营养支持联合早期肺康复锻炼对脑卒中气管切开患者带管时间及复管率的影响

目的 研究营养支持联合早期肺康复锻炼对脑卒中气管切开患者带管时间及复管率的影响。方法 选取2018年1月至2021年1月浙江省台州医院脑卒中气管切开患者108例,采用随机数字表法分为对照组(常规干预,n=54)和观察组(营养支持联合早期肺康复锻炼,n=54),比较两组患者干预前后的营养指标[血清白蛋白(albumin,ALB)、血清转铁蛋白(transferrin,TRF)、血清前白蛋白(prealbumin,PA)]、肺功能[第1s用力呼气容积(forced expiratory volume in l second,FEV_(1))、用力肺活量(forced vital capacity,FVC)]、炎症因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)]的变化。结果 干预后,观察组患者的带管时间短于对照组(P<0.05),复管率(3.70%)低于对照组(14.81%)(P<0.05);两组干预后的TRF、PA、ALB水平均较干预前明显升高(P<0.05),且观察组明显高于对照组(P<0.05);两组干预后的FVC、FEV1水平较干预前明显升高,且观察组明显高于对照组(P<0.05)。两组干预后的TNF-α、IL-6水平较干预前明显降低(P<0.05),且观察组低于对照组(P<0.05)。结论 脑卒中后行气管切开术患者采用早期肺康复锻炼+肠内营养干预可缩短带管时间,降低复管率,改善营养状况,提高肺功能,减轻炎症反应,值得推广。

Does the bile duct angulation affect recurrence of choledocholithiasis?

AIM:To investigate whether bile duct angulation and T-tube choledochostomy influence the recurrence of choledocholithiasis.METHODS:We conducted a retrospective study including 259 patients who underwent endoscopic sphincterotomy and cholecystectomy for choledocholithiasis between 2000 and 2007.The imaginary line was drawn along the center of the bile duct and each internal angle was measured at the two angulation sites ofthe bile duct respectively.The values of both angles were added together.We then tested our hypothesis by examining whether T-tube choledochostomy was performed and stone recurrence occurred by reviewing each subject's medical records.RESULTS:The overall recurrence rate was 9.3% (24 of 259 patients).The mean value of sums of angles in the recurrence group was 268.3°± 29.6°,while that in the non-recurrence group was 314.8°± 19.9° (P < 0.05).Recurrence rate of the T-tube group was 15.9% (17 of 107),while that of the non T-tube group was 4.6% (7 of 152) (P < 0.05).Mean value of sums of angles after T-tube drainage was 262.5°± 24.6° and that before T-tube drainage was 298.0°± 23.9° in 22 patients (P < 0.05).CONCLUSION:The bile duct angulation and T-tube choledochostomy may be risk factors of recurrence of bile duct stones.

Bilateral liver resection for bilateral intrahepatic stones

AIM: To evaluate the shortand long-term outcomes of bilateral liver resection for bilateral intrahepatic stones. METHODS: We reviewed retrospectively 101 consecutive patients with bilateral intrahepatic stones who underwent bilateral liver resection in the past 10 years. The shortand long-term outcomes of the patients were analyzed. The Cox proportional hazards model was used to identify the risk factors related to stone recurrence. RESULTS: There was no surgical mortality in this group of patients. The surgical morbidity was 28.7%. Stone clearance rate after hepatectomy was 84.2% and final clearance rate was 95.0% following postoperative choledochoscopic lithotripsy. The stone recurrence rate was 7.9% and the occurrence of postoperative cholangitis was 6.5% in a median follow-up period of 54 mo. The Cox proportional hazards model indicated that liver resection range, less than the range of stone distribution (P = 0.015, OR = 2.152) was an independent risk factor linked to stone recurrence. CONCLUSION: Bilateral liver resection is safe and its shortand long-term outcomes are satisfactory for bilateral intrahepatic stones.

Generation of low jitter and discrete tunable dual-wavelength optical pulses at arbitrary repetition rates

A novel and simple method to generate low timing jitter and discrete tunable dual-wavelength optical pulses at arbitrary repetition rates is demonstrated in this paper.Two multiple quantum wells distributed feedback laser diodes,were used as the external seeding sources to inject the external photons into a gain-switched Fabry-Perot laser diode.The output wavelengths can be tuned discretely to coincide with any two lasing modes in the gain spectra range of the Fabry-Perot Laser diode,and the output side mode suppression ratio was better than 25 dB.Moreover,the timing jitter of optical pulses was reduced from 1.89 ps to 0.83 ps.It was empirically found that the lowest timing jitter operation occurred when the injected light wavelength is 0.2-0.3 nm shorter than the locked mode of the Fabry-Perot laser diode.To our knowledge,this is the first report of using two DFB laser diodes as a seeding source to reduce pulses jitter and select lasing dual-wavelength simultaneously.

Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

"Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer.It would appear that whatever method you adopt in fistula management,there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery).Since,at the moment,reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking,the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease;this knowledge joined to an eclectic attitude of the surgeon,who should be familiar with different types of treatment,is the only guarantee for a satisfactory treatment.As a conclusion,it is worthwhile to remember that adequate initial treatment significantly reduces recurrence,which,when it occurs,is usually due to failure to recognise the tract and primary opening at the initial operation.

Schwarz Lemma and Hartogs Phenomenon in Complex Finsler Manifold

The authors prove the Schwarz lemma from a compact complex Finsler manifold to another complex Finsler manifold and any complete complex Finsler manifold with a non-positive holomorphic curvature obeying the Hartogs phenomenon.

Supplement and optimization of classical capillary number experimental curve for enhanced oil recovery by combination flooding

In the middle of the last century,American scientists put forward the concept of capillary number and obtained the relation curve between capillary number and residual oil through experiments.They revealed that the corresponding residual oil saturation decreased with increasing of capillary number;after capillary number reached up to a limit,residual oil saturation would become stable and did not decrease.These important achievements laid a theoretical base for enhanced oil recovery with chemical flooding.On the basis of the theory,scholars developed chemical flooding numerical simulation software UTCHEM.During the numerical simulation study of combination flooding,the authors found that as the capillary number is higher than the limit capillary number,the changes of the residual oil saturation along with the capillary number differ from the classical capillary number curve.Oil displacement experiments prove that there are defects in classic capillary number experimental curve and it is necessary to mend and improve.Capillary number‘calculation’curve is obtained with a method of numerical simulation calculation and a complete description of capillary number curve is provided;On this basis,combination flooding capillary number experimental curve QL is obtained through experiments,which is different from the classical capillary curve;and based on which,an expression of corresponding combination flooding relative permeability curve QL is given and the corresponding relative permeability parameters are determined with experiments.Further oil displacement experiment research recognizes the cause of the singular changes of the capillary number curve."Combination flooding capillary number experimental curve QL"and"combination flooding relative permeability curve QL"are written in combination flooding software IMCFS,providing an effective technical support for the application of combination flooding technical research.

Mortality and recurrence of vascular disease among stroke patients treated with combined TCM therapy

OBJECTIVE:To confirm the long-term outcomes of stroke patients and determine predicting factors for death,recurrence of vascular events and poor outcome(either recurrence or death) after the use of combined TCM therapy.METHODS:This was a retrospective hospital-based cohort study and was performed in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine in Tianjin.All subjects with stroke consecutively admitted to an inpatient ward of the Acupuncture Department from January 1,2008,to December 31,2008 were retrospectively followed through one year.The main outcomes were either a recurrence of vascular events,,mortality or both.Risk factors were recorded from medical records.Multivariate regression models were used to analyze predictors.The following independent variables were used:age,gender,hypertension,ischemic heart disease,atrial fibrillation,diabetes mellitus,carotid arterial lesions and history of stroke.RESULTS:Four-hundred and five patients were included.The 1-year mortality rate was 11.11%.23.70% of the patients had a recurrent vascular event,and 30.86% suffered a poor outcome.Multiple logistic regression analysis found that previous stroke,and advanced age were predictors of death within one year,Recurrence of vascular events was associated with carotid arterial lesions,history of diabetes and previous stroke.Long-term poor outcome was predicted by advanced age,history of diabetes,and previous stroke.CONCLUSION:Age,previous stroke,carotid arterial lesions and diabetes history seem to have different impacts on the three outcomes within one year.Our findings provide important data for planning future hospital register studies of stroke patients in TCM hospitals.

Light-emitting field-effect transistors with EQE over 20%enabled by a dielectric-quantum dots-dielectric sandwich structure

Emerging quantum dots(QDs)based light-emitting field-effect transistors(QLEFETs)could generate light emission with high color purity and provide facile route to tune optoelectronic properties at a low fabrication cost.Considerable efforts have been devoted to designing device structure and to understanding the underlying physics,yet the overall performance of QLEFETs remains low due to the charge/exciton loss at the interface and the large band offset of a QD layer with respect to the adjacent carrier transport layers.Here,we report highly efficient QLEFETs with an external quantum efficiency(EQE)of over 20%by employing a dielectric-QDs-dielectric(DQD)sandwich structure.Such DQD structure is used to control the carrier behavior by modulating energy band alignment,thus shifting the exciton recombination zone into the emissive layer.Also,enhanced radiative recombination is achieved by preventing the exciton loss due to presence of surface traps and the luminescence quenching induced by interfacial charge transfer.The DQD sandwiched design presents a new concept to improve the electroluminescence performance of QLEFETs,which can be transferred to other material systems and hence can facilitate exploitation of QDs in a new type of optoelectronic devices.