首页 > 最新文献

medRxiv - Surgery最新文献

英文 中文
The VIPR-1 trial (Visualizing Ischemia in the Pancreatic Remnant) - Assessing the role of intraoperative indocyanine green perfusion of the transected pancreas in predicting postoperative pancreatic leaks: protocol for a prospective phase II trial. VIPR-1试验(胰腺残余缺血可视化)--评估横断胰腺术中吲哚青绿灌注在预测术后胰漏中的作用:前瞻性II期试验方案。
Pub Date : 2024-09-14 DOI: 10.1101/2024.09.13.24313603
Gustavo Salgado-Garza, Annika Willy, Flavio G. Rocha, Skye C. Mayo, Brett C. Sheppard, Patrick J. Worth
Surgery of the pancreas has come a long way since its inception; however, postoperative morbidity is still high. Pancreatic leaks and fistulas are common complications in patients undergoing surgery to remove the pancreas. Fistulas delay subsequent oncological care after surgery and prolong the hospital stay. Hypoperfusion to the pancreas has been characterized as one factor leading to fistulas. Indocyanine green (ICG) injection allows the surgeon to evaluate blood perfusion to tissue in real-time. This protocol describes a trial that aims to assess the effectiveness of intraoperative ICG metrics of the cut edge of the pancreas to predict postoperative fistulas. A single group will participate in an observational, surgeon-blinded, phase II trial. ICG measurements of the cut edge of the pancreas will be recorded before reconstruction. International Study Group on Pancreatic Surgery criteria for pancreatic fistula will be used to define leaks and fistulas. The primary outcome will be the correlation between ICG measurements and the development or absence of fistula formation. Currently, limited objective intraoperative predictors exist for predicting postoperative fistulas. Having a reliable predictive tool could decrease the healthcare burden posed by fistulas. The findings of this trial will provide conclusions on the usefulness of ICG measurements in predicting postoperative pancreatic fistulas and leaks. This clinical trial is registered in ClinicalTrials.gov with the ID NCT06084013. The current protocol version is v1.0.
胰腺手术自诞生以来取得了长足的进步,但术后发病率仍然很高。胰漏和瘘管是接受胰腺切除手术的患者常见的并发症。瘘管会延误术后的肿瘤治疗,延长住院时间。胰腺灌注不足是导致瘘管的一个因素。吲哚菁绿(ICG)注射可让外科医生实时评估组织的血液灌注情况。本方案描述了一项旨在评估术中胰腺切缘 ICG 指标预测术后瘘管有效性的试验。一个小组将参与观察性、外科医生盲法的 II 期试验。重建前将记录胰腺切缘的 ICG 测量值。国际胰腺外科研究小组的胰瘘标准将用于定义漏孔和瘘管。主要结果是 ICG 测量值与瘘管形成与否之间的相关性。目前,用于预测术后瘘管的术中客观预测指标有限。拥有可靠的预测工具可以减轻瘘管造成的医疗负担。这项试验的结果将为 ICG 测量在预测术后胰瘘和胰漏方面的实用性提供结论。该临床试验已在 ClinicalTrials.gov 注册,注册号为 NCT06084013。当前方案版本为 v1.0。
{"title":"The VIPR-1 trial (Visualizing Ischemia in the Pancreatic Remnant) - Assessing the role of intraoperative indocyanine green perfusion of the transected pancreas in predicting postoperative pancreatic leaks: protocol for a prospective phase II trial.","authors":"Gustavo Salgado-Garza, Annika Willy, Flavio G. Rocha, Skye C. Mayo, Brett C. Sheppard, Patrick J. Worth","doi":"10.1101/2024.09.13.24313603","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313603","url":null,"abstract":"Surgery of the pancreas has come a long way since its inception; however, postoperative morbidity is still high. Pancreatic leaks and fistulas are common complications in patients undergoing surgery to remove the pancreas. Fistulas delay subsequent oncological care after surgery and prolong the hospital stay. Hypoperfusion to the pancreas has been characterized as one factor leading to fistulas. Indocyanine green (ICG) injection allows the surgeon to evaluate blood perfusion to tissue in real-time. This protocol describes a trial that aims to assess the effectiveness of intraoperative ICG metrics of the cut edge of the pancreas to predict postoperative fistulas. A single group will participate in an observational, surgeon-blinded, phase II trial. ICG measurements of the cut edge of the pancreas will be recorded before reconstruction. International Study Group on Pancreatic Surgery criteria for pancreatic fistula will be used to define leaks and fistulas. The primary outcome will be the correlation between ICG measurements and the development or absence of fistula formation. Currently, limited objective intraoperative predictors exist for predicting postoperative fistulas. Having a reliable predictive tool could decrease the healthcare burden posed by fistulas. The findings of this trial will provide conclusions on the usefulness of ICG measurements in predicting postoperative pancreatic fistulas and leaks. This clinical trial is registered in ClinicalTrials.gov with the ID NCT06084013. The current protocol version is v1.0.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Insulin-dependence as a Predictor of Shortened Cancer-specific Survival in Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study from the United States Neuroendocrine Study Group 胰岛素依赖是缩短胰腺神经内分泌肿瘤癌症特异性生存期的预测因素:美国神经内分泌研究小组的一项多机构研究
Pub Date : 2024-09-12 DOI: 10.1101/2024.09.11.24313436
Muhammad Bilal Mirza, Jordan Baechle, Paula Marincola Smith, Danish Ali, Mary Dillhoff, George Poultsides, Flavio Rocha, Clifford Cho, Emily Winslow, Ryan Fields, Shishir Maithel, Kamran Idrees
Introduction: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to delineate the impact of insulin dependent (IDDM) and non -insulin dependent (NIDDM) on poor oncological outcomes. Methods: Utilizing the U.S. Neuroendocrine Tumor Study Group database (1999-2016), we performed a retrospective cohort study of adult patients who underwent primary surgical resection of PNETs. Patients were categorized based on preoperative diagnosis into non-DM, NIDDM, and IDDM cohorts. We used the Kaplan-Meier method and log-rank test to study cancer-specific survival (CSS). Cox proportional Hazards models were used to assess the impact of IDDM on CSS. Results: Of the 1,122 patients included in the analysis, 870 (77%) were non-DM, 168 (15%) were NIDDM, and 84 (8%) were IDDM. The groups were similar in tumor stage and grade. However, they differed in sex, BMI, age, ASA class, tumor location, preoperative HbA1c and serum glucose (p-value <0.05). Patients with IDDM had significantly decreased 5-year CSS compared to patients without IDDM (CSS: IDDM 85%, NIDDM 94%, non-DM 93%, NIDDM + non-DM 93%; P <0.01). On multivariate analysis, IDDM was independently associated with worse CSS (HR 2.27, 95% Confidence Interval 1.15-4.45, P=0.02). Conclusion: Insulin dependence is associated with worse cancer-specific survival in PNET patients following surgical resection compared to PNET patients with NIDDM or without DM.
简介胰腺肿瘤网(PNET)是源自胰岛细胞的罕见胰腺恶性肿瘤,与糖尿病(DM)并发率高,存活率较低。然而,尚未有研究明确胰岛素依赖型(IDDM)和非胰岛素依赖型(NIDDM)对不良肿瘤预后的影响。研究方法利用美国神经内分泌肿瘤研究小组数据库(1999-2016 年),我们对接受 PNET 初级手术切除的成年患者进行了一项回顾性队列研究。根据术前诊断将患者分为非糖尿病组、NIDDM 组和 IDDM 组。我们使用 Kaplan-Meier 法和对数秩检验来研究癌症特异性生存率(CSS)。采用 Cox 比例危险度模型评估 IDDM 对 CSS 的影响。结果:在纳入分析的 1,122 例患者中,870 例(77%)为非 IDDM 患者,168 例(15%)为 NIDDM 患者,84 例(8%)为 IDDM 患者。各组患者的肿瘤分期和分级相似。但是,他们在性别、体重指数、年龄、ASA 分级、肿瘤位置、术前 HbA1c 和血清葡萄糖方面存在差异(P 值为 0.05)。与非 IDDM 患者相比,IDDM 患者的 5 年 CSS 明显降低(CSS:IDDM 85%、NIDDM 94%、非 IDDM 93%、NIDDM + 非 IDDM 93%;P <0.01)。在多变量分析中,IDDM 与较差的 CSS 独立相关(HR 2.27,95% 置信区间 1.15-4.45,P=0.02)。结论与 NIDDM 或无 DM 的 PNET 患者相比,胰岛素依赖与手术切除后 PNET 患者的癌症特异性生存率较低有关。
{"title":"Insulin-dependence as a Predictor of Shortened Cancer-specific Survival in Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study from the United States Neuroendocrine Study Group","authors":"Muhammad Bilal Mirza, Jordan Baechle, Paula Marincola Smith, Danish Ali, Mary Dillhoff, George Poultsides, Flavio Rocha, Clifford Cho, Emily Winslow, Ryan Fields, Shishir Maithel, Kamran Idrees","doi":"10.1101/2024.09.11.24313436","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313436","url":null,"abstract":"Introduction: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to delineate the impact of insulin dependent (IDDM) and non\t-insulin dependent (NIDDM) on poor oncological outcomes. Methods: Utilizing the U.S. Neuroendocrine Tumor Study Group database (1999-2016), we performed a retrospective cohort study of adult patients who underwent primary surgical resection of PNETs. Patients were categorized based on preoperative diagnosis into non-DM, NIDDM, and IDDM cohorts. We used the Kaplan-Meier method and log-rank test to study cancer-specific survival (CSS). Cox proportional Hazards models were used to assess the impact of IDDM on CSS. Results: Of the 1,122 patients included in the analysis, 870 (77%) were non-DM, 168 (15%) were NIDDM, and 84 (8%) were IDDM. The groups were similar in tumor stage and grade. However, they differed in sex, BMI, age, ASA class, tumor location, preoperative HbA1c and serum glucose (p-value &lt;0.05). Patients with IDDM had significantly decreased 5-year CSS compared to patients without IDDM (CSS: IDDM 85%, NIDDM 94%, non-DM 93%, NIDDM + non-DM 93%; P &lt;0.01). On multivariate analysis, IDDM was independently associated with worse CSS (HR 2.27, 95% Confidence Interval 1.15-4.45, P=0.02). Conclusion: Insulin dependence is associated with worse cancer-specific survival in PNET patients following surgical resection compared to PNET patients with NIDDM or without DM.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chyme Reinfusion Practices in the Neonatal Population 新生儿的食糜再输注实践
Pub Date : 2024-09-06 DOI: 10.1101/2024.09.06.24312922
Alexandria H Lim, Georges Tinawi, Taylor Harrington, Emma Ludlow, Helen Evans, Ian Bisset, Celia Keane
Abstract Introduction: The utilisation of chyme reinfusion therapy (CRT) by returning the output from the proximal limb into the distal limb of double enterostomies is a safe and effective method to improve nutritional uptake and maintain intestinal integrity in adult populations. This technique is also particularly suitable for neonatal patients with life-threatening conditions such as congenital bowel abnormalities and necrotising enterocolitis (NEC). Despite its promise, it has only had irregular uptake in neonatal patients. We aimed to identify the frequency, methodology and adverse events associated with CRT in the appropriate neonatal population. Methods: A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded. Results: Of the 49 neonates identified with double enterostomy 23 (47%) underwent CRT for high stoma output, risk of short gut syndrome or as a routine protocol before re-anastomosis. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50 - 22.89) to 24.37 (19.68 - 29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). The rate of non-infectious adverse events was 24, with 7% remaining free from any adverse events. Conclusion: Chyme reinfusion is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.
摘要 简介:利用食糜再灌注疗法(CRT),将双肠造口近端输出的食糜回流到远端,是一种安全有效的方法,可改善成人的营养吸收并保持肠道完整性。这种技术还特别适用于患有先天性肠道畸形和坏死性小肠结肠炎(NEC)等危及生命疾病的新生儿患者。尽管这项技术前景广阔,但在新生儿患者中的使用率并不高。我们旨在确定 CRT 在适当新生儿人群中的使用频率、方法和相关不良事件。方法:通过在新西兰两家大型儿科医院的数据库中搜索,进行了一项为期十年的回顾性队列研究。确定了所有具有合适解剖结构的患者,并记录了有关 CRT 方法和结果的数据。研究结果:在 49 名被确认患有双肠造口术的新生儿中,有 23 名(47%)因造口输出量高、短肠综合征风险或作为再次吻合前的常规方案而接受了 CRT。在远端肢体插入鼻胃喂养管,通过手动栓塞或自动注射器驱动装置将收集的食糜重新灌入。在 CRT 期间,体重增加的中位数(IQR)从每天 13.9 克(3.50 - 22.89)增加到 24.37 克(19.68 - 29.99)(p = 0.04)。13 名患者(56%)发生了 18 例需要医疗干预但与 CRT 无关的感染。非感染性不良事件发生率为 24 例,7% 的患者未发生任何不良事件。结论食糜再灌注是一种未被充分利用的改善肠功能衰竭新生儿营养状况的方法。需要进行双肠造口术的早产新生儿发生感染性和非感染性并发症的风险很高,但其中很少与 CRT 有关。需要制定标准化方案,提供明确的资格标准和详细的 CRT 方法,以促进这种做法的统一使用。
{"title":"Chyme Reinfusion Practices in the Neonatal Population","authors":"Alexandria H Lim, Georges Tinawi, Taylor Harrington, Emma Ludlow, Helen Evans, Ian Bisset, Celia Keane","doi":"10.1101/2024.09.06.24312922","DOIUrl":"https://doi.org/10.1101/2024.09.06.24312922","url":null,"abstract":"Abstract Introduction: The utilisation of chyme reinfusion therapy (CRT) by returning the output from the proximal limb into the distal limb of double enterostomies is a safe and effective method to improve nutritional uptake and maintain intestinal integrity in adult populations. This technique is also particularly suitable for neonatal patients with life-threatening conditions such as congenital bowel abnormalities and necrotising enterocolitis (NEC). Despite its promise, it has only had irregular uptake in neonatal patients. We aimed to identify the frequency, methodology and adverse events associated with CRT in the appropriate neonatal population. Methods: A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded. Results: Of the 49 neonates identified with double enterostomy 23 (47%) underwent CRT for high stoma output, risk of short gut syndrome or as a routine protocol before re-anastomosis. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50 - 22.89) to 24.37 (19.68 - 29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). The rate of non-infectious adverse events was 24, with 7% remaining free from any adverse events. Conclusion: Chyme reinfusion is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Traumatic Amputations - A Nationwide Epidemiological Analysis of a developing country over 16 years 创伤性截肢 - 一个发展中国家 16 年来的全国流行病学分析
Pub Date : 2024-09-06 DOI: 10.1101/2024.09.05.24313153
Marcella Moura Ceratti, Carolina Carvalho Jansen Sorbello, Isabela Roskamp Sunye, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Miguel Cendoroglo Neto, Nelson Wolosker
Background Defining the impact of amputation is essential for developing cost-effective preventive health policies. Trauma is one of the most common causes of limb loss, affecting mainly the young working population. To date, few studies have investigated the epidemiology of patients undergoing trauma-related amputations and their public health implications in developing countries. The aim of this study was to analyze all limb amputations due to traumatic injuries performed in the Brazilian public health system over a 16-year period, studying their incidence, demographics, hospitalization and costs.
背景 界定截肢的影响对于制定具有成本效益的预防性保健政策至关重要。创伤是导致肢体缺失的最常见原因之一,主要影响年轻的劳动人口。迄今为止,很少有研究调查发展中国家因外伤而截肢的患者的流行病学及其对公共卫生的影响。这项研究的目的是分析巴西公共卫生系统在 16 年间进行的所有外伤性截肢手术,研究其发病率、人口统计学、住院情况和费用。
{"title":"Traumatic Amputations - A Nationwide Epidemiological Analysis of a developing country over 16 years","authors":"Marcella Moura Ceratti, Carolina Carvalho Jansen Sorbello, Isabela Roskamp Sunye, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Miguel Cendoroglo Neto, Nelson Wolosker","doi":"10.1101/2024.09.05.24313153","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313153","url":null,"abstract":"<strong>Background</strong> Defining the impact of amputation is essential for developing cost-effective preventive health policies. Trauma is one of the most common causes of limb loss, affecting mainly the young working population. To date, few studies have investigated the epidemiology of patients undergoing trauma-related amputations and their public health implications in developing countries. The aim of this study was to analyze all limb amputations due to traumatic injuries performed in the Brazilian public health system over a 16-year period, studying their incidence, demographics, hospitalization and costs.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development and Validation of Collaborative Robot-assisted Cutting Method for Iliac Crest Flap Raising: Randomized Crossover Trial 髂嵴皮瓣提升机器人辅助协作切割法的开发与验证:随机交叉试验
Pub Date : 2024-09-05 DOI: 10.1101/2024.09.04.24312594
Paulina Becker, Yao Li, Sergey Drobinsky, Jan Egger, Kunpeng Xie, Ashkan Rashad, Klaus Radermacher, Rainer Röhrig, Matías de la Fuente, Frank Hölzle, Behrus Puladi
The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide.
目前计算机辅助颌骨重建的黄金标准包括利用患者特定的三维打印切割导板提升微血管骨瓣。切割导板的缺点是有创固定、骨膜变性、术前准备时间长和术中灵活性缺失。本研究旨在探讨机器人辅助切割法与传统的三维打印切割导板相比,在提升髂嵴骨瓣方面的可行性和准确性。
{"title":"Development and Validation of Collaborative Robot-assisted Cutting Method for Iliac Crest Flap Raising: Randomized Crossover Trial","authors":"Paulina Becker, Yao Li, Sergey Drobinsky, Jan Egger, Kunpeng Xie, Ashkan Rashad, Klaus Radermacher, Rainer Röhrig, Matías de la Fuente, Frank Hölzle, Behrus Puladi","doi":"10.1101/2024.09.04.24312594","DOIUrl":"https://doi.org/10.1101/2024.09.04.24312594","url":null,"abstract":"The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PREVALENCE AND TREATMENT OUTCOME OF ANORECTAL MALFORMATION AT MNAZI MMOJA REFERRAL HOSPITAL 2018-2022 2018-2022 年姆纳齐-莫贾转诊医院肛门直肠畸形的发病率和治疗效果
Pub Date : 2024-09-04 DOI: 10.1101/2024.09.03.24310510
Ahmad Moshi Chongera, Abdulkarim Hamad Ally, Mwanakhamis Vuai Mussa, Yasinta Edison Mnyaruge, Said A Said, Mwanabaraka Saleh Haji
BACKGROUND Anorectal Malformations (ARM) are congenital defects where the anus and rectum do not form correctly, presenting a range of complexities that often necessitate intricate surgical interventionist global incidence of ARM is approximately 1 in 2000 to 5000 live births. In developing countries like Tanzania, managing ARMs poses significant challenges due to late presentations, shortage of trained pediatric surgeons and inadequate diagnostic facilities. This study aimed to evaluate the prevalence and treatment outcomes of ARM at Mnazi Mmoja Hospital (MMH) over five years 2018 to 2022
背景肛门直肠畸形(ARM)是肛门和直肠不能正常形成的先天性缺陷,表现出一系列复杂问题,往往需要复杂的外科手术干预,全球肛门直肠畸形的发病率约为每 2000 到 5000 例活产中就有 1 例。在坦桑尼亚等发展中国家,由于发病较晚、缺乏训练有素的小儿外科医生以及诊断设施不足,ARM 的管理面临着巨大挑战。本研究旨在评估姆纳齐-姆莫加医院(MMH)在 2018 年至 2022 年五年间 ARM 的发病率和治疗效果。
{"title":"PREVALENCE AND TREATMENT OUTCOME OF ANORECTAL MALFORMATION AT MNAZI MMOJA REFERRAL HOSPITAL 2018-2022","authors":"Ahmad Moshi Chongera, Abdulkarim Hamad Ally, Mwanakhamis Vuai Mussa, Yasinta Edison Mnyaruge, Said A Said, Mwanabaraka Saleh Haji","doi":"10.1101/2024.09.03.24310510","DOIUrl":"https://doi.org/10.1101/2024.09.03.24310510","url":null,"abstract":"<strong>BACKGROUND</strong> Anorectal Malformations (ARM) are congenital defects where the anus and rectum do not form correctly, presenting a range of complexities that often necessitate intricate surgical interventionist global incidence of ARM is approximately 1 in 2000 to 5000 live births. In developing countries like Tanzania, managing ARMs poses significant challenges due to late presentations, shortage of trained pediatric surgeons and inadequate diagnostic facilities. This study aimed to evaluate the prevalence and treatment outcomes of ARM at Mnazi Mmoja Hospital (MMH) over five years 2018 to 2022","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemiological Analysis of Lower Limb Vascular Trauma over 16 years in Brazil - A Nationwide View 巴西 16 年间下肢血管创伤的流行病学分析--全国视角
Pub Date : 2024-09-03 DOI: 10.1101/2024.09.02.24312947
Carolina Carvalho Jansen Sorbello, Marcella Moura Ceratti, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Antonio Eduardo Zerati, Nelson Wolosker
Background Lower limb vascular trauma (LLVT) represents a significant public health challenge due to its potential to cause complex injuries that are difficult to manage, leading to increased morbidity, mortality and healthcare costs.
背景下肢血管创伤(LLVT)是一项重大的公共卫生挑战,因为它可能造成难以处理的复杂损伤,导致发病率、死亡率和医疗成本增加。
{"title":"Epidemiological Analysis of Lower Limb Vascular Trauma over 16 years in Brazil - A Nationwide View","authors":"Carolina Carvalho Jansen Sorbello, Marcella Moura Ceratti, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Antonio Eduardo Zerati, Nelson Wolosker","doi":"10.1101/2024.09.02.24312947","DOIUrl":"https://doi.org/10.1101/2024.09.02.24312947","url":null,"abstract":"<strong>Background</strong> Lower limb vascular trauma (LLVT) represents a significant public health challenge due to its potential to cause complex injuries that are difficult to manage, leading to increased morbidity, mortality and healthcare costs.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Application of Large Language Models for Breast Conditions: A Systematic Review 乳腺疾病大语言模型的临床应用:系统回顾
Pub Date : 2024-09-01 DOI: 10.1101/2024.08.31.24312542
Billy Ho Hung Cheung, Karen Gwyn Poon, Cheuk Fai Lai, Ka Chun Lam, Michael Co, Ava Kwong
Background The application of artificial intelligence (AI) like Large Language Models (LLM) into the healthcare system has been a frequently discussed topic in recent years.
背景将人工智能(AI)(如大型语言模型(LLM))应用于医疗系统是近年来经常讨论的话题。
{"title":"Clinical Application of Large Language Models for Breast Conditions: A Systematic Review","authors":"Billy Ho Hung Cheung, Karen Gwyn Poon, Cheuk Fai Lai, Ka Chun Lam, Michael Co, Ava Kwong","doi":"10.1101/2024.08.31.24312542","DOIUrl":"https://doi.org/10.1101/2024.08.31.24312542","url":null,"abstract":"<strong>Background</strong> The application of artificial intelligence (AI) like Large Language Models (LLM) into the healthcare system has been a frequently discussed topic in recent years.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thoracic Aortic Shape: A Data-Driven Scale Space Approach 胸主动脉形状:数据驱动的尺度空间方法
Pub Date : 2024-08-31 DOI: 10.1101/2024.08.30.24312310
Joseph A. Pugar, Junsung Kim, Kameel Khabaz, Karen Yuan, Luka Pocivavsek
The scale and resolution of anatomical features extracted from medical CT images are crucial for advancing clinical decision-making tools. While traditional metrics, such as maximum aortic diameter, have long been the standard for classifying aortic diseases, these one-dimensional measures often fall short in capturing the rich geometrical nuances available in progressively advancing imaging modalities. Recent advancements in computational methods and imaging have introduced more sophisticated geometric signatures, in particular scale-invariant measures of aortic shape. Among these, the normalized fluctuation in total integrated Gaussian curvature Embedded Image over a surface mesh model of the aorta has emerged as a particularly promising metric. However, there exists a critical tradeoff between noise reduction and shape signal preservation within the scale space parameters – namely, smoothing intensity, meshing density, and partitioning size. Through a comprehensive analysis of over 1200 unique scale space constructions derived from a cohort of 185 aortic dissection patients, this work pinpoints optimal resolution scales at which shape variations are most strongly correlated with surgical outcomes. Importantly, these findings emphasize the pivotal role of a secondary discretization step, which consistently yield the most robust signal when scaled to approximately 1 cm. The results presented here not only enhance the interpretability and predictive power of data-driven models but also introduce a methodological framework that integrates statistical reinforcement with domain-specific knowledge to optimize feature extraction across scales. This approach enables the development of models that are not only clinically effective but also inherently resilient to biases introduced by patient population heterogeneity. By focusing on the appropriate intermediate scales for analysis, this study paves the way for more precise and reliable tools in medical imaging, ultimately contributing to improved patient outcomes in cardiovascular surgery.
从医学 CT 图像中提取的解剖特征的比例和分辨率对于临床决策工具的发展至关重要。虽然主动脉最大直径等传统指标长期以来一直是主动脉疾病分类的标准,但这些一维指标往往无法捕捉不断进步的成像模式中丰富的几何细微差别。计算方法和成像技术的最新进展引入了更复杂的几何特征,特别是主动脉形状的尺度不变测量。其中,主动脉表面网格模型的总集成高斯曲率归一化波动已成为一种特别有前途的指标。然而,在尺度空间参数(即平滑强度、网格密度和分区大小)中,降噪和形状信号保持之间存在着关键的权衡。通过对来自 185 名主动脉夹层患者的 1200 多个独特尺度空间结构进行综合分析,这项研究确定了最佳分辨率尺度,在该尺度上,形状变化与手术结果的相关性最强。重要的是,这些研究结果强调了二次离散化步骤的关键作用,当缩放至约 1 厘米时,始终能产生最稳健的信号。本文介绍的结果不仅提高了数据驱动模型的可解释性和预测能力,还引入了一种方法框架,将统计强化与特定领域的知识相结合,以优化跨尺度的特征提取。这种方法不仅能开发出临床有效的模型,还能从本质上抵御患者群体异质性带来的偏差。通过重点分析适当的中间尺度,这项研究为医学成像中使用更精确、更可靠的工具铺平了道路,最终有助于改善心血管手术中患者的预后。
{"title":"Thoracic Aortic Shape: A Data-Driven Scale Space Approach","authors":"Joseph A. Pugar, Junsung Kim, Kameel Khabaz, Karen Yuan, Luka Pocivavsek","doi":"10.1101/2024.08.30.24312310","DOIUrl":"https://doi.org/10.1101/2024.08.30.24312310","url":null,"abstract":"The scale and resolution of anatomical features extracted from medical CT images are crucial for advancing clinical decision-making tools. While traditional metrics, such as maximum aortic diameter, have long been the standard for classifying aortic diseases, these one-dimensional measures often fall short in capturing the rich geometrical nuances available in progressively advancing imaging modalities. Recent advancements in computational methods and imaging have introduced more sophisticated geometric signatures, in particular scale-invariant measures of aortic shape. Among these, the normalized fluctuation in total integrated Gaussian curvature <span><span><img alt=\"Embedded Image\" data-src=\"https://www.medrxiv.org/sites/default/files/highwire/medrxiv/early/2024/08/31/2024.08.30.24312310/embed/inline-graphic-1.gif\" src=\"data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\"/><noscript><img alt=\"Embedded Image\" src=\"https://www.medrxiv.org/sites/default/files/highwire/medrxiv/early/2024/08/31/2024.08.30.24312310/embed/inline-graphic-1.gif\"/></noscript></span></span> over a surface mesh model of the aorta has emerged as a particularly promising metric. However, there exists a critical tradeoff between noise reduction and shape signal preservation within the scale space parameters – namely, smoothing intensity, meshing density, and partitioning size. Through a comprehensive analysis of over 1200 unique scale space constructions derived from a cohort of 185 aortic dissection patients, this work pinpoints optimal resolution scales at which shape variations are most strongly correlated with surgical outcomes. Importantly, these findings emphasize the pivotal role of a secondary discretization step, which consistently yield the most robust signal when scaled to approximately 1 cm. The results presented here not only enhance the interpretability and predictive power of data-driven models but also introduce a methodological framework that integrates statistical reinforcement with domain-specific knowledge to optimize feature extraction across scales. This approach enables the development of models that are not only clinically effective but also inherently resilient to biases introduced by patient population heterogeneity. By focusing on the appropriate intermediate scales for analysis, this study paves the way for more precise and reliable tools in medical imaging, ultimately contributing to improved patient outcomes in cardiovascular surgery.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patterns and Determinants of Outcomes in Cervical Spine Injury Patients: A Retrospective Study at AaBET Hospital, Addis Ababa, Ethiopia 颈椎损伤患者的预后模式和决定因素:埃塞俄比亚亚的斯亚贝巴 AaBET 医院的回顾性研究
Pub Date : 2024-08-30 DOI: 10.1101/2024.08.29.24312801
Alemayehu Beharu Tekle, Nikodimos Eshetu Dabe, Molla Asnake Kebede, Ayalew Zewde Tadesse, Bisrat Solomon Zewge, Melaku Tsediew Berhanu
A cervical spinal cord injury is a tragic occurrence for the sufferer and their loved ones. Because so many resources are needed to manage the patient during both the acute and rehabilitative stages, it has a significant impact on society and it is mainly related to cervical spine fractures and the most frequent kind of spinal fractures are those to the cervical spine. Automobile accidents, followed by diving into shallow water, firearm injuries, and sports activities are common causes of cervical spine injury. In developing countries like Ethiopia, little is known about the prevalence of cervical spinal injuries. An understanding of the prevalence of spinal injury is fundamental to developing possible preventive strategies and improving our primary trauma care. Assessing the pattern, outcome, and associated factors of patients with cervical spine injury who have visited AaBET Hospital from January 1, 2018 to November 30, 2023 is the primary objective of this study. Institution-based cross-sectional study was conducted at AaBET Hospital, Addis Ababa, Ethiopia. The study included patients who presented to the emergency department with a diagnosis of cervical spine injury from January 1, 2018, to November 30, 2023. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine associations between dependent and independent variables. A p-value <0.05 was considered statistically significant. A total data of 149 patients were analyzed, with an average age of 36.3 ± 14.9 years (ranges 9-85 years) and the male-to-female ratio was 2.9:1. Road traffic accident occurs in 49.7% of patients as a mechanism of injury followed by falling down accident (39.6%) of patients. Seventy-eight (52.3%) patients sustained with a total of 114 associated injuries (ASOI). Head injury was the commonly associated injury followed by chest and extremity injury. The most frequently injured cervical vertebra was C7 followed by C6 and T1. 68.5% of the patients have multilevel injuries. 33.6% of patients have neurological impairment ASIA class A followed by ASIA class E (29.5%). The overall hospital mortality is 7.4%. The level of cervical spine injury, the ASIA class of the patient, and the presence of associated injury were strongly associated with mortality. The mean ± SD length of hospital stay was 13.6 ± 16.4 days. And 30.2% of patients have prolonged lengths of hospital stay (PLOS). Neurosurgical intervention and the presence of associated injury have been significantly associated with PLOS. This study showed the common mechanism was RTA and C7 was the common injury level. C3 injury level, ASIA A neurologic deficit, and having associated injury were associated with mortality. Undergoing neurosurgical intervention and the presence of associated injury were associated with prolonged length of hospital stay (PLOS).
颈椎脊髓损伤对患者及其亲人来说是一个悲剧。由于在急性期和康复期都需要大量资源来管理病人,因此对社会产生了重大影响,它主要与颈椎骨折有关,而最常见的脊柱骨折是颈椎骨折。车祸是造成颈椎损伤的常见原因,其次是潜入浅水区、枪支伤害和体育活动。在埃塞俄比亚等发展中国家,人们对颈椎损伤的发病率知之甚少。了解脊柱损伤的发病率对于制定可行的预防策略和改善初级创伤护理至关重要。评估2018年1月1日至2023年11月30日期间在AaBET医院就诊的颈椎损伤患者的模式、结果和相关因素是本研究的主要目的。研究在埃塞俄比亚亚的斯亚贝巴的 AaBET 医院进行,以机构为基础进行横断面研究。研究对象包括2018年1月1日至2023年11月30日期间到急诊科就诊并诊断为颈椎损伤的患者。基线数据的统计分析采用描述性分析,因变量和自变量之间的关联采用回归分析。P值<0.05被认为具有统计学意义。共分析了 149 名患者的数据,平均年龄为(36.3 ± 14.9)岁(9-85 岁不等),男女比例为 2.9:1。49.7%的患者的受伤原因是道路交通事故,其次是跌倒事故(39.6%)。78名(52.3%)患者共遭受了114次相关损伤(ASOI)。头部损伤是最常见的相关损伤,其次是胸部和四肢损伤。最常受伤的颈椎是 C7,其次是 C6 和 T1。68.5%的患者有多级损伤。33.6%的患者有ASIA A级神经损伤,其次是ASIA E级(29.5%)。住院总死亡率为 7.4%。颈椎损伤程度、患者的ASIA分级以及伴发损伤与死亡率密切相关。平均住院时间为(13.6±16.4)天。30.2%的患者住院时间延长(PLOS)。神经外科干预和伴发损伤与住院时间明显相关。本研究显示,常见的机制是 RTA,C7 是常见的损伤水平。C3损伤程度、ASIA A神经功能缺损和伴发损伤与死亡率有关。接受神经外科干预和伴发损伤与住院时间延长(PLOS)有关。
{"title":"Patterns and Determinants of Outcomes in Cervical Spine Injury Patients: A Retrospective Study at AaBET Hospital, Addis Ababa, Ethiopia","authors":"Alemayehu Beharu Tekle, Nikodimos Eshetu Dabe, Molla Asnake Kebede, Ayalew Zewde Tadesse, Bisrat Solomon Zewge, Melaku Tsediew Berhanu","doi":"10.1101/2024.08.29.24312801","DOIUrl":"https://doi.org/10.1101/2024.08.29.24312801","url":null,"abstract":"A cervical spinal cord injury is a tragic occurrence for the sufferer and their loved ones. Because so many resources are needed to manage the patient during both the acute and rehabilitative stages, it has a significant impact on society and it is mainly related to cervical spine fractures and the most frequent kind of spinal fractures are those to the cervical spine. Automobile accidents, followed by diving into shallow water, firearm injuries, and sports activities are common causes of cervical spine injury. In developing countries like Ethiopia, little is known about the prevalence of cervical spinal injuries. An understanding of the prevalence of spinal injury is fundamental to developing possible preventive strategies and improving our primary trauma care. Assessing the pattern, outcome, and associated factors of patients with cervical spine injury who have visited AaBET Hospital from January 1, 2018 to November 30, 2023 is the primary objective of this study. Institution-based cross-sectional study was conducted at AaBET Hospital, Addis Ababa, Ethiopia. The study included patients who presented to the emergency department with a diagnosis of cervical spine injury from January 1, 2018, to November 30, 2023. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine associations between dependent and independent variables. A p-value &lt;0.05 was considered statistically significant. A total data of 149 patients were analyzed, with an average age of 36.3 ± 14.9 years (ranges 9-85 years) and the male-to-female ratio was 2.9:1. Road traffic accident occurs in 49.7% of patients as a mechanism of injury followed by falling down accident (39.6%) of patients. Seventy-eight (52.3%) patients sustained with a total of 114 associated injuries (ASOI). Head injury was the commonly associated injury followed by chest and extremity injury. The most frequently injured cervical vertebra was C7 followed by C6 and T1. 68.5% of the patients have multilevel injuries. 33.6% of patients have neurological impairment ASIA class A followed by ASIA class E (29.5%). The overall hospital mortality is 7.4%. The level of cervical spine injury, the ASIA class of the patient, and the presence of associated injury were strongly associated with mortality. The mean ± SD length of hospital stay was 13.6 ± 16.4 days. And 30.2% of patients have prolonged lengths of hospital stay (PLOS). Neurosurgical intervention and the presence of associated injury have been significantly associated with PLOS. This study showed the common mechanism was RTA and C7 was the common injury level. C3 injury level, ASIA A neurologic deficit, and having associated injury were associated with mortality. Undergoing neurosurgical intervention and the presence of associated injury were associated with prolonged length of hospital stay (PLOS).","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
medRxiv - Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1