BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique mani...BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.展开更多
Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of...Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.展开更多
The motivation for this study is that the quality of deep fakes is constantly improving,which leads to the need to develop new methods for their detection.The proposed Customized Convolutional Neural Network method in...The motivation for this study is that the quality of deep fakes is constantly improving,which leads to the need to develop new methods for their detection.The proposed Customized Convolutional Neural Network method involves extracting structured data from video frames using facial landmark detection,which is then used as input to the CNN.The customized Convolutional Neural Network method is the date augmented-based CNN model to generate‘fake data’or‘fake images’.This study was carried out using Python and its libraries.We used 242 films from the dataset gathered by the Deep Fake Detection Challenge,of which 199 were made up and the remaining 53 were real.Ten seconds were allotted for each video.There were 318 videos used in all,199 of which were fake and 119 of which were real.Our proposedmethod achieved a testing accuracy of 91.47%,loss of 0.342,and AUC score of 0.92,outperforming two alternative approaches,CNN and MLP-CNN.Furthermore,our method succeeded in greater accuracy than contemporary models such as XceptionNet,Meso-4,EfficientNet-BO,MesoInception-4,VGG-16,and DST-Net.The novelty of this investigation is the development of a new Convolutional Neural Network(CNN)learning model that can accurately detect deep fake face photos.展开更多
Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effu...Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.展开更多
Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria invol...Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.展开更多
Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LU...Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.展开更多
This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was f...This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.展开更多
Many different factors,such as species traits,socio-economic factors,geographical and environmental factors,can lead to specimen collection preference.This study aims to determine whether grassland specimen collection...Many different factors,such as species traits,socio-economic factors,geographical and environmental factors,can lead to specimen collection preference.This study aims to determine whether grassland specimen collection in China is preferred by species traits(i.e.,plant height,flowering and fruiting period),environmental range(i.e.,the temperature and precipitation range)and geographical range(i.e.,distribution range and altitudinal range).Ordinary least squares models and phylogenetic generalized linear mixed models were used to analyze the relationships between specimen number and the explanatory variables.Random Forest models were then used to find the most parsimonious multivariate model.The results showed that interannual variation in specimen number between 1900 and 2020 was considerable.Specimen number of these species in southeast China was notably lower than that in northwest China.Environmental range and geographical range of species had significant positive correlations with specimen number.In addition,there were relatively weak but significant associations between specimen number and species trait(i.e.,plant height and flowering and fruiting period).Random Forest models indicated that distribution range was the most important variable,followed by flowering and fruiting period,and altitudinal range.These findings suggest that future floristic surveys should pay more attention to species with small geographical range,narrow environmental range,short plant height,and short flowering and fruiting period.The correction of specimen collection preference will also make the results of species distribution model,species evolution and other works based on specimen data more accurate.展开更多
To quantify the seismic effectiveness of the most commonly used fishing line tie up method for securing museum collections and optimize fixed strategies for exhibitions,shaking table tests of the seismic systems used ...To quantify the seismic effectiveness of the most commonly used fishing line tie up method for securing museum collections and optimize fixed strategies for exhibitions,shaking table tests of the seismic systems used for typical museum collection replicas have been carried out.The influence of body shape and fixed measure parameters on the seismic responses of replicas and the interaction behavior between replicas and fixed measures have been explored.Based on the results,seismic effectiveness evaluation indexes of the tie up method are proposed.Reasonable suggestions for fixed strategies are given,which provide a basis for the exhibition of delicate museum collections considering the principle of minimizing seismic responses and intervention.The analysis results show that a larger ratio of height of mass center to bottom diameter led to more intense rocking responses.Increasing the initial pretension of fishing lines was conducive to reducing the seismic responses and stress variation of the lines.Through comprehensive consideration of the interaction forces and effective securement,it is recommended to apply 20%of breaking stress as the initial pretension.For specific museum collections that cannot be effectively protected by the independent tie up method,an optimized strategy of a combination of fishing lines and fasteners is recommended.展开更多
BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung diseas...BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.展开更多
This paper investigates the data collection in an unmanned aerial vehicle(UAV)-aided Internet of Things(IoT) network, where a UAV is dispatched to collect data from ground sensors in a practical and accurate probabili...This paper investigates the data collection in an unmanned aerial vehicle(UAV)-aided Internet of Things(IoT) network, where a UAV is dispatched to collect data from ground sensors in a practical and accurate probabilistic line-of-sight(LoS) channel. Especially, access points(APs) are introduced to collect data from some sensors in the unlicensed band to improve data collection efficiency. We formulate a mixed-integer non-convex optimization problem to minimize the UAV flight time by jointly designing the UAV 3D trajectory and sensors’ scheduling, while ensuring the required amount of data can be collected under the limited UAV energy. To solve this nonconvex problem, we recast the objective problem into a tractable form. Then, the problem is further divided into several sub-problems to solve iteratively, and the successive convex approximation(SCA) scheme is applied to solve each non-convex subproblem. Finally,the bisection search is adopted to speed up the searching for the minimum UAV flight time. Simulation results verify that the UAV flight time can be shortened by the proposed method effectively.展开更多
Only a small amount of spectral information is collected because the collection solid angle of the optical fiber probe and lens is very limited when collecting spectral information.To overcome this limitation,this stu...Only a small amount of spectral information is collected because the collection solid angle of the optical fiber probe and lens is very limited when collecting spectral information.To overcome this limitation,this study presents a novel method for acquiring plasma spectral information from various spatial directions.A parabolic-shaped plasma spectral collection device(PSCD)is employed to effectively collect more spectral information into the spectrometer,thereby enhancing the overall spectral intensity.The research objects in this study were soil samples containing different concentrations of heavy metals Pb,Cr,and Cd.The results indicate that the PSCD significantly enhances the spectral signal,with an enhancement rate of up to 45%.Moreover,the signal-to-noise ratio also increases by as much as 36%.Simultaneously,when compared to the absence of a device,it is found that there is no significant variation in plasma temperature when the PSCD is utilized.This observation eliminates the impact of the spatial effect caused by the PSCD on the spectral intensity.Consequently,a concentrationspectral intensity relationship curve is established under the PSCD.The results revealed that the linear fitting R^(2)for Pb,Cr,and Cd increased by 0.011,0.001,and 0.054,respectively.Additionally,the limit of detection(LOD)decreased by 0.361 ppm,0.901 ppm,and 0.602 ppm,respectively.These findings indicate that the spectral enhancement rate elevates with the increase in heavy metal concentration.Hence,the PSCD can effectively enhance the spectral intensity and reduce the detection limit of heavy metals in soil.展开更多
Wireless Sensor Network(WSN)is widely utilized in large-scale distributed unmanned detection scenarios due to its low cost and flexible installation.However,WSN data collection encounters challenges in scenarios lacki...Wireless Sensor Network(WSN)is widely utilized in large-scale distributed unmanned detection scenarios due to its low cost and flexible installation.However,WSN data collection encounters challenges in scenarios lacking communication infrastructure.Unmanned aerial vehicle(UAV)offers a novel solution for WSN data collection,leveraging their high mobility.In this paper,we present an efficient UAV-assisted data collection algorithm aimed at minimizing the overall power consumption of the WSN.Firstly,a two-layer UAV-assisted data collection model is introduced,including the ground and aerial layers.The ground layer senses the environmental data by the cluster members(CMs),and the CMs transmit the data to the cluster heads(CHs),which forward the collected data to the UAVs.The aerial network layer consists of multiple UAVs that collect,store,and forward data from the CHs to the data center for analysis.Secondly,an improved clustering algorithm based on K-Means++is proposed to optimize the number and locations of CHs.Moreover,an Actor-Critic based algorithm is introduced to optimize the UAV deployment and the association with CHs.Finally,simulation results verify the effectiveness of the proposed algorithms.展开更多
Large-scale wireless sensor networks(WSNs)play a critical role in monitoring dangerous scenarios and responding to medical emergencies.However,the inherent instability and error-prone nature of wireless links present ...Large-scale wireless sensor networks(WSNs)play a critical role in monitoring dangerous scenarios and responding to medical emergencies.However,the inherent instability and error-prone nature of wireless links present significant challenges,necessitating efficient data collection and reliable transmission services.This paper addresses the limitations of existing data transmission and recovery protocols by proposing a systematic end-to-end design tailored for medical event-driven cluster-based large-scale WSNs.The primary goal is to enhance the reliability of data collection and transmission services,ensuring a comprehensive and practical approach.Our approach focuses on refining the hop-count-based routing scheme to achieve fairness in forwarding reliability.Additionally,it emphasizes reliable data collection within clusters and establishes robust data transmission over multiple hops.These systematic improvements are designed to optimize the overall performance of the WSN in real-world scenarios.Simulation results of the proposed protocol validate its exceptional performance compared to other prominent data transmission schemes.The evaluation spans varying sensor densities,wireless channel conditions,and packet transmission rates,showcasing the protocol’s superiority in ensuring reliable and efficient data transfer.Our systematic end-to-end design successfully addresses the challenges posed by the instability of wireless links in large-scaleWSNs.By prioritizing fairness,reliability,and efficiency,the proposed protocol demonstrates its efficacy in enhancing data collection and transmission services,thereby offering a valuable contribution to the field of medical event-drivenWSNs.展开更多
BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory an...BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.展开更多
As a new type of environmental pollutants,microplastics have gradually attracted people's attention.A large number of plastics discharged into the environment by human beings are constantly aging and breaking,and ...As a new type of environmental pollutants,microplastics have gradually attracted people's attention.A large number of plastics discharged into the environment by human beings are constantly aging and breaking,and finally become microplastics.Microplastics can adsorb pollutants in the environment,and their components have certain toxicity,which can cause different degrees of harm to organisms.Due to the structural characteristics of microplastic particles,such as small particle size,large specific surface area,and their distribution in different environmental media,it is very difficult to accurately detect microplastics.Reliable collection and detection methods are the key to the study of environmental behavior of microplastics.In this study,the collection and detection methods of microplastics in the environment were reviewed,and the development direction of microplastics detection technology in the future was prospected.This study has a certain reference value for the related research and the prevention and treatment of micro-plastic pollution.展开更多
Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions...Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions includes percu-taneous,endoscopic,minimally invasive surgery,or a combined approach.Endoscopic drainage is the drainage of PFCs by creating an artificial communication between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous tract.In this editorial,we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.展开更多
BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive inte...BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.展开更多
BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinica...BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinical course of AP.It could worsen symptoms and potentially lead to additional complications.However,clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce.Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.AIM To evaluate the association between APFC and 30-day readmission in patients with AP.METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019.Patients with a primary diagnosis of AP were identified.Participants were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was performed.The primary outcome was early readmission rates.Secondary outcomes included the incidence of inpatient complications and healthcare utilization.Unadjusted analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission risks.RESULTS A total of 673059 patients with the principal diagnosis of AP were included.Of these,5.1%had APFC on initial admission.After propensity score matching,each cohort consisted of 33914 patients.Those with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APFC group also had higher readmission charges($28282 vs$22865,P<0.001).The presence of APFC increased the risk of readmission twofold(aHR 2.52,95%confidence interval:2.40-2.65,P<0.001).The independent risk factors for 30-day readmission included female gender,Elixhauser Comorbidity Index≥3,chronic pulmonary diseases,chronic renal disease,protein-calorie malnutrition,substance use disorder,depression,portal and splenic venous thrombosis,and certain endoscopic procedures.CONCLUSION Developing APFC during index hospitalization for AP is linked to higher readmission rates,more inpatient complications,longer LOS,and increased healthcare costs.Knowing predictors of readmission can help target high-risk patients,reducing healthcare burdens.展开更多
This article primarily examines the current state of tax collection and management,alongside other associated issues.It integrates insights from China’s“14th Five-Year Plan”and anticipates the imminent implementati...This article primarily examines the current state of tax collection and management,alongside other associated issues.It integrates insights from China’s“14th Five-Year Plan”and anticipates the imminent implementation of the“Golden Tax Phase Four.”With this backdrop,the article offers recommendations for advancing the reform of the tax collection and management system,fostering the development of intelligent taxation,and accelerating the modernization of tax collection and management in China.展开更多
文摘BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.
文摘Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.
基金Science and Technology Funds from the Liaoning Education Department(Serial Number:LJKZ0104).
文摘The motivation for this study is that the quality of deep fakes is constantly improving,which leads to the need to develop new methods for their detection.The proposed Customized Convolutional Neural Network method involves extracting structured data from video frames using facial landmark detection,which is then used as input to the CNN.The customized Convolutional Neural Network method is the date augmented-based CNN model to generate‘fake data’or‘fake images’.This study was carried out using Python and its libraries.We used 242 films from the dataset gathered by the Deep Fake Detection Challenge,of which 199 were made up and the remaining 53 were real.Ten seconds were allotted for each video.There were 318 videos used in all,199 of which were fake and 119 of which were real.Our proposedmethod achieved a testing accuracy of 91.47%,loss of 0.342,and AUC score of 0.92,outperforming two alternative approaches,CNN and MLP-CNN.Furthermore,our method succeeded in greater accuracy than contemporary models such as XceptionNet,Meso-4,EfficientNet-BO,MesoInception-4,VGG-16,and DST-Net.The novelty of this investigation is the development of a new Convolutional Neural Network(CNN)learning model that can accurately detect deep fake face photos.
文摘Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.
文摘Introduction: Microbiology of effusion fluids in children in Burkina Faso is characterized by the scarcity of data. This work aimed to study the bacteriological and antibiotics susceptibility profile of bacteria involved in effusion fluid infections in paediatrics in order to improve the choice of probabilistic antibiotics therapy. Methods: A cross-sectional, descriptive study was used in children aged 0 to 15 years from 2017 to 2020 at the Charles De Gaulle Pediatric University Hospital Center (CHUP-CDG) in Ouagadougou. Classical bacteriology methods such as macroscopy, Gram staining, identification galleries and antibiotics susceptibility testing were used. Results: Of 231 samples, 64 bacteria were isolated. The most common bacterial strains of pleural fluid were Staphylococcus aureus (25%) and 40% for Enterobacteriaceae. Of the peritoneal fluid, 77% were Enterobacteriaceae with 57% Escherichia coli;and from joint fluid, 33% were S. aureus and 22% for P. aeruginosa. The overall susceptibility profile showed 29% extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), 10% methicillin-resistant S. aureus (MRSA), and 8% carbapenemases. Conclusion: Bacteriological profile is characterized by ESBL-producing Enterobacteriaceae and MRSA. The most active antibiotics were macrolides, aminoglycosides, and cefoxitin (methicillin) for Gram-positive cocci, carbapenems, and aminoglycosides for Gram-negative bacilli. Then, the monitoring of antibiotics resistance must be permanent.
文摘Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.
文摘This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.
基金the Natural Science Foundation of Inner Mongolia,China(2023JQ01)the National Key R&D Program of China(2019YFA0607103)+2 种基金the Central Government Guides Local Science and Technology Development Fund Projects(2022ZY0224)the Open Project Program of Ministry of Education Key Laboratory of Ecology and Resources Use of the Mongolian Plateau,Hohhot,Inner Mongolia,China(KF2023003)Major Science and Technology Project of Inner Mongolia Autonomous Region:Monitoring,Assessment and Early Warning Technology Research of Biodiversity in Inner Mongolia(2021ZD0011)for financial support.
文摘Many different factors,such as species traits,socio-economic factors,geographical and environmental factors,can lead to specimen collection preference.This study aims to determine whether grassland specimen collection in China is preferred by species traits(i.e.,plant height,flowering and fruiting period),environmental range(i.e.,the temperature and precipitation range)and geographical range(i.e.,distribution range and altitudinal range).Ordinary least squares models and phylogenetic generalized linear mixed models were used to analyze the relationships between specimen number and the explanatory variables.Random Forest models were then used to find the most parsimonious multivariate model.The results showed that interannual variation in specimen number between 1900 and 2020 was considerable.Specimen number of these species in southeast China was notably lower than that in northwest China.Environmental range and geographical range of species had significant positive correlations with specimen number.In addition,there were relatively weak but significant associations between specimen number and species trait(i.e.,plant height and flowering and fruiting period).Random Forest models indicated that distribution range was the most important variable,followed by flowering and fruiting period,and altitudinal range.These findings suggest that future floristic surveys should pay more attention to species with small geographical range,narrow environmental range,short plant height,and short flowering and fruiting period.The correction of specimen collection preference will also make the results of species distribution model,species evolution and other works based on specimen data more accurate.
基金Beijing Nova Program under Grant No.2022036National Key Research and Development Program under Grant No.2019YFC1521000。
文摘To quantify the seismic effectiveness of the most commonly used fishing line tie up method for securing museum collections and optimize fixed strategies for exhibitions,shaking table tests of the seismic systems used for typical museum collection replicas have been carried out.The influence of body shape and fixed measure parameters on the seismic responses of replicas and the interaction behavior between replicas and fixed measures have been explored.Based on the results,seismic effectiveness evaluation indexes of the tie up method are proposed.Reasonable suggestions for fixed strategies are given,which provide a basis for the exhibition of delicate museum collections considering the principle of minimizing seismic responses and intervention.The analysis results show that a larger ratio of height of mass center to bottom diameter led to more intense rocking responses.Increasing the initial pretension of fishing lines was conducive to reducing the seismic responses and stress variation of the lines.Through comprehensive consideration of the interaction forces and effective securement,it is recommended to apply 20%of breaking stress as the initial pretension.For specific museum collections that cannot be effectively protected by the independent tie up method,an optimized strategy of a combination of fishing lines and fasteners is recommended.
文摘BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.
基金supported by the National Key Research and Development Program under Grant 2022YFB3303702the Key Program of National Natural Science Foundation of China under Grant 61931001+1 种基金supported by the National Natural Science Foundation of China under Grant No.62203368the Natural Science Foundation of Sichuan Province under Grant No.2023NSFSC1440。
文摘This paper investigates the data collection in an unmanned aerial vehicle(UAV)-aided Internet of Things(IoT) network, where a UAV is dispatched to collect data from ground sensors in a practical and accurate probabilistic line-of-sight(LoS) channel. Especially, access points(APs) are introduced to collect data from some sensors in the unlicensed band to improve data collection efficiency. We formulate a mixed-integer non-convex optimization problem to minimize the UAV flight time by jointly designing the UAV 3D trajectory and sensors’ scheduling, while ensuring the required amount of data can be collected under the limited UAV energy. To solve this nonconvex problem, we recast the objective problem into a tractable form. Then, the problem is further divided into several sub-problems to solve iteratively, and the successive convex approximation(SCA) scheme is applied to solve each non-convex subproblem. Finally,the bisection search is adopted to speed up the searching for the minimum UAV flight time. Simulation results verify that the UAV flight time can be shortened by the proposed method effectively.
基金supported by Department of Science and Technology of Jilin Province of China(Nos.YDZJ202301 ZYTS481,202202901032GX,and 20230402068GH)。
文摘Only a small amount of spectral information is collected because the collection solid angle of the optical fiber probe and lens is very limited when collecting spectral information.To overcome this limitation,this study presents a novel method for acquiring plasma spectral information from various spatial directions.A parabolic-shaped plasma spectral collection device(PSCD)is employed to effectively collect more spectral information into the spectrometer,thereby enhancing the overall spectral intensity.The research objects in this study were soil samples containing different concentrations of heavy metals Pb,Cr,and Cd.The results indicate that the PSCD significantly enhances the spectral signal,with an enhancement rate of up to 45%.Moreover,the signal-to-noise ratio also increases by as much as 36%.Simultaneously,when compared to the absence of a device,it is found that there is no significant variation in plasma temperature when the PSCD is utilized.This observation eliminates the impact of the spatial effect caused by the PSCD on the spectral intensity.Consequently,a concentrationspectral intensity relationship curve is established under the PSCD.The results revealed that the linear fitting R^(2)for Pb,Cr,and Cd increased by 0.011,0.001,and 0.054,respectively.Additionally,the limit of detection(LOD)decreased by 0.361 ppm,0.901 ppm,and 0.602 ppm,respectively.These findings indicate that the spectral enhancement rate elevates with the increase in heavy metal concentration.Hence,the PSCD can effectively enhance the spectral intensity and reduce the detection limit of heavy metals in soil.
基金supported by the National Natural Science Foundation of China(NSFC)(61831002,62001076)the General Program of Natural Science Foundation of Chongqing(No.CSTB2023NSCQ-MSX0726,No.cstc2020jcyjmsxmX0878).
文摘Wireless Sensor Network(WSN)is widely utilized in large-scale distributed unmanned detection scenarios due to its low cost and flexible installation.However,WSN data collection encounters challenges in scenarios lacking communication infrastructure.Unmanned aerial vehicle(UAV)offers a novel solution for WSN data collection,leveraging their high mobility.In this paper,we present an efficient UAV-assisted data collection algorithm aimed at minimizing the overall power consumption of the WSN.Firstly,a two-layer UAV-assisted data collection model is introduced,including the ground and aerial layers.The ground layer senses the environmental data by the cluster members(CMs),and the CMs transmit the data to the cluster heads(CHs),which forward the collected data to the UAVs.The aerial network layer consists of multiple UAVs that collect,store,and forward data from the CHs to the data center for analysis.Secondly,an improved clustering algorithm based on K-Means++is proposed to optimize the number and locations of CHs.Moreover,an Actor-Critic based algorithm is introduced to optimize the UAV deployment and the association with CHs.Finally,simulation results verify the effectiveness of the proposed algorithms.
文摘Large-scale wireless sensor networks(WSNs)play a critical role in monitoring dangerous scenarios and responding to medical emergencies.However,the inherent instability and error-prone nature of wireless links present significant challenges,necessitating efficient data collection and reliable transmission services.This paper addresses the limitations of existing data transmission and recovery protocols by proposing a systematic end-to-end design tailored for medical event-driven cluster-based large-scale WSNs.The primary goal is to enhance the reliability of data collection and transmission services,ensuring a comprehensive and practical approach.Our approach focuses on refining the hop-count-based routing scheme to achieve fairness in forwarding reliability.Additionally,it emphasizes reliable data collection within clusters and establishes robust data transmission over multiple hops.These systematic improvements are designed to optimize the overall performance of the WSN in real-world scenarios.Simulation results of the proposed protocol validate its exceptional performance compared to other prominent data transmission schemes.The evaluation spans varying sensor densities,wireless channel conditions,and packet transmission rates,showcasing the protocol’s superiority in ensuring reliable and efficient data transfer.Our systematic end-to-end design successfully addresses the challenges posed by the instability of wireless links in large-scaleWSNs.By prioritizing fairness,reliability,and efficiency,the proposed protocol demonstrates its efficacy in enhancing data collection and transmission services,thereby offering a valuable contribution to the field of medical event-drivenWSNs.
文摘BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.
基金Supported by Project of National Center of Technology Innovation for Dairy"Study on the Key Technologies of Microplastics Detection for New Pollutants in Dairy Ingredient Water"(2023-KFKT-24).
文摘As a new type of environmental pollutants,microplastics have gradually attracted people's attention.A large number of plastics discharged into the environment by human beings are constantly aging and breaking,and finally become microplastics.Microplastics can adsorb pollutants in the environment,and their components have certain toxicity,which can cause different degrees of harm to organisms.Due to the structural characteristics of microplastic particles,such as small particle size,large specific surface area,and their distribution in different environmental media,it is very difficult to accurately detect microplastics.Reliable collection and detection methods are the key to the study of environmental behavior of microplastics.In this study,the collection and detection methods of microplastics in the environment were reviewed,and the development direction of microplastics detection technology in the future was prospected.This study has a certain reference value for the related research and the prevention and treatment of micro-plastic pollution.
文摘Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions includes percu-taneous,endoscopic,minimally invasive surgery,or a combined approach.Endoscopic drainage is the drainage of PFCs by creating an artificial communication between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous tract.In this editorial,we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.
文摘BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.
文摘BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinical course of AP.It could worsen symptoms and potentially lead to additional complications.However,clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce.Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.AIM To evaluate the association between APFC and 30-day readmission in patients with AP.METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019.Patients with a primary diagnosis of AP were identified.Participants were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was performed.The primary outcome was early readmission rates.Secondary outcomes included the incidence of inpatient complications and healthcare utilization.Unadjusted analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission risks.RESULTS A total of 673059 patients with the principal diagnosis of AP were included.Of these,5.1%had APFC on initial admission.After propensity score matching,each cohort consisted of 33914 patients.Those with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APFC group also had higher readmission charges($28282 vs$22865,P<0.001).The presence of APFC increased the risk of readmission twofold(aHR 2.52,95%confidence interval:2.40-2.65,P<0.001).The independent risk factors for 30-day readmission included female gender,Elixhauser Comorbidity Index≥3,chronic pulmonary diseases,chronic renal disease,protein-calorie malnutrition,substance use disorder,depression,portal and splenic venous thrombosis,and certain endoscopic procedures.CONCLUSION Developing APFC during index hospitalization for AP is linked to higher readmission rates,more inpatient complications,longer LOS,and increased healthcare costs.Knowing predictors of readmission can help target high-risk patients,reducing healthcare burdens.
文摘This article primarily examines the current state of tax collection and management,alongside other associated issues.It integrates insights from China’s“14th Five-Year Plan”and anticipates the imminent implementation of the“Golden Tax Phase Four.”With this backdrop,the article offers recommendations for advancing the reform of the tax collection and management system,fostering the development of intelligent taxation,and accelerating the modernization of tax collection and management in China.