Internal hernia as a rare cause of small bowel obstruction:An insight from 13 years of experience

BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.

Assessing healthcare workers’knowledge and confidence in the diagnosis,management and prevention of Monkeypox

BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

Accurate quantification of the algebraic,multiplicative algebraic,and simultaneous iterative reconstruction techniques in ionosphere rebuilding based on the TIEGCM assessment

The algebraic reconstruction technique(ART),multiplicative algebraic reconstruction technique(MART),and simultaneous iterative reconstruction technique(SIRT)are computational methodologies extensively utilized within the field of computerized ionospheric tomography(CIT)to facilitate three-dimensional reconstruction of the ionospheric morphology.However,reconstruction accuracy elicits recurrent disputes over its practical application,and people usually attribute this issue to incomplete and uneven coverage of the measurements.The Thermosphere Ionosphere Electrodynamics General Circulation Model(TIEGCM)offers a reasonable physics-based ionospheric background and is widely utilized in ionospheric research.We use the TIEGCM simulations as the targeted ionosphere because the current measurements are far from able to realistically reproduce the ionosphere in detail.Optimized designations of satellite measurements are conducted to investigate the limiting performance of CIT methods in ionospheric reconstruction.Similar to common practice,electron density distributions from outputs of the International Reference Ionosphere(IRI)model are used as the iterative initial value in CIT applications.The outcomes suggest that despite data coverage,iterative initial conditions also play an essential role in ionospheric reconstruction.In particular,in the longitudinal sectors where the iterative initial height of the F2-layer peak electron density(hmF2)differs substantially from the background densities,none of the three CIT methods can reproduce the exact background profile.When hmF2 is close but the ionospheric F2-layer peak density(NmF2)is different between the targeted background and initial conditions,the MART performs better than the ART and SIRT,as evidenced by the correlation coefficients of MART being above 0.97 and those of ART and SIRT being below 0.85.In summary,this investigation reveals the potential uncertainties in traditional CIT reconstruction,particularly when realistic hmF2 or NmF2 values differ substantially from the initial CIT conditions.

Novel Methodologies for Preventing Crack Propagation in Steel Gas Pipelines Considering the Temperature Effect

Using the software ANSYS-19.2/Explicit Dynamics,this study performedfinite-element modeling of the large-diameter steel pipeline cross-section for the Beineu-Bozoy-Shymkent gas pipeline with a non-through straight crack,strengthened by steel wire wrapping.The effects of the thread tensile force of the steel winding in the form of single rings at the crack edges and the wires with different winding diameters and pitches were also studied.The results showed that the strengthening was preferably executed at a minimum value of the thread tensile force,which was 6.4%more effective than that at its maximum value.The analysis of the influence of the winding dia-meters showed that the equivalent stresses increased by 32%from the beginning of the crack growth until the wire broke.The increment in winding diameter decelerated the disclosure of the edge crack and reduced its length by 8.2%.The analysis of the influence of the winding pitch showed that decreasing the distance between the winding turns also led to a 33.6%reduction in the length of the straight crack and a 7.9%reduction in the maximum stres-ses on the strengthened pipeline cross-section.The analysis of the temperature effect on the pipeline material,within a range from-40℃ to+50℃,resulted in a crack length change of up to 5.8%.As the temperature dropped,the crack length decreased.Within such a temperature range,the maximum stresses were observed along the cen-tral area of the crack,which were equal to 413 MPa at+50℃ and 440 MPa at-40℃.The results also showed that the presence of the steel winding in the pipeline significantly reduced the length of crack propagation up to 8.4 times,depending on the temperature effect and design parameters of prestressing.This work integrated the existing methods for crack localization along steel gas pipelines.

Prediction of microstructure evolution of ZK61 alloy during hot spinning by internal state variable model

An internal state variable(ISV)model was established according to the experimental results of hot plane strain compression(PSC)to predict the microstructure evolution during hot spinning of ZK61 alloy.The effects of the internal variables were considered in this ISV model,and the parameters were optimized by genetic algorithm.After validation,the ISV model was used to simulate the evolution of grain size(GS)and dynamic recrystallization(DRX)fraction during hot spinning via Abaqus and its subroutine Vumat.By comparing the simulated results with the experimental results,the application of the ISV model was proven to be reliable.Meanwhile,the strength of the thin-walled spun ZK61 tube increased from 303 to 334 MPa due to grain refinement by DRX and texture strengthening.Besides,some ultrafine grains(0.5μm)that played an important role in mechanical properties were formed due to the proliferation,movement,and entanglement of dislocations during the spinning process.

Effect of external and internal cues on core muscle activation during the Sahrmann five-level core stability test

BACKGROUND Pain in the back or pelvis or fear of back pain may affect the timing or cocontraction of the core muscles.In both static and dynamic movements,the Sahrmann core stability test provides an assessment of core muscle activation and a person's ability to stabilize the lumbopelvic complex.Preparatory cues and images can be used to increase the activation of these muscles.To attain optimal movement patterns,it will be necessary to determine what cueing will give the most effective results for core stability.AIM To investigate the effects of external and internal cues on core muscle activation during the Sahrmann five-level core stability test.METHODS Total 68 participants(21.83±3.47 years)were randomly allocated to an external(n=35)or internal cue group(n=33).Participants performed the Sahrmann fivelevel core stability test without a cue as baseline and the five-level stability exercises with an internal or external cue.External cue group received a pressure biofeedback unit(PBU),and the internal cue group received an audio cue.A Delsys Trigno^(TM)surface electromyography unit was used for muscle activation from the rectus abdominis,external oblique,and transverse abdominis/internal oblique muscles.RESULTS Linear mixed effects model analysis showed that cueing had a significant effect on core muscle activation(P=0.001);however,there was no significant difference between cue types(internal or external)(P=0.130).CONCLUSION Both external and internal cueing have significant effects on core muscle activation during the Sahrmann five-level core stability test and the PBU does not create higher muscle activation than internal cueing.

Clinical evaluation of endoscopic biliary stenting in treatment of malignant obstructive jaundice

BACKGROUND Malignant obstructive jaundice(MOJ)is characterized by the presence of malignant tumors infiltrating or compressing the bile duct,causing poor bile drainage,generalized yellowing,pain,itching,and malaise.MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.AIM To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement,complication rates,and long-term patient outcomes.METHODS The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed.According to the treatment method,the patients were divided into an observation group(29 patients)and a control group(30 patients).General data,liver function indices,complications,adverse effects,and 3-year survival rates after different surgical treatments were recorded for the two groups.RESULTS There were no significant differences in baseline information(sex,age,tumor type,or tumor diameter)between the two groups(P>0.05).Alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels were significantly better in both groups after surgery than before surgery(P<0.05).The overall incidence of biliary bleeding,gastrointestinal bleeding,pancreatitis,and cholangitis was 6.9%in the observation group and 30%in the control group(P<0.05).No significant differences in the rates of blood transfusion,intensive care unit admission,or death within 3 years were observed between the two groups at the 1-month follow-up(P>0.05).The 3-year survival rates were 46.06%and 39.71%in the observation and control groups,respectively.CONCLUSION Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function,with minimal complications.This technique is a promising palliative approach for patients ineligible for radical surgery.However,further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.

Rat models of frozen shoulder:Classification and evaluation

Frozen shoulder(FS),also known as adhesive capsulitis,is a condition that causes contraction and stiffness of the shoulder joint capsule.The main symptoms are per-sistent shoulder pain and a limited range of motion in all directions.These symp-toms and poor prognosis affect people's physical health and quality of life.Currently,the specific mechanisms of FS remain unclear,and there is variability in treatment methods and their efficacy.Additionally,the early symptoms of FS are difficult to distinguish from those of other shoulder diseases,complicating early diagnosis and treatment.Therefore,it is necessary to develop and utilize animal models to under-stand the pathogenesis of FS and to explore treatment strategies,providing insights into the prevention and treatment of human FS.This paper reviews the rat models available for FS research,including external immobilization models,surgical internal immobilization models,injection modeling models,and endocrine modeling models.It introduces the basic procedures for these models and compares and analyzes the advantages,disadvantages,and applicability of each modeling method.Finally,our paper summarizes the common methods for evaluating FS rat models.

Parietal peritoneal hernia after abdominal hysterectomy for forty years: A case report

BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.

What Is the Psychosocial Environment of Adolescents with High or Low Internalizing Behavior?

Objective:This study aimed to examine the developmental trajectories of internalizing behaviors among adolescents and to identify key personal and environmental factors associated with these developmental patterns over time.Methods:Data were collected from 2242 adolescents(49.6%girls,aged 13.9–18.9 years)in South Korea.Latent class growth analysis was used to identify distinct developmental patterns of internalizing behaviors.Multinomial logistic regression analyses were conducted to examine the associations between these developmental patterns and various factors including gender,self-esteem,abuse and neglect experiences,peer relationships,and media use.Results:The analysis revealed three latent classes of internalizing behavior trajectories among adolescents.The first group,the“mid decreasing group”,comprised 54.5%of the sample(1221 students),indicating a moderate level of internalizing behavior that declined over time.The second group,the“high decreasing group”,included 19.1%of the sample(429 students),characterized by initially high levels of internalizing behavior that decreased.The third group,the“low maintained group”,represented 26.4%of the sample(592 students),indicating consistently low levels of internalizing behavior.Factors such as gender,self-esteem,experiences of abuse and neglect,peer relationships(trust and alienation),smartphone dependency,and time spent watching TV/videos were significantly associated with these latent groups.Conclusion:Three distinct developmental patterns of internalizing behaviors were identified among adolescents:mid-decreasing(54.5%),high-decreasing(19.1%),and low-maintained(26.4%).Gender,self-esteem,abuse experiences,and peer relationships were significant predictors of these developmental patterns.

Small bowel obstruction due to intra-abdominal hernia:New thoughts on diagnosis and treatment

Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.

Upper bound stability analysis of tiered geosynthetic-reinforced soil wall

The tiered geosynthetic-reinforced soil (GRS) walls have been increasingly applied in the high and steep retaining soil structures. However, very little is known about the design method for the tiered GRS wall in practice. This study is aimed at proposing an upper-bound stability analysis method of a tiered GRS wall. The proposed method was firstly validated by the existing results from the centrifuge test and the numerical method, and then a parametric study was performed to investigate the effects of the cohesionless backfill friction angle φ1 and the wall geometric parameters including the offset distance, the total wall height, the batter angle δ, the number of tiers n, and wall height ratio of adjacent tiers on the dimensionless equivalent earth pressure coefficient KT. The analysis results demonstrated that as the φ1 increases, the shear strength of backfill is enhanced and thus the KT or the total reinforcement tensile force decreases, and the KT decreases with the increase of the offset distance at the initial stage and then becomes stable when it reaches a certain critical value. For a fixed offset distance, the KT or the total reinforcement tensile force decreases with the increase of the δ. For the two-tiered GRS walls having the offset distance less than the critical value, the wall with the smaller wall height ratio has a larger KT. Further, the variation of the location of the critical failure surfaces of tiered GRS walls was presented in this study with the variation of the φ1 and the wall geometry.

Petersen's hernia with chylous ascites following laparoscopic total gastrectomy and Roux-en-Y anastomosis:A case report and review of literature

BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.

Difficulty removing a totally implantable venous access port:A case report

BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.

Effect of kidney transplantation on sexual dysfunction in patients with end stage renal disease:A systematic review

BACKGROUND End-stage renal disease(ESRD)is associated with a multitude of physical,psychological,and social health challenges,including a profound impact on sexual and reproductive health.Among males with ESRD,erectile dysfunction(ED)is highly prevalent due to factors such as underlying comorbidities,including diabetes and hypertension,and the physiological effects of long-term dialysis.Kidney transplantation(KTx)has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance.However,the evidence surrounding the effectiveness of KTx in improving sexual function,specifically erectile function(EF),remains inconclusive.This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction(SexDys),particularly ED,in male ESRD patients.AIM To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD,assessed using the international index of EF(IIEF),to survey the prevalence of SexDys in this population,and to assess the correlation between various factors and SexDys through regression analysis.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,Scopus,Clinical-Trials.gov,and Google Scholar was conducted,following the PRISMA 2020 guidelines.Prospective and retrospective cohort studies,as well as cross-sectional studies assessing EF pre-and post-transplantation,were included.These studies used validated tools such as the IIEF to measure EF.Meta-analyses were performed using a random-effects model to estimate standardized mean differences(SMD)and hazard ratios(HR)with 95%confidence intervals(CI).Heterogeneity was assessed using the I²statistic,and publication bias was evaluated with a funnel plot and the Egger’s test.RESULTS A total of 2419 studies were identified,with 362 abstracts screened and 193 full-text articles reviewed.Ultimately,11 studies were included for qualitative analysis and 7 for quantitative synthesis.The random effects model for SMD yielded a combined estimate of 0.43(95%CI:-0.20-1.07),indicating a small but non-significant improvement in EF post-transplantation.The heterogeneity across studies was substantial(I²=90%),reflecting significant variability in outcomes.Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors.Despite this trend,the overall result for changes in EF was not statistically significant(P=0.15).Additionally,the combined HR from the meta-analysis was 2.87(95%CI:1.76-4.69),suggesting that KTx significantly increases the likelihood of improved EF,though variability between studies persisted(I²=63%).CONCLUSION While KTx offers some promise for improving EF in male ESRD patients,the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results.Despite this,individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups,particularly living-donor recipients.Future research should focus on larger,well-designed cohort studies with standardized outcome measures to provide more definitive conclusions.Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life.However,adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.

Mechanism of internal thermal runaway propagation in blade batteries

Blade batteries are extensively used in electric vehicles,but unavoidable thermal runaway is an inherent threat to their safe use.This study experimentally investigated the mechanism underlying thermal runaway propagation within a blade battery by using a nail to trigger thermal runaway and thermocouples to track its propagation inside a cell.The results showed that the internal thermal runaway could propagate for up to 272 s,which is comparable to that of a traditional battery module.The velocity of the thermal runaway propagation fluctuated between 1 and 8 mm s^(-1),depending on both the electrolyte content and high-temperature gas diffusion.In the early stages of thermal runaway,the electrolyte participated in the reaction,which intensified the thermal runaway and accelerated its propagation.As the battery temperature increased,the electrolyte evaporated,which attenuated the acceleration effect.Gas diffusion affected thermal runaway propagation through both heat transfer and mass transfer.The experimental results indicated that gas diffusion accelerated the velocity of thermal runaway propagation by 36.84%.We used a 1D mathematical model and confirmed that convective heat transfer induced by gas diffusion increased the velocity of thermal runaway propagation by 5.46%-17.06%.Finally,the temperature rate curve was analyzed,and a three-stage mechanism for internal thermal runaway propagation was proposed.In Stage I,convective heat transfer from electrolyte evaporation locally increased the temperature to 100℃.In Stage II,solid heat transfer locally increases the temperature to trigger thermal runaway.In StageⅢ,thermal runaway sharply increases the local temperature.The proposed mechanism sheds light on the internal thermal runaway propagation of blade batteries and offers valuable insights into safety considerations for future design.

Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Suppressed Internal Intrinsic Stress Engineering in High-Performance Ni-Rich Cathode Via Multi layered In Situ Coating Structure

LiNi_(x)Co_(y)Al_(z)O_(2)(NCA)cathode materials are drawing widespread attention,but the huge gap between the ideal and present cyclic stability still hinders their further commercial application,especially for the Ni-rich LiNi_(x)Co_(y)Al_(z)O_(2)(x>0.8,x+y+z=1)cathode material,which is owing to the structural degradation and particles'intrinsic fracture.To tackle the problems,Li_(0.5)La_(2)Al_(0.5)O_(4)in situ coated and Mn compensating doped multilayer LiNi_(0.82)Co_(0.14)Al_(0.04)O_(2)was prepared.XRD refinement indicates that La-Mn co-modifying could realize appropriate Li/Ni disorder degree.Calculated results and in situ XRD patterns reveal that the LLAO coating layer could effectively restrain crack in secondary particles benefited from the suppressed internal strain.AFM further improves as NCA-LM2 has superior mechanical property.The SEM,TEM,XPS tests indicate that the cycled cathode with LLAO-Mn modification displays a more complete morphology and less side reaction with electrolyte.DEMS was used to further investigate cathode-electrolyte interface which was reflected by gas evolution.NCA-LM2 releases less CO_(2)than NCA-P indexing on a more stable surface.The modified material presents outstanding capacity retention of 96.2%after 100 cycles in the voltage range of 3.0-4.4 V at 1C,13%higher than that of the pristine and 80.8%at 1 C after 300 cycles.This excellent electrochemical performance could be attributed to the fact that the high chemically stable coating layer of Li_(0.5)La_(2)Al_(0.5)O_(4)(LLAO)could enhance the interface and the Mn doping layer could suppress the influence of the lattice mismatch and distortion.We believe that it can be a useful strategy for the modification of Ni-rich cathode material and other advanced functional material.

Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.