Nonsurgical intervention for neuroclaudication due to lumbar spinal stenosis:Interpretation of the 2021 American Association for the Study of Pain Guidelines

Lumbar Spinal Stenosis(LSS)is the major cause of Neurogenic Claudication(NC).It is common in the elderly and has an increasing incidence.In 2021,the United States Association for the Study of Pain published new evidence-based clinical practice guidelines to provide more effective nonsurgical treatment of LSS-induced NC.Based on a thorough reading of the latest guidelines,combined with new clinical developments,and in collaboration with the 2011 North American Spine Society,NASS guidelines(hereinafter referred to as the 2011 Guidelines)were compared with the 2019 Danish Health Authority(DHA)Guidelines(hereinafter referred to as the 2019 Guidelines),and the clinical diagnosis and treatment of NC caused by LSS were reviewed and suggestions were put forward.

新形势下医院医保管理及DRGs的探析

全民医保制度建立实施后,基本医疗保险参保率在95%以上,医保发挥着基础性作用。随着医改及DRGS的深入推进,医疗保障机构对医疗机构监督、制约的加强及医保支付制度的改革,如何做好医院内部管理,规范医疗服务行为,医院医保管理工作面临着新的挑战。医保部门为了确保基金安全及可持续运行,DRG本质上就是付费方式的改革,它对于促进医疗机构的精细化管理,不断推动医疗机构加强内涵建设有着非常积极的推动作用;倒逼医院采取更积极措施控制医疗费用的不合理增长,规范医疗服务行为,合理检查、治疗,主动控成本,提效率,降支出,不断提升医疗费用控制的能力水平和医疗服务管理的效率。

Pneumothorax during retroperitoneal laparoscopic partial nephrectomy in a lupus nephritis patient:A case report

BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative complications which needs immediate recognition.On the other hand,as a rheumatological disease,lupus nephritis requires a long period of hormone therapy.Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy.The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment.Her blood oxygen saturation dropped to 92%during the operation,and pneumothorax was detected by ultrasound.O2 inhalation and lung dilation were performed.Her vital signs were monitored closely throughout the operation.The operation was accomplished,and she regained consciousness smoothly.A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward,while no evidence of further pneumothorax or lib injury was observed.CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations,especially in retroperitoneal ones.It is easily neglected unless the injury of the diaphragm is found.Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.

Thermal decomposition characteristics and kinetics of methyl linoleate under nitrogen and oxygen atmospheres

The thermal decomposition characteristics of methyl linoleate （ML） under nitrogen and oxygen atmo- spheres were investigated, using a thermogravimetric analyzer at a heating rate of 10 ~C/min from room tem- perature to 600℃. Furthermore, the pyrolytic and kinetic characteristics of ML at different heating rates were stud- ied. The results showed that the thermal decomposition characteristics of ML under nitrogen and oxygen atmo- spheres were macroscopically similar, although ML exhibited relatively lower thermal stability under an oxy- gen atmosphere than under a nitrogen atmosphere. The initial decomposition temperature, the maximum weight loss temperature, the peak decomposition temperature, and the rate of maximum weight loss of ML under an oxygen atmosphere were much lower than those under a nitrogen atmosphere and increased with increasing heating rates under either oxygen or nitrogen atmosphere. In addition, the kinetic characteristics of thermal decomposition of ML were elucidated based on the experimental results and by the multiple linear regression method. The activation energy, pre-exponential factor, reaction order, and the kinetic equation for thermal decomposition of ML were obtained. The comparison of experimental and calculated data and the analysis of statistical errors of pyrolysis ratios demonstrated that the kinetic model was reliable for pyrolysis of ML with relative errors of about 1%. Finally, the kinetic compensation effect between the pre-exponential factors and the activation energy in the pyrolysis of ML was also confirmed.

Chalcogenide glass photonic integration for improved 2μm optical interconnection

In this work,on-chip chalcogenide glass photonic integrations with several fundamental photonic building blocks are designed and fabricated based on the As2 S3 platform for improved 2μm optical interconnection,achieving a broadened wavelength bandwidth and improved fabrication tolerance.A 600 nm thick As2 S3 strip waveguide has low propagation loss of 1.447 dB/cm at 2μm.Broadband vertical coupling is realized by a grating coupler with 4.3 dB coupling loss.A Bragg grating filter,power splitter,Mach–Zander interferometer,and mode converter for on-chip mode division multiplexing(MDM)are also reported at 2μm with reliable performances.Finally,a record high MDM optical interconnection capacity of 3×80 Gbps at 2μm is experimentally demonstrated based on the proposed As2 S3 chip,drawing promising prospects for future photonic integration and high-speed interconnection at the 2μm waveband.

On-chip chalcogenide microresonators with low-threshold parametric oscillation

Chalcogenide glass (ChG) is an attractive material for highly efficient nonlinear photonics,which can cover an ultrabroadband wavelength window from the near-visible to the footprint infrared region. However,it remains a challenge to implement highly-efficient and low-threshold optical parametric processes in chip-scale ChG devices due to thermal and light-induced instabilities as well as a high-loss factor in ChG films. Here,we develop a systematic fabrication process for high-performance photonic-chip-integrated ChG devices,by which planarintegrated ChG microresonators with an intrinsic quality (Q) factor above 1 million are demonstrated. In particular,an in situ light-induced annealing method is introduced to overcome the longstanding instability underlying ChG film. In high-Q ChG microresonators,optical parametric oscillations with threshold power as low as 5.4 mW are demonstrated for the first time,to our best knowledge. Our results would contribute to efforts of making efficient and low-threshold optical microcombs not only in the near-infrared as presented but more promisingly in the midinfrared range.

Emerging consensus on the mechanism of polyspecific substrate recognition by the multidrug transporter P-glycoprotein

P-glycoprotein(P-gp or ABCB1)is a member of the broad family of ABC transporters.P-gp participates in the establishment of physiological barriers limiting cellular access of a large number of toxic compounds.It thus plays important roles in the pharmacokinetics of these compounds.Cancer cells and cells infected by viruses exploit the presence of P-gp to fend off drug treatment,rendering them multidrug-resistant.Overcoming multidrug resistance caused by expression of ABC transporters has gained increasing attention in the field of drug development.Recently,studies of P-gp,especially from structural investigations by both cryo-electron microscopy and X-ray crystallography,have provided high-resolution mechanistic details for the function of this transporter.Structures with increasing resolution and accuracy in various substrate-and inhibitor-bound forms are available for analysis and a consensus on the mechanism of substrate polyspecificity is emerging.The use of new structural information may aid development of P-gp inhibitors as well as compounds that may bypass P-gp action.