Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Exploring the dynamic three-dimensional chromatin architecture and transcriptional landscape in goose liver tissues underlying metabolic adaptations induced by a high-fat diet

Background Goose, descendants of migratory ancestors, have undergone extensive selective breeding, resulting in their remarkable ability to accumulate fat in the liver and exhibit a high tolerance for significant energy intake. As a result, goose offers an excellent model for studying obesity, metabolic disorders, and liver diseases in mammals. Although the impact of the three-dimensional arrangement of chromatin within the cell nucleus on gene expression and transcriptional regulation is widely acknowledged, the precise functions of chromatin architecture reorganization during fat deposition in goose liver tissues still need to be fully comprehended.Results In this study, geese exhibited more pronounced changes in the liver index and triglyceride(TG) content following the consumption of the high-fat diet(HFD) than mice without significant signs of inflammation. Additionally, we performed comprehensive analyses on 10 goose liver tissues(5 HFD, 5 normal), including generating highresolution maps of chromatin architecture, conducting whole-genome gene expression profiling, and identifying H3K27ac peaks in the livers of geese and mice subjected to the HFD. Our results unveiled a multiscale restructuring of chromatin architecture, encompassing Compartment A/B, topologically associated domains, and interactions between promoters and enhancers. The dynamism of the three-dimensional genome architecture, prompted by the HFD, assumed a pivotal role in the transcriptional regulation of crucial genes. Furthermore, we identified genes that regulate chromatin conformation changes, contributing to the metabolic adaptation process of lipid deposition and hepatic fat changes in geese in response to excessive energy intake. Moreover, we conducted a cross-species analysis comparing geese and mice exposed to the HFD, revealing unique characteristics specific to the goose liver compared to a mouse. These chromatin conformation changes help elucidate the observed characteristics of fat deposition and hepatic fat regulation in geese under conditions of excessive energy intake.Conclusions We examined the dynamic modifications in three-dimensional chromatin architecture and gene expression induced by an HFD in goose liver tissues. We conducted a cross-species analysis comparing that of mice. Our results contribute significant insights into the chromatin architecture of goose liver tissues, offering a novel perspective for investigating mammal liver diseases.

The relationship between compartment models and their stochastic counterparts:A comparative study with examples of the COVID-19 epidemic modeling

Deterministic compartment models(CMs)and stochastic models,including stochastic CMs and agent-based models,are widely utilized in epidemic modeling.However,the relationship between CMs and their corresponding stochastic models is not well understood.The present study aimed to address this gap by conducting a comparative study using the susceptible,exposed,infectious,and recovered(SEIR)model and its extended CMs from the coronavirus disease 2019 modeling literature.We demonstrated the equivalence of the numerical solution of CMs using the Euler scheme and their stochastic counterparts through theoretical analysis and simulations.Based on this equivalence,we proposed an efficient model calibration method that could replicate the exact solution of CMs in the corresponding stochastic models through parameter adjustment.The advancement in calibration techniques enhanced the accuracy of stochastic modeling in capturing the dynamics of epidemics.However,it should be noted that discrete-time stochastic models cannot perfectly reproduce the exact solution of continuous-time CMs.Additionally,we proposed a new stochastic compartment and agent mixed model as an alternative to agent-based models for large-scale population simulations with a limited number of agents.This model offered a balance between computational efficiency and accuracy.The results of this research contributed to the comparison and unification of deterministic CMs and stochastic models in epidemic modeling.Furthermore,the results had implications for the development of hybrid models that integrated the strengths of both frameworks.Overall,the present study has provided valuable epidemic modeling techniques and their practical applications for understanding and controlling the spread of infectious diseases.

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release:A cadaveric study

BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

Numerical simulation of flow regions in red mud separation thickener's feedwell by analysis of residence-time distribution

The residence-time distribution （RTD） and the compartment model were applied to characterizing the flow regions in red mud separation thickener’s feedwells. Combined with the experimental work, validated mathematical model as well as three-dimensional computational fluid dynamics （CFD） model was established to analyze the flow regions of feedwells on an industrial scale. The concept of RTD, although a well-known method for the characterization of mixing behavior in conventional mixers and reactors, is still a novel measure for the characterization of mixing in feedwells. Numerical simulation results show that the inlet feed rate and the aspect ratio of feedwells are the most critical parameters which affect the RTD of feedwell. Further simulation experiments were then carried out. Under the optimal operation conditions, the volume fraction of dead zone can reduce by10.8% and an increasement of mixing flow volume fraction by 6.5% is also observed. There is an optimum feed inlet rate depending on the feedwell design. The CFD model in conjunction with the RTD analysis then can be used as an effective tool in the design, evaluation and optimization of thickener feedwell in the red mud separation.

Expression of Recombinant Tryptophan Decarboxylase in Different Subcellular Compartments in Tobacco Plant

The gene encoded for tryptophan decarboxylase (TDC), which is the key enzyme in terpenoil indole alkaloids pathway, was targeted to different subcellular compartments and stably expressed in transgenic tobacco (Nicotiana tabacum L.) plants at the levels detected by Western blot and tryptamine accumulation analysis. It was shown that the TDC was located in subcellular compartments, the chloroplasts and cytosol. The recombinant TDC targeted to chloroplasts and cytosol in tobacco plants was effectively expressed as soluble protein by Western blot analysis and enzymatic assay. The level of tryptamine accumulation in chloroplast was higher than that in cytosol and very low in vacuole and endoplasmic reticulum (ER) to be hardly detected by Western blot analysis. It was indicated that the highest amount of tryptamine was in chloroplasts, lower in endoplasmic reticula and the lowest in vacuoles as compared to those in wild type plants. The TDC targeted to different subcellular compartments of tobacco plants and its expression level were studied by different nucleotide sequences coding signal peptides at 5'-end of tdc gene in order to know the effects of the TDC in compartmentation on its functionality.

PERTURBATION SOLUTION FOR COMPARTMENT MODEL OF VARIABLE EXTRACELLULAR VOLUME

The two compartment model with variable extracellular volume is presented and solved by using both perturbation and analytical method. The computation for both creatinine and urea show that the perturbation solution is not only simple but also accurate enough and is a good substitute for the more exact analytical solution.

Expression of Strictosidine Synthase in Selected Subcellular Compartments of Tobacco Plant

Strictosidine synthase (STR) is a key enzyme involved in the biosynthesis of terpenoid indole alkaloids (TIA) by condensing tryptamine and secologanin into strictosidine. The transgenic tobacco plants targeting STR to subcellular compartments were established to express STR in chloroplast, vacuole and endoplasmic reticulum (ER) by the tobacco stable transformation. It was shown that STR was effectively expressed in the above subcellular compartments by Western blot analysis and STR enzymatic assay. In vitro , STR enzymatic assay was measured indirectly by fluorimetrically detecting depletion of tryptamine feeding on secologanin in the reaction mixture. The tryptamine were completely depleted by STR in the crude extract of leaves of transgenic tobacco plants targeting and expressing STR in the chloroplast, vacuole and ER, which ascertained the STR functionally targeted to the three subcellular compartments. To confirm STR correct targeting and expressing in chloroplast, the chloroplasts were isolated and the fractions of purified chloroplasts were analyzed by Western blot. The hypothesis of STR correct targeting to the chloroplast was tested. The results have implications on our understanding of the complex intracellular trafficking in metabolic intermediates of TIA biosynthesis.

酵母双杂交技术筛选宫颈癌HeLa细胞cDNA文库中FAM92A1-289关联蛋白

目的应用酵母双杂交技术从宫颈癌He La细胞c DNA文库中筛选FAM92A1-289关联蛋白。方法构建酵母双杂交p GBKT7-FAM92A1-289诱饵载体,转化至酵母AH109感受态细胞中。利用Clontech GAL4酵母双杂交系统筛选He La细胞c DNA文库中与FAM92A1-289相互作用的蛋白质,用营养缺陷型培养基和X-a-Gal双重筛选实验进行筛选,对筛选结果进行生物信息学分析,对克隆重复率较高的蛋白进行回转验证,将β-半乳糖苷酶活性阳性的克隆进行测序并分析。结果成功构建酵母双杂交p GBKT7-FAM92A1-289诱饵载体,可在酵母细胞中正常表达FAM92A1-289,且对酵母细胞无毒性,不存在自激活现象。筛选出在SD/-Ade/-His/-Leu/-Trp四缺培养基及含X-a-Gal的SD/-Ade/-His/-Leu/-Trp四缺培养基上均能生长且β-半乳糖苷酶活性阳性的克隆9个。经生物信息学分析发现4种蛋白重复率较高,即增殖细胞核抗原(PCNA)、半乳糖凝集素1(Galectin-1)、内质网高尔基体中间室标记物53(ERGIC-53)、重组人BCL2相关永生基因1(BAG1),并均与FAM92A1-289存在相互作用。结论利用酵母双杂交技术在Hela细胞c DNA文库中成功筛选出与FAM92A1-289相互作用的蛋白,为进一步研究FAM92A1-289的功能提供了新线索。

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.

Early recognition of abdominal compartment syndrome in patients with acute pancreatitis

AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.

Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine

AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber's salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients. METHODS: Eighty consecutive SAP patients, admitted for routine non-operative conservative treatment, were randomly divided into study group and control group (40 patients in each group). Patients in the study group received Da Cheng Qi Decoction enema for 2 h and external use of Glauber's salt, once a day for 7 d. Patients in the control group received normal saline (NS) enema. Routine non-operative conservative treatments included non-per os nutrition (NPON), gastrointestinal decompression, life support, total parenteral nutrition (TPN), continuous peripancreatic vascular pharmaceutical infusion and drug therapy. Intra-cystic pressure (ICP) of the two groups was measured during treatment. The effectiveness and outcomes of treatment were observed and APACHE Ⅱ scores were applied in analysis. RESULTS: On days 4 and 5 of treatment, the ICP was lower in the study group than in the control group(P < 0.05). On days 3-5 of treatment, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores for the study and control groups were significantly different (P < 0.05). Both the effectiveness and outcome of the treatment with Da Cheng Qi Decoction on abdominalgia, burbulence relief time, ascites quantity, cyst formation rate and hospitalization time were quite different between the two groups (P < 0.05). The mortality rate for the two groups had no significant difference. CONCLUSION: Da Cheng Qi Decoction enema and external use of Glauber's salt combined with routine non-operative conservative treatment can decrease the intra-abdominal pressure (IAP) of SAP patients and have preventive and therapeutic effects on abdominal compartment syndrome of SAP.

Nitrogen cycling of atmosphere-plant-soft system in the typical Calamagrostis angustifolia wetland in the Sanjiang Plain,Northeast China

The nitrogen （N） distribution and cycling of atmosphere-plant-soil system in the typical meadow Calamagrostis angustifolia wetland （TMCW） and marsh meadow Calamagrostis angustifolia wetland （MMCW） in the Sanjiang plain were studied by a compartment model. The results showed that the N wet deposition amount was 0.757 gN/（m^2·a）, and total inorganic N （TIN） was the main body （0.640 gN/（m^2·a））. The ammonia volatilization amounts of TMCW and MMCW soils in growing season were 0.635 and 0.687 gN/m^2, and the denitrification gaseous lost amounts were 0.617 and 0.405 gN/m^2, respectively. In plant subsystem, the N was mainly stored in root and litter. Soil organic N was the main N storage of the two plant-soil systems and the proportions of it were 93.98% and 92.16%, respectively. The calculation results of N turnovers among compartments of TMCW and MMCW showed that the uptake amounts of root were 23.02 and 28.18 gN/（m^2·a） and the values of aboveground were 11.31 and 6.08 gN/（m^2·a）, the re-translocation amounts from aboveground to root were 5.96 and 2.70 gN/（m^2·a）, the translocation amounts from aboveground living body to litter were 5.35 and 3.38 gN/（m^2·a）, the translocation amounts from litter to soil were larger than 1.55 and 3.01 gN/（m^2·a）, the translocation amounts from root to soil were 14.90 and 13.17 gN/（m^2·a）, and the soil （0-15 cm） N net mineralization amounts were 1.94 and 0.55 gN/（m^2·a）, respectively. The study of N balance indicated that the two plant-soil systems might be situated in the status of lacking N, and the status might induce the degradation of C. angustifolia wetland.

Open abdomen in gastrointestinal surgery:Which technique is the best for temporary closure during damage control?

AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Damage control orthopaedics: State of the art

Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

GLOBAL DYNAMICS OF AN SEIR EPIDEMIC MODEL WITH IMMIGRATION OF DIFFERENT COMPARTMENTS

The SEIR epidemic model studied here includes constant inflows of new susceptibles, exposeds, infectives, and recovereds. This model also incorporates a population size dependent contact rate and a disease-related death. As the infected fraction cannot be eliminated from the population, this kind of model has only the unique endemic equilibrium that is globally asymptotically stable. Under the special case where the new members of immigration are all susceptible, the model considered here shows a threshold phenomenon and a sharp threshold has been obtained. In order to prove the global asymptotical stability of the endemic equilibrium, the authors introduce the change of variable, which can reduce our four-dimensional system to a three-dimensional asymptotical autonomous system with limit equation.

Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS： Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group （group 1） and control group （group 2）. Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE Ⅱ scores were applied for analysis. RESULTS： On the second and fifth days after treatment, APACHE Ⅱ scores of group 1 and 2 patients were significantly different. Comparison of effectiveness （abdominalgia and burbulence relief time, hospitalization time） between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated （r = 0.552, 0.748, 0.923, P 〈 0.01） with APACHE Ⅱ scores. CONCLUSION： Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration （SVVH）, gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.

High-grade dysplasia,restricted to the basal cell layer involving the entire esophagus

This report presents a case involving a unique observation of a high-grade squamous dysplasia involving the entire esophagus.Dysplastic cells were located exclusively in the basal portion of the esophageal squamous epithelium.The findings were documented using histologic analysis of the step-biopsies from the entire esophagus,histologic examination of the esophagectomy-specimen,immunohistochemicalanalysis,and molecular pathologic analysis of the p53 gene.A minimally invasive total esophagectomy was performed at the Department of Surgery of the University of Cologne,and histologic analysis of the resection specimen confirmed extensive high-grade dysplasia involving the oral resection margin,but no invasive carcinoma.This case does not fit the current World Health Organization(WHO) definition of highgrade squamous cell dysplasia,which requires fullthickness involvement of the squamous epithelium.Thus,the WHO criteria should probably be reconsidered in order to allow for a diagnosis of high-grade dysplasia in cases where dysplastic cells are exclusively located in the basal layer of the esophageal squamous epithelium.