The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube inser...The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.展开更多
AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or...AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.展开更多
In order to prevent spontaneous coal combustion occurring at a fully mechanized caving face with large obliquity in deep mines in China, we have analyzed the characteristics of spontaneous coal combustion and explain ...In order to prevent spontaneous coal combustion occurring at a fully mechanized caving face with large obliquity in deep mines in China, we have analyzed the characteristics of spontaneous coal combustion and explain theoretically the factors affecting spontaneous coal combustion, such as rock bursts, high temperatures, high ventilation resistance, slow advancing speed and large obliquity mining. Key technologies to prevent spontaneous combustion occurring in sharply inclined seams in deep mines are pro- posed; these include pouring water, stopping leakage in upper and lower comers of the working face, choking off the goaf and cov- eting the coal. CO concentrations were controlled within two years to less than 15×10^-6 at the upper comer by applying these tech- nologies at the 1410 working face of the Huafeng coal mine. Our method has significant theoretical value and is of practical impor- tance in controlling spontaneous coal combustion occurring at a fully mechanized caving face with large obliquity in deep mines.展开更多
On November 14, 2001, an extraordinarily large earthquake (MS8.1) occurred on the Hoh Sai Hu segment of the Eastern Kunlun Fault, in the northern Qinghai-Tibetan Plateau. The seismogenic fault, the Hoh Sai Hu segment,...On November 14, 2001, an extraordinarily large earthquake (MS8.1) occurred on the Hoh Sai Hu segment of the Eastern Kunlun Fault, in the northern Qinghai-Tibetan Plateau. The seismogenic fault, the Hoh Sai Hu segment, is a left-lateral fault with a high slip rate in geological history, with the average slip rate reaching(14.8±2.8)mm/a since the late Pleistocene. Different slip rates of the Hoh Sai Hu segment can affect fault motion in the future. Therefore, this paper analyzes the effect of different slip rates and different initial friction coefficients on the fault plane of the Hoh Sai Hu segment of the eastern Kunlun Fault on the rupture behaviors of the fault. In this research, we apply the single degree of spring block model controlled by the rateand state-dependent frictional constitutive laws. Using the fault dislocation model and based on ancient earthquake research, historical earthquakes data and the achievements of previous researchers, we obtained the parameters of this model. Through numerical simulation of the rupturing motion of the Hoh Sai Hu segment in the next 6500 years under different slip rates, we find that a faster annual slip rate will shorten the recurrence interval of the earthquake. For example, the earthquake recurrence interval is 2100a at a slip rate of 0.014m/a, which agrees with previous research, but, the recurrence interval will be 1000~1500a and 2100～2500a, corresponding to the slip rates of 0.018m/a and 0.008m/a, respectively. The fault slip rate has no regular effect on the coseismic slip rate and fault displacement in an earthquake. The initial friction coefficient on the fault surface has an effect on the earthquake recurrence interval. A smaller initial friction coefficient will lengthen the earthquake recurrence interval. At the same time, the smaller initial friction coefficient will lead to larger slip rates and fault displacement when earthquakes occur.展开更多
Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fr...Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.展开更多
Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9...Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.展开更多
Purpose： Tibia plateau fracture （TPF） treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as pati...Purpose： Tibia plateau fracture （TPF） treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients＇ characteristics, severity, risk of complications, fracture displacementJdepression, degree of soft tissue injury. However, body mass index （BMI） is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately. Methods： Retrospective analysis of case series between 2011 and 2014 was done on the database of a tertiary hospital in Istanbul. There were 67 TPF patients （54 males, 13 females） in the study. Relationship between BM1 and functional knee scores or radiological score was compared statistically. Closed fractures with both high-energy and low-energy injury were included in the study. Patients with open fracture, multi-trauma presence, meniscus and/or ligamentous injury, increased co-morbidity, inadequate records （25 cases in all） were excluded. Surgery type, Schatzker classification, injury side, trauma energy, and gender were considered as possible risk factors. Binary regression analysis was done for possible factors affecting functional knee scores and radiologic score. Results： Model summary calculations were done as Nagelkerke R2 test for Knee Society score, Lysholm knee score, and Ahlback and Rydberg radiologic scores, which were 0.648, 0.831, and 0.327 respec- tively. Homer-Lemeshow test values were 0.976, 0.998, and 0.362, respectively. There is negative correlation between BMI and both knee function scores. There is no correlation between BMI and radiologic score. Conclusion： An increase in BMI has a negative effect on functional knee scores after surgical treatment of TPFs. Therefore, BMI should be considered as a risk factor for surgical treatment of TPFs.展开更多
文摘The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.
文摘AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.
基金Projects 2007B53 supported by the Foundation for National Excellent Doctoral Dissertation of ChinaBK2008123 by the Natural Science Foundation of Jiangsu Province
文摘In order to prevent spontaneous coal combustion occurring at a fully mechanized caving face with large obliquity in deep mines in China, we have analyzed the characteristics of spontaneous coal combustion and explain theoretically the factors affecting spontaneous coal combustion, such as rock bursts, high temperatures, high ventilation resistance, slow advancing speed and large obliquity mining. Key technologies to prevent spontaneous combustion occurring in sharply inclined seams in deep mines are pro- posed; these include pouring water, stopping leakage in upper and lower comers of the working face, choking off the goaf and cov- eting the coal. CO concentrations were controlled within two years to less than 15×10^-6 at the upper comer by applying these tech- nologies at the 1410 working face of the Huafeng coal mine. Our method has significant theoretical value and is of practical impor- tance in controlling spontaneous coal combustion occurring at a fully mechanized caving face with large obliquity in deep mines.
基金jointly sponsored by the Special Program of Basic R&D Fund,Institute of Geology,CEAthe Seismic Industry Research Program,CEA( 200808018)
文摘On November 14, 2001, an extraordinarily large earthquake (MS8.1) occurred on the Hoh Sai Hu segment of the Eastern Kunlun Fault, in the northern Qinghai-Tibetan Plateau. The seismogenic fault, the Hoh Sai Hu segment, is a left-lateral fault with a high slip rate in geological history, with the average slip rate reaching(14.8±2.8)mm/a since the late Pleistocene. Different slip rates of the Hoh Sai Hu segment can affect fault motion in the future. Therefore, this paper analyzes the effect of different slip rates and different initial friction coefficients on the fault plane of the Hoh Sai Hu segment of the eastern Kunlun Fault on the rupture behaviors of the fault. In this research, we apply the single degree of spring block model controlled by the rateand state-dependent frictional constitutive laws. Using the fault dislocation model and based on ancient earthquake research, historical earthquakes data and the achievements of previous researchers, we obtained the parameters of this model. Through numerical simulation of the rupturing motion of the Hoh Sai Hu segment in the next 6500 years under different slip rates, we find that a faster annual slip rate will shorten the recurrence interval of the earthquake. For example, the earthquake recurrence interval is 2100a at a slip rate of 0.014m/a, which agrees with previous research, but, the recurrence interval will be 1000~1500a and 2100～2500a, corresponding to the slip rates of 0.018m/a and 0.008m/a, respectively. The fault slip rate has no regular effect on the coseismic slip rate and fault displacement in an earthquake. The initial friction coefficient on the fault surface has an effect on the earthquake recurrence interval. A smaller initial friction coefficient will lengthen the earthquake recurrence interval. At the same time, the smaller initial friction coefficient will lead to larger slip rates and fault displacement when earthquakes occur.
文摘Purpose： The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. Methods： This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients＇ demographics, prehospitalization residential status, pre- fracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. Results： The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was 〉2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed, Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality （c-statistic 0.77）. Conclusion： Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.
基金Project supported by the China Capital Clinical Research(No.Z121107001012002)
文摘Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.
文摘Purpose： Tibia plateau fracture （TPF） treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients＇ characteristics, severity, risk of complications, fracture displacementJdepression, degree of soft tissue injury. However, body mass index （BMI） is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately. Methods： Retrospective analysis of case series between 2011 and 2014 was done on the database of a tertiary hospital in Istanbul. There were 67 TPF patients （54 males, 13 females） in the study. Relationship between BM1 and functional knee scores or radiological score was compared statistically. Closed fractures with both high-energy and low-energy injury were included in the study. Patients with open fracture, multi-trauma presence, meniscus and/or ligamentous injury, increased co-morbidity, inadequate records （25 cases in all） were excluded. Surgery type, Schatzker classification, injury side, trauma energy, and gender were considered as possible risk factors. Binary regression analysis was done for possible factors affecting functional knee scores and radiologic score. Results： Model summary calculations were done as Nagelkerke R2 test for Knee Society score, Lysholm knee score, and Ahlback and Rydberg radiologic scores, which were 0.648, 0.831, and 0.327 respec- tively. Homer-Lemeshow test values were 0.976, 0.998, and 0.362, respectively. There is negative correlation between BMI and both knee function scores. There is no correlation between BMI and radiologic score. Conclusion： An increase in BMI has a negative effect on functional knee scores after surgical treatment of TPFs. Therefore, BMI should be considered as a risk factor for surgical treatment of TPFs.
