deep

  • 文章类型: Journal Article
    随机研究表明,机器人手术对癌症患者是短期有用和安全的。我们调查了从短期结果来看,机器人是否可以改善radial骨切除边缘的深切除边缘或浅切除边缘。从机构数据库中,我们选择了所有浅表组(≤3mm)和较深组(≥4mm)接受直肠癌切除术治疗1年.我们评估了基于放射状切除大小的切缘分化术后90天的短期结果,包括第一次排便,住院时间,脓毒症,并收集淋巴结。主要结果为Clavien-Dindo量表的III-IV级和并发症。我们发现120例接受直肠癌肿瘤切除术的患者;42例径向浅切缘≤3mm的患者,以下所有结果均得到改善:收集的淋巴结,近端切除边缘,TME,排气时间,流质饮食持续时间,吻合口漏,还有败血症.这些优势之一是降低了转移风险和局部复发的整体减少。
    Randomized studies showed that robotic surgery was short-term useful and safe for cancer patients. We investigated whether robots improve deep resection margins or superficial resection margins for radial resection margins in terms of short-term results. From an institutional database, we selected all superficial groups (≤ 3 mm) and deeper groups (≥ 4 mm) with rectal cancer treated with resection for a year. We evaluated the short-term post-operative 90-day outcomes on a radial resection size-based margin differentiation, including the first bowel movement, length of hospital stay, sepsis, and harvested lymph node. The main results were grades III-IV on the Clavien-Dindo scale and complications. We found 120 patients who had oncologic resection of rectal cancer; 42 patients with a superficial radial resection margin of ≤ 3 mm, all the following outcomes improved: the harvested lymph node, proximal resection margin, TME, flatus time, liquid diet duration, anastomotic leakage, and sepsis. Among these advantages were a reduced risk of metastasis and an overall reduction in local recurrence.
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  • 文章类型: Multicenter Study
    背景:深部脑出血(ICH)的出血进展不仅涉及实质性血肿的生长,还涉及脑室内出血(IVH)的增加。寻找预测实质性血肿和IVH生长风险增加的方法是有必要的。
    方法:我们在多个中心进行了一项回顾性队列研究。深度ICH的参与者于2018年1月至2021年12月注册。基于逻辑回归分析的预测模型包括临床以及常规影像学和影像组学变量,单独或组合。使用区分措施评估每个模型的性能(例如,曲线下面积[AUC])。使用决策曲线分析(DCA)进行临床效用评估。
    结果:总体而言,纳入4个卒中中心的647人。来自3个中心的429名(66%)患者被分配到主要队列,来自另一个中心的218名(34%)被纳入验证队列。多因素分析显示,格拉斯哥昏迷量表评分,基线ICH体积,IVH,混合标志,在主要队列中,影像组学评分与出血进展相关.临床-影像组学模型(AUC=0.852和0.835)与非对比计算机断层扫描体征模型(AUC=0.666和0.618)相比,在主要和验证队列中改善了出血进展的预测性能。在决策曲线分析曲线中具有相似的结果。
    结论:临床-影像组学模型在预测深部ICH进展方面优于常规非对比计算机断层扫描体征模型。使用该模型筛查患者的临床益处可能有助于风险分层。
    Hemorrhage progression in deep intracerebral hemorrhage (ICH) involves not only the growth of parenchymal hematoma but also an increase in intraventricular hemorrhage (IVH). The search for methods that predict both the increased risk of parenchymal hematoma and IVH growth is warranted.
    We conducted a retrospective cohort study at multiple centers. Participants with deep ICH were enrolled from January 2018 to December 2021. Prediction models based on logistic regression analysis included clinical as well as routine radiographic and radiomics variables, separately or in combination. The performance of each model was evaluated using discrimination measures (e.g., area under the curve [AUC]). Evaluation of clinical utility was performed using decision curve analysis (DCA).
    Overall, 647 individuals across 4 stroke centers were included. A total of 429 (66%) patients from 3 centers were assigned to the primary cohort and 218 (34%) from another center were placed in the validation cohort. Multivariate analysis showed that the Glasgow Coma Scale score, baseline ICH volume, IVH, blend sign, and radiomics score were associated with hemorrhage progression in the primary cohort. The clinical-radiomics model (AUC = 0.852 and 0.835) improved the prediction performance of hemorrhage progression compared to the Noncontrast computed tomography signs model (AUC = 0.666 and 0.618) in both the primary and validation cohorts, with similar results in the decision curve analysis curves.
    The clinical-radiomics model outperformed the routine Noncontrast computed tomography signs model in predicting the progression of deep ICH. The clinical benefit of screening patients using this model may assist in risk stratification.
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  • 文章类型: Meta-Analysis
    We performed a meta-analysis to evaluate the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery. A systematic literature search up to July 2022 was performed and 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery using dichotomous methods with a random or fixed-effect model. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery (OR, 0.53; 95% CI, 0.41-0.70, P < .001), deep surgical site wound infections after spinal surgery (OR, 0.45; 95% CI, 0.35-0.57, P < .001), superficial surgical site wound infections after spinal surgery (OR, 0.60; 95% CI, 0.43-0.83, P = .002), and surgical site wound infections after cranial surgery (OR, 0.37; 95% CI, 0.22-0.61, P < .001) compared to control in subjects with neurosurgery. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery, deep surgical site wound infections after spinal surgery, superficial surgical site wound infections after spinal surgery, and surgical site wound infections after cranial surgery compared to control in subjects with neurosurgery. The analysis of outcomes should be done with caution even though the low number of studies with low sample size, 3 out of the 42 studies, in the meta-analysis, and a low number of studies in certain comparisons.
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  • 文章类型: Journal Article
    目的:建立深部脑出血患者血肿累及部位与血肿扩大(HE)的关系。
    方法:这项回顾性多中心研究包括2018年至2020年发病6小时内住院的深度ICH患者。排除患有继发性ICH的个体。根据入院和随访计算机断层扫描评估HE的体积。使用多变量逻辑回归分析,同时调整HE的混杂协变量,检查了深部ICH受累部位与HE之间的关联。
    结果:我们纳入了来自三个卒中中心的583名个体。最终总共460名患者的数据被用于分析;在这些患者中,159人(34.6%)患有HE。在没有调整的粗略模型中,外囊,内囊前肢,内囊后肢(PLIC)受累与HE相关。在完全调整了性别模型之后,年龄,脑室内出血,格拉斯哥昏迷量表录取分数,基线ICH体积,以及从发病到初始计算机断层扫描的时间,多变量逻辑回归显示,PLIC是深部ICH患者HE的可靠预测因子(校正比值比=2.73;95%置信区间=1.75-4.26;p<0.001)。
    结论:深度出血中内囊后肢的受累可能是HE的一个有希望的预测指标。
    OBJECTIVE: To establish the relationship between hematoma sites of involvement and hematoma expansion (HE) in patients with deep intracerebral hemorrhage (ICH).
    METHODS: Eligible patients with deep ICH admitted to hospital within 6 hours of onset between 2018 and 2020 were included in this retrospective multi-center study. Individuals with secondary ICH were excluded. The volume of HE was evaluated based on admission and follow-up computed tomography scans. Associations between deep ICH sites of involvement and HE were examined using multivariable logistic regression analysis while adjusting for confounding covariates of HE.
    RESULTS: We enrolled 583 individuals from three stroke centers. Data from a final total of 460 patients were used in the analysis; of these patients, 159 (34.6%) had HE. In the crude model without adjustment, external capsule, anterior limb of the internal capsule, and posterior limb of the internal capsule (PLIC) involvement were correlated with HE. After fully adjusted models for sex, age, intraventricular hemorrhage, Glasgow Coma Scale admission score, baseline ICH volume, and time from onset to initial computed tomography, multivariable logistic regression revealed that the PLIC is a robust predictor of HE in patients with deep ICH (adjusted odds ratio = 2.73; 95% confidence interval = 1.75-4.26; p < 0.001).
    CONCLUSIONS: Involvement of the posterior limb of the internal capsule in deep hemorrhage could be a promising predictor of HE.
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  • 文章类型: Journal Article
    通过简便的方法制备了γ-MnO2,SmMnO3和γ-MnO2/SmMnO3催化剂,其中通过一步煅烧合成SmMnO3(SMO)钙钛矿,并通过在SMO表面上原位生长γ-MnO2形成γ-MnO2/SmMnO3。这些材料通过XRD表征,SEM-mapping,N2-吸附,XPS和H2-TPR研究它们的结构性质。与SMO和γ-MnO2相比,γ-MnO2/SMO在湿空气(10vol.%),这可能归因于其较高的晶格氧与吸附氧的表面摩尔比(Olatt/Oads)和较好的低温还原性。此外,对于γ-MnO2/SMO催化剂,连续的氧化路线和BETX的内在原理(苯,乙苯,甲苯,和邻二甲苯)氧化也通过各种测试和对动力学研究的理解得到了揭示。同时,模拟实际排气条件下的实验表明,γ-MnO2/SmMnO3也是一种良好的催化剂,具有高稳定性的芳烃VOCs氧化,并满足对高湿度的耐受性(20卷。%).
    γ-MnO2, SmMnO3, and γ-MnO2/SmMnO3 catalysts were prepared by facile methods, wherein the SmMnO3 (SMO) perovskite was synthesized through one-step calcination and the γ-MnO2/SmMnO3 was formed by an in situ growth of γ-MnO2 on the surface of SMO. These materials ware characterized by XRD, SEM-mapping, N2-adsorption, XPS and H2-TPR to investigate their textural properties. Compared with that of SMO and γ-MnO2, the γ-MnO2/SMO shows better performance for catalytic oxidation of aromatic VOCs in wet air (10 vol.%), which may be attributed to its higher surface molar ratio of lattice oxygen to adsorbed oxygen (Olatt/Oads) and better low-temperature reducibility. Besides, for γ-MnO2/SMO catalyst, a successive oxidation route and the inner principle of BETX (benzene, ethylbenzene, toluene, and o-xylene) oxidation were also revealed via various tests and a comprehension of dynamics investigation. Meanwhile, the experiments under simulated realistic exhaust conditions displayed that the γ-MnO2/SmMnO3 is also a good catalyst with high stability for aromatic VOCs oxidation, and fulfilled endurability to high humidity (20 vol.%).
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  • 文章类型: Journal Article
    OBJECTIVE: We aimed to identify and analyze the characteristics of the 100 most highly-cited papers in the research field of deep brain stimulation (DBS).
    METHODS: The Web of Science was searched for highly-cited papers related to DBS research. The number of citations, countries, institutions of origin, year of publication, and research area were noted and analyzed.
    RESULTS: The 100 most highly-cited articles had a mean of 304.15 citations. These accrued an average of 25.39 citations a year. The most represented target by far was the subthalamic nucleus (STN). These articles were published in 46 high-impact journals, with Brain (n = 10) topping the list. These articles came from 11 countries, with the USA contributing the most highly-cited articles (n = 29); however, it was the University of Toronto (n = 13) in Canada that was the institution with the most highly-cited studies.
    CONCLUSIONS: This study identified the 100 most highly-cited studies and highlighted a historical perspective on the progress in the field of DBS. These findings allow for the recognition of the most influential reports and provide useful information that can indicate areas requiring further investigation.
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