准确影像定位在颈部食管腔外异物取出术的应用

目的分析颈部食管腔外异物的临床特点及准确影像定位在其诊断和治疗中的应用。方法回顾性分析2017年10月~2024年3月梅州市人民医院耳鼻咽喉科收治的10例颈部食管腔外异物患者,对颈胸部CT行多平面重建(multiplanar reconstruction,MPR),从横断位、冠状位、矢状位判断异物位置,选择合适的手术入路。结果10例颈部食管腔外异物,2例金属和1例木质异物为外伤进入颈部,7例鱼骨为误吞鱼骨迁移颈部。术前影像定位提示异物在环状软骨和甲状软骨周3例,甲状腺内1例,相对应颈椎周2例,胸锁乳突肌周2例,舌骨周2例。支撑喉镜下取出2例,经颈部切开入路取出7例,1例未取出转上级医院治疗。术中彩超协助定位3例。所有患者随访至今均痊愈。结论准确影像定位可为颈部食管腔外异物选择合适手术入路提供依据,术中若异物寻找困难,可借助术中彩超精确定位异物,为成功取出异物提供有力保障。

气管黏液表皮样癌误诊为气管异物1例

1临床资料患儿,男,5岁,因进食后呛咳、发现气管异物4 h于2022-06-17就诊于昆明市儿童医院。患儿家属代诉患儿进食鸡蛋时不慎误吸,随后出现频繁、剧烈呛咳,伴喘息。随即于当地医院就诊,行胸部CT示气管近隆突部2.2 cm处见0.9 cm×0.8 cm稍高密度影,考虑异物(图1A)。诊断为主气管异物梗阻,未行处理,由救护车送至我院ICU。查体:一般情况欠佳,双肺呼吸音粗,可闻及少许痰鸣音,未闻及哮鸣音。入院诊断:气管内异物、呼吸道感染。患儿入ICU后为防止烦躁加重气管异物位置变化,给予舒芬太尼、右美托咪定和丙泊酚持续镇静镇痛,给予头孢唑林钠、奥美拉唑以及地奈德和吸入用盐酸氨溴索雾化。

高锰酸钾致鼻腔腐蚀伤1例

1临床资料患儿,女,2岁9个月,就诊3h前意外将“高锰酸钾消毒片(0.2 g/片)”塞入左侧鼻腔,出现哭闹不止,鼻部疼痛症状,立即就诊当地医院,前鼻镜检查未见异物,于2022-10-22转入我院。前鼻镜检查双侧未见异物,左侧鼻腔可见黄褐色分泌物流出,行电子鼻咽镜检查见左侧鼻腔后端黑褐色分泌物堵塞,充分吸引清理后见后端鼻中隔黏膜、鼻底黏膜及下鼻甲黏膜成黑色腐蚀状,急诊以“鼻腔腐蚀伤”收治入院。

双向FDI互动对区域创业活跃度的影响

基于2003—2021年省际面板数据,根据耦合协调度模型测算我国省域双向FDI(foreign direct investment)互动发展水平,运用双向固定效应模型考察双向FDI互动对区域创业活跃度的影响。研究发现,双向FDI互动显著提升了区域创业活跃度,在影响过程中,经济增长和产业结构发挥正向调节作用,政府干预发挥逆向调节作用。异质性检验结果表明,在市场规模越大、创新能力越强和城市化水平越高的区域中,双向FDI互动越能促进区域创业活跃度提升。

Diamond-Like Carbon Depositing on the Surface of Polylactide Membrane for Prevention of Adhesion Formation During Tendon Repair

Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats.The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane,with histological score decreasing from 3.12±0.27 to 2.20±0.22 and anti-adhesion effectiveness increasing from 21.61%to 44.72%.Mechanistically,the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively;thus,the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited.Consequently,excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)is largely reduced.For biocompatibility evaluation,PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes.Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds,which further delays the fibrosis process.It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.

Attention Mechanism-Based Method for Intrusion Target Recognition in Railway

The detection of foreign object intrusion is crucial for ensuring the safety of railway operations.To address challenges such as low efficiency,suboptimal detection accuracy,and slow detection speed inherent in conventional comprehensive video monitoring systems for railways,a railway foreign object intrusion recognition and detection system is conceived and implemented using edge computing and deep learning technologies.In a bid to raise detection accuracy,the convolutional block attention module(CBAM),including spatial and channel attention modules,is seamlessly integrated into the YOLOv5 model,giving rise to the CBAM-YOLOv5 model.Furthermore,the distance intersection-over-union_non-maximum suppression(DIo U_NMS)algorithm is employed in lieu of the weighted nonmaximum suppression algorithm,resulting in improved detection performance for intrusive targets.To accelerate detection speed,the model undergoes pruning based on the batch normalization(BN)layer,and Tensor RT inference acceleration techniques are employed,culminating in the successful deployment of the algorithm on edge devices.The CBAM-YOLOv5 model exhibits a notable 2.1%enhancement in detection accuracy when evaluated on a selfconstructed railway dataset,achieving 95.0%for mean average precision(m AP).Furthermore,the inference speed on edge devices attains a commendable 15 frame/s.

Systematizing Teacher Development:A Review of Foreign Language Teacher Learning

Foreign language teaching practice is developing rapidly,but research on foreign language teacher learning is currently relatively fragmented and unstructured.The book Foreign Language Teacher Learning,written by Professor Kang Yan from Capital Normal University,published in September 2022,makes a systematic introduction to foreign language teacher learning,which to some extent makes up for this shortcoming.Her book presents the lineage of foreign language teacher learning research at home and abroad,analyzes both theoretical and practical aspects,reviews the cuttingedge research results,and foresees the future development trend,painting a complete research picture for researchers in the field of foreign language teaching and teacher education as well as front-line teachers interested in foreign language teacher learning.This is an important inspiration for conducting foreign language teacher learning research in the future.And this paper makes a review of the book from aspects such as its content,major characteristics,contributions and limitations.

Translocation of a fish spike from the pharynx to the thyroid gland:A case report

BACKGROUND A fish spike stuck in the throat is a common ear,nose,and throat(ENT)emergency.However,it is very rare for a fish spike to reach the thyroid tissue through the throat,which is very dangerous and can lead to pharyngeal fistula,cervical abscess,mediastinal abscess,and thyroid abscess.Proper and timely management can help reduce complications,especially in elderly patients.CASE SUMMARY In the case presented here,the causative factor was dentures,but improper management aggravated the condition.In the case presented here,an elderly woman with a history of accidentally swallowing fish bones for 20 d had a sensation of foreign bodies in her throat.Eventually,computed tomography(CT)of the neck showed that the left side of the thyroid gland had a dense shadow in the form of a stripe.CONCLUSION If a fishbone foreign body is not visible during endoscopic examination but the patient has significant symptoms,the surgeon should be aware that the fishbone may be lodged in the thyroid.To avoid a misdiagnosis,ultrasound,CT,and other tests can be used to clarify the diagnosis.T The first step in treating a fish bone in the thyroid gland is to determine the position of the foreign body and the extent of the infection,and to develop a personalized surgical plan for its removal.At the same time,scientific information should be made available to the general public so that people know that if a fish bone is accidentally lodged,they should not force it to be swallowed or be spit out by inducing vomiting,which are incorrect methods and may aggravate the condition or even cause it to migrate outside the cavity,leading to serious complications,as in this reported case.

Rail-Pillar Net:A 3D Detection Network for Railway Foreign Object Based on LiDAR

Aiming at the limitations of the existing railway foreign object detection methods based on two-dimensional(2D)images,such as short detection distance,strong influence of environment and lack of distance information,we propose Rail-PillarNet,a three-dimensional(3D)LIDAR(Light Detection and Ranging)railway foreign object detection method based on the improvement of PointPillars.Firstly,the parallel attention pillar encoder(PAPE)is designed to fully extract the features of the pillars and alleviate the problem of local fine-grained information loss in PointPillars pillars encoder.Secondly,a fine backbone network is designed to improve the feature extraction capability of the network by combining the coding characteristics of LIDAR point cloud feature and residual structure.Finally,the initial weight parameters of the model were optimised by the transfer learning training method to further improve accuracy.The experimental results on the OSDaR23 dataset show that the average accuracy of Rail-PillarNet reaches 58.51%,which is higher than most mainstream models,and the number of parameters is 5.49 M.Compared with PointPillars,the accuracy of each target is improved by 10.94%,3.53%,16.96%and 19.90%,respectively,and the number of parameters only increases by 0.64M,which achieves a balance between the number of parameters and accuracy.

Colonoscopy-assisted removal of an impaction foreign body at the rectosigmoid junction: A case report

BACKGROUND When an anorectal foreign body is found,its composition and shape should be evaluated,and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body.CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3,2023,due to a rectal foreign body that had been embedded for more than 24 h.The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids,however,the electrode tube was inadvertently inserted into the anus and could not be removed by the patient.During hospitalization,the patient underwent surgery,and the foreign body was dragged into the rectum with the aid of colonoscopy.The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body,and the local anal symptoms were then relieved with topical drugs.The patient was allowed to eat and drink,and an entire abdominal Computed tomography(CT)and colonoscopy were reviewed 3 d after surgery.CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum,and no apparent intestinal tract damage.CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases.The type,material and the potential risks of rectal foreign bodies should be considered.

Plain language in the healthcare of Japan:a systematic review of“plain Japanese”

Objective:Despite the decrease in the number of foreign visitors and residents in Japan due to the coronavirus disease 2019,a resurgence is remarkable from 2022.However,Japan's medical support system for foreign patients,especially residents,is inadequate,with language barriers potentially causing health disparities.Comprehensive interpretation and translation services are challenging,but“plain Japanese”may be a viable alternative for foreign patients with basic Japanese language skills.This study explores the application and obstacles of plain Japanese in the medical sector.Methods:A literature review was performed across these databases:Web of Science,PubMed,Google Scholar,Scopus,CINAHL Plus,Springer Link and Ichushi-Web(Japanese medical literature).The search covered themes related to healthcare,care for foreign patients,and scholarly articles,and was conducted in July 2023.Results:The study incorporated five papers.Each paper emphasized the language barriers foreign residents in Japan face when accessing healthcare,highlighting the critical role and necessity of plain Japanese in medical environments.Most of the reports focused on the challenges of delivering medical care to foreign patients and the training of healthcare professionals in using plain Japanese for communication.Conclusion:The knowledge and application of plain Japanese among healthcare professionals are inadequate,and literature also remains scarce.With the increasing number of foreign residents in Japan,the establishment of a healthcare system that effectively uses plain Japanese is essential.However,plain Japanese may not be the optimal linguistic assistance in certain situations,thus it is imperative to encourage more research and reports on healthcare services using plain Japanese.

Nasal congestion caused by long-term retention of a nasal foreign body near the orbit:A case report

BACKGROUND Nasal trauma presents a risk of foreign body invasion into the nasal cavity.However,in the early treatment stage of nasal trauma,patients and doctors are not always aware of possible foreign body invasion,resulting in delayed detection.We describe the case of an adult patient admitted to the hospital due to left nasal congestion accompanied by yellow,purulent,and bloody discharge.CASE SUMMARY Consultation with the patient revealed a history of nasal trauma 30 years prior that did not receive thorough examinations and imaging during treatment,resulting in a glass fragment retained in the nasal cavity adjacent to the orbit.After admission,computerized tomography(CT)confirmed the presence of the foreign body in the patient’s left nasal–maxillary sinus.The nasal foreign body led to symptoms such as chronic sinusitis,nasal polyps,fungal infection,and deviated nasal septum.The foreign body was successfully removed by nasal endoscopy,polypectomy,sinus fungal removal,left middle turbinate conchoplasty,fenestration via the right inferior meatus,nasal endoscopic maxillary sinus cystectomy,and septolplasty.The operation was successful and without any complications.CONCLUSION CT scans should be performed in addition to necessary debridement sutures to avoid possible foreign body invasion during nasal trauma.Surgical planning should be tailored to the patient’s specific situation.The surgical method should be carefully selected,and sufficient preparation should be undertaken before the surgery to avoid possible displacement of the nasal foreign body.

Colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure:A case report

BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.

Prevalence and features of SARS-CoV-2 infection in prisons in Tuscany

BACKGROUND Prisons can be a reservoir for infectious diseases,including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),due to the very intimate nature of the living spaces and the large number of people forced to share them.AIM To investigate the SARS-CoV-2 epidemiology in prisons,this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs.METHODS This is an observational cohort study.Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results.Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility.Another section included information on the diagnosis of the disease according to the International Classification of Diseases,Ninth Revision,and Clinical Modification.RESULTS Up until the 31 May 2021,79.2%of the prisoner cohort(n=1744)agreed to a nasopharyngeal swab test(n=1381).Of these,1288 were negative(93.3%)and 85 were positive(6.2%).A significant association[relative risk(RR)]was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians[RR=2.4,95%confidence interval(CI):1.2-4.8].A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder(RR=4,95%CI:1.8-9.1).The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in Tuscany(standardized incidence ratio 0.7,95%CI:0.6-0.9).CONCLUSION In the prisoner cohort,screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

The Exorbitant Privilege of US Treasuries and China's Choices in the New Era

After the decoupling of the US dollar from gold in 1971,US Treasuries replaced gold as the value benchmark of the international monetary system and acquired an exorbitant privilege.Subsequently,the total amount of US debt exhibited an exponential expansion trend,unbound by any substantial constraints.The so-called debt ceiling is a partisan game rather than a rigid fiscal constraint on the United States.As long as there are no fundamental changes in the global monetary system,the international credit of US Treasuries will stay stable,and their trend of infinite expansion will be sustained.Massive quantitative easing policies have failed to significantly shake this stability,and the notion of global investors offloading US Treasuries is more an illusion than a fact.The exorbitant privilege of US Treasuries grants its federal government the“freedom to borrow,”shielding the American financial sector from due penalties during global financial crises and securing excessive returns in global capital cycles.In the old days when running“twin surpluses”on capital and current accounts,China kept the value of Renminbi low to support its export manufacturing sector along the southeast coast.As a result,China accumulated huge foreign exchange reserves,mainly US Treasuries.Nowadays,this practice is no longer necessary,yielding low returns and posing significant security risks.

A Case of Esophageal Perforation Presenting as Cavitary Pneumonia: Diagnostic and Therapeutic Challenges

Esophageal perforation, a rare condition, can arise from iatrogenic, traumatic, or spontaneous origins. Even when therapy is initiated within the first 24 hours, it is associated with a mortality rate of up to 25%. Due to the varied initial presentation, treatment may be delayed, leading to poorer outcomes. Here, we present a unique case of a 27-year-old schizophrenic patient who initially presented with acute respiratory failure and septic shock and was ultimately diagnosed with cavitary pneumonia secondary to esophageal perforation.

Treatment of benign rectal stricture caused by repeated anal insertion by endoscopy and balloon dilation:A case report

BACKGROUND Benign rectal strictures can be categorized as primary(disease-related)and secondary(surgical anastomosis-related).Secondary strictures arise from surgical complications,whereas primary strictures have diverse etiologies,including various inflammatory conditions.Benign strictures are usually managed by surgery and endoscopy.We present an unusual etiology of benign rectal stricture caused by the repeated insertion of foreign objects into the rectum for sexual purposes,resulting in rectal injury and subsequent chronic inflammation.CASE SUMMARY A 53-year-old man presented to the outpatient clinic of the Colorectal Surgery Department with symptoms of chronic constipation and bloody stools.The patient previously experienced rectal injury due to foreign object insertion for sexual purposes.Colonoscopy revealed benign circumferential narrowing of the rectum.He underwent treatment by endoscopic argon plasma coagulation and balloon dilation and follow-up as an outpatient for 4 months.A colonoscopy at the end of the follow-up period revealed no evidence of rectal stricture relapse.CONCLUSION A history of rectal injury,followed by chronic inflammation,should be considered in patients with benign rectal strictures.Management with endoscopic argon plasma coagulation and balloon dilation can prevent the need for surgical resection of benign rectal strictures.

Flexible bronchoscopy for foreign body aspiration in children:A single-centre experience

BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

Paradiplomacy for Non-recognized States:Case of Palestine

This paper endeavours to elucidate the intricacies of Palestinian Paradiplomacy,focusing in the political impetus pioneered by its principle actors,namely the Palestine Liberation Organisation(PLO)and subsequently,the establishment of the Palestinian National Authority(PNA).Additionally,attention will be directed towards the creation of the Palestinian Ministry of Foreign Affairs(PMOFA)and its subsidiary,the Palestinian International Cooperation Agency(PICA),albeit briefly discussed.Drawing inspiration from Alexander S.Kuznetsov’s seminal work“Theory and Practice of Paradiplomacy:Subnational Governments in International Affairs”(2015),this paper tries to scrutinize the trajectory of Palestinian paradiplomacy and its evolutionary course over time.When it comes to activity and growth,Palestinian paradiplomacy has a unique profile.The way in which topics pertaining to nations are not yet recognized has a great deal of bearing on current discussions and academic research about urgent political concerns like the right to self-determination and human rights.The analysis of de facto states via the prism of paradiplomacy naturally arises from the dominant state recognition procedures in international politics.

A Study on the Structural Contradictions in the US-Turkey Alliance Relations

After the Cold War and especially since the Justice and Development Party administration led by Erdogan,the US-Turkey alliance relations have declined.The two countries have sharp structural contradictions on a series of issues.Due to the profound geopolitical landscape changes,the interdependence on security and defense between the United States and Turkey has been severely weakened,leading to significant divergence in threat definition and pursuit of interests.Turkey has continuously enhanced its diplomatic autonomy,seeking to change its weak position in the original alliance relations,and striving to become a regional leader.These structural contradictions inevitably trigger the hedging of policies and interests between the United States and Turkey.