Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey

BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.

Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations:A propensity-matched analysis of the United States

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United States.Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and death.However,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic.METHODS We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and cirrhosis.The primary outcomes included inpatient mortality,length of stay,and hospitalization costs.Secondary outcomes included the prevalence of systemic complications.RESULTS A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity balance.Overall,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD cohort.However,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD cohorts.CONCLUSION The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 infection.This data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been vaccinated.It will be interesting to see if these trends are present in the subsequent years of the pandemic.

Peripheral actions and direct central-local communications of melanocortin 4 receptor signaling

Melanocortin 4 receptor(MC4R),the most important monogenetic cause of human metabolic disorders,has been of great interest to many researchers in the field of energy homeostasis and public health.Because MC4R is a vital pharmaceutical target for maintaining controllable appetite and body weight for professional athletes,previous studies have mainly focused on the central,rather than the peripheral,roles of MC4R.Thus,the local expression of MC4R and its behavioral regulation remain unclear.In an attempt to shed light on different directions for future studies of MC4R signaling,we review a series of recent and important studies exploring the peripheral functions of MC4R and the direct physiological interaction between peripheral organs and central MC4R neurons in this article.

Atlas of dynamic spectra of fast radio burst FRB 20201124A

Fast radio bursts(FRBs) are highly dispersed millisecond-duration radio bursts,[1,2]of which the physical origin is still not fully understood. FRB 20201124A is one of the most actively repeating FRBs. In this paper, we present the collection of 1863 burst dynamic spectra of FRB 20201124A measured with the Five-hundred-meter Aperture Spherical radio Telescope(FAST). The current collection, taken from the observation during the FRB active phase from April to June 2021, is the largest burst sample detected for any FRB so far. The standard PSRFITs format is adopted, including dynamic spectra of the burst, and the time information of the dynamic spectra, in addition, mask files help readers to identify the pulse positions are also provided. The dataset is available in Science Data Bank, with the link https://www.doi.org/10.57760/sciencedb.j00113.00076.

语言风格对在线评论有用性的影响:调节定向视角

在线评论已经成为许多消费者进行购买决策的重要依据。基于调节定向理论和诊断性模型,本文探讨了在线评论语言风格与调节定向对评论有用性的交互作用、影响机制及边界条件。通过三个实验研究发现,对预防定向(vs.促进定向)消费者而言,陈述性(vs.修辞性)语言更能产生评论有用性感知,而感知诊断性发挥中介作用。本文也确定了服务类型对该机制的再调节作用:对体验服务而言,预防定向(vs.促进定向)消费者对陈述性(vs.修辞性)语言产生更高评论有用性;对信任服务而言,两种调节定向消费者都更喜欢陈述性语言。

Letter to the Editor: Reverse T3;a Reliable Diagnostic Test for Discerning between Euthyroid Sick and Central Hypothyroidism

Letter to the Editor.

A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen （PSA）, prostate volume （PV）, digital rectal examination （DRE） status, % free PSA and transrectal ultrasound （TRUS） findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% （223/535）. The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.

Prostate volume as an independent predictor of prostate ：ancer in men with PSA of 10-50 ng ml-1

Prostate volume （PV） has been shown to be associated with prostate cancer （PCa） detection rates in men with a prostate-specific antigen （PSA） in the ＇grey zone＇ （2.0-10.0 ng ml-1）. However, the PSA ＇grey zone＇ in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10-50 ng ml-1, Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians （〈60 and ≥60 ml）, were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk （odds ratio, 0.02; P〈0.001） compared to other variables. The PCa rates in men with PVs measuring 〈60 and ≥ 60 ml in the 10-19.9 ng ml-1 PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20-50 ng ml- 1 were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10-50 ng ml-1. In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10-50 ng ml-1 regarding their PCa risks.

Bilateral vs unilateral placement of metal stents for inoperable highgrade hilar biliary strictures: A systemic review and meta-analysis

BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction.No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.AIM To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction.METHODS PubMed,Embase,Scopus,and Cochrane databases,as well as secondary sources(bibliographic review of selected articles and major GI proceedings),were searched through January 2019.The primary outcome was the re-intervention rate.Secondary outcomes were a technical success,early and late complications,and stent malfunction rate.Pooled odds ratio(OR)and 95%confidence interval(CI)were calculated for each outcome.RESULTS A total of 9 studies were included(2 prospective Randomized Controlled Study,5 retrospective studies,and 2 abstracts),involving 782 patients with malignant hilar obstruction.Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage(OR=0.59,95%CI:0.40-0.87,P=0.009).There was no difference in the technical success rate(OR=0.7,CI:0.42-1.17,P=0.17),early complication rate(OR=1.56,CI:0.31-7.75,P=0.59),late complication rate(OR=0.91,CI:0.58-1.41,P=0.56)and stent malfunction(OR=0.69,CI:0.42-1.12,P=0.14)between bilateral and unilateral stenting for malignant hilar biliary strictures.CONCLUSION Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures,with no significant difference in technical success,and early or late complication rates.

Modern imaging of the tracheo-bronchial tree

Recent state-of-the-art computed tomography and improved three-dimensional(3-D) postprocessing techniques have revolutionized the capability of visualizing airway pathology,offering physicians an advanced view of pathology and allowing for appropriate management planning.This article is a comprehensive review of trachea and main bronchi imaging,with emphasis on the dynamic airway anatomy,and a discussion of a wide variety of diseases including,but not limited to,congenital large airway abnormalities,tracheobronchial stenoses,benign and malignant neoplasms and tracheobronchomalacia.The importance of multiplanar reconstruction,3-D reconstruction and incorporation of dynamic imaging for non-invasive evaluation of the large airways is stressed.

Prevalence of vitreous floaters in a community sample of smartphone users

AIM: To estimate the prevalence and risk factors for vitreous floaters in the general population. ·METHODS: An electronic survey was administered through a smartphone app asking various demographic and health questions, including whether users experience floaters in their field of vision. Multivariate logistic regression analysis was used to determine risk factors. ·RESULTS: A total of 603 individuals completed the survey, with 76% reporting that they see floaters, and 33% reporting that floaters caused noticeable impairment in vision. Myopes were 3.5 times more likely (P =0.0004), and hyperopes 4.4 times more likely (P =0.0069) to report moderate to severe floaters compared to those with normal vision. Floater prevalence was not significantly affected by respondent age, race, gender, and eye color. ·CONCLUSION: Vitreous floaters were found to be a very common phenomenon in this non -clinical general population sample, and more likely to be impairing in myopes and hyperopes.

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

AIM: To define the magnetic resonance imaging(MRI) parameters differentiating urethral hypermobility(UH) and intrinsic sphincter deficiency(ISD) in women with stress urinary incontinence(SUI).METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic(UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the highresolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and thevolunteer groups:(1) urethral angle;(2) bladder neck descent;(3) status of the periurethral ligaments,(4) vaginal shape;(5) urethral sphincter integrity, length and muscle thickness at mid urethra;(6) bladder neck funneling;(7) status of the puborectalis muscle;(8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows:(1) urethral mobility angle on Q-tip test;(2) Valsalva leak point pressure(VLPP) measured at 250 cc bladder volume; and(3) maximum urethral closure pressure(MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2 O. The ISD incontinence was defined with MUCP pressure below 20 cm H2 O, and VLPP pressure less or equal to 60 cm H2 O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic(ROC) analysis. All statistical analyses were performed using STATA version 9.0(Stata Corp LP, College Station, TX).RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group(P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis(area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options.

Numerical simulation of complex multi-phase fluid of casting process and its applications

The fluid of casting process is a typical kind of multi-phase flow. Actually, many casting phenomena have close relationship with the multi-phase flow, such as molten metal filling process, air entrapment, slag movement, venting process of die casting, gas escaping of lost foam casting and so on. Obviously, in order to analyze these phenomena accurately, numerical simulation of the multi-phase fluid is necessary. Unfortunately, so far, most of the commercial casting simulation systems do not have the ability of multi-phase flow modeling due to the difficulty in the multi-phase flow calculation. In the paper, Finite Different Method (FDM) technique was adopt to solve the multi-phase fluid model. And a simple object of the muiti-phase fluid was analyzed to obtain the fluid rates of the liquid phase and the entrapped air phase.

CONTINUUM TOPOLOGY OPTIMIZATION FOR MONOLITHIC COMPLIANT MECHANISMS OF MICRO-ACTUATORS

A multi-objective scheme for structural topology optimization of distributed compliant mechanisms of micro-actuators in MEMS condition is presented in this work, in which mechanical flexibility and structural stiffness are both considered as objective functions. The compliant micro-mechanism developed in this way can not only provide sufficient output work but also have sufficient rigidity to resist reaction forces and maintain its shape when holding the work-piece. A density filtering approach is also proposed to eliminate numerical instabilities such as checkerboards, mesh-dependency and one-node connected hinges occurring in resulting mechanisms. SIMP is used as the interpolation scheme to indicate the dependence of material modulus on element-regularized densities. The sequential convex programming method, such as the method of moving asymptotes （MMA）, is used to solve the optimization problem. The validation of the presented methodologies is demonstrated by a typical numerical example.

REGULARITY OF THE SOLUTIONS FOR NONLINEAR BIHARMONIC EQUATIONS IN R^N

The purpose of this article is to establish the regularity of the weak solutions for the nonlinear biharmonic equation {△^2u ＋ a（x）u = g（x, u）u∈ H^2（R^N）, where the condition u∈ H^2（R^N） plays the role of a boundary value condition, and as well expresses explicitly that the differential equation is to be satisfied in the weak sense.

Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers

The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm(SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts(honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm(IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.

Effect of β-blocker therapy in diabetic patients with stable coronary heart disease: a meta-analysis

Background β-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD).The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce.This meta-analysis summarizes the evidence relating to the BB therapy in diabetic patients with stable CHD.Methods A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies.PubMed,Embase,and Cochrane central were searched and two authors independently screened studies for eligibility.The quality of studies was assessed with the Newcastle Ottawa scale.The primary outcome of interest was all-cause mortality,cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy.A generic inverse variance model was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate.The significance threshold was set at P-value < 0.05.Heterogeneity was assessed by I2.Results Four non-randomized studies with 9515 participants were selected for the analyses.Four studies were post-hoc analyses of randomized controlled trials,and one article was an analysis of a nationally representative survey.In a fixed effects model,BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality,and MACE (27% and 32% respectively;P-value < 0.05) and was not associated with a reduction in all-cause mortality (HR 1.12;95% CI: 0.94–1.33;P-value = 0.22).Conclusion BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality.Large randomized trials are needed in this population to confirm these findings.

Effectiveness of psychological intervention following sport injury

With increasing attention given to the development and implementation of psychological interventions during the sport injury rehabilitation process,there is a need to document the effectiveness of these interventions.The purpose of this review was to summarize the empirical findings of the effects of psychological interventions in reducing post-injury psychological consequences and improving psychological coping during the injury rehabilitation process among competitive and recreational athletes.In February 2012,utilizing a comprehensive search strategy,we conducted electronic searches of multiple electronic databases for randomized and nonrandomized control trials that evaluated interventions targeting populations of injured competitive and recreational athletes age 17 years and older.We included interventions that directly intervene on injured athletes’ psychological outcomes(e.g.,psychological consequences,psychological coping and re-injury anxiety) and utilized psychological strategies including imagery,goal-setting,relaxation,and other common techniques during the post-injury rehabilitation period.Six studies,described in seven peer-reviewed published articles,met study inclusion criteria and were included in this review.Of those studies,two included randomized control trials,two used before and after study designs and two were case study designs.Two interventions utilized guided imagery and relaxation,two interventions utilized goal-setting and one each utilized microcounseling,written disclosure,and acceptance and commitment therapy.Guided imagery/relaxation was shown to be associated with improved psychological coping and reduced re-injury anxiety. Goal setting,however,was not directly associated with the reduction of negative psychological consequences.Other psychological techniques such as microcounseling skills,acceptance and commitment therapy,and written disclosure have demonstrated effectiveness in reducing negative psychological consequences,improving psychological coping,and reducing re-injury anxiety.Our findings suggest a significant need to develop and implement well-designed intervention studies that target improvement of post-injury psychological outcomes in order to assist injured athletes successfully recovery from sport injury.

Lateral patellofemoral ligament reconstruction to restore functional capacity in patients previously undergoing lateral retinacular release

AIM: To study patient outcomes after surgical correction for iatrogenic patellar instability.METHODS: This retrospective study looked at 17 patients(19 knees) suffering from disabling medial patellar instability following lateral release surgery. All patients underwent lateral patellofemoral ligament(LPFL) reconstruction by a single surgeon. Assessments in all 19 cases included functional outcome scores, range of motion, and assessment for the presence of apprehension sign of the patella to determine if LPFL reconstruction surgery was successful at restoring patellofemoral stability.RESULTS: No patients reported any residual postoperative symptoms of patellar instability. Also no patients demonstrated medial patellar apprehension or examiner induced subluxation with the medial instability test described earlier following LPFL reconstruction. Furthermore, all patients recovered normal range of motion compared to the contralateral limb. For patients with pre and postoperative outcome scores, the mean overall knee injury and osteoarthritis outcome score increased significantly, from 34.39 preoperatively(range: 7.7-70.12) to 69.54 postoperatively(range:26.82-91.46) at final follow-up(P < 0.0001). CONCLUSION: This novel technique for LPFL reconstruction is effective at restoring lateral restraint of the patellofemoral joint and improving joint functionality.

Supermicrosurgery in fingertip defects-split tibial flap of the second toe to reconstruct multiple fingertip defects: A case report

BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand,resulting in exposed distal phalanges of the middle,ring,and small fingers.The amputated distal stumps were not possible for replantation.Free flap coverage was selected in order to achieve better functional outcome.The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity.At 6-month follow-up,all three of the reconstructed fingertips had some preserved nail growth,Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.