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Cost burden following esophagectomy:A single centre observational study

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World Journal of Gastrointestinal surgery 2024年第7期16卷 2255-2269页

作者： Vered Buchholz Dong Kyu Lee David s Liu Ahmad Aly stephen A Barnett Riley Hazard Peter Le Benjamin Kioussis Vijayaragavan Muralidharan laurence Weinberg Department of surgery Austin HealthMelbourne 3084VictoriaAustralia Department of Anesthesiology and Pain Medicine Dongguk University Ilsan HospitalSeoul 14566GoyangSouth Korea Department of surgery Austin HealthThe University of MelbourneMelbourne 3084VictoriaAustralia Department of Anesthesia Austin HealthMelbourne 3084VictoriaAustralia Department of Anesthesia Austin HospitalHeidelberg 3084VictoriaAustralia Department of Critical Care The University of MelbourneMelbourne 3084VictoriaAustralia

BACKGROUND Cost analyses of patients undergoing esophagectomy is valuable for identifying modifiable expenditure drivers to target and curtail costs while improving the quality of *** aimed to define the cost-complication relationship after esophagectomy and delineate the incremental contributions to *** To assess the relationship between the hospital costs and potential cost drivers post esophagectomy and investigate the relationship between the cost-driving variables(predicting variables)and hospital costs(dependent variable).METHODs In this retrospective single center study,the severity of complications was graded using the Clavien-Dindo(CD)classification *** esophagectomy complications were categorized and defined according to consensus *** costing data included the in-hospital costs of the index admission and any unplanned admission within 30 postoperative *** used correlation analysis to assess the relationship between key clinical variables and hospital costs(in United states dollars)to identify cost drivers.A mediation model was used to investigate the relationship between these variables and hospital *** A total of 110 patients underwent primary esophageal *** median admission cost was $47822.7(interquartile range:35670.2-68214.0).The total effects on costs were $13593.9(95%CI:10187.1-17000.8,Pse in CD severity grade,$4781(95%CI:3772.7-5789.3,Pse in the number of complications,and $42552.2(95%CI:8309-76795.4,P=0.015)if a key esophagectomy complication *** esophagectomy complications drove the costs directly by $11415.7(95%CI:992.5-21838.9,P=0.032).CONCLUsION The severity and number of complications,and the development of key esophagectomy complications significantly contributed to total hospital *** institutional initiatives and strategies are needed to enhance patient outcomes and minimize costs.

关键词： Anesthesia Esophagectomy Complications Cancer surgery

A speculation: Avian Migration and the K-T Extinction

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Natural Resources 2024年第5期15卷 125-129页

作者： laurence stephenson Association of Professional Engineers and Geologists of British Columbia Vancouver Canada

One caveat to the dinosaur’s extinction is the conclusion that avian dinosaurs survived and became ancestors of birds. Their mobility enabled them to migrate great distances and find the nutrients needed to survive. Given this scenario, could the current observable migration of birds (the “dinosaurian offspring”) now be related? Migration is the regular seasonal movement undertaken by many species of birds, with the most common pattern, flying north in the Northern spring to breed in the temperate or Arctic summer and returning in the Northern autumn to wintering grounds in warmer regions of the south. The primary motivation for migration appears to be food. None of the major North-south migratory pathways fly over the Caribbean but three main fly ways, past to the west of the theorized K-T impact centre. Due to their ability to fly, the “avian Dinosaurs” adapted and survived very quickly in response to the disaster that marked the K-T boundary. It is an interesting speculation that the avian migration that we witness today is rooted in an event that occurred 66 million years ago! But it does explain why the migratory birds mostly fly from Polar summer to polar summer when they could just be as easily fly from Polar zone to the warmer equatorial region and back. In the recent article in Nature by Melanie During about identifying the late spring timing of the “Astro disaster”, it can be cited as consistent with my speculation. A late April early May Impact as suggested by During would have seen these migrations completely. The western migratory routes would have been found to be “luxurious” in vegetation in that first northern autumn after the “Astro-impact” while all eastern routes would have still been barren.

关键词： Dinosaur Clades K-T Mass Extinction Avian Migration Migratory Pathways Avian Dinosaurs K-T Impact Centre

Cardiac surgery at Yaoundé General Hospital by a Local Team: Activity Report from september 2022 to January 2024

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World Journal of Cardiovascular surgery 2024年第6期14卷 87-94页

作者： laurence Carole Ngo Yon Charles Mve Mvondo Hermann Nestor Tsague Kengni Zephanie Kobe Fokalbo sépolin Lowe Mireille Dakleu Alain Patrick Menanga William Ngatchou Djomo Vincent De Paul Djientcheu Department of Cardiothoracic and Vascular surgery Yaound General Hospital Yaound Cameroon Department of surgery and specialities Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Clinical sciences Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Clinical sciences Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon Department of surgery and specialities Faculty of Medicine and Biomedical Sciences University of Yaound Yaound Cameroon

Introduction: The practice of cardiac surgery (Cs) in sub-saharan Africa faces a number of challenges. We report on the surgical activities of the first 17 months of the program launched at the Yaoundé General Hospital (YGH), describing the types of interventions and the early results. Patients and Methods: This was a descriptive cross-sectional study including patients who underwent Cs from september 2022 to January 2024 at the YGH. Clinical, operative and postoperative data were collected and analysed retrospectively by R software. Results: A total of 37 patients underwent Cs during the study period, divided into 23 (62.2%) open-heart and 14 (37.8%) closed-heart cases. Males predominated (sex ratio 1.17). The median age and interquartile range (IQR) were 36 years (9 - 51). Isolated valve surgery, in 15 (40.5%) cases, was the most common procedure in open-heart surgery cases. Closed-heart surgery involved closure of the patent ductus arteriosus in 9 (24.3%) cases, coronary artery bypass grafting in 3 (8.1%) cases, and pericardectomy in 2 (5.4%) cases. The median duration of extracorporeal circulation and aortic cross-clamping was 101 min (IQR 84 - 143) and 74 min (IQR 54 - 112) respectively. The median duration of mechanical ventilation was 2 hours (IQR 2 - 3). The median intensive care unit stay and median hospital stay were 2 days (IQR 2 - 3) and 7 days (IQR 5 - 8) respectively. Operative mortality was 2 (5.4%). Conclusion: Cardiac surgery remains a major challenge for African populations. The early results achieved by the local team are satisfactory. An increase in surgical activity should be strongly encouraged to facilitate local training and ensure the sustainability of the activity.

关键词： Cardiac surgery sub-saharan Africa Cameroon

在中国经济转型与生态文明建设中不得不说的往事

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国际人才交流 2024年第2期 56-68页

作者：龙安志张佳艺(译) 不详

作为一名多次为跨国公司与中国国有企业谈判合资项目的律师,我无意中成了国有企业改革的专家。1997年,我被委任领导一个特别工作组,为全国性改革方案绘制蓝图。在诸多地域中,试验从安徽省开始。这不足为奇,安徽省早在20年前便吹起市场... 详细信息

作为一名多次为跨国公司与中国国有企业谈判合资项目的律师,我无意中成了国有企业改革的专家。1997年,我被委任领导一个特别工作组,为全国性改革方案绘制蓝图。在诸多地域中,试验从安徽省开始。这不足为奇,安徽省早在20年前便吹起市场化改革的春风。

关键词：国有企业改革中国国有企业中国经济转型跨国公司生态文明建设合资项目改革方案市场化改革

surgery for Peyronie＇s disease

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Asian Journal of Andrology 2013年第1期15卷 27-34页

作者： laurence A Levine stephen M Larsen Department of Urology Rush University Medical Center Chicago IL 60612 USA

Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.

关键词： penile prosthesis Peyronie's disease, penile reconstruction plaque excision and grafting plaque incision tunica albuginea plication

The effect of ozone on pine forests in south-Eastern France from 2017 to 2019

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Journal of Forestry Research 2023年第2期34卷 301-315页

作者： Anumol shashikumar svetlana Bičárová Dalstein-Richier laurence Groupe International d′Etudes Des Forêts sud-Européennes(G.I.E.F.s) 69Avenue des Hespérides06300 NiceFrance Institute of Earth science of the slovak Academy of sciences 05960 StaráLesnáTatranskáLomnicaSlovakia

In south-Eastern forests of France,risks linked to the effects of tropospheric ozone(O_(3))are real;its annual impact has been observed specifically near the coastline and in high altitude mountains during the period *** this study,the risk assessment of O_(3)pollutant was carried out using two approaches based on forest response indicators such as O_(3)specific foliar visible injury and by stomatal O_(3)*** O_(3)dose values(POD_(0))were obtained by the DO_(3)sE *** model requires hourly O_(3)concentration for POD_(0)calculation.A modified approach that uses measurements from passive samplers(monthly average O_(3)concentration)was tested for the calculation of POD_(0)and test results showed good agreement with the POD_(0)calculated using hourly O_(3)*** the model input file,the average O_(3)concentration is used for POD_(0),and this could be useful for POD_(0)calculation when the active monitor is *** this study,a flux-based assessment provided better correlation with O_(3)specific leaf injury,which is also *** visible injury in response to O_(3)indicates that Pinus cembra and Pinus halepensis are more affected and therefore more sensitive than Pinus *** POD_(0)and stomatal conductance(Gsto)seem to be induced by environmental factors,primarily rainfall and the soil water potential(fsWP).The correlation between the O_(3)flux metric and environmental variables with forest response indicators by spearman rank test confirms *** as one of the most sensitive species to O_(3).

关键词： Ozone Foliar visible injury Phytotoxic ozone dose stomatal conductance DO_(3)sE

Comparison of reduced point charge models of proteins: Molecular Dynamics simulations of Ubiquitin

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science China Chemistry 2014年第10期57卷 1340-1354页

作者： LEHERTE laurence VERCAUTEREN Daniel P. Unité de Chimie Physique Théorique et structurale Laboratoire de Physico-Chimie Informatique Namur MEdicine & Drug Innovation Center (NAMEDIC) Department of Chemistry University of Namur Rue de Bruxelles 61 B-5000 Namur Belgium

Reduced point charge models of amino acids are used to model Ubiquitin （PDB： 1UBQ）. They are designed （i） from local ex- tremum positions in charge density （CD） distribution functions built from the Poisson equation applied to smoothed molecular electrostatic potential functions, or （ii） from local maximum positions in promolecular electron density distribution （ED） func- tions. Charge values are fitted versus all-atom Amber99 molecular electrostatic potentials. The program GROMACs is used to generate molecular dynamics trajectories of the protein, under various implementation schemes, solvation, and temperature conditions. Point charges that are not located on atoms are considered as virtual sites with a null mass and radius. The results illustrate that secondary structure is best preserved with the CD-based model at low temperatures and in vacuum. This indi- cates that local potential energy wells are consistent with the all-atom model. However, at room temperature, the structure is best conserved when point charges are forced to be located on atoms, due to a better description of the Coulomb l-4 energy terms. The ED-based model, generated at a lower resolution, led to the largest discrepancies versus the all-atom case. The CD-based model allows the formation of protein-water H-bonds with geometrical properties similar to the all-atom ones. Con- trarily, intra-molecular H-bonds are not well described. structural, thermodynamical, and dynamical properties of proteins modelled with reduced point charge models are also significantly affected by the choice of the solvent force field.

关键词： molecular electrostatic potential electron density smoothing of molecular fields critical points point charge model protein Ubiquitin

Modern treatment strategies for penile prosthetics in Peyronie’s disease:a contemporary clinical review

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Asian Journal of Andrology 2020年第1期22卷 51-59页

作者： Matthew J Ziegelmann M Ryan Farrell laurence A Levine Division of Urology Rush University Medical CenterChicagoIL 60612USA

Peyronie's disease is a common condition resulting in penile deformity,psychological bother,and sexual *** dysfunction is one common comorbid condition seen in men with Peyronie’s disease,and its presence significantly impacts treatment *** a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment,penile prosthesis placement should be strongly *** some instances,such as those patients with relatively mild curvature,prosthesis placement alone may result in adequate ***,many patients will require additional straightening maneuvers such as manual modeling,penile plication,and tunica albuginea incision with or without *** patients with severe penile shortening,penile length restoration techniques may also be ***,we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's ***,we discuss preoperative indications,intraoperative considerations,adjunctive straightening maneuvers,and postoperative outcomes.

关键词： collagenase grafting penile length penile prosthesis Peyronie's

An explicit formulation of the macroscopic strength criterion for porous media with pressure and Lode angle dependent matrix under axisymmetric loading

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Journal of Rock Mechanics and Geotechnical Engineering 2021年第4期13卷 820-832页

作者： Jincheng Fan laurence Brassart Wanqing shen Xiurun Ge Institute of Deep Earth sciences and Green Energy College of Civil and Transportation EngineeringShenzhen UniversityShenzhen518060China school of Naval Architecture Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghai200240China Department of Engineering science University of OxfordOxfordOX13PJUK Department of Materials science and Engineering Monash UniversityClaytonVIC3800Australia Univ.Lille CNRSCentrale LilleUMR 9013-LaMcube-Laboratoire de MecaniqueMultiphysiqueMulti-echelle59000LilleFrance

This paper aims to propose an explicit formulation of the macroscopic strength criterion for porous media with spherical *** matrix is assumed rigid and perfectly plastic with yield surface described by the three-parameter strength criterion,which is Lode angle and pressure dependent and capable of accounting for distinct values of the uniaxial tensile strength,uniaxial compressive strength(UCs)and equal biaxial compressive strength(eBCs).An exact upper bound of the macroscopic strength is derived for porous media subjected to purely hydrostatic ***,an estimate of the macroscopic strength profile of porous media under axisymmetric loading is obtained in parametric ***,a heuristic strength criterion in explicit form is further developed by examining limit cases of the parametric strength *** developed strength criteria are assessed by finite-element based numerical *** with the parametric strength criterion which involves cumbersome functions,the heuristic one is convenient for practical *** specific values of the matrix’s strength surface,the proposed heuristic strength criterion can recover the well-known Gurson *** present work also addresses the effect of the ratio of matrix’s eBCs to UCs on the macroscopic strength of porous *** matrix with distinct values of eBCs and UCs,neglecting the difference between eBCs and UCs would result in an underestimation of the macroscopic strength,especially when the pressure is large.

关键词： Porous materials Unified strength criterion Homogenization Gurson criterion