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

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

Locally Enhanced Flow and Electric Fields Through a Tip Effect for Efficient Flow‑Electrode Capacitive Deionization

Low-electrode capacitive deionization(FCDI)is an emerging desalination technology with great potential for removal and/or recycling ions from a range of waters.However,it still suffers from inefficient charge transfer and ion transport kinetics due to weak turbulence and low electric intensity in flow electrodes,both restricted by the current collectors.Herein,a new tip-array current collector(designated as T-CC)was developed to replace the conventional planar current collectors,which intensifies both the charge transfer and ion transport significantly.The effects of tip arrays on flow and electric fields were studied by both computational simulations and electrochemical impedance spectroscopy,which revealed the reduction of ion transport barrier,charge transport barrier and internal resistance.With the voltage increased from 1.0 to 1.5 and 2.0 V,the T-CC-based FCDI system(T-FCDI)exhibited average salt removal rates(ASRR)of 0.18,0.50,and 0.89μmol cm^(-2) min^(-1),respectively,which are 1.82,2.65,and 2.48 folds higher than that of the conventional serpentine current collectors,and 1.48,1.67,and 1.49 folds higher than that of the planar current collectors.Meanwhile,with the solid content in flow electrodes increased from 1 to 5 wt%,the ASRR for T-FCDI increased from 0.29 to 0.50μmol cm^(-2) min^(-1),which are 1.70 and 1.67 folds higher than that of the planar current collectors.Additionally,a salt removal efficiency of 99.89%was achieved with T-FCDI and the charge efficiency remained above 95%after 24 h of operation,thus showing its superior long-term stability.

Late effects of the treatment of childhood cancer

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies,with more than 80%of children with cancer who have access to contemporary treatment being cured.However,the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes,referred to as late effects,which appear months to years after the completion of cancer treatment.Research has shown that 60%to 90%of childhood cancer survivors(CCSs)develop one or more chronic health conditions,and 20%to 80%of survivors experience severe or life-threatening complications during adulthood.Therefore,understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Wafer‑Scale Vertical 1D GaN Nanorods/2D MoS_(2)/PEDOT:PSS for Piezophototronic Effect‑Enhanced Self‑Powered Flexible Photodetectors

van der Waals(vdW)heterostructures constructed by lowdimensional(0D,1D,and 2D)materials are emerging as one of the most appealing systems in next-generation flexible photodetection.Currently,hand-stacked vdW-type photodetectors are not compatible with large-areaarray fabrication and show unimpressive performance in self-powered mode.Herein,vertical 1D GaN nanorods arrays(NRAs)/2D MoS_(2)/PEDOT:PSS in wafer scale have been proposed for self-powered flexible photodetectors arrays firstly.The as-integrated device without external bias under weak UV illumination exhibits a competitive responsivity of 1.47 A W^(−1)and a high detectivity of 1.2×10^(11)Jones,as well as a fast response speed of 54/71μs,thanks to the strong light absorption of GaN NRAs and the efficient photogenerated carrier separation in type-II heterojunction.Notably,the strain-tunable photodetection performances of device have been demonstrated.Impressively,the device at−0.78%strain and zero bias reveals a significantly enhanced photoresponse with a responsivity of 2.47 A W^(−1),a detectivity of 2.6×10^(11)Jones,and response times of 40/45μs,which are superior to the state-of-the-art self-powered flexible photodetectors.This work presents a valuable avenue to prepare tunable vdWs heterostructures for self-powered flexible photodetection,which performs well in flexible sensors.

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.

Relationship between parenting stress and behavioral and emotional problems in preschool children: A mediation effect analysis

BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.

Variations in quantifying patient reported outcome measures to estimate treatment effect

In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.

Improved Statistical Interconnect Timing Analysis Considering Scattering Effect

We propose an improved statistical approach for modeling interconnect slew that takes into account the scattering effect of a nanoscale wire. We first propose a simple, closed-form scattering effect resistivity model, considering the effects of both width and thickness. Then we use this model to derive statistical expressions of the slew metrics using the SS2M model. We find that the delay and slew can be greatly increased when considering the scattering effect. The proposed statistical SS2M model has an average error of 4.16% with respect to SPICE Monte Carlo simulations, with an average error of standard deviation of only 3.06%.

Effect of Hydrogen Addition on Methane HCCI Engine Ignition Timing and Emissions Using a Multi-zone Model

Ignition timing control is of great importance in homogeneous charge compression ignition engines. The effect of hydrogen addition on methane combustion was investigated using a CHEMKIN multi-zone model. Results show that hydrogen addition advances ignition tim- ing and enhances peak pressure and temperature. A brief analysis of chemical kinetics of methane blending hydrogen is also performed in order to investigate the scope of its appli- cation, and the analysis suggests that OH radical plays an important role in the oxidation. Hydrogen addition increases NOx while decreasing HC and CO emissions. Exhaust gas recir- culation （EGR） also advances ignition timing; however, its effects on emissions are generally the opposite. By adjusting the hydrogen addition and EGR rate, the ignition timing can be regulated with a low emission level. Investigation into zones suggests that NOx is mostly formed in core zones while HC and CO mostly originate in the crevice and the quench layer.

Modeling the Effect of Variable Timing of the Exhaust Valves on SI Engine Emissions for Greener Vehicles

The problem with fixed valve timing that the valve train is set by the automaker for peak efficiency running at a specific point in the engine’s operating range. When the vehicle is moving slower or faster than this ideal operating point the engine’s combustion cycle fails to properly burn the air/fuel mixture leading to considerably compromised engine performance and wastes fuel. Variable Valve Timing (VVT) is a solution developed to overcome this engine deficiency, dynamically altering the valve's opening and closing for optimal performance at any speed. The intension in this work is to contribute towards pursuing the development of variable valve timing (VVT) for improving the engine performance. This investigation covers the effect of exhaust valve opening (EVO), and closing (EVC) angle on engine performance and emissions. The aim is to optimize engine power and brake specific fuel consumption (BSFC) where the effect of engine speed has also been considered. Power, BMEP, BSFC, NO, and CO were calculated and presented to show the effect of varying valve timing on them for all the valve timing cases. The calculations of engine performance were carried out using the simulation and analysis engineering software: LOTUS”, and engine emissions were calculated using “ZINOX” program. Sensitivity analysis shows that the reduction of 10% of (EVO) angle gave a reduction of around 2.5% in power and volumetric efficiency, also a slight increase in nitrogen oxide (NO) and carbon monoxide (CO), while a 10% decrease in (EVC) causes around 1% improvement in Power. The effects of different (VVT) from the simulations are analyzed and compared with those in the reviewed literature.

The effect of urine pregnancy testing on timing of accessing antenatal care and abortion services in Western Nigeria

Objective: Effective confirmation of pregnancy is a basic component of reproductive health services. It is a determinant for accessing antenatal care (ANC) if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the effect of urine pregnancy testing in the timing of presentation for pregnancy care. Method: A cross-sectional study was conducted among 320 women presenting for antenatal care and 300 women presenting for abortion at private sector clinics in Western Nigeria. Results: The median age at first presentation was 20 weeks for ANC clients and 8 weeks for abortion clients. Obtaining urine pregnancy test of one’s accord was associated with a decrease in the gestational age at presentation of 3.7 weeks and 1.5 weeks for antenatal and abortion clients, respectively, independent of all other factors. Conclusion: Bearing in mind that the clinical benefit and public health impact of early presentation for antenatal and abortion services are unequivocal, strategies aimed at decreasing gestational age at presentation for pregnancy care should be given priority. “Fast-track” urine pregnancy testing services should be promoted in the private and public clinics in Nigeria.

240 nm AlGaN-based deep ultraviolet micro-LEDs:size effect versus edge effect

240 nm AlGaN-based micro-LEDs with different sizes are designed and fabricated.Then,the external quantum efficiency(EQE)and light extraction efficiency(LEE)are systematically investigated by comparing size and edge effects.Here,it is revealed that the peak optical output power increases by 81.83%with the size shrinking from 50.0 to 25.0μm.Thereinto,the LEE increases by 26.21%and the LEE enhancement mainly comes from the sidewall light extraction.Most notably,transversemagnetic(TM)mode light intensifies faster as the size shrinks due to the tilted mesa side-wall and Al reflector design.However,when it turns to 12.5μm sized micro-LEDs,the output power is lower than 25.0μm sized ones.The underlying mechanism is that even though protected by SiO2 passivation,the edge effect which leads to current leakage and Shockley-Read-Hall(SRH)recombination deteriorates rapidly with the size further shrinking.Moreover,the ratio of the p-contact area to mesa area is much lower,which deteriorates the p-type current spreading at the mesa edge.These findings show a role of thumb for the design of high efficiency micro-LEDs with wavelength below 250 nm,which will pave the way for wide applications of deep ultraviolet(DUV)micro-LEDs.

Effect of slake durability on time dependent swelling behavior of red-bed siltstone in Sichuan Basin

The swelling behavior of red-bed rocks is a significant factor in the abnormal uplift of subgrades for high-speed railways constructed on the red stratum in the Sichuan Basin,China.The prime objective of this paper is to investigate the impact of mineralogical composition,moisture content,and overburden load on the time-dependent unconfined and oedometric swelling behavior of red-bed siltstone in the context of differences in the slake durability.Twenty samples were prepared for the swelling test,with eleven used for the unconfined swelling and slake index tests and nine for the oedometric swelling test.The temporal dependency of swelling is characterized by the viscosity coefficient of water absorption in a proposed swelling model.Results indicate that the swelling deformation of red-bed rocks is due to a combination of hydration swelling within the rock matrix and crack expansion caused by air breakage.In the unconfined swelling test,the final axial swelling strain of red-bed rocks decreases linearly with increasing slake index,while the viscosity coefficient increases exponentially with the slake index.In the oedometric swelling test,red-bed rocks with lower slake durability show greater sensitivity to lateral constraint and overburden load compared to those with higher slake durability.

Engineering Strategies for Suppressing the Shuttle Effect in Lithium–Sulfur Batteries

Lithium–sulfur(Li–S)batteries are supposed to be one of the most potential next-generation batteries owing to their high theoretical capacity and low cost.Nevertheless,the shuttle effect of firm multi-step two-electron reaction between sulfur and lithium in liquid electrolyte makes the capacity much smaller than the theoretical value.Many methods were proposed for inhibiting the shuttle effect of polysulfide,improving corresponding redox kinetics and enhancing the integral performance of Li–S batteries.Here,we will comprehensively and systematically summarize the strategies for inhibiting the shuttle effect from all components of Li–S batteries.First,the electrochemical principles/mechanism and origin of the shuttle effect are described in detail.Moreover,the efficient strategies,including boosting the sulfur conversion rate of sulfur,confining sulfur or lithium polysulfides(LPS)within cathode host,confining LPS in the shield layer,and preventing LPS from contacting the anode,will be discussed to suppress the shuttle effect.Then,recent advances in inhibition of shuttle effect in cathode,electrolyte,separator,and anode with the aforementioned strategies have been summarized to direct the further design of efficient materials for Li–S batteries.Finally,we present prospects for inhibition of the LPS shuttle and potential development directions in Li–S batteries.

Evaluation of the intracellular lipid-lowering effect of polyphenols extract from highland barley in HepG2 cells

Active ingredients from highland barley have received considerable attention as natural products for developing treatments and dietary supplements against obesity.In practical application,the research of food combinations is more significant than a specific food component.This study investigated the lipid-lowering effect of highland barley polyphenols via lipase assay in vitro and HepG2 cells induced by oleic acid(OA).Five indexes,triglyceride(TG),total cholesterol(T-CHO),low density lipoprotein-cholesterol(LDL-C),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),were used to evaluate the lipidlowering effect of highland barley extract.We also preliminary studied the lipid-lowering mechanism by Realtime fluorescent quantitative polymerase chain reaction(q PCR).The results indicated that highland barley extract contains many components with lipid-lowering effects,such as hyperoside and scoparone.In vitro,the lipase assay showed an 18.4%lipase inhibition rate when the additive contents of highland barley extract were 100μg/m L.The intracellular lipid-lowering effect of highland barley extract was examined using 0.25 mmol/L OA-induced HepG2 cells.The results showed that intracellular TG,LDL-C,and T-CHO content decreased by 34.4%,51.2%,and 18.4%,respectively.ALT and AST decreased by 51.6%and 20.7%compared with the untreated hyperlipidemic HepG2 cells.q PCR results showed that highland barley polyphenols could up-regulation the expression of lipid metabolism-related genes such as PPARγand Fabp4.

Effect of Timing of Circumcision on Sexual Satisfaction and Function

Objectives: Male circumcision is a commonly-performed surgical procedure in the world. Currently, no consensus exists about the role of the foreskin or the effect circumcision on sexual satisfaction. All previous studies have evaluated the effect of adult circumcision on sexual function. In this study, we responded to “Does circumcision timing have different effects on sexual function?” Methods: Based on circumcision timing (receiving circumcision in less than 18 year olds or older than 18 year olds), the participants were divided into two groups. The following data and measurements were investigated: IIEF-5 score, sexual satisfaction, sexual activity [number of sexual attempt/week] and ability to achieve or maintain an erection. Results: Two hundred and fifty cases including 125 men were investigated in each group. The baseline demographic (age, marital status, education, smoking) was similar in the 2 groups. No statistically significant differences were seen regarding their sexual satisfaction (P = 0.65), sexual activity [number of sexual attempt/week] (P = 0.74), ability to achieve or maintain an erection (P = 0.44), (P = 0.9). The total mean IIEF-5 score was 24.21 +/- 1.94 and 22.23 +/- 1.12 in groups 1 and 2, respectively (p = 0.5). Conclusion: We concluded that the age at which the circumcision is preformed has no effect on the degree of sexual function and satisfaction.

Timing of Crop Removal Has Limited Effect on Merlot Grape and Wine Composition

Cluster removal during the growing season is a widely utilized vineyard management practice aiming to balance crop load to the capacity of the vine to ripen the fruit. Research was undertaken over two growing seasons (2008-2009) in Hawke’s Bay, a cool climate region of New Zealand, to establish the influence of different times of crop removal on Merlot vine growth and fruit and wine composition. The test vineyard was high-yielding, to 23 t/ha, and vigorous. A commercial standard of apical cluster thinning to remove 20 clusters per vine from vines with ca 44 clusters in 2008 and ca 47 in 2009, was carried out on uniform vigour, 7yo grafted Merlot vines at nine times between prebloom and six weeks post veraison. The 2009 season was naturally higher yielding. Timing of crop removal had no significant effect on vine vegetative growth in terms of enhanced shoot growth as measured by cane weights at pruning, or canopy leaf density. Time of thinning also had no effect on overall grape yield, cluster weight, and berry weight. There were limited effects on fruit ripeness in one season (2009) at the veraison time of thinning only, with increased Brix and lower TA levels. Berry anthocyanin concentrations were enhanced by cluster thinning in 2008, and more so when undertaken at or soon after veraison. There was however no influence of removal timing on anthocyanin levels and total phenolics in the wines. Grape ripeness, must and wine composition tended to respond more from crop removal at veraison than the other times evaluated. Data suggest that vine response was modified by excessive leafiness and shading.

Rockburst criterion and evaluation method for potential rockburst pit depth considering excavation damage effect

Excavation-induced disturbances in deep tunnels will lead to deterioration of rock properties and formation of excavation damaged zone(EDZ).This excavation damage effect may affect the potential rockburst pit depth.Taking two diversion tunnels of Jinping II hydropower station for example,the relationship between rockburst pit depth and excavation damage effect is first surveyed.The results indicate that the rockburst pit depth in tunnels with severe damage to rock masses is relatively large.Subsequently,the excavation-induced damage effect is characterized by disturbance factor D based on the Hoek-Brown criterion and wave velocity method.It is found that the EDZ could be further divided into a high-damage zone(HDZ)with D=1 and weak-damage zone(WDZ),and D decays from one to zero linearly.For this,a quantitative evaluation method for potential rockburst pit depth is established by presenting a three-element rockburst criterion considering rock strength,geostress and disturbance factor.The evaluation results obtained by this method match well with actual observations.In addition,the weakening of rock mass strength promotes the formation and expansion of potential rockburst pits.The potential rockburst pit depth is positively correlated with HDZ and WDZ depths,and the HDZ depth has a significant contribution to the potential rockburst pit depth.

Experimental study on the effect of water absorption level on rockburst occurrence of sandstone

To investigate the mechanism of rockburst prevention by spraying water onto the surrounding rocks,15 experiments are performed considering different water absorption levels on a single face.High-speed photography and acoustic emission(AE)system are used to monitor the rockburst process.The effect of water on sandstone rockburst and the prevention mechanism of water on sandstone rockburst are analyzed from the perspective of energy and failure mode.The results show that the higher the ab-sorption degree,the lower the intensity of the rockburst after absorbing water on single side of sand-stone.This is reflected in the fact that with the increase in the water absorption level,the ejection velocity of rockburst fragments is smaller,the depth of the rockburst pit is shallower,and the AE energy is smaller.Under the water absorption level of 100%,the magnitude of rockburst intensity changes from medium to slight.The prevention mechanism of water on sandstone rockburst is that water reduces the capacity of sandstone to store strain energy and accelerates the expansion of shear cracks,which is not conducive to the occurrence of plate cracking before rockburst,and destroys the conditions for rockburst incubation.

High responsivity photodetectors based on graphene/WSe_(2) heterostructure by photogating effect

Graphene, with its zero-bandgap electronic structure, is a highly promising ultra-broadband light absorbing material.However, the performance of graphene-based photodetectors is limited by weak absorption efficiency and rapid recombination of photoexcited carriers, leading to poor photodetection performance. Here, inspired by the photogating effect, we demonstrated a highly sensitive photodetector based on graphene/WSe_(2) vertical heterostructure where the WSe_(2) layer acts as both the light absorption layer and the localized grating layer. The graphene conductive channel is induced to produce more carriers by capacitive coupling. Due to the strong light absorption and high external quantum efficiency of multilayer WSe_(2), as well as the high carrier mobility of graphene, a high photocurrent is generated in the vertical heterostructure. As a result, the photodetector exhibits ultra-high responsivity of 3.85×10~4A/W and external quantum efficiency of 1.3 × 10~7%.This finding demonstrates that photogating structures can effectively enhance the sensitivity of graphene-based photodetectors and may have great potential applications in future optoelectronic devices.