Introduction: Esophageal foreign bodies (EFB) are a diagnostic and therapeutic emergency because of the serious complications they can cause. Aim: This paper aimed to study the vulnating esophageal foreign bodies in t...Introduction: Esophageal foreign bodies (EFB) are a diagnostic and therapeutic emergency because of the serious complications they can cause. Aim: This paper aimed to study the vulnating esophageal foreign bodies in the ENT and Head and Neck Surgery departments of the Yalgado Ouedraogo and Bogodogo University Hospital. Methodology: This was an analytic cross-sectional study with retrospective data collection over 10 years (2012-2021). Results: We collected 91 cases of vulnating esophageal foreign bodies, i.e. 9.1 cases/year (4.7%). The mean age of the patients was 14 ± 19 years. The sex ratio was 1.6. The circumstances of occurrence were dominated by accidental ingestion of vulnating esophageal foreign bodies (98.9%). The average time to consultation was 7.5 hours. Dysphagia was the dominant symptom (64.8%). Cervico-thoracic radiography found dual contour radiopaque images in 71.4%. Esophagoscopy with rigid tube was performed in 97.8%. The average time for extraction of the vulnating esophageal foreign bodies was 8 hours. Vulnerating esophageal foreign bodies were non-organic in 84.6%. The button cell represented 64.8%. Their location was cervical in 61.5% intraoperatively. The lesion assessment found ulcerative lesions in 42.9% (p Conclusion: Vulnating esophageal foreign bodies are relatively frequent in our ENT practice. Although their diagnosis is often easy, their treatment is still difficult and requires multidisciplinary management. Thus, for us, prevention remains the first effective weapon.展开更多
At present, there is relatively little research on the synergistic effects of heavy metals in soil, sediment, and bedrock on heavy metal pollution in water bodies. In this paper, heavy metals in soil, sediment, bedroc...At present, there is relatively little research on the synergistic effects of heavy metals in soil, sediment, and bedrock on heavy metal pollution in water bodies. In this paper, heavy metals in soil, sediment, bedrock, and water of a typical karst watershed in southwest China were investigated. The results indicated that the average values of heavy metals in soil and sediment were relatively higher than those in bedrock except for Ni and As. During the research period, As and Cd were the main heavy metal elements polluting the soil and sediment in the study area, while water bodies were mainly polluted by Ni, As, and Cd. The pollution assessment indicated that there were instances of poor or very poor water quality in the study area during the study period;the soil as a whole was slightly polluted by Cd and As;sediment was subject to moderate Cd pollution and mild As pollution. Analysis of geochemical form for heavy metals showed that heavy metals in soil and sediment were mainly in residual form, and the proportions of exchangeable As and Cd were relatively high. Multiple statistical analysis showed that heavy metals in sediment, soil, and bedrock explained 23.8%, 16.8%, and 16.2% of the changes in heavy metals of water, respectively. The research results can provide scientific basis for the prevention and control of heavy metal pollution in water bodies.展开更多
Characterization of the spatial and temporal variability of stable isotopes in surface water is essential for interpreting hydrological processes.In this study,we collected the water samples of river water,groundwater...Characterization of the spatial and temporal variability of stable isotopes in surface water is essential for interpreting hydrological processes.In this study,we collected the water samples of river water,groundwater,and reservoir water in the Burqin River Basin of the Altay Mountains,China in 2021,and characterized the oxygen and hydrogen isotope variations in different water bodies via instrumental analytics and modeling.Results showed significant seasonal variations in stable isotope ratios of oxygen and hydrogen(δ18O andδ2H,respectively)and significant differences inδ18O andδ2H among different water bodies.Higherδ18O andδ2H values were mainly found in river water,while groundwater and reservoir water had lower isotope ratios.River water and groundwater showed differentδ18O-δ2H relationships with the local meteoric water line,implying that river water and groundwater are controlled by evaporative enrichment and multi-source recharge processes.The evaporative enrichment experienced by reservoir water was less significant and largely influenced by topography,recharge sources,local moisture cycling,and anthropogenic factors.Higher deuterium excess(d-excess)value of 14.34‰for river water probably represented the isotopic signature of combined contributions from direct precipitation,snow and glacial meltwater,and groundwater recharge.The average annual d-excess values of groundwater(10.60‰)and reservoir water(11.49‰)were similar to the value of global precipitation(10.00‰).The findings contribute to understanding the hydroclimatic information reflected in the month-by-month variations in stable isotopes in different water bodies and provide a reference for the study of hydrological processes and climate change in the Altay Mountains,China.展开更多
Edutainment,in the kindergarten education stage,emphasizes the game as the basic activity and combines the content of education with the form of the game,thus it also forms the educational method of gamification teach...Edutainment,in the kindergarten education stage,emphasizes the game as the basic activity and combines the content of education with the form of the game,thus it also forms the educational method of gamification teaching.Through investigation and analysis,it is found that the current kindergarten game activity design has the problem of improper combination of educational content and game form.The current kindergarten game activity design has problems such as stereotypes,children’s lack of active learning opportunities in activities,teachers’insufficient theoretical understanding,inappropriate teacher guidance methods,and so on.Embodied cognition theory attaches importance to the important role of the body in the development of cognition,provides new guidance for classroom teaching,and opens up a new path for classroom teaching reform.Based on the perspective of embodied cognition theory,the concept of body and mind integration should be adhered to in kindergarten teaching with games as the basic activity,experiential teaching situation should be created,children’s subjective experience should be respected,and games and interactions should be designed to promote children’s physical and mental participation,thus laying a foundation for the realization of children’s individual freedom,autonomy,and all-round development.Therefore,this paper aims at the existing problems in the current kindergarten gamification teaching and discusses the design strategy of children’s game activities based on embodied cognition theory.展开更多
Combined bodies of rock-like material and rock are widely encountered in geotechnical engineering,such as tunnels and mines.The existing theoretical models describing the stress-strain relationship of a combined body ...Combined bodies of rock-like material and rock are widely encountered in geotechnical engineering,such as tunnels and mines.The existing theoretical models describing the stress-strain relationship of a combined body lack a binary feature.Based on effective medium theory,this paper presents the governing equation of the“elastic modulus”for combined and single bodies under triaxial compressive tests.A binary effective medium model is then established.Based on the compressive experiment of concretegranite combined bodies,the feasibility of determining the stress threshold based on crack axial strain is discussed,and the model is verified.The model is further extended to coal-rock combined bodies of more diverse types,and the variation laws of the compressive mechanical parameters are then discussed.The results show that the fitting accuracy of the model with the experimental curves of the concretegranite combined bodies and various types of coal-rock combined bodies are over 95%.The crack axial strain method can replace the crack volumetric strain method,which clarifies the physical meanings of the model parameters.The variation laws of matrix parameters and crack parameters are discussed in depth and are expected to be more widely used in geotechnical engineering.展开更多
The extraction of water bodies is essential for monitoring water resources,ecosystem services and the hydrological cycle,so analyzing water bodies from remote sensing images is necessary.The water index is designed to...The extraction of water bodies is essential for monitoring water resources,ecosystem services and the hydrological cycle,so analyzing water bodies from remote sensing images is necessary.The water index is designed to highlight water bodies in remote sensing images.We employ a new water index and digital image processing technology to extract water bodies automatically and accurately from Landsat 8 OLI images.Firstly,we preprocess Landsat 8 OLI images with radiometric calibration and atmospheric correction.Subsequently,we apply KT transformation,LBV transformation,AWEI nsh,and HIS transformation to the preprocessed image to calculate a new water index.Then,we perform linear feature enhancement and improve the local adaptive threshold segmentation method to extract small water bodies accurately.Meanwhile,we employ morphological enhancement and improve the local adaptive threshold segmentation method to extract large water bodies.Finally,we combine small and large water bodies to get complete water bodies.Compared with other traditional methods,our method has apparent advantages in water extraction,particularly in the extraction of small water bodies.展开更多
The pursuit-evasion game models the strategic interaction among players, attracting attention in many realistic scenarios, such as missile guidance, unmanned aerial vehicles, and target defense. Existing studies mainl...The pursuit-evasion game models the strategic interaction among players, attracting attention in many realistic scenarios, such as missile guidance, unmanned aerial vehicles, and target defense. Existing studies mainly concentrate on the cooperative pursuit of multiple players in two-dimensional pursuit-evasion games. However, these approaches can hardly be applied to practical situations where players usually move in three-dimensional space with a three-degree-of-freedom control. In this paper,we make the first attempt to investigate the equilibrium strategy of the realistic pursuit-evasion game, in which the pursuer follows a three-degree-of-freedom control, and the evader moves freely. First, we describe the pursuer's three-degree-of-freedom control and the evader's relative coordinate. We then rigorously derive the equilibrium strategy by solving the retrogressive path equation according to the Hamilton-Jacobi-Bellman-Isaacs(HJBI) method, which divides the pursuit-evasion process into the navigation and acceleration phases. Besides, we analyze the maximum allowable speed for the pursuer to capture the evader successfully and provide the strategy with which the evader can escape when the pursuer's speed exceeds the threshold. We further conduct comparison tests with various unilateral deviations to verify that the proposed strategy forms a Nash equilibrium.展开更多
To improve the anti-jamming and interference mitigation ability of the UAV-aided communication systems, this paper investigates the channel selection optimization problem in face of both internal mutual interference a...To improve the anti-jamming and interference mitigation ability of the UAV-aided communication systems, this paper investigates the channel selection optimization problem in face of both internal mutual interference and external malicious jamming. A cooperative anti-jamming and interference mitigation method based on local altruistic is proposed to optimize UAVs’ channel selection. Specifically, a Stackelberg game is modeled to formulate the confrontation relationship between UAVs and the jammer. A local altruistic game is modeled with each UAV considering the utilities of both itself and other UAVs. A distributed cooperative anti-jamming and interference mitigation algorithm is proposed to obtain the Stackelberg equilibrium. Finally, the convergence of the proposed algorithm and the impact of the transmission power on the system loss value are analyzed, and the anti-jamming performance of the proposed algorithm can be improved by around 64% compared with the existing algorithms.展开更多
Benefiting from the development of Federated Learning(FL)and distributed communication systems,large-scale intelligent applications become possible.Distributed devices not only provide adequate training data,but also ...Benefiting from the development of Federated Learning(FL)and distributed communication systems,large-scale intelligent applications become possible.Distributed devices not only provide adequate training data,but also cause privacy leakage and energy consumption.How to optimize the energy consumption in distributed communication systems,while ensuring the privacy of users and model accuracy,has become an urgent challenge.In this paper,we define the FL as a 3-layer architecture including users,agents and server.In order to find a balance among model training accuracy,privacy-preserving effect,and energy consumption,we design the training process of FL as game models.We use an extensive game tree to analyze the key elements that influence the players’decisions in the single game,and then find the incentive mechanism that meet the social norms through the repeated game.The experimental results show that the Nash equilibrium we obtained satisfies the laws of reality,and the proposed incentive mechanism can also promote users to submit high-quality data in FL.Following the multiple rounds of play,the incentive mechanism can help all players find the optimal strategies for energy,privacy,and accuracy of FL in distributed communication systems.展开更多
BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very impor...BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very important.Improper selection may lead to missed diagnosis or misdiagnosis.CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography(CT)examinations.The pain improved after the patient accepted gamma knife treatment.However,he was admitted to our hospital 2 mo later due to fever and abdominal pain.This time,he received a contrast-enhanced CT scan,which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation,then he went to the superior hospital for surgery.It lasted for more than 2 mo from the onset of the disease to the surgical treatment.A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity.Clinical perianal abscess surgery was performed,and fish bone foreign body was found in perianal soft tissue during the operation.CONCLUSION For patients with pain symptoms,the possibility of foreign body perforation should be considered.Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.展开更多
Malicious attacks against data are unavoidable in the interconnected,open and shared Energy Internet(EI),Intrusion tolerant techniques are critical to the data security of EI.Existing intrusion tolerant techniques suf...Malicious attacks against data are unavoidable in the interconnected,open and shared Energy Internet(EI),Intrusion tolerant techniques are critical to the data security of EI.Existing intrusion tolerant techniques suffered from problems such as low adaptability,policy lag,and difficulty in determining the degree of tolerance.To address these issues,we propose a novel adaptive intrusion tolerance model based on game theory that enjoys two-fold ideas:(1)it constructs an improved replica of the intrusion tolerance model of the dynamic equation evolution game to induce incentive weights;and (2)it combines a tournament competition model with incentive weights to obtain optimal strategies for each stage of the game process.Extensive experiments are conducted in the IEEE 39-bus system,whose results demonstrate the feasibility of the incentive weights,confirm the proposed strategy strengthens the system’s ability to tolerate aggression,and improves the dynamic adaptability and response efficiency of the aggression-tolerant system in the case of limited resources.展开更多
In this paper,we study some basic properties on Lipschitz star bodies,such as the equivalence between Lipschitz star bodies and star bodies with respect to a ball,the equivalence between the convergence of Lipschitz s...In this paper,we study some basic properties on Lipschitz star bodies,such as the equivalence between Lipschitz star bodies and star bodies with respect to a ball,the equivalence between the convergence of Lipschitz star bodies with respect to Hausdorff distance and the convergence of Lipschtz star bodies with respect to radial distance,and the convergence of Steiner symmetrizations of Lipschitz star bodies.展开更多
Accidental acute upper airway obstruction (UAO) is a common situation in pediatric emergencies. It is a source of morbidity and even mortality, particularly in children under 3 years of age. We report a clinical case ...Accidental acute upper airway obstruction (UAO) is a common situation in pediatric emergencies. It is a source of morbidity and even mortality, particularly in children under 3 years of age. We report a clinical case of traumatic foreign body injury to the upper aerodigestive tract in a 7-year-old girl following a play accident.展开更多
Mental disorders such as depression and anxiety inflict significant burdens on individuals and society.Commonly prescribed treatments often involve cognitive therapy and medications.However,for patients resistant to t...Mental disorders such as depression and anxiety inflict significant burdens on individuals and society.Commonly prescribed treatments often involve cognitive therapy and medications.However,for patients resistant to these conventional methods,alternative therapies like the Ketogenic Diet(KD)offer a promising avenue.KD and its key metabolite,β-hydroxybutyrate(BHB),have been hypothesized to alleviate mental disorders through antiinflammatory actions,a crucial pathway in the pathophysiology of depression.This mini-review examines 15 clinical trials exploring the influence of KD and BHB on inflammation and their potential roles in managing mental disorders.Both human and animal studies were scrutinized to elucidate possible cellular and molecular mechanisms.Out of the 15 trials,10 reported reduced levels of at least one inflammatory mediator or mRNA post KD or BHB treatment,while two observed an elevation in anti-inflammatory agents.These findings suggest that KD and BHB could modulate cellular inflammatory pathways,highlighting their potential for therapeutic application in mental disorders.展开更多
AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonme...AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.展开更多
Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage f...Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 10<sup>3</sup>/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.展开更多
BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in t...BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature.Typically,a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.CASE SUMMARY Herein,we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery,and the patient experienced dysphagia.An endoscopically-guided neck incision was made over the insertion point in the esophagus,but the surgery failed due to having a blurred image at the insertion site during the operation.After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance,the purulent fluid outflowed to the piriform recess along the sinus tract.With endoscopic guidance,the position of the fish bone was precisely located along the direction of liquid outflow,the sinus tract was separated,and the fish bone was removed.To the best of our knowledge,this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.CONCLUSION In conclusion,the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus.This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.展开更多
Parkinson’s disease(PD)is one of the primary vital degenerative diseases that affect the Central Nervous System among elderly patients.It affect their quality of life drastically and millions of seniors are diagnosed...Parkinson’s disease(PD)is one of the primary vital degenerative diseases that affect the Central Nervous System among elderly patients.It affect their quality of life drastically and millions of seniors are diagnosed with PD every year worldwide.Several models have been presented earlier to detect the PD using various types of measurement data like speech,gait patterns,etc.Early identification of PD is important owing to the fact that the patient can offer important details which helps in slowing down the progress of PD.The recently-emerging Deep Learning(DL)models can leverage the past data to detect and classify PD.With this motivation,the current study develops a novel Colliding Bodies Optimization Algorithm with Optimal Kernel Extreme Learning Machine(CBO-OKELM)for diagnosis and classification of PD.The goal of the proposed CBO-OKELM technique is to identify whether PD exists or not.CBO-OKELM technique involves the design of Colliding Bodies Optimization-based Feature Selection(CBO-FS)technique for optimal subset of features.In addition,Water Strider Algorithm(WSA)with Kernel Extreme Learning Machine(KELM)model is also developed for the classification of PD.CBO algorithm is used to elect the optimal set of fea-tures whereas WSA is utilized for parameter tuning of KELM model which alto-gether helps in accomplishing the maximum PD diagnostic performance.The experimental analysis was conducted for CBO-OKELM technique against four benchmark datasets and the model portrayed better performance such as 95.68%,96.34%,92.49%,and 92.36%on Speech PD,Voice PD,Hand PD Mean-der,and Hand PD Spiral datasets respectively.展开更多
We have developed a structure of dynamic knowledge for non-inertial systems, the so-called Theory of Dynamic Interactions (TDI) as a part of non-inertial dynamic knowledge, which incorporates a causal demonstration of...We have developed a structure of dynamic knowledge for non-inertial systems, the so-called Theory of Dynamic Interactions (TDI) as a part of non-inertial dynamic knowledge, which incorporates a causal demonstration of phenomena accelerated by rotation, which would complement Classical Mechanics. We believe that the TDI mathematical model that we propose is of great conceptual importance. In addition, we think that it is not only necessary to understand the dynamics of rotating bodies, but also to understand the dynamics of the cosmos, with bodies that orbit and with constantly recurring movements, which make possible systems that have been in dynamic equilibrium for centuries and are not in a process of unlimited expansion. We even believe that this new dynamic theory allows us a better understanding of our universe, and the matter from which it is made.展开更多
BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious mo...BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.展开更多
文摘Introduction: Esophageal foreign bodies (EFB) are a diagnostic and therapeutic emergency because of the serious complications they can cause. Aim: This paper aimed to study the vulnating esophageal foreign bodies in the ENT and Head and Neck Surgery departments of the Yalgado Ouedraogo and Bogodogo University Hospital. Methodology: This was an analytic cross-sectional study with retrospective data collection over 10 years (2012-2021). Results: We collected 91 cases of vulnating esophageal foreign bodies, i.e. 9.1 cases/year (4.7%). The mean age of the patients was 14 ± 19 years. The sex ratio was 1.6. The circumstances of occurrence were dominated by accidental ingestion of vulnating esophageal foreign bodies (98.9%). The average time to consultation was 7.5 hours. Dysphagia was the dominant symptom (64.8%). Cervico-thoracic radiography found dual contour radiopaque images in 71.4%. Esophagoscopy with rigid tube was performed in 97.8%. The average time for extraction of the vulnating esophageal foreign bodies was 8 hours. Vulnerating esophageal foreign bodies were non-organic in 84.6%. The button cell represented 64.8%. Their location was cervical in 61.5% intraoperatively. The lesion assessment found ulcerative lesions in 42.9% (p Conclusion: Vulnating esophageal foreign bodies are relatively frequent in our ENT practice. Although their diagnosis is often easy, their treatment is still difficult and requires multidisciplinary management. Thus, for us, prevention remains the first effective weapon.
基金Guizhou Provincial Key Technology R&D Program (2202023QKHZC).
文摘At present, there is relatively little research on the synergistic effects of heavy metals in soil, sediment, and bedrock on heavy metal pollution in water bodies. In this paper, heavy metals in soil, sediment, bedrock, and water of a typical karst watershed in southwest China were investigated. The results indicated that the average values of heavy metals in soil and sediment were relatively higher than those in bedrock except for Ni and As. During the research period, As and Cd were the main heavy metal elements polluting the soil and sediment in the study area, while water bodies were mainly polluted by Ni, As, and Cd. The pollution assessment indicated that there were instances of poor or very poor water quality in the study area during the study period;the soil as a whole was slightly polluted by Cd and As;sediment was subject to moderate Cd pollution and mild As pollution. Analysis of geochemical form for heavy metals showed that heavy metals in soil and sediment were mainly in residual form, and the proportions of exchangeable As and Cd were relatively high. Multiple statistical analysis showed that heavy metals in sediment, soil, and bedrock explained 23.8%, 16.8%, and 16.2% of the changes in heavy metals of water, respectively. The research results can provide scientific basis for the prevention and control of heavy metal pollution in water bodies.
基金This work was funded by the Science and Technology Program of Gansu Province(23ZDFA017,22ZD6FA005)the Third Xinjiang Scientific Expedition Program(2022xjkk0802).
文摘Characterization of the spatial and temporal variability of stable isotopes in surface water is essential for interpreting hydrological processes.In this study,we collected the water samples of river water,groundwater,and reservoir water in the Burqin River Basin of the Altay Mountains,China in 2021,and characterized the oxygen and hydrogen isotope variations in different water bodies via instrumental analytics and modeling.Results showed significant seasonal variations in stable isotope ratios of oxygen and hydrogen(δ18O andδ2H,respectively)and significant differences inδ18O andδ2H among different water bodies.Higherδ18O andδ2H values were mainly found in river water,while groundwater and reservoir water had lower isotope ratios.River water and groundwater showed differentδ18O-δ2H relationships with the local meteoric water line,implying that river water and groundwater are controlled by evaporative enrichment and multi-source recharge processes.The evaporative enrichment experienced by reservoir water was less significant and largely influenced by topography,recharge sources,local moisture cycling,and anthropogenic factors.Higher deuterium excess(d-excess)value of 14.34‰for river water probably represented the isotopic signature of combined contributions from direct precipitation,snow and glacial meltwater,and groundwater recharge.The average annual d-excess values of groundwater(10.60‰)and reservoir water(11.49‰)were similar to the value of global precipitation(10.00‰).The findings contribute to understanding the hydroclimatic information reflected in the month-by-month variations in stable isotopes in different water bodies and provide a reference for the study of hydrological processes and climate change in the Altay Mountains,China.
文摘Edutainment,in the kindergarten education stage,emphasizes the game as the basic activity and combines the content of education with the form of the game,thus it also forms the educational method of gamification teaching.Through investigation and analysis,it is found that the current kindergarten game activity design has the problem of improper combination of educational content and game form.The current kindergarten game activity design has problems such as stereotypes,children’s lack of active learning opportunities in activities,teachers’insufficient theoretical understanding,inappropriate teacher guidance methods,and so on.Embodied cognition theory attaches importance to the important role of the body in the development of cognition,provides new guidance for classroom teaching,and opens up a new path for classroom teaching reform.Based on the perspective of embodied cognition theory,the concept of body and mind integration should be adhered to in kindergarten teaching with games as the basic activity,experiential teaching situation should be created,children’s subjective experience should be respected,and games and interactions should be designed to promote children’s physical and mental participation,thus laying a foundation for the realization of children’s individual freedom,autonomy,and all-round development.Therefore,this paper aims at the existing problems in the current kindergarten gamification teaching and discusses the design strategy of children’s game activities based on embodied cognition theory.
基金the Major Program of National Natural Science Foundation of China(No.41941019)Shaanxi Province Innovative Talent Promotion Plan-Science and Technology Innovation Team(No.2021TD-55)Central University Natural Science Innovation Team(No.300102262402)。
文摘Combined bodies of rock-like material and rock are widely encountered in geotechnical engineering,such as tunnels and mines.The existing theoretical models describing the stress-strain relationship of a combined body lack a binary feature.Based on effective medium theory,this paper presents the governing equation of the“elastic modulus”for combined and single bodies under triaxial compressive tests.A binary effective medium model is then established.Based on the compressive experiment of concretegranite combined bodies,the feasibility of determining the stress threshold based on crack axial strain is discussed,and the model is verified.The model is further extended to coal-rock combined bodies of more diverse types,and the variation laws of the compressive mechanical parameters are then discussed.The results show that the fitting accuracy of the model with the experimental curves of the concretegranite combined bodies and various types of coal-rock combined bodies are over 95%.The crack axial strain method can replace the crack volumetric strain method,which clarifies the physical meanings of the model parameters.The variation laws of matrix parameters and crack parameters are discussed in depth and are expected to be more widely used in geotechnical engineering.
基金Auhui Provincial Key Research and Development Project(No.202004a07020050)National Natural Science Foundation of China Youth Program(No.61901006)。
文摘The extraction of water bodies is essential for monitoring water resources,ecosystem services and the hydrological cycle,so analyzing water bodies from remote sensing images is necessary.The water index is designed to highlight water bodies in remote sensing images.We employ a new water index and digital image processing technology to extract water bodies automatically and accurately from Landsat 8 OLI images.Firstly,we preprocess Landsat 8 OLI images with radiometric calibration and atmospheric correction.Subsequently,we apply KT transformation,LBV transformation,AWEI nsh,and HIS transformation to the preprocessed image to calculate a new water index.Then,we perform linear feature enhancement and improve the local adaptive threshold segmentation method to extract small water bodies accurately.Meanwhile,we employ morphological enhancement and improve the local adaptive threshold segmentation method to extract large water bodies.Finally,we combine small and large water bodies to get complete water bodies.Compared with other traditional methods,our method has apparent advantages in water extraction,particularly in the extraction of small water bodies.
基金supported in part by the Strategic Priority Research Program of Chinese Academy of Sciences(XDA27030100)National Natural Science Foundation of China(72293575, 11832001)。
文摘The pursuit-evasion game models the strategic interaction among players, attracting attention in many realistic scenarios, such as missile guidance, unmanned aerial vehicles, and target defense. Existing studies mainly concentrate on the cooperative pursuit of multiple players in two-dimensional pursuit-evasion games. However, these approaches can hardly be applied to practical situations where players usually move in three-dimensional space with a three-degree-of-freedom control. In this paper,we make the first attempt to investigate the equilibrium strategy of the realistic pursuit-evasion game, in which the pursuer follows a three-degree-of-freedom control, and the evader moves freely. First, we describe the pursuer's three-degree-of-freedom control and the evader's relative coordinate. We then rigorously derive the equilibrium strategy by solving the retrogressive path equation according to the Hamilton-Jacobi-Bellman-Isaacs(HJBI) method, which divides the pursuit-evasion process into the navigation and acceleration phases. Besides, we analyze the maximum allowable speed for the pursuer to capture the evader successfully and provide the strategy with which the evader can escape when the pursuer's speed exceeds the threshold. We further conduct comparison tests with various unilateral deviations to verify that the proposed strategy forms a Nash equilibrium.
基金supported in part by the National Natural Science Foundation of China (No.62271253,61901523,62001381)Fundamental Research Funds for the Central Universities (No.NS2023018)+2 种基金the National Aerospace Science Foundation of China under Grant 2023Z021052002the open research fund of National Mobile Communications Research Laboratory,Southeast University (No.2023D09)Postgraduate Research & Practice Innovation Program of NUAA (No.xcxjh20220402)。
文摘To improve the anti-jamming and interference mitigation ability of the UAV-aided communication systems, this paper investigates the channel selection optimization problem in face of both internal mutual interference and external malicious jamming. A cooperative anti-jamming and interference mitigation method based on local altruistic is proposed to optimize UAVs’ channel selection. Specifically, a Stackelberg game is modeled to formulate the confrontation relationship between UAVs and the jammer. A local altruistic game is modeled with each UAV considering the utilities of both itself and other UAVs. A distributed cooperative anti-jamming and interference mitigation algorithm is proposed to obtain the Stackelberg equilibrium. Finally, the convergence of the proposed algorithm and the impact of the transmission power on the system loss value are analyzed, and the anti-jamming performance of the proposed algorithm can be improved by around 64% compared with the existing algorithms.
基金sponsored by the National Key R&D Program of China(No.2018YFB2100400)the National Natural Science Foundation of China(No.62002077,61872100)+4 种基金the Major Research Plan of the National Natural Science Foundation of China(92167203)the Guangdong Basic and Applied Basic Research Foundation(No.2020A1515110385)the China Postdoctoral Science Foundation(No.2022M710860)the Zhejiang Lab(No.2020NF0AB01)Guangzhou Science and Technology Plan Project(202102010440).
文摘Benefiting from the development of Federated Learning(FL)and distributed communication systems,large-scale intelligent applications become possible.Distributed devices not only provide adequate training data,but also cause privacy leakage and energy consumption.How to optimize the energy consumption in distributed communication systems,while ensuring the privacy of users and model accuracy,has become an urgent challenge.In this paper,we define the FL as a 3-layer architecture including users,agents and server.In order to find a balance among model training accuracy,privacy-preserving effect,and energy consumption,we design the training process of FL as game models.We use an extensive game tree to analyze the key elements that influence the players’decisions in the single game,and then find the incentive mechanism that meet the social norms through the repeated game.The experimental results show that the Nash equilibrium we obtained satisfies the laws of reality,and the proposed incentive mechanism can also promote users to submit high-quality data in FL.Following the multiple rounds of play,the incentive mechanism can help all players find the optimal strategies for energy,privacy,and accuracy of FL in distributed communication systems.
基金Supported by the Zhangjiagang Science and Technology Project,No.ZKS2035.
文摘BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very important.Improper selection may lead to missed diagnosis or misdiagnosis.CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography(CT)examinations.The pain improved after the patient accepted gamma knife treatment.However,he was admitted to our hospital 2 mo later due to fever and abdominal pain.This time,he received a contrast-enhanced CT scan,which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation,then he went to the superior hospital for surgery.It lasted for more than 2 mo from the onset of the disease to the surgical treatment.A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity.Clinical perianal abscess surgery was performed,and fish bone foreign body was found in perianal soft tissue during the operation.CONCLUSION For patients with pain symptoms,the possibility of foreign body perforation should be considered.Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.
基金supported by the National Natural Science Foundation of China(Nos.51977113,62293500,62293501 and 62293505).
文摘Malicious attacks against data are unavoidable in the interconnected,open and shared Energy Internet(EI),Intrusion tolerant techniques are critical to the data security of EI.Existing intrusion tolerant techniques suffered from problems such as low adaptability,policy lag,and difficulty in determining the degree of tolerance.To address these issues,we propose a novel adaptive intrusion tolerance model based on game theory that enjoys two-fold ideas:(1)it constructs an improved replica of the intrusion tolerance model of the dynamic equation evolution game to induce incentive weights;and (2)it combines a tournament competition model with incentive weights to obtain optimal strategies for each stage of the game process.Extensive experiments are conducted in the IEEE 39-bus system,whose results demonstrate the feasibility of the incentive weights,confirm the proposed strategy strengthens the system’s ability to tolerate aggression,and improves the dynamic adaptability and response efficiency of the aggression-tolerant system in the case of limited resources.
基金supported by the NSFC(11971080,KJQN202000838)the funds of the Basic and Advanced Research Project of CQ CSTC(cstc2018jcyj AX0790,cstc2020jcyj-msxm X0328)+1 种基金supported by Project funded by the China Postdoctoral Science Foundation(2019TQ0097)the Science and Technology Commission of Shanghai Municipality(22DZ2229014)。
文摘In this paper,we study some basic properties on Lipschitz star bodies,such as the equivalence between Lipschitz star bodies and star bodies with respect to a ball,the equivalence between the convergence of Lipschitz star bodies with respect to Hausdorff distance and the convergence of Lipschtz star bodies with respect to radial distance,and the convergence of Steiner symmetrizations of Lipschitz star bodies.
文摘Accidental acute upper airway obstruction (UAO) is a common situation in pediatric emergencies. It is a source of morbidity and even mortality, particularly in children under 3 years of age. We report a clinical case of traumatic foreign body injury to the upper aerodigestive tract in a 7-year-old girl following a play accident.
基金Department of Science and Technology of Jilin Province,No.20210402019GH,Fundamental Research Funds of Jilin University,Seed Fund,No.2021ZZ021Jilin Province Education Science Planning Project,No.GH21006 and the Fundamental Research Funds for the Central Universities,No.2022CXTD03.
文摘Mental disorders such as depression and anxiety inflict significant burdens on individuals and society.Commonly prescribed treatments often involve cognitive therapy and medications.However,for patients resistant to these conventional methods,alternative therapies like the Ketogenic Diet(KD)offer a promising avenue.KD and its key metabolite,β-hydroxybutyrate(BHB),have been hypothesized to alleviate mental disorders through antiinflammatory actions,a crucial pathway in the pathophysiology of depression.This mini-review examines 15 clinical trials exploring the influence of KD and BHB on inflammation and their potential roles in managing mental disorders.Both human and animal studies were scrutinized to elucidate possible cellular and molecular mechanisms.Out of the 15 trials,10 reported reduced levels of at least one inflammatory mediator or mRNA post KD or BHB treatment,while two observed an elevation in anti-inflammatory agents.These findings suggest that KD and BHB could modulate cellular inflammatory pathways,highlighting their potential for therapeutic application in mental disorders.
文摘AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.
文摘Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality, affecting approximately 1% of all live births and 10% of all preterm infants. Lamellar bodies represent a storage form of pulmonary surfactant within Type II pneumocytes, secretion of which increases with advancing gestational age, thus enabling prediction of the degree of FLM. Preterm premature rupture of membranes (PPROM) complicates approximately 1/3 of all preterm births. Birth within 1 week is the most likely outcome for any patient with PPROM in the absence of adjunctive treatments. Respiratory distress has been reported to be the most common complication of preterm birth. Sepsis, intraventricular haemorrhage, and necrotizing enterocolitis also are associated with prematurity, but these are less common near to term. Objective: To assess the efficacy of the amniotic fluid lamellar body counting from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Methods: This study was conducted at Ain Shams University Maternity Hospital in the emergency ward from January 2019 to September 2019. It included 106 women with singleton pregnancies, gestational age from 28 - 36 weeks with preterm premature rupture of membranes. This study is designed to assess the efficacy of the amniotic fluid lamellar body counting (LBC) from a vaginal pool in predicting fetal lung maturity in women with preterm premature rupture of membranes. Results: The current study revealed a highly significant increase in the lamellar body count in cases giving birth to neonates without RDS compared to that cases giving birth to neonates with RDS. Also, no statistically significant difference between LBC and age, parity and number of previous miscarriages in the mother was found. Gestational age at delivery was significantly lower among cases with respiratory distress. Steroid administration was significantly less frequent among cases with respiratory distress. However, lamellar bodies had high diagnostic performance in the prediction of respiratory distress. Conclusion: Lamellar body count (LBC) is an effective, safe, easy, and cost-effective method to assess fetal lung maturity (FLM). It does not need a highly equipped laboratory or specially trained personnel, it just needs the conventional blood count analyzer. Measurement of LBC is now replacing the conventional Lecithin/Sphyngomyelin L/S ratio. LBC cut-off value of ≤42.5 × 10<sup>3</sup>/μL can be used safely to decide fetal lung maturity with sensitivity of 95.7% and specificity of 97.6%.
文摘BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature.Typically,a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.CASE SUMMARY Herein,we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery,and the patient experienced dysphagia.An endoscopically-guided neck incision was made over the insertion point in the esophagus,but the surgery failed due to having a blurred image at the insertion site during the operation.After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance,the purulent fluid outflowed to the piriform recess along the sinus tract.With endoscopic guidance,the position of the fish bone was precisely located along the direction of liquid outflow,the sinus tract was separated,and the fish bone was removed.To the best of our knowledge,this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.CONCLUSION In conclusion,the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus.This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
基金Taif University Researchers Supporting Project number(TURSP-2020/161),Taif University,Taif,Saudi Arabia.
文摘Parkinson’s disease(PD)is one of the primary vital degenerative diseases that affect the Central Nervous System among elderly patients.It affect their quality of life drastically and millions of seniors are diagnosed with PD every year worldwide.Several models have been presented earlier to detect the PD using various types of measurement data like speech,gait patterns,etc.Early identification of PD is important owing to the fact that the patient can offer important details which helps in slowing down the progress of PD.The recently-emerging Deep Learning(DL)models can leverage the past data to detect and classify PD.With this motivation,the current study develops a novel Colliding Bodies Optimization Algorithm with Optimal Kernel Extreme Learning Machine(CBO-OKELM)for diagnosis and classification of PD.The goal of the proposed CBO-OKELM technique is to identify whether PD exists or not.CBO-OKELM technique involves the design of Colliding Bodies Optimization-based Feature Selection(CBO-FS)technique for optimal subset of features.In addition,Water Strider Algorithm(WSA)with Kernel Extreme Learning Machine(KELM)model is also developed for the classification of PD.CBO algorithm is used to elect the optimal set of fea-tures whereas WSA is utilized for parameter tuning of KELM model which alto-gether helps in accomplishing the maximum PD diagnostic performance.The experimental analysis was conducted for CBO-OKELM technique against four benchmark datasets and the model portrayed better performance such as 95.68%,96.34%,92.49%,and 92.36%on Speech PD,Voice PD,Hand PD Mean-der,and Hand PD Spiral datasets respectively.
文摘We have developed a structure of dynamic knowledge for non-inertial systems, the so-called Theory of Dynamic Interactions (TDI) as a part of non-inertial dynamic knowledge, which incorporates a causal demonstration of phenomena accelerated by rotation, which would complement Classical Mechanics. We believe that the TDI mathematical model that we propose is of great conceptual importance. In addition, we think that it is not only necessary to understand the dynamics of rotating bodies, but also to understand the dynamics of the cosmos, with bodies that orbit and with constantly recurring movements, which make possible systems that have been in dynamic equilibrium for centuries and are not in a process of unlimited expansion. We even believe that this new dynamic theory allows us a better understanding of our universe, and the matter from which it is made.
文摘BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.