Blast injuries with contrasting outcomes treated by military surgery strategies: A case report.

The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.

Monitoring the Thiol/Thiophenol Molecule-Modulated Plasmon-Mediated Silver Oxidation with Dark-Field Optical Microscopy.

Surface plasmon can trigger or accelerate many photochemical reactions, especially useful in energy and environmental industries. Recently, molecular adsorption has proven effective in modulating plasmon-mediated photochemistry, however the realized chemical reactions are limited and the underlying mechanism is still unclear. Herein, by using in situ dark-field optical microscopy, the plasmon-mediated oxidative etching of silver nanoparticles (Ag NPs), a typical hot-hole-driven reaction, is monitored continuously and quantitatively. The presence of thiol or thiophenol molecules is found essential in the silver oxidation. In addition, the rate of silver oxidation is modulated by the choice of different thiol or thiophenol molecules. Compared with the molecules having electron donating groups, the ones having electron accepting groups accelerate the silver oxidation dramatically. The thiol/thiophenol modulation is attributed to the modulation of the charge separation between the Ag NPs and the adsorbed thiol or thiophenol molecules. This work demonstrates the great potential of molecular adsorption in modulating the plasmon-mediated photochemistry, which will pave a new way for developing highly efficient plasmonic photocatalysts.

Potential value of guard-wire technology in the interventional treatment for ostial coronary lesions.

BACKGROUND: To explore potential value of guard-wire technology during percutaneous coronary intervention (PCI) in patients with ostial coronary lesions. METHODS: Patients, who underwent PCI, were collected between October 2011 and March 2017. Of the 141 patients, 63 (44.7%) have ostial lesions, and 78 (55.3%) have distal bifurcation sites. They were divided into group A (n = 71) and group B (n = 70). Group A received PCI after guard-wire technology. Group B were given balloon dilation and stent after placing guide wire through target lesion vessel. X-ray exposure time, contrast agent dosage, total PCI duration, pressure incarceration times, cases of malignant arrhythmia and cases of failed PCI of all patients were analyzed, respectively. RESULTS: The general clinical characteristics includes patients age, sex ratio, the proportion of complications, smoking ratio and left ventricular ejection fraction of both groups was not significantly different. X-ray exposure time, contrast agent dosage, PCI total time, stent positioning time, pressure infestation frequency, arrhythmia frequency and complication number of group B were higher than those of group A. There is no case of malignant arrhythmia and case of failed PCI in group A, while there were five malignant arrhythmia and four failed PCI in group B. Contrast agent dosage and cases of failed PCI increased in group B compared with group A. CONCLUSION: The guard wire technology is safer and more feasible to patients with ostial coronary lesions who underwent PCI.

Optimization of Submodularity and BBO-Based Routing Protocol for Wireless Sensor Deployment.

Wireless sensors are limited by node costs, communication efficiency, and energy consumption when wireless sensors are deployed on a large scale. The use of submodular optimization can reduce the deployment cost. This paper proposes a sensor deployment method based on the Improved Heuristic Ant Colony Algorithm-Chaos Optimization of Padded Sensor Placements at Informative and cost-Effective Locations (IHACA-COpSPIEL) algorithm and a routing protocol based on an improved Biogeography-Based Optimization (BBO) algorithm. First, a mathematical model with submodularity is established. Second, the IHACA is combined with pSPIEL-based on chaos optimization to determine the shortest path. Finally, the selected sensors are used in the biogeography of the improved BBO routing protocols to transmit data. The experimental results show that the IHACA-COpSPIEL algorithm can go beyond the local optimal solutions, and the communication cost of IHACA-COpSPIEL is 38.42%, 24.19% and 8.31%, respectively, lower than that of the greedy algorithm, the pSPIEL algorithm and the IHACA algorithm. It uses fewer sensors and has a longer life cycle. Compared with the LEACH protocol, the routing protocol based on the improved BBO extends the life cycle by 30.74% and has lower energy consumption.

Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care.

PURPOSE: To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU). METHODS: Clinical data of trauma patients in the ICU of Daping Hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (<48 h) and delayed enteral nutrition group (control group, >48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q1, Q3) (non-normal distribution) and analyzed by Chi-square test, Student's t-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition. RESULTS: Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%, p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%, p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8), p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result in early enteral nutrition group than in control group regarding morality (0 vs. 11.9%, p = 0.03), length of hospital stay (days) (76.8 ± 41.4 vs. 81.4 ± 44.7, p = 0.01) and wound infection (10.3% vs. 26.2%, p = 0.03). Logistic regression analysis showed that the incidence of wound infection was related to the duration required to achieve the enteral nutrition standard (OR = 1.095, p = 0.002). Seventy-six patients (69.1%) achieved the nutritional goal within a week and 105 patients (95.5%) in the end. Trauma patients unable to reach the enteral nutrition target within one week were often combined with abdominal infection, peritonitis, bowel resection, intestinal necrosis, intestinal fistula, or septic shock. CONCLUSION: Early enteral nutrition for trauma patients in the ICU is correlated with less wound infection, lower mortality, and shorter hospital stay.

Feature selection methods for big data bioinformatics: A survey from the search perspective.

This paper surveys main principles of feature selection and their recent applications in big data bioinformatics. Instead of the commonly used categorization into filter, wrapper, and embedded approaches to feature selection, we formulate feature selection as a combinatorial optimization or search problem and categorize feature selection methods into exhaustive search, heuristic search, and hybrid methods, where heuristic search methods may further be categorized into those with or without data-distilled feature ranking measures.

Effects of terlipressin on patients with sepsis via improving tissue blood flow.

Terlipressin (TP), an analog of arginine vasopressin, was reported beneficial in sepsis patients when combined use with norepinephrine (NE), but the undetermined action, mechanism, and safety limited it to become the first-line vasopressor for sepsis patients. With 32 septic shock patients, we investigated the effects of a small dose of TP (1.3 µg/kg/h) on hemodynamic, tissue blood flow, vital organ function, acid-base balance, and coagulation function to systemically know the beneficial effect and side effects of TP on septic shock. The results showed that as compared with the single use of NE group (17 patients), a small dose of TP (1.3 µg/kg/h) in combination with NE continuous infusion, except for decreasing the mortality and NE requirement, could better improve and stabilize the hemodynamics, improve the tissue blood flow, increase the blood oxygen saturation and urine volume, and decrease the lactate level and complication rate (47% versus 82.3% in NE group). Meanwhile, TP + NE did not induce blood bilirubin increase and platelet count decrease and hyponatremia that vasopressin has. The results show that low dose of TP continuous infusion can help NE achieve the good resuscitation effect by improving tissue blood flow, stabilizing hemodynamics, and protecting organ function in septic shock patients while did not induce the side effects that high dose or bonus of TP or vasopressin induced. Low dose of TP may be recommended as the first-line vasopressor for refractory hypotension after severe sepsis or septic shock.

Ultra-high-speed spectropolarimeter based on photoelastic modulator.

Combined with the advantages of photoelastic modulator (PEM) ultra-high-speed modulation, this paper presents a method of ultra-high-speed spectropolarimeter based on PEM. The method provides the necessary measuring instruments for ultra-high-speed polarization spectroscopy. The main idea of this method is that an intensity modulator consisting of two retarders is placed before the PEM. The incident light under test goes through two retarders to the PEM. The interference signals are obtained by the PEM modulation. The different Stokes element interference signals are modulated by the PEM at different positions of the optical path difference. This method realizes the separation of Stokes element interference signals. The interference signals corresponding to each element are extracted, and the incident light Stokes element spectra can be obtained from the Fourier transforms of the interference signals. The modulation frequency of the PEM is high (tens to hundreds of kilohertz), so this method can realize ultra-high-speed full polarization spectroscopy. A prototype ultra-high-speed spectropolarimeter based on PEM was designed and tested. If the single-sided Fourier transformation is used, the single-sided interferogram scanning time is approximately 5 µs (i.e., the prototype is capable of scanning 20,000 interferograms per second). Polychromatic light polarization spectroscopy is measured by the prototype. The experimental results show that the average error of the prototype is less than 0.03.

[Chromatism Analysis of Multispectral Imaging System Based on AOTF and Hardware Compensation Strategy].

In view of the existing chromatism in the AOTF multispectral imaging system causes different wavelength imaging clarity under different focal length , even under the fixed wavelength, due to the horizontal direction (diffraction) spectral broadening, which leads to clear horizontal lines and blurring vertical lines. This paper made a concrete analysis of the chromatism of AOTF, pointing out the causes of imaging blurring. According to the imaging characteristics of AOTF multispectral imaging system, this paper proposed an improved algorithm based on SSIM, which can be used to evaluate the image sharpness. The target of the original algorithm was two images (one as a reference image, the other one as the test image), while the algorithm proposed in this paper made similarity analysis between the adjacent lines in one target image, small similarity in change edges declares great contrast, thus the image is clearer. The image quality caused by chromatism in the AOTF multispectral imaging system can be compensated by automatic focusing system, which mainly based on this algorithm. It has small calculated amount and fast speed. The feasibility and practicability of the compensation strategy were verified through experiments. The results show that this strategy can effectively solve the image blurring caused by chromatism in the AOTF multispectral imaging system, which has an important application value.

[The Research of Spectral Polarization Imaging Detection System Based Dual-AOTFs].

Acousto-optic tunable filter (AOTF) has the advantages of small size, good stability, wide range of wavelength scanning, quick modulation speed and so on. So AOTF is widely used in spectral imaging. But the detection of spectral polarization imaging is seldom found by using AOTF individually., Anew method of spectral polarization imaging based on dual-AOTFs is proposed. This method shows that the incident light is firstly divided into two beams by splitting mirror, and then two beams of light are through two AOTFs respectively, and the polarization direction of +1 diffraction order formed by AOTF is at a 45° against the other. The intensity of 0°, 45°, 90°and 135° can be obtained by ±1 diffraction orders of dual-AOTFs. Finally, the Stokes parameters are obtained by ±1 diffraction orders imaging of dual-AOTFs. They are S0 (the sum of light intensity between 0° and 90°), S1(the difference of light intensity between 0° and 90°) and S2 (the difference of light intensity between 45° and 135°). The target degree of linear polarization (DoLP) and angle of linear polarization (AoLP) is realized by corresponding theoretical formula. Furthermore, the polarization imaging of different wavelengths is realized with frequency sweep of dual-AOTFs so as to ultimately detect the spectral polarization imaging. The experiment has been verified through polarization imaging of three different lights, such as λ=500 nm, λ=550 nm and λ=600 nm.

Spectropolarimetric detection using photoelastic modulators and acousto-optic tunable filter.

This paper proposes a spectropolarimetric detection method based on three photoelastic modulators (3PEMs) and an acousto-optic tunable filter (AOTF). Operating the 3PEMs at slightly resonant frequencies (ω1,ω2,ω3) generates a different frequency signal that modulates the polarized component of the incident light at a low-frequency (0, 2ω1-2ω3, ω2-ω3). The frequency of the low-frequency modulation component is two to three orders of magnitude lower than the resonant frequency of any of the 3PEMs so the general area array detector can realize the detection. I, Q, and U of the incident light's Stokes parameters can be obtained in only one detection by extracting the low-frequency component from the detector's signals, and then combining it with an AOTF to finally realize the spectropolarimetric imaging detection. The paper introduces the basic principle, preliminarily verifies feasibility through a corresponding numerical simulation and experiment, and makes an error analysis on the polarization detection results according to factors of difference frequency and phase delay amplitude. The theory has potential application value to spectropolarimetric technology.

Mitochondrial DNA variant associated with Leber hereditary optic neuropathy and high-altitude Tibetans.

The distinction between mild pathogenic mtDNA mutations and population polymorphisms can be ambiguous because both are homoplasmic, alter conserved functions, and correlate with disease. One possible explanation for this ambiguity is that the same variant may have different consequences in different contexts. The NADH dehydrogenase subunit 1 (ND1) nucleotide 3394 T > C (Y30H) variant is such a case. This variant has been associated with Leber hereditary optic neuropathy and it reduces complex I activity and cellular respiration between 7% and 28% on the Asian B4c and F1 haplogroup backgrounds. However, complex I activity between B4c and F1 mtDNAs, which harbor the common 3394T allele, can also differ by 30%. In Asia, the 3394C variant is most commonly associated with the M9 haplogroup, which is rare at low elevations but increases in frequency with elevation to an average of 25% of the Tibetan mtDNAs (odds ratio = 23.7). In high-altitude Tibetan and Indian populations, the 3394C variant occurs on five different macrohaplogroup M haplogroup backgrounds and is enriched on the M9 background in Tibet and the C4a4 background on the Indian Deccan Plateau (odds ratio = 21.9). When present on the M9 background, the 3394C variant is associated with a complex I activity that is equal to or higher than that of the 3394T variant on the B4c and F1 backgrounds. Hence, the 3394C variant can either be deleterious or beneficial depending on its haplogroup and environmental context. Thus, this mtDNA variant fulfills the criteria for a common variant that predisposes to a "complex" disease.

[The Study of Large OPD's PEM Based on Micro Trapezoidal Photo-Elastic Crystals].

Existing Photoelastic Modulator (PEM), whose optical path difference (OPD) is small, has strict requirements on the incident spot size and is poor in the aspect of light use efficiency under multiple reflections. What's more, Photoelastic Modulator based Fourier transform spectrometer (PEM-FTS) spectral resolution is relatively poor. Because there are these disadvantages in the PEM, this paper presents a method of large optical path difference whose PEM is based on micro trapezoidal photoelastic crystals. By improving the structure of photoelastic crystal, the PEM becomes micro trapezoidal octagonal structure. And two transmission surfaces are changed slightly into a certain angle. Therefore, the PEM improved can not only increase the optical path difference of the PEM, but also have less requirements on the incident spot size. Firstly, a detailed analysis of the maximum modulation optical path difference was made in this paper. Secondly, the equation of maximum optical path difference was deduced under any angle and any position of incident light, vibration displacement and stress distribution of PEM are analyzed by the way of COMSOL Multiphysics 4.3a. Again, a method was analyzed to find the best angle of incidence, combining with maximum optical path difference and energy efficiency. Then the large OP's PEM is designed and processed, including two parts: photoelastic crystal and piezoelectric crystal. Moreover, ZnSe crystal is used as photoelastic crystal, and piezoelectric quartz crystal is used as piezoelectric crystal. With experiment analyzed by 632. 8 nm He-Ne laser, the results show that under the same driving voltage, the optical path difference of the PEM improved is about 19. 25 times bigger than the normal PEM, and the relative error is 1.3%.

[A New Strategy of Spectrum and Polarization Measuring based on LCVR and AOTF].

In view of the existing relatively cumbersome polarization measurement method of using liquid crystal phase variable retarder (LCVR) and acousto-optic tunable filter (AOTF), a new strategy of spectrum and polarization measurement is put forward. This method removed mechanical movement and reduced the amount of phase delay from four groups to two groups. This method realizes the spectrum and polarization measurements by measuring the plus and minus 1 level diffraction light of the system with two LCVR, one AOTF and two same version detectors. For the polarization measurement of a particular wavelength, the computer controlled LCVR driving voltage to achieve the required phase delay in accordance with the requirements of the wavelength, it also controlled the driving frequency to implement the required wavelength selection of AOTF. Because of the different driving frequencies of AOTF corresponding to the different wavelengths, so it can get the spectral information by scanning the whole frequency bands, In this paper detailed principles are deduced and the polarization model of AOTF is analyzed, it also deduced the measurement formula of I, Q, U in the corresponding Stokes parameter through the theoretical calculation Muller matrix of the LCVR and AOTF. Finally it analyzed and simulated the measurement error of the whole system which was caused by the tiny deviation of phase delay, the simulation results show that relative error <3% when the phase delay amount within the range of ±π/100. This experiment proved the feasibility and accuracy of the measurement system, the results show that the error of the measuring system overall <6%. This study provides a new method of polarization measurement which is simple, feasible and precise, it has important application value.

[Research on the neas infrared focal plane array detector imaging technology used in the laser warning].

In order to achieve the incoming laser's accurate position, it is necessary to improve the detected laser's direction resolution. The InGaAs focal plane array detector with the type of FPA-320 x 256-C was selected as the core component of the diffraction grating laser warning device. The detection theory of laser wavelength and direction based on diffraction grating was introduced. The drive circuit was designed through the analysis of the detector's performance and parameters. Under the FPGA' s timing control, the detector's analog output was sampled by the high-speed AD. The data was cached to FPGA's extended SRAM, and then transferred to a PC through USB. Labview on a PC collects the raw data for processing and displaying. The imaging experiments were completed with the above method. With the wavelength of 1550 nm and 980 nm laser from different directions the diffraction images were detected. Through analysis the location of the zero order and one order can be determined. According to the grating diffraction theory, the wavelength and the direction of the two-dimensional angle can be calculated. It indicates that the wavelength error is less than 10 nm, and the angle error is less than 1 degrees.

[Research of dual-photoelastic-modulator-based beat frequency modulation and Fourier-Bessel transform imaging spectrometer].

As the existing photoelastic-modulator(PEM) modulating frequency in the tens of kHz to hundreds of kHz between, leading to frequency of modulated interference signal is higher, so ordinary array detector cannot effectively caprure interference signal..A new beat frequency modulation method based on dual-photoelastic-modulator (Dual-PEM) and Fourier-Bessel transform is proposed as an key component of dual-photoelastic-modulator-based imaging spectrometer (Dual-PEM-IS) combined with charge coupled device (CCD). The dual-PEM are operated as an electro-optic circular retardance modulator, Operating the PEMs at slightly different resonant frequencies w1 and w2 respectively, generates a differential signal at a much lower heterodyne frequency that modulates the incident light. This method not only retains the advantages of the existing PEM, but also the frequency of modulated photocurrent decreased by 2-3 orders of magnitude (10-500 Hz) and can be detected by common array detector, and the incident light spectra can be obtained by Fourier-Bessel transform of low frequency component in the modulated signal. The method makes the PEM has the dual capability of imaging and spectral measurement. The basic principle is introduced, the basic equations is derived, and the feasibility is verified through the corresponding numerical simulation and experiment. This method has' potential applications in imaging spectrometer technology, and analysis of the effect of deviation of the optical path difference. This work provides the necessary theoretical basis for remote sensing of new Dual-PEM-IS and for engineering implementation of spectra inversion.

Esophageal pressure monitoring and its clinical significance in severe blast lung injury.

Background: The incidence of blast lung injury (BLI) has been escalating annually due to military conflicts and industrial accidents. Currently, research into these injuries predominantly uses animal models. Despite the availability of various models, there remains a scarcity of studies focused on monitoring respiratory mechanics post-BLI. Consequently, our objective was to develop a model for monitoring esophageal pressure (Pes) following BLI using a biological shock tube (BST), aimed at providing immediate and precise monitoring of respiratory mechanics parameters post-injury. Methods: Six pigs were subjected to BLI using a BST, during which Pes was monitored. We assessed vital signs; conducted blood gas analysis, hemodynamics evaluations, and lung ultrasound; and measured respiratory mechanics before and after the inflicted injury. Furthermore, the gross anatomy of the lungs 3 h post-injury was examined, and hematoxylin and eosin staining was conducted on the injured lung tissues for further analysis. Results: The pressure in the experimental section of the BST reached 402.52 ± 17.95 KPa, with a peak pressure duration of 53.22 ± 1.69 ms. All six pigs exhibited an anatomical lung injury score ≥3, and pathology revealed classic signs of severe BLI. Post-injury vital signs showed an increase in HR and SI, along with a decrease in MAP (p < 0.05). Blood gas analyses indicated elevated levels of Lac, CO2-GAP, A-aDO2, HB, and HCT and reduced levels of DO2, OI, SaO2, and OER (p < 0.05). Hemodynamics and lung ultrasonography findings showed increased ELWI, PVPI, SVRI, and lung ultrasonography scores and decreased CI, SVI, GEDI, and ITBI (p < 0.05). Analysis of respiratory mechanics revealed increased Ppeak, Pplat, Driving P, MAP, PEF, Ri, lung elastance, MP, Ptp, Ppeak - Pplat, and ΔPes, while Cdyn, Cstat, and time constant were reduced (p < 0.05). Conclusion: We have successfully developed a novel respiratory mechanics monitoring model for severe BLI. This model is reliable, repeatable, stable, effective, and user-friendly. Pes monitoring offers a non-invasive and straightforward alternative to blood gas analysis, facilitating early clinical decision-making. Our animal study lays the groundwork for the early diagnosis and management of severe BLI in clinical settings.

Evaluation of COVID-19 vaccines in primary prevention against infections and reduction in severity of illness following the outbreak of SARS-CoV-2 omicron variant in Shanghai.

Objectives: To evaluate COVID-19 vaccines in primary prevention against infections and lessen the severity of illness following the most recent outbreak of the SARS-CoV-2 Omicron variant in Shanghai. Data sources: Data from 153,544 COVID-19 patients admitted to the Shanghai "Four-Leaf Clover" Fangcang makeshift shelter hospital were collected using a structured electronic questionnaire, which was then merged with electronic medical records of the hospital. For healthy controls, data on vaccination status and other information were obtained from 228 community-based residents, using the same structured electronic questionnaire. Methods: To investigate whether inactivated vaccines were effective in protecting against SARS-CoV-2 virus, we estimated the odds ratio (OR) of the vaccination by comparing cases and matched community-based healthy controls. To evaluate the potential benefits of vaccination in lowering the risk of symptomatic infection (vs. asymptomatic), we estimated the relative risk (RR) of symptomatic infections among diagnosed patients. We also applied multivariate stepwise logistic regression analyses to measure the risk of disease severity (symptomatic vs. asymptomatic and moderate/severe vs. mild) in the COVID-19 patient cohort with vaccination status as an independent variable while controlling for potential confounding factors. Results: Of the 153,544 COVID-19 patients included in the analysis, the mean age was 41.59 years and 90,830 were males (59.2%). Of the study cohort, 118,124 patients had been vaccinated (76.9%) and 143,225 were asymptomatic patients (93.3%). Of the 10,319 symptomatic patients, 10,031 (97.2%), 281 (2.7%), and 7 (0.1%) experienced mild, moderate, and severe infections, respectively. Hypertension (8.7%) and diabetes (3.0%) accounted for the majority of comorbidities. There is no evidence that the vaccination helped protect from infections (OR = 0.82, p = 0.613). Vaccination, however, offered a small but significant protection against symptomatic infections (RR = 0.92, p < 0.001) and halved the risk of moderate/severe infections (OR = 0.48, 95% CI: 0.37-0.61). Older age (≥60 years) and malignant tumors were significantly associated with moderate/severe infections. Conclusion: Inactivated COVID-19 vaccines helped provide small but significant protection against symptomatic infections and halved the risk of moderate/severe illness among symptomatic patients. The vaccination was not effective in blocking the SARS-CoV-2 Omicron Variant community spread.

Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study.

BACKGROUND: The currently preferred minimally invasive approaches have substantially improved outcomes of infected walled-off pancreatic necrosis (iWON). However, iWON with deep extension (iWONde) still poses a tricky challenge for sufficient necrosis evacuation by one stand-alone approach, often requiring repeated interventions. The aim of this study was to assess the effectiveness and safety of a minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (hereafter called VARTD) in the management of iWONde. METHODS: Patients who had developed an iWONde were recruited to receive the VARTD in this prospective single-arm study. The primary efficacy endpoint was clinical improvement up to day 28 after the VARTD, defined as a ≥ 75% reduction in size of necrotic collection (in any axis) on CT and clinical resolution of sepsis or organ dysfunction. The primary safety endpoint was a composite of major complications or death during follow-up. Six-month postdischarge follow-up was available. RESULTS: Between July 18, 2018, and November 12, 2020, we screened 95 patients with necrotizing pancreatitis; of these, 21 iWONde patients (mean [SD] age, 42.9 [11.7] years; 10 [48%] women) were finally enrolled. The primary efficacy endpoint was achieved by most participants (14/21, 67%). No participants required repeated interventions. The primary safety endpoint occurred in six patients (29%). Except one in-hospital death attributable to repeated intra-abdominal hemorrhage, others were discharged without any major complication. CONCLUSIONS: The VARTD approach appears to have a reasonable efficacy with acceptable complication rates and thus might be an option for improving clinical management of iWONde. TRIAL REGISTRATION: This study is registered with Chinese Clinical Trial Registry (chictr.org.cn number, ChiCTR1800016950).