Change and significance of T-cell subsets and TNF-α in patients with advanced malignant obstructive jaundice treated by percutaneous transhepatic biliary external and internal drainage

The aim of this article was to study the influence of immunity function of advanced malignant obstructive jaundice(MOJ)treated by percutaneous transhepatic biliary external and internal drainage.Ninety-six cases of MOJ were divided into two groups according to the different ways of biliary drainage.Fifty-two external drainage tubes were placed in 41 cases of percutaneous transhepatic biliary exter-nal drainage group and 66 metal stents were placed in 55 cases of percutaneous transhepatic biliary internal drainage group.Liver function,serum TNF-α and cellular function were examined one day before operation and one week after operation and liver function was re-examined two weeks after operation,in order to observe the change and analyze the association among them and compare with the control group.All patients’conditions were improved after operation.In the percutaneous transhepatic biliary external and internal drainage groups,the total level of bilirubin decreased from(343.54±105.56)μmol/L and(321.19±110.50)μmol/L to(290.56±103.46)μmol/L and(283.72±104.95)μmol/L after operation respectively,which were significantly lower than pre-operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Serum alanine aminotransferase(ALT)of all patients one week after opera-tion was significantly lower than that before operation.TNF-a in percutaneous transhepatic biliary external and internal groups decreased from(108.58±19.95)pg/mL,(109.98±16.24)pg/mL of pre-operation to(104.32±19.59)pg/mL,(83.92±13.43)pg/mL of post-operation respectively,there was notable improvement(P<0.01)in internal drainage group after operation.Patients’serum CD4,CD3 and CD4/CD8 were notably increased,but CD8 was notably decreased(P<0.05).There was no difference in external drainage group(P>0.05).There was a significant difference between the two groups.Serum TNF-α and ALT had positive correlation.Percutaneous transhepatic biliary internal or external drain-age was an effective and important method to treat MOJ.Patients’immune function was weak when they suffered MOJ,but body’s cellular immune function can be notably improved after internal biliary drainage.

“As You Wish” A Combination of External Flexibility and Internal Integrity

A phrase often on the Chinese lips is ＂＇As you wish.＂ When there is a visiting guest at someone＇s home, a host asks, ＂What would you like to drink, tea, coffee or something else？＂ The guest may answer ＂As you wish.＂ This does not mean the guest would not mind what you serve. It inadvertently shows their respect for the host.

External versus Internal Loads of Nutrients of an Urban Eutrophic Tropical Reservoir （Southeastern Brazil）

This study aimed to evaluate the external and internal fluxes of nutrients of an urban eutrophic reservoir （lbirit6 reservoir, SE-Brazil）. External loads were estimated in the tributaries （Pintados and Ibirit6 creeks） through nutrient concentrations and discharge measurements. Using Fick＇s law, internal loads were estimated in the reservoir from fluxes across sediment-water interface from nutrient concentration gradients between the pore water and the water. The Ibirit6 creek （urban sewage recipient） contributes with 72%-47% of ammonium （NH4^＋） and 100%-8% of SRP （soluble reactive phosphorus） of the total quantity entering the reservoir, whereas the Pintados creek （oil refinery effluent recipient） contributions are 20%-19% and 44%-100%, respectively. Despite the high external loads （130 and 2.2 ton-yr^-1 of NH4＋ and SRP, respectively）, internal loads （average flux of 120 and 2 mg·cm^-2yr^-1, respectively） correspond to 25% of the total external loads which may sustain a high productivity in the reservoir for a long time even if the external loads are controlled. The stocks of ammonium and SRP of the interstitial water （100 cm of sediment） would be released to the water in six years and five months, respectively, The release time would be extremely larger （〉 3,000 years） considering the stocks of total N and bioavailable P.

Quality oriented value and performance drivers

The quality endeavors of an organization, like other enterprise activities, must be oriented towards the economic principles. This approach gives a way to many organizations to question the extent to which the quality management contributes for the overall business success and to pin point the areas where particularly a high value or performance can be created in order to attain the maximum possible economic benefits out of quality management systems. Without including the answer of this question in the decision making process, the resources can not be allocated optimally for the quality purpose. Quality management activities create variety of effects that indirectly contributes towards the economic success and thus increase the company and stakeholder value. A closer look at the quality management philosophy reveals eight major principles namely： customer focus, leadership, involvement of people, process approach, system approach to management, continual improvement, factual approach to decision making, mutually beneficial supplier relationships. These eight principles lead the efforts in the domain of quality management to project a positive impact on the company. For an understanding of response relationships, it is necessary to consider in detail the indicators along the response relationships. They provide helpful clues and give an insight into the complex mechanisms of action of the quality approaches on the path to the company＇s success. The following illustration depicts how the quality based activities generate the value to enhance the performance and a variety of indicators reflects how they indirectly add value to an organization and hence contribute to its economic success.

The U.S. Post-crisis Era Sustainable and Balanced Growth Strategy： Policies and Assessment

The financial crisis in 2008 dragged the U.S. economy into the dilemma of imbalanced and sluggish growth. Thus, the federal government carried out the sustainable and balanced growth strategy. This paper draws the framework of U.S. new growth strategy and summarizes the main measures applied in last five years. Further, it assesses the comprehensive strategic effects on economy and finally discusses the future challenges for the U.S..

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.