With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of...With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
Colorectal carcinoma is common,particularly on the left side.In 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is base...Colorectal carcinoma is common,particularly on the left side.In 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/CT.The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains unknown.For the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or tubes.The operative plan should be either one-stage or two-stage resection.One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity.Two-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of life.Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing.For the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic decompression.The role of minimally invasive surgery(laparoscopic or robotic)is a subject of debate.Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic complications.The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates.Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes.Management plans are crucial and must be individualized to better fit each case.Core Tip:Acute obstruction is common in patients with more advanced colorectal carcinoma and may be the first manifestation mainly of left-sided obstruction and in elderly individuals.Emergency decompression is mandatory.Emergency surgical resection and primary anastomosis accompanied or not accompanied by proximal defunctioning stoma must be the first treatment choice for fit patients under 70 years.Hartmann’s two-stage procedure,although more preferable,must be the second alternative choice.Emergency endoscopic self-expendable metal stents must be preferred in unfit patients as a bridge to surgery and for palliative treatment in all inoperable cases.However,these basic management principles constitute a general direction.Decision-making is important and should be individualized.展开更多
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modali...BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.展开更多
Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently s...Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.展开更多
Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resista...Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.展开更多
Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients s...Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.展开更多
Drawing upon a characteristic analysis of the latency period in emergencies,this paper proposes an emergency plan selection method based on interval language variables and information entropy to address the challenge ...Drawing upon a characteristic analysis of the latency period in emergencies,this paper proposes an emergency plan selection method based on interval language variables and information entropy to address the challenge of acquiring critical information during this crucial stage.Initially,decision-makers employ interval language variables to express the preference information regarding emergency plans,while also introducing an enhanced information entropy theory to derive the weight coefficients of key indicators.Subsequently,the weighted arithmetic average operator of interval language is applied twice to aggregate the preference information alongside the relative importance of decision-makers and the weight coefficients of key indicators.Finally,the ranking coefficients of each emergency plan are sorted to determine the optimal scheme.The feasibility and effectiveness of this method are demonstrated through a case study involving the selection of an emergency plan for a flood disaster in a specific location.展开更多
To effectively deal with fuzzy and uncertain information in public engineering emergencies,an emergency decision-making method based on multi-granularity language information is proposed.Firstly,decision makers select...To effectively deal with fuzzy and uncertain information in public engineering emergencies,an emergency decision-making method based on multi-granularity language information is proposed.Firstly,decision makers select the appropriate language phrase set according to their own situation,give the preference information of the weight of each key indicator,and then transform the multi-granularity language information through consistency.On this basis,the sequential optimization technology of the approximately ideal scheme is introduced to obtain the weight coefficient of each key indicator.Subsequently,the weighted average operator is used to aggregate the preference information of each alternative scheme with the relative importance of decision-makers and the weight of key indicators in sequence,and the comprehensive evaluation value of each scheme is obtained to determine the optimal scheme.Lastly,the effectiveness and practicability of the method are verified by taking the earthwork collapse accident in the construction of a reservoir as an example.展开更多
Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of th...Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay.Among them,85 cases(September 2018–September 2020)underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter(Group A),and 90 cases(October 2020–September 2023)underwent AE treatment(Group B).The treatment effects of the two groups were compared.Results:The treatment effectiveness of Group B is higher than that of Group A(P<0.05).The urinary hemoglobin level of Group B is lower than that of Group A at 1,6,12,and 24 hours after treatment(P<0.05).Among the 90 cases treated with AE,7 cases had a fever,with body temperatures ranging from 37.3°C to 38.9℃,with a mean temperature of 38.2±0.3℃.Four cases experienced local pain,nausea,and vomiting,while two cases of intra-iliac AE showed transient buttock pain.These patients with adverse reactions were treated symptomatically for 7 days.All patients recovered after treatment.Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition,the renal function returned to normal,and the blood urea nitrogen and blood creatinine test results were within the normal range.After 1 year of follow-up,no hypertension occurred.Conclusion:AE treats MBUS patients in the emergency department with remarkable efficacy.It has the advantages of less damage to the body,rapid hemostasis,high safety,and maximum preservation of organ function.展开更多
The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical...The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical resources.With the advancement of medical information technology,mobile technology,and information management,these features have been gradually incorporated into emergency pre-examination and triage and have shown promising outcomes.In this article,the benefits of implementing mobile technology and the current status of integrated information management to provide a reference for the future development and enhancement of emergency pre-examination and triage are reviewed.展开更多
In recent years,China has formed a more perfect emergency management system,and has achieved more significant results.The form of safety production has maintained a continuous good development trend,showing the charac...In recent years,China has formed a more perfect emergency management system,and has achieved more significant results.The form of safety production has maintained a continuous good development trend,showing the characteristics of"two declines,one being basically flat,and one zero occurrence".In order to further strengthen the implementation of production safety responsibilities and resolutely prevent and contain extremely major accidents,the recent national production safety teleconference deployed 15 measures to pay close attention to the implementation,seriously pursue accountability,adhere to the red line,and immediately carry out in-depth and solid production safety inspections across the country.In such a high pressure situation,the ways to effectively carry out the security management of enterprises were briefly described in this paper.展开更多
The subway is the primary travel tool for urban residents in China. Due to the complex structure of the subway and high personnel density in rush hours, subway evacuation capacity is critical. The subway evacuation mo...The subway is the primary travel tool for urban residents in China. Due to the complex structure of the subway and high personnel density in rush hours, subway evacuation capacity is critical. The subway evacuation model is explored in this work by combining the improved social force model with the view radius using the Vicsek model. The pedestrians are divided into two categories based on different force models. The first category is sensitive pedestrians who have normal responses to emergency signs. The second category is insensitive pedestrians. By simulating different proportions of the insensitive pedestrians, we find that the escape time is directly proportional to the number of insensitive pedestrians and inversely proportional to the view radius. However, when the view radius is large enough, the escape time does not change significantly, and the evacuation of people in a small view radius environment tends to be integrated. With the improvement of view radius conditions, the escape time changes more obviously with the proportion of insensitive pedestrians. A new emergency sign layout is proposed, and the simulations show that the proposed layout can effectively reduce the escape time in a small view radius environment. However, the evacuation effect of the new escape sign layout on the large view radius environment is not apparent. In this case, the exit setting emerges as an additional factor affecting the escape time.展开更多
The importance of ecological environment monitoring was discussed,and the problems in ecological emergency environment monitoring were analyzed.Based on this,some suggestions were put forward for ecological environmen...The importance of ecological environment monitoring was discussed,and the problems in ecological emergency environment monitoring were analyzed.Based on this,some suggestions were put forward for ecological environment emergency monitoring,in order to provide effective reference for relevant staff.展开更多
Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation ...Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.展开更多
BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction ...BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.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
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
BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of p...BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.展开更多
The recoil response of a deep-water drilling riser following an ED(Emergency Disconnection)scenario is a transient and sensitive process.The recoiling displacement of the riser is the resultant of recoil motion and ax...The recoil response of a deep-water drilling riser following an ED(Emergency Disconnection)scenario is a transient and sensitive process.The recoiling displacement of the riser is the resultant of recoil motion and axial stretch.How-ever,it is typically represented by one variable in recoil simulations.As axial deformation is quite small compared with axial motion in the recoil process,it inevitably introduces numerical errors(i.e.,a large number annihilating a small number).Thus,it is hard to perform a quantitative analysis of axial deformation,although a consensus initial deformation is essential for recoil dynamics.Moreover,the triggered axial natural modes have never been examined before.In this study,the recoil response is decomposed into two parts:recoil motion and axial deformation,and a novel model is developed by Galerkin method.It has demonstrated that the initial stretch has a significant effect at the initial stage in recoil.The existing models underestimate the effects of axial deformation.The new model can capture information of triggered natural modes and figure out the modes undergoing dynamic compression.This study can be beneficial to overpull setting,determination of ED time and anti-recoil control optimization.展开更多
基金supported by the National Natural Science Foundation of China under Grant 62131012/61971261。
文摘With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘Colorectal carcinoma is common,particularly on the left side.In 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/CT.The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains unknown.For the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or tubes.The operative plan should be either one-stage or two-stage resection.One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity.Two-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of life.Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing.For the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic decompression.The role of minimally invasive surgery(laparoscopic or robotic)is a subject of debate.Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic complications.The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates.Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes.Management plans are crucial and must be individualized to better fit each case.Core Tip:Acute obstruction is common in patients with more advanced colorectal carcinoma and may be the first manifestation mainly of left-sided obstruction and in elderly individuals.Emergency decompression is mandatory.Emergency surgical resection and primary anastomosis accompanied or not accompanied by proximal defunctioning stoma must be the first treatment choice for fit patients under 70 years.Hartmann’s two-stage procedure,although more preferable,must be the second alternative choice.Emergency endoscopic self-expendable metal stents must be preferred in unfit patients as a bridge to surgery and for palliative treatment in all inoperable cases.However,these basic management principles constitute a general direction.Decision-making is important and should be individualized.
文摘BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.
文摘Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.
基金funded by the Science and Technology Research and Development Plan of the China State Railway Group Company Limited(No.N2023J053).
文摘Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.
文摘Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.
文摘Drawing upon a characteristic analysis of the latency period in emergencies,this paper proposes an emergency plan selection method based on interval language variables and information entropy to address the challenge of acquiring critical information during this crucial stage.Initially,decision-makers employ interval language variables to express the preference information regarding emergency plans,while also introducing an enhanced information entropy theory to derive the weight coefficients of key indicators.Subsequently,the weighted arithmetic average operator of interval language is applied twice to aggregate the preference information alongside the relative importance of decision-makers and the weight coefficients of key indicators.Finally,the ranking coefficients of each emergency plan are sorted to determine the optimal scheme.The feasibility and effectiveness of this method are demonstrated through a case study involving the selection of an emergency plan for a flood disaster in a specific location.
文摘To effectively deal with fuzzy and uncertain information in public engineering emergencies,an emergency decision-making method based on multi-granularity language information is proposed.Firstly,decision makers select the appropriate language phrase set according to their own situation,give the preference information of the weight of each key indicator,and then transform the multi-granularity language information through consistency.On this basis,the sequential optimization technology of the approximately ideal scheme is introduced to obtain the weight coefficient of each key indicator.Subsequently,the weighted average operator is used to aggregate the preference information of each alternative scheme with the relative importance of decision-makers and the weight of key indicators in sequence,and the comprehensive evaluation value of each scheme is obtained to determine the optimal scheme.Lastly,the effectiveness and practicability of the method are verified by taking the earthwork collapse accident in the construction of a reservoir as an example.
文摘Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay.Among them,85 cases(September 2018–September 2020)underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter(Group A),and 90 cases(October 2020–September 2023)underwent AE treatment(Group B).The treatment effects of the two groups were compared.Results:The treatment effectiveness of Group B is higher than that of Group A(P<0.05).The urinary hemoglobin level of Group B is lower than that of Group A at 1,6,12,and 24 hours after treatment(P<0.05).Among the 90 cases treated with AE,7 cases had a fever,with body temperatures ranging from 37.3°C to 38.9℃,with a mean temperature of 38.2±0.3℃.Four cases experienced local pain,nausea,and vomiting,while two cases of intra-iliac AE showed transient buttock pain.These patients with adverse reactions were treated symptomatically for 7 days.All patients recovered after treatment.Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition,the renal function returned to normal,and the blood urea nitrogen and blood creatinine test results were within the normal range.After 1 year of follow-up,no hypertension occurred.Conclusion:AE treats MBUS patients in the emergency department with remarkable efficacy.It has the advantages of less damage to the body,rapid hemostasis,high safety,and maximum preservation of organ function.
文摘The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical resources.With the advancement of medical information technology,mobile technology,and information management,these features have been gradually incorporated into emergency pre-examination and triage and have shown promising outcomes.In this article,the benefits of implementing mobile technology and the current status of integrated information management to provide a reference for the future development and enhancement of emergency pre-examination and triage are reviewed.
文摘In recent years,China has formed a more perfect emergency management system,and has achieved more significant results.The form of safety production has maintained a continuous good development trend,showing the characteristics of"two declines,one being basically flat,and one zero occurrence".In order to further strengthen the implementation of production safety responsibilities and resolutely prevent and contain extremely major accidents,the recent national production safety teleconference deployed 15 measures to pay close attention to the implementation,seriously pursue accountability,adhere to the red line,and immediately carry out in-depth and solid production safety inspections across the country.In such a high pressure situation,the ways to effectively carry out the security management of enterprises were briefly described in this paper.
基金supported by the National Natural Science Foundation of China (Grant Nos. 51874183 and 51874182)the National Key Research and Development Program of China (Grant No. 2018YFC0809300)。
文摘The subway is the primary travel tool for urban residents in China. Due to the complex structure of the subway and high personnel density in rush hours, subway evacuation capacity is critical. The subway evacuation model is explored in this work by combining the improved social force model with the view radius using the Vicsek model. The pedestrians are divided into two categories based on different force models. The first category is sensitive pedestrians who have normal responses to emergency signs. The second category is insensitive pedestrians. By simulating different proportions of the insensitive pedestrians, we find that the escape time is directly proportional to the number of insensitive pedestrians and inversely proportional to the view radius. However, when the view radius is large enough, the escape time does not change significantly, and the evacuation of people in a small view radius environment tends to be integrated. With the improvement of view radius conditions, the escape time changes more obviously with the proportion of insensitive pedestrians. A new emergency sign layout is proposed, and the simulations show that the proposed layout can effectively reduce the escape time in a small view radius environment. However, the evacuation effect of the new escape sign layout on the large view radius environment is not apparent. In this case, the exit setting emerges as an additional factor affecting the escape time.
文摘The importance of ecological environment monitoring was discussed,and the problems in ecological emergency environment monitoring were analyzed.Based on this,some suggestions were put forward for ecological environment emergency monitoring,in order to provide effective reference for relevant staff.
文摘Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.
基金supported by the National Key Research and Development Program of China(2021YFC2501800)。
文摘BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.
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.
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.
文摘BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.
基金supported by the National Natural Science Foundation of China(Grant No.51879161).
文摘The recoil response of a deep-water drilling riser following an ED(Emergency Disconnection)scenario is a transient and sensitive process.The recoiling displacement of the riser is the resultant of recoil motion and axial stretch.How-ever,it is typically represented by one variable in recoil simulations.As axial deformation is quite small compared with axial motion in the recoil process,it inevitably introduces numerical errors(i.e.,a large number annihilating a small number).Thus,it is hard to perform a quantitative analysis of axial deformation,although a consensus initial deformation is essential for recoil dynamics.Moreover,the triggered axial natural modes have never been examined before.In this study,the recoil response is decomposed into two parts:recoil motion and axial deformation,and a novel model is developed by Galerkin method.It has demonstrated that the initial stretch has a significant effect at the initial stage in recoil.The existing models underestimate the effects of axial deformation.The new model can capture information of triggered natural modes and figure out the modes undergoing dynamic compression.This study can be beneficial to overpull setting,determination of ED time and anti-recoil control optimization.
