The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Peri-operative Treatment for Pheochromocytoma

The perioperative management of 81 cases with pheochromocytoma was reviewed including blood pressure and arrhythmia control, blood volume expansion, patient′s general condition improvement and vital signs monitoring. It was stressed that pre and intra operative management was of prime importance in the treatment of pheochromocytoma.

Loosely coordinating diluted highly concentrated electrolyte toward -60℃ Li metal batteries

Lithium metal batteries(LMBs) promise energy density over 400 Wh kg^(-1).However,they suffer severe electrochemical performance deterioration at sub-zero temperatures.Such failure behavior highly correlates to inferior lithium metal anode(LMA) compatibility and sluggish Li^(+) desolvation.Here,we demonstrate that cyclopentylmethyl ether(CPME) based diluted high-concentration electrolyte(DHCE)enables-60℃ LMBs operation.By leveraging the loose coordination between Li^(+) and CPME,such developed electrolyte boosts the formation of ion clusters to derive anion-dominant interfacial chemistry for enhancing LMA compatibility and greatly accelerates Li^(+) desolvation kinetics.The resulting electrolyte demonstrates high Coulombic efficiencies(CE),providing over 99.5%,99.1%,98.5% and 95% at 25,-20,-40,and-60℃respectively.The assembled Li-S battery exhibits remarkable cyclic stability in-20,and-40℃ at 0.2 C charging and 0.5 C discharging.Even at-60℃,Li-S cell with this designed electrolyte retains> 70% of the initial capacity over 170 cycles.Besides,lithium metal coin cell and pouch cell with10 mg cm^(-2) high S cathode loading exhibit cycling stability at-20℃.This work offers an opportunity for rational designing electrolytes toward low temperature LMBs.

Perioperative Materno-Fetal Morbimortality Related to the Caesarean in the Hospital Setting in Mali

Introduction: During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both the pregnant women and newborns. Objective: To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. Patient and Methods: We conducted a cross sectional survey in the departments of intensive care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Touré of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry and the databasis of the department of gyneco-obstetric. The test of khi2 of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. Results: During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 ans. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on previously operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in a context of hemorrhage in 50% of the cases. The factors of maternal morbi-mortality were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation and the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of endo-tracheal intubation, technic of anesthesia, realization of the anesthesia consultation, context of the Caesarean, iterative Caesarean and the mode of admission (p ≤ 0.05). Conclusion: The caesarean is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.

Effectiveness of an Underbody Forced Warm-Air Blanket during Coronary Artery Bypass Surgery in the Prevention of Postoperative Hypothermia: A Prospective Controlled Randomized Clinical Trial

Introduction: Perioperative hypothermia in cardiac surgery is associated with adverse outcome. The aim of this investigation was to study whether an underbody forced-air warming blanket during coronary artery bypass graft surgery with normothermic cardiopulmonary bypass can prevent postoperative hypothermia. Methods: After Medical Ethics Committee approval, 60 low-risk cardiac surgery patients at random were assigned into a group that received standard thermal care management (control group n = 30) and a group that received the underbody forced-air warming system plus the standard thermal care (intervention group n = 30). Results: The temperature after-drop from the end of cardiopulmonary bypass to arrival in the ICU was less in the intervention group versus control group (0.4°C ± 0.3°C vs 0.6°C ± 0.4°C;P = 0.027). Out of the intervention group, 27 patients arrived in the ICU with a bladder temperature ? 36°C (90%) as compared to 14 patients (46.7%) from the control group (P < 0.001). The peripheral temperature was significantly higher in the intervention group as compared to the control group (P < 0.001). Conclusions: A full underbody forced-air warming blanket prevents postoperative hypothermia in normothermic coronary artery bypass graft surgery patients.

<i>H</i>(.,.)<i>- φ - η -</i>Accretive Operators and Generalized Variational-Like Inclusions

In this paper, we generalize H(.,.) accretive operator introduced by Zou and Huang [1] and we call it H(.,.)- φ - η - accretive operator. We define the resolvent operator associated with H(.,.)- φ - η - accretive operator and prove its Lipschitz continuity. By using these concepts an iterative algorithm is suggested to solve a generalized variational-like inclusion problem. Some examples are given to justify the definition of H(.,.)- φ - η - accretive operator.

Operable gastro-oesophageal junctional adenocarcinoma: Where to next?

Oesophageal junctional adenocarcinoma is a challeng-ing and increasingly common disease. Optimisation ofpre-operative staging and consolidation of surgery inlarge volume centres have improved outcomes, howev-er the preferred adjunctive treatment approach remainsa matter of debate. This review examines the benefitsof neoadjuvant, peri-operative, and post-operative che-motherapy and chemoradiotherapy in this setting in anattempt to reach an evidence based conclusion. Recentfindings relating to the molecular characterisation ofoesophagogastric cancer and their impact on therapeu-tics are explored, in addition to the potential benefitsof fluoro-deoxyglucose positron emission tomography(FDG-PET) directed therapy. Finally, efforts to decreasethe incidence of junctional adenocarcinoma using earlyintervention in Barrett's oesophagus are discussed,including the roles of screening, endoscopic mucosalresection, ablative therapies and chemoprevention.

Semi-Commutative Differential Operators Associated with the Dirac Opetator and Darboux Transformation

In the present paper, the semi-commutative differential oparators associated with the 1-dimensional Dirac operator are constructed. Using this results, the hierarchy of the mKdV (-) polynomials are expressed in terms of the KdV polynomials. These formulas give a new interpretation of the classical Darboux transformation and the Miura transformation. Moreover, the recursion operator associated with the hierarchy of the mKdV (-) polynomials is constructed by the algebraic method.

A Comparative Analysis of the New -3(-n) - 1 Remer Conjecture and a Proof of the 3n + 1 Collatz Conjecture

This scientific paper is a comparative analysis of two mathematical conjectures. The newly proposed -3(-n) - 1 Remer conjecture and how it is related to and a proof of the more well known 3n + 1 Collatz conjecture. An overview of both conjectures and their respective iterative processes will be presented. Showcasing their unique properties and behavior to each other. Through a detailed comparison, we highlight the similarities and differences between these two conjectures and discuss their significance in the field of mathematics. And how they prove each other to be true.

冠心病患者非心脏手术围术期心血管不良事件的危险因素分析

目的分析冠心病患者非心脏手术围术期主要心血管不良事件(MACE)的危险因素。方法回顾性分析2014-01-01/2019-12-31期间在广西医科大学第一附属医院接受非心脏手术冠心病患者619例,根据是否发生MACE将患者分为事件组(n=36)和非事件组(n=583),采用多因素Logistic回归分析冠心病患者围术期MACE的独立危险因素。观察终点为麻醉开始至患者出院期间发生的MACE,包括恶性心律失常、心肌梗死、心力衰竭及心源性死亡,记录及比较2组患者临床资料。结果冠心病患者非心脏手术围术期MACE发生率为5.8%(36/619)。多因素Logistic回归分析显示,ASAⅣ级(OR=18.515)、脑血管病史(OR=3.599)、不稳定性心绞痛史(OR=5.152)、心肌梗死史(OR=5.421)、急诊手术(OR=4.551)、腹部手术(胃肠、肝胆手术)(OR=10.384)、术中出血量500~1500 mL(OR=21.055)及术中出血量≥1500 mL(OR=83.885)是冠心病患者非心脏手术围术期MACE的危险因素(P<0.05),差异有统计学意义。结论ASAⅣ级、脑血管病史、不稳定性心绞痛史、心肌梗死史、急诊手术、腹部手术(胃肠、肝胆手术)、术中出血量是冠心病患者非心脏手术围术期MACE的危险因素。

WHOQOL-BREF在大肠癌患者围手术期生存质量的前瞻性研究

目的使用WHOQOL-BREF量表评估大肠癌患者围手术期生存质量的改变。方法应用WHO推荐的生存质量简表"WHOQOL-BREF量表"对我院胃肠外科中心收治的75例确诊为大肠癌且拟行根治性手术治疗的患者,在入院时(术前)和术后第7天分别进行评估,比较手术前、后生存质量的差异。结果完成研究的大肠癌患者为59例,与术前相比,其术后生存质量在生理领域得分和四领域总分低于术前,差异有显著意义(P<0.05),而其余各领域得分与术前比较差异无显著意义;且对重要的细条目进行了分析,发现生理领域除"休息与睡眠"和"工作能力"差异无显著意义,其余条目以及单列条目食欲得分均为术后低于术前,差异有显著意义(P<0.05);而心理领域各条目得分在手术前、后比较差异无显著意义。结论大肠癌患者术后比术前生存质量总体有所降低,主要表现在生理领域,故应加强术后护理,提高患者生存质量。

颞肌贴覆-颅内外动脉搭桥术治疗烟雾病的围手术期护理

烟雾病（Moyamoya disease）又称为脑底异常血管网病，是以双侧颈内动脉末端进行性狭窄或闭塞，颅底异常血管网生成为特征的一组脑血管病。目前，外科治疗主要是通过颅内外血管重建手术改善脑血流动力学障碍和缩小以后发生卒中的危险性。近年来，我科采用颞肌贴覆一颅内外动脉搭桥（间接血管重建加直接血管重建）治疗烟雾病患者，效果满意，现将围手术期护理报告如下。

先天性心脏病救治网络系统平台--新型的综合转诊系统的应用

目的：检验新建立的全国首个复杂、危重先天性心脏病（先心病）患儿救治网络系统在网络远程会诊、综合转诊的安全性和有效性。方法：通过先心病救治网络系统（系统组96例）和传统转诊途径（传统组148例），完成了244例复杂、危重症先心病的地区内、区域性转诊，分析、比较通过两组途径转诊患儿的基本数据、临床资料、院外停留周期、围手术期恢复状况。结果：系统组患儿年龄12（10～19）个月，传统组患儿年龄12（9．3～19）个月，两组比较差异无统计学意义（P=O．321）。系统组复杂先心病的比例高于传统组，呼吸机辅助通气时间和儿科重症监护室（PIUC）停留时间长于传统组患儿（P：0．002和P〈O．001），但系统组的住院总天数少于传统组（P=O．023）。住院期间，两组均无死亡。两组总并发症发生率相似（P=O．447）。但系统组患儿院外停留周期明显短于传统组（1．5±0．5）dVS（5．5±2．5）d，P〈O．001），系统组的院外停留总花费明显低于传统组[（464．3±97．4）元VS（1023．6±231．4）元，P〈O．001]。结论：与传统就诊途径的患儿相比，经过先心病救治网络系统转诊的患儿存在复杂先心病的比例较高，住院天数和院前停留时间较短，院前发生费用较低。住院并发症的发生率相似。

腰大池-腹腔分流术治疗交通性脑积水患者的围手术期护理

目的总结可调压腰大池腹腔分流术的围手术期护理要点,提高治疗效果。方法对我院10例接受可调压腰大池腹腔分流术治疗的交通性脑积水患者的临床资料进行分析,归纳疗效及并发症发生情况与护理要点间的关系。结果部分患者出现下肢疼痛、分流管堵塞的情况,无严重并发症发生,总体效果良好。结论做好围手术期护理,有助于提高可调压腰大池腹腔分流术的治疗效果。

经鼻-蝶窦垂体瘤切除术围手术期护理

目的 :探讨经鼻 -蝶窦垂体瘤切除术患者围手术期的护理。方法 :对本组 2 0例病人进行全面的术前、术后护理。特别是针对术后较易出现的并发症采取相应的护理措施。结果 :本组 2 0例病人中 2例出现尿崩症 ,1例出现切口感染并高热 ,经采取相应的治疗及护理措施缓解 ,其余均未发生明显并发症。结论 :针对术后易出现的并发症及早采取相应的治疗及护理措施是提高手术成功率。

O-ARM应用于齿状突骨折前路内固定手术中的护理配合

目的总结O-ARM在齿状突骨折前路内固定手术中的护理配合经验。方法回顾性分析2014年2-12月我院16例齿状突骨折术中应用O-ARM的患者,对手术体位摆放要求、O-ARM的术前准备、术中操作、注意事项以及日常维护进行了总结,并制订齿状突骨折前路内固定手术应用O-ARM的护理流程及模式。结果 16例患者手术均顺利完成,平均手术时间约90min,未发生术中及术后严重并发症,手术效果满意。结论齿状突骨折前路内固定手术应用O-ARM,可明显缩短手术操作时间,减少出血量,大大降低术中并发症的发生。

慢性充血性心力衰竭患者CRT/CRT-D植入的围手术期护理

目的探讨植入心脏再同步治疗(CRT)或CRT联合植入式心脏复律除颤器(CRT-D)(CRT/CRT-D)围手术期护理方法。方法对2001年1月～2009年5月在湘雅二医院行CRT/CRT-D植入术的34例慢性心力衰竭患者进行术前心理护理,完善各项相关检查;术中重视稳定患者情绪,安抚患者,使患者配合手术,积极处理术中的突发情况;术后密切观察患者生命体征,加强并发症的观察和护理。结果经围手术期护理,患者对手术的焦虑和恐惧等心理状态明显缓解,术中能较好地配合手术,在拟进行CRT/CRT-D植入的34例慢性充血性心衰患者,30例成功植入CRT/CRT-D(成功率88.2%),提高了患者术后治疗的依从性。结论准确、全面和及时的围手术期护理是实施CRT/CRT-D术患者获得预期临床疗效的重要环节和保障。

Surgical treatment of hepatocellular carcinoma: Evidence-based outcomes

Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.

Low noise,continuous-wave single-frequency 1.5-μm laser generated by a singly resonant optical parametric oscillator

We report a low noise continuous-wave （CW） single-frequency 1.5-μm laser source obtained by a singly resonant optical parametric oscillator （SRO） based on periodically poled lithium niobate （PPLN）. The SRO was pumped by a CW single-frequency Nd：YVO4 laser at 1.06μm. The 1.02 W of CW single-frequency signal laser at 1.5 μm was obtained at pump power of 6 W. At the output power of around 0.75 W, the power stability was better than ±l.5% and no mode-hopping was observed in 30 min and frequency stability was better than 8.5 MHz in 1 min. The signal wavelength could be tuned from 1.57 to 1.59 μm by varying the PPLN temperature. The 1.5-μm laser exhibits low noise characteristics, the intensity noise of the laser reaches the shot noise limit （SNL） at an analysis frequency of 4 MHz and the phase noise is less than 1 dB above the SNL at analysis frequencies above 10 MHz.

Efficacy of Auxiliary Therapy with Danggui Buxue Decoction No.1(当归补血汤1号) in Treating Patients of Non-small Cell Lung Cancer at Peri-operational Stage

Objective:To observe the therapeutic efficacy of Danggui Buxue Decoction No.1(当归补血汤1号,DB1) in treating patients of non-small cell lung cancer(NSCLC) at the peri-operational stage and its impact on the patients immune function.Methods:Eighty-two NSCLC patients were randomly assigned to two groups equally,the control group and the test group,they were given conventional treatment,while to the test group, DB1 were given additionally.The observation was conducted by testing the changes of T-lymphocyte subsets,...