The safety and stability of high-speed maglev trains traveling on viaducts in crosswinds critically depend on their aerodynamic characteristics.Therefore,this paper uses an improved delayed detached eddy simulation(ID...The safety and stability of high-speed maglev trains traveling on viaducts in crosswinds critically depend on their aerodynamic characteristics.Therefore,this paper uses an improved delayed detached eddy simulation(IDDES)method to investigate the aerodynamic features of high-speed maglev trains with different marshaling lengths under crosswinds.The effects of marshaling lengths(varying from 3-car to 8-car groups)on the train’s aerodynamic performance,surface pressure,and the flow field surrounding the train were investigated using the three-dimensional unsteady compressible Navier-Stokes(N-S)equations.The results showed that the marshaling lengths had minimal influence on the aerodynamic performance of the head and middle cars.Conversely,the marshaling lengths are negatively correlated with the time-average side force coefficient(CS)and time-average lift force coefficient(Cl)of the tail car.Compared to the tail car of the 3-car groups,the CS and Cl fell by 27.77%and 18.29%,respectively,for the tail car of the 8-car groups.It is essential to pay more attention to the operational safety of the head car,as it exhibits the highest time average CS.Additionally,the mean pressure difference between the two sides of the tail car body increased with the marshaling lengths,and the side force direction on the tail car was opposite to that of the head and middle cars.Furthermore,the turbulent kinetic energy of the wake structure on the windward side quickly decreased as marshaling lengths increased.展开更多
AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defoc...AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.展开更多
BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these obser...BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.展开更多
The breakdown of the Heisenberg Uncertainty Principle occurs when energies approach the Planck scale, and the corresponding Schwarzschild radius becomes similar to the Compton wavelength. Both of these quantities are ...The breakdown of the Heisenberg Uncertainty Principle occurs when energies approach the Planck scale, and the corresponding Schwarzschild radius becomes similar to the Compton wavelength. Both of these quantities are approximately equal to the Planck length. In this context, we have introduced a model that utilizes a combination of Schwarzschild’s radius and Compton length to quantify the gravitational length of an object. This model has provided a novel perspective in generalizing the uncertainty principle. Furthermore, it has elucidated the significance of the deforming linear parameter β and its range of variation from unity to its maximum value.展开更多
The fundamental frequency plays a significant part in understanding and perceiving the pitch of a sound. The pitch is a fundamental attribute employed in numerous speech-related works. For fundamental frequency extrac...The fundamental frequency plays a significant part in understanding and perceiving the pitch of a sound. The pitch is a fundamental attribute employed in numerous speech-related works. For fundamental frequency extraction, several algorithms have been developed which one to use relies on the signal’s characteristics and the surrounding noise. Thus, the algorithm’s noise resistance becomes more critical than ever for precise fundamental frequency estimation. Nonetheless, numerous state-of-the-art algorithms face struggles in achieving satisfying outcomes when confronted with speech recordings that are noisy with low signal-to-noise ratio (SNR) values. Also, most of the recent techniques utilize different frame lengths for pitch extraction. From this point of view, This research considers different frame lengths on male and female speech signals for fundamental frequency extraction. Also, analyze the frame length dependency on the speech signal analytically to understand which frame length is more suitable and effective for male and female speech signals specifically. For the validation of our idea, we have utilized the conventional autocorrelation function (ACF), and state-of-the-art method BaNa. This study puts out a potent idea that will work better for speech processing applications in noisy speech. From experimental results, the proposed idea represents which frame length is more appropriate for male and female speech signals in noisy environments.展开更多
In order to reveal the complex network characteristics and evolution principle of China aviation network,the relationship between the node degree and the average path length of China aviation network in 1988,1994,2001...In order to reveal the complex network characteristics and evolution principle of China aviation network,the relationship between the node degree and the average path length of China aviation network in 1988,1994,2001,2008 and 2015 was studied.According to the theory and method of complex network,the network system was constructed with the city where the airport was located as the network node and the airline as the edge of the network.On the basis of the statistical data,the node average path length of China aviation network in 1988,1994,2001,2008 and 2015 was calculated.Through regression analysis,it was found that the node degree had a logarithmic relationship with the average length of node path,and the two parameters of the logarithmic relationship had linear evolutionary trace.Key word:China aviation network,complex network,node degree,average length of node path,logarithmic relationship,evolutionary trace.展开更多
Text summarization aims to generate a concise version of the original text.The longer the summary text is,themore detailed it will be fromthe original text,and this depends on the intended use.Therefore,the problem of...Text summarization aims to generate a concise version of the original text.The longer the summary text is,themore detailed it will be fromthe original text,and this depends on the intended use.Therefore,the problem of generating summary texts with desired lengths is a vital task to put the research into practice.To solve this problem,in this paper,we propose a new method to integrate the desired length of the summarized text into the encoder-decoder model for the abstractive text summarization problem.This length parameter is integrated into the encoding phase at each self-attention step and the decoding process by preserving the remaining length for calculating headattention in the generation process and using it as length embeddings added to theword embeddings.We conducted experiments for the proposed model on the two data sets,Cable News Network(CNN)Daily and NEWSROOM,with different desired output lengths.The obtained results show the proposed model’s effectiveness compared with related studies.展开更多
BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalizat...BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.展开更多
Grain size influences the yield and quality of rice(Oryza sativa L.),and grain length is one of the component traits of grain size.In this study,a near-isogenic line LB3 with long grain size was constructed using japo...Grain size influences the yield and quality of rice(Oryza sativa L.),and grain length is one of the component traits of grain size.In this study,a near-isogenic line LB3 with long grain size was constructed using japonica rice cultivar 02428,with short grain size,as the recipient parent and indica rice cultivar ZYX,with long grain size,as the donor parent,by multi-generation backcrossing and selfing.BSA-seq was used for preliminary QTL mapping and InDel markers were developed to fine map the locus.The major QTL,tentatively named qGL10,for grain length was located in a 128.45 kb region of chromosome 10.Combined with haplotype analysis of rice varieties,expression pattern analysis of candidate genes suggested LOC_Os10g39130(OsMADS56)as a candidate gene.Sequence alignment of OsMADS56 in 02428 and LB3 revealed that there were 15 SNPs in the promoter region and four in the coding region.Further haplotype analysis suggested that SNP9(G/A)located in the TGTCACA motif might account for the different expression levels of OsMADS56 in 02428 and LB3.These results lay a foundation for the application of qGL10 in molecular breeding of new rice varieties.展开更多
BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients wi...BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.展开更多
The plant-pollinator‘arms race’model posits that a major driver of the evolution of elongated corollas in flowers is reciprocal selection for‘morphological fit’between pollinator-tongue length and access distance ...The plant-pollinator‘arms race’model posits that a major driver of the evolution of elongated corollas in flowers is reciprocal selection for‘morphological fit’between pollinator-tongue length and access distance to nectar(usually corolla-tube length).Evidence for the pollinator-mediated selection on tube length and evolution of multiple,correlated floral traits remains inconclusive.To gain possible insights into the strength of stabilizing selection by assessing standing phenotypic variation,we measured a series of functionally important floral traits,including corolla tube length and‘effective’tube depth and degree of style coiling.We then calculated coefficients of variation(CV)for these traits in three field populations of R.schneideriana.Unlike in most long-tubed flowers,the bottom part of the corolla tube is completely occupied by the style,with no room for nectar.The length of this portion of the corolla tube was more variable(higher CV)than the upper part of the corolla tube,suggesting that functional tube depth was under stronger stabilizing selection.The degree of style coiling was negatively related to the corolla-tube length in all three populations of R.schneideriana,suggesting that there may be conflicting selection acting on style length and corolla-tube length,which are otherwise usually tightly correlated.Given the lack of nectar in the flowers of this species,the long corolla tubes and long styles may represent morphological holdovers from ancestors that were pollinated by long-tongued pollinators,as is still seen in related species in the western Himalayas.展开更多
Compliant vertical access risers(CVAR)have broad application prospects in deep-water oil and gas transportation.However,the mechanical behaviors of the CVAR with a variable length during installation remains unclear.T...Compliant vertical access risers(CVAR)have broad application prospects in deep-water oil and gas transportation.However,the mechanical behaviors of the CVAR with a variable length during installation remains unclear.To address this issue,based on the flexible segment method,a model of CVAR with a variable length during installation is established in this study,which is verified by the comparison with commercial software.Then,the mechanical behaviors of CVAR during installation are investigated.The results reveal that the CVAR configuration is significantly affected by the buoyancy blocks.The streamwise displacement of CVAR increases with the increase of current velocity.When the BOP weight is insuffcient,obvious upbending is observed in the lower region and transition region,leading to local compression.When the platform moves in the opposite direction to the current,the maximum stress is larger than that of the scenario when the platform moves in the same direction as the current.展开更多
AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.ME...AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.METHODS:In this cross-sectional study,160 clusters were sampled using multi-stage cluster sampling in Tehran,Iran.After a preliminary interview,the participants underwent optometric examinations including visual acuity and refraction measurement followed by slit lamp biomicroscopy.Finally,ocular imaging was done using the Pentacam AXL to measure AL,ACD,ACV,and ACA.RESULTS:A total of 4519 eyes of 2436 participants were evaluated,of whom 58.0%(n=1412)were female.The mean age of the subjects was 67.32±6.05y(range:60-95y).The mean AL,ACD,ACV,and ACA was 23.22 mm(23.18-23.27 mm),2.61 mm(2.59-2.62 mm),126.56 mm3(125.08-128.04 mm3),and 30.61°(30.3°-30.92°),respectively.In the multivariable model,after adjusting for the effect of both eyes,the longest and shortest AL was seen in myopic and hyperopic subjects,respectively.AL,ACD,ACV and ACA were significantly larger in men compared to women(P<0.001).Except ACA,other evaluated parameters showed an inverse correlation with age(P<0.001),however,this correlation was insignificant for AL(P=0.623).CONCLUSION:Normative value of AL,and other biometric parameters are specific for each ethnicity,age and sex group.Any alteration in these parameters and their effect on refraction should be considered in this age group,especially in case of cataract surgery.展开更多
Background: Bioactive peptides derived from hydrolyzed collagen have broad physiological functions and beneficial effects on human health, ranging from reducing skin aging to modifying lipid metabolism. Telomere lengt...Background: Bioactive peptides derived from hydrolyzed collagen have broad physiological functions and beneficial effects on human health, ranging from reducing skin aging to modifying lipid metabolism. Telomere length shortening is an established biomarker of cellular aging. It is not known if collagen consumption is associated with telomere length protection. Our purpose was to investigate the relationship between dietary collagen consumption and telomere length in a nationally representative US adult population. Methods: We analyzed the data of 6173 adults aged 20 - 84 from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Multivariable linear regression and a generalized additive model with smoothing plot were used to assess the association between the total collagen consumption and log-transformed leukocyte telomere length (LTL). Results: Compared with the lowest quartile of total collagen (Q1), we found that the second quartile of collagen (Q2) consumption (1.36 - 3.40 g/1000kcal) was positively associated with telomere length (β: 0.017;95% CI: 0.006, 0.028;P = 0.022) in the females while no association in the males (β: −0.003;95% CI: −0.019, 0.012;P = 0.678) and overall population (β: 0.008;95% CI: −0.002, 0.018;P = 0.141). The association in the females is nonlinear with an inflection point of 2.5 g/1000kcal (P for non-linearity: Conclusion: In conclusion, moderate dietary collagen has a positive and nonlinear association with telomere length in US females, while no significant associations were found in the males and the overall population.展开更多
AIM:To report the myopia-controlling effect of repeated low-level red-light(RLRL)therapy in patients with Stickler syndrome(STL),an inherited collagenic disease typically presenting with early onset myopia.METHODS:Thr...AIM:To report the myopia-controlling effect of repeated low-level red-light(RLRL)therapy in patients with Stickler syndrome(STL),an inherited collagenic disease typically presenting with early onset myopia.METHODS:Three STL children,aged 3,7,and 11y,received RLRL therapy throughout the follow-up period of 17,3,and 6mo,respectively after exclusion of fundus anomalies.Data on best-corrected visual acuity(BCVA),intraocular pressure,cycloplegic subjective refraction,ocular biometrics,scanning laser ophthalmoscope,optical coherence tomography,genetic testing,systemic disease history,and family history were recorded.RESULTS:At the initiation of the RLRL therapy,the spherical equivalent(SE)of 6 eyes from 3 patients ranged from-3.75 to-20.38 D,axial length(AL)were from 23.88 to 30.68 mm,and BCVA were from 0.4 to 1.0(decimal notation).Myopia progression of all six eyes slowed down after RLRL therapy.AL in five out of the six eyes shortened-0.07 to-0.63 mm.No side effects were observed.CONCLUSION:Three cases of STL whose progression of myopic shift and AL elongation are successfully reduced and even reversed after RLRL therapy.展开更多
AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.M...AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.展开更多
The Extended Exponentially Weighted Moving Average(extended EWMA)control chart is one of the control charts and can be used to quickly detect a small shift.The performance of control charts can be evaluated with the a...The Extended Exponentially Weighted Moving Average(extended EWMA)control chart is one of the control charts and can be used to quickly detect a small shift.The performance of control charts can be evaluated with the average run length(ARL).Due to the deriving explicit formulas for the ARL on a two-sided extended EWMA control chart for trend autoregressive or trend AR(p)model has not been reported previously.The aim of this study is to derive the explicit formulas for the ARL on a two-sided extended EWMA con-trol chart for the trend AR(p)model as well as the trend AR(1)and trend AR(2)models with exponential white noise.The analytical solution accuracy was obtained with the extended EWMA control chart and was compared to the numer-ical integral equation(NIE)method.The results show that the ARL obtained by the explicit formula and the NIE method is hardly different,but the explicit for-mula can help decrease the computational(CPU)time.Furthermore,this is also expanded to comparative performance with the Exponentially Weighted Moving Average(EWMA)control chart.The performance of the extended EWMA control chart is better than the EWMA control chart for all situations,both the trend AR(1)and trend AR(2)models.Finally,the analytical solution of ARL is applied to real-world data in the healthfield,such as COVID-19 data in the United Kingdom and Sweden,to demonstrate the efficacy of the proposed method.展开更多
Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on c...Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.展开更多
BACKGROUND Immunosuppressive therapy and matched sibling donor hematopoietic stem cell transplantation(MSD-HSCT)are the preferred treatments for aplastic anemia(AA).CASE SUMMARY In this report,we describe a 43-year-ol...BACKGROUND Immunosuppressive therapy and matched sibling donor hematopoietic stem cell transplantation(MSD-HSCT)are the preferred treatments for aplastic anemia(AA).CASE SUMMARY In this report,we describe a 43-year-old male patient with severe AA who carried BRIP1(also known as FANCJ),TINF2,and TCIRG1 mutations.Screening of the family pedigree revealed the same TINF2 mutation in his mother and older brother,with his older brother also carrying the BRIP1 variant and demonstrating normal telomere length and hematopoietic function.The patient was successfully treated with oral cyclosporine A,eltrombopag,and acetylcysteine,achieving remission 4 years after receiving MSD-HSCT from his older brother.CONCLUSION This case provides a valuable clinical reference for individuals with suspected pathogenic gene mutations,normal telomere length,and hematopoietic function,highlighting them as potential donors for patients with AA.展开更多
Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher...Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.展开更多
基金supported by Wuyi University Hong Kong and Macao Joint Research and Development Fund(GrantsNos.2021WGALH15,2019WGALH17,2019WGALH15)the National Natural Science Foundation of China-Guangdong Joint Fund(GrantsNo.2019A1515111052)+2 种基金the National Natural Science Foundation of China(Grant No.52202426)a grant from the Research Grants Council(RGC)of the Hong Kong Special Administrative Region(SAR),China(Grants No.15205723)a grant from the Hong Kong Polytechnic University(Grant No.P0045325).
文摘The safety and stability of high-speed maglev trains traveling on viaducts in crosswinds critically depend on their aerodynamic characteristics.Therefore,this paper uses an improved delayed detached eddy simulation(IDDES)method to investigate the aerodynamic features of high-speed maglev trains with different marshaling lengths under crosswinds.The effects of marshaling lengths(varying from 3-car to 8-car groups)on the train’s aerodynamic performance,surface pressure,and the flow field surrounding the train were investigated using the three-dimensional unsteady compressible Navier-Stokes(N-S)equations.The results showed that the marshaling lengths had minimal influence on the aerodynamic performance of the head and middle cars.Conversely,the marshaling lengths are negatively correlated with the time-average side force coefficient(CS)and time-average lift force coefficient(Cl)of the tail car.Compared to the tail car of the 3-car groups,the CS and Cl fell by 27.77%and 18.29%,respectively,for the tail car of the 8-car groups.It is essential to pay more attention to the operational safety of the head car,as it exhibits the highest time average CS.Additionally,the mean pressure difference between the two sides of the tail car body increased with the marshaling lengths,and the side force direction on the tail car was opposite to that of the head and middle cars.Furthermore,the turbulent kinetic energy of the wake structure on the windward side quickly decreased as marshaling lengths increased.
基金the Deputyship for Research and Innovation,Ministry of Education in Saudi Arabia for funding this research work through the project(No.IFKSUOR3-433-1)。
文摘AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.
文摘BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.
文摘The breakdown of the Heisenberg Uncertainty Principle occurs when energies approach the Planck scale, and the corresponding Schwarzschild radius becomes similar to the Compton wavelength. Both of these quantities are approximately equal to the Planck length. In this context, we have introduced a model that utilizes a combination of Schwarzschild’s radius and Compton length to quantify the gravitational length of an object. This model has provided a novel perspective in generalizing the uncertainty principle. Furthermore, it has elucidated the significance of the deforming linear parameter β and its range of variation from unity to its maximum value.
文摘The fundamental frequency plays a significant part in understanding and perceiving the pitch of a sound. The pitch is a fundamental attribute employed in numerous speech-related works. For fundamental frequency extraction, several algorithms have been developed which one to use relies on the signal’s characteristics and the surrounding noise. Thus, the algorithm’s noise resistance becomes more critical than ever for precise fundamental frequency estimation. Nonetheless, numerous state-of-the-art algorithms face struggles in achieving satisfying outcomes when confronted with speech recordings that are noisy with low signal-to-noise ratio (SNR) values. Also, most of the recent techniques utilize different frame lengths for pitch extraction. From this point of view, This research considers different frame lengths on male and female speech signals for fundamental frequency extraction. Also, analyze the frame length dependency on the speech signal analytically to understand which frame length is more suitable and effective for male and female speech signals specifically. For the validation of our idea, we have utilized the conventional autocorrelation function (ACF), and state-of-the-art method BaNa. This study puts out a potent idea that will work better for speech processing applications in noisy speech. From experimental results, the proposed idea represents which frame length is more appropriate for male and female speech signals in noisy environments.
文摘In order to reveal the complex network characteristics and evolution principle of China aviation network,the relationship between the node degree and the average path length of China aviation network in 1988,1994,2001,2008 and 2015 was studied.According to the theory and method of complex network,the network system was constructed with the city where the airport was located as the network node and the airline as the edge of the network.On the basis of the statistical data,the node average path length of China aviation network in 1988,1994,2001,2008 and 2015 was calculated.Through regression analysis,it was found that the node degree had a logarithmic relationship with the average length of node path,and the two parameters of the logarithmic relationship had linear evolutionary trace.Key word:China aviation network,complex network,node degree,average length of node path,logarithmic relationship,evolutionary trace.
基金funded by Vietnam National Foundation for Science and Technology Development(NAFOSTED)under Grant Number 102.05-2020.26。
文摘Text summarization aims to generate a concise version of the original text.The longer the summary text is,themore detailed it will be fromthe original text,and this depends on the intended use.Therefore,the problem of generating summary texts with desired lengths is a vital task to put the research into practice.To solve this problem,in this paper,we propose a new method to integrate the desired length of the summarized text into the encoder-decoder model for the abstractive text summarization problem.This length parameter is integrated into the encoding phase at each self-attention step and the decoding process by preserving the remaining length for calculating headattention in the generation process and using it as length embeddings added to theword embeddings.We conducted experiments for the proposed model on the two data sets,Cable News Network(CNN)Daily and NEWSROOM,with different desired output lengths.The obtained results show the proposed model’s effectiveness compared with related studies.
文摘BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.
基金supported by the Guangdong Provincial Key R&D Program(2021B0707010010)the Key R&D Program of Guangzhou Science and Technology Project(202103000083).
文摘Grain size influences the yield and quality of rice(Oryza sativa L.),and grain length is one of the component traits of grain size.In this study,a near-isogenic line LB3 with long grain size was constructed using japonica rice cultivar 02428,with short grain size,as the recipient parent and indica rice cultivar ZYX,with long grain size,as the donor parent,by multi-generation backcrossing and selfing.BSA-seq was used for preliminary QTL mapping and InDel markers were developed to fine map the locus.The major QTL,tentatively named qGL10,for grain length was located in a 128.45 kb region of chromosome 10.Combined with haplotype analysis of rice varieties,expression pattern analysis of candidate genes suggested LOC_Os10g39130(OsMADS56)as a candidate gene.Sequence alignment of OsMADS56 in 02428 and LB3 revealed that there were 15 SNPs in the promoter region and four in the coding region.Further haplotype analysis suggested that SNP9(G/A)located in the TGTCACA motif might account for the different expression levels of OsMADS56 in 02428 and LB3.These results lay a foundation for the application of qGL10 in molecular breeding of new rice varieties.
文摘BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.
基金This work was supported by the National Natural Science Foundation of China(grant nos.31270281,32030071)to SQHNNSFC(32071671)to ZYT.
文摘The plant-pollinator‘arms race’model posits that a major driver of the evolution of elongated corollas in flowers is reciprocal selection for‘morphological fit’between pollinator-tongue length and access distance to nectar(usually corolla-tube length).Evidence for the pollinator-mediated selection on tube length and evolution of multiple,correlated floral traits remains inconclusive.To gain possible insights into the strength of stabilizing selection by assessing standing phenotypic variation,we measured a series of functionally important floral traits,including corolla tube length and‘effective’tube depth and degree of style coiling.We then calculated coefficients of variation(CV)for these traits in three field populations of R.schneideriana.Unlike in most long-tubed flowers,the bottom part of the corolla tube is completely occupied by the style,with no room for nectar.The length of this portion of the corolla tube was more variable(higher CV)than the upper part of the corolla tube,suggesting that functional tube depth was under stronger stabilizing selection.The degree of style coiling was negatively related to the corolla-tube length in all three populations of R.schneideriana,suggesting that there may be conflicting selection acting on style length and corolla-tube length,which are otherwise usually tightly correlated.Given the lack of nectar in the flowers of this species,the long corolla tubes and long styles may represent morphological holdovers from ancestors that were pollinated by long-tongued pollinators,as is still seen in related species in the western Himalayas.
基金supported by the National Natural Science Foundation of China-Shandong Joint Fund(Grant No.U2006226).
文摘Compliant vertical access risers(CVAR)have broad application prospects in deep-water oil and gas transportation.However,the mechanical behaviors of the CVAR with a variable length during installation remains unclear.To address this issue,based on the flexible segment method,a model of CVAR with a variable length during installation is established in this study,which is verified by the comparison with commercial software.Then,the mechanical behaviors of CVAR during installation are investigated.The results reveal that the CVAR configuration is significantly affected by the buoyancy blocks.The streamwise displacement of CVAR increases with the increase of current velocity.When the BOP weight is insuffcient,obvious upbending is observed in the lower region and transition region,leading to local compression.When the platform moves in the opposite direction to the current,the maximum stress is larger than that of the scenario when the platform moves in the same direction as the current.
基金Supported by National Institute for Medical Research Development(NIMAD)affiliated with the Iranian Ministry of Health and Medical Education(No.963660).
文摘AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.METHODS:In this cross-sectional study,160 clusters were sampled using multi-stage cluster sampling in Tehran,Iran.After a preliminary interview,the participants underwent optometric examinations including visual acuity and refraction measurement followed by slit lamp biomicroscopy.Finally,ocular imaging was done using the Pentacam AXL to measure AL,ACD,ACV,and ACA.RESULTS:A total of 4519 eyes of 2436 participants were evaluated,of whom 58.0%(n=1412)were female.The mean age of the subjects was 67.32±6.05y(range:60-95y).The mean AL,ACD,ACV,and ACA was 23.22 mm(23.18-23.27 mm),2.61 mm(2.59-2.62 mm),126.56 mm3(125.08-128.04 mm3),and 30.61°(30.3°-30.92°),respectively.In the multivariable model,after adjusting for the effect of both eyes,the longest and shortest AL was seen in myopic and hyperopic subjects,respectively.AL,ACD,ACV and ACA were significantly larger in men compared to women(P<0.001).Except ACA,other evaluated parameters showed an inverse correlation with age(P<0.001),however,this correlation was insignificant for AL(P=0.623).CONCLUSION:Normative value of AL,and other biometric parameters are specific for each ethnicity,age and sex group.Any alteration in these parameters and their effect on refraction should be considered in this age group,especially in case of cataract surgery.
文摘Background: Bioactive peptides derived from hydrolyzed collagen have broad physiological functions and beneficial effects on human health, ranging from reducing skin aging to modifying lipid metabolism. Telomere length shortening is an established biomarker of cellular aging. It is not known if collagen consumption is associated with telomere length protection. Our purpose was to investigate the relationship between dietary collagen consumption and telomere length in a nationally representative US adult population. Methods: We analyzed the data of 6173 adults aged 20 - 84 from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Multivariable linear regression and a generalized additive model with smoothing plot were used to assess the association between the total collagen consumption and log-transformed leukocyte telomere length (LTL). Results: Compared with the lowest quartile of total collagen (Q1), we found that the second quartile of collagen (Q2) consumption (1.36 - 3.40 g/1000kcal) was positively associated with telomere length (β: 0.017;95% CI: 0.006, 0.028;P = 0.022) in the females while no association in the males (β: −0.003;95% CI: −0.019, 0.012;P = 0.678) and overall population (β: 0.008;95% CI: −0.002, 0.018;P = 0.141). The association in the females is nonlinear with an inflection point of 2.5 g/1000kcal (P for non-linearity: Conclusion: In conclusion, moderate dietary collagen has a positive and nonlinear association with telomere length in US females, while no significant associations were found in the males and the overall population.
文摘AIM:To report the myopia-controlling effect of repeated low-level red-light(RLRL)therapy in patients with Stickler syndrome(STL),an inherited collagenic disease typically presenting with early onset myopia.METHODS:Three STL children,aged 3,7,and 11y,received RLRL therapy throughout the follow-up period of 17,3,and 6mo,respectively after exclusion of fundus anomalies.Data on best-corrected visual acuity(BCVA),intraocular pressure,cycloplegic subjective refraction,ocular biometrics,scanning laser ophthalmoscope,optical coherence tomography,genetic testing,systemic disease history,and family history were recorded.RESULTS:At the initiation of the RLRL therapy,the spherical equivalent(SE)of 6 eyes from 3 patients ranged from-3.75 to-20.38 D,axial length(AL)were from 23.88 to 30.68 mm,and BCVA were from 0.4 to 1.0(decimal notation).Myopia progression of all six eyes slowed down after RLRL therapy.AL in five out of the six eyes shortened-0.07 to-0.63 mm.No side effects were observed.CONCLUSION:Three cases of STL whose progression of myopic shift and AL elongation are successfully reduced and even reversed after RLRL therapy.
基金Supported by the National Natural Science Foundation of China (No.81770972,No.81970843)。
文摘AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.
基金Thailand Science ResearchInnovation Fund,and King Mongkut's University of Technology North Bangkok Contract No.KMUTNB-FF-65-45.
文摘The Extended Exponentially Weighted Moving Average(extended EWMA)control chart is one of the control charts and can be used to quickly detect a small shift.The performance of control charts can be evaluated with the average run length(ARL).Due to the deriving explicit formulas for the ARL on a two-sided extended EWMA control chart for trend autoregressive or trend AR(p)model has not been reported previously.The aim of this study is to derive the explicit formulas for the ARL on a two-sided extended EWMA con-trol chart for the trend AR(p)model as well as the trend AR(1)and trend AR(2)models with exponential white noise.The analytical solution accuracy was obtained with the extended EWMA control chart and was compared to the numer-ical integral equation(NIE)method.The results show that the ARL obtained by the explicit formula and the NIE method is hardly different,but the explicit for-mula can help decrease the computational(CPU)time.Furthermore,this is also expanded to comparative performance with the Exponentially Weighted Moving Average(EWMA)control chart.The performance of the extended EWMA control chart is better than the EWMA control chart for all situations,both the trend AR(1)and trend AR(2)models.Finally,the analytical solution of ARL is applied to real-world data in the healthfield,such as COVID-19 data in the United Kingdom and Sweden,to demonstrate the efficacy of the proposed method.
基金supported by the National Nature Science Foundation(grant nos.81871577 and 81971864)。
文摘Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.
文摘BACKGROUND Immunosuppressive therapy and matched sibling donor hematopoietic stem cell transplantation(MSD-HSCT)are the preferred treatments for aplastic anemia(AA).CASE SUMMARY In this report,we describe a 43-year-old male patient with severe AA who carried BRIP1(also known as FANCJ),TINF2,and TCIRG1 mutations.Screening of the family pedigree revealed the same TINF2 mutation in his mother and older brother,with his older brother also carrying the BRIP1 variant and demonstrating normal telomere length and hematopoietic function.The patient was successfully treated with oral cyclosporine A,eltrombopag,and acetylcysteine,achieving remission 4 years after receiving MSD-HSCT from his older brother.CONCLUSION This case provides a valuable clinical reference for individuals with suspected pathogenic gene mutations,normal telomere length,and hematopoietic function,highlighting them as potential donors for patients with AA.
文摘Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.
