High-dependency units play a key role in the treatment of a Chinese military patient who developed liver failure while abroad

High-dependency units(HDUs)provide high-level care to patients who suffer from single organ failure,with the exception of respiratory failure requiring mechanical ventilation;HDUs serve as an intermediary between general wards and Intensive Care Units.Due to military and civilian needs,our hospital has established a unique HDU for patients with liver disease in China.A Chinese military officer in the United Nations Peacekeeping Forces in South Sudan was transferred to our HDU for liver failure treatment in 2018.The patient’s disease status,nutrition,sleep habits,and psychological behaviour were monitored on different scales.The patient was provided with vascular monitoring,telemetry,pulse oximetry,drug treatment,nutritional support,sleep intervention,psychological intervention,and humanistic care by a multidisciplinary treatment team.After treatment,the patient recovered and avoided liver transplantation.Based on the experience with this HDU,this new model may create an efficient treatment process for military and civilian patients with severe liver disease at home or abroad.

Simulation of Low TDS and Biological Units of Fajr Industrial Wastewater Treatment Plant Using Artificial Neural Network and Principal Component Analysis Hybrid Method

Being familiar with characteristics of industrial town effluents from various wastewater treatment units, which have high qualitative and quantitative variations and more uncertainties compared to urban wastewaters, plays very effective role in governing them. With regard to environmental issues, proper operation of wastewater treatment plants is of par- ticular importance that in the case of inappropriate utilization, they will cause serious problems. Processes that exist in environmental systems mostly have two major characteristics: they are dependent on many variables;and there are complex relationships between its components which make them very difficult to analyze. In order to achieve a better and efficient control over the operation of an industrial wastewater treatment plant (WWTP), powerful mathematical tool can be used that is based on recorded data from some basic parameters of wastewater during a period of treatment plant operation. In this study, the treatment plant was divided into two main subsystems including: Low TDS (Total Dissolved Solids) treatment unit and Biological unit (extended aeration). The multilayer perceptron feed forward neural network with a hidden layer and stop training method was used to predict quality parameters of the industrial effluent. Data of this study are related to the Fajr Industrial Wastewater Treatment Plant, located in Mahshahr—Iran that qualita- tive and quantitative characteristics of its units were used for training, calibration and validation of the neural model. Also, Principal Component Analysis (PCA) technique was applied to improve performance of generated models of neural networks. The results of L-TDS unit showed good accuracy of the models in estimating qualitative profile of wastewater but results of biological unit did not have sufficient accuracy to being used. This model facilitates evaluating the performance of each treatment plant units through comparing the results of prediction model with the standard amount of outputs.

Performance Simulation of H-TDS Unit of Fajr Industrial Wastewater Treatment Plant Using a Combination of Neural Network and Principal Component Analysis

Nowadays, with regard to environmental issues, proper operation of wastewater treatment plants is of particular importance that in the case of inappropriate utilization, they will cause serious problems. Processes that exist in environmental systems and environmental engineers are dealing with them mostly have two major characteristics: they are dependent on many variables;and there are complex relationships between its components which make them very difficult to analyze. Being familiar with characteristics of industrial town effluents from various wastewater treatment units, which have high qualitative and quantitative variations and more uncertainties compared to urban wastewaters, plays very effective role in governing them. In order to achieve a better and efficient control over the operation of an industrial wastewater treatment plant, powerful mathematical tool can be used that is based on recorded data from some basic parameters of wastewater during a period of treatment plant operation. In this study, the multilayer perceptron (MLP) feed forward neural network with a hidden layer and stop training method was used to predict quality parameters of the industrial effluent. Data of this study are related to the Fajr Industrial Wastewater Treatment Plant located in Mahshahr—Iran that qualitative and quantitative characteristics of its units were used for training, calibration and evaluation of the neural model. Also, Principal Component Analysis technique was applied to modify and improve performance of generated models of neural networks. The results of this model showed good accuracy of the model in estimating qualitative pro- file of wastewater. This model facilitates evaluating the performance of each treatment plant units through comparing the results of prediction model with the standard amount of output.

Method for Converting Cone-Beam CT Values into Hounsfield Units for Radiation Treatment Planning

Cone-beam CT (CBCT) images acquired during radiation treatment can be used to recalculate the dose distribution as well as to confirm the treatment location. However, it is difficult to obtain the electron densities (EDs) necessary for dose calculation from CBCT images because of the effects of scatter contamination during CBCT image acquisition. This paper presents a mathematical method for converting the pixel values of CBCT images (CBCT values) into Hounsfield units (HUs) of radiation treatment simulation CT (simCT) images for use in radiation treatment planning. CBCT values are converted into HUs by matching the histograms of the CBCT values with the histograms of the HUs for each slice via linear scaling of the CBCT values. For prostate cancer and head-and-neck cancer patients, the EDs obtained from converted CBCT values (mCBCT values) show good agreement with the EDs obtained from HUs, within approximately 3.0%, and the dose calculated on the basis of CBCT images shows good agreement with the dose calculated on the basis of the simCT images, within approximately 2.0%. Because the CBCT values are converted for each slice, this conversion method can account for variation in the CBCT values associated with differences in body size, body shape, and inner tissue structures, as well as in longitudinally displaced positions from the isocenter, unlike conventional methods that use electron density phantoms. This method improves on conventional CBCT-ED conversion and shows considerable potential for improving the accuracy of radiation treatment planning using CBCT images.

Treatment of gasification effluent of fertilizer with biochemical united technology

Introduced the technology and application of treating the gasification effluent offertilizer with the physical-chemistry and biochemistry united technology.The technology issimple and viable, and occupies less land.When the main equipment runs normally, thegasification effluent of fertilizer treated with the united technology reached the requirementby second-degree discharge standard of the'Discharge standard of water pollutants forsynthesize ammonia industry'.

The Basic Units of Living Things:A Cell

What is a cell?Definition,A cell is the basic unit of all living things.It is the unit of life.Some living things consistof only one cell.They are called unicellular(one-celled).Other living things consist of more thanone cell.They are called multicellular(many-celled).All plants and animals are multicellular.God provided his creation with a great variety of cells.Yet,as you will learn,all cells have somethings in common.Basic parts of a cell.

Release of Uranium by an Ore Treatment Unit at Caldas,MG,Brazil

This study aims to assess the behavior of the release of Unat (i.e. uranium isotopes in natural relative abundance) from the release of water treated by the Ore Treatment Unit (UTM) in Caldas, state of Minas Gerais, Brazil, during the years 1999 to 2009. During this period, the unit showed no industrial activity, except between 2004 and 2005, when UTM operated 400 tons of monazite in a process to obtain rare earths. Unat was analyzed by spectrophotometry once per week in the effluent waters at sampling point 014. Two fractions were considered for analysis: the soluble one (that passes through a 0.45 μm filter) and the particulate one (retained on a 0.45 μm filter). Statistical analyses were performed: the “Z” test and Pearson’s r2 correlation index. The values for the soluble fraction were consistently lower than those of the particulate fraction and no statistically significant correlation was observed between the soluble and particulate fractions. However, the particulate and the total fractions (the sum of soluble and particulate) strongly correlated.

Characteristics of patients with Wilson disease in the United States: An insurance claims database study

BACKGROUND Wilson disease(WD)is a progressive,potentially fatal degenerative disease affecting the liver and central nervous system.Given its low prevalence,collecting data on large cohorts of patients with WD is challenging.Comprehensive insur-ance claims databases provide powerful tools to collect retrospective data on large numbers of patients with rare diseases.AIM To describe patients with WD in the United States,their treatment and clinical outcome,using a large insurance claims database.METHODS This retrospective,longitudinal study was performed in the Clarivate Real-World Data Product database.All patients with≥2 claims associated with an Interna-tional Classification of Diseases 10(ICD-10)diagnostic code for WD(E83.01)between 2016 and 2021 were included and followed until death or study end.Patients were divided into two groups by whether or not they were documented to have received a specific treatment for WD.Clinical manifestations,hospital-isations,liver transplantation and death were documented.RESULTS Overall,5376 patients with an ICD-10 diagnostic code for WD were identified.The mean age at inclusion was 41.2 years and 52.0%were men.A specific WD treatment was documented for 885 patients(15.1%),although the number of patients taking zinc salts may be underestimated due to over the counter purchase.At inclusion,the mean age of patients with a documented treatment was 36.6±17.8 years vs 42.2±19.6 years in those without a documented treatment.During follow-up,273 patients(5.1%)died.Compared with the American general population,the standardised mortality ratio was 2.19.The proportion of patients with a documented WD-specific treatment who died during follow-up was 4.0%and the mean age at death 52.7 years.CONCLUSION Patients treated for WD in the United States had an excess early mortality compared with the American population.These findings indicate that there is a significant unmet need for effective treatment for WD in the United States.

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.

Deep learning-based intelligent management for sewage treatment plants

It is generally believed that intelligent management for sewage treatment plants(STPs) is essential to the sustainable engineering of future smart cities.The core of management lies in the precise prediction of daily volumes of sewage.The generation of sewage is the result of multiple factors from the whole social system.Characterized by strong process abstraction ability,data mining techniques have been viewed as promising prediction methods to realize intelligent STP management.However,existing data mining-based methods for this purpose just focus on a single factor such as an economical or meteorological factor and ignore their collaborative effects.To address this challenge,a deep learning-based intelligent management mechanism for STPs is proposed,to predict business volume.Specifically,the grey relation algorithm(GRA) and gated recursive unit network(GRU) are combined into a prediction model(GRAGRU).The GRA is utilized to select the factors that have a significant impact on the sewage business volume,and the GRU is set up to output the prediction results.We conducted a large number of experiments to verify the efficiency of the proposed GRA-GRU model.

AIDS Treatments Efficiency Analysis Based on Cost Efficiency Data Envelopment Analysis Model

Three data envelopment analysis (DEA) models were used to analyse the relative efficiencies of four AIDS treatments in AIDS Clinical Trial Group (ACTG) Study 193A(1 309 patients in total, classified into 4 age groups). Results from the output-oriented BCC model show that Treatment 4 ( 600 mg of zidovudine plus 400 mg of didanosine plus 400 mg of nevirapine) is particularly efficient for age group 14—25, but not efficient for the older age groups; Treatment 1 (600 mg of zidovudine alternating monthly with 400 mg of didanosine)and Treatment 2 (600 mg of zidovudine plus 2.25 mg of zalcitabine) are efficient for the age groups 35—45 and 45— ; age group 25—35 does not have a particularly efficient treatment, but Treatments 1 and 2 are relatively good. The cost efficiency BCC model, which takes the treatment cost into account, gives similar results as the output-oriented model. Results from the indirect output-oriented BCC model, which allows the replacement among medicines, show that the efficiency of Treatment 2 has greatly decreased compared with that of the output-oriented model, and a set of optimal medicine amounts for different age groups is obtained.

Construction of a New Water Treatment System Based on Material Circulation

A new water treatment system based on material circulation was constructed for purification of naturally polluted pond water in an aquarium. The water treatment system consisted of microbial columns with different flow rates (1.8 L/min/column in 6-columns unit and 2.9 L/min/column in 3-columns unit). Two hundred liters of water from a naturally polluted pond were treated for 14 days using the water treatment system. After treatment, the COD, TC, and TN had been reduced by up to 19.2%, 14.4%, and 20.1%, respectively. The bacterial biomass in the 3-columns unit was 7-fold higher than that in the 6-columns unit, and PCR-DGGE analysis showed slightly different bacterial communities between the two columns (<86%). The new water treatment system also worked efficiently in a fish-cultivated aquatic environment, with TC and TN removal rates of 190 mg/week and 260 mg/week, respectively.

Effects of USPSTF guidelines on patterns of screening and treatment outcomes for prostate cancer

The updated United States Preventive Services Task Force(USPSTF) for prostate cancer in 2012 recommends against prostate-specific antigen(PSA) based screening for men of all ages. Prostate cancer is the second most common and second most deadly cancer in American men. PSA screening for prostate cancer has been present since 1994 leading to an over diagnosis and over treatment of low volume disease. There is an overall agreement of men towards the guidelines but even with the understanding of the USPSTF, these men tend to follow more personal beliefs that have been influenced by their knowledge of the disease process and physician influence. Physicians also followed the directions of the patients and opted not to change their current practice of PSA screening despite the new guidelines. Time, legal, and ethical issues were some of the barriers that physicians faced in tailoring their practice towards screening. The importance of informed consent is highlighted by both the patients and the physicians and clearly more effective when the patient was pre-informed of the disease processand prompted the physicians to initiate conversation of informed screening. Younger patients were inclined towards aggressive treatment and older patients opted towards watchful waiting both with emphasis on the importance of evidence-based information provided by the physician. Decision aids were useful in making informed decisions and could be used to educate patients on screening purposes and treatment options. However, even with well-created decision aids and physician influence, patients' own belief system played a major part in healthcare decision making in either screening or treatment for prostate cancer.

Units 9—12词语辨析

1.比较辨析:add,add to,increase与raise①add:to put something with another thing or a group of things eg: When the sauce is thick,add the cheese.②add to something:to make something such as a feeling or a quality greater,eg:

基于物联网技术的医疗废弃物综合管理平台构建研究

目的:构建基于物联网技术的医疗废弃物综合管理平台,实现医疗废弃物规范化精细化管理。方法:基于射频识别(RFID)传感技术、自动化装备技术、人工智能(AI)机器人技术、大数据、5G通讯等数字化技术,采用浏览器与服务器(B/S)架构,设置感知层、边缘计算层、传输层、平台层、应用层和展现层,构建集医疗废物收集、运输和处理全过程实时跟踪和监控管理的医疗废弃物综合管理平台。结果:医疗废弃物综合管理平台基于物联网架构设计,由智能化硬件装备、医疗废弃物业务管理系统和辅助决策系统3部分组成,完成医疗废弃物搜集处理的全流程、各环节自动化分类、识别、灭菌、环境信息采集、操作记录和自动化分发转运,实现医疗废弃物从收集到处置各业务环节全过程“零接触”处理、全方位“零死角”监控和全数据“一张网”分析的全程追溯,并实现非人工干预。结论:基于物联网技术的医疗废弃物综合管理平台能够满足医疗废弃物处置全流程监管,提升医疗废弃物管理机构日常运行效率,降低人工成本。

物联网肺康复在慢性阻塞性肺疾病患者中的研究现状

慢性阻塞性肺疾病(COPD)是我国最常见的慢性呼吸系统疾病,患病率高,疾病负担重。提高COPD人群生存质量、延缓疾病进展、降低疾病负担是COPD的主要治疗目标。肺康复可提高患者的运动耐力、降低再住院率和死亡率、改善生活质量及致残率,是COPD重要的非药物治疗方式,也是COPD规范化治疗中的重要内容。肺康复在提升患者生活质量的同时,也实现了节约医疗资源,具有良好的经济和社会效益。但传统的居家肺康复模式存在患者不能全面掌握肺康复相关知识、容易遗忘、依从性较低等情况,导致患者出现肺康复积极性差、训练方式错误、训练强度过高或过低等诸多局限性。基于物联网的肺康复模式打破了地域限制,不仅为患者肺康复提供了安全保障、增加了康复的趣味性、提高了患者积极性及依从性,也有利于医生对患者肺康复情况的远程监测和指导,对COPD的诊疗、管理、改善预后、降低疾病负担等方面具有积极意义。

某大型综合医院神经外科重症监护患者营养治疗实施状况分析

目的:分析南通大学附属医院神经外科重症监护病房(neurosurgery intensive care unit,NICU)收治患者的营养治疗现状。方法:以2022年1月—2023年1月入住南通大学附属医院NICU的患者为调查对象,收集患者基本信息和临床指标,包括营养风险筛查评分(nutrition risk score 2002,NRS 2002)、危重症营养风险评分(nutrition risk score in the critically ill,NUTRIC)、胃肠功能损伤分级、营养治疗实施的时机和途径、入病房第1、3和7天热卡及蛋白达标情况、喂养耐受情况以及患者的28 d临床转归情况。结果:调查共收集患者133例,平均年龄(58.3±15.4)岁。患者格拉斯哥昏迷评分、序贯器官衰竭评分和急性生理与慢性健康评分分别为(4.07±2.41)、(7.10±2.59)、(11.0±3.4)分。28 d临床转归存活100例(75.2%),死亡33例(14.8%)。除BMI(P=0.0192)外,男性与女性患者在年龄、病情严重程度方面差异均无统计学意义(均P>0.05)。133例患者中,胃肠功能正常或轻度损害95例(71.4%),中-重度损害29例(21.8%),衰竭8例(6.0%)。入NICU 24 h内即开始肠内营养(enteral nutrition,EN)患者82例(61.7%)。72 h内达到20 kcal/(kg·d)的热卡目标的有28例(31.5%),1周总热卡达标率为12.3%(11/89),达到80%蛋白质喂养目标的有5例(3.76%)。高营养风险组的白蛋白水平在入NICU第7天显著低于低营养风险组。结论:目前我院NICU内超过70%的患者在48 h内接受EN治疗,喂养期间出现最多的不耐受症状是腹胀。补充性肠外营养的比例、1周左右的热卡及蛋白达标率均较低。应加强个性化制定热卡和蛋白目标进行营养补充。

镇痛镇静治疗对神经外科重症监护室患者颅内压及预后的影响研究

研究了镇痛镇静治疗对神经外科重症监护室(neurosurgical intensive care unit,NICU)患者颅内压及预后的影响。以接受不同治疗方法的NICU外伤性高颅压患者为例,比较了观察组和对照组患者的镇痛镇静效果、颅内压、意识状态、神经功能以及预后情况。结果表明,观察组VAS评分、Ramsay评分、颅内压、NIHSS评分均低于对照组,GCS评分均高于对照组,预后情况的有效率高于对照组,P<0.05。由此可见,联合应用镇痛镇静治疗对于神经重症监护室的患者是有效的,能降低患者的颅内压,减轻昏迷程度,改善NICU患者的神经功能,对患者康复预后有积极影响。