General Conditions Research Articles

Acuut hemorragisch oedeem van de kinderleeftijd bij een 9 maanden oude jongen

Acute hemorrhagic edema of infancy in a 9-month-old boy This case report discusses the medical history of a 9-month-old boy with acute hemorrhagic edema of infancy (AHEI). AHEI is an acute cutaneous vasculitis that typically occurs in young children aged 4 to 24 months. Its clinical presentation is characterized by a low-graded fever, non-pitting edema and pronounced purpura. The contrast between the unsettling rash and swelling, and the children’s good general condition is a hallmark of AHEI. It is a benign, self-limiting disease in which complications are rare. As a pediatrician, it is important to recognize AHEI to avoid unnecessary investigations and therapy. In addition, it is crucial to rule out other serious illnesses and to be aware of potentially severe complications.

A singular perturbation result for a class of periodic-parabolic BVPs

Abstract In this article, we obtain a very sharp version of some singular perturbation results going back to Dancer and Hess [Behaviour of a semilinear periodic-parabolic problem when a parameter is small, Lecture Notes in Mathematics, Vol. 1450, Springer-Verlag, Berlin, 1990, pp. 12–19] and Daners and López-Gómez [The singular perturbation problem for the periodic-parabolic logistic equation with indefinite weight functions, J. Dynam. Differential Equations 6 (1994), 659–670] valid for a general class of semilinear periodic-parabolic problems of logistic type under general boundary conditions of mixed type. The results of Dancer and Hess [Behaviour of a semilinear periodic-parabolic problem when a parameter is small, Lecture Notes in Mathematics, Vol. 1450, Springer-Verlag, Berlin, 1990, pp. 12–19] and [The singular perturbation problem for the periodic-parabolic logistic equation with indefinite weight functions, J. Dynam. Differential Equations 6 (1994), 659–670] were found, respectively, for Neumann and Dirichlet boundary conditions with L = − Δ {\mathfrak{L}}=-\Delta . In this article, L {\mathfrak{L}} stands for a general second-order elliptic operator.

Lowering reporting limit values for respirable crystalline silica analysis by X-ray diffraction in preparation of the 0.025mg/m3 occupational exposure limit.

Internationally, respirable crystalline silica (RCS) occupational exposure limits (OELs) are being reassessed and, in some jurisdictions, lowered, putting pressure on the capabilities of the analytical techniques used to achieve robust analyses and reliable detection limits. In preparation of a lower OEL, options for lowering the limit of detection (LoD) for RCS analysis have been assessed. Using a Direct-on-Filter X-Ray Diffraction (XRD) analysis under reduced scan speeds in combination with low-noise RCS sampling filters, an LoD of 0.25 µg/filter and a limit of quantification (LoQ) of 0.82 µg/filter can be achieved. Both limits would translate in an LoD of 0.24 µg/m3 and LoQ of 0.78 µg/m3 when sampling respirable dust for 8h at 2.2L/min, providing a technical solution to monitor exposures at the proposed OEL of 0.025mg/m3 (25 µg /m3) and below, with general sampling conditions as typically applied in Australia. This is the first report showing that the OEL of 0.025mg/m3 (25 µg /m3) is measurable by one of the standardized, direct-on-filter XRD methods.

Comparing the Differences in Adverse Events among Chimeric Antigen Receptor T-Cell Therapies: A Real-World Pharmacovigilance Study

In this study, we compared the similarities and differences in adverse events (AEs) among CAR T-cell products through signal mining via the FDA Adverse Event Reporting System (FAERS) and identified unknown AEs to provide a reference for safe clinical medication. Data from the FAERS database spanning from the fourth quarter of 2017 to the first quarter of 2024 were extracted. Signals were identified using the reporting odds ratio (ROR) method and the Medicines and Healthcare Products Regulatory Agency (MHRA) method. A total of 11,386 AE reports related to six CAR T-cell products were selected. The top three categories of AEs reported were nervous system disorders, immune system disorders, and general disorders and administration site conditions. However, there were variations in the AE spectra among the different CAR T-cell products. The BCMA-targeting drugs idecabtagene vicleucel (Ide-cel) and ciltacabtagene autoleucel (Cilta-cel) were found to be associated with parkinsonism, which were not observed in CD19-targeting drugs. Tisagenlecleucel (Tisa-cel) and axicabtagene ciloleucel (Axi-cel) exhibited cerebrovascular accident-related AEs, graft versus host disease, and abnormal coagulation indices. Cilta-cel was associated with cerebral hemorrhage, intracranial hemorrhage, cranial nerve disorder, and facial nerve disorder. Cardiopulmonary toxicity, including hypoxia, tachypnoea, cardiorenal syndrome, and hypotension, exhibited strong signal intensities and considerable overlap with CRS. The number of positive signals for cardiopulmonary toxicity associated with drugs targeting CD-19 is greater. Clinicians should assess patients prior to medication and closely monitor their vital signs, mental status, and laboratory parameters during treatment.

Disproportionality analysis of data from VigiBase and other global product safety databases on toxicity of iron chelating agents

ABSTRACT Background Iron chelators; deferasirox, deferiprone, and deferoxamine; used to treat iron toxicities due to excessive ingestions or blood transfusions, may cause serious adverse reactions. Research design and methods This study investigates pharmacovigilance data to uncover unknown safety information. Disproportionality analysis was conducted using VigiBase, the WHO global database of individual case safety reports, to known safety profile of products and the FDA Adverse Event Reporting System, reviewing over 117.000 iron chelator cases between 2010 and 2020. Results Commonly reported adverse events for iron chelators are general disorders and administration site conditions and GI-related disorders. Reporting Odds Ratio was calculated for iron chelator associations to headache (common), blurred vision (rare) and sepsis (serious). Strong association between deferoxamine and blurred vision (ROR: 2.47 in VigiBase and 3.04 in FAERS), deferiprone and sepsis (ROR; 5.95 in VigiBase and 1.24 in FAERS) were identified. However, results showed some inconsistent associations, such as headache and deferiprone, blurred vision and deferasirox association as per FAERS data; sepsis and deferasirox and deferoxamine association as per VigiBase data. Forty-five new potential signals with different associative values were suggested. Conclusion The study identified strong associations between specific iron chelators and adverse events, though some inconsistencies were observed in the data. These findings, including the 45 new potential signals, suggest areas for further review and validation with additional data.

When left and right disagree: entropy and von Neumann algebras in quantum gravity with general AlAdS boundary conditions

Euclidean path integrals for UV-completions of d-dimensional bulk quantum gravity were recently studied in [1] by assuming that they satisfy axioms of finiteness, reality, continuity, reflection-positivity, and factorization. Sectors HB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{\\mathcal{B}} $$\\end{document} of the resulting Hilbert space were then defined for any (d − 2)-dimensional surface B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document}, where B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document} may be thought of as the boundary ∂Σ of a bulk Cauchy surface in a corresponding Lorentzian description, and where B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document} includes the specification of appropriate boundary conditions for bulk fields. Cases where B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document} was the disjoint union B ⊔ B of two identical (d − 2)-dimensional surfaces B were studied in detail and, after the inclusion of finite-dimensional ‘hidden sectors,’ were shown to provide a Hilbert space interpretation of the associated Ryu-Takayanagi entropy. The analysis was performed by constructing type-I von Neumann algebras ALB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{A}}_L^B $$\\end{document}, ARB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{A}}_R^B $$\\end{document} that act respectively at the left and right copy of B in B ⊔ B.Below, we consider the case of general B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document}, and in particular for B\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{B} $$\\end{document} = BL ⊔ BR with BL, BR distinct. For any BR, we find that the von Neumann algebra at BL acting on the off-diagonal Hilbert space sector HBL⊔BR\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{B_L\\bigsqcup {B}_R} $$\\end{document} is a central projection of the corresponding type-I von Neumann algebra on the ‘diagonal’ Hilbert space HBL⊔BL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{B_L\\bigsqcup {B}_L} $$\\end{document}. As a result, the von Neumann algebras ALBL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{A}}_L^{B_L} $$\\end{document}, ARBL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{A}}_R^{B_L} $$\\end{document} defined in [1] using the diagonal Hilbert space HBL⊔BL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{B_L\\bigsqcup {B}_L} $$\\end{document} turn out to coincide precisely with the analogous algebras defined using the full Hilbert space of the theory (including all sectors HB\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{\\mathcal{B}} $$\\end{document}). A second implication is that, for any HBL⊔BR\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\mathcal{H}}_{B_L\\bigsqcup {B}_R} $$\\end{document}, including the same hidden sectors as in the diagonal case again provides a Hilbert space interpretation of the Ryu-Takayanagi entropy. We also show the above central projections to satisfy consistency conditions that lead to a universal central algebra relevant to all choices of BL and BR.

Using the load distribution between girders to monitor the condition of bridges

This study looks at the load distribution among beams in a 3-dimensional bridge Finite Element Model under normal traffic loading and the resulting effect of damage, modelled as a localised loss of elements in a beam. The load distribution is captured, both transversely across the girders and also longitudinally along the girders, and used to identify damage that is remote from the strain sensor location. When there is a loss of elements in a section of the bridge (e.g. due to a strike from a vehicle passing underneath), a portion of the load will redistribute along alternative load paths in the structure. This is most pronounced when the position of the loading and the location of the damage align but also happens when they do not. The study examines the effect of vehicles of different weight and axle configuration on the load distribution, and how grouping results by axle configuration can overcome this. A further novelty of this approach is that the strain response can be transformed into an influence line, which then allows data from large populations of general traffic to be used irrespective of axle configuration. The effect of various transverse positions of vehicles within the driving lane is overcome by combining data from large populations of vehicles. An advantage of this method is that the load distribution from a vehicle crossing is calculated as a ratio i.e. when the bridge is experiencing the same general environmental conditions, and thus reducing the difficulty in controlling the effects of varying environmental conditions when comparing results to a healthy baseline.

Criterion for unhomogeneous yielding of porous materials

A criterion is developed for the unhomogeneous yielding of materials containing arbitrarily oriented ellipsoidal voids. The criterion is built upon classical estimates for pure pressure and pure shear. A data-driven approach is then followed to incorporate the effects of void shape and orientation. A large number of micromechanical unit cell results are used to calibrate the yield criterion. A key feature of the criterion is that it predicts a significant reduction of the effective shear yield strength due to mere void inclination, with the reduction increasing with the void dimension perpendicular to the shear. The coupling between tension and shear deformation results in an apparent rotation of the yield surface, which provides a sound micromechanical basis for predicting void closure in shear among other new features. Once supplemented with evolution equations of relevant internal parameters, the resulting constitutive formulation will enable ductile failure simulations heretofore impossible to carry out on a sound physical basis for general loading conditions.

Fourier decay of equilibrium states for bunched attractors

Let M be a closed manifold, and let f:M→M be a C2+α Axiom A diffeomorphism. Suppose that f has an attractor Ω with codimension 1 stable lamination. Under a generic nonlinearity condition and a suitable bunching condition, we prove polynomial Fourier decay in the unstable direction for a large class of invariant measures on Ω. Our result applies in particular for the measure of maximal entropy. We construct in the appendix an explicit solenoid that satisfies the nonlinearity and bunching assumption.

The extended Grossman human capital model with endogenous demand for knowledge

This paper extends the Grossman human capital model by including endogenous demand for knowledge capital. Human capital investment behavior is modeled from the start of a person's life rather than only after she has acquired the optimal stock of knowledge capital or reached the mandatory schooling age. The general condition for the optimal knowledge capital stock and the optimal health capital stock is derived, and the conditions for an individual's choices of interior and corner solutions for learning time that increases knowledge capital stock are presented. The extended Grossman human capital model provides a theoretical basis for explaining and predicting the effects of economic conditions on educational attainment from a distinctive perspective based on the joint determination of health capital and knowledge capital.

FASTOCH: Feasibility of Electronic Patient-Reported Outcomes in Older Patients With Cancer-A Multicenter Prospective Study.

Multiple studies have demonstrated that electronic patient-reported outcomes (ePROs) improve overall survival and quality of life in cancer care. However, there are no specific prospective data on remote ePRO monitoring in the older population, although they represent a significant proportion of patients with cancer. From February 2021 to April 2022, patients age 75 years and older under active anticancer treatment were consecutively recruited in six institutions. Remote ePRO feasibility was determined in intention-to-test (ITT) on the basis of the number of active users in the overall population. Primary failure applied to patients who had no Internet access or declined to test ePROs, while the other patients were assigned to the ITT population. Feasibility was also determined per-protocol on the basis of the number of active patients in the ITT population. Of the 473 patients included, primary failure applied to 288 patients (233 of whom had no Internet access). Among the 185 patients in ITT, 122 used ePROs, leading to a 26% feasibility in ITT and a 66% feasibility per protocol. In a multivariate analysis, the intent to test population was from a higher socioprofessional category (P = .009) and felt in better general condition in the Geriatric 8-score evaluation (P = .002). Active patients significantly differed from the inactive on their self-assessment of a better general condition (P < .001) only. Our multicenter study showed a limited feasibility rate (26%) of remote ePROs monitoring for older patients with cancer, mainly because of technology barriers. Yet, among the patients who did have Internet access, most of them indeed used ePROs (66%). Given the expected benefit of ePROs, the technology barriers therefore need to be lifted to improve cancer care in older patients.

The Study of Remazolam Combined With Propofol on Painless Gastroscopy: A Randomized Controlled Trial

PurposeGastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. Remazolam besylate, a new type of ultrashort-acting benzodiazepine drug, has been less studied in gastroscopy. In this study, we studied the efficacy and safety of remazolam combined with propofol for painless gastroscopy. DesignThis was a single-center, placebo-controlled randomized trial. MethodsOne hundred patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups (n = 50 per group): the control group (Con group) and the remazolam group (Rem group). Sufentanil, remazolam, and propofol were used to anesthetize the patients, and then, the effects of different solutions on these patients were compared and analyzed. The patient's general condition, vital signs at different times, the dosage of propofol (mg) and additional times, complications, duration of gastroscopy (minutes), recovery time (minutes), length of stay in the recovery room (minutes), and adverse reactions were recorded. FindingsRem group systolic blood pressure was more stable (P < .05). The amount of additional propofol in Rem group was less (P < .05). The incidence of hypotension, bradycardia, and dizziness was lower in Rem group, as well as the time of awakening and stay in the recovery room were shorter (P < .05). ConclusionsRemazolam combined with sufentanil and propofol has less effect on hemodynamics in painless gastroscopy, and the patients have shorter awakening times.

A 5-Year Clinical Experience of Pediatric Ophthalmic Ambulatory Surgery Under General Anesthesia From a Chinese Tertiary Children's Hospital

PurposeAmbulatory surgery (same-day or day surgery) is an efficient medical practice. However, there were few reports regarding the safety of ophthalmic ambulatory surgery for children under general anesthesia. This study aims to explore its clinical complications. DesignA retrospective observational study. MethodsThe clinical data of pediatric patients who received ambulatory ophthalmic surgery under general anesthesia at the Children’s Hospital of Fudan University from January 2015 to December 2019 were analyzed retrospectively. Postoperative complications, unplanned reoperation, delayed discharge, and other adverse events were analyzed. FindingsConsecutive patients (N = 4,616) had an average age of 4.6 ± 2.6 years. The primary surgical procedures included chalazion incision and curettage (62.89%), strabismus surgery (18.98%), trichiasis surgery (14.36%), eyelid or orbital mass resection (2.49%), blepharoptosis surgery (0.91%), and other procedures (0.37%). The average operative time was 25.28 ± 20.45 minutes (n = 2,698), while the average length of hospital stay was 8.45 ± 2.61 hours. No serious adverse events or death happened. One case had delayed postoperative hemorrhage, one had a postoperative infection, and two had delayed discharge. The rate of unplanned reoperation was 0.39% 90 days after surgery, with recurrence of chalazion and postoperative complications of ptosis as the primary reasons. ConclusionsPediatric ophthalmic ambulatory surgery under general anesthesia is a feasible and efficient operation mode with few complications for simple procedures with good general conditions. Further randomized controlled studies are needed to provide strong evidence of the safety and socioeconomic efficacy of this mode.

A Rare Clinical Form of Candidaemia: A Pediatric Case of Leukemia with Skin Involvement

Cutaneous involvement is seen in very few patients with candidemia. Cutaneous involvement of candidemia is usually seen in immunocompromised patients with hematologic-oncologic diseases. Lesions may be maculopapular or nodular. In this case report, cutaneous lesions due to disseminated candidemia in an eight-year-old child with leukemia and febrile neutropenia are presented. The general condition of the patient was quite poor. Blood and port cultures grew resistant Candida. The diagnosis was made clinically. The patient was given amphotericin B and voriconazole combination therapy. The lesions disappeared. Today, Candida spp. infections are becoming more common, and the rate of skin involvement is also increasing. However, the diagnosis of Candida skin involvement may be difficult. Histopathology can be used in the diagnosis. Skin involvement is more common in candidemia patients with risk factors, especially in patients with Candida tropicalis growth.

Hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway-based ulcer-healing mechanism of Astragalus Aqueous extract in diabetic foot rats.

The main objective of this work was to investigate the mechanism of Astragalus aqueous extract ulcer healing in diabetic foot model rats through the hypoxia-inducible factor 1-alpha (HIF-1ɑ)/vascular endothelial growth factor (VEGF) signalling pathway. Fifty specific-pathogen-free male Sprague Dawley rats were divided into blank (A), model control (B), Astragalus extract (C) and mupirocin (D) treatment groups. Group A received a regular diet, whereas the other groups received a high-fat/high-sugar diet and intraperitoneal streptozotocin injections to induce diabetes. Diabetic foot ulcers were created via skin excision. Subsequently, ulcers were debrided daily. Groups B, C and D received wet saline gauze, wet gauze with Astragalus extract and gauze with mupirocin, respectively, on the affected area. Group A received no treatment. After 14days, the rats were assessed for ulcer healing and general condition. Immunohistochemistry was used to detect HIF-1ɑ and VEGF levels in the dorsalis pedis artery, and ELISA was used to determine serum IL-6 and CRP levels. The results revealed that Groups C and D had significantly faster ulcer healing compared with Group B (p < 0.01), and ulcer healing was faster in Group C than in Group D (p < 0.01). Group C exhibited notably higher HIF-1ɑ and VEGF protein expression levels compared with Groups B and D (p < 0.01). IL-6 and CRP expression levels in Groups C and D were significantly lower than those in Group B (p < 0.01). In summary, Astragalus aqueous extract effectively treats diabetic foot ulcers by up-regulating HIF-1ɑ and VEGF expression, activating the HIF-1ɑ/VEGF pathway, improving local tissue ischaemia and hypoxia, promoting collateral circulation and enhancing dorsalis pedis artery formation, thereby accelerating ulcer repair in diabetic rats.

Study of the therapeutic strategy to improve survival outcomes from the perspective of perioperative conditions in elderly gastric cancer patients: a propensity score-matched analysis

BackgroundElderly gastric cancer patients (EGCPs) require treatment according to not just the stage of their cancer, but also to their general condition and organ function, and rather than full treatment, the appropriate amount of treatment is necessary.MethodsA total of 425 patients who underwent gastrectomy for primary gastric cancer in our institution between April 2013 and March 2020 were classified by age into two groups: elderly patients (EP, age ≥ 80 years, n = 89); and younger patients (YP, age < 80 years, n = 336). The preoperative, intraoperative, and postoperative conditions of the two groups were then compared. Propensity score matching (PSM) was performed, and factors affecting complications and survival outcomes were examined in detail. In addition, the necessary treatment strategy for EGCPs in the preoperative, intraoperative, and postoperative periods was investigated.ResultsOf the preoperative factors, American Society of Anesthesiologists physical status (ASA-PS) was significantly higher, and respiratory function was significantly lower in the EP group than in the YP group, and the prognostic nutritional index (PNI) also tended to be lower. Of the intraoperative factors, there was no difference in the level of lymph node dissection. However, the EP group had significantly higher rates of postoperative pneumonia and anastomotic leakage. Of the postoperative factors, on simple comparison, postoperative long-term outcomes of the EP group were significantly worse (63.8% vs. 85.4%, p < 0.001), but there was no significant difference in disease-specific survival (DSS), and the DSS survival curves after PSM were almost identical, indicating that the survival rate in the EP group was decreased by death from other disease. Though the survival rate of laparoscopic surgery was significantly better than that of open surgery in the YP group, there was a significantly lower rate of postoperative complications in the EP group after PSM.ConclusionsIn EGCPs, one needs to be aware of short-term complications such as pneumonia and anastomotic leakage due to respiratory dysfunction and malnutrition that are present before surgery. Furthermore, to suppress deaths from other diseases that reduce postoperative survival rates, prevention of postoperative complications (particularly pneumonia) through minimally invasive surgery can be effective.

Beware of misdiagnosis and incorrect treatment of acute gout flare and postoperative infections after arthroscopic surgery for knee gouty arthritis

To analyze the differences of clinical features of acute gout flare and postoperative infection under arthroscopy of knee gouty arthritis patients to offer guiding opinions of clinical diagnosis and treatment. Between January 2017 and December 2022, 235 patients with gouty knee osteoarthritis were admitted, and underwent arthroscopic debridement combined with synovectomy. Among them, 35 cases had fever with a temperature higher than 38 °C postoperatively while acute inflammatory appears under redness, swelling, heat and pain of the operated joints. There were 29 males and 6 females, with an average age of (41.48±13.90) years old. Among them 23 patients were diagnosed with acute gout attack, and recovered well after being given colchicine and prednisolone;12 patients were diagnosed with postoperative joint infection, and were cured after being given anti-infective treatments and cleaning and rinsing of the joint cavity. The two groups of patients were compared and analyzed in terms of preoperative general data, surgical conditions, hematology, joint fluid, limb function and other clinical characteristics. There were no significant difference in the preoperative general data between two groups. The onset of fever in the postoperative acute gout flare group occurred mostly within 48 hours, significantly earlier than that in the postoperative infection group(P=0.037). The visual analogue scale score was significantly higher in the acute gout flare group (5.32±1.38) score than in the postoperative infection group (2.45±0.68) score (P=0.000), while 14 patients with acute gout flare were accompanied by severe pain in other joints. Hematologically, indicators such as white blood cell counts and ratios were significantly higher in both groups. In terms of inflammatory indicators, IL-6, erythrocyte sedimentation rate, procalcitonin and other inflammatory indicators were significantly elevated in both groups, but there was no statistical difference between two groups. The C-reactive protein level in the postoperative infection group (220.97±116.30) mg·L-1 was higher than that in the postoperative acute gout attack group(120.67±82.45) mg·L-1(P=0.006). Blood uric acid (316.55±112.84) μmol·L-1 was higher in the acute postoperative gout flare group than in the postoperative infection group (159.14±126.92) μmol·L-1(P=0.001). In the joint fluid examination of the postoperative infection group, the glucose metabolism indicator was significantly lower than that of the acute gout flare group, and five of them had positive bacterial cultures. The symptoms of acute gout flare could be mistaken as postoperative infection due to their similarity, therefore requires careful differentiation. Differential diagnosis should be based on a combination of clinical signs, hematology and joint fluid findings, and targeted treatment should be given to avoid serious complications.

Evaluation of the effect of dental anxiety on vital signs in the order of third molar extraction

BackgroundDental anxiety is a prevalent concern affecting patients undergoing various dental procedures, particularly surgical interventions. Understanding the impact of patients’ anxiety levels on their physiological responses during dental surgeries, such as third molar impaction surgery, is crucial for optimizing patient care and outcomes. Therefore, this study aimed to investigate the effect of patients’ anxiety levels on vital signs during third molar teeth impaction surgery.MethodsA cross-sectional study was conducted, including 45 randomly selected, healthy patients. Demographic information was recorded after obtaining consent from the patients prior to surgical intervention. Preoperative anxiety levels were determined using the Modified Dental Anxiety Scale (MDAS). Pupil measurements were taken from the patients before surgery, at 10 min after the surgery began, and at 10 min after the surgery ended. Systolic (SBP) and diastolic (DBP) blood pressure, pulse rate, temperature, and haemoglobin oxygen saturation (SpO2) values were recorded.ResultsThe MDAS test results were statistically significantly higher in women compared to men (p < 0.001). Positive correlations were observed between MDAS score and both preoperative pulse rate (r = 0.344, p = 0.021) and SpO2 level during the operation (r = 0.462, p = 0.001). However, no significant correlations were found between MDAS and DBP (p = 0.575), SBP (p = 0.176), fever (p = 0.238), or pupil diameter (p = 0.338).ConclusionsThird molar impaction surgery induces anxiety in adult patients 20 years and older. Vital sign monitoring provides information about the patient’s emotional state, both before and during the procedure. Since anxiety causes changes in vital signs during dental procedures, it is important to follow these findings to have an idea about the general condition of the patients.

Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery

To investigate the effect of Polyetheretherketone (PEEK) rod semi-rigid pedicle screw fixation system in lumbar spine non-fusion surgery. A total of 74 patients with tow-level lumbar degenerative diseases who underwent surgery from March 2017 to December 2019 were divided into PEEK rod group and titanium rod group. In the PEEK rod group, there were 34 patients, including 13 males and 21 females, aged from 51 to 79 years old with an average of (62.4±6.8) years old;There were 1 patient of L1-L3 segments, 7 patients of L2-L4 segments, 20 patients of L3-L5 segments and 6 patients of L4-S1 segments. In the titanium rod group, there were 40 patients, including 17 males and 23 females, aged from 52 to 81 years old with an average of (65.2±7.3) years old;There were 3 patient of L1-L3 segments, 11 patients of L2-L4 segments, 19 patients of L3-L5 segments and 7 patients of L4-S1 segments. The general conditions of operation, such as operation time, intraoperative blood loss, postoperative drainage was recorded. The visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI) were compared in preoperatively and postoperatively(3 months, 12 months and last follow-up) between two groups. The change of range of motion (ROM) was observed by flexion and extension x-ray of lumbar. All patients successfully completed the operation. The follow-up time ranged from 22 to 34 months with an average of(26.8±5.6) months. The operative time (142.2±44.7) min and intraoperative blood loss(166.5±67.4)ml in PEEK group were lower than those in titanium group [(160.7±57.3) min、(212.8±85.4) ml](P<0.05). There was no significant differences in postoperative drainage between the two groups (P>0.05). At the final follow-up visit, in PEEK group and titanium group VAS of low back pain[(0.8±0.4) points vs (1.0±0.5) points], VAS for leg pain [ (0.7±0.4) points vs (0.8±0.5) points] and ODI [(9.8±1.6)% vs (12.1±1.5)%] were compared with preoperative [ (5.8±1.1) points vs (6.0±1.1)points], [ (7.2±1.7) points vs (7.0±1.6) points], [(68.5±8.9)% vs(66.3±8.2)%] were significantly different(P<0.05). There was no significant difference in VAS scores between the two groups at each postoperative time point (P>0.05). At 3 months after surgery, there was no difference in ODI between the two groups (P>0.05). There were significant differences in ODI between PEEK group and titanium rod group at 12 months [(15.5±2.1)% vs (18.4±2.4)%] and at the last follow-up [(9.8±1.6)% vs (12.1±1.5)%] (P<0.05). The total range of motion (ROM) of lumbar decreased in both groups after surgery. At 12 months after surgery and the last follow-up, the PEEK group compared with the titanium rod group, the total range of motion of lumbar was statistically significant (P<0.05). The range of motion (ROM) of the fixed segments decreased in both groups after surgery. The ROM of the fixed segments in PEEK group decreased from (9.5±4.6)° to (4.1±1.9)° at the last follow-up (P<0.05), which in the titanium rod group was decreased from (9.8±4.3)°to (0.9±0.5)° at the last follow-up (P<0.05). The range of motion (ROM) of upper adjacent segment increased in both groups, there was statistical significance in the ROM of upper adjacent segment between the two groups at 12 months after surgery and the last follow-up, (P<0.05). There was no screw loosening and broken rods in both groups during the follow-up period. The PEEK rod semi-rigid pedicle screw internal fixation system used in lumbar non-fusion surgery can retain part of the mobility of the fixed segment, showing comparable short-term clinical efficacy to titanium rod fusion. PEEK rod semi-rigid pedicle screw internal fixation system is a feasible choice for the treatment of lumbar spine degenerative diseases, and its long-term efficacy needs further follow-up observation.

Determining the cut-off value for the Minimal Documentation System (MIDOS2) screening tool to initiate specialized palliative care based on patient’s subjective need for palliative support and symptom burden in inpatients with advanced cancer

PurposeThe Minimal Documentation System (MIDOS2) is recommended as a systematic screening tool for assessing symptom burden and patient needs in advanced cancer patients. Given the absence of an optimal weighting of individual symptoms and a corresponding cut-off value, this study aims to determine a threshold based on inpatient’s subjective need for palliative support. Additionally, we investigate the correlation between symptom burden and subjective need for palliative support collected through a patient-reported outcome measure (PROM) with survival duration of less or more than one year.MethodsInpatients diagnosed with advanced solid cancer completed an electronic PROM, which included the MIDOS2 questionnaire among other tools. Differences in symptom burden were analysed between patients expressing subjective need for palliative support and those with survival of less or more than one year using ANOVA, Mann–Whitney-U Test, logistic regression, Pearson and Spearman correlation tests. Cut-off analyses were performed using a ROC curve. Youden-Index, sensitivity, and specificity measures were used as well.ResultsBetween April 2020 and March 2021, 265 inpatients were included in the study. Using a ROC curve, the MIDOS2 analysis resulted in an Area under the curve (AUC) of 0.732, a corresponding cut-off value of eight points, a sensitivity of 76.36% and a specificity of 62.98% in assessing the subjective need for palliative support. The MIDOS2, with double weighting of the significant symptoms, showed a cut-off value of 14 points, achieving a sensitivity of 78.18% and a specificity of 72.38%. A total of 55 patients (20.8%) expressed a need for support from the palliative care team. This need was independent of the oncological tumour entity and increased among patients with a survival of less than one year. These patients reported significantly poorer physical (p < 0.001) or mental (p < 0.001) condition. Additionally, they reported higher intensities of pain (p = 0.002), depressive symptoms (p < 0.001), weakness (p < 0.001), anxiety (p < 0.001), and tiredness (p < 0.001).ConclusionUsing the established MIDOS2 cut-off value with an adjusted double weighting in our study, a large proportion of inpatients may be accurately referred to SPC based on their subjective need for palliative support. Additionally, subjective reports of poor general, mental, and physical condition, as well as pain, depressive symptoms, weakness, anxiety, and tiredness, increase the subjective need for palliative support, particularly in patients with a survival prognosis of less than one year.