脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康...脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康复机制仍不明确,需要更多的研究和探索。本文从TMS在运动功能评估、干预和康复预测模型的建立等方面入手,梳理、总结了近年来TMS在脑卒中运动康复领域的发展进程和研究现状,以期为后续研究提供参考。展开更多
AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017...AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.展开更多
Leakage occurring in the tube sockets of the main steam thermometers can seriously threaten the safe operation of coal-fired power plants.Here,assuming a 300 MW unit as a relevant testbed,this problem is investigated ...Leakage occurring in the tube sockets of the main steam thermometers can seriously threaten the safe operation of coal-fired power plants.Here,assuming a 300 MW unit as a relevant testbed,this problem is investigated numerically through solution of the equations of fluid-dynamics in synergy with the mathematical treatment of relevant statistics.The results indicate that the steam can form a large-scale spiral flow inside the tube socket and continuously scour the inner wall.In the model with the protective casing setting angle of 60°,the average tangential fluid velocity can reach up to 4.8 m/s,which is about twice higher than that in the model with the protective casing setting angle of 0°.The wake disturbance generated by the flow around the thermo-sensitive body leads to differences in the fluid motion inside the tube sockets between the upstream and downstream thermometers.These differences are affected by the distance between the thermometers,the setting angle of protective casing,and other factors.The pressure of the main steam inside the tube socket for a R3 thermometer,located outside the curved pipeline,is about 1756 Pa higher than that of the L3 thermometer located outside the straight pipeline,indicating that the secondary flow generated in the curved pipeline is able to provide stronger energy for the large-scale spiral flow inside the tube socket.On the basis of these findings,an improvement scheme for the installation of long-itudinal ribs in the tube sockets is proposed.The simulation results show that the average tangential velocity of the fluid within the near-wall area of tube sockets decreases by more than 90%,which should be enough to effectively alleviate the damage to the inner wall caused by high-pressure fluid or particles.展开更多
Mycoplasma pneumoniae(M.pneumoniae),primarily transmitted through respiratory droplets when infected individuals cough or sneeze,is a common cause of communityacquired pneumonia,especially among school-age children an...Mycoplasma pneumoniae(M.pneumoniae),primarily transmitted through respiratory droplets when infected individuals cough or sneeze,is a common cause of communityacquired pneumonia,especially among school-age children and adolescents.The infection occurs endemically with an epidemic peak every few years.The worldwide incidence confirmed by direct test methods was reported to be 8.61%between 2017 and 2020 across all age groups[1].展开更多
Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the c...Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the clinical findings regarding 2009 influenza A(H1N1)-associated pediatric deaths in China,including the risk factors for death.Methods:The definition of 2009 influenza A(H1N1)-associated pediatric death is death in a child who is younger than 14 years and has laboratory-confirmed influenza.We collected data of total 810 hospitalized patients with 2009 influenza A(H 1N 1)infection from September 2009 to February 2010 in 17 hospitals across China.The clinical characteristics,laboratory abnormalities,and treatment course were retrospectively studied.Results:Of the 810 patients hospitalized with 2009 influenza A(H1N1)infection,19(2.3%)died.Ten patients died from severe pneumonia and acute respiratory distress syndrome;eight died from encephalopathy/encephalitis;one died from secondary fungal meningitis.Patients who died were more likely than patients who survived to have neutrophilia,lymphopenia,elevated C-reactive protein,and elevations of lactate dehydrogenase,creatine kinase,creatine kinase-MB,aspartate aminotransferase and alanine aminotransferase.There were no significant differences in the median age,median time from onset of illness to admission,underlying chronic disease,and initiation of antiviral therapy within 48 hours of illness onset,between patients who died and those who survived.Interpretation:The risk factors for pediatric death associated with 2009 influenza A(H 1N 1)infection are different from those of seasonal influenza.The most common causes of death are viral pneumonia,acute respiratory distress syndrome,and encephalopathy/encephalitis.展开更多
BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resectio...BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.展开更多
During the COVID-19 epidemic,it is important for ensuring infection prevention and control in the pediatric respiratory clinics.Herein,we introduced the practice of infection prevention and control in pediatric respir...During the COVID-19 epidemic,it is important for ensuring infection prevention and control in the pediatric respiratory clinics.Herein,we introduced the practice of infection prevention and control in pediatric respiratory clinics in China.Triage measures for patients who visit respiratory clinics,quality control for pediatric respiratory clinics and other preventive measures for related examinations and treatment have been introduced in this review article.展开更多
文摘脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康复机制仍不明确,需要更多的研究和探索。本文从TMS在运动功能评估、干预和康复预测模型的建立等方面入手,梳理、总结了近年来TMS在脑卒中运动康复领域的发展进程和研究现状,以期为后续研究提供参考。
文摘AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.
文摘Leakage occurring in the tube sockets of the main steam thermometers can seriously threaten the safe operation of coal-fired power plants.Here,assuming a 300 MW unit as a relevant testbed,this problem is investigated numerically through solution of the equations of fluid-dynamics in synergy with the mathematical treatment of relevant statistics.The results indicate that the steam can form a large-scale spiral flow inside the tube socket and continuously scour the inner wall.In the model with the protective casing setting angle of 60°,the average tangential fluid velocity can reach up to 4.8 m/s,which is about twice higher than that in the model with the protective casing setting angle of 0°.The wake disturbance generated by the flow around the thermo-sensitive body leads to differences in the fluid motion inside the tube sockets between the upstream and downstream thermometers.These differences are affected by the distance between the thermometers,the setting angle of protective casing,and other factors.The pressure of the main steam inside the tube socket for a R3 thermometer,located outside the curved pipeline,is about 1756 Pa higher than that of the L3 thermometer located outside the straight pipeline,indicating that the secondary flow generated in the curved pipeline is able to provide stronger energy for the large-scale spiral flow inside the tube socket.On the basis of these findings,an improvement scheme for the installation of long-itudinal ribs in the tube sockets is proposed.The simulation results show that the average tangential velocity of the fluid within the near-wall area of tube sockets decreases by more than 90%,which should be enough to effectively alleviate the damage to the inner wall caused by high-pressure fluid or particles.
基金funded by the Science and Technology Commission of Shanghai Municipality(No.21511104502)Shanghai Hospital Development Center(No.SHDC22022221).
文摘Mycoplasma pneumoniae(M.pneumoniae),primarily transmitted through respiratory droplets when infected individuals cough or sneeze,is a common cause of communityacquired pneumonia,especially among school-age children and adolescents.The infection occurs endemically with an epidemic peak every few years.The worldwide incidence confirmed by direct test methods was reported to be 8.61%between 2017 and 2020 across all age groups[1].
文摘Importance:A cluster of influenza-associated deaths occurred among children during pandemic 2009 influenza A(H 1N1)in China,but the risk factors and causes for death have not been clarified.Objective:We describe the clinical findings regarding 2009 influenza A(H1N1)-associated pediatric deaths in China,including the risk factors for death.Methods:The definition of 2009 influenza A(H1N1)-associated pediatric death is death in a child who is younger than 14 years and has laboratory-confirmed influenza.We collected data of total 810 hospitalized patients with 2009 influenza A(H 1N 1)infection from September 2009 to February 2010 in 17 hospitals across China.The clinical characteristics,laboratory abnormalities,and treatment course were retrospectively studied.Results:Of the 810 patients hospitalized with 2009 influenza A(H1N1)infection,19(2.3%)died.Ten patients died from severe pneumonia and acute respiratory distress syndrome;eight died from encephalopathy/encephalitis;one died from secondary fungal meningitis.Patients who died were more likely than patients who survived to have neutrophilia,lymphopenia,elevated C-reactive protein,and elevations of lactate dehydrogenase,creatine kinase,creatine kinase-MB,aspartate aminotransferase and alanine aminotransferase.There were no significant differences in the median age,median time from onset of illness to admission,underlying chronic disease,and initiation of antiviral therapy within 48 hours of illness onset,between patients who died and those who survived.Interpretation:The risk factors for pediatric death associated with 2009 influenza A(H 1N 1)infection are different from those of seasonal influenza.The most common causes of death are viral pneumonia,acute respiratory distress syndrome,and encephalopathy/encephalitis.
基金Supported by the Engineering Training Funds in Shenzhen,No.SYLY201718,No.SYJY201714,and No.SYLY201801Technical Research and Development Project of Shenzhen,No.JCYC20170307100911479,No.JCYJ20190807145617113,No.JCYJ20210324113802006.
文摘BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.
基金Health Science and Technology Project of Shanghai Pudong New Area Health and Health Committee(PW2017E-1)Science and Technology Support Project in Biomedical Field of“Science and Technology Innovation Action Plan”of Shanghai Science and Technology Commission(19441909000)Health Science and Technology Project of Shanghai Pudong New Area Health and Health Committee(PW2019A-37).
文摘During the COVID-19 epidemic,it is important for ensuring infection prevention and control in the pediatric respiratory clinics.Herein,we introduced the practice of infection prevention and control in pediatric respiratory clinics in China.Triage measures for patients who visit respiratory clinics,quality control for pediatric respiratory clinics and other preventive measures for related examinations and treatment have been introduced in this review article.
