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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

政府补贴与企业环保投资选择:前端预防还是末端治理?

政府补贴是推动绿色低碳发展、经济转型和实现社会可持续目标的重要激励政策措施。不同于以往文献主要关注政府补贴对企业整体环保投资的影响,本文以2007—2020年中国A股上市公司为样本,基于手工整理的政府补贴和环保投资数据,从企业内外部视角划分前端预防和末端治理的环保投资类型,分析政府补贴政策对两种不同企业环保投资行为的影响差异。研究发现,政府对前端预防项目进行补贴可以缓解企业融资约束、增加投资项目的预期收益,进而促使企业加大投资力度;政府对末端治理项目进行补贴无法提高投资项目的预期收益,对企业自身的投资额具有挤出效应。上述结论为优化环保补贴结构以及加快企业清洁生产转型提供了科学依据。

干眼症的药物治疗策略及研究进展

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

基于剪切波弹性成像评价颈肩痛与斜角肌的关系

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

降低急性胰腺炎的病死率:基于日本2021版诊疗指南的探讨

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

陈旧性Ⅱ型齿状突骨折的术式选择及治疗效果

目的:探讨陈旧性Ⅱ型齿状突骨折的临床术式选择及其治疗效果。方法:2010年6月~2015年6月收治77例骨折时间超过3周的陈旧性Ⅱ型齿状突骨折患者,其中男52例,女25例,年龄16~65岁(37.0±14.5岁),根据骨折后时间长短和复位的难易程度,5例患者采用前路单枚中空拉力螺钉固定,6例采用寰枢椎后路钉棒固定非融合,40例采用后路寰枢椎钉棒固定融合,26例采用经口咽前路寰枢椎复位钢板(transoral atlantoaxial reduction plate,TARP)固定融合。采用美国脊髓损伤学会(ASIA)分级及日本骨科学会(JOA)评分对神经功能进行评价,术前ASIA分级D级32例,E级45例;术前J0A评分12.9±2.4分。术后定期复査X线片、CT,评价齿状突骨折愈合、寰枢椎复位、植骨融合情况。结果:77例患者均成功完成手术,术中未发生椎动脉、脊髓损伤。术后颈项部疼痛、四肢麻木及肌力下降等症状均不同程度改善,术前32例ASIA分级为D级的患者中20例术后改善为E级,其余患者分级无变化;术后J0A评分改善至15.2±1.2分,与术前比较差异有统计学意义(t=-12.211,P=0.000)。所有患者均获随访,随访时间3~36个月(27.0±9.6个月),1例前路单枚中空螺钉固定者齿状突骨折呈纤维/瘢痕愈合,4例前路单枚中空螺钉固定及6例寰枢椎后路钉棒临时固定者的齿状突骨折均获复位及骨折端的骨性愈合,40例后路及26例前路固定植骨融合者的寰枢椎脱位均获复位及寰枢椎间的骨性融合。结论:陈旧性Ⅱ型齿状突骨折根据骨折时间及骨折复位情况选择恰当的手术方式,可获得满意的临床治疗效果。

废弃混凝土处理方式的环境影响比较

废弃混凝土处理过程的环境影响是辅助废弃混凝土管理决策的重要依据。采用生命周期评价方法,对废弃混凝土再生骨料利用、再生原料利用、基础填料利用和填埋四种方式的环境影响,进行了核算。其中,生命周期影响评价方法采用"中点法"计算生命周期环境影响状况,并通过社会支付意愿的概念将生命周期影响状况结果转化为以货币价值表示的单一环境影响分值。结果表明:在材料替代的前提下,废弃混凝土再生骨料利用的环境影响最低,最能体现废弃混凝土的资源价值。目前西宁市建筑垃圾填埋弃置的收费标准,不能弥补填埋造成的环境影响,亦不足以改善废弃混凝土的再生利用。

桡骨远端骨折的临床治疗方案选择

目的报告桡骨远端骨折的临床治疗方案选择。方法将桡骨远端骨折按Cooney（1990）通用分类法选择临床治疗方案,无移位关节外骨折及有移位但稳定性关节外骨折采用手法复位石膏外固定;不稳定性关节外骨折、稳定性关节内骨折采用经皮穿克氏针＋石膏外固定;不可闭合复位且复位后不稳定的关节外骨折及可闭合复位但复位后不稳定关节内骨折采用切开复位＋外固定架;粉碎性关节内骨折采用切开复位钛板内固定术＋植骨术。结果本组60例患者全部获得随访,随访时间8~16个月,平均9个月,骨折均愈合,无桡骨短缩、掌倾角改变及骨不连发生,无针道感染及创伤性关节炎,根据腕关节功能与X线测量综合指标,优38例,良17例,可5例,优良率为91.7%。结论随着广大医务工作者对腕关节解剖和生物力学的不断深入认识,桡骨远端骨折的治疗方法也不断改善,由传统的石膏外固定,发展为经皮穿针内固定和外固定器,使骨折稳定性有很大的提高。手术对于骨折解剖结构和功能的恢复的确有较好作用,但同时也有创伤及引起相应并发症的风险,且增加了经济负担,因此在治疗桡骨远端骨折时应结合具体情况选择适当的治疗方案。

各级医师对慢性前列腺炎治疗方法的选择

目的:了解医师常用的慢性前列腺炎(CP)治疗方法的选择及其在不同级别医院/职称医师中的差别。方法:向全国63个城市399家医院泌尿外科、男科和社区医院医师发放问卷,对回收的有效问卷进行统计分析。结果:2046名医师对问卷完成了有效回答,其中来自三级、二级、一级医院的医师分别为62.7%、29.8%、7.5%;高级、中级、初级职称医师分别为23.6%、48.7%、27.7%。医师最常选择的CP治疗方法是药物治疗、调整生活方式和心理治疗。前列腺穿刺注射/经尿道灌注药物、手术等有创治疗方法选择比例最低。医院级别越高的医师,越倾向于选择心理治疗和调整生活方式;职称越高的医师,越倾向于选择心理治疗和坐浴等无创治疗方法。结论:各级医师普遍能够规范、合理地选择CP治疗方法,医院级别或职称越高的医师越倾向于选择心理治疗、调整生活方式及无创治疗方法。

基于排污权交易的厂商污染治理新技术投资决策的期权博弈模型

应用期权博弈理论建立了排污权交易条件下领导厂商与跟随厂商污染治理新技术投资决策模型,给出了领导厂商与跟随厂商污染治理新技术投资的期权价值和最佳时机,并进行了仿真计算。结果表明,通过排污权市场预期价格与期权价值临界值的比较,可以进行厂商污染治理新技术投资或者等待的决策。

儿童皮肤脉管异常的临床特点和治疗选择

目的总结儿童皮肤脉管异常的临床特点和治疗选择。方法回顾性分析了2007年1月~12月在北京儿童医院皮肤科就诊的384例儿童皮肤脉管异常患者的临床资料,并按1996年国际血管性疾病研究协会分类方法对患儿进行分类。结果384例患儿中,婴儿血管瘤185例,男女比例为1∶1.7,78.4%就诊年龄在生后6个月内,50.8%皮损位于头面部;先天性血管瘤132例,男女比例1∶1.9,75.0%就诊年龄在生后6个月内,皮损以头面部比例最高(37.1%);微静脉畸形27例,男女比例1∶1.3,就诊年龄以1岁内最多(40.7%),77.8%皮损位于头面部;静脉畸形16例,男女比例1∶1.3,就诊年龄以1岁内最多(31.3%),56.3%皮损位于头面部。250例(65.1%)患儿采取随诊观察,对其中80例未采取任何治疗措施血管瘤类患儿的随访结果显示,有66例在1.5~2岁间肿瘤出现颜色明显变淡,面积减小一半以上,其中34例肿瘤基本完全消退。结论在儿童脉管性疾病中,婴儿血管瘤和先天性血管瘤所占比例最大,肿瘤类疾病女性发病率高于男性,具有内皮细胞增生的脉管性疾病就诊年龄较早,皮损主要分布于面部,多数患儿采取随诊观察预后良好。

层次分析法在农村生活污水处理模式优选中的应用

农村生活污水处理时需考虑环境、经济、技术、管理和政策等诸多影响因素,因此如何选取合适的处理模式一直是当前研究的热点。文章在介绍农村生活污水特点以及存在问题的基础上,根据层次分析法的原理建立农村生活污水处理模式层次模型,并以E村为研究对象,通过判断矩阵、计算权重以及层次总排序得出湿地处理为E村生活污水的最优处理技术。方法的应用为农村生活污水处理模式的选择提供了指导作用。