal of Gastrointestinal Surgery,Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence.This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery,emphasizing the impact of obesity,surgical site infection,and the choice of incision location on its development.Furthermore,we summarize the currently available preventive measures for IH.Given the low surgical repair rate and high recurrence rate associated with IH,prevention deserves greater research and attention compared to treatment.

Relationship between Helicobacter pylori infection and colorectal polyp/colorectal cancer

Helicobacter pylori(H.pylori)plays an important role in the development of gastric cancer,although its association to colorectal polyp(CP)or colorectal cancer(CRC)is unknown.In this issue of World Journal of Gastrointestinal Surgery,Zhang et al investigated the risk factors for H.pylori infection after colon polyp resection.Importantly,the researchers used R software to create a prediction model for H.pylori infection based on their findings.This editorial gives an overview of the association between H.pylori and CP/CRC,including the clinical significance of H.pylori as an independent risk factor for CP/CRC,the underlying processes of H.pylori-associated carcinogenesis,and the possible risk factors and identification of H.pylori.

砜吡草唑与丙炔氟草胺对杂草的联合作用及玉米安全性评价

为筛选出有效防除玉米田杂草的除草剂混剂配比及其作物安全性,采用室内盆栽法测定了砜吡草唑与丙炔氟草胺及其不同比例混配组合对杂草生长的抑制作用及玉米安全性。结果表明,砜吡草唑与丙炔氟草胺不同比例的混配组合对稗草、马唐和藜均表现出加成作用,其中砜吡草唑与丙炔氟草胺质量比为1.25~20∶1时加成作用更为明显。砜吡草唑与丙炔氟草胺质量比为1~20∶1时,其在供试玉米品种和杂草之间的选择性指数较高,对玉米作物安全。

采用催化臭氧氧化降解煤化工含盐废水中有机物效能研究

采用催化臭氧氧化技术对煤化工气化污水生物处理单元出水中有机物进行强化去除。中试试验结果表明,采用碳基载锰氧化物催化剂催化臭氧氧化,能够显著提高臭氧对水中有机污染物的去除效能,较高的水样pH值、催化剂填充比、臭氧投量均有助于提高催化臭氧氧化体系对水中有机物污染物的去除效能。当臭氧投加量为32 mg/min,催化剂填充比例为1/8,反应时间60 min时,投加碳基载锰氧化物催化剂后,臭氧对水中有机物(COD)去除率由14.0%提升至65.0%。

简析我国高速公路汽车维修行业现状及发展预测

分析高速公路汽车维修服务体系低质量发展和低社会认可度问题,系统研究行业发展历程及特征。通过国内外对高速公路及高速公路汽车维修服务模式的研究历史和现状分析,系统总结我国高速公路汽车维修行业发展阶段,提出汽修行业常见问题,通过高速公路服务区汽车维修服务标准建议、行业管理改革建议、企业经营服务模式建议等方式,提出行业发展的管理对策与建议。

我国汽车维修行业发展历程研究

为清晰化我国汽车维修行业发展现状的历史成因,系统总结我国汽车维修行业发展过程,从行业管理改革、市场发展特征,以及汽车行业发展历程视角,回顾我国在不同历史阶段汽车维修行业所面临的主要问题及解决方案。汽车维修行业的发展史具有历史阶段特征,其不同阶段问题与特征与我国经济、社会、管理状态匹配。以动态发展的观点分析汽车维修行业,结合行业发展历程中的遗留影响,可以明确我国汽车维修行业发展现状中的问题,启示相关人员研究行业问题解决方案。