Climate change affects the activity of global and regional tropical cyclones(TCs).Among all TCs,typical super typhoons(STYs)are particularly devastating because they maintain their intensity when landing on the coast ...Climate change affects the activity of global and regional tropical cyclones(TCs).Among all TCs,typical super typhoons(STYs)are particularly devastating because they maintain their intensity when landing on the coast and thus cause casualties,economic losses,and environmental damage.Using a 3D tidal model,we reconstructed the typhoon(TY)wind field to simulate the storm surge induced by typical STYs.The TY activity was then analyzed using historical data.Results showed a downtrend of varying degrees in the annual frequency of STYs and TCs in the Western North Pacific(WNP)Basin,with a significant trend change observed for TCs from 1949 to 2021.A large difference in the interannual change in frequency was found between STYs and TCs in the WNP and Eastern China Sea(ECS).Along the coast of EC,the frequency of landfall TCs showed a weak downtrend,and the typical STYs showed reverse micro growth with peak activity in August.Zhejiang,Fujian,and Taiwan were highly vulnerable to the frontal hits of typical STYs.Affected by climate change,the average lifetime maximum intensity(LMI)locations and landfall locations of typical STYs in the ECS basin showed a significant poleward migration trend.In addition,the annual average LMI and accumulated cyclone energy showed an uptrend,indicating the increasing severity of the disaster risk.Affected by the typical STY activity in the ECS,the maximum storm surge area also showed poleward migration,and the coast of North China faced potential growth in high storm surge risks.展开更多
The gonadotropin-releasing hormone (GnRH) antagonist protocol has emerged as an efficacious alternative to the GnRH agonist protocol for controlled ovarian hyperstimulation (COH) during in vitro fertilization (IVF) cy...The gonadotropin-releasing hormone (GnRH) antagonist protocol has emerged as an efficacious alternative to the GnRH agonist protocol for controlled ovarian hyperstimulation (COH) during in vitro fertilization (IVF) cycles, and has been demonstrated applicability in infertile female patients with diverse ovarian responses. While the clinical implementation of the antagonist COH protocol has achieved widespread consensus, opportunities for refinement persist. Therefore, this review article focuses on the advantages and disadvantages of GnRH antagonist protocol, the selection of optimal standard doses, and the strategies for adjusting antagonist doses after the premature luteinizing hormone (LH) surge, aiming to provide more reasonable and scientific recommendations for the application of this scheme.展开更多
Storm surge is often the marine disaster that poses the greatest threat to life and property in coastal areas.Accurate and timely issuance of storm surge warnings to take appropriate countermeasures is an important me...Storm surge is often the marine disaster that poses the greatest threat to life and property in coastal areas.Accurate and timely issuance of storm surge warnings to take appropriate countermeasures is an important means to reduce storm surge-related losses.Storm surge numerical models are important for storm surge forecasting.To further improve the performance of the storm surge forecast models,we developed a numerical storm surge forecast model based on an unstructured spherical centroidal Voronoi tessellation(SCVT)grid.The model is based on shallow water equations in vector-invariant form,and is discretized by Arakawa C grid.The SCVT grid can not only better describe the coastline information but also avoid rigid transitions,and it has a better global consistency by generating high-resolution grids in the key areas through transition refinement.In addition,the simulation speed of the model is accelerated by using the openACC-based GPU acceleration technology to meet the timeliness requirements of operational ensemble forecast.It only takes 37 s to simulate a day in the coastal waters of China.The newly developed storm surge model was applied to simulate typhoon-induced storm surges in the coastal waters of China.The hindcast experiments on the selected representative typhoon-induced storm surge processes indicate that the model can reasonably simulate the distribution characteristics of storm surges.The simulated maximum storm surges and their occurrence times are consistent with the observed data at the representative tide gauge stations,and the mean absolute errors are 3.5 cm and 0.6 h respectively,showing high accuracy and application prospects.展开更多
The concept of a virtual human is rapidly fermenting with the boom of the metaverse in 2020.In March 2021,Roblox,a game company focusing on the socialization of teenagers’games and the free realization of UGC,went pu...The concept of a virtual human is rapidly fermenting with the boom of the metaverse in 2020.In March 2021,Roblox,a game company focusing on the socialization of teenagers’games and the free realization of UGC,went public.In its prospectus,Roblox is defined as the concept of the metaverse.Under this background,as the direct embodiment of“virtual identity”and“virtual reality coexisting”under the concept of the metaverse,the emerging definition of virtual human and its representative virtual image has gradually caught the attention of the public.展开更多
The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transp...The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).展开更多
Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: ...Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.展开更多
The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bo...The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.展开更多
Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and ...Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of acute surgical abdomens operated in the surgical emergency department of the Centre Hospitalier Universitaire Souro Sanou (CHUSS). This was a retrospective descriptive study of 426 cases of surgical acute abdomens operated in the CHUSS surgical emergency department from 1 January to 31 December 2015. These 426 cases accounted for 24.14% of the emergency interventions carried out in the CHUSS surgical emergency department. These were 314 (73.7%) men and 112 (26.3%) women with an average age of 30 years. Among the causes, there were 187 (43.9%) cases of acute generalized peritonitis, 71 (16.7%) cases of acute intestinal occlusions, 49 (11.5%) cases of acute appendicitis, 38 (9.4%) cases of strangulated parietal hernias, 16 (3.8%) cases of abdominal contusions, and 15 (3.5%) cases of penetrating wounds of the abdomen. The appendectomy was the most performed gesture with 112 (26.3%) cases. The time to surgery was greater than 48 hours in 29 (6.8%) cases. Complications were observed in 68 (16%) cases with 35 (8.2%) cases of parietal infections, 18 (4.2%) cases of postoperative peritonitis. The death occurred in 37 (8.7%) patients. The average hospital stay was 8.7 days. Improving the prognosis of acute surgical abdomens requires early diagnosis and treatment, as well as better postoperative follow-up.展开更多
A method to improve the surge current capability of silicon carbide(SiC)merged PiN Schottky(MPS)diodes is presented and investigated via three-dimensional electro-thermal simulations.When compared with a conventional ...A method to improve the surge current capability of silicon carbide(SiC)merged PiN Schottky(MPS)diodes is presented and investigated via three-dimensional electro-thermal simulations.When compared with a conventional MPS diode,the proposed structure has a more uniform current distribution during bipolar conduction due to the help of the continuous P+surface,which can avoid the formation of local hotspots during the surge process.The Silvaco simulation results show that the proposed structure has a 20.29%higher surge capability and a 15.06%higher surge energy compared with a conventional MPS diode.The bipolar on-state voltage of the proposed structure is 4.69 V,which is 56.29%lower than that of a conventional MPS diode,enabling the device to enter the bipolar mode earlier during the surge process.Furthermore,the proposed structure can suppress the occurrence of‘snapback'phenomena when switching from the unipolar to the bipolar operation mode.In addition,an analysis of the surge process of MPS diodes is carried out in detail.展开更多
Coastal flooding caused by tropical cyclones has long been a major threat to life,property,and infrastructure in coastal zones.This study assessed the risk of flooding in Chittagong,southeastern Bangladesh,under extre...Coastal flooding caused by tropical cyclones has long been a major threat to life,property,and infrastructure in coastal zones.This study assessed the risk of flooding in Chittagong,southeastern Bangladesh,under extreme sea level scenarios caused by high astronomical tides and storm surges.The Jelesnianski typhoon model and the ADvanced CIRCulation hydrodynamic model were used to simulate 91 typhoons that occurred in the Bay of Bengal between 1981 and 2017,and observational data were used for model validation.The inundation model was based on a digital elevation model and a seed spread algorithm,and a geographical information system was used to visualize the flood risk.Under four scenarios,the changes in flood levels caused by sea level rise had no signifi-cant influence on the extent of flooding in Chittagong.At flood levels of 8.82m(50-year storm surge without sea level rise)and 8.89 m(50-year storm surge with sea level rise),the maximum estimated area of inundation was 11.35 km^(2).The western coastal and southeastern river coastal plain areas of Chittagong have the highest risk of inundation due to their low-lying terrain.At flood levels of 9.83m(100-year storm surge without sea level rise)and 9.97m(100-year storm surge with sea level rise),the maximum simulated flood extent was 36.44km^(2).Simulated floodwaters propagated in a south–north direction,and most of the northern areas of the city are at risk of inundation under these scenarios.展开更多
BACKGROUND Abnormal colonic pressure profiles have been associated with an increased risk of colonic diverticulosis.A surgical history is a known risk factor for abdominal adhesions and these may lead to increased int...BACKGROUND Abnormal colonic pressure profiles have been associated with an increased risk of colonic diverticulosis.A surgical history is a known risk factor for abdominal adhesions and these may lead to increased intraluminal colonic pressure.AIM To assess whether previous abdominal surgery is associated with colonic divertic-ulosis or diverticulitis.METHODS We analyzed data from a study of patients undergoing colonoscopy for different indications from 2020 through 2021.Patients completed a structured question-naire concerning previous abdominal surgeries,dietary and lifestyle exposures including smoking,alcohol use and co-morbidities.RESULTS Three hundred and fifty-nine patients were included in the study.The mean age was 67.6 and 46%were females.Diabetes mellitus,hypertension,ischemic heart disease,chronic obstructive pulmonary disease,chronic renal failure,and body mass index were similar in the diverticulosis and control groups.The overall prevalence of colonic diverticulosis was 25%(91/359)and 48%of the patients had previous abdominal surgery.As expected,the prevalence of diverticulosis increased with age.There was no difference in the rate of previous abdominal surgery between patients with or without diverticulosis(49%vs 47%,P=0.78).In regards to specific surgeries,inguinal hernia repair was significantly associated with diverticulosis(52%vs 20%,P=0.001),but not diverticulitis.In contrast,appendectomy was not associated with diverticulosis(6%vs 14%,P=0.048).CONCLUSION These findings suggest that post-operative abdominal adhesions inducing high colonic intraluminal pressures do not appear to be the mechanism for diverticula formation.Rather,inguinal hernia and diverticulosis may share similar connective tissue pathologies with no causative relationship between them.展开更多
Compared with the traditional wind turbine of a single rotor,dual-rotor wind turbines(DRWTs)have higher wind energy capture efficiency and a more complex structure.Therefore,the aerodynamic performance of the DRWT ins...Compared with the traditional wind turbine of a single rotor,dual-rotor wind turbines(DRWTs)have higher wind energy capture efficiency and a more complex structure.Therefore,the aerodynamic performance of the DRWT installed on the floating platform will be greatly affected by the motion caused by wind and wave loads.In this paper,5 MW and 750 kW single rotor wind turbines(SRWTs)are combined into a 5 MW-5 MW DRWT and a 5 MW-750 kW DRWT,and their power output and wake field characteristics in different motions are studied.The flow field is obtained by solving the Reynolds-averaged Navier–Stokes equation(RANS).The overset grid technique is employed to achieve the large-amplitude multiple-degree-of-freedom motion of the DRWT.The overall performance of the 5 MW single rotor wind turbine is determined by a numerical method.For the DRWTs,numerical results show that the surge motion and heave motion both have a negative effect on the power output of the DRWT.The surge motion is a critical factor that causes the power output of the DRWT to periodically change with motion.The average power output of the DRWT influenced by motion is lower than that of a DRWT with a fixed bottom.The surge motion significantly disturbs the wake of the DRWT due to the mutual interference between the upstream and downstream rotors.Under the influence of heave motion,low-velocity regions downstream of the blade tip are enhanced.This study indicates that attenuating the surge and heave motion of offshore DRWT is very significant for improving its efficiency and should be taken into consideration during the design procedure.展开更多
Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of ac...Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1<sup>st</sup> Jan 2017 to 31<sup>st</sup> Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.展开更多
Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the centra...Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.展开更多
BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the mos...BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.展开更多
BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety ...BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.展开更多
The South China Sea suffers strongly from the typhoon storm surge disasters in China,and its northern coastal areas are facing severe risks.Therefore,it is necessary and urgent to establish an assessment system for ra...The South China Sea suffers strongly from the typhoon storm surge disasters in China,and its northern coastal areas are facing severe risks.Therefore,it is necessary and urgent to establish an assessment system for rating typhoon storm surge disaster.We constructed an effective and reliable rating assessment system for typhoon storm surge disaster based on the theories of over-threshold,distribution function family,and composite extreme value.The over-threshold sample was used as the basis of data analysis,the composite extreme value expansion model was used to derive the design water increment,and then the disaster level was delineated based on the return period level.The results of the extreme value model comparison show that the Weibull-Pareto distribution is more suitable than the classical extreme value distribution for fitting the over-threshold samples.The results of the return period projection are relatively stable based on different analysis samples.Taking the 10 typhoon storm surges as examples,they caused landfall in the Guangdong area in the past 10 years.The results of the assessment ranking indicate that the risk levels based on the return period levels obtained from different distributions are generally consistent.When classifying low-risk areas,the classification criteria of the State Oceanic Administration,China(SOA,2012)are more conservative.In the high-risk areas,the results of the assessment ranking based on return period are more consistent with those of the SOA.展开更多
BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,a...BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.展开更多
Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal ...Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.展开更多
Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures ...Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.展开更多
基金supported by four funds,including the National Key Research and Development Program of China(No.2022YFC3106102)the Marine Science and Technology Innovation Project of Jiangsu Province(Nos.JSZRH YKJ202105,JSZRHYKI202303)+1 种基金the Nantong Social and Livelihood Science and Technology Project(Nos.MS12022009,MS22022082,MS22022083)the Project on Excellent Post-Graduate Dissertation of Hohai University(No.422003470).
文摘Climate change affects the activity of global and regional tropical cyclones(TCs).Among all TCs,typical super typhoons(STYs)are particularly devastating because they maintain their intensity when landing on the coast and thus cause casualties,economic losses,and environmental damage.Using a 3D tidal model,we reconstructed the typhoon(TY)wind field to simulate the storm surge induced by typical STYs.The TY activity was then analyzed using historical data.Results showed a downtrend of varying degrees in the annual frequency of STYs and TCs in the Western North Pacific(WNP)Basin,with a significant trend change observed for TCs from 1949 to 2021.A large difference in the interannual change in frequency was found between STYs and TCs in the WNP and Eastern China Sea(ECS).Along the coast of EC,the frequency of landfall TCs showed a weak downtrend,and the typical STYs showed reverse micro growth with peak activity in August.Zhejiang,Fujian,and Taiwan were highly vulnerable to the frontal hits of typical STYs.Affected by climate change,the average lifetime maximum intensity(LMI)locations and landfall locations of typical STYs in the ECS basin showed a significant poleward migration trend.In addition,the annual average LMI and accumulated cyclone energy showed an uptrend,indicating the increasing severity of the disaster risk.Affected by the typical STY activity in the ECS,the maximum storm surge area also showed poleward migration,and the coast of North China faced potential growth in high storm surge risks.
基金Hainan Province Major Science and Technology Plan Projects(No.ZDKJ2021037,ZDKJ2017007)National Natural Science Foundation of China(No.81960283),and Co-funded by the Hainan Provincial Academician Innovation Platform Research Project and the Hainan Provincial Clinical Medicine Center Construction Project。
文摘The gonadotropin-releasing hormone (GnRH) antagonist protocol has emerged as an efficacious alternative to the GnRH agonist protocol for controlled ovarian hyperstimulation (COH) during in vitro fertilization (IVF) cycles, and has been demonstrated applicability in infertile female patients with diverse ovarian responses. While the clinical implementation of the antagonist COH protocol has achieved widespread consensus, opportunities for refinement persist. Therefore, this review article focuses on the advantages and disadvantages of GnRH antagonist protocol, the selection of optimal standard doses, and the strategies for adjusting antagonist doses after the premature luteinizing hormone (LH) surge, aiming to provide more reasonable and scientific recommendations for the application of this scheme.
基金The National Natural Science Foundation of China under contract No.42076214.
文摘Storm surge is often the marine disaster that poses the greatest threat to life and property in coastal areas.Accurate and timely issuance of storm surge warnings to take appropriate countermeasures is an important means to reduce storm surge-related losses.Storm surge numerical models are important for storm surge forecasting.To further improve the performance of the storm surge forecast models,we developed a numerical storm surge forecast model based on an unstructured spherical centroidal Voronoi tessellation(SCVT)grid.The model is based on shallow water equations in vector-invariant form,and is discretized by Arakawa C grid.The SCVT grid can not only better describe the coastline information but also avoid rigid transitions,and it has a better global consistency by generating high-resolution grids in the key areas through transition refinement.In addition,the simulation speed of the model is accelerated by using the openACC-based GPU acceleration technology to meet the timeliness requirements of operational ensemble forecast.It only takes 37 s to simulate a day in the coastal waters of China.The newly developed storm surge model was applied to simulate typhoon-induced storm surges in the coastal waters of China.The hindcast experiments on the selected representative typhoon-induced storm surge processes indicate that the model can reasonably simulate the distribution characteristics of storm surges.The simulated maximum storm surges and their occurrence times are consistent with the observed data at the representative tide gauge stations,and the mean absolute errors are 3.5 cm and 0.6 h respectively,showing high accuracy and application prospects.
文摘The concept of a virtual human is rapidly fermenting with the boom of the metaverse in 2020.In March 2021,Roblox,a game company focusing on the socialization of teenagers’games and the free realization of UGC,went public.In its prospectus,Roblox is defined as the concept of the metaverse.Under this background,as the direct embodiment of“virtual identity”and“virtual reality coexisting”under the concept of the metaverse,the emerging definition of virtual human and its representative virtual image has gradually caught the attention of the public.
文摘The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).
文摘Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.
文摘The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.
文摘Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of acute surgical abdomens operated in the surgical emergency department of the Centre Hospitalier Universitaire Souro Sanou (CHUSS). This was a retrospective descriptive study of 426 cases of surgical acute abdomens operated in the CHUSS surgical emergency department from 1 January to 31 December 2015. These 426 cases accounted for 24.14% of the emergency interventions carried out in the CHUSS surgical emergency department. These were 314 (73.7%) men and 112 (26.3%) women with an average age of 30 years. Among the causes, there were 187 (43.9%) cases of acute generalized peritonitis, 71 (16.7%) cases of acute intestinal occlusions, 49 (11.5%) cases of acute appendicitis, 38 (9.4%) cases of strangulated parietal hernias, 16 (3.8%) cases of abdominal contusions, and 15 (3.5%) cases of penetrating wounds of the abdomen. The appendectomy was the most performed gesture with 112 (26.3%) cases. The time to surgery was greater than 48 hours in 29 (6.8%) cases. Complications were observed in 68 (16%) cases with 35 (8.2%) cases of parietal infections, 18 (4.2%) cases of postoperative peritonitis. The death occurred in 37 (8.7%) patients. The average hospital stay was 8.7 days. Improving the prognosis of acute surgical abdomens requires early diagnosis and treatment, as well as better postoperative follow-up.
基金the National Research and Development Program for Major Research Instruments of China(Grant No.62027814)the National Natural Science Foundation of China(Grant No.61904045)Zhejiang Provincial Natural Science Foundation of China(Grant No.LQ20F040004)。
文摘A method to improve the surge current capability of silicon carbide(SiC)merged PiN Schottky(MPS)diodes is presented and investigated via three-dimensional electro-thermal simulations.When compared with a conventional MPS diode,the proposed structure has a more uniform current distribution during bipolar conduction due to the help of the continuous P+surface,which can avoid the formation of local hotspots during the surge process.The Silvaco simulation results show that the proposed structure has a 20.29%higher surge capability and a 15.06%higher surge energy compared with a conventional MPS diode.The bipolar on-state voltage of the proposed structure is 4.69 V,which is 56.29%lower than that of a conventional MPS diode,enabling the device to enter the bipolar mode earlier during the surge process.Furthermore,the proposed structure can suppress the occurrence of‘snapback'phenomena when switching from the unipolar to the bipolar operation mode.In addition,an analysis of the surge process of MPS diodes is carried out in detail.
基金funded by the National Key Research and Development Program of China(No.2016YFC1401103)Funds for the Central Universities(No.202165003)the Open Fund of Shandong Province Key Laboratory of Ocean Engineering,Ocean University of China(No.kloe201903).
文摘Coastal flooding caused by tropical cyclones has long been a major threat to life,property,and infrastructure in coastal zones.This study assessed the risk of flooding in Chittagong,southeastern Bangladesh,under extreme sea level scenarios caused by high astronomical tides and storm surges.The Jelesnianski typhoon model and the ADvanced CIRCulation hydrodynamic model were used to simulate 91 typhoons that occurred in the Bay of Bengal between 1981 and 2017,and observational data were used for model validation.The inundation model was based on a digital elevation model and a seed spread algorithm,and a geographical information system was used to visualize the flood risk.Under four scenarios,the changes in flood levels caused by sea level rise had no signifi-cant influence on the extent of flooding in Chittagong.At flood levels of 8.82m(50-year storm surge without sea level rise)and 8.89 m(50-year storm surge with sea level rise),the maximum estimated area of inundation was 11.35 km^(2).The western coastal and southeastern river coastal plain areas of Chittagong have the highest risk of inundation due to their low-lying terrain.At flood levels of 9.83m(100-year storm surge without sea level rise)and 9.97m(100-year storm surge with sea level rise),the maximum simulated flood extent was 36.44km^(2).Simulated floodwaters propagated in a south–north direction,and most of the northern areas of the city are at risk of inundation under these scenarios.
基金The study was reviewed and approved by the Helsinki Committee of Shamir Medical Center(0107-20-ASF).
文摘BACKGROUND Abnormal colonic pressure profiles have been associated with an increased risk of colonic diverticulosis.A surgical history is a known risk factor for abdominal adhesions and these may lead to increased intraluminal colonic pressure.AIM To assess whether previous abdominal surgery is associated with colonic divertic-ulosis or diverticulitis.METHODS We analyzed data from a study of patients undergoing colonoscopy for different indications from 2020 through 2021.Patients completed a structured question-naire concerning previous abdominal surgeries,dietary and lifestyle exposures including smoking,alcohol use and co-morbidities.RESULTS Three hundred and fifty-nine patients were included in the study.The mean age was 67.6 and 46%were females.Diabetes mellitus,hypertension,ischemic heart disease,chronic obstructive pulmonary disease,chronic renal failure,and body mass index were similar in the diverticulosis and control groups.The overall prevalence of colonic diverticulosis was 25%(91/359)and 48%of the patients had previous abdominal surgery.As expected,the prevalence of diverticulosis increased with age.There was no difference in the rate of previous abdominal surgery between patients with or without diverticulosis(49%vs 47%,P=0.78).In regards to specific surgeries,inguinal hernia repair was significantly associated with diverticulosis(52%vs 20%,P=0.001),but not diverticulitis.In contrast,appendectomy was not associated with diverticulosis(6%vs 14%,P=0.048).CONCLUSION These findings suggest that post-operative abdominal adhesions inducing high colonic intraluminal pressures do not appear to be the mechanism for diverticula formation.Rather,inguinal hernia and diverticulosis may share similar connective tissue pathologies with no causative relationship between them.
基金financially supported by the Guangdong Basic and Applied Basic Research Foundation,China (Grant Nos.2021A1515011771 and 2022B1515250005)the National Natural Science Foundation of China (Grant Nos.52171289,52201350,and 52201394)+1 种基金the National Key Research and Development Program of China (Grant No.2022YFC28063)the Innovation Group Project of Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai) (Grant No.SML 2022016)。
文摘Compared with the traditional wind turbine of a single rotor,dual-rotor wind turbines(DRWTs)have higher wind energy capture efficiency and a more complex structure.Therefore,the aerodynamic performance of the DRWT installed on the floating platform will be greatly affected by the motion caused by wind and wave loads.In this paper,5 MW and 750 kW single rotor wind turbines(SRWTs)are combined into a 5 MW-5 MW DRWT and a 5 MW-750 kW DRWT,and their power output and wake field characteristics in different motions are studied.The flow field is obtained by solving the Reynolds-averaged Navier–Stokes equation(RANS).The overset grid technique is employed to achieve the large-amplitude multiple-degree-of-freedom motion of the DRWT.The overall performance of the 5 MW single rotor wind turbine is determined by a numerical method.For the DRWTs,numerical results show that the surge motion and heave motion both have a negative effect on the power output of the DRWT.The surge motion is a critical factor that causes the power output of the DRWT to periodically change with motion.The average power output of the DRWT influenced by motion is lower than that of a DRWT with a fixed bottom.The surge motion significantly disturbs the wake of the DRWT due to the mutual interference between the upstream and downstream rotors.Under the influence of heave motion,low-velocity regions downstream of the blade tip are enhanced.This study indicates that attenuating the surge and heave motion of offshore DRWT is very significant for improving its efficiency and should be taken into consideration during the design procedure.
文摘Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1<sup>st</sup> Jan 2017 to 31<sup>st</sup> Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.
文摘Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.
文摘BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.
文摘BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.
基金Supported by the National Natural Science Foundation of China(Nos.52071306,52101360)the Natural Science Foundation of Shandong Province(No.ZR2019MEE050)the State Key Laboratory of Coastal and Offshore Engineering(No.LP2104)。
文摘The South China Sea suffers strongly from the typhoon storm surge disasters in China,and its northern coastal areas are facing severe risks.Therefore,it is necessary and urgent to establish an assessment system for rating typhoon storm surge disaster.We constructed an effective and reliable rating assessment system for typhoon storm surge disaster based on the theories of over-threshold,distribution function family,and composite extreme value.The over-threshold sample was used as the basis of data analysis,the composite extreme value expansion model was used to derive the design water increment,and then the disaster level was delineated based on the return period level.The results of the extreme value model comparison show that the Weibull-Pareto distribution is more suitable than the classical extreme value distribution for fitting the over-threshold samples.The results of the return period projection are relatively stable based on different analysis samples.Taking the 10 typhoon storm surges as examples,they caused landfall in the Guangdong area in the past 10 years.The results of the assessment ranking indicate that the risk levels based on the return period levels obtained from different distributions are generally consistent.When classifying low-risk areas,the classification criteria of the State Oceanic Administration,China(SOA,2012)are more conservative.In the high-risk areas,the results of the assessment ranking based on return period are more consistent with those of the SOA.
基金The Nanjing Health Science and Technology Development Fund Project,No.YKK18241.
文摘BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.
文摘Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.
文摘Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.