Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer

BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.

Application of Sigma Metric Analysis to Evaluate the Performance of the Biochemistry Analytical System in a Medical Biology Laboratory in Côte d’Ivoire

Introduction: The Six Sigma methodology is an opportunity for a better understanding of the performance of analytical methods and for a better adaptation of the quality control management policy of the medical biology laboratory. Using the sigma metric, this study assessed the performance of the Biochemistry analytical system of a medical biology laboratory in Côte d'Ivoire. Methods: Six Sigma methodology was applied to 3 analytes (alanine aminotransferase, glucose and creatinine). Performance indicators such as measurement imprecision and bias were determined based on the results of internal and external quality controls. The sigma number was calculated using the total allowable error values proposed by Ricos et al. Results: For both control levels, ALT had a sigma number greater than 6 (7.6 for normal control and 7.9 for pathological control). However, low sigma numbers, less than or equal to 2 for creatinine (1.4 for normal control and 2 for pathological control) and less than 1 for glucose were found. Conclusion: This study revealed good analytical performance of ALT from the point of view of 6 sigma analysis. However, modifications to the overall quality control procedure for glucose and creatinine are needed to improve their analytical performance. The study should be extended to the entire laboratory’s analytes in order to modify the strategies of quality control procedures based on metric analysis for an overall improvement in analytical performance.

Study on the Total Amount Control of Atmospheric Pollutant Based on GIS

To provide effective environmental management for total amount control of atmospheric pollutants. Methods An atmospheric diffusion model of sulfur dioxide on the surface of the earth was established and tested in Shantou of Guangdong Province on the basis of an overall assessment of regional natural environment, social economic state of development, pollution sources and atmospheric environmental quality. Compared with actual monitoring results in a studied region, simulation values fell within the range of two times of error and were evenly distributed in the two sides of the monitored values. Predicted with the largest emission model method, the largest emission of sulfur dioxide would be 54 279.792 tons per year in 2010. Conclusion The mathematical model established and revised on the basis of GIS is more rational and suitable for the regional characteristics of total amount control of air pollutants.

Study on the Environmental Quality Guarantee Ratio on the Basis of Total Air Pollutant Emission Amount Control

The hourly and daily air quality concentration in the total air pollutant emission amount control zone is not sure to be continuously up to national ambient air quality standard, even though the total annual air pollutant emission is permitted under the total air pollutant emission amount control (TAPEAC) on the basis of A-value method. So the concept of the environmental quality guarantee ratio (EQGR) for TAPEAC is advanced in this paper and its quantitative formula is figured out for both hourly and daily EQGR. It is concluded that the EQGR is related with the yearly arrangement of A-value besides the pollutant type. According to the meteorological data in a lower area along Yangtze River in 2000, the yearly A-value trend is analyzed. Based on the data, the hourly EQGR of SO 2 and NO 2 is respectively 97.4% and 90.2%, and daily EQGR respectively 90.2% and 79.5%.

Total Amount Control Test of Nitrogen Fertilizer and Phosphate Fertilizer on Winter Wheat

[Objective] This study was conducted to optimize the suitable application amounts of nitrogen fertilizer and phosphate fertilizer for winter wheat.[Method] A field experiment was carried out to investigate the effects of the application amounts of nitrogen fertilizer and phosphate fertilizer on the yield of winter wheat.[Result]The quadratic simulation function between the application of nitrogen fertilizer and wheat yield was y =-0.6611x^2＋20.091 x ＋234.85,with a correlation coefficient of0.970 8,and the yield of winter wheat was the highest at the application amount of nitrogen fertilizer of 228.0 kg/hm^2.The quadratic simulation function between the application of phosphate fertilizer and wheat yield was y =-0.572 6x^2＋13.168 x ＋340.4,with a correlation coefficient of 0.921 95,and the yield of winter wheat was the highest at the application amount of phosphate fertilizer of 172.5 kg/hm^2.[Conclusion] This study provides a scientific basis for the rational application of nitrogen fertilizer and phosphate fertilizer on winter wheat.

Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks

Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postoperative pain,and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery.The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal.Many different approaches and techniques for peripheral nerve blockades,either landmark or,more recently,ultrasound guided have been described over the last decades.This includes but is not restricted to techniques discussed in this review.The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block.Moreover,ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block.In contrast to patient controlled analgesia using opioids,patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction;this is important as hospital rank-ings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure.This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications,considerations and outcomes.

Overall Evaluation of the Control Schemes of Automobile Pollution and Its Multi-Target Decision

Various control schemes of automobile pollution are comprehensively evaluated by using the weighting and feyzzy methods, from which several feasible schemes are selected, and then mulit-target decision is made by using the minimum distance and hierarcby analysis methods, for determining the optimal control methods of automobile pollution.

Harmoniousness analysis of total amount control of water use

Based on the fundamental principles of total amount control of water use, the harmony theory was used in this study to develop a concept of the degree of harmony of total amount control of water use. Based on this concept, the harmoniousness of total amount control of water use was analyzed in terms of the supply and demand of water resources, water resources management, water use benefits, and water-saving level. An evaluation index system of the degree of harmony of total amount control of water use was established, and a method for calculation of the degree of harmony of total amount control of water use was developed based on the analytic hierarchy process （AHP） and fuzzy comprehensive analysis （FCA） methods. The new evaluation index system was applied to a certain area in Jiangsu Province, China. The degree of harmony of total amount control of water use over this area was calculated for different years. Results indicate that the evaluation index system and calculation method proposed in this study are feasible, and such a harmoniousness analysis can provide scientific references for the strict water resources management system that will be implemented in China in the near future.

The Effect of State-Dependent Control for an SIRS Epidemic Model with Varying Total Population

Based on the mechanism of prevention and control of infectious disease, we propose, in this paper, an SIRS epidemic model with varying total population size and state-dependent control, where the fraction of susceptible individuals in population is as the detection threshold value. By the Poincaré map, theory of differential inequalities and differential equation geometry, the existence and orbital stability of the disease-free periodic solution are discussed. Theoretical results show that by state-dependent pulse vaccination we can make the proportion of infected individuals tend to zero, and control the transmission of disease in population.

Unified Control Theory from PID to ACPID

To address the challenge of achieving unified control across diverse nonlinear systems, a comprehensive control theory spanning from PID (Proportional-Integral-Derivative) to ACPID (Auto-Coupling PID) has been proposed. The primary concept is to unify all intricate factors, including internal dynamics and external bounded disturbance, into a single total disturbance. This enables the mapping of various nonlinear systems onto a linear disturbance system. Based on the theory of PID control and the characteristic equation of a critically damping system, Zeng’s stabilization rules (ZSR) and an ACPID control force based on a single speed factor have been designed. ACPID control theory is both simple and practical, with significant scientific significance and application value in the field of control engineering.

Novel prognostic score based on the preoperative total bilirubinalbumin ratio and fibrinogen-albumin ratio in ampullary adenocarcinoma

BACKGROUND The preoperative total bilirubin-albumin ratio(TBAR)and fibrinogen-albumin ratio(FAR)have been proven to be valuable prognostic factors in various cancers.AIM To detect the prognostic value of TBAR and FAR in ampullary adenocarcinoma(AC)patients who underwent curative pancreaticoduodenectomy.METHODS AC patients who underwent curative pancreaticoduodenectomy in the National Cancer Center of China between 1998 and 2020 were retrospectively reviewed.The prognostic cutoff values of TBAR and FAR were determined through the best survival separation model.Then,a novel prognostic score combining TBAR and FAR was calculated and validated through the logistic regression analysis and Cox regression analysis.RESULTS A total of 188 AC patients were enrolled in the current study.The best cutoff values of TBAR and FAR for predicting overall survival were 1.7943 and 0.1329,respectively.AC patients were divided into a TBAR-low group(score=0)vs a TBAR-high group(score=1)and a FAR-low group(score=0)vs a FAR-high group(score=1).The total score was calculated as a novel prognostic factor.Multivariable logistic regression analysis revealed that a high score was an independent protective factor for recurrence[score=1 vs score=0:Odds ratio(OR)=0.517,P=0.046;score=2 vs score=0 OR=0.236,P=0.038].In addition,multivariable survival analysis also demonstrated that a high score was an independent protective factor in AC patients(score=2 vs score=0:Hazard ratio=0.230,P=0.046).CONCLUSION A novel prognostic score based on preoperative TBAR and FAR has been demonstrated to have good predictive power in AC patients who underwent curative pancreaticoduodenectomy.However,more studies with larger samples are needed to validate this conclusion.

System Evaluation and Meta Analysis of Total Clinical Effective Rate of Acupuncture and Moxibustion in Treating Depression during 2019-2022

[Objectives]To systematically evaluate the total clinical effective rate of acupuncture treatment of depression,and provide clinical reference for the scheme design and selection of acupuncture treatment of depression.[Methods]By searching CNKI,Wanfang Data,CBM,VIP,Cochrane Library,Cochrane Central,Springer and other databases,randomized controlled experiment(RCT)on acupuncture and moxibustion treatment of depression from January 1,2019 to August 31,2022 was collected,to extract relevant data of total clinical effective rate and conduct methodological quality evaluation.ReviewManager 5.4.1 software was used for Meta analysis.[Results]22 RCTs were included,1602 patients in total.Among them,there were 804 cases in treatment group and 798 cases in control group.Meta analysis results displayed that acupuncture and moxibustion treatment of depression may be better than the control group in improving the total clinical effective rate,and the difference was statistically significant[MD=1.16,95%CI(1.11,1.21)].[Conclusions]Acupuncture and moxibustion can achieve a higher total clinical effective rate in the treatment of depression,which is worthy of clinical application.However,due to fewer studies included in this systematic evaluation,small sample size,and low quality,there was a high possibility of bias.Therefore,the above conclusions needed to be verified by high-quality,large-sample,and multi-center RCTs.

Use of Total Precipitable Water Classification of A Priori Error and Quality Control in Atmospheric Temperature and Water Vapor Sounding Retrieval

This study investigates the use of dynamic a priori error information according to atmospheric moistness and the use of quality controls in temperature and water vapor profile retrievals from hyperspectral infrared （IR） sounders. Temperature and water vapor profiles are retrieved from Atmospheric InfraRed Sounder （AIRS） radiance measurements by applying a physical iterative method using regression retrieval as the first guess. Based on the dependency of first-guess errors on the degree of atmospheric moistness, the a priori first-guess errors classified by total precipitable water （TPW） are applied in the AIRS physical retrieval procedure. Compared to the retrieval results from a fixed a priori error, boundary layer moisture retrievals appear to be improved via TPW classification of a priori first-guess errors. Six quality control （QC） tests, which check non-converged or bad retrievals, large residuals, high terrain and desert areas, and large temperature and moisture deviations from the first guess regression retrieval, are also applied in the AIRS physical retrievals. Significantly large errors are found for the retrievals rejected by these six QCs, and the retrieval errors are substantially reduced via QC over land, which suggest the usefulness and high impact of the QCs, especially over land. In conclusion, the use of dynamic a priori error information according to atmospheric moistness, and the use of appropriate QCs dealing with the geographical information and the deviation from the first-guess as well as the conventional inverse performance are suggested to improve temperature and moisture retrievals and their applications.

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy(TP) on complications, tumor recurrence and overall survival.METHODS Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.RESULTS High early postoperative fasting blood glucose(FBG) levels(OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels(OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative Hb A1 c levels over 7%(HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative Hb A1 c levels over 7% had much poorer overall survival than those with Hb A1 c levels less than 7%(9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus(HR = 15.019, 95%CI: 1.278-176.211, P= 0.031) and alcohol history(B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.CONCLUSION At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on longterm outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

Design and Control of Thermally Coupled Reactive Distillation Sequence for Biodiesel Production

Decreasing petroleum reserves and growing alternative fuels requirements have promoted the study of biodiesel production. In this work, two thermally coupled reactive distillation designs for biodiesel production were investigated, and the sensitivity analysis was conducted to obtain the appropriate design values. The thermodynamic analysis and economics evaluation were performed to estimate the superiority of the thermally coupled designs over the base case. The proposed biodiesel production processes were simulated using the simulator Aspen Plus, and calculation results show that the exergy loss and economic cost in the two thermally coupled designs can be greatly reduced. It is found that the thermally coupled side-stripper reactive distillation design provides more economic benefits than the side-rectifier one. The dynamic performance of the thermally coupled side-stripper design was investigated and the results showed that the proposed control structure could effectively handle large feed disturbances.

Distributions of dissolved inorganic carbon and total alkalinity in the Western Arctic Ocean

The third Chinese National Arctic Research Expedition （3rd CHINARE-Arctic in 2008） was carried out from July to September 2008. During the survey, numerous sea water samples were taken for CO2 parameter measurement （including total alkalinity TA and total dissolved inorganic carbon DIC）.The distribution of COs parameters in the Western Arctic Ocean was determined, and the controlling factors are addressed. The ranges of summertime TA, normalized TA （nTA）, DIC and normalized DIC （nDIC） in the surface seawater were 1 757 2 229 umol.kg 1 2 383-2 722 umol.kg-1, 1 681 2 034 pmol.kg 1, 2 119--2 600 umol.kg-1, respectively. Because of dilution from ice meltwater, the surface TA and DIC concentrations were relatively low. TA in the upper 100 m to the south of 78°N had good correlation with salinity, showing a conservative behavior. The distribution followed the seawater-river mixing line at salinity 〉30, then followed the seawater mixing line （diluted by river water to salinity = 30） with the ice meltwater. The DIC distribution in the Chukchi Sea was dominated by biological production or respiration of organic matter, whereas conservative mixing dominated the mixed layer TA distribution in the ice-free Canada Basin.

Three-Dimensional Water Quality Model Based on FVCOM for Total Load Control Management in Guan River Estuary,Northern Jiangsu Province

Guan River Estuary and adjacent coastal area(GREC) suffer from serious pollution and eutrophicational problems over the recent years.Thus,reducing the land-based load through the national pollutant total load control program and developing hydrodynamic and water quality models that can simulate the complex circulation and water quality kinetics within the system,including longitudinal and lateral variations in nutrient and COD concentrations,is a matter of urgency.In this study,a three-dimensional,hydrodynamic,water quality model was developed in GREC,Northern Jiangsu Province.The complex three-dimensional hydrodynamics of GREC were modeled using the unstructured-grid,finite-volume,free-surface,primitive equation coastal ocean circulation model(FVCOM).The water quality model was adapted from the mesocosm nutrients dynamic model in the south Yellow Sea and considers eight compartments:dissolved inorganic nitrogen,soluble reactive phosphorus(SRP),phytoplankton,zooplankton,detritus,dissolved organic nitrogen(DON),dissolved organic phosphorus(DOP),and chemical oxygen demand.The hydrodynamic and water quality models were calibrated and confirmed for 2012 and 2013.A comparison of the model simulations with extensive dataset shows that the models accurately simulate the longitudinal distribution of the hydrodynamics and water quality.The model can be used for total load control management to improve water quality in this area.

The Accuracy of GIS Tools for Transforming Assumed Total Station Surveys to Real World Coordinates

Most surveying works for mapping or GIS applications are performed with total station. Due to the remote nature of many of the sites surveyed, the surveys are often done in unprojected, local, assumed coordinate systems. However, without the survey data projected in real world coordinates, the range of possible analyses is limited and the value of existing imagery, elevation models, and hydrologic layers cannot be exploited. This requires a transformation from the local assumed to the real world coordinate systems. There are various built-in and add-in tools to perform transformations through GIS programs. This paper studies the effect of using Georeferencing tool, Spatial Adjustment tool (Affine and similarity) and CHaMP tool on the precision and relative accuracy of total station survey. This transformation requires real-world coordinates of at least two control points, which can be collected from different sources. This paper also studies the effect of using geodetic GPS, hand-held GPS, Google Earth (GE) and Bing Basemaps as sources for control points on the precision and relative accuracy of total station survey. These effects have been tested by using 111 points covered area of 60,000 m2and the results have shown that the CHaMP tool is the best for preserving the relative accuracy of the transformed points. The Georeferencing and spatial adjustment (similarity) tools give the same results and their accuracy are between 1/1000 and 1/300 depending on the source of control points. The results have also shown that the cornerstone to preserve the precision and relative accuracy of the transformed coordinates is the relative position of the control points despite their source.