Treatment Options for Pin Site Infection during Kirschner Wires in Elective Forefoot Surgery

The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years. The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18 - 44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50 Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.

Surgical treatment options and its results for thoracic and thoracolumbar disc herniation with or without ossification of ligment flavum

Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with

Treatment options for alcoholic and non-alcoholic fatty liver disease: A review

Alcoholic liver disease(ALD)and non-alcoholic fatty liver disease(NAFLD)are serious health problems worldwide.These two diseases have similar pathological spectra,ranging from simple steatosis to hepatitis to cirrhosis and hepatocellular carcinoma.Although most people with excessive alcohol or calorie intake display abnormal fat accumulation in the liver(simple steatosis),a small percentage develops progressive liver disease.Despite extensive research on understanding the pathophysiology of both these diseases there are still no targeted therapies available.The treatment for ALD remains as it was 50 years ago:abstinence,nutritional support and corticosteroids(or pentoxifylline as an alternative if steroids are contraindicated).As for NAFLD,the treatment modality is mainly directed toward weight loss and co-morbidity management.Therefore,new pathophysiology directed therapies are urgently needed.However,the involvement of several inter-related pathways in the pathogenesis of these diseases suggests that a single therapeutic agent is unlikely to be an effective treatment strategy.Hence,a combination therapy towards multiple targets would eventually be required.In this review,we delineate the treatment options in ALD and NAFLD,including various new targeted therapies that are currently under investigation.We hope that soon we will be having an effective multi-therapeutic regimen for each disease.

Impacts of Chromium from Tannery Effluent and Evaluation of Alternative Treatment Options

The paper has focused on the challenges/impacts of tannery effluent and evaluates the alternative treatment options used to treat, recover or recycle chromium from the waste water. The paper was done entirely on secondary data by consulting literature sources including scientific journals, chapters of books, conference report papers and websites. The results of this review paper indicated that chromium is highly toxic and carcinogenic to human beings, animals, plants and the general environment (soil and water sediment). It is found out that chrome is the primary threat when ever tanning industry comes in to practice. Though many treatment options were evaluated to prevent its consequence on the environment, neither of them could achieve to treat or recover chrome 100%. Treatment options are either;inef-ficient, complicated, energy demanding, costly or applicable to a certain parts of the world due to technology or skilled man power demand. Therefore, to tackle this serious challenge stringent environmental regulation with law enforce-ment has to be exercised to use better treatment system which is widely applicable. Polluters must also know the envi-ronmental cost of their industry and treated according to polluter pay or precautionary principles. Moreover, the gen-eral public has to be aware of it and all concerned organizations and governments has to work hand in hand to reach zero discharge level or at least to attain the EPA chrome discharge

Technological Options to Ameliorate Waste Treatment of Intensive Pig Production in China:An Analysis Based on Bio-Economic Model

Ameliorating waste treatment by technological improvements affects the economic and the ecological-environment benefits of intensive pig production. The objective of the research was to develop and test a method to determine the technical optimization to ameliorate waste treatment methods and gain insight into the relationship between technological options and the economic and ecological effects. We developed an integrated bio-economic model which incorporates the farming production and waste disposal systems to simulate the impact of technological improvements in pig manure treatment on economic and environmental benefits for the case of a pilot farm in Beijing, China. Based on different waste treatment technology options, three scenarios are applied for the simulation analysis of the model. The simulation results reveal that the economic-environmental benefits of the livestock farm could be improved by reducing the cropland manure application and increasing the composting production with the current technologies. Nevertheless, the technical efficiency, the waste treatment capacity and the economic benefits could be further improved by the introduction of new technologies. It implies that technological and economic support policies should be implemented comprehensively on waste disposal and resource utilization to promote sustainable development in intensive livestock production in China.

Type 2 diabetes in children and adolescents:Exploring the disease heterogeneity and research gaps to optimum management

Over the past 20 years,the incidence and prevalence of type 2 diabetes mellitus(T2DM)in children and adolescents have increased,particularly in racial and ethnic minorities.Despite the rise in T2DM in children and adolescents,the pathophysiology and progression of disease in this population are not clearly understood.Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM.Furthermore,the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients,mostly due to the challenges of implementing clinical trials.A better understanding of the mechanisms underlying the development and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies.This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.

Exploring the limited use of transdermal medications in psychiatry:Challenges and potential solutions

Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.

基于剪切波弹性成像评价颈肩痛与斜角肌的关系

背景:在临床工作中,医疗人员主要以触诊的方法评估颈肩痛患者颈部软组织的僵硬程度,主观性强,缺乏客观依据。实时剪切波弹性成像是一种定量弹性超声技术,能够客观评估肌肉组织弹性值,评价肌肉状态。目的:应用实时剪切波弹性成像评估颈肩痛患者斜角肌的僵硬程度,观察颈肩痛患者双侧前斜角肌与中后斜角肌的肌肉硬度变化特征。方法:于2021年12月至2022年6月在广州中医药大学深圳医院(福田)招募健康者受试者(对照组)36例和颈肩痛患者(试验组)36例,在颈部中立位及侧屈位时,应用实时剪切波弹性成像测量两组双侧前、中后斜角肌弹性模量平均值及横截面积。结果与结论:①在相同体位下,两组组内左侧与右侧前斜角肌的弹性模量平均值、左侧与右侧中后斜角肌的弹性模量平均值比较差异均无显著性意义(P>0.05),两组组内左侧与右侧前斜角肌的横截面积、左侧与右侧中后斜角肌的横截面积比较差异均无显著性意义(P>0.05),两组组内中后斜角肌的弹性模量平均值与横截面积均高于前斜角肌(P<0.01,P<0.001);②在颈部中立位及侧屈位时,试验组前斜角肌、中后斜角肌的弹性模量平均值高于对照组(P<0.001),前斜角肌、中后斜角肌的横截面积均低于对照组(P<0.01,P<0.001);③结果表明,应用实时剪切波弹性成像技术能直观地评价颈肩痛患者前、中后斜角肌在颈部肌肉不同状态下弹性模量的差异,颈肩痛患者的双侧斜角肌处于劳损、僵硬状态。

干眼症的药物治疗策略及研究进展

干眼症(DED)是一种复杂的多因素疾病,表现出不同的症状,这些症状可影响视觉功能,导致日常生活活动受限,工作效率降低,从而严重影响生活质量。本综述对目前临床上DED的治疗药物以及市场上正在开发的DED治疗策略进行总结,旨在对临床研究提供参考。

降低急性胰腺炎的病死率:基于日本2021版诊疗指南的探讨

如何降低急性胰腺炎的病死率是一项意义重大的课题。日本2021版诊疗指南提出了对急性胰腺炎患者的“集束化管理措施”,在此指导下,日本急性胰腺炎总体病死率下降至2.6%,重症急性胰腺炎病死率下降至6.1%,远低于全球各国报道的病死率。本文对该指南之诊疗方案进行分析,并与我国现行指南进行对比,以期对AP患者的临床诊治提供指导意义,并期待日后有更多更深入的该领域相关研究。

Group Decision-Making Model of Renal Cancer Surgery Options Using Entropy Fuzzy Element Aczel-Alsina Weighted Aggregation Operators under the Environment of Fuzzy Multi-Sets

Since existing selection methods of surgical treatment schemes of renal cancer patients mainly depend on physicians’clinical experience and judgments,the surgical treatment options of renal cancer patients lack their scientifical and reasonable information expression and group decision-making model for renal cancer patients.Fuzzy multi-sets(FMSs)have a number of properties,which make them suitable for expressing the uncertain information of medical diagnoses and treatments in group decision-making(GDM)problems.To choose the most appropriate surgical treatment scheme for a patient with localized renal cell carcinoma(RCC)(T1 stage kidney tumor),this article needs to develop an effective GDM model based on the fuzzy multivalued evaluation information of the renal cancer patients.First,we propose a conversionmethod of transforming FMSs into entropy fuzzy sets(EFSs)based on the mean and Shannon entropy of a fuzzy sequence in FMS to reasonably simplify the information expression and operations of FMSs and define the score function of an entropy fuzzy element(EFE)for ranking EFEs.Second,we present the Aczel-Alsina t-norm and t-conorm operations of EFEs and the EFE Aczel-Alsina weighted arithmetic averaging(EFEAAWAA)and EFE Aczel-Alsina weighted geometric averaging(EFEAAWGA)operators.Third,we develop a multicriteria GDM model of renal cancer surgery options in the setting of FMSs.Finally,the proposed GDM model is applied to two clinical cases of renal cancer patients to choose the best surgical treatment scheme for a renal cancer patient in the setting of FMSs.The selected results of two clinical cases verify the efficiency and rationality of the proposed GDM model in the setting of FMSs.

C-MET Inhibitors as New Members of the NSCLC Treatment Armamentarium—A Pooled Analysis

Objective: Capmatinib and tepotinib, two recently FDA-approved and highly specific small-molecule inhibitors of c-MET exon 14 skipping mutations are new and important therapeutic options for the treatment of NSCLC patients harbouring c-MET alterations. However, the precise role of these molecules as a new treatment option is still not fully defined. Methods: In an attempt to further evaluate the contributions of c-MET inhibitors to the armamentarium of treatment options for advanced and metastatic NSCLCs, relevant phase II and III studies were retrospectively analyzed in terms of ORR and mPFS (mOS numbers are still not available for current c-MET trials and therefore not considered for statistical purposes). Results: Treatment of advanced and metastatic NSCLC patients harbouring c-MET exon 14 skipping mutations with the novel and highly selective c-MET inhibitors is significantly superior (p Conclusion: The novel and highly selective c-MET inhibitors capmatinib and tepotinib are promising novel treatment options for patients with c-MET-dysregulated NSCLC primarily in the first-line setting, albeit a clear mOS benefit has not yet been established. Since immunotherapy did not appear to be particularly effective in NSCLC patients harbouring c-MET alterations, the vast majority of these patients are treated with immunotherapy plus chemotherapy. C-Met inhibitors appear to be equally effective and thereby sparing patients from the toxic effects of the chemotherapy. The routine testing of c-MET exon 14 skipping mutations should be performed as the GEOMETRY mono-1 data clearly showed higher response rates with capmatinib in treatment-naive than in pretreated patients, indicating that c-MET exon 14 skipping mutations should preferably be molecularly assessed at baseline. C-MET exon 14 skipping mutations are, therefore, clear biomarkers of response to c-MET inhibitors.

替代医疗方案告知缺陷的法律风险研究

替代医疗方案告知是实施手术、特殊检查、特殊治疗不可或缺的环节,是侵袭性医疗行为违法阻却事由,也是患者知情同意内容的完善。《民法典》明确了医疗告知对象、方式及侵权责任,对医务人员履行告知义务提出了更高要求。为此,通过分析《民法典》实施背景下替代医疗方案告知缺陷的法律风险,提出应对策略,以期更好地规避风险,合理保护医患双方的合法权益。

猫传染性腹膜炎的研究进展

猫传染性腹膜炎病毒(FIPV)是猫冠状病毒家族的成员,猫传染性腹膜炎(FIP)难以治愈,死亡率高,虽然目前学术界对于FIP已取得了不少的研究进展,但却始终没有有效的、全面的诊断和治疗方法,针对FIPV感染的药物发展缓慢。详细介绍了FIP的发生机制、相关治疗方案以及相关治疗药物对FIP治疗的有效性和差异性。

地铁基础减振地段钢轨异常波磨治理方案研究

针对地铁线路产生的钢轨异常波磨问题,调研了某地铁线路的钢轨波磨情况以及基本特征,对轨道刚度、钢轨廓形、轨距以及轨道动力特征进行测试,提出钢轨异常波磨的治理思路,并对波磨治理效果进行跟踪测试,提出既有线以及新建地铁线路钢轨波磨的治理以及预防方案。研究表明:地铁钢轨波磨较为严重,波长在25~100mm之间;轨道垂向刚度、横向刚度整体较弱,钢轨位移大,保持轨距能力差,轮轨关系恶化,在特定频段范围内轮轨振动加剧,从而引起钢轨波磨的产生和发展。通过更换扣件及垫板、轨道精测精调、钢轨打磨措施可以使车内噪声降低5~10 dB,轨面不平顺显著降低,打磨周期延长至1倍以上;既有线路可通过“细调查、调参数、精维修、动态检查”治理钢轨波磨,新建地铁线路应在规划、设计、运营维护、动态验收阶段严格把关,合理采用减振轨道,避免钢轨异常波磨的产生和发展。

基于SEER数据库倾向性评分匹配分析不同治疗方案对肾母细胞瘤患儿预后的影响

目的 基于SEER数据库的大样本临床资料,比较不同治疗方案对肾母细胞瘤(WT)患儿预后的影响,为临床上WT治疗方案的选择提供参考。方法 回顾分析SEER数据库2006至2019年1768例18岁以下WT患儿的资料。采用倾向评分匹配法(PSM)将符合筛选条件的1329例患儿分为术前化疗组(n=309)和直接手术组(n=309),采用单因素χ^(2)检验比较临床病理特征差异。采用Kaplan-Meier法绘制两组的特异性生存(CSS)和总生存(OS)曲线,Log Rank法进行组间比较。采用Cox单因素及多因素分析影响预后的变量。结果 PSM后,直接手术治疗方案改善患儿的CSS(χ^(2)=8.317,P=0.004)和OS(χ^(2)=5.836,P=0.016),其中术前化疗组中位生存时间51个月(IQR 21.5~98.5个月),直接手术组中位生存时间55个月(IQR 22~104个月)。多因素分析显示:在CSS方面,SEER分期为远处转移(HR=3.217,95%CI=1.124~9.210,P=0.029)是影响预后的危险因素,而直接手术(HR=0.388,95%CI=0.181~0.832,P=0.015)是影响预后的保护因素。在OS方面,直接手术(HR=0.498,95%CI=0.251~0.986,P=0.046)是影响预后的保护因素。亚组分析中,直接手术治疗方案改善局限性肿瘤组患儿的CSS(χ^(2)=3.949,P=0.047),其中直接手术患儿的中位生存时间为61个月(IQR 21~118个月),术前化疗患儿的中位生存时间为49个月(IQR 17~80个月)。在区域转移、远处转移组中,两组患儿差异无统计学意义(区域转移组:χ^(2)=3.248,P=0.072;远处转移组:χ^(2)=1.644,P=0.200)。结论 直接手术的治疗方案可以改善患儿OS。在CSS方面,直接手术的治疗方案对SEER分期属于局限性肿瘤的患儿(相当于COG和SIOP分期为Ⅰ期)也可以提供更长的生存时间,而对于SEER分期在区域和远处转移的WT患儿(相当于COG和SIOP分期在Ⅱ~Ⅳ期),两种治疗方案对于生存时间的影响无明显差异。

创伤性硬膜下假性动脉瘤的临床特点及治疗选择(附6例报道)

目的 探讨创伤性硬膜下假性动脉瘤(TS-PSAN)的治疗方法选择及疗效。方法 回顾性分析中国人民解放军联勤保障部队第九〇〇医院神经外科2016年1月—2021年12月收治的6例TS-PSAN患者的临床治疗。所有患者均通过头颅DSA明确诊断,4例行血管内治疗,其中2例闭塞载瘤动脉,2例双支架联合弹簧圈栓塞;1例患者行颅内外血管搭桥手术;1例保守治疗。术后随访8个月~6年。结果 6例TS-PSAN外伤后均有蛛网膜下腔出血,5例首次CTA或DSA检查明确动脉瘤诊断,1例伤后第1次CTA阴性,因眼球充血肿胀,42 d后行CTA检查明确颅内巨大动脉瘤伴颈内动脉海绵窦瘘。6例患者动脉瘤均治愈,4例获得CTA随访,2例获得DSA随访,术后6个月随访时改良Rankin量表评分0分2例,1分1例,2分3例。随访(33.95±13.86)个月内均无复发。结论 应根据动脉瘤位置及形态,结合患者颅脑损伤的治疗策略选择最佳治疗方案,血管内治疗首选血管重建;代偿良好者或较末梢且不影响功能者,闭塞载瘤动脉是安全的;开颅手术同样是一项重要治疗方法。

肝母细胞瘤肺转移治疗的研究进展

肺是肝母细胞瘤最常见的转移部位,一旦发生肺转移,病情发展迅速,预后差。本文对肝母细胞瘤伴肺转移的治疗包括化疗药物治疗、外科手术治疗、自体外周造血干细胞移植术等进行综述,并对上述治疗方法的优势与局限性进行讨论,以期为肝母细胞瘤并肺转移患者治疗方案的个体化选择提供指导意见。

艾滋病合并乙型肝炎病毒感染的影响因素与治疗方案分析

目的:探究艾滋病(AIDS)合并乙型肝炎病毒(HBV)感染的高危影响因素及临床治疗方案分析,为临床制订标准策略提供参考。方法:选取2019年10月—2021年3月开封市传染病医院收治的160例AIDS患者作为研究对象,根据是否合并HBV感染分为观察组(AIDS合并HBV感染,n=39)、对照组(单纯AIDS,n=121)。收集两组研究对象临床资料,包括患者人口学特征包括性别、年龄、体质量(BMI)、吸毒史、职业等、合并感染高危因素包括人类免疫缺陷病毒(HIV)感染途径、吸毒史、HBV家族史、乙肝疫苗接种史等,进行实验室测验,并给予观察组患者一线抗逆转录病毒(ART)疗法(替诺福韦酯+拉米夫定+依非韦伦)。对比两组AIDS患者基线资料及感染高危因素指标,并采用多因素logistic回归模型分析AIDS合并HBV感染的影响因素。对比AIDS合并HBV感染患者用药前、用药3个月后相关疗效指标。结果:观察组年龄、吸毒史、HBV家族史、乙肝疫苗接种史是AIDS合并HBV感染的影响因素,差异有统计学意义(χ^(2)=9.688、2.192、4.462、31.378,P<0.05)。多因素logistic分析结果显示,AIDS合并HBV感染主要影响因素为25~45岁、存在HBV家族史,无乙肝疫苗接种史(OR=6.437、2.647、1.746,P<0.05)。ART疗法用药3月后患者丙氨酸氨基转科移酶(ALT)指标、HBV DNA、HIV DNA载量明显降低,CD4^(+)明显升高,差异有统计学意义(t=5.215、11.231、3.124、4.221,P<0.05)。结论:AIDS合并HBV感染高危因素主要为25~45岁、存在HBV家族史,无乙肝疫苗接种史人群,应重点关注存在上述因素AIDS患者,给予ART疗法以有效控制病情进展,促进疾病转归。

临沂市地热尾水环境负效应及处理方案研究

临沂市地热资源丰富,开发历史悠久,已建成河东汤头、沂南铜井、沂南松山、沂水许家湖等四个温泉开发示范区。地热资源利用过程中会产生尾水污染,破坏地表环境,为实现地热尾水无害化排放,对地热尾水进行处理尤为关键。本文在对临沂市各个示范区温泉开发企业地热尾水特征调查基础上,对临沂市地热尾水排放的环境负效应进行分析,对比探讨地热尾水处理的合理方案。结果表明:临沂市地热资源开发利用形式以医疗、洗浴为主,利用形式单一,利用效率整体较低,高温尾水直接排放到天然水体,会迅速和天然水体进行热量交换和物质弥散,引起河流水温升高、水质变化、影响生物生长、破坏局部水生态平衡,造成热污染;会引起化学污染,间接引发土壤化学成分的改变;参考已有地热尾水处理的典型案例,认为临沂地区地热水矿化度高、组分复杂,地热尾水化学-生物复合处理方案在沂南铜井温泉示范区已取得较好应用,具有推广意义。