Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.
ObjectiveTo explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.MethodsThe clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.ResultsAll patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).ConclusionPosterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.
To explore the self-organization robustness of the biological neural network, and thus to provide new ideas and methods for the electromagnetic bionic protection, we studied both the information transmission mechanism of neural network and spike timing-dependent plasticity (STDP) mechanism, and then investigated the relationship between synaptic plastic and adaptive characteristic of biology. Then a feedforward neural network with the Izhikevich model and the STDP mechanism was constructed, and the adaptive robust capacity of the network was analyzed. Simulation results showed that the neural network based on STDP mechanism had good rubustness capacity, and this characteristics is closely related to the STDP mechanisms. Based on this simulation work, the cell circuit with neurons and synaptic circuit which can simulate the information processing mechanisms of biological nervous system will be further built, then the electronic circuits with adaptive robustness will be designed based on the cell circuit.
Objective To explore the timing and safety of limited-period lung cancer surgery in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Clinical data of of patients infected with COVID-19 undergoing lung cancer surgery (an observation group) in the Department of Thoracic Surgery of Guangdong Provincial People's Hospital, the Department of Thoracic Surgery of General Hospital of Southern Theater Command of PLA, and the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Guangdong Pharmaceutical University from December 2022 to January 2023 were retrospectively analyzed and compared with patients who underwent surgery during the same period but were not infected with COVID-19 (a control group), to explore the impact of COVID-19 infection on lung cancer surgery. Results We finally included 110 patients with 73 patients in the observation group (28 males and 45 females at age of 52.62±12.80 years) and 37 patients in the control group (22 males and 15 females at age of 56.84±11.14 years). The average operation time of the observation group was longer than that of the control group, and the incidence of anhelation was higher than that of the control group (P<0.05). There were no statistcal differences in blood loss, length of hospital stay, moderate or above fever rate, degree of cough and chest pain, or blood routine between the two groups. ConclusionIt is safe and feasible to perform lung cancer surgery early after recovery for COVID-19 patients with lung cancer.
With inherent sparse spike-based coding and asynchronous event-driven computation, spiking neural network (SNN) is naturally suitable for processing event stream data of event cameras. In order to improve the feature extraction and classification performance of bio-inspired hierarchical SNNs, in this paper an event camera object recognition system based on biological synaptic plasticity is proposed. In our system input event streams were firstly segmented adaptively using spiking neuron potential to improve computational efficiency of the system. Multi-layer feature learning and classification are implemented by our bio-inspired hierarchical SNN with synaptic plasticity. After Gabor filter-based event-driven convolution layer which extracted primary visual features of event streams, we used a feature learning layer with unsupervised spiking timing dependent plasticity (STDP) rule to help the network extract frequent salient features, and a feature learning layer with reward-modulated STDP rule to help the network learn diagnostic features. The classification accuracies of the network proposed in this paper on the four benchmark event stream datasets were better than the existing bio-inspired hierarchical SNNs. Moreover, our method showed good classification ability for short event stream input data, and was robust to input event stream noise. The results show that our method can improve the feature extraction and classification performance of this kind of SNNs for event camera object recognition.
Since the outbreak of COVID-19 pandemic, a large number of elective or limited operations, including tumor treatment, have been postponed. With the deepening of the understanding of the virus and the change of the prevention policy, the impact of the pandemic is gradually shrinking, and a large number of operations delayed by the pandemic will be rescheduled. However, there is no consensus on the best time to perform surgery for patients infected with SARS-CoV-2, and the consensus on thoracic surgery is more limited. This article reviews the research progress in the timing of surgical operations, especially thoracic surgery, after SARS-CoV-2 infection.
Current guidelines recommend follow-up observation for moderate aortic stenosis (MAS), but clinical evidence shows that its prognosis is poor, especially when combined with left ventricular systolic dysfunction, the risk of death and hospitalization for heart failure is significantly increased. With the technical maturity and device development of transcatheter aortic valve replacement (TAVR), its therapeutic potential in MAS has attracted attention. This paper systematically reviewes the risk stratification indicators of MAS and the clinical research results of early TAVR intervention, and analyzes the key clinical issues such as patient selection and operation timing. It points out that early TAVR may improve the prognosis and quality of life of some high-risk MAS patients, but its wide clinical application still needs more evidence-based medical evidence support.
Objective To systematically evaluate the effect of the timing of left ventricular (LV) unloading on the outcomes of patients with cardiogenic shock (CS) receiving extracorporeal membrane oxygenation (ECMO). MethodsA systematic literature search was conducted in PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), SinoMed, and the VIP databases from their inception to February 2025. Literature screening was conducted according to predefined inclusion and exclusion criteria. Two researchers independently assessed the study quality and extracted the data. Patients were divided into an early unloading group and a late unloading group based on the timing of LV unloading. RevMan 5.4 software was used to perform the heterogeneity test and meta-analysis. Results A total of 8 studies involving 2 117 patients were included (1 338 in the early unloading group and 779 in the late unloading group). The meta-analysis showed no statistically significant differences between the two groups in the rates of successful ECMO weaning, in-hospital mortality, or 30-day all-cause mortality (all P>0.05). Compared with the late unloading group, the early unloading group had a lower risk of sepsis [RR=0.79, 95% CI (0.64, 0.96), P=0.02] and abdominal complications [RR=0.67, 95% CI (0.46, 0.96), P=0.03]. ConclusionCompared with late LV unloading, early LV unloading does not significantly improve the successful ECMO weaning rate or early survival. However, early LV unloading is associated with a reduced risk of sepsis and abdominal complications.
Objective To investigate the effectiveness of Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy in treating T?nnis type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH) in children and explore the urgical timing. Methods A retrospective collection was performed for 74 children with T?nnis type Ⅲ and Ⅳ DDH who were admitted between January 2018 and January 2020 and met the selection criteria, all of whom were treated with Salter osteotomy combined with subtrochanteric shortening and derotational osteotomy. Among them, there were 38 cases in the toddler group (age, 18-36 months) and 36 cases in the preschool group (age, 36-72 months). There was a significant difference in age between the two groups (P<0.05), and there was no significant difference in gender, side, T?nnis typing, and preoperative acetabular index (AI) (P>0.05). During follow-up, hip function was assessed according to the Mckay grade criteria; X-ray films were taken to observe the healing of osteotomy, measure the AI, evaluate the hip imaging morphology according to Severin classification, and assess the occurrence of osteonecrosis of the femoral head (ONFH) according to Kalamchi-MacEwen (K&M) classification criteria. Results All operations of both groups were successfully completed, and the incisions healed by first intention. All children were followed up 14-53 months, with an average of 27.9 months. There was no significant difference in the follow-up time between the two groups (P>0.05). At last follow-up, the excellent and good rates according to the Mckay grading were 94.73% (36/38) in the toddler group and 83.33% (30/36) in the preschool group, and the difference between the two groups was significant (P<0.05). The imaging reexamination showed that all osteotomies healed with no significant difference in the healing time between the two groups (P>0.05). There was no significant difference in AI between the two groups at each time point after operation (P>0.05), and the AI in the two groups showed a significant decreasing trend with time extension (P<0.05). The result of Severin classification in the toddler group was better than that in the preschool group at last follow-up (P<0.05). There was no significant difference in the incidence of ONFH between the two groups (P>0.05). In the toddler group, 2 cases were K&M type Ⅰ; in the preschool group, 3 were type Ⅰ, and 1 type Ⅱ. There was no dislocation after operation.ConclusionSalter osteotomy combined with subtrochanteric shortening and derotational osteotomy is an effective way to treat T?nnis type Ⅲ and Ⅳ DDH in children, and surgical interventions for children aged 18-36 months can achieve better results.
