Ten-year observation of corneal densitometry and associated factors following small incision lenticule extraction

●AIM:To investigate the long-term changes of corneal densitometry(CD)and its contributing elements after small incision lenticule extraction(SMILE).●METHODS:Totally 31 eyes of 31 patients with mean spherical equivalent of-6.46±1.50 D and mean age 28.23±7.38y were enrolled.Full-scale examinations were conducted on all patients preoperatively and during followup.Visual acuity,manifest refraction,axial length,corneal thickness,corneal higher-order aberrations,and CD were evaluated.●RESULTS:All surgeries were completed successfully without complications or adverse events.Ten-year safety index was 1.17±0.20 and efficacy 1.04±0.28.CD value of 0–6 mm zones in central layer was statistically significantly lower 10y postoperatively,compared with preoperative values(0–2 mmΔ=-1.62,2–6 mmΔ=-1.24,P<0.01).There were no correlations between CD values and factors evaluated.●CONCLUSION:SMILE is a safe and efficient procedure for myopia on a long-term basis.CD values get lower 10y postoperatively,whose mechanism is to be further discussed.

Changes in posterior corneal elevation after small incision lenticule extraction for different myopic diopters

●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.

Clinical observation of extraction-site incisional hernia after laparoscopic colorectal surgery

BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.

Endoscopic radial incision and cutting method for adult congenital duodenal webs:A case report

BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.

Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure

BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective:To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients.Methods:96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A(ultrasonic emulsification)and group B(small-incision extracapsular cataract extraction),with 48 cases each.Results:At 1 week,1-month,and 3 months post-operation,the visual acuity of group A was higher and the astigmatism value was lower than that of group B(P<0.05);at 12h,24h,and 48h post-operation,the intraocular pressure of group A was higher than that of group B(P<0.05);the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation(P<0.05).Conclusion:Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism,improving visual acuity,and regulating macular thickness.However,due to the high energy of ultrasonic emulsification,the risk of complications such as high postoperative intraocular pressure was higher.Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

Postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens implantation versus small incision lenticule extraction in myopic eyes:a Meta-analysis

AIM:To compare the postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens(ICL)implantation versus small incision lenticule extraction(SMILE)in myopia eyes.METHODS:Pub Med,EMBASE,Web of Science,Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia.The primary outcomes were efficacy,safety,and predictability.And the secondary outcomes were postoperative higher-order ocular aberrations(HOAs),modulation transfer function cutoff frequency(MTF),objective scatter index(OSI),contrast sensitivity and a quality of vision(Qo V)questionnaire.RESULTS:A total of 1036 eyes from 10 studies,of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE,were enrolled in this Meta-analysis.Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity(CDVA)(P=0.007,<0.00001,respectively),and a lower percentage of eyes with a postoperative CDVA lost 1 line(P=0.007)than the SMILE group.No significant differences were found in comparison of the other primary outcomes.In the longterm follow-up(>6mo),ICL group had a lower total HOA,coma,and spherical aberration than SMILE group(P=0.003,<0.00001,0.04).Yet higher trefoil was found in ICL group at 6mo after surgery(P=0.003).Additionally,ICL group also had a higher MTF value(P=0.02),and a higher contrast sensitivity score for spatial frequencies of 1.5,6,and 12 cpds(P=0.02,0.005,0.02,respectively).And it also had a lower score of bothersome in Qo V questionnaire than SMILE group(P=0.003).CONCLUSION:ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia.However,ICL group is relatively safer and also has better visual quality in comparison of SMILE group.

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity:case series

AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

Effectiveness and the nomogram of small incision lenticule extraction in the correction of myopic anisometropia in adults

AIM:To evaluate the safety,effectiveness,and predictability of small incision lenticule extraction(SMILE)for the treatment of anisometropia,and to explore the personalized design scheme of SMILE in correcting adult myopia anisometropia based on the nomogram.METHODS:It’s a prospective cohort study.Patients with anisometropic myopia of refractive difference≥2.0 diopters(D)who underwent SMILE between September 2020 and March 2021 were enrolled.Clinical features and visual function were assessed preoperatively and at 1wk,1,3,and 6mo after the operation.The examination included tests for uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),refractive errors,effectiveness index(preoperative CDVA/postoperative UDVA),safety index(postoperative CDVA/preoperative CDVA),nomogram and stereoscopic function.Paired t-test,Wilcoxon signed-rank test and repeated-measures analyses of variance were used for continuous variables,and Pearson Chi-squared test was used for categorical variables.RESULTS:The study involved 45 consecutive patients(average age:25.0±6.9y;82 out of 90 eyes underwent SMILE,while 8 eyes were not operated).The average preoperative spherical equivalent(SE)was-4.74±0.22 D.Six months after surgery,the effectiveness index was 1.05±0.12,and the safety index was 1.09±0.11.Seventy eyes(85.4%)exhibited SE correction error within±0.5 D.The percentage of eyes with Titmus stereoscopic function equal to or less than 200”significantly increased from 55.6%preoperatively to 88.9%postoperatively(P<0.05).There was statistically significant difference between higher myopia eyes and contralateral eyes in average nomogram value/spherical refraction ratio.CONCLUSION:SMILE is safe,effective and predictable in correcting myopic anisometropia,and it improves stereoscopic visual function of anisometropia patients.The precise and individualized design of the nomogram is a vital element to ensure the balance of both eyes after SMILE.

A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia

AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.

Comparative study of functional optical zone:small incision lenticule extraction versus femtosecond laser assisted excimer laser keratomileusis

AIM:To investigate the size of functional optical zone(FOZ)after small incision lenticule extraction(SMILE)versus femtosecond laser assisted excimer laser keratomileusis(FS-LASIK)for myopia correction and potential associated factors for FOZ.METHODS:A total of 133 patients who received corneal refractive surgery in our hospital between November 2018 and July 2021 were retrospectively enrolled.There were 63 patients(123 eyes)in SMILE group and 70patients(139 eyes)in FS-LASIK group.The size of FOZ was measured using Pentacam 3-dementional anterior segment analyzer before and 3mo after surgery,so as to analyze postoperative achieved functional optical zone(AFOZ)and its contributing parameters.RESULTS:When planned functional optical zone(PFOZ)was 6.5 mm for both groups,AFOZ was 1.45±0.27 and 1.67±0.25 mm smaller than preoperative FOZ in SMILE group and FS-LASIK group 3mo after surgery.AFOZ in SMILE group was significantly larger than that in FS-LASIK group(P<0.001).Variation of FOZ was negatively correlated with preoperative spherical equivalent(SE)and positively correlated with variation of mean keratometry value(△Km),variation of spherical aberration(△SA),and variation of Q-value(△Q,all P<0.001)in both groups.Multiple variable linear regression equations were△FOZ=1.354-0.1×pre-SE+0.336×△Q+1.462×△SA in SMILE group and△FOZ=1.512+0.137×△Q+0.468×△SA in FS-LASIK group.CONCLUSION:AFOZ is significantly smaller than preoperative FOZ in both SMILE and FS-LASIK groups.With the same PFOZ,larger AFOZ is achieved in SMILE group than in FS-LASIK group.

Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery:a surgery assisted by fibrin glue

AIM:To observe the clinical efficacy of the combined use of small incision lenticule extraction(SMILE)-derived lenticule patches in corneal dermoid excision,with fixation of the lenticule patches assisted by fibrin glue.METHODS:Seventeen eyes of 17 patients with corneal dermoid were treated with dermoid removal combined with SMILE-derived lenticule transplantation.All lenticule patches were fixed by fibrin glue.Ocular changes were assessed using slit lamp microscopy and anterior-segmental optical coherence tomography.The best-corrected visual acuity(BCVA)and ocular dioptric variations were examined preoperatively and postoperatively.Intraocular pressure(IOP)was also monitored in all visited time.RESULTS:Totally,18 lenticule patches were used on 17 eyes of 17 cornea dermoid patients.The mean follow-up time was 11.47±5.28mo.All lenticule patches we resuccessfullyg lued,kept on its location and maintained transparent during the follow-up time,with a consecutive epithelial cover for 1wk.Nine of the patients could coordinate visual and optometry exam well.Their preoperative BCVA is 0.60±0.35 in decimal,significantly improved to 0.80±0.26 in decimal at 6mo postoperatively(Z=-2.392,P=0.017),but the changes of their corneal astigmatism diopters showed no significance,with 2.22±1.91 D preoperatively,and 2.28±1.31 D at 6mo postoperatively(Z=-0.135,P=0.893).Limbal pannus formation occurred in 4(23.52%)cases and decreased with the application of tacrolimus eyedrops.IOP increased in 2(11.76%)cases,but well decreased by timolol maleate eyedrops.All the adult patients or guardians of minor patients were satisfied with the cosmetic improvement.CONCLUSION:Dermoid excision combined with transplantation of SMILE-derived lenticule patches using fibrin glue is a safe and effective novel tectonic keratoplasty procedure for corneal dermoid.

A Sandwich Technique Employing Right Ventricular Incision to Repair Posterior Ventricular Septal Rupture with Right Ventricular Wall Dissection: A Case Report

Background: Ventricular septal rupture (VSR) leading to right ventricular (RV) wall dissection is an extremely rare and life-threatening complication of inferior myocardial infarction (MI) with posterior VSR. Its rare incidence and complex pathology make it difficult to select the appropriate surgical procedures to prevent fatalities. Case Presentation: A 68-year-old woman was transferred to our hospital because of a post-infarction VSR 12 days after symptom onset. Short-axis image obtained using transthoracic echocardiography demonstrated a large posterior VSR. Moreover, the VSR was continuous, with a large echo-free space in the posterior wall of the right ventricle. Color echocardiography showed blood flowing into the echo-free space through the septal defect and blood flowing out into the RV lumen. Coronary angiography revealed complete occlusion of the second segment of the right coronary artery. Thus, dissection of the posterior wall of the right ventricle that continued into the RV lumen was considered to have been caused by the posterior VSR caused by an inferior MI. The patient underwent urgent surgery to repair the VSR using the sandwich double-patch technique by making a posterior RV incision that was repaired using a third patch. No additional procedure was required to block the flow from the cavity of the RV wall dissection into the RV lumen. Postoperative echocardiography and contrast-enhanced computed tomography demonstrated that the VSR was closed securely and the RV wall dissection was almost completely thrombosed. Conclusion: In this case, a patient with a posterior VSR and RV wall dissection was successfully treated using the sandwich double-patch technique with a posterior RV incision. No additional procedure may be needed for RV wall dissection when a secure VSR repair is complete;however, close follow-up is essential to improve the long-term prognosis.

Clinical Study of Liposuction Combined with Subareolar Incision Adenectomy for Gynecomastia

Objective: To investigate the clinical effect of liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular gynecomastia (GYN). Methods: From March 2021 to March 2022, the data of patients with Simon Grade Ⅲ adipo-glandular GYN treated by liposuction combined with glandectomy in the Department of Plastic Surgery, Zhongshan Hospital Affiliated to Dalian University and Henan Plastic Surgery and Aesthetic Hospital were retrospectively analyzed. Based on the medical records, color ultrasound was performed on the patient’s breast before surgery, which was determined to be GYN (more than 50% glandular tissue). A 3 mm long incision was made at the lower boundary of the surgical range, through which the adipose tissue in the hypertrophic region of the breast was repeatedly aspirated until a satisfactory thickness was achieved. The residual glandular tissue was removed by a semicircular arc incision under the areola, and then the areola incision was sutured in position. The blood flow, sensation, and wound healing of bilateral nipples and areola were observed after surgery, and the morphology of bilateral thorax and scar of incision were followed up. Results: A total of 15 GYN patients aged 18 to 35 years with body mass index of 23.8 to 26.5 kg/m2 (mean = 24.8 kg/m2) were included in this study. The average intraoperative liposuction volume of unilateral breast was 170 mL (150-200 mL), the average glandectomy volume was 115 g (95-125 g), and the average blood loss was about 40 mL (15-75 mL). Postoperative hypertrophic breast volume decreased significantly, and no complications such as hematoma, infection, skin ischemic necrosis, or sensory disturbance occurred in the nipple and areola, during the healing process. The patients were followed up for 3 to 6 months, and the bilateral thorax was smooth, symmetrical, and natural in contour. The incision was concealed, and the scar was not obvious. Conclusion: Liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular GYN is safe. The postoperative chest contour is smooth and natural, and the scar is small and invisible, which achieves good aesthetics.

Right Sub-Axillary Incision for Right Pulmonary Vein Atresia in a Child:A Case Report and Literature Review

Unilateral pulmonary vein atresia(UPVA)in children is a rare disease that is characterized by a recurrent pulmonary infection and hemoptysis in childhood.This paper is a report of a case of pulmonary venous atresia treated by a right sub-axillary incision.Hopefully,more literature can be produced to improve the awareness and treatment level of pulmonary vein atresia.

Analysis of the Role of Nursing Intervention in Operating Room in the Prevention of Incision Infection in Orthopedic Aseptic Surgery

Objective:To explore and analyze the role of nursing in the operating room in the prevention of incision infection in aseptic orthopedic surgery.Methods:68 patients that underwent aseptic orthopedic surgery in our hospital from January 2021 to December 2022.They were divided into a research group(n=34)and a control group(n=34)by the random number table method.The patients in the control group received conventional nursing intervention in the operating room,and the patients in the study group received the optimized and modified nursing intervention in the operating room;then,the related indicators of nursing intervention of the two groups were compared.Results:The incidence of incision infection in the study group was lower than that of the control group(P<0.05);the average duration of surgery and length of stay the study group were lower than those in the control group(P<0.05);the stress response indexes of patients in the study group were lower than those in the control group 24 hours after operation(P<0.05);the degree of satisfaction of the patients in the study group to the services provided by the nursing staff was significantly higher than that of the control group(P<0.05).Conclusion:High-quality nursing intervention in the operating room for aseptic orthopedic surgery patients can significantly reduce the incidence of incision infection,reduce the stress response caused by surgery,shorten the duration of surgery and length of stay,and improve nursing satisfaction,which makes it worthy of popularization.

装配式桥梁板玻璃纤维混凝土-U形钢筋湿接缝受力与变形分析

为解决装配式桥梁板体系湿接缝处力学性能不稳定、易变形的问题,提出采用玻璃纤维混凝土-U形钢筋加强方案优化湿接缝性能,以雄安新区荣乌高速荣乌主线桥为背景进行研究。选取主线桥2个试验段(试验段A湿接缝采用普通混凝土-U形钢筋方案,钢筋点焊;试验段B湿接缝采用玻璃纤维混凝土-U形钢筋加强方案,钢筋满焊)进行梁板体系湿接缝性能试验,监测湿接缝处搭接钢筋力学响应及混凝土接触面变形特征,同时对长期运载及强降雨影响下的钢筋受力与混凝土变形进行监测。结果表明:长期运载下,试验段B横筋受力约为试验段A的一半,其中部纵筋承受外力远大于试验段A,边缘纵筋承受外力较少,试验段B稳定性更优;试验段B较试验段A在湿接缝部位变形量小,其稳定性及耐久性更优;强降雨阶段,试验段B较试验段A变形及力学响应波动程度更低,其抗渗能力、耐久性更优。由此可知基于玻璃纤维混凝土-U形钢筋加强方案的湿接缝构造在外力传导、抵抗变形方面具有较强稳定性,不易受恶劣环境影响。

东昆仑大格勒农场南辉长岩锆石U-Pb年代学、地球化学特征及地质意义

东昆仑志留纪岩浆活动强烈,记录了东昆仑造山带原特提斯洋演化晚期大洋俯冲阶段与碰撞阶段转换地质过程。本次研究对东昆仑大格勒农场南志留纪基性侵入岩开展了详细的岩相学、岩石地球化学、锆石U-Pb年代学和Hf同位素研究,以确定其形成时代、岩石成因和构造环境。研究结果表明大格勒农场南辉长岩的结晶年龄为430.2±2.4 Ma,形成时代为中志留世。辉长岩SiO_(2)(51.40%~53.66%)含量较低,MgO(18.56%~22.16%)和FeO^(T)(7.54%~10.64%)含量高,Mg^(#)为79~82。微量元素富集Rb、Th、Ba、Cs等大离子亲石元素(LILE),亏损Nb、Ta、Ti等高场强元素(HFSE),具有高Ni(276~973μg/g)、Cr(2152~3574μg/g)和Sc(35.5~53.1μg/g)含量,低Nb/Ta值(3.23~8.68)和εHf(t)值(-7.3~-3.6)。大格勒农场南辉长岩的地球化学组成具有岛弧基性岩特征,其成因可能是流体和俯冲沉积物加入的富尖晶石橄榄岩部分熔融的结果。综合区域资料表明,大格勒农场南辉长岩形成于东昆仑原特提斯洋俯冲晚期阶段,进一步限定原特提斯洋晚期俯冲与碰撞转换时限为中志留世,随后转入碰撞造山阶段。

引入上下文信息和Attention Gate的GUS-YOLO遥感目标检测算法

目前基于通用YOLO系列的遥感目标检测算法存在并未充分利用图像的全局上下文信息,在特征融合金字塔部分并未充分考虑缩小融合特征之间的语义鸿沟、抑制冗余信息干扰的缺点。在结合YOLO算法优点的基础上提出GUS-YOLO算法,其拥有一个能够充分利用全局上下文信息的骨干网络Global Backbone。除此之外,该算法在融合特征金字塔自顶向下的结构中引入Attention Gate模块,可以突出必要的特征信息,抑制冗余信息。另外,为Attention Gate模块设计了最佳的网络结构,提出了网络的特征融合结构U-Net。最后,为克服ReLU函数可能导致模型梯度不再更新的问题,该算法将Attention Gate模块的激活函数升级为可学习的SMU激活函数,提高模型鲁棒性。在NWPU VHR-10遥感数据集上,该算法相较于YOLOV7算法取得宽松指标mAP^(0.50)1.64个百分点和严格指标mAP^(0.75)9.39个百分点的性能提升。相较于目前主流的七种检测算法,该算法取得较好的检测性能。

体育锻炼与中国老年人生活满意度的倒U型关系:抑郁的中介作用

目的:探究体育锻炼与中国老年人生活满意度的关系以及抑郁的中介作用。方法:采用STATA 15.1软件对2018年中国健康与养老追踪调查数据中的60岁以上老年人生活满意度等基本情况进行描述性统计分析,运用基准回归模型与PSM(倾向得分匹配法)分析体育锻炼与老年人生活满意度的关系,通过建立中介模型考察抑郁在体育锻炼与生活满意度间的中介作用。结果:体育锻炼与老年人生活满意度呈倒U型关系(P<0.001),与抑郁呈U型关系(P<0.001),抑郁负向预测生活满意度(P<0.001),农村与城市老年人倒U型曲线出现拐点的阈值分别为3.133、3.455,在男女老年群体中倒U型曲线出现拐点的阈值分别为3.231、2.938,抑郁在体育锻炼与生活满意度间起中介作用。结论:体育锻炼在提升老年人生活满意度的过程中存在一定的剂量效应,体育锻炼对老年人生活满意度的影响具有异质性,老年人体育锻炼既可直接影响生活满意度,也可通过抑郁间接影响生活满意度。