Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

降压药能与抗ED药物同服吗

高血压作为一种最常见的心血管疾病,与勃起功能障碍(ED)有着密切的联系。根据美国马萨诸塞州男性老年化研究资料显示,在40~70岁男性当中有超过一半的人受到不同程度ED的困扰,年发病率为124/1000。同时据流行病学研究发现,ED在非高血压人群中发生率为16%;在高血压人群中,发病率则高达32.1%,远高于正常血压人群。那为什么高血压容易并发ED呢?原因主要有以下3点。

Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis

BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

EDS成分分析法在电气熔痕鉴定中的应用

EDS成分分析法是微量物证鉴定的常用方法,具有灵敏度高、操作简单快速等特点,在纤维、金属、玻璃、油漆及纸张等各类微量物证的鉴定中有着广泛的应用。在火灾痕迹物证鉴定领域,EDS成分分析法已成为重要方法之一。通过探讨三起采用EDS成分分析法对电气熔痕进行鉴定的实例,提出在火灾现场物证取样、熔痕鉴定和鉴定意见运用等方面的注意事项。

A dual-RPA based lateral flow strip for sensitive,on-site detection of CP4-EPSPS and Cry1Ab/Ac genes in genetically modified crops

Traditional transgenic detection methods require high test conditions and struggle to be both sensitive and efficient.In this study,a one-tube dual recombinase polymerase amplification(RPA)reaction system for CP4-EPSPS and Cry1Ab/Ac was proposed and combined with a lateral flow immunochromatographic assay,named“Dual-RPA-LFD”,to visualize the dual detection of genetically modified(GM)crops.In which,the herbicide tolerance gene CP4-EPSPS and the insect resistance gene Cry1Ab/Ac were selected as targets taking into account the current status of the most widespread application of insect resistance and herbicide tolerance traits and their stacked traits.Gradient diluted plasmids,transgenic standards,and actual samples were used as templates to conduct sensitivity,specificity,and practicality assays,respectively.The constructed method achieved the visual detection of plasmid at levels as low as 100 copies,demonstrating its high sensitivity.In addition,good applicability to transgenic samples was observed,with no cross-interference between two test lines and no influence from other genes.In conclusion,this strategy achieved the expected purpose of simultaneous detection of the two popular targets in GM crops within 20 min at 37°C in a rapid,equipmentfree field manner,providing a new alternative for rapid screening for transgenic assays in the field.

给定控制数的连通图的最大EDS极图

图G的偏心距离和(EDS)定义为ξ^(d)(G)=∑_(v∈V)ε_(G)(v)D_(G)(v),其中ε_(G)(v)是顶点v的偏心率,D_(G)(v)是顶点v到G中其它所有顶点的距离之和.通过研究图的EDS,给出了Miao等猜想的一个更简单的证明,确定了给定控制数的连通图的最大EDS极图.

Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

Performance evaluation of laterite soil embankment stabilized with bottom ash,coir fiber,and lime

In tropical regions,heavy rainfall induces erosion and shallow landslides on road embankments.Cement-based stabilization methods,common in these regions,contribute to climate change due to their high carbon footprint.This study explored the potential application of coir fiber-reinforced laterite soil-bottom ash mixtures as embankment materials in the tropics.The objective is to enhance engineered embankment slopes'erosion resistance and stability while offering reuse options for industrial byproducts.This study examined various mix designs for unconfined compressive strength(UCS)and permeability,utilizing 30%bottom ash(BA)and 1%coir fiber(CF)with varying sizes ranging from 10 to 40 mm,6%lime,and laterite soil(LS),followed by microstructural analyses.The results demonstrate that the compressive strength increases as the CF length increases to 25 mm.In contrast,permeability increases continuously with increasing CF length.Lime-treated mixtures exhibit superior short-and long-term strength and reduce permeability owing to the formation of cementitious materials,as confirmed by microstructural analyses.A lab-scale slope box was constructed to evaluate the surface erosion of the stabilized laterite soil embankment.Based on the rainfall simulation results,the LS-BA-CF mixtures show better resistance to erosion and deformation compared to untreated LS,especially when lime is added to the top layer.This study provides insights into a sustainable and cost-effective approach for slope stabilization using BA and CF,offering a promising solution for tropical regions susceptible to surface erosion and landslides.

Outstanding proton conductivity over wide temperature and humidity ranges and enhanced mechanical, thermal stabilities for surface-modified MIL-101-Cr-NH2/Nafion composite membranes

High-performance proton exchange membranes are of great importance for fuel cells.Here,we have synthesized polycarboxylate plasticizer modified MIL-101-Cr-NH2(PCP-MCN),a kind of hybrid metal-organic framework,which exhibits a superior proton conductivity.PCP-MCN nanoparticles are used as additives to fabricate PCP-MCN/Nafion composite membranes.Microstructures and characteristics of PCP-MCN and these membranes have been extensively investigated.Significant enhancement in proton conduction for PCP-MCN around 55℃ is interestingly found due to the thermal motion of the PCP molecular chains.Robust mechanical properties and higher thermal decomposition temperature of the composite membranes are directly ascribed to strong intermolecular interactions between PCP-MCN and Nafion side chains,i.e.,the formation of substantial acid–base pairs(-SO_(3)^(-)…^(+)H–NH-),which further improves compatibility between additive and Nafion matrix.At the same humidity and temperature condition,the water uptake of composite membranes significantly increases due to the incorporation of porous additives with abundant functional groups and thus less crystallinity degree in comparison to pristine Nafion.Proton conductivity(σ)over wide ranges of humidities(30-100%RH at 25℃)and temperatures(30-98℃ at 100%RH)for prepared membranes is measured.The s in PCPMCN/Nafion composite membranes is remarkably enhanced,i.e.0.245 S/cm for PCP-MCN-3wt.%/Nafion is twice that of Nafion membrane at 98℃ and 100%RH,because of the establishment of well-interconnected proton transport ionic water channels and perhaps faster protonation–deprotonation processes.The composite membranes possess weak humidity-dependence of proton transport and higher water uptake due to excellent water retention ability of PCP-MCN.In particular,when 3 wt.%PCP-MCN was added to Nafion,the power density of a single-cell fabricated with this composite membrane reaches impressively 0.480,1.098 W/cm^(2) under 40%RH,100%RH at 60℃,respectively,guaranteeing it to be a promising proton exchange membrane.

Thermo-Mechanical, Physico-Chemical, Morphological, and Fire Characteristics of Eco-Friendly Particleboard Manufactured with Phosphorylated Lignin Addition

Lignin,lignosulfonate,and synthesized phosphorylated lignosulfonate were introduced as greenfillers in citric acid-sucrose adhesives for bonding particleboard fabricated from areca leaf sheath(ALS).The characteristics of particleboards were compared to that of ultralow emitting formaldehyde(ULEF-UF).Thefillers derived from Eucalyptus spp.kraft-lignin were added forflame retardancy enhancement.10%of each lignin and modified lig-nin was added into the ULEF-UF and citric acid-sucrose bonded particleboards.Analyses applied to particle-boards included thermal characteristics,X-ray diffraction analysis(XRD),morphological properties,Fourier transform infrared spectroscopy(FTIR),as well as physical,mechanical,andfire resistance characteristics of the laboratory-fabricated particleboards.Lignin and modified lignin resulted in improved thermal stability of the composites bonded with ULEF-UF while the improvement in the particleboard bonded with citric acid-sucrose was not significant.The introduction offiller exerted a higher influence on the UF-bonded particleboards compared to composites fabricated with citric acid-sucrose.Generally,the presence of lignin,lignosulfonate,and phosphorylated lignosulfonate enhanced the mechanical strength of the ULEF-bonded particleboards,although their dimensional stability has deteriorated.Markedly,the use of lignin and lignosulfonate enhanced thefire resis-tance of the particleboards produced with lower observed weight loss.All laboratory particleboards exhibited satisfactoryfire resistance,attaining a V-0 rating in according to the UL-94 standard.

SEM-EDS结合结垢趋势模拟软件在反渗透膜污堵原因分析中的应用

回用水系统中,反渗透膜的污堵问题经常发生。而污堵的原因常常难以确定,进而导致无法从根本上解决污堵问题。详细阐述了先利用SEM-EDS分析反渗透膜微观结构污堵情况和污堵物元素分布,确定污堵物主要成分,再利用结垢趋势模拟软件模拟出反渗透系统最佳运行条件,从而解决反渗透膜污堵问题的过程和方法。从实际应用案例来看,SEM-EDS结合结垢趋势模拟软件可以快速准确的找到膜系统污堵原因,并从根本上解决污堵问题。

能量色散X射线荧光光谱法(ED-XRF)测定粗硒中的硒含量

针对容量法和重量法测定粗硒中硒含量过程中存在的流程长、操作繁琐等问题,本文考察了不同的压样条件,调整压力以及添加不同比例的纤维素、硼酸和碳酸锂等,最终选择采用碳酸锂作为混合剂,将粗硒粉末样品和碳酸锂粉末按照比例1∶1混匀,然后在压样机上用10 t压力压制成测试样片,并考察了测试样片的均匀性。在选定的工作条件下,采用能量色散X射线荧光光谱仪(ED-XRF)建立工作曲线,可以实现对粗硒中硒含量的定量测定,同时将测定结果与容量法测定结果进行对比,结果一致。本方法快速准确。

Pathogenesis and treatment of diabetes mellitus-related erectile dysfunction: current therapies and potential challenges

Erectile dysfunction(ED)is one of the important complications of diabetes,which is very common in diabetic patients,affecting more than half of male patients,and the incidence of the disease is about 3.5 times that of the normal population.The pathogenesis of diabetic erectile dysfunction(DMED)is complex,involving nerve,vascular,endocrine,muscular and psychological aspects.At present,the therapeutic approaches of DMED include drug therapy,surgery,physical therapy and so on.This article provides a review of current research on the pathogenesis and treatment of DMED.Further elucidation of the pathogenesis of DMED and the development of new therapeutic approaches are of great significance for the prevention and treatment of DMED.

Determination of Egg Shell Structure and Mineral Composition Using SEM-EDS and Identification the Possibility to Produce Fertilizer

Throwing out egg shells without using them depreciates a vital source of calcium. As an egg shell contains twice the amount of calcium a person needs a day, it is considered as the richest source of calcium of natural origin. Egg shells have been traditionally and widely used in medicine, beauty science and food production for decades. In spite of that, there is a lack of new solutions that profoundly study mineral elements and beneficial components contained in egg shells for further usage as a product. Assuming we consume 2 eggs a day, the yearly consumption for a person is 730 eggs. As beneficial component, the egg shell structure and mineral elements, were determined in 3 types of samples (Mongolian eggs, Russian eggs, and iodized eggs) by SEM-EDS (Scanning electron microscopy with energy dispersive spectroscopy), a state-of-the-art research method. Consequently, it was established that egg shells consists of Ca (72.6% - 85.7%), Mg (2.7% - 4.5%), Si (0.3% - 0.6%), P (7.0% - 18.1%), S (0.5% - 2.0%), K (0.4% - 0.9%), I (2.6% - 3.0%), respectively. Additionally, the D3.8 × 120, 250, 500, and 1000 times zoomed images of shell structure (SEM) of each sample were examined, and the results were compared and evaluated. The reverse titration method examination has demonstrated that the calcium carbonate (CaCO3) content in egg shells is 91% - 92.5%, and pH is 8.41 - 8.75. Ultimately, fertilizer containing 97.7% Ca without chemical additives has been extracted by grounding the eggshells to 4.4 μm, then preparing the mixture at the rate of 20:0.5 (shell: mix, enriched with mandarin and lemon peel) and adjusting its pH to 7.5 - 8.0. Further research on the impact of fertilizer on growing process of indoor flowers has been commenced.

Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

AIM:To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis(SAP).METHODS:A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization.An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d.The sinus tract of the drainage catheter was expanded gradually with a skin expander,and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d.Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.RESULTS:Among the 42 patients,the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts.No death and complication occurred during the procedure.CONCLUSION:Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

基于ED-SIFT算法的高分辨率遥感图像快速拼接

基于特征点检测的高分辨率图像拼接运算量大、速度慢,改进后可以提高效率。从减少参与SIFT计算的数据量和优化算法两方面实现图像拼接加速。建立基于ED-SIFT的图像拼接算法,图像边缘检测优选Soble算子;使用Python+OpenCV,对WorldView3切片数据进行拼接实验,平均耗时为0.96 s;与传统基于SIFT的图像拼接算法相比,在保证一定数目的特征点同时,速度加快9.47倍。使用该算法对重叠率为20%、65%、80%的切片数据拼接成功,平均耗时都在0.96~1.08 s。继续用OpenCV+Numba并行运算实现该算法,对运算提速已不明显。基于ED-SIFT的图像拼接算法对高分辨率遥感图像拼接提速明显,对不同重叠率图像拼接皆有效。

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study

AIM To look into the management options of early debridement of the wound, followed by vascularized cover to bring in fresh blood supply to remaining tissue in electrical burns. METHODS A total of 16 consecutive patients sustaining full thickness forearm burns over a period of one year were included in the study group. Debridement was undertaken within 48 h in 13 patients. Three patients were taken for debridement after 48 h. Debridement was repeated within 2-4 d after daily wound assessment and need for further debridement. RESULTS On an average two debridements(range 1-4) was required in our patients for the wound to be ready for definitive cover. Interval between each debridement ranged from 2-18 d. Fourteen patients were provided vascularized cover after final debridement(6 free flaps, 8 pedicled flaps). Functional assessment of gross hand function done at 6 wk, 2 mo, 3 mo and 6 mo follow-up. CONCLUSION High-tension electrical burns lead to significant morbi-dity. These injuries are best managed by early decompression followed by multiple serial debridements. The ideal timing of free flap coverage needs further investigation.

Modified ulcer debridement in the treatment of the superficial fungal infection of the cornea

AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS： The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes（93.3%）, with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty（PK）（1 eye）, anterior lamellar keratoplasty（LK）（7 eyes）, conjunctival flap covering（4 eyes） or amniotic membrane transplantation（2 eyes）. The best corrected visual acuity（BCVA） was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon（P=0.036） and ever using steroid（P=0.025）.CONCLUSION： Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.