Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).

Clinical effect of operative vs nonoperative treatment on humeral shaft fractures:Systematic review and meta-analysis of clinical trials

BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.

Non-steroidal anti-inflammatory drugs in postoperative hand fracture management:Do they positively or negatively impact recovery?

This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.

Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.

法舒地尔缓解β-淀粉样蛋白1-42诱导的SH-SY5Y细胞凋亡

背景:法舒地尔对阿尔茨海默病小鼠脑内的线粒体动力学有调节作用,并且可以抑制神经炎症,但能否调节线粒体自噬和NLRP3炎症小体进而减轻β-淀粉样蛋白毒性尚不清楚。目的:探究法舒地尔对β-淀粉样蛋白1-42诱导的人源神经母细胞瘤细胞株SH-SY5Y凋亡和线粒体自噬以及NLRP3炎症小体的调节作用。方法:将SH-SY5Y细胞接种于孔板内,细胞贴壁后分3组干预:对照组不加入任何药物,模型组加入20μmol/L β-淀粉样蛋白1-42,法舒地尔组同时加入20μmol/L β-淀粉样蛋白1-42与15 mg/L法舒地尔,干预24 h后,采用MTT法检测细胞活性,TUNEL染色检测细胞凋亡,qRT-PCR和Western blot检测凋亡相关蛋白表达,免疫荧光染色和Western blot检测线粒体自噬相关蛋白表达,免疫荧光染色和Western blot检测NLRP3炎症小体相关蛋白表达。结果与结论:(1)与对照组比较,模型组细胞活性降低、凋亡率升高(P<0.05);与模型组比较,法舒地尔组细胞活性升高、凋亡率降低(P<0.05);(2)qRT-PCR和Western blot检测结果显示,与对照组比较,模型组细胞Bax mRNA与蛋白表达升高(P<0.05),Bcl-2 mRNA与蛋白表达降低(P<0.05);与模型组比较,法舒地尔组细胞Bax mRNA与蛋白表达降低(P<0.05),Bcl-2 mRNA与蛋白表达升高(P<0.05);(3)免疫荧光染色和Western blot检测结果显示,与对照组相比,模型组细胞PINK1、帕金森病蛋白和LC3蛋白表达降低(P<0.05),p62蛋白表达升高(P<0.05);与模型组相比,法舒地尔组细胞PINK1、帕金森病蛋白和LC3蛋白表达升高(P<0.05),p62蛋白表达降低(P<0.05);(4)免疫荧光染色和Western blot检测结果显示,与对照组相比,模型组细胞NLRP3、ASC、Caspase-1和白细胞介素1β蛋白表达升高(P<0.05);与模型组相比,法舒地尔组细胞NLRP3、ASC、Caspase-1和白细胞介素1β蛋白表达降低(P<0.05);(5)结果表明,法舒地尔可以减轻β-淀粉样蛋白1-42诱导的SH-SY5Y细胞凋亡,其机制可能与激活线粒体自噬且抑制NLRP3炎症小体激活有关。

加拿大“Co-operative Education”教育模式研究

通过分析加拿大百年理工学院的"Co-operative Education"实习教育模式,了解了"CO-OP"项目的具体运作方式。加拿大高职实习教育重视政府职能的参与,强调学校、企业和学生的三方合作,通过"COOP"项目实现三方共赢,其模式值得我们借鉴。

Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia

AIM: To discuss the long-term postoperative results of bilateral lateral rectus recession(BLR) and unilateral lateral rectus recession-medial rectus resection(RR) in therapy of intermittent exotropia.METHODS: We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection(esotropia/phoria 】5△), orthophoria(esotropia/phoria ≤5△to exotropia/phoria ≤10△), and undercorrection/recurrence(exotropia/phoria 】10△).Titmus test was used to evaluate stereoacuity, the stereoacuity 【800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12,24 mo and at 36 mo examination between groups. RESULTS: At 12, 24 mo after surgery, the motor outcomes had no difference(P 】0.05) between groups.However, the motor outcomes at 6, 36 mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group(83.02%vs 82.24%, P 【0.05) but the result was contrary at the 3y examination(60.75% vs 43.40%, P 【0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up.CONCLUSION: The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the3 y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group’s.

Novel Investigation of Stochastic Fractional Differential Equations Measles Model via the White Noise and Global Derivative Operator Depending on Mittag-Leffler Kernel

Because of the features involved with their varied kernels,differential operators relying on convolution formulations have been acknowledged as effective mathematical resources for modeling real-world issues.In this paper,we constructed a stochastic fractional framework of measles spreading mechanisms with dual medication immunization considering the exponential decay and Mittag-Leffler kernels.In this approach,the overall population was separated into five cohorts.Furthermore,the descriptive behavior of the system was investigated,including prerequisites for the positivity of solutions,invariant domain of the solution,presence and stability of equilibrium points,and sensitivity analysis.We included a stochastic element in every cohort and employed linear growth and Lipschitz criteria to show the existence and uniqueness of solutions.Several numerical simulations for various fractional orders and randomization intensities are illustrated.

Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.

自旋-轨道耦合作用下极化激元凝聚中的调制不稳定性

利用线性稳定性分析方法,对存在自旋-轨道耦合(SOS)作用的二维极化激元玻色-爱因斯坦凝聚(BEC)系统中的调制不稳定性(MI)进行了研究.分析了组分内部,组分之间以及SOC相互作用对系统调制不稳定性的影响.结果显示,当系统内部不存在SOC作用,组分之间的相互作用为0,组分内部存在排斥作用时,不会出现调制不稳定性,组分内部存在吸引作用时,会出现调制不稳定性,并且调制不稳定性区间长度随吸引作用的增强而增加;组分之间相互作用不为0时,组分之间的相互作用以平方形式出现,其正负不会对调制不稳定性产生实质性影响.存在SOC相互作用时,SOC相互作用会引起增益谱曲线的不规则振荡,破坏原来的调制不稳定性区间.

Correlation analysis of compromised immune function with perioperative sepsis in HIV-positive patient

Objective: To investigate the relationship between immune function and perioperative sepsis in HIV-positive patients. Methods: Retrospective analysis of 144 HIV-positive patients surgically treated from Oct 2008 to Dec 2010 in Shanghai Public Health Clinical Center. The patients were divided into four groups based on their CD4+ T cells counts in preoperative period: group A (0 – 99 cell/ul), group B (100 – 199 cell/ul),group C (200 – 349 cell/ul),group D (≥350 cell/ul). All patients had received standardized surgical procedures, careful surgical routines were applied. To reduce operational damage, conventional antibi-otics, anti-TB, anti-fugal, antiretroviral therapies were used to prevent infection and promptly treatment of complications. Results among 144 HIV-positive patients (male 133 and female 11, aged 42.6 ± 12.5), 80 patients got perioperative sepsis (14 cases in preoperative period and 66 cases in postoperative period). 64 cases did not get sepsis. The average CD4+ T cell count was 276.97 ± 137.91 in preoperative period of patients without sepsis, which was significant higher than the patients with preoperative sepsis (151.29 ± 110.64) and patients with postope- rative sepsis(161.14 ± 128.45) (F = 13.91, P χ2 = 23.680, P +T cells (r = –0.987, P = 0.013). Conclusions With the decrease of preoperative CD4+T cells, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatments may obtain better effect for the patients infected HIV.

双偶氮苯-二苯并[b,i]噻蒽-[2,3-b]苯-5,7,12,14-四酮衍生物分子的二阶非线性光学性质

使用密度泛函理论(DFT)M06-2X方法、采用6-311+g(d,p)基组,分别对26个双偶氮-二苯并[b,i]噻蒽-[2,3-b]苯-5,7,12,14-四酮衍生物分子进行结构优化与频率计算;使用含时密度泛函理论(TD-DFT)TD-M06-2X方法计算了a1~d6分子的前线分子轨道与电子吸收光谱,采用有效场FF方法研究了二阶非线性光学性质(NLO).研究结果表明,26个噻蒽四酮类衍生物分子的能隙在1.33—2.02 eV范围,归属于有机半导体;最低能量吸收峰波长在601.8~609.5nm范围;在增大分子的二阶非线性光学系数β_(μ)(或β_(0))值方面,含相同偶氮苯基团或含不同偶氮苯基团分别引入到二苯并[b,i]噻蒽-[2,3-b]苯-5,7,12,14-四酮分子两侧的2,10位优于2,9位,在2,10位分别端接含推、拉基团的偶氮苯优于含相同给电子基团的偶氮苯.在偶氮苯苯环对位分别端接强吸电子基(-NO_(2))与强供电子基(如-N(CH_(3))_(2)、-N(Ph)_(3)、-N-苯基咔唑等)可增强体系的二阶非线性光学性能,获得性能良好的非线性光学材料.

GENERALIZED FORELLI-RUDIN TYPE OPERATORS BETWEEN SEVERAL FUNCTION SPACES ON THE UNIT BALL OF C^(N)

In this paper,we investigate sufficient and necessary conditions such that generalized Forelli-Rudin type operators T_(λ,τ,k),S_(λ,τ,k),Q_(λ,τ,k)and R_(λ,τ,k)are bounded between Lebesgue type spaces.In order to prove the main results,we first give some bidirectional estimates for several typical integrals.

Selective dorsal rhizotomy in cerebral palsy spasticity-a newly established operative technique in Slovenia: A case report and review of literature

BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.

Fuzzy Nash equilibrium of fuzzy n-person non-cooperative game

The fuzzy non-cooperative game with fuzzy payoff function is studied. Based on fuzzy set theory with game theory, the fuzzy Nash equilibrium of fuzzy non-cooperative games is proposed. Most of researchers rank fuzzy number by its center of gravity or by the real number with its maximal membership. By reducing fuzzy number into a real number, we lose much fuzzy information that should be kept during the operations between fuzzy numbers. The fuzzy quantities or alternatives are ordered directly by Yuan＇s binary fuzzy ordering relation. In doing so, the existence of fuzzy Nash equilibrium for fuzzy non-cooperative games is shown based on the utility function and the crisp Nash theorem. Finally, an illustrative example in traffic flow patterns of equilibrium is given in order to show the detailed calculation process of fuzzy Nash equilibrium.

An Intelligent MCGDM Model in Green Suppliers Selection Using Interactional Aggregation Operators for Interval-Valued Pythagorean Fuzzy Soft Sets

Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.

Weighted multilinear p-adic Hardy operators and commutators on p-adic Herz-type spaces

In this paper,we introduce the weighted multilinear p-adic Hardy operator and weighted multilinear p-adic Ces`aro operator,we also obtain the boundedness of these two operators on the product of p-adic Herz spaces and p-adic Morrey-Herz spaces,the corresponding operator norms are also established in each case.Moreover,the boundedness of commutators of these two operators with symbols in central bounded mean oscillation spaces and Lipschitz spaces on p-adic Morrey-Herz spaces are also given.

Maximal operators of pseudo-differential operators with rough symbols

Consider a pseudo-differential operator T_(a)f(x)=∫_(R^(n))e^(ix,ζ)a(x,ζ)f(ζ)dζwhere the symbol a is in the rough Hormander class L^(∞)S_(ρ)^(m)with m∈R andρ∈[0,1].In this note,when 1≤p≤2,if n(ρ-1)/p and a∈L^(∞)S_(ρ)^(m),then for any f∈S(R^(n))and x∈R^(n),we prove that M(T_(a)f)(x)≤C(M(|f|^(p))(x))^(1/p) where M is the Hardy-Littlewood maximal operator.Our theorem improves the known results and the bound on m is sharp,in the sense that n(ρ-1)/p can not be replaced by a larger constant.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Hydrogeochemical Characterization of Groundwater from Fissured Aquifers in the Angovia Mine Operating Permit Area (Central-West Côte d’Ivoire)

The main objective of this study is to determine the hydrogeochemical specificities of the groundwater of the Angovia mine operating permit, located in the Yaouré mountains in the center-west of Côte d’Ivoire. To do so, descriptive and multivariate statistical analysis methods with the SOM (Self Organizing Maps) algorithm were applied to the physicochemical parameters of 17 boreholes using the calcite (ISC) and dolomite (ISD) saturation indices. The results obtained have shown that the groundwater in the Angovia mine operating permit area has an average temperature of 27.52°C (long rainy season) and 27.87&degC (long dry season) and has an average pH of 7.09 ± 0.35 during the main rainy season and 7.32 ± 0.35 during the main dry season. They are mineralized with an average electrical conductivity of 505.98 ± 302.85 μS/cm during the long rainy season and with 450.33 ± 233.74 μS/cm as average during the long dry season. The main phenomena at the origin of groundwater mineralization are water residence time, oxidation-reduction and surface inflow. The study of the relative age of the water shows that the groundwater in the Angovia mine operating permit area is mainly undersaturated with respect to calcite and dolomite. They are therefore very old in the aquifer with a slow circulation speed during the long rainy season and the long dry season.