Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

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.

Osteoid osteoma of the elbow mimicking hemophilic arthropathy

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.

Deadwood position matters:Diversity and biomass of saproxylic beetles in a temperate beech forest

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.

Minerals in edible insects:a review of content and potential for sustainable sourcing

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.

Ion emission from warm dense matter produced by irradiation with a soft x-ray free-electron laser

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.

CK母公司PVH集团CEO曼尼·奇里科:流动性是当下重中之重

4月20日,CK母公司PVH集团董事长兼首席执行官曼尼•奇里科(Manny Chirico)接受彭博电视连线访问,讨论新冠疫情对服装饰品类零售业的冲击,这部分业努在疫情结束时将会如何恢复,以及被积压的库存将如何处理等。

High-contrast,high-resolution photochromic silicone polymer based on photoswitchable[Ru(bpy)_(2)OSO]PF_(6)building blocks

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 compound
Rubpy2OSOPF6 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.

Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

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.

基于像素分配的文本检测方法研究

针对现有方法在场景文本检测上的不足,提出一种基于像素分配方的场景文本检测方法,并采用了交叉注意力模块和多尺度特征自适应模块来分别在空间和和通道上优化特征提取;为了丰富不同尺度的特征表示,采用多尺度特征自适应模块进行自动分配不同尺度特征的权重;为了有效获取上下文信息,将特征网络提取到的特征送入交叉注意力模块;对每个像素,在其所在的水平路径和垂直路径上收集上下文信息;再通过循环操作,每一个像素便可以在全图范围内获取上下文信息;通过全卷积网络方法,使用多任务学习框架学习文本实例的几何特征,结合多任务学习的结果完成像素到文本框的分配,经过简单处理后重建文本实例的多边形边界框;在任意形状公开数据集Total-text上进行测试,文章方法的召回率、精确率、F值分别为75.71%、89.15%、81.89%,在多方向公开数据集ICDAR2015上也表现良好,经实验得召回率、精确率、F值分别为79.06%、89.24%、83.84%,证明了文章方法的有效性。

The impact of prehospital blood sampling on the emergency department process of patients with chest pain:a pragmatic non-randomized controlled trial

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.

基于知识蒸馏的低分辨率陶瓷基板图像瑕疵检测

陶瓷基板是电子器件的重要基础材料,利用机器视觉技术结合深度学习策略实现陶瓷基板的瑕疵检测对保证产品质量具有重要的意义。增加成像设备的视场以实现多个陶瓷基板的同时成像,可以显著提高陶瓷基板的检测速度;但也带来了图像分辨率的降低,并最终导致瑕疵检测精度的降低。针对上述问题,本文提出了一种基于知识蒸馏的低分辨率陶瓷基板瑕疵自动检测方法。该方法利用YOLOv5框架分别构建了教师网络和学生网络,基于知识蒸馏思想将教师网络获得的高分辨率图像特征信息指导学生网络的训练,以提高学生网络对低分辨率陶瓷基板图像的瑕疵检测能力;同时,在教师网络中引入基于Coordinate Attention(CA)注意力思想的特征融合模块,使得教师网络学习到的特征同时适应高分辨率图像信息和低分辨率图像信息,从而能较好地指导学生网络的训练;最后,引入基于Gradient Harmonizing Mechanism(GHM)的置信度损失函数,以提高瑕疵的检出率。实验结果表明,本文基于知识蒸馏的陶瓷基板瑕疵检测方法对于224×224分辨率输入图像的污渍、异物、多金、缺瓷以及损伤这五类瑕疵检测的平均准确率和平均召回率分别达到了96.80%和90.01%,相比于目前主流的目标检测算法,本文算法取得了更好的检测结果。

Fractures around the shoulder in the skeletally immature:A scoping review

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.

59000t穿梭油轮船型优化方法

为了使59000t穿梭油轮达到设计航速,进行了模型快速性试验.通过对试验时船模波形分析以及试验结果与船舶数据库内同类船型的直接比较,实现了船型优化.通过Fluent计算为船型优化方案的最终确定提供了依据.计算结果表明,优化船型有效马力下降5%,试验结果显示收到马力下降3.8%,达到了设计航速.

利用化学键方法寻找新型光学晶体(英文)

利用化学键的观点定量地研究了一些具有各种晶体结构实用材料的介电性质。采用已建立的化学键方法 ,分析了这些晶体的介电性质与其组成化学键之间的关系。更进一步 ,基于晶体的化学键方法提出了一个组合方法用于定量确定具有相似晶体结构材料的介电性质。从目前的工作中可以推导出光学晶体非线性起源的结构信息 ,因此可以在一定程度上帮助人们开展非线性光学晶体工程的研究工作。

窒息新生儿生化指标变化及意义

新生儿窒息对器官特别是脑及心肌的损伤的报道较多〔１〕。窒息对肝肾损伤也不能忽视，肾损伤可能比脑损伤出现早〔２〕。为全面了解新生儿窒息对全身器官的损伤，我们对３０例窒息新生儿作心肌酶等１２项生化指标分析，并与非窒息新生儿比较。对象与方法１．受检对象：１...

Within-brood body size and immunological differences in Blue Tit(Cyanistes caeruleus)nestlings relative to ectoparasitism

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.

肝脏炎性假性肿瘤 形态学、细胞光度测定和鉴别诊断

肝脏大部分占位性病变为恶性肿瘤,一为原发性肿瘤,另为转移癌。组织学诊断一般无困难。除常规形态学检查外,目前许多单克隆抗体用于鉴别诊断的免疫组化检查。肝脏炎性假肿瘤的形态学诊断十分困难。

Challenges in diagnosing mesenteric ischemia

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.

Challenges in diagnosing adhesive small bowel obstruction

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.

基于改进YOLOV4的陶瓷基板瑕疵检测

陶瓷基板是半导体元器件的重要基础材料,其瑕疵检测对保证产品质量具有重要的意义。提出了一种基于改进YOLOV4网络的陶瓷基板瑕疵自动检测方法。针对陶瓷基板瑕疵尺寸较小、颜色形状多变以及不同类瑕疵间尺寸变化较大导致的瑕疵检测困难问题,改进的YOLOV4网络通过借鉴Complete Intersection over Union(CIoU)思想优化初始先验框设计,引入基于梯度协调机制的置信度损失函数和十字交叉注意力网络来改善缺陷检测能力。实验结果表明,基于改进YOLOV4的陶瓷基板瑕疵检测方法对于陶瓷基板污染、异物、多金、缺瓷以及损伤这5类瑕疵检测的平均准确性达到98.3%,可满足工业现场对陶瓷基板瑕疵的检测精度要求。