Clinical characteristics, effectiveness and cost of different treatment methods for invasive Klebsiella pneumoniae liver abscess syndrome. / ä¾µè¢­æ€§è‚ºç‚Žå ‹é›·ä¼¯èŒè‚è„“è‚¿ç»¼åˆå¾çš„ä¸´åºŠç‰¹å¾åŠä¸åŒæ²»ç–—æ–¹å¼çš„æœ‰æ•ˆæ€§ä¸Žè´¹ç”¨åˆ†æž.

OBJECTIVES: Bacterial liver abscess is one of the common infectious diseases of the digestive system. Invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) refers to cases where, in addition to liver abscess, there are migratory infections foci or other invasive manifestations. The clinical characteristics and risk factors of IKLAS are not fully elucidated, and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods. This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS, and explore effective and economical treatment methods. METHODS: This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023. A total of 201 patients were included, dividing into an IKLAS group (n=37) and a non-IKLAS group (n=164). Differences in demographics, symptoms and signs, laboratory indicators, imaging characteristics, comorbidities, treatment methods, treatment outcomes, and direct treatment costs between 2 groups were analyzed. The study also compared the effectiveness and costs of different treatment methods. RESULTS: Compared with the non-IKLAS group, the proportion of patients with diabetes, Quick Sequential Organ Failure Assessment (qSOFA)≥2, immune deficiency, anemia, and thrombocytopenia in the IKLAS group was higher, and the level of procalcitonin at the onset in the IKLAS group was also higher (all P<0.05). In terms of symptoms and signs, the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain (both P<0.05). In terms of complications, the incidence of combined pleural effusion, pulmonary infection, acute renal failure, respiratory failure, and multiple organ failure was higher in the IKLAS group (all P<0.05). The IKLAS group had a higher proportion of patients treated with antibiotics alone (24.32% vs 11.59%), while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage (86.59% vs 64.86%, both P<0.05). The overall effective rate of the IKLAS group (83.78%) was lower than that of the non-IKLAS group (95.73%), and the treatment and drug costs were higher (all P<0.05). The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100% improvement rate, antibiotics combined with abscess puncture and drainage had an 84.9% improvement rate, and in antibiotics alone had an 82.1% improvement rate, with statistical differences among the 3 treatment methods (P<0.05). In terms of treatment costs, antibiotics alone were the most expensive (P<0.05). CONCLUSIONS: Patients with IKLAS have poorer prognosis and higher direct medical costs. The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone, suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.

Energy dissipation efficiency as a new variable in the empirical correlation of total dissolved gas.

Total dissolved gas (TDG) supersaturation, which occurs during dam spilling, may result in fish bubble disease and mortality. Many studies have been conducted to identify the factors pertaining to TDG generation, such as the spilling discharge and tailwater depth. Additionally, the energy dissipation efficiency should be considered due to its effect on the air entrainment, which influences the TDG generation process. According to the TDG field observations of 49 cases at Dagangshan and Xiluodu hydropower stations, the TDG was positively related to the energy dissipation efficiency, tailwater depth and discharge per unit width. A correlation between the generated TDG level and these factors was established. The empirical equations proposed by the USACE were calibrated, and the TDG level estimation performance was compared with the established correlation for 25 spillage cases at seven other dams. Among the considered cases, the standard error of the TDG estimation considering the energy dissipation efficiency was 5.7%, and those for the correlations obtained using the USACE equations were 13.0% and 10.0%. The findings indicated that the energy dissipation efficiency considerably influenced the TDG level, and its consideration helped enhance the precision of the TDG estimation. Finally, the generality of this approach and future work were discussed.

Experimental Study on the Effects of Vegetation on the Dissipation of Supersaturated Total Dissolved Gas in Flowing Water.

High dam discharge can lead to total dissolved gas (TDG) supersaturation in the downstream river, and fish in the TDG-supersaturated flow can suffer from bubble disease and even die. Consequently, it is of great value to study the transport and dissipation characteristics of supersaturated dissolved gas for the protection of river fish. Floodplains may form downstream of high dams due to flood discharge, and the plants on these floodplains can affect both the hydraulic characteristics and TDG transport of the flowing water. In this study, the velocity distribution and the retention response time under different flow conditions and vegetation arrangements were studied in a series of experiments. The retention time was significantly extended by the presence of vegetation, and an empirical formula for calculating the retention time was proposed. In addition, the responses of the dissipation process of supersaturated TDG to hydraulic factors, retention time, and vegetation area coefficient were analyzed. The dissipation of supersaturated TDG significantly increased with increases in the vegetation area coefficient in the water. To quantitatively describe the TDG dissipation process in TDG-supersaturated flow under the effect of vegetation, the TDG dissipation coefficient was fitted and analyzed. The basic form of the formula for the dissipation coefficient involving various influence factors was determined by dimensional analysis. An equation for calculating the TDG dissipation coefficient of flowing water with vegetation was proposed by multivariate nonlinear fitting and was proven to have great prediction accuracy. The calculated method developed in this paper can be used to predict TDG dissipation in flowing water with vegetation and is of great significance for enriching TDG prediction systems.

Cumulative effects of cascade hydropower stations on total dissolved gas supersaturation.

Elevated levels of total dissolved gas (TDG) may occur downstream of dams during the spill process. These high levels would increase the incidence of gas bubble disease in fish and cause severe environmental impacts. With increasing numbers of cascade hydropower stations being built or planned, the cumulative effects of TDG supersaturation are becoming increasingly prominent. The TDG saturation distribution in the downstream reaches of the Jinsha River was studied to investigate the cumulative effects of TDG supersaturation resulting from the cascade hydropower stations. A comparison of the effects of the joint operation and the single operation of two hydropower stations (XLD and XJB) was performed to analyze the risk degree to fish posed by TDG supersaturation. The results showed that water with supersaturated TDG generated at the upstream cascade can be transported to the downstream power station, leading to cumulative TDG supersaturation effects. Compared with the single operation of XJB, the joint operation of both stations produced a much higher TDG saturation downstream of XJB, especially during the non-flood discharge period. Moreover, the duration of high TDG saturation and the lengths of the lethal and sub-lethal areas were much higher in the joint operation scenario, posing a greater threat to fish and severely damaging the environment. This work provides a scientific basis for strategies to reduce TDG supersaturation to the permissible level and minimize the potential risk of supersaturated TDG.

ELNES for boron, carbon, and nitrogen K-edges with different chemical environments in layered materials studied by density functional theory.

Electron energy-loss near-edge fine structures (ELNES) were calculated for graphene, doped graphene, a hexagonal BN monolayer, and a hexagonal BC2N layer using an ab initio pseudopotential plane wave method including the core-hole effect. Spectral features that can be used to distinguish different chemical environments are identified. The spectral features are closely related to the atomic species and arrangement. The connection between chemical environments and fine structures is discussed.