<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> During childbirth by Caesarean, several types...<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> 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 </span><span style="font-family:Verdana;">the pregnant</span><span style="font-family:Verdana;"> women and newborns. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. </span><b><span style="font-family:Verdana;">Patient and Methods: </span></b><span style="font-family:Verdana;">We conducted a </span><span style="font-family:Verdana;">cross sectional</span><span style="font-family:Verdana;"> survey in the departments of </span><span style="font-family:Verdana;">intensive</span><span style="font-family:Verdana;"> 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 </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the </span><span style="font-family:Verdana;">databasis</span><span style="font-family:Verdana;"> of the department of gyneco-obstetric. The test of khi</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. </span><span style="font-family:Verdana;">The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">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 </span><span style="font-family:Verdana;">ans</span><span style="font-family:Verdana;">. 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 </span><span style="font-family:Verdana;">previously</span><span style="font-family:Verdana;"> operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in </span><span style="font-family:Verdana;">a context</span><span style="font-family:Verdana;"> of hemorrhage in 50% of the cases. The factors of maternal </span><span style="font-family:Verdana;">morbi-mortality</span><span style="font-family:Verdana;"> were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of </span><span style="font-family:Verdana;">endo-tracheal</span><span style="font-family:Verdana;"> intubation, technic of anesthesia, </span><span style="font-family:Verdana;">realization</span><span style="font-family:Verdana;"> of the anesthesia consultation, </span><span style="font-family:Verdana;">context</span><span style="font-family:Verdana;"> of the Caesarean, iterative Caesarean </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the mode of admission (p</span></span><span style="font-family:""><span style="font-family:Verdana;"> ≤ </span><span><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> 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.</span></span></span>展开更多
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 g...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.展开更多
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 inferio...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.展开更多
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 ...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.展开更多
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 ...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.展开更多
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 pr...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.展开更多
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 ...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.展开更多
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...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.展开更多
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...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.展开更多
Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty se...Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre or post operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri operative complications and elevating success rate of operation.展开更多
<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. A...<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. <b>Methods:</b> We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. <b>Results:</b> We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. <b>Conclusion:</b> Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.展开更多
目的探讨加速康复外科管理模式对初次全髋关节置换术后患者血液指标的影响。方法选取江苏大学附属医院2021年6月—2022年1月入院的初次髋关节置换患者进行回顾性研究,ERAS组43例,围手术期采用加速康复外科(enhanced recovery after surg...目的探讨加速康复外科管理模式对初次全髋关节置换术后患者血液指标的影响。方法选取江苏大学附属医院2021年6月—2022年1月入院的初次髋关节置换患者进行回顾性研究,ERAS组43例,围手术期采用加速康复外科(enhanced recovery after surgery,ERAS)管理模式。对照组43例,围手术期采用传统的诊疗常规方案管理。比较ERAS组与对照组术前及术后白细胞、血红蛋白、血小板、白蛋白、D-二聚体、C-反应蛋白、红细胞等相关血液指标。结果ERAS组在术后1、3 d的Hb、总蛋白、白蛋白显著高于对照组(P<0.05)。ERAS组在术后3 d的白细胞、CRP、D-二聚体显著低于对照组(P<0.05)。结论ERAS管理模式能减少初次髋关节置换患者围手术期失血量,能够促进患者早期康复进程,对凝血系统重新达到稳态有促进作用。展开更多
文摘<strong>Introduction</strong><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> 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 </span><span style="font-family:Verdana;">the pregnant</span><span style="font-family:Verdana;"> women and newborns. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. </span><b><span style="font-family:Verdana;">Patient and Methods: </span></b><span style="font-family:Verdana;">We conducted a </span><span style="font-family:Verdana;">cross sectional</span><span style="font-family:Verdana;"> survey in the departments of </span><span style="font-family:Verdana;">intensive</span><span style="font-family:Verdana;"> 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 </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the </span><span style="font-family:Verdana;">databasis</span><span style="font-family:Verdana;"> of the department of gyneco-obstetric. The test of khi</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. </span><span style="font-family:Verdana;">The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">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 </span><span style="font-family:Verdana;">ans</span><span style="font-family:Verdana;">. 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 </span><span style="font-family:Verdana;">previously</span><span style="font-family:Verdana;"> operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in </span><span style="font-family:Verdana;">a context</span><span style="font-family:Verdana;"> of hemorrhage in 50% of the cases. The factors of maternal </span><span style="font-family:Verdana;">morbi-mortality</span><span style="font-family:Verdana;"> were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of </span><span style="font-family:Verdana;">endo-tracheal</span><span style="font-family:Verdana;"> intubation, technic of anesthesia, </span><span style="font-family:Verdana;">realization</span><span style="font-family:Verdana;"> of the anesthesia consultation, </span><span style="font-family:Verdana;">context</span><span style="font-family:Verdana;"> of the Caesarean, iterative Caesarean </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> the mode of admission (p</span></span><span style="font-family:""><span style="font-family:Verdana;"> ≤ </span><span><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> 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.</span></span></span>
文摘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.
基金supported by the National Natural Science Foundation of China(Nos.21975087,22008082)。
文摘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.
文摘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.
文摘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.
基金Supported by NIHR RM/ICR Biomedical Research Centre
文摘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.
基金supported by JSPS KAKENHI Grant Number 2354-0255.
文摘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.
文摘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.
基金a Grant-in-Aid for Scientific Research from the Ministry of Education Science and Culture, No. 13307037, No. 16209038
文摘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.
文摘Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre or post operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri operative complications and elevating success rate of operation.
文摘<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. <b>Methods:</b> We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. <b>Results:</b> We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. <b>Conclusion:</b> Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.