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Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis

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World Journal of Orthopedics 2022年第3期13卷 307-328页

作者： Marion JLF Heymans nanne p kort Barbara AM Snoeker Martijn GM Schotanus Zuyderland Academy Zuyderland Medical CenterSittard 6155 NHNetherlands Department of Orthopedic Surgery CortoclinicsSchijndel 5482 WNNetherlands Department of Clinical Epidemiology Biostatistics and BioinformaticsAmsterdam Medical CenterUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Orthopaedic Surgery and Traumatology Zuyderland Medical CenterSittard-Geleen 6162 BGLimburgNetherlands Care and public Health Research Institute Maastricht University Medical CentreFaculty of HealthMedicine&Life SciencesMaastricht 6229 ERLimburgNetherlands

BACKGROUND Over the past decades,clinical pathways(Cps)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and *** The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERp)with regular pathways for patients with hip and/or knee *** A literature search in healthcare databases(Embase,pubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June *** randomized controlled trials as well as observational studies comparing ERp,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were *** effect of both Cps was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(pROMs),and financial *** possible,a meta-analysis was *** case of considerable heterogeneity among studies,a qualitative analysis was *** Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative *** total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of *** methodological quality of the included studies ranged from average to *** ERp had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and pROMs compared to regular *** analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(p=0.01).ERp were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported

关键词： Hip arthroplasty Knee arthroplasty Joint arthroplasty Clinical pathway Enhanced recovery pathway Systematic review Meta-analysis

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patient specific guides for total knee arthroplasty are ready for primetime

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World Journal of Orthopedics 2016年第1期7卷 61-68页

作者： Martijn GM Schotanus Bert Boonen nanne p kort Depart-ment of Orthopaedic Surgery Zuyderland Medical Centre

AIM: To present the radiological results of total knee arthroplasty(TKA) with use of patient specific matched guides(pSG) from different manufacturer in patients suffering from severe osteoarthritis of the knee ***: This study describes the results of 57 knees operated with 4 different pSG systems and a group operated with conventional instrumentation(n = 60) by a single surgeon. The pSG systems were compared with each other and subdivided into cut- and pin pSG. The biomechanical axis [hip-knee-ankle angle(HKA)], varus/valgus of the femur [frontal femoral component(FFC)] and tibia(frontal tibial component) component, flexion/extension of the femur [flexion/extension of the femur component(LFC)] and posterior slope of the tibia [lateral tibial component(LTC)] component were evaluated on long-leg standing and lateral X-rays. A percentage of > 3° deviation was seen as an outlier. RESULTS: The inter class correlation coefficient(ICC) revealed that radiographic measurements between both assessors were reliable(ICC > 0.8). Fisher exact test was used to test differences of proportions. The percentage of outliers of the HKA-axis was comparable between both the pSG and conventional groups(12.28% vs 18.33%, p pin pSG groups(14.3% vs 10.3%, p percentage of outliers of the FFC(0% vs 18.33%, p p p pSGgroup. There were no significant differences regarding the outliers between the individual pSG systems and the pSG group subdivided into cut- and pin ***: pSG for TKA show significant less outliers compared to the conventional technique. These single surgeon results suggest that pSG are ready for primetime.

关键词： Total knee arthroplasty patient specific matched guides patient matched instruments Single surgeon Alignment Conventional instruments Cutting guides pin guides

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Nutrient Evaluation of Dining Center Food Waste and Comparison to Monogastric and Ruminant Feedstuffs

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Open Journal of Animal Sciences 2023年第3期13卷 323-335页

作者： Nelsa M. Beckman phillip A. Lancaster Haley K. Otott Rachel N. kort Katherine M. Krauss Melissa A. Schrader Jordan T. Gebhardt Charles R. Stark Chad B. paulk Department of Grain Science and Industry Kansas State University Manhattan USA Department of Clinical Sciences Kansas State University Manhattan USA Department of Housing and Dining Kansas State University Manhattan USA Department of Diagnostic Medicine pathobiology Kansas State University Manhattan USA

The objective of this study was to analyze the nutrient composition and variability of university dining hall food waste and compare it with common feedstuffs used in ruminant and monogastric diets. Food waste was categorized into two initial streams: mainstream (MS) from the serving line and vegetable preparation (Vp) from the kitchen. Waste was collected from the Kramer Dining Center, Kansas State University, resulting in 30 daily samples. Waste was weighed and ground to homogenous particle size. Daily samples of MS and Vp were analyzed for nutrient composition, where results were combined to calculate the nutrient profile of a hypothetical mixed food waste stream (MX) composited by total weight. Data were analyzed using R statistical software (v 4.2.2). Moisture and neutral detergent fiber (NDF) were greater in Vp (p , while ether extract (EE) was less compared to MS and MX. Crude protein (Cp) was greater (p pared to Vp. The total digestible nutrients (TDN) and energy were greater in MS food waste than in MX, which was also greater than Vp (p content, measured by standard deviation, was similar (p > 0.05) among streams for NDF, nitrogen-corrected neutral detergent fiber, acid detergent insoluble crude protein, Cp, ash, lignin, and digestible and metabolizable energy. Dry matter and EE variation were greater (p p was less (p pared to MX. Standard deviation increased (p protein, TDN, and gross energy when compared to Vp. Despite having 70% - 80% moisture, dining hall food waste does have nutritive value and the potential to be included in ruminant and monogastric diets. Further research needs to be done to understand the value of including it in animal diets.

关键词： Food Waste Feedstuffs Monogastric Ruminant Nutrient Variability

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pyrolysis Oil from the Fruit and Cake of Jatropha curcas produced Using a Low Temperature Conversion (LTC) process: Analysis of a pyrolysis Oil-Diesel Blend

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Energy and power Engineering 2011年第3期3卷 332-338页

作者： Monique kort-Kamp Figueiredo Gilberto Alves Romeiro Raquel Vieira Santana Silva priscila Alvares pinto Raimundo Nonato Damasceno Luiz Antonio d`Avila Amanda p. Franco 不详

Background: The LTC process is a technique that consists of heating solid residues at a temperature of 380oC - 420oC in an inert atmosphere and their products are evaluated individually: these products include pyrolysis oil, pyrolytic char, gas and water. The objective of this study was to compare the effects of the use of oils obtained by pyrolysis of Jatropha curcas as an additive for diesel in different proportions. Results: A Low Temperature Conversion (LTC) process carried out on samples of Jatropha curcas fruit and generated pyrolysis oil, pyrolyic char, gas and aqueous fractions in relative amounts of 23, 37, 16 and 14% [w/w] respectively for Jatropha curcas fruit and 19, 47, 12 and 22% [w/w] respectively for Jatropha curcas cake. The oil fractions were analyzed by FTIR, 1H NMR, 13C NMR, GCMS and physicochemical analysis. The pyrolysis oil was added to final concentrations of 2, 5, 10 and 20% [w/w] to commercial diesel fuel. The density, viscosity, sulfur content and flash point of the mixtures were determined. Conclusions: The results indicated that the addition of the pyrolysis oil maintained the mixtures within the standards of the diesel directive, National petroleum Agency (ANp no 15, of 19. 7. 2006), with the exception of the viscosity of the mixtures containing 20% pyrolysis oil.

关键词： Jatropha curcas Low Temperature Conversion Fuel and pyrolysis Oil

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两类血管预示不同的肾透明细胞癌预后

两类血管预示不同的肾透明细胞癌预后

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第四届中国肿瘤学术大会暨第五届海峡两岸肿瘤学术会议

作者：姚欣 Eric J．kort James H．Resau Bin Tean Teh 天津医科大学附属肿瘤医院盆腔泌尿科 Laboratory of Cancer Genetics Van Andel Research Institute333 Bostwick Ave NEGrand RapidsMI 49503．Department of Molecular Epidemiology and BiostatisticsKarolinska InstituteSweden Laboratory of Cancer Genetics Van Andel Research Institute333 Bostwick Ave NEGrand RapidsMI 49503．Department of Molecular Epidemiology and BiostatisticsKarolinska InstituteSweden Laboratory of Cancer Genetics Van Andel Research Institute333 Bostwick Ave NEGrand RapidsMI 49503．Department of Molecular Epidemiology and BiostatisticsKarolinska InstituteSweden

目的:血管生成是肿瘤生长的必需条件,也与肿瘤的血行转移有密切的关系。VHL基因是目前已知的低氧诱导因子（hypoxia—inducible factor,HIF）信号传导通路中极为重要的调节因子,VHL突变诱导的下游蛋白表达,如HIF, VEGF等参与调节血管生... 详细信息

目的:血管生成是肿瘤生长的必需条件,也与肿瘤的血行转移有密切的关系。VHL基因是目前已知的低氧诱导因子（hypoxia—inducible factor,HIF）信号传导通路中极为重要的调节因子,VHL突变诱导的下游蛋白表达,如HIF, VEGF等参与调节血管生成和细胞生长。在很多肿瘤类型中, 增加的肿瘤内血管密度和肿瘤缺氧状态与不良的肿瘤预后有直接关系。肾癌是常见的泌尿系统恶性肿瘤,80％为肾透明细胞癌（CCRCC）,41-53％的CCRCC发生VHL突变,而肿瘤血管生成与CCRCC预后的关系却一直有争论。本研究目的在于评价肿瘤内血管生成与CCRCC预后的关系,揭示转移性CCRCC血管生成的分子遗传学特征。方法:（1）Tissue Microarray（TMA）,芯片包括78例CCRCC、16例肾乳头状细胞癌（papillary renal cell carcinoma,pRCC）、5例肾嫌色细胞癌（Chromophobe renal cell carcinoma,ChRCC）、4例肾嗜酸细胞瘤（Oncocytoma）和16例正常肾皮质,常规方法比较血管内皮细胞标志物CD31、CD34和CD105标识的血管密度（microvascular density,MVD）与CCRCC预后的关系。（2）双重免疫荧光分析,CD31,CD34蛋白与血管外周细胞标志物（SMA）和淋巴管内皮细胞抗原LYVE-1的定位关系。（3）成熟肿瘤内血管密度（mature intratumoral mi- crovascular density,MIMVD）与非成熟肿瘤内血管密度（immature intratumoral microvascular density,IMIMVD）的预后意义,具有完整的10年随访资料的76例CCRCC石蜡包埋标本,常规IHC方法检测CD31和CD34表达,选择5 个CD31的血管分布热点区域（200X）,计数血管,均值为 MVDCD31,在连续组织切片相同区域,计数CD34均值为 MIMVD,MVDCD31与MIMVD的差值为IMIMVD。单因素和多因素分析方法比较MIMVD和IMIMVD与CCRCC预后的关系,以及与肿瘤细胞分化程度的关系。（4）oligonucleotide array gene profiling,自92例非转移肾透明细胞癌（术后平均随访5年）、13例转移性CCRCC和12例正常肾皮质中提取、纯化总RNA,使用Affymetrix HGU133 plus 2．0基因芯片（包含54,675寡核苷酸探针,标识47,000基因及其突变体）及推荐操作方法,采用R1．9．1软件包分析基因表达数据,比较不同预后的组织中基因转录水平的差异。结果:（1） CCRCC的MVD值高于其它亚型的肾上皮细胞肿瘤,而低于正常的肾皮质血管密度（p＜0．005）。文献报道CD105可以识别活化的乳腺癌血管内皮,TMA结果显示,抗CD105抗体不能识别正常的肾皮质内血管,在肿瘤组织中CD105仅识别 CD34阳性表达的血管内皮,MVDCD105与MVDCD34的相似系数为0．979。MVDCD105与MVDCD34与CCRCC术后转移风险负相关（p=0．043,p=0．0001）。CD34抗原仅在分化的血管肉瘤内皮细胞表达,而CD31则表达于分化和未分化的两类血管。本组中,CD31不仅标识具有明显管腔的成熟肿瘤内血管。还标识无明显管腔的血管内皮细胞。在不同预后的两组CCRCC中,MVDCD31无显著性差异,而转移组中 MVDCD31与MVDCD34的差值显著地高于非转移组（p＜0． 0001）,提示未成熟血管密度与CCRCC的不良预后有关。（2） CD31和CD34均与淋巴管内皮细胞的特异性抗体LYVE-1无交叉染色,CD34着色的血管外周均有SMA包饶,而部分 CD31着色的微血管外周无SMA着色,说明CD31抗原在有支持细胞的成熟血管和无支持细胞的非成熟血管内皮均表达。（3）单因素分析,MIMVD与CCRCC生存期延长正相关（HR 0．96,p=0．0004）,IMIMVD与CCRCC生存期呈负相关（HR 1．016,p＜0．0001）。多因素结果分析,IMIMVD是独立的 CCRCC预后因素（p=0．04）。分化好的CCRCC组织MIMVD 显著地高于分化差的肿瘤组织,而IMIMVD则与之相反。（4） cDNA microarray显示,部分与肿瘤血管形成＼缺氧效应相关的基因在未转移C C R C C中的转录水平高于转移性 CCRCC,包括VEGF（1．32倍,p＜0．01）,pDGFRB（1．75 倍,pp＜0．001）,KDR／VEGFR2（2．99倍,p＜0．001）,CD34 （1．82倍,p＜0．001）,

关键词：血管生成肾细胞癌转移预后

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血小板活化因子显著提高非男性因素所致不孕症患者宫腔内人工受精的妊娠率

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世界核心医学期刊文摘（妇产科学分册） 2005年第1期1卷 26-27页

作者： Roudebush W.E. Toledo A.A. kort H.I. 李焱 Reproductive Bi ology Associates Atlanta GAUnited States Dr.

Objective To determine the efficacy of treating semen specimens with platelet -activating factor (pAF) before IUI. Design prospective randomized double-blin ded study of pAF treatment of sperm for patients with a history of infertility u ndergoing IUI. Setting private infertility center. Intervention(s) patients had ovulation induction therapy with clomiphene citrate (CC)-or gonadotropin, two I UIs per month with pAF treatment. Main outcome measure(s) Clinical pregnancy rat es. Result( s) There was a significant difference in IUI pregnancy rates per cyc le between control (10/56; 17.9%) and pAF (14/47; 29.8%) treatment groups in t he normal male study arm. There was a significant difference in cumulative IUI p regnancy rates between control (10/35; 28.6%) and pAF (14/26; 53.9%) patient g roups in the normal male study arm. There was no significant difference in IUI p regnancy rates per cycle between control (12/124; 9.7%) and pAF (14/119; 11.8% ) treatment groups in the male factor study arm. There was no significant differ ence in cumulative IUI pregnancy rates between control (12/46; 26.1%) and pAF ( 14/38; 36.8%) patient groups in the male factor study arm. There was a signific ant difference in overall cumulative IUI pregnancy rates between control (21/81; 25.9%) and pAF (27/64; 42.2%) patient groups. Conclusion( s) The inclusion of pAF into the IUI spermwash procedure significantly improves pregnancy rates. Ho wever, the signifi-cant improvement can only be shown to affect men presenting with normal semen parameters.

关键词：人工受精男性因素血小板活化因子诱导排卵克罗米芬有显著性差异正常男性随机双盲无显著性差异洗涤过程

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Flatography: Detection of gastrointestinal diseases by faecal gas analysis

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World Journal of Gastrointestinal pharmacology and Therapeutics 2015年第4期6卷 111-113页

作者： Evelien F de Groot Tim G de Meij Daniel J Berkhout Marc p van der Schee nanne K de Boer Department of Gastro-enterology and Hepatology VU University Medical Centre Department of paediatric Gastroenterology VU University Medical Centre

patients presenting with gastro-intestinal symptoms might suffer from a range of possible underlying diseases. An unmet need exists for novel cost-effective,reproducible, easy-to-perform and non-invasive tests. Hippocrates used body odours to diagnose diseases circa 460 before Christ. The art of diagnostic smelling is making a promising high-tech come-back with portable "electronic diagnostic noses". Analysis of faecal volatile organic compounds is a novel field in metabolomics with considerable potential to improve the diagnosis, phenotyping and monitoring of gastro-intestinal disease. Challenges will be to mature over the coming years by development of a standardized methodology for stool sample collection, storage, handling and analysis. Furthermore, key volatiles need to be identified to improve test accuracy and sensitivity by development of sensors tailored toward the accurate identification of disease specific volatiles. If these challenges are adequately faced, analysis of faecal volatiles has realistic potential to considerably improve screening, diagnosis and disease monitoring for gastro-intestinal diseases.

关键词： Flatography Electronic nose Smell Volatile organic

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Fifteen-year follow-up of quality of life in type 1 diabetes mellitus

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World Journal of Diabetes 2014年第4期5卷 569-576页

作者： peter R van Dijk Susan JJ Logtenberg Klaas H Groenier Joost C Keers Henk JG Bilo nanne Kleefstra Diabetes Centre Isala 8000 GK Zwolle The Netherlands Department of Internal Medicine University Medical Center Groningen University of Groningen 9712 CP Groningen The Netherlands Department of General practice University Medical Center Groningen University of Groningen 9712 CP Groningen The Netherlands Research Institute Martini Hospital 9728 NT Groningen The Netherlands Department of Internal Medicine Isala 8000 GK Zwolle The Netherlands Langerhans Medical Research Group 8000 GK Zwolle The Netherlands

AIM:To evaluate metabolic control and health-related quality of life(HRQOL)in a type 1 diabetes mellitus(T1DM)***:As part of a prospective cohort study,283T1DM patients treated with various insulin treatment modalities including multiple daily injections(MDI)and continuous subcutaneous insulin infusion(CSII)were examined *** was measured using the SF-36 and EuroQol *** regarding HRQOL,glycaemic and metabolic control from baseline and follow-up measures in 2002 and 2010 were *** mixed models were used to calculate estimated values and differences between the three moments in time and the three treatment ***:Significant changes[meanΔ(95%CI)]in body mass index[2.4 kg/m2(1.0,3.8)],systolic blood pressure[-6.4 mmHg(-11.4,-1.3)]and EuroQol-VAS[-7.3(-11.4,-3.3)]were observed over *** 2010,168 patients were lost to *** mode of therapy,52 patients remained on MDI,28 remained on CSII,and 33 patients switched from MDI to CSII during *** patients on MDI,HRQOL decreased significantly over time:mental component summary[-9.8(-16.3,-3.2)],physical component summary[-8.6(-15.3,-1.8)]and EuroQol-VAS[-8.1(-14.0,-2.3)],ppatients using CSII,the EuroQol-VAS decreased[-9.6(-17.5,-1.7)].None of the changes over time in HRQOL differed significantly with the changes over time within the other treatment ***:No differences with respect to metabolic and HRQOL parameters between the various insulin treatment modalities were observed after 15 years of follow-up in T1DM patients.

关键词： Type 1 diabetes mellitus Health-related quality of life Glycaemic control Insulin treatment Multiple daily injections Continuous subcutaneous insulin infusion

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应用计算机断层扫描迭代重建对肺气肿、空气潴留、气道大小进行评估

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国际医学放射学杂志 2012年第6期 606-606页

作者： O.M.Mets M.J.Willemink F.p.L.de kort C.p.Mol T.Leiner M.Oudkerk 陶英伟 Department of Radiology UMC UtrechtP.O.Box 85500E1323508GAUtrechtthe Netherlands

目的与滤波反投影(FBp)相比较,确定CT的迭代重建(IR)对肺气肿、空气潴留、气道管腔大小测量的影响。方法分别使用FBp和IR对75例病人[男37例,女38例,平均年龄(64.0±5.7)岁]吸气相和呼气相的胸部CT进行重建。应用几种常用的量化方法对CT... 详细信息

目的与滤波反投影(FBp)相比较,确定CT的迭代重建(IR)对肺气肿、空气潴留、气道管腔大小测量的影响。方法分别使用FBp和IR对75例病人[男37例,女38例,平均年龄(64.0±5.7)岁]吸气相和呼气相的胸部CT进行重建。应用几种常用的量化方法对CT影像中肺气肿、空气潴留及段支气管的大小进行定量分析。用一致性相关系数(pc)和Wilcoxon符号秩检验两种算法对以上分析进行比较。结果当IR与FBp进行比较时,只有参数E/I-ratioMLD作为衡量标准时,CT影像中的空气潴留及气道大小的测量没有表现出显著差异,而其余所有CT影像中肺气肿及其他CT影像中的空气潴留的测量差异具有统计学意义(p<0.001)。结论 IR算法显著影响定量CT对肺气肿和空气潴留的测量。然而,参数E/IratioMLD作为衡量CT影像中空气潴留以及气道测量的标准时,不受此重建方法的影响。肺部的定量CT需要注意CT检查序列的选择,特别是使用迭代重建时。

关键词： CT 迭代重建肺气肿慢性阻塞性肺疾病定量CT

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