Traditional Chinese medicine breast massage,also known as breast Tuina or manual expression of breast milk,is a technique of using certain manipulations to act on specific positions or acupoints of the breast to promo...Traditional Chinese medicine breast massage,also known as breast Tuina or manual expression of breast milk,is a technique of using certain manipulations to act on specific positions or acupoints of the breast to promote blood and lymphatic circulation of breast and facilitate the discharge of stagnant milk.This technique is widely used in China to treat breastfeeding problems such as breast engorgement,mastitis,and postpartum hypogalactia.In this article,we introduce the definition and standardization process of breast massage,elaborate the operating procedures of breast massage in detail,and summarize and discuss the current situation of its clinical application,so as to provide a reference for its wide application and in‑depth research.展开更多
Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vagin...Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.展开更多
A three-step synthesis strategy for the automatic synthesis of operating procedures in batch processoperations is presented in this paper.The first step is pre-operation which consists of a set of checks that mustbe c...A three-step synthesis strategy for the automatic synthesis of operating procedures in batch processoperations is presented in this paper.The first step is pre-operation which consists of a set of checks that mustbe considered before starting the basic process operation.The second step is operation which is described by a setof basic control instructions.The third step is post-operation described by a set of instructions that must becarried out when the basic process operation is terminated.The three-step synthesis method has been imple-mented as part of a prototype recipe management system.展开更多
Objective: The aim of this study was to investigate the situations and factors that cause nurses not to follow standard operating procedures (SOPs) during the clinical trial process. Methods: Five cases involving ...Objective: The aim of this study was to investigate the situations and factors that cause nurses not to follow standard operating procedures (SOPs) during the clinical trial process. Methods: Five cases involving patients enrolled in a clinical trial were divided into two groups, pre-SOP training and post-SOP training, to compare and observe the process problems and whether nurses fol- lowed SOPs in clinical trials. The causes of problems were analyzed and corrective measures were proposed. Results: Our results indicate significant improvement in compliance with SOPs after training. There were three occurrences of irregular behavior after training compared with 21 occurrences of irregular behavior before training. Conclusions: The quality of clinical trials can be improved if nurses strictly follow SOPs.展开更多
As an external treatment technique of traditional Chinese medicine(TCM),auricular point sticking,which is rooted in holographic biology theory and TCM viscera and meridian theory,is a safe and effective treatment meth...As an external treatment technique of traditional Chinese medicine(TCM),auricular point sticking,which is rooted in holographic biology theory and TCM viscera and meridian theory,is a safe and effective treatment method.This article introduces the technology overview and development process.The auricular point sticking technique for constipation is taken as an example to specify the basic requirements,assessment,operational points,acupoint selection and matters needing attention during the implementation of the auricular acupressure technique,providing a reference for the operating procedures of this technique in the clinical treatment of other diseases such as insomnia,diarrhea,colds,hypertension,headache,and dysmenorrhea.展开更多
In this paper, we conduct research on the operation mechanism of claim in civil procedure law and the applications on the court trial way reform. The ultimate goal of the rule of law lies in identifying and protecting...In this paper, we conduct research on the operation mechanism of claim in civil procedure law and the applications on the court trial way reform. The ultimate goal of the rule of law lies in identifying and protecting the rights of citizens. Way to protect the rights of citizens is diverse, but the judicial relief is the most basic and important form of insurance. Everyone can “into” the court and get the impartiality of the judicial relief, is a measure of a country judicial level height and the rule of law implementation degree of important yardstick. Judicial system and judicial procedure to build and build a better, if the subject of litigation rights are not being met and the safeguard, can’t get through the door and it is the legislators and legal scholars over the many efforts are meaningless, under this basic condition, we propose the new perspective on the corresponding issues that is necessary.展开更多
<正>Let 1<ρ≤2,E be a real ρ-uniformly smooth Banach space and T:E→E be a continuous and strongly accretive operator.The purpose of this paper is to investigate the problem of approximating solutions to the ...<正>Let 1<ρ≤2,E be a real ρ-uniformly smooth Banach space and T:E→E be a continuous and strongly accretive operator.The purpose of this paper is to investigate the problem of approximating solutions to the equation Tx=f by the Ishikawa iteration procedure with errors (?) where x_0 ∈ E,{u_n},{υ_n}are bounded sequences in E and{α_n},{b_n},{c_n},{a_n~'},{b_n~'},{c_n~'} are real sequences in[0,1].Under the assumption of the condition 0<α≤b_n+c_n,An≥0, it is shown that the iterative sequence{x_n}converges strongly to the unique solution of the equation Tx=f.Furthermore,under no assumption of the condition(?)(b_n~'+c_n~')=0,it is also shown that{x_n}converges strongly to the unique solution of Tx=f.展开更多
BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hyperten...BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.展开更多
AIM:To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh(CTP) and model for end-stage liver disease(MELD)score to predict th...AIM:To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh(CTP) and model for end-stage liver disease(MELD)score to predict that outcome. METHODS:We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period.The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS:Patients who reached the endpoint had a higher MELD score,a higher CTP score and were more likely to have undergone an urgent procedure.Among patients undergoing elective surgical procedures,no statistically significant difference was noted in the mean MELD(12.8±3.9 vs 12.6±4.7,P=0.9)or in the mean CTP(7.6±1.2 vs 7.7±1.7,P=0.8)between patients who reached the endpoint and those who did not.Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures(MELD:22.4± 8.7 vs 15.2±6.4,P=0.0007;CTP:9.9±1.8 vs 8.5±1.8, P=0.008).The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair,without a significant difference between them (AUC=0.755±0.066 for MELD vs AUC=0.696±0.070 for CTP,P=0.3). CONCLUSION:The CTP and MELD scores performedequally,but only fairly in predicting the outcome of urgent surgical procedures.Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.展开更多
In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from...In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from the scattered radiation. Herein, investigation is made of the 3D stray-radiation distribution, the simulation being made of a realistic interventional scenario through use of the Monte Carlo code Geant4 (version 10.3). The simulation is conducted based on the high definition reference Korean-man (HDRK-man) computational phantom and a GE Infinia 3/8” C-arm machine, focusing on the effect of variation of kVp and field of view (FoV) on the scattered particles’ spatial distribution. With direct measurement of the absorbed dose remaining challenging, not least in respect of the organs at risk, we computed the scatter fractions, defined as the ratio of the air kerma free-in-air to the entrance surface air kerma (ESAK), which are both easily quantifiable. Scatter fraction distributions were simulated for X-ray tube outputs (and half-value layers, HVL) of 60 kVp (2.3 mm Al), 80 kVp (3.2 mm Al) and 120 kVp (4.3 mm Al) and FoV of 15, 20, 25 and 30 cm. The distributions are obtained for different height levels, corresponding to the lens of the eye, and the lung and prostate, all radiosensitive organs. Investigations are made for eight likely locations around the patient. At fixed FoV results reveal an inverse relationship between ESAK and kVp, also that change in kVp from 60 to 80 has a greater effect than from 80 to 120. For change in FoV at fixed kVp, the scatter fraction remains constant. The particular staff locations are found to be optimal in seeking mitigation of dose. Moreover, the combined usage of numerical human model and Monte Carlo simulation can be considered as an added value to the radiation safety research field, especially to the interventional radiology staff and to the patient.展开更多
The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on informati...The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on information fusion strategies to enhance its recognition power. The system was implemented using RFID technology. It monitored the presence of surgical tools in the interventional site and the instrument tray and combined the measured information by applying redundant, complementary, and cooperative information fusion strategy to achieve a more comprehensive model of the current situation. An evaluation study was performed that showed a correct classification rate of 97% for the system.展开更多
BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center gu...BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.展开更多
Cupping,as one of the characteristic therapies of traditional Chinese medicine,has been applied for more than 2000 years and has a unique curative effect in clinic.With the evolution of the times,the types and operati...Cupping,as one of the characteristic therapies of traditional Chinese medicine,has been applied for more than 2000 years and has a unique curative effect in clinic.With the evolution of the times,the types and operation techniques of cupping method are also iterating.In the process of its inheritance and development,cupping technology is also known by more and more people.Starting from the development and efficacy of cupping method,this paper introduces the clinical operation steps and precautions of cupping method in detail,and lists the representative diseases such as lumbar muscle strain,herpes zoster,and ankylosing spondylitis,to provide reference for clinical application.展开更多
Pricking-cupping therapy is a Traditional Chinese Medicine(TCM)nursing technology that can adjust the viscera of the human body,make the meridians smooth,and Yin and Yang balanced mainly by means of relieving heat and...Pricking-cupping therapy is a Traditional Chinese Medicine(TCM)nursing technology that can adjust the viscera of the human body,make the meridians smooth,and Yin and Yang balanced mainly by means of relieving heat and detoxification,harmonizing Qi and blood,promoting blood circulation and removing blood stasis,dredging meridians and activating collaterals,reducing swelling and pain,purging heat and calming shock,clearing heat,and opening orifices.Pricking-cupping therapy has a long history and wide application.After thousands of years of development,it has made great progress.They are widely used to treat lumbar disc herniation,herpes zoster,acute arthritis,migraine,and other diseases in China.Through the clinical practice and theoretical exploration of physicians of past dynasties,the therapeutic mechanism and application scope of pricking-cupping therapy have been greatly enriched.Modern TCM practitioners have conducted in-depth researches on the operation norms of the therapy on the basis of the ancients,hoping to grasp the essence of the disease more accurately and make the rational use of the operation technology of the therapy.展开更多
This paper explores the integration of Standard Operating Procedures (SOPs) using virtual reality and smart glasses technology in food manufacturing. The study employs a thorough methodology, combining observational i...This paper explores the integration of Standard Operating Procedures (SOPs) using virtual reality and smart glasses technology in food manufacturing. The study employs a thorough methodology, combining observational insights to develop a comprehensive SOP. Implementation at different firms resulted in significant improvements, reducing product waste and enhancing overall efficiency. The use of virtual reality further augments SOP adoption. The findings underscore SOPs’ transformative influence, offering a tangible solution to challenges in the food production sector. Recommendations include regular SOP reviews and ongoing training for sustained success. Different firms exemplify SOPs as indispensable tools for operational excellence.展开更多
目的探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。方法本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及...目的探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。方法本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及远期预后等资料,并与同期收治的58例中高危单灶性HB患儿进行疗效对比。结果21例多灶性HB患儿中,11例为2个瘤灶,4例为3个瘤灶,1例为5个瘤灶,5例肝内瘤灶超过5个且无法明确计数。21例均接受肿瘤切除手术,其中9例行解剖性肝切除术,11例行不规则肝切除或瘤灶剜除术,1例行联合肝脏离断及门静脉结扎的分次肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)。20例为R0切除,1例为R1切除,术后无一例发生严重并发症。本组多灶性HB患儿接受手术联合化疗的多学科综合治疗后,中位随访时间57个月,18例患儿无瘤生存,3例死亡。本组多灶性HB患儿3年无事件生存率(event-free survival,EFS)为57.58%,3年总生存率(overall survival,OS)为82.00%,局部进展累积发生率(cumulative incidence of local progression,CILP)为38.00%。同期收治的单灶性中高危HB患儿上述指标分别为91.84%、74.96%、20.04%。两组数据对比,差异无统计学意义(P>0.05)。结论多灶性HB经规范外科手术切除辅助术前、术后化疗,可以获得较为满意的预后。展开更多
文摘Traditional Chinese medicine breast massage,also known as breast Tuina or manual expression of breast milk,is a technique of using certain manipulations to act on specific positions or acupoints of the breast to promote blood and lymphatic circulation of breast and facilitate the discharge of stagnant milk.This technique is widely used in China to treat breastfeeding problems such as breast engorgement,mastitis,and postpartum hypogalactia.In this article,we introduce the definition and standardization process of breast massage,elaborate the operating procedures of breast massage in detail,and summarize and discuss the current situation of its clinical application,so as to provide a reference for its wide application and in‑depth research.
文摘Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.
文摘A three-step synthesis strategy for the automatic synthesis of operating procedures in batch processoperations is presented in this paper.The first step is pre-operation which consists of a set of checks that mustbe considered before starting the basic process operation.The second step is operation which is described by a setof basic control instructions.The third step is post-operation described by a set of instructions that must becarried out when the basic process operation is terminated.The three-step synthesis method has been imple-mented as part of a prototype recipe management system.
文摘Objective: The aim of this study was to investigate the situations and factors that cause nurses not to follow standard operating procedures (SOPs) during the clinical trial process. Methods: Five cases involving patients enrolled in a clinical trial were divided into two groups, pre-SOP training and post-SOP training, to compare and observe the process problems and whether nurses fol- lowed SOPs in clinical trials. The causes of problems were analyzed and corrective measures were proposed. Results: Our results indicate significant improvement in compliance with SOPs after training. There were three occurrences of irregular behavior after training compared with 21 occurrences of irregular behavior before training. Conclusions: The quality of clinical trials can be improved if nurses strictly follow SOPs.
文摘As an external treatment technique of traditional Chinese medicine(TCM),auricular point sticking,which is rooted in holographic biology theory and TCM viscera and meridian theory,is a safe and effective treatment method.This article introduces the technology overview and development process.The auricular point sticking technique for constipation is taken as an example to specify the basic requirements,assessment,operational points,acupoint selection and matters needing attention during the implementation of the auricular acupressure technique,providing a reference for the operating procedures of this technique in the clinical treatment of other diseases such as insomnia,diarrhea,colds,hypertension,headache,and dysmenorrhea.
文摘In this paper, we conduct research on the operation mechanism of claim in civil procedure law and the applications on the court trial way reform. The ultimate goal of the rule of law lies in identifying and protecting the rights of citizens. Way to protect the rights of citizens is diverse, but the judicial relief is the most basic and important form of insurance. Everyone can “into” the court and get the impartiality of the judicial relief, is a measure of a country judicial level height and the rule of law implementation degree of important yardstick. Judicial system and judicial procedure to build and build a better, if the subject of litigation rights are not being met and the safeguard, can’t get through the door and it is the legislators and legal scholars over the many efforts are meaningless, under this basic condition, we propose the new perspective on the corresponding issues that is necessary.
基金This work was supported partially by the Teaching and Research Award Fund for Outstanding Young Teachers in Higher Education Institutions by Ministry of Educationthe Department Fund of Science and Technology in Shanghai Higher Education Institutionsthe Special Funds for Major Specialities by the Shanghai Education Committee.
文摘<正>Let 1<ρ≤2,E be a real ρ-uniformly smooth Banach space and T:E→E be a continuous and strongly accretive operator.The purpose of this paper is to investigate the problem of approximating solutions to the equation Tx=f by the Ishikawa iteration procedure with errors (?) where x_0 ∈ E,{u_n},{υ_n}are bounded sequences in E and{α_n},{b_n},{c_n},{a_n~'},{b_n~'},{c_n~'} are real sequences in[0,1].Under the assumption of the condition 0<α≤b_n+c_n,An≥0, it is shown that the iterative sequence{x_n}converges strongly to the unique solution of the equation Tx=f.Furthermore,under no assumption of the condition(?)(b_n~'+c_n~')=0,it is also shown that{x_n}converges strongly to the unique solution of Tx=f.
文摘BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.
文摘AIM:To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh(CTP) and model for end-stage liver disease(MELD)score to predict that outcome. METHODS:We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period.The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS:Patients who reached the endpoint had a higher MELD score,a higher CTP score and were more likely to have undergone an urgent procedure.Among patients undergoing elective surgical procedures,no statistically significant difference was noted in the mean MELD(12.8±3.9 vs 12.6±4.7,P=0.9)or in the mean CTP(7.6±1.2 vs 7.7±1.7,P=0.8)between patients who reached the endpoint and those who did not.Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures(MELD:22.4± 8.7 vs 15.2±6.4,P=0.0007;CTP:9.9±1.8 vs 8.5±1.8, P=0.008).The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair,without a significant difference between them (AUC=0.755±0.066 for MELD vs AUC=0.696±0.070 for CTP,P=0.3). CONCLUSION:The CTP and MELD scores performedequally,but only fairly in predicting the outcome of urgent surgical procedures.Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.
文摘In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from the scattered radiation. Herein, investigation is made of the 3D stray-radiation distribution, the simulation being made of a realistic interventional scenario through use of the Monte Carlo code Geant4 (version 10.3). The simulation is conducted based on the high definition reference Korean-man (HDRK-man) computational phantom and a GE Infinia 3/8” C-arm machine, focusing on the effect of variation of kVp and field of view (FoV) on the scattered particles’ spatial distribution. With direct measurement of the absorbed dose remaining challenging, not least in respect of the organs at risk, we computed the scatter fractions, defined as the ratio of the air kerma free-in-air to the entrance surface air kerma (ESAK), which are both easily quantifiable. Scatter fraction distributions were simulated for X-ray tube outputs (and half-value layers, HVL) of 60 kVp (2.3 mm Al), 80 kVp (3.2 mm Al) and 120 kVp (4.3 mm Al) and FoV of 15, 20, 25 and 30 cm. The distributions are obtained for different height levels, corresponding to the lens of the eye, and the lung and prostate, all radiosensitive organs. Investigations are made for eight likely locations around the patient. At fixed FoV results reveal an inverse relationship between ESAK and kVp, also that change in kVp from 60 to 80 has a greater effect than from 80 to 120. For change in FoV at fixed kVp, the scatter fraction remains constant. The particular staff locations are found to be optimal in seeking mitigation of dose. Moreover, the combined usage of numerical human model and Monte Carlo simulation can be considered as an added value to the radiation safety research field, especially to the interventional radiology staff and to the patient.
文摘The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on information fusion strategies to enhance its recognition power. The system was implemented using RFID technology. It monitored the presence of surgical tools in the interventional site and the instrument tray and combined the measured information by applying redundant, complementary, and cooperative information fusion strategy to achieve a more comprehensive model of the current situation. An evaluation study was performed that showed a correct classification rate of 97% for the system.
文摘BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.
文摘Cupping,as one of the characteristic therapies of traditional Chinese medicine,has been applied for more than 2000 years and has a unique curative effect in clinic.With the evolution of the times,the types and operation techniques of cupping method are also iterating.In the process of its inheritance and development,cupping technology is also known by more and more people.Starting from the development and efficacy of cupping method,this paper introduces the clinical operation steps and precautions of cupping method in detail,and lists the representative diseases such as lumbar muscle strain,herpes zoster,and ankylosing spondylitis,to provide reference for clinical application.
文摘Pricking-cupping therapy is a Traditional Chinese Medicine(TCM)nursing technology that can adjust the viscera of the human body,make the meridians smooth,and Yin and Yang balanced mainly by means of relieving heat and detoxification,harmonizing Qi and blood,promoting blood circulation and removing blood stasis,dredging meridians and activating collaterals,reducing swelling and pain,purging heat and calming shock,clearing heat,and opening orifices.Pricking-cupping therapy has a long history and wide application.After thousands of years of development,it has made great progress.They are widely used to treat lumbar disc herniation,herpes zoster,acute arthritis,migraine,and other diseases in China.Through the clinical practice and theoretical exploration of physicians of past dynasties,the therapeutic mechanism and application scope of pricking-cupping therapy have been greatly enriched.Modern TCM practitioners have conducted in-depth researches on the operation norms of the therapy on the basis of the ancients,hoping to grasp the essence of the disease more accurately and make the rational use of the operation technology of the therapy.
文摘This paper explores the integration of Standard Operating Procedures (SOPs) using virtual reality and smart glasses technology in food manufacturing. The study employs a thorough methodology, combining observational insights to develop a comprehensive SOP. Implementation at different firms resulted in significant improvements, reducing product waste and enhancing overall efficiency. The use of virtual reality further augments SOP adoption. The findings underscore SOPs’ transformative influence, offering a tangible solution to challenges in the food production sector. Recommendations include regular SOP reviews and ongoing training for sustained success. Different firms exemplify SOPs as indispensable tools for operational excellence.
文摘目的探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。方法本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及远期预后等资料,并与同期收治的58例中高危单灶性HB患儿进行疗效对比。结果21例多灶性HB患儿中,11例为2个瘤灶,4例为3个瘤灶,1例为5个瘤灶,5例肝内瘤灶超过5个且无法明确计数。21例均接受肿瘤切除手术,其中9例行解剖性肝切除术,11例行不规则肝切除或瘤灶剜除术,1例行联合肝脏离断及门静脉结扎的分次肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)。20例为R0切除,1例为R1切除,术后无一例发生严重并发症。本组多灶性HB患儿接受手术联合化疗的多学科综合治疗后,中位随访时间57个月,18例患儿无瘤生存,3例死亡。本组多灶性HB患儿3年无事件生存率(event-free survival,EFS)为57.58%,3年总生存率(overall survival,OS)为82.00%,局部进展累积发生率(cumulative incidence of local progression,CILP)为38.00%。同期收治的单灶性中高危HB患儿上述指标分别为91.84%、74.96%、20.04%。两组数据对比,差异无统计学意义(P>0.05)。结论多灶性HB经规范外科手术切除辅助术前、术后化疗,可以获得较为满意的预后。