Overview of the Theoretical Exploration and Application of Lean Six Sigma

In contemporary contexts,Lean Six Sigma(LSS)is extensively utilized and has evolved across various sectors due to its substantial benefits.This paper aims to explore the definition,origin,and development of LSS,as well as its key tools,methods,theoretical research,and future prospects.Furthermore,it analyzes the theoretical foundations and practical applications of LSS in-depth,with an emphasis on anticipating future development trends.The goal is to provide readers with a comprehensive overview of LSS and offer insights for enterprises seeking to implement LSS for process improvement and innovation.

Update in lean metabolic dysfunction-associated steatotic liver disease

BACKGROUND A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD).They are now defined as metabolic dysfunction-associated steatotic liver disease(MASLD),which includes cardiometabolic criteria in adults.This condition,extensively studied in obese or overweight patients,constitutes around 30%of the population,with a steady increase worldwide.Lean patients account for approximately 10%-15%of the MASLD population.However,the pathogenesis is complex and is not well understood.AIM To systematically review the literature on the diagnosis,pathogenesis,characteristics,and prognosis in lean MASLD patients and provide an interpretation of these new criteria.METHODS We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023,specifically focusing on lean NAFLD,MAFLD,or MASLD patients.We include original articles with patients aged 18 years or older,with a lean body mass index categorized according to the World Health Organization criteria,using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.RESULTS We include 85 studies in our analysis.Our findings revealed that,for lean NAFLD patients,the prevalence rate varied widely,ranging from 3.8%to 34.1%.The precise pathogenesis mechanism remained elusive,with associations found in genetic variants,epigenetic modifications,and adaptative metabolic response.Common risk factors included metabolic syndrome,hypertension,and type 2 diabetes mellitus,but their prevalence varied based on the comparison group involving lean patients.Regarding non-invasive tools,Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients.Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles,with some medications showing efficacy to a lesser extent.However,lean NAFLD patients exhibited a worse prognosis compared to the obese or overweight counterpart.CONCLUSION MASLD is a complex disease comprising epigenetic,genetic,and metabolic factors in its pathogenesis.Results vary across populations,gender,and age.Limited data exists on clinical practice guidelines for lean patients.Future studies employing this new nomenclature can contribute to standardizing and generalizing results among lean patients with steatotic liver disease.

Timing theory integrated nursing combined behavior change integrated theory of nursing on primiparous influence

BACKGROUND The comprehension and utilization of timing theory and behavior change can offer a more extensive and individualized provision of support and treatment alternatives for primipara.This has the potential to enhance the psychological well-being and overall quality of life for primipara,while also furnishing healthcare providers with efficacious interventions to tackle the psychological and physiological obstacles encountered during the stages of pregnancy and postpartum.AIM To explore the effect of timing theory combined with behavior change on selfefficacy,negative emotions and quality of life in patients with primipara.METHODS A total of 80 primipara cases were selected and admitted to our hospital between August 2020 and May 2022.These cases were divided into two groups,namely the observation group and the control group,with 40 cases in each group.The nursing interventions differed between the two groups,with the control group receiving routine nursing and the observation group receiving integrated nursing based on the timing theory and behavior change.The study aimed to compare the pre-and post-nursing scores of Chinese Perceived Stress Scale(CPSS),Edinburgh Postpartum Depression Scale(EPDS),Self-rating Anxiety Scale(SAS),breast milk knowledge,self-efficacy,and SF-36 quality of life in both groups.RESULTS After nursing,the CPSS,EPDS,and SAS scores of the two groups was significantly lower than that before nursing,and the CPSS,EPDS,and SAS scores of the observation group was significantly lower than that of the control group(P=0.002,P=0.011,and P=0.001 respectively).After nursing,the breastfeeding knowledge mastery,selfefficacy,and SF-36 quality of life scores was significantly higher than that before nursing,and the breastfeeding knowledge mastery(P=0.013),self-efficacy(P=0.008),and SF-36 quality of life(P=0.011)scores of the observation group was significantly higher than that of the control group.CONCLUSION The integration of timing theory and behavior change integrated theory has been found to be an effective approach in alleviating negative mood and stress experienced by primipara individuals,while also enhancing their selfefficacy and overall quality of life.This study focuses on the key concepts of timing theory,behavior change,primipara individuals,negative mood,and quality of life.

Heterostructured nickel-cobalt metal alloy and metal oxide nanoparticles as a polysulfide mediator for stable lithium-sulfur full batteries with lean electrolyte

Batteries that utilize low-cost elemental sulfur and light metallic lithium as electrodes have great potential in achieving high energy density.However,building a lithium-sulfur(Li-S)full battery by controlling the electrolyte volume generally produces low practical energy because of the limited electrochemical Li-S redox.Herein,the high energy/high performance of a Li-S full battery with practical sulfur loading and minimum electrolyte volume is reported.A unique hybrid architecture configured with Ni-Co metal alloy(NiCo)and metal oxide(NiCoO_(2))nanoparticles heterogeneously anchored in carbon nanotube-embedded selfstanding carbon matrix is fabricated as a host for sulfur.This work demonstrates the considerable improvement that the hybrid structure's high conductivity and satisfactory porosity promote the transport of electrons and lithium ions in Li-S batteries.Through experimental and theoretical validations,the function of NiCo and NiCoO_(2) nanoparticles as an efficient polysulfide mediator is established.These particles afford polysulfide anchoring and catalytic sites for Li-S redox reaction,thus improving the redox conversion reversibility.Even at high sulfur loading,the nanostructured Ni-Co metal alloy and metal oxide enable to have stable cycling performance under lean electrolyte conditions both in half-cell and full-cell batteries using a graphite anode.

Metal-free two-dimensional phosphorene-based electrocatalyst with covalent P-N heterointerfacial reconstruction for electrolyte-lean lithium-sulfur batteries

The use of lithium-sulfur batteries under high sulfur loading and low electrolyte concentrations is severely restricted by the detrimental shuttling behavior of polysulfides and the sluggish kinetics in redox processes.Two-dimensional(2D)few layered black phosphorus with fully exposed atoms and high sulfur affinity can be potential lithium-sulfur battery electrocatalysts,which,however,have limitations of restricted catalytic activity and poor electrochemical/chemical stability.To resolve these issues,we developed a multifunctional metal-free catalyst by covalently bonding few layered black phosphorus nanosheets with nitrogen-doped carbon-coated multiwalled carbon nanotubes(denoted c-FBP-NC).The experimental characterizations and theoretical calculations show that the formed polarized P-N covalent bonds in c-FBP-NC can efficiently regulate electron transfer from NC to FBP and significantly promote the capture and catalysis of lithium polysulfides,thus alleviating the shuttle effect.Meanwhile,the robust 1D-2D interwoven structure with large surface area and high porosity allows strong physical confinement and fast mass transfer.Impressively,with c-FBP-NC as the sulfur host,the battery shows a high areal capacity of 7.69 mAh cm^(−2) under high sulfur loading of 8.74 mg cm^(−2) and a low electrolyte/sulfur ratio of 5.7μL mg^(−1).Moreover,the assembled pouch cell with sulfur loading of 4 mg cm^(−2) and an electrolyte/sulfur ratio of 3.5μL mg^(−1) shows good rate capability and outstanding cyclability.This work proposes an interfacial and electronic structure engineering strategy for fast and durable sulfur electrochemistry,demonstrating great potential in lithium-sulfur batteries.

Effect of nano-CaO particle on the microstructure,mechanical properties and corrosion behavior of lean Mg-1Zn alloy

The effects of nano-CaO contents on the microstructure,mechanical properties and corrosion resistance of lean Mg-1Zn alloy were investigated.The results showed that the addition of nano-CaO significantly refined the grain size and improved mechanical properties of the Mg-1Zn alloy.At the same time,CaO reacted with molten Mg in situ to form nano-MgO,whose corrosion product in SBF solution was the same with the degradation product of Mg matrix,resulting in the enhanced compactness of the Mg(OH)_(2) layer and reduced corrosion rate of matrix.The Mg-1Zn alloy had lower corrosion resistance due to excessively large grain size and shedding of corrosion products.The composite with 0.5 wt.%CaO had the best corrosion resistance with a weight loss of 9.875 mg·y^(-1)·mm^(-2)due to the small number of Ca_(2)Mg_(6)Zn_(3) phase and suitable grain size.While for composites with high content of CaO(0.7 wt.%and 1.0 wt.%),they had lower corrosion resistance due to the coexistence of large number of Ca_(2)Mg_(6)Zn_(3) and Mg_(2)Ca at grain boundaries,especially for 1.0 wt.%CaO composite,resulting from the strong micro-galvanic corrosion.

Fracturing timing of Jurassic reservoirs in the Dibei-Tuziluoke gas field,Kuqa foreland basin:Evidence from petrography,fluid inclusions,and clumped isotopes

Determining the timing of fracturing is crucial for understanding reservoir evolution and hydrocarbon accumulation in foreland basins.Using fracturing data from cores,borehole images,and outcrops,combined with the clumped isotope(D47)and fluid inclusion analyses of carbonate minerals filled in pores and fractures,this study ascertained the fracturing timing of the Jurassic reservoirs in the Dibei-Tuziluoke Gas Field,Kuqa Foreland Basin.Data from outcrops and borehole images show two dominant fracture sets in the study area:W-E and NE-SW striking fractures.Some W-E striking fractures are carbonate-filled,while NE-SW striking fractures lack mineral fillings.Bitumen veins,not easy to be identified in borehole images,are prevalent in cores.The petrographic analysis reveals that these bitumen veins formed before the calcite cementation in pores and display high viscosity and low maturity.Homogenization temperatures(T_(h))from primary fluid inclusion assemblages in two representative calcite vein samples were notably lower than T_(△47) values from corresponding samples.This suggests the △_(47) signature underwent alteration due to partial reordering during burial.Thus,△_(47)-derived temperatures(apparent temperatures)may not faithfully represent the mineral precipitation temperatures.When plotting these apparent temperatures vs.the burial history,only the possible latest ages of fracturing emerged.These ages were further refined by considering petroleum charging,tectonic evolution,and stress orientation.Bitumen-filled fractures likely resulted from the Late Cretaceous uplift,marking the migration of low-maturity hydrocarbons in the study area.Carbonate-filled E-W striking fractures emerged during the late Miocene(~13-6.5 Ma)alongside fold development.NE-striking fractures that crosscut W-E ones possibly formed recently due to stress reorientation.

Evolution mechanism and treatment timing of penetrating fissures

The Inner Mongolia mining area in western China are characterized by the development of numerous penetrating fissures,resulting in severe land damage.It is significant to reveal the underlying evolution mechanism and identify treatment timing for restoring the ecological environment.The Guanbanwusu mining subsidence area in Inner Mongolia,China was selected as the research case for this study.The evolution mechanism of different penetrating fissures was revealed by field measurement,physical simulation and theoretical analysis.The treatment timing prediction model for the mining subsidence area was established based on the enhanced Weibull time function.The results show that the ground fissures are mainly step-type and collapse-type fissures.The breaking form of overlying strata determines their vertical opening and horizontal dislocation.The high mining intensity in the western mining area results in a shortened period of dynamic fissure expansion and reduced closure degree.The damage extent of the overlying strata exhibits zoning characteristics both vertically and horizontally.The relative standard deviation of the prediction model is only 3.7%.Concurrently,the prediction model is employed to determine the optimal timing for treatment in the study area,estimated to be 259 days.Subsequently,once this threshold is reached,the study area undergoes treatment and restoration of its e cological environment.This study addresses the knowledge gap in this field by highlighting the interconnectedness between rock strata structure and evolution mechanism of penetrating fissures,thereby providing a method for determining the treatment timing in mining subsidence areas.

Optimization method of refracturing timing for old shale gas wells

Based on the elastic theory of porous media,embedded discrete fracture model and finite volume method,and considering the micro-seepage mechanism of shale gas,a fully coupled seepage-geomechanical model suitable for fractured shale gas reservoirs is established,the optimization method of refracturing timing is proposed,and the influencing factors of refracturing timing are analyzed based on the data from shale gas well in Fuling of Sichuan Basin.The results show that due to the depletion of formation pressure,the percentage of the maximum horizontal principal stress reversal area in the total area increases and then decreases with time.The closer the area is to the hydraulic fracture,the shorter the time for the peak of the stress reversal area percentage curve to appear,and the shorter the time for the final zero return(to the initial state).The optimum time of refracturing is affected by matrix permeability,initial stress difference and natural fracture approach angle.The larger the matrix permeability and initial stress difference is,the shorter the time for stress reversal area percentage curve to reach peak and return to the initial state,and the earlier the time to take refracturing measures.The larger the natural fracture approach angle is,the more difficult it is for stress reversal to occur near the fracture,and the earlier the optimum refracturing time is.The more likely the stress reversal occurs at the far end of the artificial fracture,the later the optimal time of refracturing is.Reservoirs with low matrix permeability have a rapid decrease in single well productivity.To ensure economic efficiency,measures such as shut-in or gas injection can be taken to restore the stress,and refracturing can be implemented in advance.

Clinical efficacy and safety of kyphoplasty for the treatment of osteoporotic vertebral compression fractures at different surgical timings based on the theory of“dynamic-static integration”

Objective:To investigate the clinical efficacy and safety of percutaneous kyphoplasty at different surgical timings in the treatment of osteoporotic vertebral compression fracture(OVCF)based on the theory of“dynamic-static integration”.Methods:Patients with OVCF who underwent percutaneous kyphoplasty in our hospital were selected and divided into Groups A,B,and C for those undergoing surgery within 7,7—21,and>21 days of fracture occurrence.The variations in the amount of bone cement injected,pre-and post-operative pain levels,functional activity,deformity correction of the injured vertebrae,bone cement leakage,and vertebral body height loss were compared among the three groups.Results:Regarding pain relief and functional activity,the postoperative Visual Analog Scale and Oswestry Disability Index scores of the three groups significantly improved.Furthermore,the deformities of the injured vertebrae in the three groups were significantly corrected,with Groups A and B exhibiting superior correction compared to Group C.Moreover,the bone cement leakage rates in groups A and C were higher than that in Group B.At the 3-month follow-up,the loss of vertebral height in Group C was significantly higher than those in groups A and B.Conclusion:Kyphoplasty is effective for OVCF treatment.Early surgery can effectively restore the vertebral height of the injured vertebra,reduce kyphosis,and reduce height loss of the injured vertebra after surgery;nevertheless,treatment within 1—3 weeks of the fracture can reduce the occurrence of bone cement leakage,making the surgery safer.Therefore,surgical treatment within 1—3 weeks of fracture is safer and can achieve satisfactory therapeutic effects.From the perspective of traditional Chinese medicine,PKP surgery can transform the fracture end from a micromotion state to a fixed state,which fully embodies the theory of“dynamic-static integration”.

Timing impact on the initiation of pirfenidone therapy on idiopathic pulmonary fibrosis disease progression

In this editorial,we comment on the article by Lei et al,with a specific focus on the timing of the initiation of the antifibrotic agent pirfenidone(PFD)in the management of idiopathic pulmonary fibrosis(IPF)and its impact on lung function of IPF patients.PFD is an antifibrotic agent that is widely used in the management of IPF in both early and advanced stages.It inhibits various pathways and has antifibrotic,anti-inflammatory,and antioxidant properties.Despite dosage lowering,PFD slowed IPF progression and maintained functional capacity.The 6-min walk distance test indicated that patients tolerated adverse events well,and PFD significantly reduced the incidence of progression episodes and death.Even when a single disease-progression event occurred,continuing PFD treatment had benefits.

Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intraabdominal fluid accumulation

BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis(SAP).However,there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter place-ment and drainage.AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumu-lation.METHODS Using a retrospective approach,184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement:group A(catheter placement within 2 d of symptom onset,n=89),group B(catheter placement between days 3 and 5 after symptom onset,n=55),and group C(catheter placement between days 6 and 7 after symptom onset,n=40).The differences in progression rate,mortality rate,and the number of cases with organ dysfunction were compared among the three groups.RESULTS The progression rate of group A was significantly lower than those in groups B and groups C(2.25%vs 21.82%and 32.50%,P<0.05).Further,the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C(41.57%vs 70.91%and 75.00%,P<0.05).The mortality rates in group A,group B,and group C were similar(P>0.05).At postoperative day 3,the levels of C-reactive protein(55.41±19.32 mg/L vs 82.25±20.41 mg/L and 88.65±19.14 mg/L,P<0.05),procalcitonin(1.36±0.51 ng/mL vs 3.20±0.97 ng/mL and 3.41±0.98 ng/mL,P<0.05),tumor necrosis factor-alpha(15.12±6.63 pg/L vs 22.26±9.96 pg/L and 23.39±9.12 pg/L,P<0.05),interleukin-6(332.14±90.16 ng/L vs 412.20±88.50 ng/L and 420.08±87.65ng/L,P<0.05),interleukin-8(415.54±68.43 ng/L vs 505.80±66.90 ng/L and 510.43±68.23ng/L,P<0.05)and serum amyloid A(270.06±78.49 mg/L vs 344.41±81.96 mg/L and 350.60±80.42 mg/L,P<0.05)were significantly lower in group A compared to those in groups B and group C.The length of hospital stay in group A was significantly lower than those in groups B and group C(24.50±4.16 d vs 35.54±6.62 d and 38.89±7.10 d,P<0.05).The hospitalization expenses in group A were also significantly lower than those in groups B and groups C[2.70(1.20,3.55)ten-thousand-yuan vs 5.50(2.98,7.12)ten-thousand-yuan and 6.00(3.10,8.05)ten-thousand-yuan,P<0.05).The incidence of complications in group A was markedly lower than that in group C(5.62%vs 25.00%,P<0.05),and similar to group B(P>0.05).CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.

The Timing of Primary Neurosurgical Repair and Wound-Site Infection in Children with Myelomeningocele

Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Timing of Continuous Renal Replacement Therapy Initiation in Sepsis-Associated Acute Kidney Injury: A Comprehensive Review and Future Directions

This review examines the application of continuous renal replacement therapy(CRRT)in patients with sepsis-associated acute kidney injury(S-AKI),with a particular focus on the timing of CRRT initiation.This review addresses the controversy surrounding initiation timing and proposes future research directions.Through a systematic review of recent literature on CRRT for S-AKI,working principles,therapeutic mechanisms,initiation timing of CRRT,and related meta-analyses were summarized.Current studies indicate that the optimal timing for CRRT initiation in S-AKI patients remains inconclusive,with ongoing debate regarding whether early initiation significantly improves patient survival and renal function.This lack of consensus reflects the heterogeneity of the S-AKI patient population and the limitations of existing research methodologies.Future studies should focus on advancing the application of precision medicine in S-AKI and developing individualized treatment strategies by integrating multidimensional information to optimize CRRT utilization and improve patient outcomes.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes:a pilot study

AIM:To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters.METHODS:This study enrolled 48 healthy participants aged 20-35y(both males and females).Clinical assessment included the Ocular Surface Disease Index(OSDI)questionnaire,non-invasive tear break-up time(NITBUT),tear meniscus height(TMH),and lipid layer pattern(LLP).Based on these initial results,participants were categorized as either non-dry eye or dry eye.Participants in each group were randomly allocated to either Blephaclean■or Systane■treatments.Changes in NITBUT,TMH,and LLP levels before and after lid wipe treatment were assessed.RESULTS:The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group(P<0.001).Following the application of eyelid wipes(Systane■wipes),dry eye subjects experienced a significant improvement in NITBUT levels(P=0.0014)compared to the non-dry eye individuals.Although the remaining participants showed a marginal increase in TMH and NITBUT levels,these changes did not achieve statistical significance(P>0.05).Similarly,the LLP levels were significantly improved with Systane■(P<0.001)post-treatment compared to individuals in the non-dry eye group.However,the dry eye subjects showed higher posttreatment LLP levels than the untreated group(P<0.02).CONCLUSION:The short-term effects of Systane®eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease.Nonetheless,further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Boosting Lean Electrolyte Lithium-Sulfur Battery Performance with Transition Metals: A Comprehensive Review

Lithium–sulfur(Li–S) batteries have received widespread attention, and lean electrolyte Li–S batteries have attracted additional interest because of their higher energy densities. This review systematically analyzes the effect of the electrolyte-to-sulfur(E/S) ratios on battery energy density and the challenges for sulfur reduction reactions(SRR) under lean electrolyte conditions. Accordingly, we review the use of various polar transition metal sulfur hosts as corresponding solutions to facilitate SRR kinetics at low E/S ratios(< 10 μL mg~(-1)), and the strengths and limitations of different transition metal compounds are presented and discussed from a fundamental perspective. Subsequently, three promising strategies for sulfur hosts that act as anchors and catalysts are proposed to boost lean electrolyte Li–S battery performance. Finally, an outlook is provided to guide future research on high energy density Li–S batteries.

基于Lean管理理念的门诊医疗服务质量提升研究

目的分析在Lean管理理念基础上实施门诊护理管理对门诊医疗服务质量提升的影响。方法选取2021年1月—2022年12月在南京医科大学附属逸夫医院门诊工作的34名护理人员作为研究对象,2021年1—12月实施常规管理(实施前组),2022年1—12月实施Lean管理理念(实施后组)。比较实施前后护理质量、不良事件发生率及交接班质量评分。结果实施后组护理质量评分高于实施前组,差异有统计学意义(P<0.05)。实施后组护理差错、缺陷、纠纷发生率均低于实施前组,差异有统计学意义(P均<0.05)。实施后组护理人员交接班质量评分高于实施后组,差异有统计学意义(P<0.05)。结论Lean管理理念在门诊护理管理中的应用能有效提升护理质量,降低护理差错发生率,减少护患纠纷和投诉发生率,对提升门诊医疗服务质量具有积极意义。

Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

BACKGROUND Intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.