Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,whi...Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.展开更多
A case of osteoid osteoma of the elbow in a patient with hemophilia A is described. This male patient presented with chronic and nocturnal pain of the left elbow which was alleviated with acetaminophen. Besides pain, ...A case of osteoid osteoma of the elbow in a patient with hemophilia A is described. This male patient presented with chronic and nocturnal pain of the left elbow which was alleviated with acetaminophen. Besides pain, he also complained of stiffness. Before these complaints, he had recurrent bleedings in the elbow because of hemophilia. A delayed diagnosis of osteoid osteoma in the proximal part of the left ulna was established by a bone scan and a multislice spiral computed tomography(CT) scan. The lesion was surgically removed under CT-guidance. The histopathological analyses did not show specific features of osteoid osteoma. Two months after the operation, the complaints decreased and the range of motion of the left elbow improved. A diagnosis of osteoid osteoma of the elbow should be considered in young adult patients with persistent elbow pain and histological confirmation is not always necessary.展开更多
Deadwood plays a key role for biodiversity in forests.A significant number of beetles from this group are currently listed as endangered in the Red List.In addition to other management recommendations,there have been ...Deadwood plays a key role for biodiversity in forests.A significant number of beetles from this group are currently listed as endangered in the Red List.In addition to other management recommendations,there have been recent efforts to enrich stands with dead wood to promote biodiversity.An important parameter for forestry enterprises is the optimization of these interventions.The study investigated the abundance,species richness,gamma diversity,conservation value and biomass of saproxylic beetles in natural forests using window traps.A total of 89traps were used for saproxylic beetle monitoring,of which 29 were placed on lying logs,30 on snags and 30 as controls in forest stand space.A total of 35,011 beetles were recorded in 564 species(61 families).Notably,20,515 of these belong to saproxylic beetles(59%)in 311 species(55%),with 62 classified as Red-List species(20%).In the group of'all saproxylic beetles',the results indicate that a diversity and y diversity(q=0)remain consistent across various deadwood types,whileβdiversity showed significant differences.Significant differences were found in the Red-List species group,where a diversity and y diversity differed,with higher values observed in snags.Rarefaction based total species richness of site was estimated to be 391 species,including 74 Red-Listed species.Comparing the sample coverage of the studied stand categories showed that all saproxylic species exhibit a pronounced preference for inhabiting areas featuring lying logs.Conversely,Red-List species mainly inhabit snags,withβdiversity being more similar to snags and forest stand space.Notably,both the conservation value(weighted average by conservation status)and beetle biomass are significantly highest in snags,whereas stand space shows the lowest values across all measured saproxylic beetle indices.Furthermore,the use of traps set on the poles in forest stand space resulted in an underestimation of the actual stand richness by 20%-25%.Our results support the conclusion that snags are indispensable features in beech forests,playing a key role in promoting high species diversity,especially among Red-List species,and supporting the biomass of saproxylic beetles.Consequently,it becomes crucial to incorporate a higher percentage of standing deadwood in managed forests or actively create equivalent environments by introducing high stumps.展开更多
In response to the rapid increase in world population and subsequent demands for food,edible insects represent an alternative food source for humans that is rich in proteins,amino acids and minerals.Entomophagy is a t...In response to the rapid increase in world population and subsequent demands for food,edible insects represent an alternative food source for humans that is rich in proteins,amino acids and minerals.Entomophagy is a tradition in many countries including China and Thailand,and edible insects have attracted a lot of attention in Western World due to their suitable nutrient composition,high mineral content(e.g.,Fe,Zn,Ca,Mg)and potential use as a supplement in human diet.In this study,we surveyed mineral content in seven insect orders and 67 species of mass produced and wild-harvested edible insects.The total content of essential elements in edible insects was very high in Tenebrio molitor,Bombyx mori,and Zonocerus variegatus.The heavy metal content(summarized for eight species)was below the maximum limit allowed for safe consumption.Sustainable supply of minerals derived from insect biomass is complicated due to the high variations of mineral content in insects and the potential of its change due to processing.展开更多
We report on an experiment performed at the FLASH2 free-electron laser(FEL)aimed at producing warm dense matter via soft x-ray isochoric heating.In the experiment,we focus on study of the ions emitted during the soft ...We report on an experiment performed at the FLASH2 free-electron laser(FEL)aimed at producing warm dense matter via soft x-ray isochoric heating.In the experiment,we focus on study of the ions emitted during the soft x-ray ablation process using time-of-flight electron multipliers and a shifted Maxwell–Boltzmann velocity distribution model.We find that most emitted ions are thermal,but that some impurities chemisorbed on the target surface,such as protons,are accelerated by the electrostatic field created in the plasma by escaped electrons.The morphology of the complex crater structure indicates the presence of several ion groups with varying temperatures.We find that the ion sound velocity is controlled by the ion temperature and show how the ion yield depends on the FEL radiation attenuation length in different materials.展开更多
The implementation of photoinduced linkage isomerism in molecular-based optical materials represents a promising approach for the synthesis of high-contrast,high-resolution photosensitive materials that are necessary...The implementation of photoinduced linkage isomerism in molecular-based optical materials represents a promising approach for the synthesis of high-contrast,high-resolution photosensitive materials that are necessary for high-density(holographic)data storage and/or real-three-dimensional(holographic)displays.The unsolved task of embedding a photofunctional coordination complex into a matrix like polymer polydimethylsiloxane(PDMS)with photoinduced isomerism of a SO-bond in the sulfoxide compoundRubpy2OSOPF6 is addressed.This approach allows to preserve the spectral properties within the solid dielectric environment,with an impact of PDMS on population and relaxation dynamics.All data are discussed in the framework of photofunctionality,storage,and display applications.展开更多
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
BACKGROUND:In patients with chest pain who arrive at the emergency department(ED)by ambulance,venous access is frequently established prehospital,and could be utilized to sample blood.Prehospital blood sampling may sa...BACKGROUND:In patients with chest pain who arrive at the emergency department(ED)by ambulance,venous access is frequently established prehospital,and could be utilized to sample blood.Prehospital blood sampling may save time in the diagnostic process.In this study,the association of prehospital blood draw with blood sample arrival times,troponin turnaround times,and ED length of stay(LOS),number of blood sample mix-ups and blood sample quality were assessed.METHODS:The study was conducted from October 1,2019 to February 29,2020.In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome(ACS),outcomes were compared between cases,in whom prehospital blood draw was performed,and controls,in whom blood was drawn at the ED.Regression analyses were used to assess the association of prehospital blood draw with the time intervals.RESULTS:Prehospital blood draw was performed in 100 patients.In 406 patients,blood draw was performed at the ED.Prehospital blood draw was independently associated with shorter blood sample arrival times,shorter troponin turnaround times and decreased LOS(P<0.001).No differences in the number of blood sample mix-ups and quality were observed(P>0.05).CONCLUSION:For patients with acute chest pain with low suspicion for ACS,prehospital blood sampling is associated with shorter time intervals,while there were no significant differences between the two groups in the validity of the blood samples.展开更多
Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable pote...Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable potential for remodeling,which is why most of these fractures in children can be treated conservatively.However,the key is to understand when a child benefits from surgical management.Clear indications for surgery of these fractures are lacking.This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children.The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures,tenting of the skin with necrosis,associated neurovascular injury,or a floating shoulder.There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic.In the rare case of a symptomatic malunion of the clavicle in children,corrective osteosynthesis is a viable treatment option.For proximal humerus fractures in children,treatment is dictated by the patient's age(and thus remodeling potential)and the amount of fracture displacement.Under ten years of age,even severely displaced fractures can be treated conservatively.From the age of 13 and onwards,surgery has better outcomes for severely displaced(Neer types III and IV)fractures.Between 10 and 13 years of age,the indications for surgical treatment are less clear,with varying cut-off values of angulation(30-60 degrees)or displacement(1/3–2/3 shaft width)in the current literature.展开更多
Several ectoparasites parasitise nestlings decreasing their body condition,growth and survival.To minimise any loss of fitness due to ectoparasites,birds have developed a wide variety of defence mechanisms,potentially...Several ectoparasites parasitise nestlings decreasing their body condition,growth and survival.To minimise any loss of fitness due to ectoparasites,birds have developed a wide variety of defence mechanisms,potentially including hatching asynchrony.According to the Tasty Chick Hypothesis(TCH),the cost of parasitism would be reduced if ectoparasites tend to eat on less immunocompetent nestlings,typically the last-hatched chick in asynchronously hatched broods,as they are in poor body condition.Two predictions of the TCH are that immune capacity is lower in smaller nestlings than in larger ones and that parasites should provoke a more negative effect on smaller nestlings.Here,we test these predictions in a population of Blue Tits(Cyanistes caeruleus)whose broods are parasitised by Hen Fleas(Ceratophyllus gallinae)and Blowflies(Protocalliphora azurea).We recorded the presence of both ectoparasites and analysed the immunocompetence(number of leucocytes per 10,000 erythrocytes and cutaneous immune response to phytohaemagglutinin)and body condition of smaller and larger nestlings within individual broods.The leucocyte count was higher in smaller nestlings than in larger ones,whereas the cutaneous immune response did not differ between smaller and larger nestlings.Smaller nestlings,but not larger nestlings,had lower body mass when fleas were present.Blowflies,by contrast,had no detectable negative effect on nestlings.Overall,our findings provide partial support to the TCH.Lower immune capacity in smaller nestlings than in larger ones was not supported,but Hen Fleas seemed to negatively impact on smaller nestlings more than on larger ones.展开更多
Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment ad...Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.展开更多
Adhesive small bowel obstruction(ASBO)is the most frequently encountered surgical disorder of the small intestine.Up to 80%of ASBO cases resolve spontaneously and do not require invasive treatment.It is important to i...Adhesive small bowel obstruction(ASBO)is the most frequently encountered surgical disorder of the small intestine.Up to 80%of ASBO cases resolve spontaneously and do not require invasive treatment.It is important to identify such patients that will benefit from conservative treatment in order to prevent unnecessarily exposing them to the risks associated with surgical intervention,such as morbidity and further adhesion formation.For the remaining ASBO patients,timely surgical intervention is necessary to prevent small bowel strangulation,which may cause intestinal ischemia and bowel necrosis.While early identification of these patients is key to decreasing ASBO-related morbidity and mortality,the non-specific signs and laboratory findings upon clinic presentation limit timely diagnosis and implementation of appropriate clinical management.Combining the clinical presentation findings with those from other diagnostic imaging modalities,such as abdominal X-ray,computed tomography-scan and water-soluble contrast studies,will improve diagnosis of ASBO and help clinicians to better evaluate the potential of conservative management as a safe strategy for a particular patient.Nonetheless,patients who present with moderate findings by all these approaches continue to represent a challenge.A new diagnostic strategy is urgently needed to further improve our ability to identify early signs of strangulated bowel,and this diagnostic modality should be able to indicate when surgical management is required.A number of potential serum markers have been proposed for this purpose,including intestinal fatty acid binding protein andα-glutathione S transferase.On-going research is attempting to clearly define their diagnostic utility and to optimize their potential role in determining which patients should be managed surgically.展开更多
载波芯片(chip on carrier,COC)是光发射次模块(transmitter optical subassembly,TOSA)的重要组成部分,被广泛应用于光通信领域,实现光电转换。针对载波芯片崩口、定位柱破损以及波导污渍三种不同类别缺陷的实时检测问题,提出了一种基...载波芯片(chip on carrier,COC)是光发射次模块(transmitter optical subassembly,TOSA)的重要组成部分,被广泛应用于光通信领域,实现光电转换。针对载波芯片崩口、定位柱破损以及波导污渍三种不同类别缺陷的实时检测问题,提出了一种基于轻量级卷积神经网络的载波芯片缺陷检测算法YOLO-Efficientnet。为了减少网络参数,缩短检测时间,采用轻量级卷积神经网络Efficientnet作为主干网络对图像进行特征提取,在移动翻转瓶颈卷积(MBConv)的基础上,引入了压缩与激发网络(SENet)的注意力思想,在通道维度上引入注意力机制;为了解决下采样的过程中导致信息丢失的问题,引入空间金字塔池化(SPP)结构来增大图像的感受野,分离出更加显著的上下文特征。针对COC缺陷多尺度以及波导区域污渍小目标难以检测的问题,引入了PANet结构进行多尺度特征融合。实验结果表明,提出的算法对COC缺陷检测的准确率达到了98.5%,检测时间达到每张图片0.42 s,满足实时检测的需求。展开更多
文摘Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.
文摘A case of osteoid osteoma of the elbow in a patient with hemophilia A is described. This male patient presented with chronic and nocturnal pain of the left elbow which was alleviated with acetaminophen. Besides pain, he also complained of stiffness. Before these complaints, he had recurrent bleedings in the elbow because of hemophilia. A delayed diagnosis of osteoid osteoma in the proximal part of the left ulna was established by a bone scan and a multislice spiral computed tomography(CT) scan. The lesion was surgically removed under CT-guidance. The histopathological analyses did not show specific features of osteoid osteoma. Two months after the operation, the complaints decreased and the range of motion of the left elbow improved. A diagnosis of osteoid osteoma of the elbow should be considered in young adult patients with persistent elbow pain and histological confirmation is not always necessary.
基金supported by the Ministry of Agriculture of the Czech Republic(Grant No.QK23020008)。
文摘Deadwood plays a key role for biodiversity in forests.A significant number of beetles from this group are currently listed as endangered in the Red List.In addition to other management recommendations,there have been recent efforts to enrich stands with dead wood to promote biodiversity.An important parameter for forestry enterprises is the optimization of these interventions.The study investigated the abundance,species richness,gamma diversity,conservation value and biomass of saproxylic beetles in natural forests using window traps.A total of 89traps were used for saproxylic beetle monitoring,of which 29 were placed on lying logs,30 on snags and 30 as controls in forest stand space.A total of 35,011 beetles were recorded in 564 species(61 families).Notably,20,515 of these belong to saproxylic beetles(59%)in 311 species(55%),with 62 classified as Red-List species(20%).In the group of'all saproxylic beetles',the results indicate that a diversity and y diversity(q=0)remain consistent across various deadwood types,whileβdiversity showed significant differences.Significant differences were found in the Red-List species group,where a diversity and y diversity differed,with higher values observed in snags.Rarefaction based total species richness of site was estimated to be 391 species,including 74 Red-Listed species.Comparing the sample coverage of the studied stand categories showed that all saproxylic species exhibit a pronounced preference for inhabiting areas featuring lying logs.Conversely,Red-List species mainly inhabit snags,withβdiversity being more similar to snags and forest stand space.Notably,both the conservation value(weighted average by conservation status)and beetle biomass are significantly highest in snags,whereas stand space shows the lowest values across all measured saproxylic beetle indices.Furthermore,the use of traps set on the poles in forest stand space resulted in an underestimation of the actual stand richness by 20%-25%.Our results support the conclusion that snags are indispensable features in beech forests,playing a key role in promoting high species diversity,especially among Red-List species,and supporting the biomass of saproxylic beetles.Consequently,it becomes crucial to incorporate a higher percentage of standing deadwood in managed forests or actively create equivalent environments by introducing high stumps.
基金founded by Jiangsu Agricultural Science and Technology Innovation Fund(CX(20)3179)Dongminghuanghetan Ecological Agriculture Co.,Ltd(204032897)+1 种基金partially funded funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no.861976,project SUSINCHAINthe German Federal Ministry of Education and Research(BMBF),in the frame of FACCE-SURPLUS/FACCE-JPI project UpWaste,grant number 031B0934A。
文摘In response to the rapid increase in world population and subsequent demands for food,edible insects represent an alternative food source for humans that is rich in proteins,amino acids and minerals.Entomophagy is a tradition in many countries including China and Thailand,and edible insects have attracted a lot of attention in Western World due to their suitable nutrient composition,high mineral content(e.g.,Fe,Zn,Ca,Mg)and potential use as a supplement in human diet.In this study,we surveyed mineral content in seven insect orders and 67 species of mass produced and wild-harvested edible insects.The total content of essential elements in edible insects was very high in Tenebrio molitor,Bombyx mori,and Zonocerus variegatus.The heavy metal content(summarized for eight species)was below the maximum limit allowed for safe consumption.Sustainable supply of minerals derived from insect biomass is complicated due to the high variations of mineral content in insects and the potential of its change due to processing.
文摘We report on an experiment performed at the FLASH2 free-electron laser(FEL)aimed at producing warm dense matter via soft x-ray isochoric heating.In the experiment,we focus on study of the ions emitted during the soft x-ray ablation process using time-of-flight electron multipliers and a shifted Maxwell–Boltzmann velocity distribution model.We find that most emitted ions are thermal,but that some impurities chemisorbed on the target surface,such as protons,are accelerated by the electrostatic field created in the plasma by escaped electrons.The morphology of the complex crater structure indicates the presence of several ion groups with varying temperatures.We find that the ion sound velocity is controlled by the ion temperature and show how the ion yield depends on the FEL radiation attenuation length in different materials.
基金This work was financially supported by the Deutsche Forschungsgemeinschaft(project INST 190/137-1)and the Ministry of Science and Culture of Lower Saxony(MWK).
文摘The implementation of photoinduced linkage isomerism in molecular-based optical materials represents a promising approach for the synthesis of high-contrast,high-resolution photosensitive materials that are necessary for high-density(holographic)data storage and/or real-three-dimensional(holographic)displays.The unsolved task of embedding a photofunctional coordination complex into a matrix like polymer polydimethylsiloxane(PDMS)with photoinduced isomerism of a SO-bond in the sulfoxide compoundRubpy2OSOPF6 is addressed.This approach allows to preserve the spectral properties within the solid dielectric environment,with an impact of PDMS on population and relaxation dynamics.All data are discussed in the framework of photofunctionality,storage,and display applications.
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
文摘BACKGROUND:In patients with chest pain who arrive at the emergency department(ED)by ambulance,venous access is frequently established prehospital,and could be utilized to sample blood.Prehospital blood sampling may save time in the diagnostic process.In this study,the association of prehospital blood draw with blood sample arrival times,troponin turnaround times,and ED length of stay(LOS),number of blood sample mix-ups and blood sample quality were assessed.METHODS:The study was conducted from October 1,2019 to February 29,2020.In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome(ACS),outcomes were compared between cases,in whom prehospital blood draw was performed,and controls,in whom blood was drawn at the ED.Regression analyses were used to assess the association of prehospital blood draw with the time intervals.RESULTS:Prehospital blood draw was performed in 100 patients.In 406 patients,blood draw was performed at the ED.Prehospital blood draw was independently associated with shorter blood sample arrival times,shorter troponin turnaround times and decreased LOS(P<0.001).No differences in the number of blood sample mix-ups and quality were observed(P>0.05).CONCLUSION:For patients with acute chest pain with low suspicion for ACS,prehospital blood sampling is associated with shorter time intervals,while there were no significant differences between the two groups in the validity of the blood samples.
文摘Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable potential for remodeling,which is why most of these fractures in children can be treated conservatively.However,the key is to understand when a child benefits from surgical management.Clear indications for surgery of these fractures are lacking.This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children.The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures,tenting of the skin with necrosis,associated neurovascular injury,or a floating shoulder.There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic.In the rare case of a symptomatic malunion of the clavicle in children,corrective osteosynthesis is a viable treatment option.For proximal humerus fractures in children,treatment is dictated by the patient's age(and thus remodeling potential)and the amount of fracture displacement.Under ten years of age,even severely displaced fractures can be treated conservatively.From the age of 13 and onwards,surgery has better outcomes for severely displaced(Neer types III and IV)fractures.Between 10 and 13 years of age,the indications for surgical treatment are less clear,with varying cut-off values of angulation(30-60 degrees)or displacement(1/3–2/3 shaft width)in the current literature.
基金supported by two projects in the National Plan of the Spanish Ministry of Economy and Competition(CGL2014-55969-P and CGL2017-84938-P)the Andalusian government(A-RNM-48-UGR20)+2 种基金financed with FEDER funds from the European Union(EU)funded by Erasmus+grants from the EUsupported by a FPU pre-doctoral contract from the Spanish Ministry of Education(FPU18/03034)。
文摘Several ectoparasites parasitise nestlings decreasing their body condition,growth and survival.To minimise any loss of fitness due to ectoparasites,birds have developed a wide variety of defence mechanisms,potentially including hatching asynchrony.According to the Tasty Chick Hypothesis(TCH),the cost of parasitism would be reduced if ectoparasites tend to eat on less immunocompetent nestlings,typically the last-hatched chick in asynchronously hatched broods,as they are in poor body condition.Two predictions of the TCH are that immune capacity is lower in smaller nestlings than in larger ones and that parasites should provoke a more negative effect on smaller nestlings.Here,we test these predictions in a population of Blue Tits(Cyanistes caeruleus)whose broods are parasitised by Hen Fleas(Ceratophyllus gallinae)and Blowflies(Protocalliphora azurea).We recorded the presence of both ectoparasites and analysed the immunocompetence(number of leucocytes per 10,000 erythrocytes and cutaneous immune response to phytohaemagglutinin)and body condition of smaller and larger nestlings within individual broods.The leucocyte count was higher in smaller nestlings than in larger ones,whereas the cutaneous immune response did not differ between smaller and larger nestlings.Smaller nestlings,but not larger nestlings,had lower body mass when fleas were present.Blowflies,by contrast,had no detectable negative effect on nestlings.Overall,our findings provide partial support to the TCH.Lower immune capacity in smaller nestlings than in larger ones was not supported,but Hen Fleas seemed to negatively impact on smaller nestlings more than on larger ones.
文摘Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.
文摘Adhesive small bowel obstruction(ASBO)is the most frequently encountered surgical disorder of the small intestine.Up to 80%of ASBO cases resolve spontaneously and do not require invasive treatment.It is important to identify such patients that will benefit from conservative treatment in order to prevent unnecessarily exposing them to the risks associated with surgical intervention,such as morbidity and further adhesion formation.For the remaining ASBO patients,timely surgical intervention is necessary to prevent small bowel strangulation,which may cause intestinal ischemia and bowel necrosis.While early identification of these patients is key to decreasing ASBO-related morbidity and mortality,the non-specific signs and laboratory findings upon clinic presentation limit timely diagnosis and implementation of appropriate clinical management.Combining the clinical presentation findings with those from other diagnostic imaging modalities,such as abdominal X-ray,computed tomography-scan and water-soluble contrast studies,will improve diagnosis of ASBO and help clinicians to better evaluate the potential of conservative management as a safe strategy for a particular patient.Nonetheless,patients who present with moderate findings by all these approaches continue to represent a challenge.A new diagnostic strategy is urgently needed to further improve our ability to identify early signs of strangulated bowel,and this diagnostic modality should be able to indicate when surgical management is required.A number of potential serum markers have been proposed for this purpose,including intestinal fatty acid binding protein andα-glutathione S transferase.On-going research is attempting to clearly define their diagnostic utility and to optimize their potential role in determining which patients should be managed surgically.