Large Conventional Osteosarcoma of the Proximal Humerus in a 13-Year-Old Child: Case Report

Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.

Traumatic Diaphragmatic Hernia in Children: A Case Report

Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.

Neonatal Intestinal Obstruction in Acute Renal Failure in Premature Infant: A Case Report

Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Peritoneal dialysis (PD) is an effective, albeit invasive, therapy for neonatal renal failure. We report a case of neonatal obstruction with severe renal failure treated by PD to highlight our hospital practice and possible remedies in a context of limited resources. Case Presentation: This was a female neonate of moderate prematurity admitted on day 4 of life for management of a flat neonatal obstruction. Radiological diagnosis suggested small bowel atresia. Biological tests revealed severe renal failure with creatinine levels of 416 micromoles per liter and blood urea of 27.1 micromoles per liter. Management consisted of preoperative peritoneal dialysis for 48 hours followed by laparotomy. The intraoperative diagnosis was GROSFELD type IIIa digestive atresia. The postoperative course was favourable, transit was resumed on day 5 and the patient returned home on day 12. Progress at 3 months was satisfactory. Conclusion: Neonatal intestinal obstruction with renal failure in premature infants is associated with a poor prognosis, even more so if there is a delay in treatment. Peritoneal dialysis seems to be a suitable alternative for this management in our working conditions with limited resources.

Community Caregivers’ Experiences and Programmatic Strategies to Improve Active Case Finding in Community Tuberculosis Care in Botswana 2016-2021

Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.

Childhood Papillary Thyroid Carcinoma: A Case Report

Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.

Benefits of Dielectric Oil Regeneration Systems in Power Transmission Networks: A Case Study

The criticality of transformers and reactors in the power transmission network and the paramount importance of ensuring their reliability through maintenance of the insulating oil is known. This paper presents a comprehensive examination of the efficacy and economic viability of a dielectric oil regeneration system, as implemented by the Transmission System Maintenance Department (TSMD) of the Independent Power Transmission Operator (IPTO), Greece’s sole transmission operator. Through a detailed chemical analysis and performance evaluation, we assess the impact of the regeneration system on treated insulating oil quality over multiple cycles. The study reveals that the electrical properties of the insulating oil are fully restored after regeneration, negating the need to fully replace it, while the investment becomes cost-neutral within weeks from the commissioning of the regeneration system. This economic analysis, coupled with the system’s environmental benefits of reducing waste oil generation, positions the dielectric oil regeneration system as a compelling solution for the maintenance of power transmission assets.

Investigating the Air Quality Parameters in Louisiana’s Industrial Corridor: A Baton Rouge Case Study

In a local context, sustainable development entails utilizing the current resources—material and immaterial, measurable and immeasurable, popular and unpopular—of the community in a manner that avoids overexploitation and ensures intergenerational equity. This approach prioritizes the safety and health of local citizens, placing communal productivity above corporate profitability. This research aims to assess air quality surrounding 28 chemical industry sites in Baton Rouge, Louisiana, to understand the environmental and health impacts of industrial pollutants, with a focus on environmental justice. Air quality pollutants, including PM2.5, PM10, O3, NO2, CO, and SO2, were monitored for 75 days during the Summer, using the BreezoMeter app. Python, Mapize, and QGIS software technologies were utilized for data analysis and visualization. Findings indicate a reduction in NO2 and CO levels, compared to existing literature. However, the persistent challenge of particulate matter suggests areas for further environmental management efforts. Additionally, the research suggests a significant disparity in air pollution exposure, probably affecting marginalized communities. Although the nature of the study might not fully capture annual pollution trends, the findings highlight the urgent need for the chemical industry to adopt efficient production methods and for policymakers to enhance air quality standards and enforcement, particularly in pollution-sensitive areas. The disproportionate impact of air pollution on vulnerable communities calls for a more inclusive approach to environmental justice, ensuring equitable distribution of clean air benefits and community involvement in pollution management decisions.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

干酪乳杆菌(Lactobacillus casei)FV006对发酵食品中生物胺的降解性能

为验证干酪乳杆菌(Lactobacillus casei)对生物胺的降解性能及潜在应用价值。本研究利用高效液相色谱法,探究该菌在液态培养条件下的降胺性能和应用于贵州6种市售发酵食品中的降胺效果。结果表明,在液态培养试验中该菌对组胺、亚精胺、苯乙胺、腐胺、尸胺、酪胺和色胺的降胺率分别为9.44%、23.39%、16.27%、13.68%、19.14%、18.16%和12.45%。此外,研究发现该菌对道菜中色胺的降胺率为56.68%;对豆瓣酱中尸胺、组胺和亚精胺的降胺率分别为68.06%、74.52%和85.82%;对酱油中色胺和尸胺的降胺率为66.75%%、81.53%;对泡菜中色胺的降胺率为45.74%;对鱼罐头中色胺、尸胺、组胺和亚精胺的降胺率分别为55.66%、63.92%、45.96%、52.62%;对香肠中色胺、组胺和亚精胺的降胺率分别为71.15%、56.26%、75.54%。研究还发现该菌既具有产生物胺的能力,也具有降解生物胺的能力,且对不同食品中同一种生物胺的降解具有差异性。本研究为干酪乳杆菌(Lactobacillus casei)在低胺发酵食品中的应用提供理论依据。

稠油热采井射孔孔眼应力分析及影响因素

针对稠油热采井生产过程中,射孔井段套管频繁出现损伤断裂的问题,基于弹塑性和热力学理论,采用有限元方法建立注汽—焖井—生产过程射孔套管有限元热力学耦合模型,对各阶段射孔套管应力分布特征进行研究,并开展不同射孔参数下射孔套管强度影响规律分析。研究表明:生产过程中射孔孔眼位置出现明显应力集中现象,在温差及内外压差等共同作用下,注采前期套管应力最大可达498.16 MPa,并逐渐产生塑性失效现象,当注采作业完成时,套管塑性失效现象最严重;随着射孔相位角增大,射孔密度对Mises应力值的影响逐渐减小,而套管孔眼最大应力与射孔相位角成反比关系。该研究对延长稠油热采井射孔套管使用年限和保障正常生产作业具有十分重要的意义。

基于Comsol软件的电磁兼容课程案例式教学设计

该文介绍基于Comsol软件的电磁兼容课程案例式教学方法。通过案例教学和仿真,学生将理论知识应用于实际问题,深入理解电磁兼容的概念和原理。通过仿真案例的可视化结果,学生直观地理解电磁辐射和传导,观察不同参数对电磁兼容性的影响。结果表明,仿真案例具有直观性和可视化等优势,同时又有简化模型、缺乏实际操作经验和对计算机的依赖等局限性。在设计仿真案例时,要充分发挥其优势,规避不足,为学生的学习提供实践性、直观性和灵活性,培养学生的工程设计与研发能力。

国有企业的低碳双元战略发展路径——基于上海申通地铁集团的案例研究

在中国特色社会主义经济制度下,国有企业始终肩负着发展经济和服务社会的双重使命。根据企业所处的行业特点与所承担的业务特征,国有企业很可能面临高耗能的挑战。选取上海申通地铁集团有限公司作为典型案例,基于双元理论探究国有企业低碳双元战略的动态发展路径。研究发现,国有企业的低碳发展首先是将低碳理念融入其“经济—社会”双元目标,形成具有经济属性的成本性和效益性低碳导向,以及具有社会属性的政策性和公益性低碳导向。基于此,国有企业开发低碳双元战略实践,包括具有经济属性的低碳成本管理和低碳业务投资,以及具有社会属性的低碳政策落实和产业低碳引领。此外,知识和资源开发促进了低碳双元战略实践的相互转化,实现了低碳双元战略的协调统一。研究结论既为国有企业低碳发展中的协同辩证关系提供了新的理解,又拓展了双元理论在企业低碳管理领域的应用。

MDT联合PBL+CBL模式在临床肝癌教学中的应用

目的探讨多学科会诊(multiple disciplinary team,MDT)联合问题导向教学法(problem based learning,PBL)+案例教学法(case based learning,CBL)教学模式在肝癌临床教学中的应用效果。方法选择2019年10月—2022年6月入院实习的128名临床医学专业学生为研究对象,采用抽签法将其分为对照组64名和观察组64名,对照组采取传统教学模式,观察组采取MDT联合PBL+CBL教学模式。对比两组学生考核成绩、对教学效果的认同度、教学满意度。结果观察组考核成绩得分[理论知识(89.01±6.39)分、病例分析(84.16±5.04)分、技能操作(85.19±6.08)分]均高于对照组[理论知识(80.14±5.63)分、病例分析(76.69±5.60)分、技能操作(75.93±5.47)分],差异有统计学意义(P<0.05)。观察组对MDT联合PBL+CBL教学模式能激发学习兴趣(95.31%)、加深对理论知识的理解(100.00%)、提升临床思维能力(93.75%)和临床分析能力(96.88%)、提高理论联系实践的能力(100%)、提升自学能力(96.88%)和团队协作能力(95.31%)的认同度均高于对照组(56.25%、60.94%、39.06%、62.50%、43.75%、35.94%、35.94%),差异有统计学意义(P<0.05)。观察组对教学的满意度(92.19%)高于对照组(51.56%),差异有统计学意义(P<0.05)。结论MDT联合PBL+CBL的肝癌临床教学模式能提高教学质量,提升学生的综合素质。

Verbal Dyspraxia: A Case Study

Introduction: While approaching the aspect of learning disorders, particular attention is paid to verbal dyspraxia, a phenomenon that runs its course regularly over the last years. Verbal dyspraxia is inherent in the person without mental disorders and accompanies them throughout the whole spectrum of life. Comorbidity is an added issue. Although dyspraxia is met in homogeneous groups, some common elements such as intelligence, difficulty regarding linguistic skills, low learning performance and low self-esteem are present. Purpose: The object is to research how dyspraxia is manifested and how it affects a 6-year-old boy as well as the possibility of promptly interfering and simplifying his everyday life. Method: In the current case study, Achenbach’s questionnaire was used, combined with the use of expressive vocabulary. Results: The results of the research were unveiled through experts’ references in coordinance with the conferences conducted. Conclusion: Winding up, dyspraxia is a learning disorder that exists within the person through their lifespan. Immediate diagnosis, combined with experts’ personalized intervention programs (and perhaps, a differentiated curriculum, where applicable) can guide the person to live up to the educational needs. Family’s role is to be supportive, intending to eliminate possible emotional strains.

临床药学专业抗感染PBL案例库的建设与探索

抗菌药物合理使用已成为临床药学实践教学的重要内容之一。传统的教学方式存在局限性,往往不能有效提升学生在实际临床工作中抗菌药物合理使用的能力。为解决这一问题,笔者研究了以以问题为基础的教学法(problem-based learning,PBL)为基础的案例库建设在抗菌药物合理使用教学中的应用;探讨了PBL案例库在抗菌药物合理使用教学中的重要意义和实用性。它不仅能激发学生的主动学习兴趣,还有助于培养其跨学科团队合作和临床决策能力。文章还明确了PBL案例库编写的基本原则、方法以及案例的结构和内容,以确保建设案例库的可行性。本研究在临床药学专业硕士研究生教育中的实践证明,该方法适用于现代教学模式,有望显著提高抗菌药物合理使用教学的质量和效果,具有重要的教学和临床实践意义。

大型飞机多支柱交联式起落架一体化载荷校准及建模研究

针对某大型飞机多支柱交联式起落架结构受力及传力特点,首次采用一体校准、独立建模的载荷试验方法,三支柱起落架侧挂正向一体安装、一体加载,解决了多支柱之间的载荷影响问题。根据交联式多支柱结构受力及传力特点,进行应变电桥及载荷工况设计,载荷工况既包括常规的单支柱加载,还包括满足多支柱影响的两支柱及三支柱组合加载工况。提出了多支柱广义响应系数概念,并通过广义响应系数对支柱之间的影响效果进行分析,显示支柱载荷向前单向传递,后支柱影响紧邻前支柱,前支柱不影响后支柱。据此提出了支柱独立建模、载荷逐次迭代、基于广义响应系数的支柱消扰载荷建模方法,获得了满足精度要求的载荷模型。

多元化教学模式在缺血性脑血管病介入进修医师培训中的应用探索

目的 探讨多元化教学模式在提高缺血性脑血管病介入诊疗进修医师培训质量和效率方面的应用。方法 选择2018年1月-2022年12月在南京大学医学院附属鼓楼医院神经内科接受脑血管介入培训的进修医师为研究对象,应用多元化教学模式,即将多种教学方法融合交叉的培训模式进行教学。采用问卷调查的形式对进修医师满意度及其在培训前后介入诊疗理论知识和实践操作能力进行评估。结果 共纳入55名进修医师,年龄32~50岁,其中男性51名(92.73%)。89.09%的进修医师对多元化教学模式非常满意;分别有83.64%和85.45%的进修医师认为多元化教学模式激发了学习兴趣和自主学习能力。经过多元化教学模式培训后,能够独立完成颅外支架置入治疗的进修医师显著增加(41.82%vs. 12.73%,P=0.002)。结论 多元化教学模式是提高缺血性脑血管病介入进修医师培训质量和效率的有效手段。

Pancytopenia and Pulmonary Tuberculosis: A Case Report

Background: Hematopoietic system is seriously affected by tuberculosis. It exerts a dazzling variety of hematological effects involving both cell lines and plasma components [1]. Anemia and leukopenia are not unusual with tuberculosis (TB), but pancytopenia is rare [2]. Findings: In this report, we described a case of a 42 years man presenting bleeding and pancytopenia;bacteriological pulmonary TB was established by genotypic rapid test and treatment following the WHO guidelines on drug-sensitive TB treatment. Patient recovered entirely with the WHO recommended regimen associated with general and local treatment of the bleeding. Conclusion: This case report emphasizes the importance of always suspecting tuberculosis in a tuberculosis-endemic area, even when the clinical manifestations are atypical, like pancytopenia and also of properly investigating the differential diagnosis. Even though prognosis seems to be less good, actual treatment regimen is still effective.

页岩气多级压裂断层动态滑移规律研究

泸州页岩气区块开发过程中套管变形现象严重,而多级压裂是诱发断层滑移并导致套管变形的主要因素,但目前缺乏对断层动态滑移演化规律的研究。在分析泸州地区套管变形失效特征和相关性的基础上,考虑水力裂缝沟通并激活断层实际,建立了多级压裂条件下断层滑移动态演化数值模型。研究结果表明:多级压裂导致近井筒位置孔隙压力随压裂逐级增加,有效地应力降低;模拟时间越长、注入点流量越大,断层滑移量越大,而压裂液黏度影响断层滑移量效果弱;断层长度、断层与井筒的夹角与其滑移量关系密切,断层长度越大,断层滑移量越大;断层与井筒夹角在一定范围内越大,断层滑移量越小;水平地应力差较大的地层断层滑移会越明显。研究成果可为页岩气多级压裂过程中控制压裂施工参数提供参考。

基于BOPPPS线上线下混合式案例教学模式的中医诊断学教学探索

在分析中医院校中医诊断学课程定位及当前教学中存在的突出问题后,作者基于BOPPPS教学模型,创新性地将线上线下教学与案例教学相融合,采取课前线上线下教学、课中线下教学、课后线上师生交流和线下学生深入实践探寻问题相结合的模式,对提高学生学习积极性和学习效果进行探索。经初步实践证实,该教学模式能够激发学生的学习积极性与主动性,进一步提高学生的主体意识和自学能力,提高其四诊技能的综合运用能力和临床思辨能力,有效提高教学质量。因此,在中医诊断学课程教学中,基于BOPPPS教学模型的线上线下混合式案例教学模式为改善当前传统教学模式的不足提供了一种新的思路,值得研究及推广。